"Throughout history, the ancient word, midwife, has been used to describe women who are 'with women' at birth," notes the website for the American College of Nurse-Midwives--ACNM (http://www.midwife.org). Even the German word for midwife, Hebamme, is derived from the old high German word hev(i)anna meaning Großmutter, die das Neugeborene (vom Boden) aufhebt. Translation: Grandmother who lifts the newborn up (from the floor). In both languages the profession of midwifery focuses on birth, babies and women, all very important factors in considering choosing the care of a midwife during your pregnancy.

As soon as we started telling people that I was pregnant in late summer of 1997, the first question they would ask is: "Do you have a midwife?". Well, since no one I knew in the U.S.A. had ever used a midwife, and I myself had never been pregnant before, I found it a strange question and wondered whether it was the "thing to do" here in Germany.

Then we found out that your gynecologist would not be the one to deliver your baby, rather whichever doctor and midwife were on duty at the hospital when you arrived in labor (except in rare instances). And I began to worry. What kind of care could a stranger provide me in such a sensitive and intimate experience as giving birth? Sure, all the details of my prenatal treatment would be recorded in my blue Mutterpass (Mother's Passport), but how can that compete with personal knowledge of a patient?

Then we met a young couple with a newborn baby at a garden party, and we asked them if they had a midwife and how one went about finding one. They told us about the special midwife they had used, of which there are only a handful in Hamburg. They are called Beleghebammen; and they not only provide you with prenatal care, they also deliver your baby and provide postpartum care for you and your newborn. Just the type of service we were looking for!

Up until meeting with our midwife for the first time, we were completely unaware of all the services a midwife provides, most of which are covered by all types of German health insurance (both public and private). Here is a listing of just a few: prenatal consultations, prenatal gynecological examinations, treatment of pregnancy symptoms, birth preparation classes, monitoring of unborn babies, delivering babies, immediate care of a newborn and mother, monitoring of postpartum care for mother and baby and breastfeeing consultation. If you are lucky, you can find a midwife who provides all of these services, or you may have two or three, depending on the number of services each one provides.

In Germany, in fact, there is a special law governing midwives (called the Hebammengesetz). This piece of legal documentation outlines exactly what a midwife is, how one becomes a qualified and certified midwife, and what services a midwife is qualified to provide. Paragraph 4 (§4) of this law even REQUIRES the presence of a midwife at every birth (it is the responsibility of the attending physician to call in the midwife). Midwives, however, are not required to call in a doctor, unless the medical situation extends beyond their capabilities as outlined in §4.

From my own personal experience, I can highly recommend choosing a midwife to accompany the medical care offered by a gynecologist during pregnancy, birth and beyond. According to Midwifery Today (http://www.midwiferytoday.com), midwives adhere to the following principles:

• midwives trust a women's power to give birth successfully



• midwives are non-interventionists



• midwives emphasize good nutrition, beneficial education and useful information, natural birth and breastfeeding



• midwives are the guardians of normal birth

And the ACNM adds to this a philosophy that "is focused on the needs of the individual and family for physical care, emotional and social support and active involvement of significant others according to cultural values and personal preferences".

I can only verify that the German midwives I have worked with follow the same principles and philosophy and function as an essential advocate for the rights of the mother and unborn baby in a medical system that is sometimes hostile to the individual needs of the patient, whether it be for scientific reasons, political reasons or economical reasons. I am glad that I have had the opportunity to give birth in Germany because, had I remained in the U.S.A., I probably never would have had the experience of a midwife, which is now such an essential part of being pregnant and giving birth for me that I would not want to go through a pregnancy without one.

To learn more about midwifery, visit the websites mentioned in this article. The website for the ACNM even provides sample letters to insurers to request coverage of midwife services in the U.S.A., as well as a search engine to locate a midwife near you. For information in German, as well as a search to find a midwife in your area, contact the Bund deutscher Hebammen (Frau Henriette Thomas, Tel. (0721) 98 18 90) or visit the following website: http://www.kidnet.de (look under Karteikasten).

[WebEditor's Note: See also Susan L's article on Midwives as part of her extensive coverage on Having a Baby in Hamburg.]