Preparing for birth

The birth of a child is a significant life event. Many questions arise when preparing for this event, as expectant mothers and their partners look ahead to future life with a new baby. This is all the more true when it is the parents’ first child. They need to choose a midwife and decide where to have the baby. Lots of information is available on preparing for a new arrival. Sources include information events organized by hospitals or birthing centers, birthing classes, and counseling services providing support in the event of problems. 

Every pregnant woman is entitled to avail of the assistance of a midwife, which is covered by statutory health insurance. Midwives provide support to expectant mothers. They can be responsible for antenatal (prenatal) care before the birth, provide support for any health issues or problems, and assist with the birth of the child in a hospital setting, at a birthing center, or at home. Most midwives also offer birthing classes and activity programs, such as pregnancy swimming, yoga, meditation, baby massage, and postnatal exercises after the birth. After the birth, they provide young families with support for up to 9 months over the phone or in person during home visits.

Consult the following sources for a list of midwives close to where you live: 

• list of midwives published by your regional midwifery association: www.hebammenverband.de
• search engine in collaboration with the Germany Midwifery Association: www.ammely.de
• list of midwives published by the National Association of Statutory Health Insurance Funds (Spitzenverband der gesetzlichen Kranken- und Pflegekassen, GKV): www.gkv-spitzenverband.de
• midwifery and obstetric (ob-gyn) practices
• list of midwives for your city and region 
• health insurance providers
• public health authority
• gynecologists
• family education centers
• hospitals and birthing centers
• phone books

You may well need to contact several midwives, as they are often fully booked due to the long periods for which they provide care. For this reason, it’s a good idea for pregnant women to begin looking for a midwife early on in the pregnancy. If you’re having your baby in hospital, the hospital will provide you with a midwife for the birth.

At a birthing class, expectant mothers and their partners are given information about pregnancy, birth, and caring for their baby in the early days after the birth. The classes also give you an opportunity to meet other expectant mothers and share experiences with them. Many classes are geared toward couples who are expecting their first child. However, classes are also available for singles or for women who have already had a child.

A birthing class is intended to help women overcome their fears, look forward to the birth with a positive attitude, and trust in their own bodies. Attending partners learn to understand what expectant mothers need and how to best support them during pregnancy and birth. 

Information and exercises relating to caring for infants help participants to prepare for their new roles as parents. In many classes, dolls are used to allow expectant parents to practice lifting and dressing a newborn and changing a diaper (nappy). Women are given tips on recovering from the birth and how to strengthen their wombs and bodies after labor. 

Typical content of a birthing class

• preparing the body with relaxation and breathing exercises for pregnancy and birth
• massages and other non-medication options to relieve pain during labor
• nutrition, physical care, and wellbeing during pregnancy
• information about the birthing process, the postnatal recovery period following the birth, and breastfeeding
• presentation of possible locations for the birth and delivery options
• familiarization with various birthing postures (positions) 
• tips for infant care
• preparations for breastfeeding
• possible changes that parenthood may bring

Before registering for a course of classes, it can be useful to find out about the key points covered, how the course is structured, the size of the group, and the qualifications held by the course instructor. Birthing classes may be delivered once weekly over an extended period or as a one-off compact seminar. As the classes usually fill up pretty quickly, it’s advisable to register for them early in pregnancy.

Availability of birthing classes

Courses to help prepare for a birth are available from various providers and professionals. These include:

• midwives
• family education centers 
• maternity hospitals
• adult education centers
• gynecology practices 
• physiotherapists 
• public health authorities
• health centers
• women’s centers
• gyms

Birthing courses for pregnant women are covered by health insurance. Statutory health insurance schemes cover the cost of 14 hours of birthing classes. Participating partners are often required to make a contribution towards the cost. However, some health insurance schemes cover the cost in full.

Supplementary classes

In addition to standard birthing classes, a wide range of other classes are available to pregnant women. These include:

• yoga
• meditation
• pregnancy exercise
• swimming
• fitness 
• belly dancing

Some insurance providers will partially cover the cost of these classes. Their main purpose is to promote the wellbeing of expectant mothers, enhance their body awareness, and prepare them for the birth. However, they cannot replace a full course of birthing classes.

Most women in Germany give birth in a hospital. If there are no specific risks to the mother or baby, the birth may also take place at home or in a birthing center. Information about possible locations for the birth is provided as part of birthing classes or by the midwife who is providing care to the expectant mother. Maternity hospitals and birthing centers also host regular information events and visits. A midwife will always provide support during the birth to an expectant mother, regardless of where she decides to give birth.

Hospital birth

Maternity hospitals offer guaranteed medical care around the clock. Some hospitals have special pediatric and neonatal departments, as well as intensive care units for high-risk cases. Information events are hosted at hospitals to allow expectant parents to find out the exact details of the care provided. It is usually also possible to visit the delivery room.

Most hospitals provide their own midwife for the birth. Some hospitals allow expectant mothers to have their own self-employed midwife with them as the attending midwife for the birth.

In addition to peridural (epidural) anesthesia for pain relief, many hospitals also use methods from alternative medicine, such as massage, heat, and movement.

After the birth, mother and baby usually stay in a room with just one or two beds. Some hospitals offer family rooms, where the woman’s partner and other children are able to stay too. The cost of these has to be paid privately. It is also possible to deliver the baby in a hospital on an outpatient basis. In this case, mother and baby are discharged just 2 to 6 hours after the birth, provided that they are in good health.

Birthing center birth

At present, there are around 100 birthing centers in Germany, offering an alternative to a hospital delivery. Most of these are midwife-led. Some birthing centers also work with doctors. At a birthing center, the focus is on ensuring that women have a calm and pleasant experience under close supervision.

Birthing centers are subject to rigorous hygiene and quality controls. They have medical equipment and oxygen, as well as monitoring devices for tracing the heartbeat of the unborn baby. For pain, they offer alternative medicine and light pain-relieving medication. Medical interventions, such as a cesarean section or a peridural anesthetic to relieve pain are not possible in a birthing center. If complications arise during the birth, the woman has to be transferred to hospital.

A birthing center may apply charges, which are often covered by health insurance.

When choosing a birthing center, it’s also important to consider how far the woman will have to travel to get there when the time comes. It may make sense to choose one that isn’t too far away. After all, labor can sometimes progress so rapidly that long journeys can’t be undertaken.

Home birth

In the past, giving birth at home was the norm. Today, however, only a small minority of women opt to have their child born at home. The main reason most of these choose to do so is their desire to have their baby in a relaxed atmosphere in a familiar environment.

A home birth is only an option if no risks or complications are foreseen. The doctor and midwife providing care to the expectant mother will consider this matter very carefully. A home birth also needs to be meticulously planned. Statistics show that if adequate preparation is made, critical situations requiring a transfer to hospital are rare. For the sake of safety, a woman who chooses to have a home birth should also register with a nearby hospital. The hospital will then have all of the expectant mother’s medical details on file in case an emergency arises or if the woman changes her mind at the last minute and decides in favor of hospital birth.

The costs of a home birth are covered by statutory health insurance. Midwives generally charge an additional fee if the expectant mother wants them to be on call for the birth.

The birth of a child is a very emotional, but also very intimate and intense event. For this reason, it is important to give some thought to who should be present during the birth. Most women want their partners to support them during labor. However, a best friend, mother, or another trusted person can also act as a birthing partner. Some women decide to experience the birth alone, supported only by a midwife.

In most cases, however, the woman’s partner attends the birth as the person closest to them. Many men find it a very enriching experience to be there when their child comes into the world. Other men feel anxious at the thought of the impending birth or find it difficult to deal with the pain their partner is going through. In this case, the woman may need to consider having another trusted person support her during the birth instead. However, it may help if the couple attends a birthing class together.

A close friend, mother, or other loved one can also provide a woman with support during birth. To ensure a sense of calm, it makes sense to avoid having more than one or two people as your birthing partners. In most cases, the location of the birth will also determine how many people can attend (usually just one). As labor can take a long time to reach its conclusion, it may also be possible to have rotating birthing partners as support at different stages. This should always be discussed in-depth and decided upon in advance of the birth. Many women like to be held or massaged during birth. It is useful to clarify in advance whether the birthing partner is to remain in the room while the woman is being examined or during possible medical procedures such as a peridural anesthesia. 

Expectant mothers need to pack a bag of clothes for herself and her baby a few weeks in advance of the expected due date. The hospital bag needs to be ready once labor starts, which it may do earlier than expected. Women who plan to have a home birth or a hospital delivery as an outpatient also need to have a bag packed and ready in preparation for an emergency. All items in the bag should be labeled with the mother’s name if possible.

Useful items for the hospital bag:

Important documents

• maternity record
• personal identification card
• health insurance card
• family register or marriage certificate; birth certificate for single mothers

For the birth

• comfortable clothes
• T-shirts to change into
• warm socks and a warm fleece jacket, cardigan, or hoodie
• hairband (for long hair)
• favorite music (as a cell phone playlist or CD)
• massage oil, aromatherapy oil, bath oil 
• essential aids, such as glasses or hearing aids
• cell phone or camera for the first baby photos (don’t forget the charger!)
• energy-rich snacks or fruit 
• list of phone numbers for people to be informed after the birth

For a possible hospital stay

• comfortable clothes to wear after the birth (tip: these should be clothes that fitted during the sixth month of pregnancy or thereabouts) 
• nightdress or pajamas
• slippers
• dressing gown
• breastfeeding bra and breastfeeding pads
• nursing tops that open to allow breastfeeding or loose, wide-fitting shirts
• towels and washcloths
• toiletries

For the baby

• baby vests in size 56 to 62
• sleepsuits or soft trousers, tops, and socks
• newborn jacket and hat
• baby blanket
• diapers for the trip home

A detailed checklist of what to include in the hospital bag is provided by the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung) at familienplanung.de.

It is also useful to discuss this list with the hospital or midwife in advance.

Most women think of the birth of their baby as something they long for, but also as an event to be treated with the greatest respect. Many have fears about labor pains, worry about facing the unknown, or feel anxious about the health of their baby, the future with a child, or how things will change with their partner. In some cases, negative experiences recounted by other mothers or reports in the media contribute to a sense of unease.

During birthing classes, expectant mothers and their partners are given plenty of information about birth and what they can expect to experience. Any questions or worries can be addressed and solutions found in this environment. The midwife and obstetrician are also there to help with any fears surrounding the birth that may arise at any stage.

A wide range of conventional and alternative methods and medications are available to help the expectant mother to relax and to relieve her pain during labor. These are provided at the woman’s request during labor – not only for medical reasons. In Germany, 50% of women receive pain relief during labor. Procedures such as peridural anesthesia or – in the case of a cesarean section – a spinal anesthetic allow women to experience a pain-free birth while being fully conscious. However, medication and epidural anesthesia should only be used when they are really needed. Plenty of preparation and support, knowledge about what’s to be expected during the birth, and breathing and relaxation are the most important pain-relieving methods.

Support for expectant mothers is available from:

Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium für Familie, Senioren, Frauen und Jugend): schwanger-und-viele-fragen.de

Many support options are available to expectant mothers and young parents in crisis situations. The Federal Office of Family Affairs and Civil Society Functions (Bundesamt für Familie und zivilgesellschaftliche Aufgaben) has set up a helpline as a first point of contact. The number to dial is 0800 40 40 020. Advice can be sought anonymously, free of charge and round the clock in several languages.

Federal Initiative for Early Childhood Intervention (Bundesinitiative “Frühe Hilfen”)

Federal Foundation “Mother and Child – Protection of Unborn Life” (Bundesstiftung Mutter und Kind – Schutz des ungeborenen Lebens)

The first 6 to 8 weeks after childbirth are sometimes referred to as the postpartum recovery period. During this period, the focus is on caring for and getting to know the new baby. Most partners take time off work to be available during the first few weeks after the birth.

Women need plenty of rest, loving care, and support in order to recover from the physical strain of giving birth. That’s why it’s a good idea to avoid having too many visitors or taking on responsibilities during this period. It can be helpful to have friends and family members take care of everyday tasks such as grocery shopping.

Every new mother is entitled to up to 20 visits from a midwife in the first 10 days after the birth. After this period, the midwife will continue to support the family by phone or with home visits until the child is 12 weeks old. If necessary, this support can continue until the end of the breastfeeding period or when the child is 9 months old. Midwives can help and advise on all issues relating to the health of the mother and child. They provide guidelines on caring for and feeding a newborn and are a source of help and advice for any worries or problems. The costs are covered by statutory health insurance.

It is advisable to attend postnatal exercise classes after a pregnancy to help strengthen the body after the physical changes it has gone through. The pelvic floor and many other muscles become slack and stretched as a result of pregnancy and birth. Specific exercises help support the internal organs, strengthen the pelvic floor, and promote the tightening of muscles in the back, abdomen, and legs. Postnatal exercises also help reduce the risk of bladder weakness (incontinence) resulting from the birth. 

Women can begin attending postnatal exercise classes as soon as they are no longer in pain and their daily routine allows them to attend on a regular basis. It is recommended that women begin these classes 6 to 8 weeks after the birth. Postnatal exercise classes are offered by midwives and physiotherapists in hospitals and birthing centers or by private providers. In most cases, the woman may bring her baby with her.

Statutory health insurance schemes cover the cost of 10 hours of postnatal exercise classes with a midwife, provided that these begin no later than 4 months after the birth and finish no later than 9 months after the birth.

Once a child is born, the parents are required to provide some information to the authorities. Various applications need to be submitted in order for them to receive the support they are entitled to. Some of this paperwork can be begun or completed before the birth.

The main formalities include:

• collecting the birth certificate from the civil registry office (within one week of the birth) – the hospital or midwife are responsible for registering the child
• notifying the employer, training company, university or school of the birth (as soon as possible after the birth)
• applying for family health insurance for the child from the mother’s or father’s health insurance scheme (after the birth certificate has been received). Until the baby receives a health insurance card, he/she is insured on the mother’s card.
• applying for parental allowance from the relevant parental allowance office (after receipt of the birth certificate)
• applying for child benefit from the Family Office (Familienkasse) of the Federal Employment Agency (Agentur für Arbeit) (after the birth certificate has been received)
• informing employers about planned parental leave (no later than 7 weeks before the end of maternity leave)

A detailed checklist of paperwork and applications to be completed is provided by the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung) at familienplanung.de.