An honest and personal look at the differences between birthing in Germany and America by Kirstan B.

Originally published in Currents 2002 and revised/republished in June 2007. 

I am kind of officially over the pregnancy-baby thing. I have paid my motherly dues and have conceived, carried and delivered three wonderful babies in my 17-year stay in the Fatherland.  As I have never had the opportunity to do so in my homeland of the United States, I can't really give a comparison story except for my scant knowledge, secondhand stories and family input.I come from a medical family: my dad is a surgeon; brother an eye surgeon married to a radiologist, sister a mid­wife r.n. and half-sister in medical school. My older brother and I are the renegades, pursuing careers in aviation and design, respectively. I grew up in a household not afraid of hospitals, enjoying great healthcare, complying with the notion "for every pain there is a prescription drug." Why should I be totally at odds with the idea of having a baby in Hamburg? 

The few that had gone before me ...those brave souls who fed my imagination with horror stories of forced natural labor...opened the notion that giving birth in Germany could be vastly archaic compared to American birthing methods. How different was it, I wondered? You have to get the baby out eventually, with not a lot of choices on how (anatomy will answer that one). The answer is, of course, everything depends on chance, luck, and the mystery of why each pregnancy and delivery is different from the start, whether you squat on the African plain or lie flat on your back in an antiseptic birthing room. In general, things have changed in the small time span since my first birthing in 1995 to my last in 2001. In the space of six years, insurance and methods have evolved in leaps and bounds, in my opinion. But I guess my purpose here is to point out a few obvious differences and let the rest fall under the category of wait-and see.

 1. Drugs during childbirth are more of an issue. Epidurals, or spinal blocks, have been around for years. Many of our mothers had epidurals for our own births, and in America it is simply a matter of request, without judgment or consideration. It seems in a world where we receive Novocain to get a filling at the dentist, it would be a no-brainer to assume six pounds or more of infant being pushed through your pelvic cavity would warrant appropriate drugs. The choice to have a natural labor vs. medication is extremely personal, but I can't think of anyone who was faced with first­ time labor who didn't consider the option of pain relief before the due date. The thoughts alone are daunting, calling into play our own idea of pain threshold (can I do it or am I a wimp?). Although I haven't come across a situation where epidurals and the like are forbidden, at every one of those hospital open houses (full of mostly first-time expectant mothers/fathers), it was me who asked the question about pain relief at the end of the session. Of course, this made me feel like a coward, the American who wanted it easy, the one who couldn't deal with unpleasant situations. The answer is always that epidurals are available, but you have to please sign the lengthy waiver when you register, and first try homeopathic remedies: positioning, walking, breathing, yoga, meditation, acupunc­ture, birthing pool, New Age music, etc., before we go that route. I only had an epidural for my second baby, and he was a hellacious delivery that ended up as a C-section after 14 hours of labor. I also knew a mom who had to rifle through her purse to get pain relief, coming up with a bottle of extra strength Tylenol for her labor misery in Stuttgart. This is one of those horror stories that haunted me for at least six of the nine months in my first pregnancy. Things have changed, and Germans seem to be embracing medication more enthusiastically in recent years...so stick to your guns if it is an issue for you, and find the right hospital/doctor/ midwife that shares your idea of pain management. 

2. Your OB is not delivering your baby. In almost every scenario in Germany, your regular obstetrician is not going to be the one to catch your baby in the hospital, birthing center or home. First of all, the German midwife is running the whole delivery show, as opposed to America, where midwifery is fighting for a rightful place in the birthing process. Here, there are many ways to go about finding the right "birth managers." Some women opt to see a midwife throughout the pregnancy instead of doctors. Most, though, tend to see a regular OB and hook up with a midwife towards the end of the pregnancy, to prepare for birth. In almost every situation, the German midwife is a great supporter of homeopathy, and has a bagful of home remedies that have remained tried and true in Germany.  

In the German delivery room, a doctor will be on “standby" to administer medical procedures like epidurals, caesareans, episiotomies, post-labor stitching, and any complications. The midwife will be managing your birth, from internal examinations to pushing and actual delivery. Doctor and mid­wife live in beautiful harmony in Germany, each respecting the other’s role. If you plan wisely, you can even manage to get the midwife of your choice at some hospitals. Preferred doctors are practically impossible to guarantee in a hospital birth. The true value of a midwife, to me, lies in these three things: support, understanding and answers. Your midwife will be making house calls pre-and post-partum, and will be willing to do a number of things to help you out with: checking on incision sites; breastfeeding tips; breast problems like engorgement, infections, etc; pain; itching; discomfort; insomnia; tired­ness; water retention; etc. Mine administered acupuncture on my sofa at nine months to prepare the uterus for delivery and even took care of the baby on one post-partum visit so I could shower at 3 p.m. I received instructions on what remedy to take with pregnancy itching (sulfur), which tea to drink to build up milk supply (fennel), which foods to avoid to lessen baby colic (broccoli, etc), to apply cold cabbage leaves and quark to swollen breasts and cold wet teabags to ease sore nipples...(laugh if you must, but these really do work). Do not scoff at the help that is offered, and it will, in almost all cases, be paid for by your insurance. 

3. Modesty standards are not the same in Germany. As we all know, strutting your naked stuff is common place at the sauna, gym, etc. Same goes in the hospital. Think nothing of laboring in just a T-shirt; bottom half free to the wind, ten different people may very well be in the room while you have your legs high. Afterwards, when you are romantically cradling your baby in your arms in your room, beware of nurses who bang the door open, march over to your bed, open your top and purposefully squeeze your breasts to check on the milk situation. Breastfeeding is considered the norm, and it is the job of these none-too-shy nurses to enforce the sucking connection. At the same time, if you are having difficulties in the feeding department, the experience and knowledge of many a nurse will be invaluable. Germans are just so practical about things that the American way of modesty is a luxury tossed aside for the purpose of feeding the baby, pronto.

 4. Your hospital stay will be different. Aside from the above-mentioned nurse patrol, you will most likely have the option of staying longer in a German hospital than you would an American one. The standard U.S. stay is up to 48 hours post partum, maybe four days max with a c-section. Here, I was offered seven days with a "normal" vaginal birth in 1995. By 2001, it was down to three to four days, but that still is a luxury in world health standards. It was no wonder that I occasionally slipped and said "hotel room" instead of hospital room. If you are under standard public insurance, your room will be a gang room, with two to three beds, with all the babies rooming-in with their mothers. Visiting hours become a nightmare, especially with roommates who have large families that aren't regular deodorant users. I have had both public and private rooms, and there are benefits and drawbacks. Companionship and sharing the experience can be fun in a big room, but peace and quiet is invaluable when you have other children to return home to. You can always pay an insurance supplement to get a private room, but plan in advance for that. A cleaning person will be mopping at least three times a day. Your meals will include lots of bread, a vat of milk-building tea three times a day, a mountain of cold cuts, warm lunch at 12 p.m. sharp (beware), and cold Abendbrot at 5 p.m. I had the luxury of Mr. Green salads and take-out Chinese food brought in by my husband, and the staff and patients were just floored at that bold move. Personal roughage supplies will be greatly appreciated, as will towels and pajamas from home. If you want flat water, bring your own crate.But, you just can't complain when a nurse gives you nose spray to alleviate hemorrhoid pain (yes...it does work) or the ward fridge is stocked with that cold cabbage and quark I mentioned earlier for breast pain. And don't forget the "personal trainer" that appears at the foot of your bed, notoriously five minutes after you drifted into a peaceful nap. Almost always annoyingly perky, these physical therapists are there to keep your circulation going and to avoid the possibility of thrombosis from lying in bed too long. The exercises are laughably easy and repetitive (five times please), unless you had a c-section. Pointing toes, lifting butt, breathing... Every morning, your baby will be dressed in unmatching hospital clothing from the community closet, so if you are picky, go choose something yourself in the unbusy afternoon hours and dress your baby alone. Guaranteed, your baby will be decked out by the nurse in these layers, summer or winter, no exceptions: powder for the umbilical, diaper (I have seen wool knitted washable diapers being offered, no lie), wrap t-shirt, thick velour or terry shirt, velour or terry jumpsuit and socks over that. Then the freshly-dressed tyke will be loaded in a basket/bed with a towering down puff comforter secured around it, so not one ounce of draft (German nightmare) can reach your tightly rolled infant. Checkout day is more like a reality check     all of a sudden, as much as you may have balked at the different type of care in Germany, you realize you have to do it alone. Car seat ordeal and husband help (all the wrong things were brought from home) will be a hindrance, but somehow you will manage to escape your own womb-like hospital stay and be born into the real world of parenting. ~