Germany Midwife, giving birth at home

12
Germany - A midwife
Giving birth at home
Photos: Patrick Junker
Ann Loos, 37, is a midwife who is passionate about her work. She is also one of the last midwives in Germany who is still helping women who want to give birth at home.
The country has about 20,000 midwives, and about 3,000 of them work freelance. Of the approximately 750,000 births this year, about 4,000 will take place at home. Rising costs, increasing uncertainty on the part of the insurers and social pressure mean that more and more midwives are giving up their jobs.
Over the last 10 years the insurance premium has increased more than fivefold. In June 2015 new exclusion criteria were established for home births. Now, if a baby is more than three days overdue, the mother must be admitted to a clinic. This is unusual from a scientific point of view as babies are rarely born on the expected date. In order to qualify for the backup surcharge, a midwife must help deliver at least one baby every three months. This, together with the exclusion criteria that have been introduced, could see the end of home births.
Legislators have also introduced a "guarantee surcharge" to help midwives cover their expenses. But the compensation has a limit of € 4,340. The midwives themselves have to pay additional costs. For the midwives working in obstetrics, the new compensation system has led to a deterioration in the quality of service. Because of this, many midwifes can only provide care immediately before and after birth.

Ann Loos is often booked up for months on end. In order to find a free midwife, women have to book during their first week of pregnancy. Midwives can no longer guarantee coverage. Over last 10 years the insurance premium has increased more than fivefold to € 7,639. This dramatic rise is being justified by the increasing costs for birth damages. This is in spite of the fact that cases of birth damages have actually decreased. For individual cases, no particular branch of the profession may be held responsible.
With up to 30 home births per year, the average midwife is under a lot of stress. Ann Loos says: "Next year I want a summer without being on call, and to experience normal family life. That would be easier, if I had enough colleagues who could cover for me. It is hard for me to turn down expectant mothers, but these breaks help me recharge my batteries, so that I can keep on working as a midwife".
Midwives in clinics on the other hand, often have to deliver one baby after another. A midwife must often look after several women at the same time. Ann has to travel long distances to see the expectant mothers. She also looks after the women over the course of the pregnancy, so that she can understand their needs and foresee complications more effectively.
Ann Loos spent the first five years of her career as a midwife working in a clinic. That experience convinced her that the domestic environment was more conducive to a peaceful birth. Many women were unhappy with their experiences in clinics. They felt that they weren't listened to, that labour was induced with medication. Their memories of birth were often traumatic.
For this reason many women prefer to give birth at home, where it is a more natural process. The women have faith in the midwives and their abilities.

Ann Loos is one of the last midwives who helps with home births. When asked why she is prepared to work under increasingly difficult conditions, she says: "I am convinced that I am doing the right thing. After every birth I appreciate how important it is for the families."
And this is evident in the number of families who still prefer home birth.
Germany Midwife, giving birth at home
International photojournalism