The Crisis of Midwifery in German Cities

Urban areas in Germany grapple with a severe shortage of midwives, prompting a call for urgent reforms in maternal healthcare.

The pivotal role of midwives in supporting women through childbirth has been recognized for centuries. However, a deepening crisis in Germany, especially in urban areas, is highlighting the diminishing number of midwives available to pregnant women.

Maja, a midwife in Köln, after a grueling ten-hour shift, reflects on the seven childbirths she attended to in just one night. Such a scenario might sound exaggerated, but it underscores a critical reality – the acute shortage of midwives in Germany is reaching a tipping point.

Simone Logar, a practicing midwife and the vice-president of the Berlin Midwives Association, reveals that some women, in their quest for a midwife, face up to 80 rejections. This daunting challenge is far from an anomaly. "The shortage of midwives is intensifying across all federal states," Logar notes.

In recent years, the birth rate in Germany has been on an upward trajectory. Yet, paradoxically, birth units are closing down, healthcare systems are becoming more centralized, and the venues where women can give birth are dwindling. The compounding pressures of budget cuts in clinics aggravate the situation further. Comparing Germany to its European counterparts, a midwife oversees 30 to 40 births annually. However, in Germany, this number escalates to an average of 90, and in some clinics, it reaches a staggering 120 births per year. The question emerges – is such a workload sustainable and safe?

Photo by Jimmy Conover

The German Midwives Association advocates for a 1-to-1 care ratio during childbirth, not as a luxury but a necessity. Maja Böhler, in her book "Die Wehenschreiberin," emphasizes that when a skilled professional is present, laboring women require fewer painkillers. Moreover, potential complications can be detected earlier. The goal is to prioritize the physical and psychological well-being of the birthing individual.

Beyond the confines of hospitals, the impact of the midwifery shortage is evident. In major cities, desperate parents are resorting to bribery in a bid to secure a midwife, offering incentives such as money, free taxi rides, or even parking spaces. Logar, despite being on parental leave, finds her mailbox flooded with requests.

Midwives not only offer medical support but also provide psychosocial care, establishing a bond of trust and ensuring postpartum well-being. Logar highlights the significance of their role, "A new mother might not recognize symptoms of neonatal jaundice in her infant and whether medical intervention is required." With such sparse availability, parents are left overwhelmed.

Addressing this crisis demands multi-pronged solutions. "We need more funds, more time, and more staff," asserts Logar. Currently, the compensation a midwife receives is less than that of an anesthetist nurse. Furthermore, midwives, due to their substantial responsibilities and potential liabilities, face burnout risks. Logar proposes the establishment of a liability fund to ensure their protection.

Balancing work in this profession with personal commitments is another challenge. The high liability sum doesn't adjust according to the working hours of a midwife. Consequently, many opt out due to non-feasibility, leading to a talent drain in the sector.

The culmination of these factors dims the allure of what Logar describes as "the most beautiful profession in the world." The scarcity is pushing individuals towards private services like Doulas or lactation consultants, which are out-of-pocket expenses. The dilemma then is, what about those who can't afford these services?

In a sardonic twist, some midwives humorously advise couples to plan their conception such that the birth doesn't coincide with Christmas or summer holidays, hinting at the dire situation.

While the role of midwives is indispensable, the escalating challenges in Germany's healthcare landscape emphasize the urgent need for reform.

Source: Berliner Zeitung