Skyrocketing insurance claims are making it more difficult for community midwives in Germany to make ends meet. Women who want to give birth at home often struggle to find a midwife to care for them.
Midwife Stefanie Weißenborn is making a house visit to a mother who gave birth just two weeks ago. After checking the baby's umbilical cord is healing properly, Stefanie weighs the tiny infant. She delivered baby Clara in this very house.
Stefanie has been working as a midwife for 18 years and currently practises in the Karlsruhe area of south-western Germany.
"I basically do home births because then I can care for each woman as an individual. I get to know the women beforehand so I know what her needs are during the birth and I know how she ticks," Stefanie told DW. "I'm not subject to loads of regulations like in a hospital. This personal support is exactly what I love about home birthing."
But Stefanie is a rare breed. She is one of only 4,000 midwives in Germany offering home birth services. The number is so small because the combination of terrible pay and working nights and weekends doesn't make the job very attractive. Now, to make matters worse, midwives in the country are facing further hurdles: The cost of malpractice insurance for home births is skyrocketing.
Fewer midwives = less choice
Rike Herkel is the Karlsruhe representative of the German Midwives Association, which claims that around one third of midwives have stopped providing home births in the past few years.
"There are quite a few that give up their profession because they can't afford the rising liability insurance premiums. In 2005, they had to pay 1,300 euros ($1,620) for a year of coverage and now it will rise to over 4,000 euros by the middle of this year," Herkel told DW. She explained that since the average salary for a midwife is around 24,000 euros per year, this sum makes up a high percentage of their income.
The wider issue, says the association, is that with fewer midwives offering home birth services, women have less choice about how and where to have their babies.
Choosing to give birth at home
Dagmar has three young children - all of whom were born at home. She gave birth to her third son, Toby, in a birthing pool in the living room.
"I didn't want a stranger and I wanted someone who stayed with me throughout the birth," she explained. "I didn't want a shift change or somebody strange coming in because I thought that would upset me and then I thought, well if I want that then I should have a home birth."
Dagmar's first two children were born in England where she says it was incredibly easy to organise a home birth. It was a completely different story with Toby in Germany.
"It was difficult to find a midwife who would be prepared to come to my house. I had a long list of midwives, and I started ringing round and realised that there were only very few who would do a home birth."
The difference is that home-birth midwives in England are state employees. But in Germany, home-birth midwives are self-employed which is why they have to pay the insurance premiums out of their own pockets.
More protection for self-employed midwives?
Back at baby Clara's house, midwife Stefanie fills in the mother and infant health chart and makes an appointment to come back for a check up the next week.
Stefanie says she would hate to give up her private practise to go back working in a hospital maternity ward, but she may have no choice.
"The question comes up every year in our practice - whether we can continue to offer home births or not. But now we need some kind of support, or we won't be able to keep doing this. We just can't work like this anymore."
Faced with a 15 percent hike in malpractice insurance this year alone, the German Midwives Association is lobbying for midwives to be paid more for helping deliver babies. The association also wants the government to put a cap on court payouts to stop the insurance premiums spiralling out of control. Currently though, it's not having much success.
Author: Kate Hairsine, Karlsruhe / ji
Editor: Helen Seeney