Are you interested in giving birth at birthing center or at home in Germany? If so, you may be wondering what guidelines and processes to follow to explore this option.
First off, there are two option for an out-of-hospital birth:
Traveling to a birthing center (Geburtshaus in German)
Planning a home birth (Hausgeburt in German) at your house/apartment
Both are accompanied by midwives only.
It may be interesting to note that Germany wide, only 1.94% of births took place outside of a hospital (not including those that were meant to take place at the hospital), according to the 2022 statistics.
Who can opt for an out-of-hospital birth?
Anyone with an uncomplicated pregnancy expecting only one child can consider an out-of-hospital birth.
Note however that certain health conditions may prevent a birth at home or at a birthing center, for example:
Pregnancy with multiples (twins, triplets…)
Baby in breech position
Premature births
Obesity (BMI higher than 35 pre-pregnancy)
(Pregnancy) diabetes with insulin treatment
Low iron levels
Delivery after week 42+0
Check with your midwife and/or OBGYN if you have any concerns.
Why choose an out-of-hospital birth?
Choosing a place to give birth is a very individual decision. In the end, it comes down to where you feel safe and well taken care of, both when it comes to the medical assistance and the atmosphere.
In our blog post “How to choose where to give birth”, we look at the pros and cons of a hospital birth versus an out-of-hospital birth.
If you’re interested in an out-of-hospital birth, you could read the first part of Marie Mongan’s book “Hypnobirthing” which talks about a woman’s needs in labour and what makes her feel safe and sound.
If you are considering it, here are some of the positive aspects to highlight for an out-of-hospital birth:
Your midwife (who takes care of you during your pregnancy) will be on-call 24/7 for the last few weeks of your pregnancy (you will need to pay an on-call fee, which may be partially refunded by public health insurance)
You can call them when you think labor may have started to discuss next steps
You will have 1-on-1 care with your personal midwife, who you will have developed a close relationship with, during labor (usually, a second midwife joins to assist)
The environment will be calm, cozy and home(-like)
There will be no drip or CTG cables, you can move around freely
No transfer to the birthing place during labor with a home birth
Immediate bonding with the family (partner, siblings) at home
What are the cons of an out-of-hospital birth?
There’s a few things you need to be aware of if you’re considering giving birth at home or at the birthing center:
There is no option for an epidural or other chemical pain medication
There will not be a doctor on-site, nor a neonatal unit
If complications arise, you will need to transfer to a hospital and will be taken care of by the midwives on staff at the hospital (in most instances, your “personal” midwife will not be able to come). In 2022 15% of planned out-of-hospital births were calmly transferred to a nearby hospital while 1% had to be emergency transferred.
If not already home, you will go home about 3 hours after the baby is born at the birthing center. This may seem scary but your midwife will come check on you at home frequently (up to twice a day in the first days) and you may actually be better taken care of at home than at the hospital where sometimes the maternal ward is not very well staffed.
Registration of birth needs to be done by you within 7 days of the birth (find out what you need to do for this at the Standesamt of your district)
The U2 baby checkup needs to be done at a pediatrician’s within 10 days so you need to make sure you have a pediatrician lined up for this (not all pediatrician’s do the U2 since a lot of families have it done at the hospital). Check if perhaps they can visit you at home for the checkup.
You will need to schedule an appointment for the newborn hearing screening at an ENT office. You will get a referral paper at the U2.
If your midwife does not offer the newborn screening, this needs to be done within 36 to 72 hours of the birth at the pediatrician’s office (this is a voluntary blood test to check for certain metabolic diseases and hormonal disorders that is paid for by your health insurance).
Home birth versus birthing center?
Objectively, the two are the same so it will depend on your personal preference. Here’s some questions to help with the decision making:
Will you feel more comfortable at home or at a birthing center?
Do you mind the transfer to the birthing center during labor and after you gave birth?
What is the distances to the nearest hospital should you need to be transferred?
What are the “amenities” at home and at the birthing center (eg a bath tub)?
Do you mind purchasing a few additional throw away items (sheets, towels, water proof pads, etc.) for a home birth? (The midwife will provide a list beforehand and will generally help with the biggest items to clean up after)
What are the risks and how can I learn more?
If you’d like to consider an out-of-hospital birth, make sure you are aware of the risks associated with it. Attend an information session at the birthing center or meet with a home birth midwife to learn more and have your questions answered. If afterwards you are still considering this option, you will have an appointment with your midwife where they talk in more detail about the risks.
If you decide to go for it, you will also have an appointment closer to your due date to talk about what to do if the midwife does not get there in time, if there are complications during labor, etc. It is important (for both partners) to be aware and comfortable with these factors before making a decision.
Questions to ask
Here’s some of the questions you might like to ask your midwife when deciding if this is the right option for you:
Number of years of experience, number of births attended
Why did they decide to offer out-of-hospital births? What is their birthing philosophy?
What are the steps when labor begins?
What percentage of women are transferred to the hospital and what is the main reason for this?
What other complications have they seen arise?
Will a second midwife join? If so, can you meet them in advance?
Will they be able to also do the post-natal care?*
Do they offer (or can they recommend) a birth preparation course?
Any specific questions you have about your personal situation, your pregnancy or any fears and doubts that might plague you.
*Sometimes, midwives working at a birthing center or doing home births don’t have capacity to do the post-natal care, so it is a good idea to start looking for a separate midwife to cover this period while you explore your options.
How to register for an out-of-hospital birth?
In many places, spots for an out-of-hospital birth fill up quickly, so we recommend to prioritize this decision.
If you’d like to learn more, check with your closest birthing center(s) about upcoming information sessions.
For a home birth, you can select this option in the midwife search platform ammely and perhaps the local platform in your town or city as well.
Happy birthing! Sources:
"Gesellschaft für Qualität in der außerklinischen Geburtshilfe" QUAG e.V.
