Severe Birth

There was a time when Ulrike worked for Geppert-Orthofer as a midwife. It was the mid-nineties. At that time you had to deal with only a birth at the moment. “One-to-one care, great Doctors, and I had the best Job in the world,” she recalls. Then the maternity ward of a small closed hospital in the state of Baden-Württemberg, where she had worked. Geppert-Orthofer, now President of the midwife Association of Germany, was never again comparable working conditions. And she’s not the Only one.

Finally, the Helios Mariahilf Klinik Hamburg hit the headlines. The chief doctor for obstetrics and several attendings had terminated in December, the delivery room had to be temporarily closed because staff lacked.

At the beginning of February a woman died at the birth of their child. The dismissals and the death had nothing to do with each other, – said the head of the Department. It should be sufficient personnel in the use, the care of Pregnant women. “Not to worry”, it said on the website of the clinic.

In fact, the run, most of the births without problems, death in Hamburg are very rare. In 2016, 16 women were not nationwide during the birth lost their lives, more recent Figures are not available so far.

The Cost Factor Of Birth

However, the problems of the Hamburg clinic are symptomatic of a nationwide development: The care of expectant mothers has worsened in the past few years, complain of Doctors, midwives and parents.

Since 1991, 40 percent of the maternity wards were closed in Germany, show Figures from the Federal Statistical office. There were mostly minor, such as the one at the Geppert-Orthofer had worked. In some regions, this leads to a birth-tourism. Pregnant women who live on the island of Sylt, to the birth, for example, to the mainland.

Video: pregnant on the island of Sylt

The reason for the closures: obstetrics is expensive, not every hospital can afford it. 60 percent of the obstetric departments cost more than they bring in, we calculated the German hospital society, 2014. Only from 600 to 800 births per year, a clinic could operate economically, to argue that the competent professional organisations.

Add to that rising insurance costs. A fatal error during the delivery happens rarely, but if something happens, it is usually expensive. Especially if the child comes to harm, and a lifetime of compensation can make payments for the claim. On average, according to the Association of the German insurance economy (GDV) in such cases to be around 3.2 million euros – tendency rising. (Read more about it here.)

Hospitals and independent midwives are to become insurers, therefore, unpopular. The risks are difficult to calculate the sums, calling insurance companies, are accordingly explodes. Many hospitals and midwives can or want to birth this simply can not afford more.

This must not be necessarily the Problem, if adjacent can ill jump in houses. This is, however, becoming increasingly difficult. Not only in maternity wards are rare, but also the staff. In each delivery room, statistically speaking, is 1.6 plan are not occupied for midwives. Again and again, maternity wards due to staff shortages Pregnant reject. If it runs bad, it’s a bring your child alone to the world, as a concerned mother reported to the MIRROR.

No reporting requirement for medical errors

Rare individual cases, or soon everyday life? This question is shockingly difficult to answer. Because of How bad it is to supply mothers-to-be will really stands out, is difficult to assess. Between cases while the birth is not recorded centrally are not – even if the clinic has made errors in the treatment.

In 2017, the Medical service of the top Association Confederation of health insurance funds (MDS) 278 assessment of cases registered in connection with obstetrics. In 76 cases, the auditor confirmed that a treatment error. This corresponds approximately to the level from previous years. The true figure is likely to be significantly higher, because of the MDS detects only the charges that are collected through health insurance companies.

A large part of the actual treatment failure is not known, because the clinics rules, and the patients have to compensate the charges made, if appropriate, without the need to provide information.

“We have Long been calling for a reporting requirement,” says Max Skorning from the MDS. A similar System existed in many countries, for example in the UK. This structure would be detected rapidly and systematically, in case of doubt, will be amended again. In this way, checklists for operations to be sustained. “In Germany the professional public knows but not once about errors in a comprehensive decision,” he Skorning. “This comes at the expense of patient safety, because from mistakes you don’t know, you can not learn.”

In a survey of 950 midwives and Doctors, two-thirds reported “to have multiple experiences with a suspected or actual birth damage”. In more than half of the cases, a lack of Resources as a cause for the incident, for example, through Congestion and time delays.

“That doesn’t surprise me,” says Geppert-Orthofer. Of a One-to-one care of the majority of the midwives was removed in the meantime. In most cases, you would have to look after several women in labour at the same time.

According to an analysis by the Scientific service of the German Bundestag, a midwife in the UK takes an average of about 31 Pregnant in a year. This may not sound like much but the work is not done with the birth alone, most of the time spends the midwife with the and aftercare. The British Tool for staff planning, “BR “, therefore, recommends that should take care of a midwife in an average of 29.5 Pregnant women per year. In most countries this value is higher. In France, a midwife provided an average of 40 births per year. In Hungary, the rate is even higher, with 56 births.

And as Germany is there? An international comparison is difficult, because midwives here in Germany to work differently. Some are permanently employed in hospitals and care for women, especially in childbirth. Others work as self-employed in the hospitals as so-called proof of the midwife and care of women during childbirth, but also before and after. And others to offer only -, and follow-up. How many a midwife in the average Pregnant woman takes care of, is to be estimated, therefore, difficult.

In the year 2016 11.077 midwives worked, according to the Federal statistical office, in the obstetric departments of hospitals, where 98 percent of the children come to the world. More recent Figures are not available so far. In the year 792.131 children were born in Germany. On average, were 70 Pregnant women per midwife. Thus, Germany is one of the riders in the international comparison, of the top.

The constant stress has consequences: According to an analysis of your professional Association only every Fifth of the more than 1600 respondents midwives in full-time work. Nine out of ten reported that they could not comply with the prescribed break times. “Many midwives get off after about seven years in the Job,” says Geppert-Orthofer. Others offer no aid in childbirth, but only Before – and after-care.

The midwife Association has Recently presented key points for a birth to help strengthen the law. The main points are as follows:

  • A special program for more Midwife,
  • a binding personal key that provides for a midwife in full-time 30 births per year.,
  • Hospitals should be required to make the number of deliveries per year per midwife in public
  • outpatient obstetric emergency care, to relieve the pressure on maternity wards.

If your term as President of the midwifery Association is to end, would Geppert return-Orthofer back in the profession. But only to the terms and conditions as at the beginning of their career.

Summarized: In the past few years, smaller hospitals have closed their maternity wards because of rising costs. Larger hospitals have problems to close this gap, because there is a lack of staff. Thus, midwives need to attend more and more births. Because of the Overload, many only work part-time or give up the profession, exacerbating the shortage of staff. How this affects patient safety, it is hard to assess because hospitals have to give information about any treatment error.