German midwifery care threatened

On May 5, International Day of the Midwife, the kids and I attended a protest in Berlin in support of German midwives.  Midwifery care in Germany is currently threatened due to significant increases in the liability insurance premiums that midwives have to pay. According to the Deutscher Hebammen Verband (German Association of Midwives), the premiums over the years have gone up significantly and have tripled in the past three years:

• 1981 - 30.68 Euro


• 1992 - 178.95 Euro


• 2007 - 1,218.00 Euro


• 2009 - 2,370.48 Euro


• 2010 - 3,689.00 Euro

The increase in insurance premiums is not due to increased risk during births attended by a midwife. In fact, an there are fewer birth complications now than in the past. The increase in premiums comes from increasingly higher payouts being awarded by the courts in individual cases.

Midwives in Germany earn around 237 Euros for a birth in the hospital, 445 Euros for a birth in a birthing centre, and 537 Euros for a home birth. But this is not sufficient to cover ever-increasing insurance costs. As compensation for the increase in the liability premiums, the health insurance plans provide midwives with an additional 4.39 Euros per hospital birth and 14.19 Euros for a non-hospital birth. This is not nearly enough to cover the cost of the ever-rising insurance premiums and midwives end up working to pay the insurance, rather than working to live.  The annual salary for midwives (before taxes and other required fees) is around 23,300 Euros. After all costs are taken away, a midwife earns around 7.50 Euros per hour.

As a result, birth centres are closing, midwives are being laid off, and some midwives are opting only to offer prenatal education and postnatal support, rather than helping moms deliver babies. This not only threatens midwifery as a career option, but also threatens the access of mothers to a midwife as their birth attendant. Currently, about 1/4 of German births are attended by a midwife (compared with between 2% and 5% in the Canadian provinces where public health care covers midwifery services ref: Canadian Institutes of Health Information). If the situation remains as is, those numbers will certainly drop. A drop in the number of midwife attended births in Germany, not only means fewer midwife attended births, but also greater pressure on other birth attendants (i.e. obstetricians).

In an attempt to find a solution to this problem, the German midwives have organized an e-petition and are collecting signatures in an attempt to force the Budestag (German Parliament) to discuss this situation.

For any of my readers in Germany who are interested in supporting the practice of midwifery or passing the information along to their friends in Germany, please see:

• Information on how to sign the E-Petition


• Facebook page for the Hebammenprotest


• Twitter account for the Hebammenprotest

Sources for information on German Midwife Protest:

• Hintergrundinformationen zur E-Petition des DHV - Deutscher Hebammen Verband


• Hebammen - In anderen Umständen - Suddeutsche Zeitung

Comments

[Denise]

Wow, that is scary. I'm a student midwife in New Zealand, and the amount German midwives earn is so much less than what a midwife, who works as an independent, would earn. Even less than a midwife who works in a hospital. And liability insurance premiums are lower in New Zealand, however, that is only due to ACC (a form of state insurance that you pay towards for accidents and injuries). But then a New Zealand midwife also has to pay levies to ACC, so works out to be the same as in Germany.

[Brenna]

It is really sad how midwives are treated in many developed countries now. I don't understand it and don't think I ever will. Many props to you for getting involved in advocating for German midwives!

[Barefoot Momma]

This is sad and a testimony to how very quickly things change. I was born at home in Germany in the sixties as was my sister. We immigrated to the States and had our children at home with midwives - a very tentative right :-(

[Amber Morrisey]

This is downright awful. Amazing job speaking up and lending your voice.

I hope a solution will be found, and that Midwifery in Germany can continue to stand, and flourish.
Seems like it will be a battle, but one worth fighting.

[phdinparenting]

Update: The e-petition got enough signatures in just 3 days to require a discussion of the issue in the German Parliament! Now we just have to hope they find a solution to the problem.

[Mike Hardy]

Are the insurance premiums set by regulations?

[phdinparenting]

Mike:

From my understanding they are not. Or at least if they are, the regulations allow for these significant increases to reflect the court ordered payouts in cases where there has been an incident. The midwives here understand why the premiums have gone up and do not debate that, but (if I understood correctly), would either like some regulation of the payout that a court can order to control costs that way or an increase in their pay to cover the increased premiums.

[Mike Hardy]

Something I saw on the web somewhere suggested that these premium increases take effect on the first of July. If it's not a regulatory thing, how is it that all insurers are altering the premiums at exactly the same time? Or is that not in fact what's happening? Your answer also suggests that the amount that midwives are paid is regulated. Is that correct?

[phdinparenting]

Mike:

I'm reading through the German background document again.

I wasn't able to find the information on exactly how/if the premiums are regulated. I do know that in general, in Germany, there is a trend towards self-regulation in industry (to avoid big government). So it may be that the premiums are set, but that they are set by an agreement among all companies in the industry.

With regards to pay, the midwives pay was set by the law until 2007 (so fully regulated). Since then, it is negotiated between the health insurance companies and midwives.

[Karen]

Hi Denise,

I'm a student midwife in Australia, researching New Zealand's Primary Maternity Services and was wondering how much the LMC's have to pay for professional indemnity.

Hope all is well with you and your practice

[Alyssa]

I am living in Marburg Germany right now and am working to help bring attention to this issue for our Local Geburtshaus. The insurance costs, low pay and unreasonable reimbursement by health insurance companies are putting this type of care completely out of business. Germany is a leader in quality of Midwifery care, and could provide much needed help and training to developing countries who have no care at all...unfortunately the German Midwives are fighting for the survival of their own livelihood!
The Health Minister here stated last week that something must be done about it, but what and when? Does anyone have ideas on what we can to bring more attention (and action) to this issue and how we can help Birth houses and Mid-wives who assist in Births to survive until something changes???

[Alyssa]

My understanding is the midwives ask that pay is increased by 30% and that the Health Minister lead in making it happen. I believe that the expectation is that the HEALTH insurance companies (both social and private) that pay for the care of the Mothers, pay an increased amount and that the government would give some supplemental support to the payment of the increased wages making up the 30% increase that would allow midwives to stay in business AND pay their liability insurance premiums

[YOUSSER]

I M leaving in TUNISIA, I M a midwife , i m working in a Hospital , i have 30years old.
I realy want to find a job in Germany,i adore it...Can you please help me as soon as possible?
welcome to you in Tunisia

[Carolyn]

And here we are over five years later... http://www.doulabutterflybeginnings.com/blog/the-end-of-german-midwifery-as-we-know-it