In collaboration with Duitslandnieuws.nl
Congratulations—your daughter has been born. How was the birth experience different here compared to the Netherlands?
In my case, that doesn’t quite reflect how things are done here, because—going against the German trend—I chose to give birth at home. Since I’d given birth at home twice in the Netherlands, I really didn’t need to get involved with the medical system this time either. Giving birth at home in Germany is quite rare; nationwide, only 2% of women do so, and in Berlin, 3%—which apparently is already considered a high percentage. There are also very few midwives who assist with home births—about 380 nationwide—which is surprisingly few for a population of 82 million.
Normally, German women go to the hospital or a birthing center as soon as contractions begin. You’re allowed to go there earlier than in the Netherlands—where you try to manage contractions at home for as long as possible—and you’re also allowed to stay longer after giving birth. Most women I know stay in the hospital for at least three to four days, even if their baby is completely healthy. This has to do with the German tendency to avoid risks, but also with the fact that there are no postpartum care workers here. So, during those first few days, they actually spend their postpartum week in the hospital, with support from the nurses and, if applicable, their own midwife (called a “Beleghebamme” here; she often delivers the baby in the hospital, though if something goes wrong, the gynecologist takes over).
For me, it didn’t go much differently than in the Netherlands; the midwife arrived on time, and right at the very end, a second midwife—a colleague of hers—joined us.
What do you think is better, and what’s worse?
Of course, I didn’t go to the hospital myself this time, but I do prefer the Dutch approach that mother and child can best recover at home after childbirth, as soon as possible—provided everything went well, of course. In addition, the Dutch postpartum care worker is a unique profession, and I wish every woman—including every German woman—could have someone like that. It’s really a shame that this service doesn’t exist here. The midwife does come by every day, but she doesn’t help with housework or your older children. There’s a home help service you can request, but that’s usually only used by single women or women who’ve had a very difficult delivery. And because there’s no postpartum care provider, there’s also much less guidance on feeding.
For example, my midwife didn’t really understand the concept of pumping after giving birth. I have an electric breast pump (like many women in the Netherlands, because they usually go back to work after three or four months but still want to continue breastfeeding). And in the Netherlands, I started pumping right away on day 2 after giving birth to help get my milk supply going (on the advice of the maternity nurse, who really does know everything there is to know about this in most cases). My German midwife raised her eyebrows, because she believed that feeding the baby more often should be enough. A few days later, my daughter Elise had lost more weight than she should have, and she’s only gaining weight very slowly now. So in week 2, I decided on my own to start pumping—and that helped right away.
Do you know if there are differences by state?
I don’t know exactly how it works in each state, but the nationwide trend is that there are fewer and fewer independent midwives. Most of those who still choose this profession work as permanent employees at hospitals. There are hardly any midwife practices left like the ones in the Netherlands, because they can no longer afford the insurance premiums. Throughout Germany, there’s only one provider that insures midwives for the period during which they must be on call for mothers going into labor, and that provider charges more than 4,000 euros per year per midwife. They receive a portion of this back from health insurers, but not enough, according to the midwives themselves.
In addition, there is a nationwide problem: throughout the country (and especially in rural areas), maternity wards at smaller hospitals are closing. Across the board, more people are still dying in Germany than are being born, so many hospitals are no longer willing or able to maintain expensive maternity wards. This is leading to some truly bizarre situations in small towns and villages. Because there are also hardly any midwives, pregnant women have to travel to a major city two weeks in advance to “check in” at the hospital and wait for the birth (for example, on the island of Sylt: you have to go to the mainland to give birth).
Or you have to accept that you’ll first have to drive an hour or an hour and a half to the nearest hospital—not a pleasant thought when you’re heavily pregnant, I’d imagine.
What I don’t understand is this: home births, for example, cost health insurers much less than a hospital birth. And yet, you have to pay extra out of pocket for a home birth, while a hospital birth is fully reimbursed. Something about that system doesn’t add up; it doesn’t make sense.
Germany wants to address its aging population—is that why the system is better organized for mothers (young families)?
Absolutely. They’ve pulled out all the stops to encourage more children to be born. Strangely enough, the birth rate still remains below the Dutch average; only Berlin and Hamburg have seen high birth rates in recent years. Childcare in Berlin is free starting at age 3 (and, starting in 2017, even free starting at age 1), you can take a full year off (up to 14 months if the father also takes two months of parental leave) and receive 67% of your last salary during that time. That’s a very generous arrangement that even applies to freelancers. Your most recent tax return determines how much you’ll receive from the government during that first year with your baby, with a maximum amount of 1,800 euros per month. And during that same period, your health insurance premiums are waived, so you’ll quickly save about 500 euros per month—health insurance costs are high in Germany.
On top of that, you also receive 180 euros per month per child in child benefits. In the Netherlands, that’s only a fraction of this amount. Germans often don’t realize how well off they are, and to be honest, I also find myself wondering every time where all these costs are coming from. And especially why the Dutch government can’t set aside a little more for parents and families, because the Netherlands is actually a much more child-friendly country—I think that has to do with the mindset. So financially, things are really well organized for families here; I’d really like to see the ministers from both countries sit down and discuss this.
So, as a woman, you can take a whole year off for your baby—and usually you have to, because daycare centers in Berlin rarely accept children under 1 year old. In my case, I have a daycare center that does accept children under one, but I’ve also heard from people many times that I’d be crazy not to take that whole year off. As a freelancer, you have the luxury of being able to decide that as you go along; if you have a big assignment, for example, you can take a month off, go back to work, and then resume receiving “Elterngeld” after that month. I still have to apply for it all, so I don’t know if it’ll really go smoothly, but the program looks very good on paper.
Do you have to deal with more paperwork in Germany than in the Netherlands?
Yes and no. If you walk into the Jugendamt as an unmarried couple so the father can acknowledge his child (the same as in the Netherlands), you’re really walking into an office with a large filing cabinet full of files containing a lot of paper. So at first glance, it seems incredibly old-fashioned—very little is done digitally.
On the other hand, there are plenty of civil servants who are very friendly and get things sorted out for you pretty quickly, with a smile and personal attention. So it all looks a bit more businesslike and outdated at first glance, but essentially you have to take care of the same administrative details. Some of the financial matters are handled through your health insurance provider, so it really depends on who your insurer is. I have a very good one that responds very quickly and is easy to reach—and where many things can also be done digitally. You do have to apply for Elterngeld by mail, with a lot of paperwork and “supporting documentation”—that’s more of a hassle than in the Netherlands. But you’re getting money from the government, so I’m happy to put in the effort.
Are there different traditions in Germany surrounding pregnancy and childbirth?
Yes. There are hardly any. And I think that’s a real shame. In the Netherlands, they hang out the flag after a birth, storks fly through the windows, balloons are hung up, and signs with the baby’s first name are put in the garden—for everyone in the neighborhood, it’s a celebration when a baby is born. Some people think that’s over the top in the Netherlands, but I really appreciate it.
In my apartment complex here in Berlin, three babies have been born in recent years—well, you just don’t notice any of it at all. No balloons, no decorations, and German women who’ve given birth don’t start receiving visitors until much later. It’s simply not done here for everyone to drop by during the first few days, as is customary in the Netherlands. The mother and baby are left in peace as much as possible. I understand the reasoning, but I think it’s wonderful that the Dutch make such a celebration out of it. Waffles with anise seeds, diaper cakes, baby gift baskets, cards in the mailbox—it’s all a bit more subdued and down-to-earth here, which is a real shame. We still have the decorations hanging on the door and have also hung balloons on the balcony—in that respect, I’ve become completely Dutch.
How is postpartum care organized?
Since there’s no such thing as a postpartum care nurse here, you get a daily visit from the midwife. She weighs the baby and checks the position of the uterus. And that’s pretty much it. I was really surprised by this after giving birth: in Part 1, you could read about all the prenatal checkups you have here in Germany, but after giving birth, there are far fewer checkups here than in the Netherlands. Coming from the Netherlands, I was used to there being a care record for both mother and child. In it, the postpartum nurse notes every feeding, the baby’s skin color, the mother’s and baby’s temperature, and the color of the stool—every day during that first week.
Here, not a single temperature was taken—not Elise’s, and not mine either. The midwife also checks skin color and things like that, but she doesn’t, for example, check the baby’s diapers or stool (in my case, at least). She just asked me what it looked like. In the Netherlands, things are a bit more precise; a maternity nurse really checks all of that very carefully. Here, my midwife did have a sort of record, but it’s only on her own paper—it’s not a booklet that I get to keep afterward.
Recently, I pulled out the Dutch care record for my second child to read what was in it. And now I really use that as a guide when it comes to feeding—I think it’s really great that everything is written down so precisely during those first few days after giving birth.
I’m lucky that my mom lives just around the corner from me. She’d heard my stories about the postpartum nurses in the Netherlands and had experienced it herself with my first children—so she took over as much as possible during that first week, and I barely even missed having a postpartum nurse myself.
Which system is better?
Despite all the discussions, I’d be in favor of finding the ideal balance between the two systems. Before giving birth: See the midwife if everything is going well, but in the Netherlands, refer patients to the gynecologist sooner—just to err on the side of caution sometimes, since the “natural” approach can go too far at times. And in Germany, things could be a bit more relaxed; doctors could also offer some reassuring words, show a little more empathy for something so beautiful, and not just focus on the risks. Sometimes they’re simply trying to cover their own backs: “I’ve examined everything; it won’t be my fault if anything goes wrong.” I think that’s a shame. Being pregnant isn’t an illness, but plenty can happen. It’s not black and white, and things can change as quickly as a leaf on a tree. Good care should therefore be just as flexible, which means that both doctors and midwives really need to put the pregnant woman’s best interests first. In both the Netherlands and Germany, they’re still far too focused on their own little worlds.
And after childbirth: The Netherlands should take a look at how Germany provides financial support to families—there’s a lot of room for improvement there. And Germany could also look to the Netherlands when it comes to support from midwives and, especially, postpartum care providers—in that regard, too, they have quite a bit to learn from each other.
