Do I need a Midwife in pregnancy?
Pregnancy check-ups with the Doctor or a Midwife?
Pregnant women have the option to have check-ups with
a) a Gynakologist (Frauenartzt / Gynäkologen)
b) from a Midwife (Hebamme) or
c) Both (alternating between the two).
Most people don`t know that a midwife can be so support you so early on in your pregnancy. All three options above are covered by health insuance.
Doctors and Midwives have the same goal during your check-ups: The well-being of the mother & child. Both follow the standard guidelines and reccomendations for pregnancy check-ups (Schwangerschaftsvorsorge). Both Doctors and midwives detail their routine check-ups and your lab test results in your Mutterpass . Only the procedures with which they measure you are different.
The pregnancy check-up with a midwife:
When women choose a midwife, they are not only choosing a helper during this time, but they are choosing a highly experienced and specialised medical birth worker who will guide them through pregnancy, perhaps birth and up until the first year after the birth of your baby.
The physical check-up with a midwife is based on their own senses and experience. They feel the bump from outside to make sure that the baby is growing well and which position it is in. During a vaginal examination, the midwife checks the cervix.
In order to hear the baby’s heartbeat, they use an ear trumpet (often made of wood) or sometimes a small elctronic fetal doppler. Just like your Frauenartzt, a midwife can use a CTG in pregnancy. Blood pressure and body weight as well as your urine sample can all be tested. Many midwives place less emphasis on electronic devices and more focus on the pregnant women and her own intuition as well as the midwife’s own experience.
The pregnancy check-up with a doctor (Frauenartzt):
Using an ultrasound the doctor is able to check the position of the baby. In early to mid pregnancy this is with a vaginal ultrasound although later in the pregnancy, this moves to an external ultrasound of your bump. During this ultrasound, the growth of the baby is also measured. By feeling inside your vagina, the doctor also measures the height of the cervix. Your baby’s heartbeat is measured using a CTG. On top of that, the doctor performs a gynakological check-up including a swab of the cervix.
What are differences between the two options?
The most important point is the ultrasound check-up. Normally, these are not performed by the midwives themselves, they send the pregnant women to a doctor to have an ultrasound. A midwife is also not able to perfom Pretnatal screening.
However, the midwives have trust and a private atmosphere on their side. The check-ups are held in the midwife’s own practice or by the pregnant woman at home. If you already have a young child at home, this could be a huge benefit. The time factor also plays a large role - normally, midwives take more time for the women as well as having an open ear for problems that might not be related to the medical check-up but are nevertheless influencing the pregnancy.
Better Together!
All in all, its not easy to make a decision - friends and family are bound to have opinions but in the end, it has to feel right for you. You should have the check-ups where you feel most comfortable. The most important thing is that the Mama feels good. Women who value modern medicine would probably be best suited to a doctor whereas a midwife can offer more emotional support.
The combination of both is also possible. Many women swap between their frauenarzt and hebamme. There are also doctors who share a practice with a midwife. Most of the time that works brilliantly. There are doctors who refuse this option, normally this is because of money. However, all women have the right to the preventative care they want and if you come across a doctor like this, stand by your rights and don’t be put off!
Your right to have check-ups with a doctor AND a midwife.
In recent years it has become more common that women visiting a gynaecological practice have been warned against being additionally supported by a midwife or swapping doctors. In this situation, there could be extra costs that would not be paid for by the health insurance. In an open letter the „Netzwerk Elterinitiative für Geburtskultur“ informed the German govenment of this situation. They reacted with this statement:
Women are allowed to be cared for by a doctor AND a midwife or if they wish, to change their doctor, within the same quarter. „A pregnant woman can change her gynaecologist and does not have to pay for the treatment herself.“ According to the Federal Ministry of Health (BMG), cooperation between gynaecologists and midwives is "not excluded in principle". In any case, the patient's health insurance covers the costs and the women do not have to pay privately.
So: Insist on your rights and don't let yourself be intimidated.
With love & respect,
Laura xx