Having a Baby in Germany: Prenatal Care

by Erin “ebe” Porter, overlord of an American expat family in Berlin. She is writing, drinking and eating her way across the country at ianandebe.blogspot.de.

Pregnancy in Germany: Part 1

Finding out you’re pregnant can be intimidating. Finding out you’re pregnant in Germany can be terrifying. Luckily, healthcare in general and prenatal care (Vorsorgeuntersuchungen) in particular is superb in Germany. There are first-class facilities, well-trained (often English-speaking) staff, and extensive options for every step of your pregnancy. German health insurance, Krankenkasse, offers comprehensive coverage for care and leave. Private insurance (Privatversicherung) is much more variable. Check with your insurer for coverage.

Pregnant in Berlin

The author super pregnant in Berlin. PHOTO provided by the author.

Knowing it is going to be okay is half the battle. Knowing exactly what you can expect when you’re pregnant in Germany is the other half. It is also good to know that Germany is one of the best places to be a new mom, with generous benefits and work leave (for both parents) after you give birth.

Pregnancy Tests in Germany
Maybe your boobs are feeling a little bit bigger or whenever a German asks “Wie geht’s?” you can only tiredly say “müde.” Or perhaps you are experiencing the big flashing light of missing a period. In any case, the first step when you suspect you may be pregnant (schwanger) is to take a pregnancy test or Schwangerschaftstest in German.

From your local Apotheke (pharmacy) to Rossman to DM, you’ll easily find basic, pee-on-a-stick pregnancy tests. If you are a lady on the go, you may find the “Maybe Baby” vending machines on random S-Bahn platforms more accessible.

Prenatal Doctor Visits
If you get the blue line or positive symbol or whatever indicates that – yes! – you are pregnant, it is time to make an appointment with your gynecologist (OB/GYN), aka die Frauenarzt. They generally recommend that you wait until eight weeks after conception. This visit will confirm the pregnancy with a vaginal exam and transvaginal scan. Prepare to unceremoniously disrobe as the German attitude toward nudity is much more relaxed than in places like the USA. This means no cover-up sheet or discreet changing room.

The Frauenarzt will point out the minuscule fetus and you may be able to hear the fetal heartbeat. The doctor will go over your health history, answer questions and explain the next steps. Ideally you should start taking Folsäure (folic acid) before you even intend to get pregnant, but if you haven’t started it yet the doctor will provide an easy vitamin regime.

Before you leave, you will make an appointment with the receptionist for every four weeks from the confirmation of pregnancy appointment up until week 32. At this point, check-ups will take place every two weeks. If you pass your due date, checks increase to every two days.

A basic exam consists of urinanalysis (drink a bionade before you get there!), blood pressure check, weigh-in, periodic blood tests, ultrasound, and talk with the doctor.

CTG machine

A CTG (electronic fetal monitor, EFM) scan is done in the later stages of your pregnancy.
PHOTO provided by the author.

A Schwangerschaftsdiabetes test (for gestational diabetes) is administered between 24 to 28 weeks. Though this only affects between 2 to 14 percent of pregnant women it can significantly complicate a pregnancy. The glucose tolerance test is simple. After some light fasting, you must drink a syrupy mixture (50g glucose in 200ml water) and after an hour, a blood sample is taken to check your blood-sugar level and see if your body has processed it appropriately. If the reading is too high (which happens 15 to 23 percent of the time) a similar three-hour test is administered. Most women don’t turn out to have gestational diabetes. And even if you do, it is simply a matter of management with most babies unaffected and the condition disappearing soon after birth.

Near the end of the pregnancy, CTG (electronic fetal monitor, EFM) scans will be added. These external monitors measure Braxton-Hicks contractions and heart rate and take about an hour. Now is the time to try and relax, get as much sleep as possible and start preparing for the loads of German paperwork to come.

Der Mutterpass
The first and most important piece of paperwork you will receive is the Mutterpass (“mother pass”). This vital booklet is issued by your doctor at around 10-12 weeks. It charts medical examinations, tests, medical history, etc. The Mutterpass will be required throughout your pregnancy and should be kept with you at all times. While most mothers have their birth plan well thought out and a specific birth site in mind, this document allows mother’s to deliver in any facility in Germany.

Pregnancy Ultrasounds in Germany
Along with your exams, there will be an Ultraschall (ultrasound) scan at almost every doctor visit. These are safe, non-invasive scans which produce an image of the growing fetus within the uterus. In the later weeks, you may observe the baby moving and even get your first look at the little person you’re preparing to welcome into the world. For low-risk pregnancies this can include anything from a minimum of three to seven ultrasounds.

When to expect ultrasounds:

  • Week 9-12
  • Week 19-22
  • Week 29-32

Scans are covered by public insurance, but before nine weeks there may be an additional fee of €30. If you have private insurance, check what exactly is covered.

In addition, most people get an anatomy ultrasound (Feindiagnostik) or 3D scan. Your doctor should recommend a specialist around the 25th week. You will receive a referral and can usually make an appointment fairly quickly. This scan is a fascinating chance to see your baby in the flesh and diagnose serious issues. Babies like covering their face with their hands during this exciting exam so don’t be alarmed if the doctor manually manipulates your belly to get a better look. The look at your baby’s face is worth the mild discomfort!

The doctor and technician will measure everything from the thigh bone to the cranial ridges and examine the output of various organs. Indicators of spina bifida and Down syndrome may be identified, but note that it is impossible to determine every possible issue. This is merely a stepping stone to identify early problems.

Ask how to prepare before you arrive as many offices have different requirements. In general:

  • Bring your Mutterpass, Überweisungsschein (referral) and Versicherungskarte (insurance card). Foreigners may also need to bring their ID (passport is ideal).
  • Partners should try and attend these scans, but children are best left at home.
  • A towel or full bladder is usually not necessary.
  • Avoid putting any cream or oil on your belly beforehand as that could obscure the scan.
  • Photos and a short video are often offered; ask about options.

Where to Give Birth in Germany
There are three common location options for giving birth in Germany:

  • Krankenhausgeburt – At a hospital. In addition to the Kreißsaal (delivery room), there is a maternity ward, doctors on call, easy access to an epidural (called a PDA in German), and emergency services in case of Kaiserschnitt (caesarean, C-section) or other issues. Families usually stay for at least three nights following a normal vaginal birth and at least five nights following a C-section. It is possible to leave sooner, but discouraged.
  • Geburtshausgeburt – At a birthing house. A middle ground between the hospital and a home birth, these centers provide a more relaxed atmosphere and some have maternity wards, but not emergency services.
  • Hausgeburt – Home birth. A Hebamme (midwife) is present to help deliver a baby at a person’s home. This offers a familiar, comfortable environment, but if an emergency arises you may need to be transferred to the hospital.

All options are covered by Krankenkasse and are valid options. It is your decision where you would like to give birth, as each option has pros and cons.

Take an advance tour of the facilities, as most have informational nights and are happy to answer questions. There is also a registration meeting roughly a month before your due date where decisions can be made beforehand – not in the midst of labor crisis.

No matter where you give birth in Germany, a highly qualified Hebamme will be the one delivering the baby. Doctors only step in if there is a problem.

Hebammen (Midwives)
Towards the end of their pregnancy, most women in Germany begin meeting with a Hebamme (hay-BAHM-muh). A Hebamme is an expert in childbirth who is versed in both traditional and modern medical techniques. A German midwife comes to your home, monitors changes, and helps you prepare before and after the birth. She will answer questions ranging from breastfeeding to baby-proofing your home. In larger cities such as Berlin there are many English-speaking Hebammen. There are national search sites like hebammensuche.de that allow you to specify language, location and services, or local sites like berliner-hebammenverband.de. Hospitals and birthing clinics also provide lists of local midwives. Collect referrals from friends and contacts to find the perfect midwife for you.

Your Hebamme may take over your check-ups around week 35, or you may meet with them in addition to your doctor. You should start your search early, as most midwives only take a few clients at a time and can be booked up. Some Hebammen work out of a specific hospital or Geburtshaus, so if you have a place where you wish to give birth, ask about their available staff. If you want to hire a Hebamme to be with during your birth, look for a Beleghebamme. There is usually a small, additional cost over what is covered by German health care. Krankenkasse covers twelve advice sessions with a Hebamme as well as aftercare for up to eight weeks. This can include daily visits until the baby is ten days old.

practicing couple

Prenatal Classes: Couples are encouraged to practice together to prepare for the birth.
PHOTO provided by the author.

Prenatal Classes
Prenatal courses in Germany come in all shapes in sizes. They usually cover exercises, what exactly to expect during the birth, and how to handle your newborn. Often led by a Hebamme in hospitals or birthing centers, they may include just a few intensive courses or occur over the course of eight weeks and can be held in a variety of languages. Sign up for classes early, but plan to have the course finish approximately 3-4 weeks before your due date.
Also consider fitness and therapy classes (swimming, yoga, etc.) as many are at least partially covered (up to 80 percent) by Krankenkasse.

The GW Store: For Mom and Baby – From our store and Amazon.de – with recommendations by Jane Park

Next | Having a Baby in Germany: Giving Birth (Part 2)

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