You’re pregnant! Now what?

You will need the confirmation of a medical professional who can be found in the Yellow Pages, Gelbe Seiten, under Ärzte, doctors (in the German alphabet "ä" = "ae" and hence follows "ad"). The specialization is listed under Frauenheilkunde und Geburtshilfe (Gynecology and Obstetrics).

Though in the U.S. you would look to an obstetrician, German obstetrics are not separate from gynecology. However, depending upon the age of the doctor’s patients or neighborhood, one German gynecologist will focus more on obstetrics than another.

Since you are to visit your doctor frequently, you will be best served to find a doctor located near you. Do not feel obliged to have an exam at the first meeting, making it clear to the office staff, Sprechstundenhelferin, that the appointment is meant for introduction or interview. If you speak little German this is your best opportunity to hear the doctor's English proficiency. A large number of required medical school text books are in English, so do assume at least the younger doctors speak it well.

Once comfortable with your choice of doctor, upon your first exam the doctor will issue you a Mutterpass, Mother Passport. This booklet will contain the complete history of your pregnancy. Your doctor will recommend that you keep it with you at all times. This booklet is very important to the staff at the hospital where you deliver; a private practice doctor who sees you through your pregnancy is not present at your delivery.

In routine pregnancies, ten visits to the doctor will be scheduled: once monthly starting in your 2nd month of pregnancy (visits 1 - 6); and twice monthly in your 8th and 9th months (visits 7 - 10). Once overdue to deliver, you will visit every few days; if the baby is fine you can expect not to be induced until 14 days past due. You will have, in addition, one postnatal visit six weeks after the baby's birth. At each visit your doctor will check your urine, blood pressure, weight, the size of your uterus, and inquire after your general condition. An internal examination will not occur at every visit nor will an ultrasound, Ultraschall.

Some doctors in America and here will perform an ultrasound whenever you like; however the standard procedure is for only two or three times. It has not been scientifically proven one way or the other if an ultrasound harms the baby; nonetheless many doctors believe that it does heat or stress the baby.

Gowns: It is not the custom to provide the patient with a gown. In order to avoid standing there stark naked when the doctor only asks "Machen Sie Ihren Unterleib frei" (make your lower body free), wear a long shirt.

Schedules to keep:

• By the 20th week of pregnancy you should reserve a place for Birthing Classes, although participation begins around the 30th week.



• Between the 32nd and 34th week it is recommended to present your referral to register at the Hospital of your choice. Be aware that by being tardy in this matter your preferred hospital could refuse you. This applies only to the publicly insured. The public insurers determine the budget of the hospitals meaning that clinic A will receive a set amount of money for X number of deliveries; hence to perform any deliveries beyond this set number is for the hospital to do so without payment. This system assures that efficient clinic A is not swamped and pathetic clinic F is not left empty handed. Privately insured patients are spared rejection because the hospital bills directly for services rendered.



• In the 8th month of pregnancy you will need to select your Pediatrician, Kinderarzt, as your baby will receive three medical examinations, Untersuchungen, called the U1, U2 and U3 during its first month of life.

Public Insurance, die Krankenkassen, and private insurers pay for certain prenatal and postnatal care that is considered standard in Germany.

• Prenatal: The midwife providing your birthing class will ask for your insurance details and bill your insurer directly. This does not cover your partner’s participation so he will be asked to pay cash, about DM 100, a fee (his) private insurers may reimburse.



• Postnatal (Wochenbettbetreuung): Your German insurance pays for ten visits over a period of up to eight weeks by a midwife to your home upon your return from the hospital.

You should arrange for one well before your delivery date. She will want to introduce herself to you before the baby arrives as well as take a look at the baby's room to recommend certain preparations. Once the baby is there she will look after the both of you.

A midwife is not a throw back to ancient ways but a trained and certified professional.

• She will, like most German midwives, focus strongly on the reconditioning of pelvic floor muscles, Beckenbodenmuskulatur. These exercises will reduce an infirmity common to elderly women: 'incontinence' or unrestrained urination.



• She will provide priceless information on how to avoid gas - yes this is what makes babies cry! - in the baby's belly (your diet, special teas) and how to help relieve him/her of it (belly massages, the medication Lefax).



• She will examine the healing from your episiotomy, Dammschnitt. An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening just before the birth of the baby's head; is performed in 80% to 90% of first births, and in about 50% of subsequent deliveries", from the American publication What to Expect When You’re Expecting. The percentage rates are lower in Germany.
(See Reading Recommendations.)


• She will inform you that Wochenbett does not refer to one week but six weeks of recovery.



• She will do much over which you are currently ignorant, and later endlessly thankful, but what assures that you will never forget her kind face as long as you live, is that she will teach you and your baby how to breast feed, as neither of you have ever done it before - like bike riding, rather difficult to learn, but looks so simple once you know how.

A midwife may require a payment from you for her services to offset the meager sums the Krankenkasse pays - as was my case; although I looked for a midwife from my neighborhood, she was coincidentally one of the founders of the superb Geburtshaus which made her somewhat of a supermidwife. Also note that it is the custom to give your midwife a gift or moneys upon her last visit as a sign of gratitude.

[WebEditor's Note: See also Jennifer M's article on Midwifery to read about her personnal experiences in giving birth with the invaluable services of midwives.]

According to What to Expect When You’re Expecting (see Reading Recommendations) the classes cover information to "reduce fears, improve the ability to cope with pain ... (by) the teaching of specially designed techniques of relaxation, distraction, muscular control, and respiratory activity." There are various options available in Hamburg; the classes are taught by midwives.

Hospitals sponsor labor preparation courses and you should reserve a place by your 20th week of pregnancy although participation begins around the 30th week. There are also independent midwives who offer classes from their offices. Your doctor should - and a maternity hospital will - have a complete list of midwives in the various Stadtteile (parts of town), or contact the Hebammen Verband (Midwives Guild) which represents almost all of the city’s 300 midwives.

• Hebammen Verband Hamburg e.V.

  Wagnerkoppel 5c
  22159 Hamburg - Farmsen
  Tel. (040) 66 21 41
  Fax. (040) 66 21 41

• Hebammen Verband Hamburg e.V.

  Nissenstrasse 12
  20251 Hamburg
  Tel. (040) 48 54 31
  Fax. (040) 48 54 31

Another alternative, which your author highly recommends, is yoga. It is offered by:

• Geburtshaus Hamburg e.V.

  Am Felde 2 (Gewerbehof)
  22765 Hamburg - Ottensen near Altona Train Station
  Tel. (040) 390 11 28
  Telefon-Sprechzeiten: Mon., Wed., Fri. 9 a.m. - 12 p.m.

It is a one hour class for DM 12, just show up on Mondays at 5:30 p.m. or Fridays at 10 a.m. This is a class of yoga breathing exercises, concentration, informative details on pelvic floor training, dealing with pain and much more, and is taught by a midwife. Beyond yoga, the Geburtshaus offers varied pre- and postnatal care; its raison d’être is to provide an alternative to hospital birth; there is no doctor on hand.

Yoga is also offered by:

• Arbeitsgruppe für natürliche Geburt e.V.

  Yogazentrum
  Midwife: Nanak Niwas
  Epperdorfer Weg 209
  20253 Hamburg
  Tel. (040) 420 36 36 or (040) 420 36 56
  Telefon-Sprechzeiten: Mon. - Thur. 10 a.m. - 1 p.m.
  Seven classes x 2 hours = DM 260

• Kaifu Lodge

  Bundesstrasse 107, Eimsbüttel
  Tel. (040) 40 12 81

Week 18 is the earliest point where a reliable sample of amniotic fluid can be drawn. (The chorionic villus sampling / CVS can be performed at 12 weeks but this has a higher miscarriage rate). The results take two weeks. In Germany there is a debate to end the practice of abortion in the 20th week on the grounds that although the pregnancy is aborted the baby is born alive, surviving despite being severely premature. To avoid a live birth in the U.S. the abortion procedure is proceeded by the crushing of the skull. If you are over 35 the expense is covered by the Krankenkasse.

Big Ultrasound: If you do not wish to have a amniocentesis but would like to know as much as possible about the baby's development, there is what is called the Big Ultrasound. It is performed on a special machine not usually found in every doctor's (ob/gyn) office; therefore your doctor, upon request, will provide you with an Überweisung for a special clinic. During this procedure the size and development of all major organs and bone structure are observed and measured. The cost is not covered by the Krankenkasse but if you are over 35 and make a fuss, chances are that you can convince them to pay, else reckon DM 400.

There are a few considerations when choosing a hospital:

1. its reputation;


2. its physical location to your home - preferably between home and partner’s work;


3. if this is a difficult pregnancy, does it have an intensive care unit for babies - to avoid mother and baby being in two separate hospitals; and lastly


4. do not forget to ask your doctor for his or her opinion.

Your doctor will provide you with a referral, Überweisung, to the hospital of your choice - this is more a Krankenkasse requirement than a medical form. You are expected to visit the hospital between the 32nd and 34th week, latest the 36th week, of pregnancy to present the referral to the Kreissaal (delivery ward's station nurse). Do call in advance for an appointment. She will inquire after your due date, name of referring doctor, insurance carrier, and review your Mutterpass and any difficulties that the hospital staff should be made aware of.

This visit to the floors of the hospital's Kreissaal will be your best opportunity to look around before labor: where's the WC before the runs set in. So do note where best to park the car, the quickest route from the parking lot to delivery ward; the stairs may be closest but once your water has broken you may prefer the elevator.

Take a peek at the rooms of the maternity ward. Room Size: If you are not privately insured you will probably receive a room with more than one bed. Clarify it now if you want to pay a premium to assure your room size. One hospital may have standard rooms of either two or four beds (but if the ward is not full the patients will be evenly distribute throughout the rooms) while another hospital has only one or two bed rooms but multi-bed delivery rooms with curtains.

Hospitals sponsor an open-house, Information Abend, for expecting mothers to learn more about their hospital stay and meet some staff. Thirteen of Hamburg's hospitals have maternity wards. A complete list detailing location, year built, room size, deliveries per year, Cesarean sections per year, staff size, birthing positions, ... can be found in Baby in Hamburg for DM 16.80. The city maps of Hamburg found in almost every home list on the last pages hospitals and addresses. "Wo bekomme ich mein Baby" at your doctor’s office is also informative. (See Reading Recommendations.)

Below is a short list of the better known hospitals; the most popular hospitals of the late 1990's are listed first and second.

1. Albertinenkrankenhaus (Schnelsen, NW Hamburg)

  Süntelstr. 11
  Tel. (040) 55 88-1, Reception
  Tel. (040) 55 88-22 26, Kreissaal
  Intensive Care Unit for Babies
Information Evening: first Tuesday of each month, 8:00 p.m. in the chapel


2. Marienkrankenhaus (Hohenfelde)

  Alfredstr. 9
  Tel. (040) 25 46-0, Reception
  Tel. (040) 25 46-16 66, Kreissaal
  Intensive Care Unit for Babies
Information Evening: first Monday of each month, 7:30 p.m. in the cafeteria


3. UKE Universitäts-Krankenhaus-Eppendorf (Eppendorf)

  Martinistr. 52
  Tel. (040) 428  03-0, Reception
  Tel. (040) 428 03 25 18 Kreissaal
  Intensive Care Unit for Babies in separate buildings
Information Evening: first Wednesday of each month, 6:00 p.m. in the auditorium Hörsaal der Frauenklinik


4. AK Barmbek (Barmbek)

  Rübenkamp 148
  Tel. (040) 63 85-0, Reception
  Tel. (040) 63 85-20 26, Kreissaal
  Intensive Care Unit for Babies
Information Evening: every Monday, 6 p.m. in the Administration Building, Verwaltungsgebäude, Middle Entrance first floor


5. AK Altona (Altona)

  Paul-Ehrlich-Str. 1
  Tel. (040) 88 22-0, Reception
  Intensive Care Unit for Babies


6. Frauenklinik Altona (Altona)

  Bülowstr. 9
  Tel. (040) 88 22-16 94, Aufnahme
Information Evening: first and third Monday of each month, 6 p.m. in the auditorium main building Hörsaal Haupthaus vom Kreissaal, second floor