The profession of midwives is threatened

The profession of midwives is under threat: freelance midwives are giving up their jobs on a massive scale

29/03/2011

More and more freelance midwives offer obstetrics and the profession seems altogether at risk, warns the Mittelfranken midwives association in a recent press release. Expectant mothers could release future in continuation of the existing trend only in clinics.

The German Midwives Association (DHV) had already pointed out the problems of midwives in the past year and pleaded with an online petition for the preservation of local care with midwife help. In particular, the enormously increased insurance fees make the freelance midwives throughout Germany, said the DHV. The most extreme liability insurance contributions in the past 20 years have increased from the equivalent of less than 180 euros to today's 3,689 euros per year. Many midwives therefore give up obstetrics and freelance work completely, said Steffi Kuntze, chairman of the midwives association Mittelfranken.

Many midwives give up employment because of financial problems
Regardless of how much a midwife actually works, a liability insurance premium of € 3,689 per year is due, which is difficult to finance with a net hourly wage of only € 7.50 even with full-time employment, said the chairman of the Midwives Midwives Association. Under these conditions, fewer and fewer midwives are willing to practice their profession, emphasized Steffi Kuntze. The first chairman of the Bavarian Midwives Association (BHLV), Astrid Giesen, assesses the situation similarly and emphasized that the hourly rate of 30 euros gross, pay the health insurance companies for birth care, the profession as a whole is threatened. „A craftsman would not start for under 40 euros“, explained Astrid Giesen. In addition, the obstetrics are not paid by the hour, but with a case lump sum, which brings further problems according to the chairman of the Bavarian Midwives Association. For example, there would be around 550 euros for a home birth, of which about 220 euros remain net (as a documentary midwife in a clinic 180 euros), explained the BHLV chairman. However, it is not considered whether the birth takes six or 36 hours, criticized Astrid Giesen. In addition, the weekday visits paid flat-rate, regardless of how much time the midwife takes for the care of the young family. In addition, the midwife had to be available around the clock in the period of the calculated due date (three weeks before to two weeks) and had enormous responsibility, emphasized Giesen.

Burdens on midwives are out of all proportion to earnings
The financial situation as a freelance midwife is so difficult that more and more people give up their responsible and strenuous job, or at least no longer offer midwifery. According to the BHLV, around ten percent of freelance midwives in Bavaria ceased their activities last year. Homebirths or childbirth in the birth house could become impossible in the future, as there are no longer enough midwives available for care, said the chairman of the Midwives Association. Frequently, midwives today only provide prenatal care and follow-up care, but are not present at the actual birth at the hospital. However, according to the German Midwives Association (DHV) at birth, the relationship of trust between midwife and expectant mother actually plays a particularly important role. Altogether, according to the DHV, the burden is out of all proportion to the earnings of the midwives, so that the task of the profession is in most cases easy to understand.

German Midwives Association submitted online petition
Therefore, last year the German Midwives Association submitted an online petition for the preservation of near-residential care with midwife help, which was joined by 186,356 signatories, whereby the request of the DHV received the most supporters of all petitions submitted so far. At the subsequent hearing with Federal Health Minister Philipp Rösler (FDP) he promised to convene a round table with representatives of the health insurance funds and the midwives association. But nothing has happened since then and the financial problems of many midwives are getting worse and worse. The result is a looming lack of freelance midwives. BHLV chairman Astrid Giesen doubted that the midwives, who have now given up their profession, will resume their activities if the remuneration and insurance regulations change. „I do not think we can get the women back in the boat once gone“, Giesen emphasized.

Homebirths or childbirth in the birthplace excluded in the future?
In view of the massive support of the online petition, the political parties have also increasingly taken up the topic, with the Bundestag faction of Alliance 90 / The Greens in particular intervening intensively in the interests of midwives. The Green Nuremberg City Councilor Elke Leo emphasized: „The regulations for midwife performance are still set out in the Reich Insurance Code of 1911“ and so far excluded from updates. Therefore, a transfer to the Social Code is urgently needed. „This job is drained under the current conditions“, warned the Nuremberg Environmental and Health Officer, Peter Pluschke. Steffi Kuntze, the chairman of the Mid-Franconian Midwives Association criticized, however, that despite the announcements from the policy so far little had happened. While the politicians are discussing possible solutions, more and more midwives are giving up their jobs and, in the opinion of the chairman of the Mid-Frankish Midwives Association, these will probably not resume their work later. If measures are not taken promptly, the Expert believes that in the future the birth, or at home, preferred by many women will probably no longer be possible. (Fp)

Also read:
Warning of midwife shortage
Midwives: No obstetric perspective?
Midwives: Open letter to the Minister of Health
Tips for successful breastfeeding

Picture: Hartmut910