Having a Baby in Germany
You'd think that something as basic as childbirth would be the same everywhere, right? Well, not quite. Here's what to expect in Germany.
If you are going to have a baby in Germany, congratulations! Although medical systems are quite different, the level of care is the same with all of the same diagnostic testing available. Many doctors speak English, though not all the staff at the hospitals do (e.g., midwives, or Hebammes).
In order to limit the number of unnecessary surprises before having your child, you might like to get a little extra background on the German system, terminology, etc. The doctors and midwives at the hospital of your choice can answer your questions and at the same time you can tour the hospital facilities.
You might like to do a little research on your own. In this case a very helpful publication is: Wo Bekomme Ich Mein Kind? This magazine can be purchased at any convenience/newspaper store or "Kiosk" or baby supply store. The publication contains lists of doctors, hospitals, maternity clothing stores and baby supply stores throughout Germany by region. The hospitals listed are described according to their specific facilities and amenities as well as all of the important related telephone numbers. If you feel that your German is not up to this task, you may want to devote a language tutoring session to going through this information. You will want to learn some of the vocabulary.
Some Pertinent Procedural Differences
One of the first differences that you may experience is the manner in which you and your doctor interact. Many have found that information that you are accustomed to receiving automatically may need to be requested. We are not sure if this is a cultural difference (i.e., in general, Americans expect to participate in medical care decisions more than their German counterparts), a language difference (i.e., since it is awkward communicating in a language other than our mother tongue, we tend to communicate less), a procedural difference (i.e., dosage information in the U.S. is provided by the doctor and in Germany it is provided at the Pharmacy or Apotheke) or a combination of all three.
Whatever the reason, you may need to stress to the doctor that you want to fully understand what choices are available and what risks are associated with them. Should this be perceived as questioning his/her judgment, you may find it helpful to remind the doctor/staff that German is not your first language and, therefore, may require more information from them than over native-speaking patients (e.g., dosage amounts, schedules, etc, that you may have difficulty reading in the pamphlets in medicine packages).
Secondly, you will find that holistic medicine (homeopathic) is more widely accepted in Germany and is endorsed by the medical community. You may have your doctor, midwife and other medical professionals recommending and performing acupuncture, acupressure and massage therapies for various medical conditions, especially during labor. Herbal teas and homeopathic medicines will be prescribed or recommended for you and your baby routinely instead of antibiotics.
Thirdly, pediatric medication is not always available in a liquid form. For example, analgesics for children are normally administered by suppository instead of in a liquid to be taken orally. Infant vitamins are in tablet form. Note that much of the tap water is not fluoridated so a fluoride tablet may be a good choice for your child while in Germany. If you use one of the boxed/bottled waters specifically for infant use, look to see if fluoride is one of the ingredients.
Choosing an OB/GYN (Frauenartz)
The first thing you need to do is find an OB/GYN. Keep in mind that the northern German medical system has a strict separation of responsibilities between hospitals and private practice and only hospital staff obstetricians are permitted to deliver babies. You may choose an OB/GYN that has a private practice and works outside of the hospital, or you may work with a doctor at the hospital where you will actually deliver your baby.
If you choose a doctor that does not work out of a Klinik at the Krankenhaus (hospital), he or she will not be the one to deliver your baby. He/she will perform all routine medical exams and oversee the pregnancy until labor begins, then the hospital of choice takes over.
Another option for an OB/GYN is working with the pediatric staff at the hospital. The head doctor (Chefarzt) usually oversees the entire pediatric department at the hospital. He/she is available to patients who are privately insured and because there are so few head doctors (usually one for the pediatric department) he or she will probably not be available to assist with the labor and delivery. However, the rest of the staff is trained to do exactly that and communicate with the Chefarzt frequently. One benefit of having your regular exams performed at the hospital is that it allows you to develop a rapport with the staff and you are better able to familiarize yourself with the hospital prior to giving birth. (See Choosing a Hospital.)
In Germany, the main responsibility for delivering your child rests with the midwife (Hebamme). You can choose a Hebamme in advance and she will work with you throughout your pregnancy and also be there to help with the delivery. Some Hebamme's are only "authorized" to work at certain hospitals, so you will want to know this when selecting a Hebamme and a hospital. If you do not choose a Hebamme in advance, the hospital provides one for you. (See Choosing a Midwife.) Your best source may be other women who have actually had a baby here.
In Germany, it is customary that a patient is not given an examination gown to put on before the doctor performs the examination. If this makes you uncomfortable, plan to wear a skirt, dress or long shirt that you can pull up as you lay on the table. Also, many doctors do not have a separate changing room to dress and undress, and they do not leave the room specifically to afford you some privacy (they may stay, come-and-go, etc.). In general, it is no problem to bring children with you to appointments. Some doctors allow them in the examining room with you and others may have a play area or room for them.
There are usually 12 examinations before the baby's due date (Termin Datum) - one per month until the 32nd week and then every two weeks thereafter. If you go past your due date, you may be required to go everyday or every other day. Ultrasounds/Sonograms or Ultraschallaufnahmen are not considered at all hazardous in Germany so you can expect these much more frequently. You may receive as many as six sonograms during a normal pregnancy as well as routine pelvic exams. During a routine exam the doctor will check your blood, blood pressure, urine and weight. The recommended weight gain per pregnancy is 10-11 kg (22-25 lbs). Near term, the baby's heart rate and any contractions are measured and this may take anywhere from 10 to 30 minutes, so allow extra time for these appointments.
After the pregnancy is confirmed, the doctor will have a booklet issued to you called a mother's pass (Mutterpass). It is essentially a passport to track the progress of your pregnancy and document all pertinent information such as the results of all tests and examinations made during your pregnancy. You will need to bring this to each examination as well as to the hospital. This is an especially important document since the doctor who will be performing your examinations will, most likely, not be the one delivering the baby. The person delivering your baby will need this information. It should be carried with you at all times during your pregnancy.
Choosing a Hospital (Krankenhaus)
This decision may be tied to choosing your doctor; if you want your OB to be at the delivery, then you need to choose one affiliated with a particular hospital. You will need to do this first. If you have chosen an OB who is in private practice, he/she is an excellent resource for hospital information and can help to arrange tours and appointments for you.
The hospitals hold regular information sessions (dates and times are usually posted in the hospitals, in the magazine Wo Bekommeich Mein Kind? and/or your doctor's office). If you feel that your German is not up to an information session, you may want to ask your language tutor if he/she will use a "lesson" to go with you. An appointment can be arranged for a private consultation and he/she can help you get a tour of the facilities by a Hebamme or nurse (Krankenschwester). It is also possible to arrange private Lamaze classes with your midwife. Your Hebamme may be willing to meet you in your own home or you can work with her at the hospital where you can actually see the facilities. It is important to take a tour of the hospital and familiarize yourself with the facility.
As you tour the facilities, keep in mind that not every hospital has birthing suites, chairs, tanks, etc., so look carefully. If there is something specific that is important to you, make sure you ask. Be aware that while all hospitals have some pediatric care facilities, not all have a full pediatric hospital (Kinderklinik). If the baby is born premature or needs extra care, your baby will be transferred to the nearest Kinderklinik and you will remain at the hospital where you gave birth. Therefore, you will be separated.
Regarding medication, each hospital may vary with what they provide and each midwife may vary in what she will allow you to have. Yes, some midwives have absolutely refused to give epidurals! If you know you will want an epidural, make sure you ask prior to ever going into labor!
Pre-Registration at the Hospital
Once you have chosen a hospital, you should register at the delivery room (Kreissaal) at the hospital. If you pre-register, the hospital will already have all the information they need in order to process you and then they can focus on the baby and not worry about it. It is important that they have your insurance information on record as well as your room preference (private or not). If you have the choice of a private room, I would highly recommend it! You are often given a chance to register at the information sessions as well. Be sure to bring your Mutterpass and passport when registering and ask what you should bring at the delivery. It is possible that they will want a copy of your birth certificate, your husband's birth certificate and a copy of your marriage license. But just ask to make sure.
Preparing for Childbirth
Before your 26th week of pregnancy, you should decide where to take your birth preparation classes (Schwangerschaftsvorbereitung). The most popular method in Germany is the Read Method, which emphasizes relaxation more than breathing techniques. Classes in this as well as other methods such as Lamaze are available either through the hospital or the Red Cross, which are less expensive than the hospital-sponsored ones. Another good alternative is to hire a registered midwife for your birth preparation, or private classes with a licensed midwife. You may want to contact the local Nachbarschaftshilfe for a list of courses and midwives. This could also be useful after the baby is born for Rückbildungsgymantik and Krabbelgruppen. (See Choosing a Midwife).
Some hospitals offer other classes like swimming and parenting (Eltern Schule). If you can get into some of the classes, it can help you familiarize yourself with both the facilities and staff of the hospital (and may improve your German along the way - the classes are taught in German!).
Choosing a Midwife (Hebamme)
The midwives in Germany are trained medical professionals, licensed to perform physical examinations of mom and baby including removing sutures. They are on call 24 hours a day and will help with absolutely any questions that you may have (including breast-feeding, formula where's and how's, bathing - the list is endless) before, during and after delivery. As mentioned earlier, it is the midwife who is ultimately responsible for the birth process.
Some of you might like to hire a midwife privately for at home pre-birth instruction, to accompany you to the hospital for the actual birth and/or to provide follow-up medical care for mom and baby at home after the birth. Others might want to hire one that they liked from the hospital for post-delivery help only. This is a nice choice if you want to leave the hospital earlier than the standard amount of time, which is 5-7 days for a vaginal delivery and 7-12 for a Cesarean section (Kaiserschnitt).
In the Hospital
When you think that you are in labor, either call or report directly to the Frauenklinik at the hospital that you have selected and then go to the delivery room area or Kreissaal. Check with your doctor or midwife ahead of time to confirm when you should go to the hospital. Usually, this is done when the contractions are about 5 minutes apart and regular, or if your water has broken. If you are not sure, you can call either the doctor or midwife and they will help you decide. See Items to Bring to the Hospital with You.)
Generally, the first thing that will be done is to confirm the contractions by measuring them with an Electrocardiogram followed by and examination. If all is progressing well, they will prepare you for delivery. Some hospitals routinely administer an enema and shave the pubic area. All deliveries and hospitals are different - some offer the mother a warm bath, medications, acupuncture, etc. Most of these things should have been discussed and decided upon earlier (see Choosing a Hospital). As mentioned under "Pertinent Procedural Differences," you may want/need more information /clarification to participate in making your medical care decisions than the staff is accustomed to, so you will need to be clear that you want to fully understand what choices they are making and why. Knowing the appropriate medical terms and possibly having a German/English dictionary can be invaluable. (See List of Terms and Special Expressions.) One area to be clear on is "induction." In some hospitals, it is policy to induce once the mother has gone past her due date by 13 days. Others allow Mother Nature to run its course as long as the placenta, water and baby are fine.
Once the baby is born, you will remain in the delivery room for a while to make sure you and the baby are healthy. Once you have been released to your room, you will have to interact with the nursery staff. Introduce yourself and ask them to explain how the system works as they all may from hospital to hospital. Many hospitals support rooming-in (your husband can spend the night with you in your room) and breast-feeding choices. They do not offer ice, so bring some with you if you would like.
The common length of hospitalization (referred to as das Wochenbett) here is 7 days for a vaginal delivery and 7-14 days for a Cesarean Section (Kaiserschnitt). Many hospitals conduct exercise classes to help you to get back into shape, offer healing measures (sitting bathes, Sunlamp therapy, etc.) and, generally, give you and the baby time to recover. You can leave earlier (within 24 hours) if you would like, but you will need to discuss this with your doctor either when you pre-register at the hospital or once you are there after delivery and deemed to be healthy.
The Baby's Care
The baby will remain in the hospital as long as you do. While in the hospital, certain tests will be performed on the baby to confirm its health. Shortly after the baby is born, the baby will be given APGAR scores. If you don't know what APGAR stands for, ask your doctor. If any problems are detected, he/she may be taken to a Kinderklinik for further evaluation/treatment. If there are no problems or further tests required, the baby will accompany you to your room in the nursery. Depending on the hospital, he/she will be regularly weighed. If you are breastfeeding, this may be as often as every feeding to determine the amount of intake. If the nurses don't come to you to do this, take the initiative and ask the nurses to weigh your baby. Be very observant of what the other mothers in the hospital are doing and try to do the same.
The baby will also have his/her first "well-baby" check-up somewhere around the 4th day, which will probably include an ultrasound of the kidneys or Ultraschall Untersuchung. Practices vary by hospital, so check what is standard at the one you choose. Bathing, feeding, etc. practices vary a lot so you will need to look and ask to learn what is expected at your hospital. The nurses are very willing to show you how to feed and bathe your baby when asked, but often will not volunteer this information. Also, most nurseries have an area where mothers can pump their breast milk if needed.
When you and the baby are given a clean bill of health to leave, the hospital will give you at least three documents. First, they will return your Mutterpass to you complete with all of the details of your labor and delivery for this birth (it has room to record two births). You will also be given a children's examination book or Kinder-Untersuchungsheft - basically, this is similar to the Mutterpass for the baby. It contains the child's medical information from the hospital, a place for his/her height, weight and head circumference to be charted, general development milestones as well as outlining the German schedule of "well-baby" visits. You should bring this book with you to all doctor visits. Thirdly, they will give you a record of birth, which you will need to obtain a Birth Certificate and to register the baby (see Paperwork). A fourth item is sometimes given to you and that is a letter for your doctor to better explain any unique circumstances, complications, etc. which may affect you.
Here are some general hints to help ease your way through the paperwork and bureaucracy.
- Most government offices have very limited hours. Be aware of them before you go especially during lunchtime.
- Leave yourself plenty of time. You may want to consider asking someone to watch your child/children if that is an option for you.
- Be patient. Many local offices have different procedures, requirements, hours, etc. It's impossible to anticipate all of these, so be aware that you may have to make more than one trip to satisfy the individual requirements of a local office.
- Bring several copies of everything - always!
- Bring plenty of extra cash. There is a fee for almost every document you need.
- Keep all of your documents. You never know if they will be needed in your home country when it comes time to register your child.
- In most German offices they will only speak German. It may be helpful to ask your German instructor, to accompany you to the German offices.
The five main items of paperwork you will need to obtain/handle following the birth of your child:
- A birth certificate (German and international)
- A Consular Report of Birth Abroad (a U.S. birth certificate, if you are a U.S. citizen)
- A Social Security Number (or whatever your home country requires)
- A Residence permit for the baby
- Update your Tax Card with Ford and the local government office
There are two other things that you may hear about - Kindergeld and Erziehungsgeld - both of which are moneys paid by the German government to residents to help them defray the cost of raising a child. There are several forms to fill out and all are in German. So before you spend a lot of time trying to fill them out, you may want to see whether you are eligible.
To apply for a birth certificate you will need the following (originals and extra copies):
- The record of birth document from the hospital (completed and signed)
- The parents' passports
- The parents' birth certificates
- An official translation (in German) of your marriage license/divorce papers
- Diplomas for any parent having a Master's Degree or higher
These documents, along with some Euros, should be taken to the city offices or Standesamt of the city in which the baby was born. If you are not sure where this is, ask at the hospital. The Germans accept both compound (hyphenated) and differing surnames (e.g., if the mother did not take the father's name when married). Be prepared for some difficulties, however, if you have other unusual circumstances. Examples of problems that people have encountered include situations where one or both parents drastically changed their name (last or middle) through marriage; where either parent was born outside of the U.S., but remained a U.S. citizen; or where there were several officiates at your wedding. None of these (or other hurdles you may encounter) are insurmountable, but you may need to supply more documentation/ explanation to accomplish your goal.
Once you have provided the necessary documents, the office will issue several copies of a German Birth Certificate and an International Birth Certificate. Hang on to all of them! You will need to file other paperwork. We would recommend obtaining two copies of the German Birth Certificate and four copies of the International Birth Certificate.
Consular Report of Birth
To apply for a Consular Report of Birth, U.S. Passport and Social Security Number, you will need the following (originals and extra copies):
- The German (or International) birth certificate
- The parents' passports
- The parents' birth certificates
- At least two identical photos of the baby (see note below)
- Your marriage license/divorce papers
These items are grouped together since the same office - the Consular Section of your home country's Embassy - is the one that you need for all three. Most offices are open from 8 to 11:00 a.m., but call ahead and verify before you drive to the Embassy. You have two options for the photos. Many photo shops can provide the correct size and composition photo for you. You will need several passport size photos of the baby's face in color or black and white. For Americans, the birth certificate will be issued that day and the passport will be sent to you in the mail within 48 hours. The Social Security number paperwork will be forwarded to the U.S. and the number will be sent to you from the United States within several weeks.
Once you have a passport for the baby, you need to register him/her at your local Standesamt (city office) and to file your new tax card. This will be the Standesamt for the city in which you live. This may be a different building if the baby was born in a city that is different from the one in which you live. You will need the following items (originals and extra copies):
- The German (or international) birth certificate
- The parents' passports
- The baby's passport
- Your New Tax Card
These documents, along with some money (in euros - the amount needed varies by city), should be taken to the appropriate office in the city in which you live and they will put a sticker in the child's passport to document his/her registration and file your new tax card.
Items to Bring to the Hospital with You
All hospitals will vary in what they provide, so make sure you ask about these items during your tour of the facilities. This way you will know exactly what to bring.
- Cooler with ice, water and juice
- List of terms and special expressions
- German/English dictionary
- Toiletries (including soap)
- Towels and washcloth
- The Mutterpass
- Radio/tape player with tapes (most hospitals have CD players now and not all have TV's)
- Breast pump (most hospitals will have this) - if you are separated from your baby
- Nursing bras and pads (if you are breast feeding)
- Flip-flops/slippers (showers and toilets may not be in your room)
- Phone list and directions for using your calling service away from home (cell phones are not allowed in the hospital)
- Calculator (to convert grams and centimeters to pounds and inches)
At home, have your passports and any advanced-degree diplomas all together. You may need them to register the baby at the local city office. You register him/her at the city office of birth to the get the birth certificate (both German and International). Use those to get a passport at the embassy and apply for a Social Security Number. Then take the passport to the city of residence office to get the residence permit and papers for your tax card.
Our thanks to the American Women's Club of Cologne for contributing this article to How To Germany.