New Midwifery Assistance Contract Raises Concerns Among Mothers and Midwives
Germany’s new midwifery contract tightens rules on billing and documentation. Midwives warn of less care time and rising pressure.
The updated midwifery assistance contract (“Hebammenhilfevertrag”), which came into effect on 1 November 2025, has sparked growing unease among freelance midwives and expectant mothers across Germany. The agreement regulates how midwives provide antenatal, birth and postpartum care – and determines how their work is remunerated. While the reform aims to standardize billing and clarify documentation rules, many professionals fear it could make the midwifery profession even less sustainable.
What Has Changed
The contract introduces new documentation and billing requirements, modifies compensation structures and redefines what qualifies as reimbursable communication and consultation. Services that were once flexible – such as remote consultations, follow-up questions via text or short check-ins – are now bound to stricter frameworks.
Midwives warn that the changes could:
Increase administrative workload and reduce available care time,
Complicate billing for shorter or asynchronous communication,
Limit the number of women a midwife can support simultaneously,
Lead to financial losses for freelance practitioners.
Growing Pressure on Midwifery Care
The German Midwives Association (Deutscher Hebammenverband, DHV) has voiced strong criticism, arguing that the new rules threaten to undermine continuity of care. Germany already faces shortages in midwifery coverage, particularly in rural areas and urban peripheries. If working conditions become more restrictive, some midwives may reduce their caseloads or leave the profession entirely.
For expectant mothers, this could mean longer waiting times, less individualized care and greater uncertainty during pregnancy, birth and postpartum recovery.
Photo by Curated Lifestyle
The Systemic Context
Freelance midwives in Germany form the backbone of perinatal care: they accompany pregnancies, assist births at home or in clinics and support mothers after delivery. Yet the profession has long struggled with rising insurance costs, administrative pressure and stagnant pay rates.
Negotiations between midwifery associations and statutory health insurers were meant to modernize the framework and ensure fair compensation. However, the final version of the contract is seen by many as shifting focus from care quality to bureaucratic compliance.
Why It Matters
Midwifery is not only a medical but also a relational profession – built on trust, proximity and the ability to respond flexibly to mothers’ needs. Restrictive billing categories risk eroding this personal dimension.
Experts warn that when midwives spend more time documenting than supporting mothers, the continuity of care – one of the most important predictors of maternal well-being – is jeopardized.
Broader Implications
The debate over the new contract reflects a larger structural issue: how to maintain humane, accessible and economically viable maternity care within a digitalizing healthcare system. Standardization can improve transparency but must not come at the expense of professional autonomy.
Midwives and women’s health advocates are now calling for an urgent review of the contract and for a renewed focus on what truly matters – safe, continuous and compassionate care during one of life’s most vulnerable phases.
Source: Tagesschau
