Prenatal care: check-ups and counseling

Check-ups are an important part of every pregnancy. During these check-ups, a doctor or midwife regularly checks the health of the expectant mother and the unborn baby. This enables early detection of risks and abnormalities. Prenatal care also includes counseling, for example, advice about nutrition, oral health and the flu vaccine. Check-ups are initially scheduled on a monthly basis during pregnancy. From week 32 of the pregnancy onwards, they take place every 14 days. The costs are covered by statutory health insurance funds and usually also by private health insurance providers.

Every pregnancy is an extraordinary event. It is a time of constant change, as the unborn child develops and grows and the expectant mother’s body changes.
 
During prenatal check-ups, changes and developments are closely observed in order to be able to respond in time to any health problems or risks in relation to the mother and child. The results of the check-ups are then recorded in the mother’s maternity record. 

Parents-to-be are informed about the results of check-ups and how the pregnancy is progressing. They are also given advice on important aspects of the pregnancy, such as nutrition and oral health. In addition, they are provided with information about additional testing and treatment options. If necessary, they receive advice about regional supports for parents and children.

Prenatal care services for those covered by statutory health insurance include the following:

• counseling for the pregnant woman
• testing of the pregnant woman, e.g. monitoring of blood pressure and blood tests to detect gestational diabetes
• monitoring of high-risk pregnancies
• ultrasound diagnostics
• screening for infections: HIV, hepatitis B, syphilis and chlamydia
• determining the rhesus factor: if the mother is rhesus-negative, a blood test is used to determine the rhesus factor D of the unborn baby.

Statutory health insurance also covers the costs of check-ups and counseling for new mothers shortly after delivery in the postpartum period. 

Additional tests 

Special tests, such as the toxoplasmosis test and certain tests for prenatal diagnostics, which can, for example, detect chromosomal abnormalities such as trisomy 21, are not included in standard prenatal services as defined by law. However, health insurance providers will cover the costs if there is a well-founded suspicion of a disease, in the case of high-risk pregnancies or if abnormalities need to be clarified.

Otherwise, these tests are classified as individual health services or IGeL (short for “individuelle Gesundheitsleistungen”) in German. As such, they can only be performed if the expectant mother grants her consent and has been informed of the potential benefits and risks. Individual health services also have to be paid for by patients themselves. 

Check-ups are generally every four weeks from the start of the pregnancy and every 14 days from week 32 onwards. At the first check-up, the maternity record is usually issued, in which the results of all subsequent check-ups will also be documented.

At each check-up, the pregnant woman’s blood pressure and weight are noted, and her urine is tested. During ultrasound scans, the doctor checks the position of the baby and measures the baby’s heart rate. The uterus is also palpated. A blood sample is taken from the mother to detect deficiencies or diseases at regular intervals. Finally, the doctor or midwife checks whether any vaccinations are required, for example, against rubella or flu. From week 11 of the pregnancy onward, the rhesus factor D of the unborn baby can be determined in blood taken from the expectant mother. This is particularly important for a rhesus-negative woman. If she is carrying a rhesus-positive child, her blood may form defensive substances known as anti-D antibodies. From week 23 of the pregnancy, an antibody screening for anti-D antibodies is performed for all pregnant women. Expectant mothers who are rhesus-negative and don’t have anti-D antibodies are injected with anti-D immunoglobulin between week 27 and week 29 of the pregnancy to avoid potential complications. 
 
In the third, sixth and eighth months of pregnancy, ultrasound examinations are scheduled:

First ultrasound examination (week 9 to week 12)

This first ultrasound is mainly performed to confirm the pregnancy and to check if the embryo/fetus has attached to the uterus. It is easier to determine the week of pregnancy and the due date at this point than at a later time. The shape of the body and the beating heart give an initial indication of whether the pregnancy is intact and how far along it is. A multiple pregnancy can also usually be detected at this scan.

Second ultrasound examination (week 19 to week 22)

At this check-up, pregnant women can choose between having a regular “big scan” or an extended “big scan” at this time. The basic “big scan” is an ultrasound scan to check for age-appropriate development of the baby – the size of the head, abdomen and lower leg bones, as well as the amount of amniotic fluid and the position of the placenta. If abnormalities are detected, further examinations may be necessary.
 
In an extended “big scan”, the doctor also checks that the abdominal wall and spine are closed and that the stomach and urinary bladder are visible. The head, cerebral ventricles and cerebellum, as well as the size relationship between the chest and heart, are measured more precisely. Not all gynecologists are qualified to perform the big scan. A referral to a qualified specialist may be necessary.

Third ultrasound examination (week 29 to week 32)

This is another examination to check the development of the unborn child. The position of the baby and the placenta, as well as the amount of amniotic fluid are also checked. These check-ups are important for planning of the birth, for example. If there are any abnormalities, the doctor may order further examinations.

After the birth, two more check-ups are scheduled. Within the first week, it is important for the mother to have a blood test to check the hemoglobin level and to detect a potential iron deficiency. Six to eight weeks after the birth, the mother then has a general check-up and a gynecological exam. Her blood pressure is measured and urine is checked for protein, sugar and infections. The new mother is also given advice on any questions she may have about her newborn baby. 
 
Midwife assistance for postpartum care begins immediately after the birth or after discharge from the hospital. The costs are covered by health insurance providers. The midwife usually visits the mother at home and examines and weighs the baby regularly. She asks the mother questions and advises her regarding any physical complaints she may be experiencing. She assists with questions about breastfeeding, diapering, sleeping, and more. New mothers are entitled to consult a midwife at least once a day up for up to 10 days after the birth. In the first 12 weeks after the birth, the midwife will visit the new parents at home up to 16 times. If there are any problems, for example, with breastfeeding, the costs of any additional midwife visits are covered by health insurance. 

Every pregnancy is an extraordinary event; it is not called a “miracle” for no reason. It is a time of constant change. The unborn child develops and grows, the woman’s body changes.

During prenatal examinations, changes and developments are closely observed in order to be able to respond in time to health problems or risks in the mother and child. The results of the examinations are then recorded in the mother’s maternity record. Parents-to-be are also informed about the results of the examinations and how the pregnancy is progressing. They are also advised about additional examinations and treatment options. These planned measures are part of the standard prenatal services covered by the health insurance companies.

During pregnancy, it is particularly important for patients to have a doctor with whom they feel comfortable and well advised. Midwives can also perform many check-ups during pregnancy if directed to do so by the doctor or if the doctor has determined that the pregnancy is normal and that there are no concerns. This does not apply to medical ultrasound scans and other special tests that may be required, such as testing the urine for bacteria, for example. In the case of high-risk pregnancies, all check-ups have to be performed by a gynecologist.

Midwives can sometimes have a little more time than doctors to answer questions or address concerns. They can help with choosing a place to give birth and provide valuable support overall. In addition, it is good to get to know the midwife early on, as she may later be able to take over postpartum care.

An easy way to find a midwife is to use the midwife search provided by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). All midwives whose services are covered by statutory health insurance are listed here.

Many expectant parents are concerned about the impact of the coronavirus pandemic on pregnancy and birth. Many also wonder whether pregnant women should get vaccinated against COVID-19. Answers to these and other questions are provided by the Federal Center for Health Education (BZgA) on the websites www.infektionsschutz.de and www.familienplanung.de.

All benefits provided by statutory health insurance during pregnancy and shortly after the birth are listed in the maternity regulations defined by the Joint Federal Committee (Gemeinsamer Bundesausschuss – G-BA). You can read and download the maternity regulations on the website of the G-BA.