During pregnancy and shortly after delivery, women are entitled to regular examinations. This allows risks and possible complications to be detected and treated early. Good to know: a midwife can also perform many of the examinations.
At a glance
- Every pregnant woman is entitled to regular medical examinations.
- The purpose of prenatal care is to monitor the health of the pregnant woman and the development of the child.
- Most of the examinations can be performed by doctors as well as midwives.
- There are also three ultrasound examinations, which are performed by the gynecologist.
- The costs are covered by the statutory and private health insurance funds.
- For women who receive benefits under the Federal Social Assistance Act (Bundessozialhilfegesetz), the social welfare office covers the costs.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
Prenatal care: examinations plus counseling
During prenatal care examinations, a doctor or midwife regularly checks the health of the mother and child. Prenatal care also includes counseling sessions. Initially, these appointments are scheduled on a monthly basis, but from the 32nd week of pregnancy onwards, they take place every two weeks.
Identifying risks as early as possible
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.
These prenatal services include:
- examination and counseling of the pregnant woman
- observation of the development of the unborn child
- detection and monitoring of high-risk pregnancies
- ultrasound diagnostics
- examination for infections, including the option of an HIV test
- examination and consultation after birth, in the postpartum period
Special examinations, such as the toxoplasmosis test and certain tests for prenatal diagnostics, which can be used, for example, to detect chromosomal abnormalities such as trisomy 21, are not included in standard prenatal services. They are classified as individuelle Gesundheitsleistungen (IGeL) – “individual health services”. They are only performed if the pregnant woman has given her informed consent and usually have to be paid for by the patient. In the case of high-risk pregnancies and if there is a well-founded suspicion of a disease, the health insurance fund will cover the costs.
Prenatal care: what examinations when?
Check-ups are generally every four weeks from the start of the pregnancy and every 14 days from the 32nd week of pregnancy. During the first appointment, the maternity record will usually be issued in which the results of all subsequent examinations will also be documented.
At each checkup, the pregnant woman’s blood pressure and weight are noted, and her urine is tested. During ultrasound examinations, the doctor checks the position of the baby and records the heartbeat. The uterus is also palpated. A blood sample is taken from the mother to detect deficiencies or diseases at regular intervals. Finally, the doctor checks whether vaccinations are necessary, for example against rubella or influenza.
In the 3rd, 6th and 8th months of pregnancy, ultrasound examinations are scheduled:
First ultrasound examination (9th to 12th week of pregnancy)
This first ultrasound is mainly performed to confirm the pregnancy and to check if the embryo 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 determined here.
Second ultrasound examination (19th to 22nd week of pregnancy)
At this checkup, pregnant women can choose between a basic ultrasound and an extended basic ultrasound. The basic ultrasound examines the 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 there are abnormalities, further examinations may be necessary.
During the extended basic ultrasound examination, 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 of the chest and heart, are measured more precisely. Not all gynecologists are qualified to perform these types of the second ultrasound. A referral to a colleague may be necessary.
Third ultrasound examination (29th to 32nd week of pregnancy)
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 examinations are also important for planning the birth. If there are any abnormalities, the doctor may order further examinations.
Important: In the event of risks or abnormalities, additional ultrasound appointments may be necessary. High-risk pregnancies usually require additional ultrasound examinations and generally closer supervision.
After the birth, two more appointments are scheduled. In the 1st week, a blood test is important to detect possible infections and deficiencies. About 8 weeks after delivery, a general and gynecological exam is performed, blood pressure is taken, and urine is checked.
Midwife assistance for postpartum care begins immediately after the birth or after discharge from the hospital. The midwife then visits the mother at home, examines and weighs the baby regularly. She asks the mother questions and advises her regarding any complaints. She assists with questions about breastfeeding, diapering, sleeping, and more. This care is available for 8 to 12 weeks and is covered by health insurance.
Who conducts the examinations?
During pregnancy, it is particularly important for women to have a doctor with whom they feel comfortable and well advised. All ultrasound examinations are performed exclusively by a gynecologist.
What many don’t know is that apart from the ultrasound, midwives can also perform some of the examinations during pregnancy, either in their own practice, in the birth center, or during home visits. Every woman with statutory health insurance is entitled to support from a midwife.
The advantage is that midwives can sometimes take a little more time 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.
- Gemeinsamer Bundesausschuss. Richtlinien des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung. Aufgerufen am 20.04.2020.
- Bundeszentrale für gesundheitliche Aufklärung. familienplanung.de. Vorsorgeuntersuchungen: Sicherheit für Mutter und Kind. Aufgerufen am 20.04.2020.
- Bundeszentrale für gesundheitliche Aufklärung. familienplanung.de. Ultraschall-Untersuchungen in der Schwangerschaft. Aufgerufen am 18.05.2020.