10 Steps to Make Your Voice Heard – Giving Birth in Germany

If you are like many women facing pregnancy and birth in another country, culture and language, you may have certain doubts about how you will manage everything. You may even find that the tide of anxiety tends to ebb and flow as you eagerly anticipate those days, hours and still intangible moments leading up to the birth of YOUR child. After all, this is your baby's true BIRTH day and a profound and defining moment in your life.

But have no fear. In Germany, you have a range of support options and resources at your disposal to help you navigate these seemingly deep waters: your partner, local midwives, doulas, childbirth educators, support groups, friends and more. In addition to your partner, your care provider is there to work with you, helping you make informed decisions about your baby, your body and your labor. S/he shares professional expertise related to health and pregnancy and plays a central role in ensuring that you understand any proposed course of care. Yet, you remain the expert on your body, your baby and what YOU need to give birth.

Here are 10 steps you can take to help make your voice heard:

STEP 1: Familiarize yourself with the customary standard of care
Although hospitals, clinics, birthing centers and home birth midwifery care adhere to a unified set of medical standards, each may deviate slightly in terms of its own unique customary care. Invariably, each facility will have different rates of induction, caesarean surgery and may have particular timelines or preferences regarding the implementation of assistive birth strategies (such as the use of instruments or 'kristellern'). Expanding your knowledge base about what to expect can help you develop more focused questions to ask staff when visiting your chosen location of birth or while on a hospital/clinic tour.

STEP 2: Register for a childbirth education class
If you are insured through a German health insurance provider (public or private), then some percentage of the cost of childbirth preparation may be covered. For specific details, contact your carrier. A childbirth preparation course not only provides you with an abundance of information, it serves as a window into the birth culture in Germany. Carefully researching and choosing course that best fits your needs will allow you to catch a glimpse into what you can expect when giving birth in Germany. For childbirth courses taught in English by The Counselling Center for Natural Birth and Parenting e.V., Lulu & Tintin and midwife Jenny Kugelberg, see Resources.

STEP 3: Talk to your ante- and postnatal midwife (Hebamme)
Similarly, German insurance convers postnatal support provided by a licensed midwife. Take advantage of this. Many midwives who are hired for postnatal care, also meet with you during pregnancy in order to better customize their support in the days and weeks following birth. This is an opportune time to share your vision and preferences for birth and receive some feedback as to which facility might best accommodate your specific needs and work with you in achieving a positive birth experience - one in which you felt heard, respected and cared for.

STEP 4: Consult your OB/GYN (Frauenarzt)
If your chosen location of birth is at a hospital or clinic, you have likely been receiving antenatal care from an OB/GYN over the course of your pregnancy. Your care provider has specific knowledge of your health during pregnancy and can offer you further insight with respect to the advantages and disadvantages of each of the facilities you may be considering as it pertains to you, your health, and your baby's health. S/he can also outline general expectations about birth in Germany that may help you in engaging in more detailed conversations with hospital or clinic staff as you are preparing for birth.

STEP 5: Hire a doula (Geburtsbegleiterin)
Having a doula by your side who speaks both English and German can drastically ease communication and mitigate cultural misunderstandings that could be a source of stress or anxiety during labor and birth. S/he is aware of these cultural differences and can help you navigate them during pre-birth planning sessions so that you may approach the birth of your baby with a sense of calm, security and preparedness. While your doula does not speak on your behalf, s/he is experienced and competent at recognizing, or even creating opportunities for you to share your preferences or voice your concerns to staff throughout labor and birth.

STEP 6: Learn useful phrases and birth-related vocabulary in German
No, you mustn't speak perfect or, for that matter, even good German, but learning some useful phrases like "I do not understand", "Please explain again" or "Please speak more slowly" in addition to birth-related vocabulary can equip you with the linguistic tools and confidence you need to communicate more effectively with your providers. You may also find that your effort to speak as much German as possible may indeed positively affect your relationship with clinic staff and, thus, your overall satisfaction. In the coming weeks, I will be posting a list of birth-related concepts and vocabulary for your future reference.

STEP 7: Ask questions at hospital informational evenings, tours and pre-birth meetings
Many hospitals and clinics offer evening informational sessions, tours and pre-birth meetings to help familiarize you with the terrain of labor and delivery. These are all excellent opportunities to ask questions about what you would most like to know. Answers to questions like, "How do you see most women birth at your clinic?", "How do you view the process of birth?" and "What kind of interventions do you see most?" can be a highly effective means of shedding light on the kind of interaction and support you are likely to receive there. Knowing this ahead of time can help you anticipate the nature of future interactions and gauge in advance with what kind of enthusiasm your preferences could be met.

STEP 8: Communicate your birth preferences prior to labor and birth
Take some time to consider what is important to you during labor and birth. You can convey your needs on a list of Birth Wishes or Birth Preferences. This can be in bullet point form, briefly outlining your desires and specific needs to birth your baby. If knowing what is happening before it happens is of great importance to you, you may even consider adding a highlighted bullet point explicitly stating that your informed consent be obtained before the administration of any medication and all procedures including but not limited to (for example): vaginal exams (Untersuchungen), stripping of the membranes (Eipollösung), artificial rupturing of the membranes (Fruchtblase aufmachen), an episiotomy (Dammschnitt), the use of uterine fundal pressure (Kristeller Maneuver) during the second stage of labor, or premature cord-clamping (die Frühabnabelung).

STEP 9: Define the kind of support you need from your partner
Having the support of your partner during labor and birth is one of the most effective ways to help ensure your voice is heard. Partners are exceptionally skilled at protecting a mother's birthing space. You can begin by discussing your birth preferences with your partner. As you explain why your wishes are critical to experiencing birth positively, you help your partner understand how to better support you when you need it most. During labor and birth, your partner can help remind you of your shared goals and advocate for all three of you, allowing yourselves the time you need to decide what is best for you and your baby.

STEP 10: Know your rights and remember to use your B.R.A.I.N.
As a 'patient' in Germany you have the right to informed consent. This, however, does not imply that recommendations are grounded in evidence-based research. Rather, it means that your provider is obliged to thoroughly explain any suggested procedure/medication in a way that you can understand, disclose potential risks and benefits and obtain your permission before proceeding. Here is an excerpt from the German Federal Ministry of Health's info sheet on patients' rights (translation is mine*):

"Patients must be fully and completely informed of all important matters pertaining to treatment including diagnosis, the probable health outcome and the appropriate therapy.  For only careful and comprehensive patient education leads to the patient exercising his/her right to self-determination and being able to make a well thought out decision regarding his/her consent to a procedure. This includes education on risks, benefits and alternative treatment.

In this respect, the law requires that a patient be informed in a clear, understandable manner. The treating health care professional must use terminology understood by the patient and may not use only medical jargon. An informed consent discussion is to be conducted within a reasonable timeframe prior to the procedure. Then the patient, should s/he not understand something, is able to request more information and has time to make her/his decision without pressure. [...] A recent change [in the law] states that the patient must receive a signed copy of the documents that s/he may take home afterward."

* Disclaimer: this is not an official translation of the original document, thus its accuracy cannot be verified. By reading this blog you recognize that I do not take accountability for its content in translated or original form. Please find original here.

For more information on informed consent and your universal rights as a birthing mother, visit the website: Human Rights in Childbirth.

If it is not an emergency, remember to use your B.R.A.I.N.:
How pregnancy and birth unfold is unpredictable. We can never fully anticipate what comes our way. Knowing what questions to ask can help you make a decision with greater confidence and peace of mind. When facing a decision during pregnancy, labor and birth, refer to this acronym to help you gather the information you need to make an informed decision.

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If you have found this blog helpful, please feel free to like and share it.
Thank you to Karina of Karina Schuh Photography and Tammy of Tammy Nicole Photography for generously allowing me to include their beautiful images on this blog post.

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