Many women experience an uncomplicated pregnancy and give birth to their baby on the due date. If you ask them what kind of birth support they would like, they don't have to think long: of course they want to have the midwife to themselves the whole time. This is "one-to-one care" by a midwife during the birth. The only question is how this can be achieved.
As a pregnant woman today, you can basically choose where you want to give birth to your child. There are various places of birth available to you: You can have your baby at home with the help of a midwife or in a birth centre run by midwives. You can also choose to give birth in a clinic.
The most important thing for you is to be well informed about which place of birth makes sense for you and your child and what you can expect at each place of birth.
What is the situation in the clinics?
Most children - over 98 per cent - are born in a hospital. Assuming an unremarkable pregnancy and vaginal birth at term, this is what awaits you there:
In the hospital, you will usually be cared for by an obstetric team consisting of midwives and doctors. If the birth proceeds without complications, you will usually only have to deal with the midwives caring for you during the entire labour. A doctor will then join you for the actual birth.
In a few clinics, there is also a so-called midwife delivery room, which is the sole responsibility of midwives. Here, doctors are only involved if they are necessary or requested by the woman giving birth (e.g. in the case of an epidural).
Whether you can be accompanied one-to-one by a midwife in the clinic depends on many factors. This is the case in delivery rooms run by midwives, but not (always) otherwise. For this reason, some women bring their "own" midwife to the hospital with them to ensure this. These so-called accompanying midwives work on a freelance basis, but have a contract with the labour ward in the hospital. They usually already know the woman/couple very well from their care during pregnancy. When the due date approaches, they are on call. When it "gets going", they accompany the woman to the clinic and accompany her throughout the labour. This model also guarantees one-to-one care. However, until you are dependent on the available clinic staff, it is quite possible that you will be on your own for a while or even longer during labour and only have your partner by your side. There can be many reasons for this, such as a lack of staff or because several births are taking place at the same time and therefore several women need to be cared for at the same time. Depending on the time and duration of labour, it may also be the case that a particular midwife looks after you for a while - and then another one after the shift change.
What do the experts recommend?
The new S3 guideline for vaginal births at term (2021) is unequivocal here: it recommends uninterrupted one-to-one support from a midwife from the active opening phase onwards. This means that women giving birth should have a midwife at their side for at least 80 per cent, preferably 100 per cent of this time - and during the actual birth anyway. According to the S3 guideline, this support should not be disrupted by a shift change.
The active opening phase begins when the cervix is 5 cm wide and regular contractions indicate that the birth is now progressing. Most women in labour are not in the delivery room during the time before this. The latency phase of labour is often spent at home and sometimes in their room at the hospital.
The German Society of Gynaecology and Obstetrics and the German Society of Midwifery Science, with the involvement of various specialist societies, did not simply make this recommendation "from the gut". Rather, it has now been proven: In one-to-one care, the woman giving birth receives the best emotional support from the midwife according to her personal needs, continuous recognition of her labour, constant information about the progress of the birth, good guidance on relaxation techniques and much more.
This package has a positive effect on the entire birth process, as further studies have shown: One-to-one care by a midwife, for example, leads to more vaginal ("natural") births and fewer caesarean sections, less use of oxytocics and painkillers and also fewer higher-grade perineal tears. And these are just some of the many positive effects.
What does that mean for you?
You may trust yourself, your midwife and the people around you so much that you decide in favour of a home birth. One-to-one care is always included. The same applies to a birth in a birthing centre.
If you decide to give birth in hospital, choose the hospital carefully. In my opinion, one-to-one care from a midwife could be the deciding factor here. So ask carefully whether and how the clinic can ensure this. And don't be afraid to ask about possible shift changes. The more you know beforehand about what to expect, the better you will cope during labour. Although, from my point of view, it should actually be the other way round: it's not you who should have to adapt to the conditions in the clinic, but the clinic to you and your wishes. Sometimes this works - but sometimes it doesn't.
You and your partner should prepare well for the latency phase. It usually lasts much longer than the time you spend with the midwives in the delivery room. Studies have shown that medical support during this phase cannot have a positive effect during a normal labour. However, the course of the latency phase has a major influence on the rest of your labour. As only you as a mum can be the expert for this time of your baby's birth, it is important that you are well prepared for the birth. Your knowledge, your breathing technique, your movement and your calmness will help your baby the most during this time. A Birth preparation course is not only important so that you are well prepared for the time in the delivery room without a midwife, but also so that you can organise the latency phase at home well for you and your baby.
