Pregnant women start thinking about where and how they can give birth to their child relatively early on. This is exactly right. After all, feeling comfortable at the place of birth has a fundamental influence on a positive birth experience. Thinking about the best place to give birth early on in pregnancy is also important because more and more delivery rooms are closing and fewer and fewer midwives are offering out-of-hospital births. The choice has been decreasing throughout Germany for years. The law simply states that every insured pregnant woman is entitled to have the costs of an outpatient or inpatient birth covered by statutory health insurance. A woman can give birth on an outpatient basis in a hospital, in a facility run by a midwife (birth centre), in a facility run by a doctor, in a midwife's practice or at home. The assumption of costs is important for pregnant women, but is only useful if these options are available.
While it goes without saying that women who give birth outside the hospital will give birth on an outpatient basis, this option is also available to women who give birth in a hospital. They stay in the delivery room for two to four hours after the birth and then go home with their baby instead of going to the postnatal ward.
After a spontaneous labour, mothers usually remain in the maternity clinic with their newborns for two to four days.
However, you may be wondering whether an outpatient birth would be right for you. This means that you give birth to your baby in a birthing centre, a midwife's practice or a maternity clinic - and return home with your newborn just a few hours later. Here the new family can get to know each other better in familiar surroundings.
Women who opt for an outpatient birth in a clinic usually want to combine the safety of medical care for mother and child during labour with the subsequent familiarity of their own four walls. Particularly in the first few days after the birth, they value their own bed and a personalised daily routine at home more than the hospital routine.
The Federal Statistical Office calculated a total of 795,492 births in Germany in 2021. Of these, 765,694 births took place in a clinic. How large a proportion of these outpatient hospital births is unfortunately not shown separately. It is probably still very low, but the demand for outpatient hospital births is increasing. We know more about non-clinical Births from the "Out-of-hospital obstetrics quality report": In 2021, exactly 15,125 children were born at home, in birth centres and midwives' practices.
Enough of the figures - let's take a look at outpatient birth together. It wants and needs to be well prepared. And that doesn't just apply to the examinations that are on the programme for newborns in the first few days of life. But I'll come to that in more detail later.
How does an outpatient delivery work?
In the birthplace: If you decide in favour of this outpatient birth location, it is usually clear from the outset that you will go home with your baby a few hours after the birth. Provided that there are no complications during or after the birth that would require you to be transferred to the nearest hospital. However, some birthing centres even have their own postnatal wards. Whether you can spontaneously change your mind after the birth and spend a few more days resting and being cared for there also depends on the number and occupancy of beds. In most cases, mums go home with their baby after the birth in the birth centre and are visited there daily by the midwife during the postnatal period.
An outpatient delivery in a birthing centre is an option if your pregnancy has proceeded without complications and no problems are expected during the delivery. Enquire about this in good time! For example, certain (previous) illnesses of the pregnant woman, a malposition of the child or placenta as well as other particularities rule out a delivery in a birthing centre from the outset. For women who have no pre-existing conditions, however, giving birth in a birthing centre is a safe alternative to giving birth in hospital. This was confirmed by the National Association of Statutory Health Insurance Funds in a Study 2011.
In the clinic: Would you like your child Outpatient in hospital, you should inform the maternity clinic of your choice well in advance. You can then clarify certain procedures and formalities in advance. For example, each hospital has its own guidelines on how long a woman in labour must stay after giving birth (usually three to six hours). If you change your mind at short notice, you can also stay in hospital. For example, just for one night. No mother is sent away just because she was previously registered as an "outpatient".
An unplanned hospitalisation is also necessary if you or the baby are not feeling well.
A birth cannot be reliably planned. I therefore recommend that the pregnant women I look after who want to give birth on an outpatient basis in the clinic always take a bag with the essentials for "just in case". You can also take a look at here in my checklist for the hospital bag so that I don't forget anything important.
During the time that the mother spends in the delivery bed before she goes home, her heartbeat and blood pressure, her body temperature and the involution of the uterus are monitored. If the mum has any injuries from the birth, these are treated. The newborn must also be physically "fit" and able to feed independently at mum's breast.
Before the family leaves for home, the mother must also be able to stand up independently and have been to the toilet once to urinate.
By the way: The clinic will also register the newborn at the registry office in the event of an outpatient delivery.
For whom is an outpatient birth an option?
In principle, any woman or couple can decide in favour of an outpatient hospital birth. However, there are prerequisites for this:
- The spontaneous labour proceeded largely without complications and no/hardly any interventions were necessary.
- Mother and child are well.
However, there are certain exclusion criteria for an outpatient birth. I will go into this in more detail later.
Whether you leave the hospital straight after giving birth also depends on whether you are confident enough to be home alone again with a baby that is just a few hours old. The most important thing here is a midwife who regularly checks on the mother and the newborn during the postnatal period. You can read more about the necessary preparations for an outpatient birth below.
Ultimately, it is up to each woman to decide what feels "right" for her. And that certainly depends on her individual circumstances. I know women, for example, who were completely satisfied with their decision to give birth on an outpatient basis when they first gave birth. And it can also be a good opportunity for siblings to get to know the new baby early on and "make friends" with him or her. Especially as mum is only absent for a relatively short time. However, some women simply want undisturbed time at the beginning that is just for them and their baby and is unaffected by the rest of family life. One mum recently confided to me after her second outpatient birth: "I often wished I was back in a quiet hospital bed in the first few days! There was just too much hustle and bustle at home, even without the crowds of visitors."
As a midwife, I have looked after countless young families in the first few days after the birth. I have found that a well-planned outpatient postnatal period is more relaxed for mum and baby. Postnatal recovery is less complicated with outpatient births, breastfeeding works better and the baby reaches its birth weight more quickly. Bonding with the second parent is also often quicker. After all, both parents are intensively involved in caring for the new arrival right from the start.
What rules out an outpatient birth?
At this point, I would like to emphasise once again: If you are suddenly unsure during or after the delivery whether you should actually leave the hospital after a few hours, you can always change your mind. In some cases, the obstetric team will also recommend that you stay in the hospital for certain reasons.
However, there are certain indications for which an outpatient delivery is not possible. These include, for example
- Premature birth: If the child is born before the 38th week of pregnancy, it still requires medical observation and, if necessary, care.
- Sectio: A Caesarean section is a surgical procedure. Afterwards, the mother has to stay in hospital for a few days for monitoring.
- Peridural anaesthesia (PDA): If a local anaesthetic was used during the birth to relieve the pain - for example a Peridural anaesthesia- If the baby needs anaesthesia, its effects must first have safely worn off. For this reason, prolonged monitoring is then carried out either in the delivery room or on the maternity ward.
- Pregnancy diseases: Certain medical conditions during pregnancy, such as gestational diabetes, Pre-eclampsia or a serious infection do not allow for an outpatient birth. In many cases, the pregnancy is then considered a high-risk pregnancy anyway, which usually prevents an outpatient delivery.
- High-risk pregnancy: In the case of certain findings, pregnancy is considered High-risk pregnancy classified. This is the case, for example, with multiple pregnancies, a previous miscarriage or certain pre-existing conditions of the mother such as diabetes. Even then, an outpatient birth is usually ruled out for safety reasons.
- Birth injuries: A "simple" perineal tear or incision does not have to be a compelling reason to forego an outpatient birth. Depending on the severity, however, the situation may be different. Other birth injuries that require medical care and treatment can also thwart plans for an outpatient birth.
What should you prepare for the outpatient delivery?
Regardless of whether a woman gives birth in a birthing centre or in an outpatient maternity clinic, she should make some preparations during pregnancy for the first few days at home.
If the mother and child remain in the maternity clinic for three to four days, routine examinations will be carried out on the newborn before discharge. The situation is different after an outpatient delivery, as you are responsible for organising everything yourself at home. Therefore, my urgent advice is to start the preparations in good time!
These include:
- Find a midwife: By far the most important aspect of an outpatient birth is the aftercare midwife, who looks after mum and baby at home from day one. She not only has tips and answers to all your questions, but also keeps an eye on you and your baby to make sure everything is OK. She can also visit you twice a day in the first few days after the birth.
Unfortunately, it is no longer so easy to find a midwife. So please really start early to ask around. It's not just about getting to know your midwife during your pregnancy and building up a relationship of trust with her. My colleagues should also be able to plan, as they will be meeting three weeks before the Calculated date of birth have to have a lot of time ready for you.
- organise personal care: With an outpatient birth, you need someone who will be there for you and the baby around the clock during the first few days. This person takes care of the catering, the household, the siblings, pets, etc. to relieve the mother of all tasks. This could be your partner, your own mother, mother-in-law or sister, a friend, grandma or whoever. If this option is not available or if the mother is a single parent, your health insurance provider can also finance a suitable home help (ask them!).
- Organise examinations for the newborn: At home, you must (pre-)ensure that your child visits the paediatrician between the 3rd and 10th day of life. U2 preventive check-up. Many paediatricians come to your home for this check-up. So ask in good time so that your paediatrician can schedule this visit. The same applies to the Newborn hearing screening in the first two weeks of life. In addition, the test for metabolic disorders (Guthrie test) can be organised, in which a small amount of blood is taken from the heel of the newborn within 72 hours of life. Your aftercare midwife may also be able to carry out this test. In this case, however, you will need the information papers from your paediatrician in advance so that your midwife can carry out the test. The Pulse oximetry screening for congenital heart defects should again be carried out between the 24th and 48th hour of your child's life. In the case of an outpatient hospital birth, the screening can also be brought forward and thus still be carried out there. Otherwise, it is also possible to carry out the examination during the U2 at the latest.
- Stock up on supplies: After an outpatient birth at home, it's easier for you if dad or the relevant carer doesn't have to deal with any major shopping straight away. It is therefore advisable to have sufficient supplies at home, from pre-cooked meals to drinks, nappies, detergent and pads for the postpartum flow.
- Gain security: As a mum, you can and should rely on your intuition when dealing with your baby. Nevertheless, it is important that you familiarise yourself in advance with your baby's needs and the correct way to care for an infant. The Online infant care course from nodtdiensthebamme.de suitable. Because it helps you prepare for your baby during pregnancy. The videos are also available after the birth. If you are no longer sure how best to care for your baby in the postnatal period, you can watch the individual videos again.
Does this list seem long to you? That's right - it's also a whole lot of tasks. But it's worth making these preparations. After all, the postpartum period is an exciting and wonderful time for which it is worth making arrangements. This also applies if you want to spend the first few days in hospital. With the Online workshop You can optimally prepare yourself for this wonderful learning phase via the postpartum period.
Are you still looking for products to help you prepare for the birth? For the last few weeks of pregnancy, Mabyen has the birth preparation set with an organic hay flower bath for soothing sitz baths, organic raspberry leaf tea for relaxing moments and organic date snacks for in between. Here to get to the products. You get 15% discount on all Mabyen products. Simply enter the voucher code when placing your order: KATHARINA15758
2 responses