No doubt, that's it, the pregnancy test is positive. Your wish has just come true and the dream of starting a family is very real. But here you are, expats in Germany, without any reference points and not many trusted people to turn to for questions.
What does the medical follow-up look like? What are the main steps not to be missed? Where can I give birth? Let's zoom in on German practices in terms of pregnancy and birth...
Sort out your insurance status
Perhaps you have just arrived in Germany and do not yet have insurance here, perhaps you are temporarily insured with a private insurance for expats. In any case, check your social security coverage and tell them about your pregnancy. Ask them explicitly what is covered (most insurances have a special pregnancy booklet for this purpose) and what is not.
Find a gynaecologist
If you don't have one, obviously, it remains a must for pregnancy follow-up. For publicly insured mothers, it is important to know that once you have had an appointment with a gynaecologist in a calendar trimester (e. g. January to March), then you will not be entitled to a consultation with another gynaecologist during that trimester. It is therefore difficult to shop and consult several doctors before making your choice.
Find a midwife
All women are entitled to a midwife in Germany, paid for by the health insurance. The midwife in Germany has a multifaceted role: childbirth of course for those working in hospitals, but most importantly for you: pregnancy follow-up (alone or in addition to the gynaecologist), and especially medical follow-up of the mother at home when she returns from the clinic. Some regions in Germany are in need of midwives, so it is better to start your research as soon as possible (for a midwife who can provide pre- but especially post-natal care for you).
The pregnancy booklet (Mutterpass)
At the first appointment that confirms your pregnancy, you will receive a pregnancy booklet (the Mutterpass) from your gynaecologist. It contains all the information about medical examinations and your general state of pregnancy. It allows the gynaecologist and midwife to note all the remarks concerning the follow-up of your pregnancy and you will take it with you on the day of delivery (to the clinic or birth centre).
Where to give birth?
The 3 main options can be summarized as: home birth, in a birthing centre or in a clinic / hospital. Each option has its own set of advantages and disadvantages. I always recommend that the mother let her instincts guide her, which will make her stronger in her decision. In general terms:
- home birth: a very cosy and comfortable way to give birth in a familiar setting at your own pace. You must find a midwife quickly who will assist with this type of birth, the formalities are then relatively simple. The midwife will guide you through the preparation of the details.
- Birth in a birthing centre: there are only a handful of birthing centres and they are often taken by storm. Most of them offer information evenings to visit the sites, so be sure to check these early. More intimate than a clinic but without medical intervention possible (no epidural or c-section), no doctor on site but experienced midwives who will refer you to the nearest clinic if necessary.
- Birth in a hospital: you can choose which clinic or hospital you want to give birth in, it does not depend on where you live. It is however advisable to register in advance at the clinic of your choice, most of them offering information evenings, so that the staff can have all your medical records. If this has not been done, you can always go to the nearest hospital on D-Day, which will take care of you or redirect you to the nearest available clinic, depending on your stage of labour The clinic is the only option for obtaining an epidural or a c-section for example.
Maternity leave (Mutterschutz)
Maternity leave in Germany begins 6 weeks before the due date and ends 8 weeks after the birth. Women employees who are insured in the public sector (gesetzlich versichert) are entitled to 100% of their salary during this period (part of it part by the insurance company, the rest by the employer). Women insured in the private sector are entitled to a fixed compensation of €210 over this period. Women employees and/or self-employed women who are voluntarily insured in the public sector (freiwillig versichert) are only entitled to compensation up to their normal salary if they have taken out sick leave insurance (Krankengeld) with their insurance company. If they so wish, women are entitled to work during the 6 weeks preceding the birth (they must inform their health insurance so that they do not receive maternity leave allowance during this time) On the other hand, it is absolutely forbidden for a woman to work during the 8 weeks after the birth. In the event of premature birth and/or multiple births, maternity leave will be extended (12 weeks for example for twins).
Parental leave (Elternzeit)
Your belly is gradually getting rounder, and it is important to start thinking about your wishes for parental leave. In Germany, both parents, when they are employed, are entitled to parental leave (up to 3 years per parent and per child - be careful, the leave does not necessarily mean paid leave). Self-employed parents do not have parental leave since they are not attached to an employer (but they are entitled to parental leave allowance - Elterngeld - see below). Since your employer must be informed of your plans and wishes for parental leave 7 weeks before they start, it is important to think about them well before the birth. Especially since there is the possibility of working part-time during parental leave, without changing the parent's work contract.
Parental leave allowance (Elterngeld)
If parental leave concerns only employed parents, all parents who work between 0 and 30 hours/week are entitled to parental leave allowance (Elterngeld). This even includes stay-at-home parents or student parents. The amount of this allowance is calculated either on the basis of the average salary of the last 12 months less (for employees) or on the income of the tax year preceding the birth (for self-employed persons). On average, a parent receives 67% of his or her average monthly income before the birth, minimum 300€ maximum 1800€. Parents are entitled to 14 months of allowance between them, to be shared: minimum 2 months, maximum 12 months per parent. If parents so wish, they can receive half of this allowance over twice the duration (28 months instead of 12 to be shared, minimum 4 months, maximum 24 months per parent). This is known as Elterngeld Plus.
Declaration of paternity / sharing of custody rights
For married parents, there is no need on this side: the mother's husband is automatically declared as the child's father, and he shares 50% of the child's custody rights with the mother. If the parents are not married at the time of birth, it is worth considering a declaration of paternity (Vaterschaftsanerkennung) and in most cases, shared custody rights (Sorgerechtserklärung). The declaration of paternity allows the father to recognize the child as his own, while the sharing of custody rights shares all the rights, but also the responsibilities towards the child between mother and father, as the name implies. Both formalities can be done before or after birth. The declaration of paternity can be declared at the Standesamt or Jugendamt in your district, or before a notary (approved in Germany). The sharing of custody rights, on the other hand, can only be done before the Jugendamt in your district or before a notary.
Select your delivery team
In a lot of western countries, women tend to rely completely on the medical team and not to have much choice about who is present at the birth. In Germany, on the other hand, women may decide to have more than one person present at their side: the father, but also the sister or grandmother, a doula or a Beleghebamme. A doula is a non-medical birth attendant, an emotional and practical support that supports and guides parents, especially in increasingly overcrowded hospitals. A Beleghebamme is a midwife who specializes in individual support. A Beleghebamme must be hired from the first weeks of pregnancy, its cost is partially reimbursed by public insurance. A doula can be found in the second or even third trimester, its cost is not covered at all by the health insurance.
Find a paediatrician
In some places, it may be advisable to contact local paediatricians even before delivery. The hospital often asks for the name of the pediatrician in order to send them the delivery report, and it is necessary to make an appointment as soon as you leave the hospital to arrange for the mandatory paediatric examinations (U3 on week 4 after birth).
Childbirth preparation classes
The childbirth preparation courses are either in the form of intensive weekends (two days of 8 hours) or information evenings (about ten dates at a rate of 2 hours / evening). The preparation courses are reimbursed for the mother's participation by her (public) insurance. You should check with private insurance companies to see what they can reimburse. Dad's participation is often not refunded. In most cases, the course is provided by a midwife (otherwise it is not reimbursed) and covers questions such as: what are the signs of the birth process starting, when to go to the maternity ward, birth options, possible complications (episiotomy, cesarean section, etc.) and post-natal care (breastfeeding, post-natal care).
Even if parental leave allows parents to stay at home longer with their babies, sooner or later they will have to leave their babies in competent hands to return to work. So start familiarizing yourself with the childcare options available around your home as early as possible. A brief overview of the options:
- Tagesmutter: the equivalent of a child minder, she looks after about 4 to 5 children between 2 months and 3 years old at home. She sometimes joins forces with another Tagesmutter and they look after about ten children together.
- Kita (also called Kindertagesstätte, Kinderladen or Kindergarten): the equivalent of a kindergarten / pre-school. A Kita can be managed by the state (staatliche), by a private organization (privat), by a parent association (Eltern-initiativ), or by a charitable organization (humanistiche). The staff is qualified (equivalent to early childhood educators). A Kita generally welcomes children from 1 year old (sometimes younger but this is rare) until they enter primary school.
School is compulsory only from the age of 6. Before that, it is the responsibility of parents to look for and find childcare for their children themselves. The cost of childcare is managed in most "Länder" (German regions) by a Gutschein (voucher) system (the more parents work, the more they are entitled to subsidized childcare). It should be noted that there are major differences between the Länder (in Berlin childcare is free since August 2018, while in Schleswig-Holstein it is about 400€ for a half-day childcare).
Put your papers in order
And finally: sort and store your papers! The various forms to fill in will only be more difficult if your pay slips are nowhere to be found and you have lost your marriage certificate.
So much for a list (certainly not exhaustive) to help you understand your pregnancy in Germany. If you have any questions about any of the above topics or if you would like someone to take care of it for you, please do not hesitate to contact me. I have helped dozens of families navigate the German system, whether it was to find the right health professionals, help them fill out their papers or explain what to expect. I look forward to your message: firstname.lastname@example.org