Reference ResourceThe GermanMaternity System

You decide. In Germany you choose who provides your pregnancy care, and a midwife can do far more of it here than in most other countries. That surprises almost every international mother I work with.

Yourgynaecologist

Your gynaecologist confirms and dates the pregnancy by ultrasound and can issue your Mutterpass. They do the routine ultrasound scans and any fine diagnostic tests, which a midwife cannot do. Past the scans, how much of your care they give you is up to you. Some women see them for every check-up, some only for the scans.

Your midwife(Hebamme)

Your midwife can do all of your routine prenatal check-ups, except the ultrasound scans and certain fine diagnostic tests. So you can be looked after by your midwife for the whole pregnancy and see the gynaecologist only for the scans, if that is what you want. One thing worth knowing early: German law puts midwives at the centre of birth. A doctor may not conduct a birth without calling a midwife in, which is a duty on the doctor rather than a rule about you. In practice, wherever you give birth with professional care, a midwife is there. A midwife also comes to your home after the birth, though that is often a different midwife again, which is what the next part is about.

The typesof midwife you may meet

“Midwife” covers several different jobs in Germany. The midwife at your prenatal check-ups may not be the one who attends your birth, and that one may not be the one who visits you at home afterwards.

Most families will not know the midwife attending their birth unless they have arranged continuity care.

For depth on each type of midwife, how to find one, and what your insurance pays for, see Your Hebamme.

Almost everything, and you will rarely see a bill. Germany has two parallel health insurance systems, statutory (gesetzliche Krankenversicherung, GKV) and private (private Krankenversicherung, PKV). Around 90% of people here are on statutory insurance.

Statutory cover is set nationally, so it is the same whichever statutory insurer you are with. It pays for every routine antenatal check-up, three ultrasound scans, the blood work, midwife care through pregnancy, birth and the weeks after, an antenatal class, a birth in any of the three settings, your six-week check, and a postnatal recovery course (Rückbildungskurs). Private cover varies by policy and mostly works on reimbursement.

What you pay for yourself is a short list: services offered beyond the standard schedule (IGeL-Leistungen), a midwife's on-call fee for a home or birth-house birth, hospital comfort extras, and a partner's place on an antenatal class. Each phase, each exception, the questions to ask about a private policy, and how to insure your baby are in What your insurance covers.

In a hospital, in a birth house, or at home. Statutory insurance covers all three for eligible pregnancies. Which one is right is not mine to answer, and not your gynaecologist's either: the best one is whichever fits you, your family, and your wishes for this birth. One practical note before the three. For a birth house or home birth, the midwife's on-call fee (Rufbereitschaftspauschale) is billed separately and many insurers only pay part of it, so ask your Krankenkasse what they cover.

Transfer arrangementsand neonatal levels

German hospitals with maternity care sit in four tiers, based on the neonatal care they can give: Perinatalzentrum Level 1 (the most specialised neonatal unit) and Level 2, then Perinataler Schwerpunkt, then a basic maternity clinic (Geburtsklinik). A higher tier is not “better” for everyone. It means more intensive newborn care on site, which matters most for the smallest and earliest babies. If you book a birth house or home birth, transfer to a hospital is part of the plan from the start. It is what makes birth outside a hospital safe.

Seeingthem for yourself

Most hospitals run information evenings (Infoabende) and tours of their labour ward (Kreißsaal), and birth houses do the same. If you are still deciding, a visit tells you more than any brochure will, and two or three in mid pregnancy is plenty.

For how each setting actually works, what each tends to feel like, and how to choose between them, see Where to Give Birth.

The care after birth is for you too, not only the baby. Three things are covered by statutory health insurance and worth knowing by name.

Midwifehome visits

Your midwife visits you at home daily for the first 10 days after the birth, then up to 16 more visits through the first 12 weeks, and more again for breastfeeding support. All covered by your insurance, all in your own home, while you stay in your dressing gown.

Six-week check(Nachuntersuchung)

This one is a physical examination. At around six weeks your gynaecologist checks how you have healed, talks through contraception, and usually clears you for exercise and sex. That is what the appointment is for, and it is often a short one.

As a doula, it is the appointment I most wish went further. Six weeks is early. Your body is still recovering at six weeks, and how you are feeling matters as much as how you have healed, but that is not what this check covers. If you do want to talk about how you are, it helps to say so at the start rather than on the way out.

Your midwife is still available to support you at this point, up to 12 weeks after the birth and longer for feeding support, and is often the easier person to ask.

Postnatal recovery course(Rückbildungskurs)

A postnatal recovery course, usually up to 10 sessions, is covered by health insurance. It starts around week 6 after the birth and you can take it any time in the first 9 months. It rebuilds the pelvic floor and core after what pregnancy and birth have put them through.

What these weeks are actually like, and what helps with rest, food, visitors, the partner's part in it and building support when your family is far away, is in The Wochenbett.