Terminations by Community Midwives: What Developments in Thüringen Mean for Maternity Care

Terminations by community midwives in Thüringen reveal how remuneration policies affect hospital maternity care and access for families.

In the German state of Thüringen, several self‑employed community midwives (Beleghebammen) have terminated their cooperation with hospitals. The trigger is a revised national remuneration framework for midwifery services that has been gradually implemented since late 2024. A report by the Mitteldeutscher Rundfunk (MDR) highlights the situation at the Helios Klinikum Erfurt and illustrates that the issue extends far beyond a regional dispute.

Community midwives as a cornerstone of hospital-based maternity care

Community midwives in Germany work as independent professionals while being structurally integrated into hospital delivery units. They attend births on site, bill statutory health insurers directly, and often ensure continuity of care for families. In many regions, this model covers a substantial share of clinical births. If community midwives withdraw, hospitals may be forced to restructure services, recruit staff at short notice, or reduce birth capacities.

The revised remuneration framework and its intended goals

The current midwifery services contract aims to strengthen one‑to‑one care during labour, meaning one midwife per birthing woman. Higher fees are assigned to this care model. However, everyday clinical reality does not always align with this standard. In busy delivery units, midwives frequently care for more than one woman simultaneously. Under the revised framework, such parallel care is reimbursed at significantly lower rates, which has become a central point of criticism.

Photo by George Dagerotip 

Economic consequences for self-employed midwives

According to the MDR report, the new billing structure leads to noticeable income reductions for many community midwives. At the same time, documentation requirements have increased, with services needing to be recorded in very small time units. For self‑employed midwives, who bear entrepreneurial risks without the protections of salaried employment, this creates economic uncertainty. Some teams report that their financial viability is at risk, prompting them to withdraw from hospital-based maternity care.

Implications for hospitals and expectant families

These terminations are not without consequences for maternity care provision. Hospitals depend on the availability of qualified midwives in delivery rooms. When community midwives leave, facilities may have to reorganize workflows or limit birth services. For pregnant women and families, this can translate into longer travel distances to maternity units, fewer choices of birthplace, and reduced continuity of care.

Political and societal dimensions

Developments in Thüringen highlight a broader tension within maternity care policy. While high-quality one‑to‑one care is widely regarded as a benchmark, remuneration systems must also reflect real working conditions and workloads in delivery units. Political representatives have already called for adjustments to prevent risks to regional maternity care provision.

A broader perspective on maternity care systems

The situation of community midwives illustrates structural pressures within the German health system. Rising quality requirements, extensive documentation, and economic constraints coincide with workforce shortages and the high responsibility inherent in maternity care. International evidence suggests that stable working conditions for midwives are a key factor in achieving positive maternal and neonatal outcomes.

Outlook for the future of maternity care

Whether the community midwife model can be sustained in its current form will depend largely on further revisions to remuneration rules. Without viable solutions, regional gaps in care may emerge. More broadly, the debate raises fundamental questions about how quality standards, economic sustainability, and clinical realities can be aligned without compromising the safety of mothers and newborns.

Source:  MDR