"Not only the child is born through the mother, but also the mother through the child." (Gertrud von Le Fort)

This article is divided into two parts.
Part I is very personal and tells from my experience and views on giving birth to my son.
Part II includes research, data and numbers.

I apologize in advance for maybe unfortunate language, for I am not a native English speaker.

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The topic of "birth" has been moving me for a long time and I decided finally to post it here.

It is my intention to examine births in Germany in more detail. I didn't know much of the information I had researched and at the time when I wasn't even thinking about having children, it was about as important as when you pass a playground during your lunch break and see some "leisure mothers" with their offspring sitting next to the sandbox. Completely meaningless.

Well, I want to give meaning to the whole thing, because the subject deserves it.

Every single one of us is born once. Although I have no memory of that day, it meant something to my mother and influenced how I was accepted into the human community as an infant. Even without my conscious memory I have stored everything that was good and everything that was bad in my body memory.

Why in the 21st century a baby has something to do with risk assessment, liability and shareholding: I will refer to that in the second part of this article. But first of all, however, after thinking about writing this article for a long time, I will become personal. Because without my intimate details my text would be half-hearted and somehow I don't think that it would really touch anyone. But that is my intention!

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Part I

About half a year ago, I read the extensive court ruling on a trial of a German midwive who was sentenced to almost seven years imprisonment, fifty thousand Euros in compensation and a life-long ban on her profession. She received this verdict because a baby had died.

The incredible length of the text almost killed me and it was hard to read. I really can't judge the course of events and the medical background.

The death of the baby, the suffering of the parents and the ruin of the midwive ... all have lost. However, I will only deal with this tragedy indirectly.

Status Quo in Germany - largely without alternatives

Expectant mothers and fathers are not able to identify or at least believe that there are few alternatives to common practice (which is giving birth in a clinic). They accept by a majority what is recognized by school medicine. This is very provocative for people who want or need something else.

The fact that the midwife, as the course of events described, had to have transferred the birth giving mother to a hospital and failed to do so is, for me, an expression of the rejection felt by her and therefore not so much of arrogance as was evidently being seen that way in some parts of the judgment. In my opinion, it is probably a form of overestimation of herself, which - this is my speculation - will probably have arisen from numerous successful births. Self overestimation paired with hatred of the system: this often goes wrong.

It seems to me that the case of this midwife represents a discrepancy between the established approach in hospitals and the alternatives available for this purpose, or it is generally assumed that these alternatives do not exist and that the acceptance of these alternatives is non-existent.

What might be the reason for this? Why did the midwife want to form such a blatant counterweight to the maternity hospitals? Certainly her personal experiences and evaluations played a role. Judging this, however, is not an issue here. But there are reasons which, from what I have researched and how I myself have experienced my pregnancy and the birth of my son, refer to the aspect of lack of alternatives.

Clinic or home?

When women who become pregnant for the first time in their lives consider where they want to give birth to their child, the question is usually: In which hospital? Not necessarily: In a clinic or at home or a birth house?

The professional stations that I went through during my pregnancy didn't raise this question at all and in my circle of friends and family nobody discussed this possibility. I had heard about it, but I didn't get the idea to deal with it in more depth, because other questions came to the fore, one of them was whether I wanted to give birth with or without a PDA, for the reason that I took the prenatal course in the clinic. I was extremely busy with this question; it was connected to fear. My image and my knowledge of birth and pregnancy up to the time of my own: Equal to zero.

Please don't just ignore this point. Is it "normal" not to know anything about births as an adult woman?

I think that I would have considered the question of the place of birth if someone had mentioned it and made it significant. But if the environment, family, friends and husband don't give an impulse to do so, plus the power of habit and that which is considered established, then a possible voice of one's own is not the one a pregnant woman listens to. She wants to assume that those who are familiar with it will give all the important information and want her to move in the safety of an environment that treats expectant mothers appropriately.

In retrospect, I have often asked myself - and not just now that I have read about this case - why it is generally so completely underrepresented that babies can be born in one's own home or in a birthplace. Why it seems so unquestionably accepted that birth is considered to be more of a "risk" than a natural process.

Is it because there used to be a high mortality rate among mothers and children?

At the same time, however, it has to be said that the high mortality rate resulted from inadequate hygiene, poor health and malnutrition of the mothers, if they had to live in poor conditions and with nutritional deficits. Mothers must have had psychological stress when they had an unwanted child, the shame and social ostracism weakened their self-confidence. They also suffered from having too many children, either because there was no prevention or because religious belief forbade it. Mothers were and still are working animals, because they have always been involved in a variety of tasks and took care of children.

Anyone who has given birth to a child knows that trust in themselves plays an important role. All mothers will confirm this, as well as those assisting the mothers, whether in hospital or at home.

What if you don't intervene at all?

Therefore, I would be interested to know how low the complication rate is for both child and mother when spontaneously given birth, i. e. born in a natural way and without any intervention! (peridural anesthesia/PDA,"Kristeller-help", drugs, caesarean section etc.).

I would be even more interested to know whether there are any relevant data on births at home and at birth houses.

I have looked up and yes, there are surveys on this subject here: "Our society has been documenting the quality of the births cared for in this outpatient care area since 1999" (outside the clinic).

Apart from that, I had heard during the time I was pregnant how important it is that I needed a good midwife before and after birth, but no one really explained what this actually meant. If I had known what I was supposed to ask specifically, I would have done so.

Apparently, I have read the wrong books - a lot of books - and it was only clear to me why a good midwife is important when my son and I came home. Be it that I hadn't found the literature that was right for me, be it that home births didn't occur in my neighborhood, since I didn't hear of any of them in my entire childhood and later in my adult life, and be it that as the last child I didn't experience any younger brothers and sisters on my mother's chest.

I was as virgin as a woman who's never had sex in maternity.

Let me say that all this is a disadvantage.

This complete ignorance and lack of experience in watching other pregnant women and the absence of experiencing births in my daily life had a negative effect on me.

One could ask: Who stopped you from informing yourself? That would be like telling someone to search in hell for holy water (to exaggerate a bit). Or to order a glass of champaign in an Irish Pub.

There is a significant difference between information and experience.

I can inform myself: But a really good preparation for the act of birth is not and never will be the theory. The best for me would have been to observe and be in friendly contact to other mothers. I didn't know a single one before giving birth in my age and space, only later on after stretching my activities out to them.

If the whole world says that ...

• births are the most natural thing in the world, on the other hand there is talk of "risk",
• the hospital wants to protect itself against possible mistakes,
• you only see screeching, moaning and panic women (and men) on television,
• in the news there is never really anything important to the subject,
• the mainstream is full of praise for "safe technologically advanced achievements",

... then, yes, then fiction and possibility and reality form into a great whole that looks like this: That giving birth is very threatening and incredibly painful and strenuous, that you are not even competent and that it would be nothing special at the same time, because women have been having babies for thousands of years.

I at least gave my autonomy at the door to the delivery room.

Am I to be blamed for my complete cluelessness?

I have to deny that categorically!

The issue of birth should not be reduced to the nine month window.

The topic is much more comprehensive and important (!) than as naive first mothers as I have believed it. And as women continue to believe, since they are intimidated by comments about home births, such as: "They should satisfy their adventurousness elsewhere". Home births are now suffering from a flaw and parents are assumed "to take an unnecessary risk" or have a "transfigured idea". Even if it is not taboo, home births are not generally accepted and there is much less knowledge.

Births receive a complete exaggeration in a culture of extremes on the one hand - by turning to a language that one denigrates as "esoteric" or on the other hand equates with a "heroic deed", because the woman can barely endure pain for hours, even almost unearthly, in which "men faint".

At the same time, women are being disparaged by attributions such as "throwing" numerous children, as if they were dumb animals, i. e. women who have children, too stupid to prevent them or who have children for reasons of work-shyness.

Why would I personally prefer home or birth house birth:

It's a very personal and intimate thing. I don't want to see strangers bursting in during sex either. I didn't feel safe at the birth of my child. I didn't know any of the midwives, I've never seen the doctor before. The anesthesiologist who gave me the PDA was a man I could hardly understand due to his mumbling pronunciation and who made a very uncertain impression on me. I had the feeling that my fear of this impressive injection was transferred to him, which made the whole thing very stressful for me. The peeping of the contraction writer and the measuring of the heart tones were very annoying and I felt more disturbed than supported by the midwives.

Aggressive birthing

Since I was in regular labour and tried to find a rhythm and peace for myself, I found it completely inappropriate when - I don't know who - my husband was asked if he wanted to have lunch. He agreed, while I was totally baffled by it. When the tray came and the smell of food got into my nose, it made me nauseous and I would have liked to take my husband and his meal out of the room, to say the least. That's how it happened all the time: someone came in and went out again.

I didn't get into a state where I would have been the one who controlled the process. I was annoyed and angry all the time.

The anger felt by women in the delivery room comes, as I think, because it is obvious that the scepter has been given out of the hand and that interruptions by unfamiliar people in an unfamiliar environment do not have a good influence.

The idea of sleeping with your loved one and someone else fumbles around in intimate places and all sorts of apparatuses beep next to your bed: No! Here's a film that illustrates this in a funny way:

Also, that I accepted an enema (!) right at the beginning was a degrading experience for me. Why couldn't I have gone to the toilet if I had decided to go to the toilet myself? This enema, which I felt as violent and unnecessary and then sitting on this arctic and uncomfortable toilet in the corridor of the ward with stomach pain and contractions at the same time: why is it necessary? So that no one from the hospital staff gets into an embarrassing situation?

I had the feeling of galloping through the birth at a pace that was much too fast for me, but today I think that it was not so much the speed, but my perceived misfortune that I had to experience myself as incapable and alienated.

Gaps in memory
The faces of the midwives and the doctor are not memorable. I don't even know who these people were and I haven't seen them since. I cannot remember any significant moment or a loving word from the staff.

The final stage of the birth: After only about five hours (!) - since my arrival up to this moment - I was told that it is now time and that I have to push hard. I had only just received the PDA and to my knowledge the ability to press or feel the abdomen is limited. After a short press phase I was told that I had to participate more strongly.

Fighting or escape not possible

Which didn't seem to have any special effect, because the next time I got it with three (? not sure how many) adults to do, who all fell at the same time on my belly and pushed me from above brachially. I was raped. I just wanted it to go away. Finally, I was told that if it wasn't possible now, they would have to use the suction cup to fetch the child. Whether it was this threat or something else, I don't know, but then my son finally came and someone said,"The little one had his hand on his head". Which was taken as a reason for doing an episiotomy that I hadn't been informed and given permission about. Much later I researched this method, which is called "Kristellern".

I can't tell you about a differentiated feeling of having given birth to my child myself, because now it seems to me as if my son was "somehow" born, but not through my own strength. I didn't feel any pain from pressing. What remains is the threat, the violence, the immense unrest during the entire act and the subsequent suturing by the doctor, with whom I exchanged the first dissociated words as she pulled the thread up and down.

When I was brought into a bed room with two other mothers, sweaty and glowing, I felt like I was not from this world. I asked for a window to be opened because I almost died of heat. Since it was winter, the other women (they only spoke English) complained about it and about me. I understood every word. When my husband came to me a short time later, I asked him if he could take care of moving me to a single room, which fortunately was no problem. I felt deeply hurt by everything.

I regret all these experiences to this day and the sadness of not having experienced the birth of my son as an act of strength and self-confidence remains. I got seriously ill, but I don't want to say anything more about it here.

Strong women

The fact that there are mothers who, despite such an atmosphere, keep their trust in themselves and remain conductors of the birth process seems to me to be a miracle, which of course is not the case. But the special thing about birth, remaining related to myself and being immune to the banality of the professional everyday life of others: this requires a lot of strength. To have it in such an exposed situation for hours and hours and to tune in in the times of the individual stages, because I can perceive them and find confirmation or encouragement, is in my eyes a feat.

In the clinic, it is not the mother giving birth that impresses and qualifies as „competent“, but the staff who is present in its role as professionals with the institution of the hospital in their back. The woman should help and, if it is not fast enough, something is insufficient in the procedure. If the woman does not manage to do so,"measures must be taken". However, it is not the woman who determines this in a clinic. Coming up with the idea that the mother has a feeling and a relationship to her body and the baby in it: less and less of this can be achieved in the apparatus environment.

No "reasonable" person should accept this role reversal when life demands something else!

I had a short and intimate time with myself.

It was in the early morning, when I woke up and realized with great certainty: today I will greet my child.

There was no question, no uncertainty, but rather a clarity that I hold on to, as it is the only one left on that day. It was perhaps half past seven in the morning and I felt the first pull in my body and identified it as a woe. The contractions gradually began to occur much more pronounced than the familiar period pain. I remained completely calm and knew that I didn't need to become active until the contractions came every five minutes. I stayed alone until nine o' clock and woke up my husband only after the intervals had reached the five minutes and told him that we could set off on our way.

Until then, I felt strangely calm.

I started to regret that we had to get into the car and felt like I didn't want to leave the safety and security of my surroundings behind me. Not being able to take this gift of clarity with me.

In fact, the fear rose up in me because I suddenly realized that I had no idea what was awaiting me in the clinic.

When we got out of the car, I would have preferred to drive back standing on my feet.

The entrance to the clinic, the way I went up to the ward, I didn't experience it any more than resting in myself, but rather leaving it to my husband to register us. This had interrupted the rest, disturbed me in my contemplation, I didn't realize that clearly when I walked towards the building.

I know today that I would have preferred to remain alone and to have asked for the support of others only if I thought I needed it myself. In an environment with familiar smells, my bathroom and the personal touch of my apartment. The midwife would have been my guest there, following my rules. That's how it all got turned upside down. I was the one who had to adjust.

I then also accused myself of not having been able to make this adjustment.

You don't want to hear all flappy comments about it.

For me, my notion and rising unwillingness to make my way to the clinic would have been an indication of the fact that I spontaneously changed my decision.

But who would do such a thing? The clinic place was booked, it would have upset my husband at that time totally and put him into stress, because it would have been him who would have had to cope with my change of decision. Even if I had raised the objection, I do not think that I would have met with approval.

It is said that women who give birth at home or in the birth centre change their mind. This decision is legitimate. On the other hand, an inverse decision would not be legitimate but strange.

That this is the case shows me how much of an alternative view this issue presents. I will never know whether the birth of my son would have been successful without PDA, episiotomy and the brutal intervention of those involved. I assume, however, that this would be the case, because neither I nor anyone in the staff ever felt that my child's life was in acute danger.

However, it is not "feeling" in the case of personnel,

because what a midwife may feel must not determine her actions. Her "intuition" is also meaningless, and in this environment one doesn't talk about it and doesn't mention it to any doctor at all, if one wants to stay respected in ones profession. Those who can express this impartially are the mothers and perhaps a doctor may be reached by them. But he probably would only talk to his wife in the evening about being impressed by "intuition" and ask her not to broadcast it. .... Irony off.

What I didn't know until today is that ...

... German law requires that a midwife must be present at birth.

Not the other way around, as I understood it so far. After all, a doctor alone is not allowed to give birth to a child, but a midwife is. I had not assumed that, I thought it otherwise. This course of reversal, where does it come from? It is certainly not based on informed parents or the general public. It is an expression of disinformation and faith in the competence of doctors or machines. „Birth“ is the only exception in the hospital environment, which is not „sickness“. It must therefore be explicitly considered. It won't, though. Hardly anyone says this explicitly.

I have no recollection that, during the consultation with the doctor when it came to my admission and the formalities, this provision was so clearly mentioned. Because it's assumed to be general knowledge? Why is there not a midwife present at the consultation with the doctor in the first hand?

Everything seems so "normal", such as laying flat. But why that is has something to do with:

The staff needs easy access to the mother in order to be able to look between her legs

Of course, the connection to the appliances also works better when the woman is lying down. But how normal is it that the mother gives birth in a lying posture? At least this fact seems to be slowly spreading, that gravity actually helps the baby to slide down the birth canal.

In my opinion, it would be normal for me to use no bed and no apparatus such as contraction measuring, ECG or CTG as long as the mother-to-be and the midwife do not give a signal. It would be normal for the midwife, who had already taken care of the pregnant woman before, to be present at the hospital on the day of birth and to accompany her one-on-one. So it is not necessary to be ready for other births. Even if the woman does not need it or wishes to remain alone for a while. It would be normal if the midwife could go into a quiet room next to the birth room and remain in silent resonance with the woman. Normally, there would be a toilet in the room and not in the ward corridor. Normally, a warm and personal environment would be a good place. An intervention would only be normal if there were a clear reason for it.

Not normal are machines and staff routines.

This automatic connection to apparatuses, this subtle pressure to agree to an enema, this very clearly noticeable "we'll just do it before" and "just to be absolutely sure" and otherwise not to worry about anything, even though it's not necessary at all. This is not normal.

It is not normal to see that being connected to the machines is a way of enabling the midwife to read a protocol, because she is not always in the sphere of the mother and must be kept up to date when she comes from another woman. In fact, when she goes over the hallway, meets people, is exposed to noise and stress and has to adjust to different women, she loses her intimate connection to the mother who gives birth.

After all these demands, which I have formulated here and the criticism, one could say that it would really be better to give birth at home, because a hospital cannot afford all this and is not the right place for it. Correct!

I can say that there is little or no information here about alternatives to the hospital.

Why women who want to give birth differently are in the minority has something to do with disinformation.

It may have been in my own situation, that there was no reconnaissance. However, I assume that as long as the woman does not ask the doctor (gynaecologist, registration interview in the hospital) in a targeted way, the procedure is routine and the topic is not raised specifically. If you have other experience with gynaecologists and maternity hospitals, please tell me.

Part II

And now for the money

Financing plays a major role in all areas of life. Let us assume that the 70 million Euro that it would cost the Federal Republic of Germany to help babies into the world (at an average cost of one thousand and two hundred Euros per birth and a figure of 700,000 births per year) would have to be paid by the taxpayer and not by the health insurance funds. How would that be?

The issue of decoupling births from the health care system is basically a logical thought, because pregnant women are not sick!

It also seems logical to me that mothers think that this subject is one for the general public.

But it could also be said that this doesn't matter, since the statutory health insurance companies also follow the principle of solidarity and thus ensure that the general public of the contributors ensures that they finance the births. Those who do not have to take out statutory health insurance but who, because of a high income or self-employment, take out private health insurance policies are not included. However, women are generally classified with higher contributions than men. Precisely because they are said to be more expensive in terms of prevention, pregnancy and birth. In both cases, the question of costs has been resolved. In this context, it is interesting to ask whether a planned Caesarean section, which is not based on a medical indication, is also paid for by the general public. No, I checked.

However, this is a matter of medical indication, and one could say that the question of liability is contrary to that.

But since the health insurance companies don't take responsibility for birth defects,

liability is a separate issue when you file a claim for damages and only pay the normal costs of a birth. And that's a huge topic.

Not only do clinics have to ensure that the complete documentation of the individual births is kept, if they want to be on the safe side, they tend to make incisions due to the risk of liability and the fees incurred by the surgical team.

Exploding C-section rate

Although it is refused that these are the reasons for the upward development of C-section births, the almost straight-line increase of the nationwide Sectios is meaningful. To justify this solely with medical indication is not only cynical, but almost a fraud - whoever is a doctor should be careful with such statements.

Rather, compared to a spontaneous birth, which you don't know how long it will take, a sectio fits much better into the shift and operation plans of a hospital. In addition, the Sectio is more expensive - and thus more profitable - than a vaginal birth.

C-section Births in German hospitals (Wikipedia):

1991 = 15.3 %.
1992 = 16.2 %
1993 = 16.9 %
1994 = 17.3 %
1995 = 17.6 %
1996 = 18.0 %
1997 = 18.5 %.
1998 = 19.5 %
1999 = 20.3 %
2000 = 21.5 %
2001 = 22.6 %
2002 = 24.4 %
2003 = 25.5 %
2004 = 26.8 %
2005 = 27.6 %
2006 = 28.6 %
2007 = 29.3 %
2008 = 30.2 %
2009 = 31.3 %
2010 = 31.9 %
2011 = 32.1 %
2012 = 31.7 %

Any more questions?

In Hamburg, we are proud of 36%.

See also Seite 15 - Beschreibung der Qualitätsindikatoren
für das Erfassungsjahr 2015:

The overall picture fits in with the development: the decline in home births to clinical births. The decline from vaginal births to sectional births.

The text says:

• „The number of Caesarean sections has more than doubled in Germany alone in the last 20 years and currently accounts for more than 30% of all hospital births (...). Although the "total sectiorate" is often given, it is important to distinguish between primary and secondary sections (...). Primary section is a pre-planned procedure, whereas secondary section is performed spontaneously due to complications of birth (...). However, it is questionable after preparatory analyses whether the above-mentioned differentiation between primary and secondary Sectio caesarea is always adhered to in coding practice "*.

Go on, then.

In addition to the risks for the mother as a result of the surgical procedure itself, there are indications of medium and long-term consequences for the child and mother, which should be examined in detail in further studies.

About the administration of antibiotics to the mother in a section,

The consequences for the health of the newborn baby or for the development of resistance to antimicrobial agents have not been adequately investigated.

Please READ this and make your decision.

C-section? Wasn't that just in an „absolute emergency“?

I am stunned that the risks associated with a section are as little researched as they seem to be, or that there are no studies on them, but that the practice has nevertheless experienced such a rapid increase, even though there is no definite evidence of possible consequences.

• „In many studies, there are indications that in sections compared to vaginal birth, there is an increased likelihood that certain clinical pictures will appear in the further course of the child (e. g. increased risk of respiratory distress syndrome and bronchial asthma in childhood)."*

If we now assume that ten percent of all women receive a desired sectio, then we have to ask ourselves what these women actually know and what they think they know.

Perhaps the women think that a birth of an incision is not a "real" operation?

In medicine, the tenor of "minimally invasive methods" can be heard, which could tempt a layman to think that surgery today is less brute in hurting the body.

But where they cut, the body is injured. So muscles and tendons and nerves. Everyone can imagine the cut that it takes to get a baby out of the wound.

It is interesting in this context that, at least on the Internet, court rulings can be found that refer to errors that have occurred in the case of birth complications and that should have initiated a section. The births caused by not (!) initiated emergency Caesarean sections and the damage to the newborn child and later adults were determined decades later by court proceedings and settled over claims for damages.

The question now arises as to whether legal proceedings can ever prove the consequences of (!) administering antibiotics or the risk of infection in a section, and whether this will possibly result from more lawsuits in the courts. It does not seem to be assumed that this is the case, as it would otherwise be necessary to hurry up the analysis or investigation of these factors which has not yet taken place.

Personally, I don't think much of going to court.

It is likely to be difficult to establish causal relationships the longer the birth lays in the past, and all other causes of an established disease would have to be ruled out first.

My assumption that the question of liability is very important to the Sectio and my assumption that no one would say this directly is wrong.
At least in the text on Wikipedia and the reference to a Bertelsmann study of women insured by the Barmer Ersatzkasse, it is said:

• "A survey of around 4,200 BARMER GEK insured mothers conducted by the Bertelsmann Foundation in February 2012 showed that "the sectiorate without medical indication is less than two percent". According to the study, a "tendency towards (supposed) risk avoidance" is to be seen, since the risk orientation of gynaecologists, both during pregnancy and during childbirth, results in a "defensive birth medicine" for liability law reasons."* Translation: It all points to Sectio.

The Caesarean Section lobby, on the other hand, tells us that "defensive birth medicine" is nothing to apologize for. So here we have created a term that suggests a "gentle birth".

The lobby's a tough one, though.

"My wish C-section

There is a website of its own and it starts right away with a court ruling that "will go down in history". The "medical indication" (reason for giving birth to an incision) is now the one that is most likely to be abolished altogether. Here's the music:

„One of the judges has clearly recognised that this is not a purely medically justifiable view, but that the motives stem from quite elsewhere:"It looks in a way as if vaginal birth is morally preferable to Caesarean section". The doctor's ideology was that the natural birth had to be better. However, this could not be the basis for clarification.“ Source

To speak out in favour of natural birth (vaginal) has thus become an „ideology“. Uh-huh.

So when I decide to give natural birth, then I am a dogmatic ideologist? Please, woman, does anyone of you thought, that natural birth does NOT have any risks?

Thank goodness there are better sources!:

The "good birth" - the result of correct decisions?
Die „gute Geburt“ – Ergebnis richtiger
Entscheidungen?

Short turn into the intensive care unit:

I experienced that those working in hospitals actually behave defensively and become accustomed to this kind of behaviour, which is laborious or aggressive, and defend themselves against relatives or patients, when I visited my dying mother in a clinic and, on the one hand, we were coarsely hissed when we forgot to put the sterile clothes into the garbage bin in the room itself when we left it. Just as the evening staff refused to take up the bed lattice for our mother and told us that they were not allowed by law. In this situation, they asked us to do it ourselves, even though the technique with which this had to happen was not easy for me to understand. I found the situation absurd, the staffs reaction aggressive and inappropriate, without recognizing who or what this clearly perceptible discomfort was directed against. In the context of accompanying our dying mother, all these hedging efforts had a very inhumane and absolutely annoying aftertaste.

One of the women in particular made it very clear that any request to her was taken up as a suspicion against her, as if her competence were being called into doubt by us relatives, while my sister and I only wished that my mother should be treated with sensitivity according to her needs and that we wanted to recognize a bit of humanity and personal compassion.

I now know that the bed lattice fulfils the condition of deprivation of liberty and that it may only be adjusted by the patient himself on explicit instruction. Since we had not yet been given any judicial authority to make decisions for our mother at that time, our requests were not valid. My mother was no longer able to speak for herself. The days that such a thing then demands are sometimes infinitely precious, because my mother died in the hospital during the week and it was more than painful to have to submit to the rules of such a hospital policy. We couldn't and weren't allowed to spend the night there to take care of everything. We were dependend on the cooperation of the staff.

The staff at the bottom of the hierarchy - at least, it seems - lives in a permanent fear of violating the conditions and being confronted with liability issues by their superiors or the legal department.

This makes it very clear what determines the rules of everyday clinical life: the fear of mistakes.

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The fear of lawsuits. The fear of high compensation claims. Consequently, the process must be logical in such a way that complete documentation, absolutely error-free behaviour on the part of the personnel and strict adherence to rules and regulations are maintained. In order for this to happen even in the course of legislation and medical innovations, the personnel must be trained and sworn in on an ongoing basis.

I wonder where the aspect of compassion, the time for personal interest in the patient and the relatives, is supposed to take place. I imagine having to work in such an environment of fear. It must be absolutely horrible.

liability for midwives

I have read elsewhere that the liability insurance contributions for midwives are so high not only because there are so few midwives in Germany, but also because the sums of money from claims for damages are very high.

If one were to ask me how much I estimate the influence of the liability issue on everyday life in a maternity hospital, I would say that it will increase in the course of further lawsuits and perhaps determine the majority of the procedure in a few years' time (maybe one should look at the development of the number of lawsuits in other clinical departments in comparison to the prescribed documentation and check how high the patient satisfaction is actually in relation to the prescribed documentation). What is thus readily acclaimed in the media as a success, when millions of sums of compensation for damages go over the table, always has a far greater significance and scope than the reader would expect.

The midwives, who must be the first to recognize when a birth threatens to become complicated and must be able to document their actions in the event of damage and a subsequent lawsuit, are therefore not allowed to involve a mother who comes to their clinic in the decision whether a CTG is permanently written or not!

It is subject to the hospital's directive and is therefore banned from the sphere of influence of the mother-to-be. The direction of the march is somehow clear, however, that this whole effort, the uncertainty, whether a birth is dangerous, uncomplicated or even without any special occurrences, is to be avoided from the outset and that possible complaints, at least in the area of the Sectio, do not pose a current threat in comparison with births that have begun naturally. I wonder how this is to be stopped when the issue of liability becomes so dominant.

Is that what we women and mothers want?

My wish list of amenities and personal sympathy and the alternative methods for giving birth does not correspond in any way. However, this will happen if the contributions for independend midwives are not distributed differently and the right to recourse is maintained. Since the profession of midwife can then only take place in the service of a hospital via from hospital engaged and payed midwives, because the financing is not otherwise possible, we can prepare ourselves for the end of independent midwives.

Obstetrics on the black market - midwives criminal

Those who want to give birth at home will probably only be able to do so if a midwife provides this service illegally and makes themselves liable to prosecution. However absurd this may sound in my own ears, many other ears seem to look at home births as a "madness" and almost "irresponsible", not to locate a birth in the „safe and protective“ framework of a clinic.

Hospitals that have already had a lost claim will certainly have changed their procedures and made them bullet proof. This is also compelling logic, because which clinic wants to spare time, money and resources for court proceedings when a case is much easier to solve due to clear violations of the rules and identified responsible persons.

Better to design births like a physical arrangement ...

... and keep every detail, no matter how small or relevant, in a monitoring log. In any case, it is preferable to avoid a lawsuit and so a clinic has to stand on very firm feet. Avoidance and weighing of risks is in favor of a sectio.

To sharpen the perception of the patients that everything is in order, that the procedures have compelling medical reasons and that steps A, B, Z and Y have the greatest possible security and guarantee of intactness. All other risks, „please keep liability free and sign here, here, here and here“ and otherwise "everything at your own risk".

The fact that the perception of patients then develops exactly that way and ignores other factors, however, is also shown by the increasing apprehension due to so-called medical malpractice.

If, on the one hand, it is done in such a way that nothing can actually happen and everything is very safe, damages and disadvantages in the sterile environment of hospitals are the big exception to the rule, on the other hand, it is not surprising that patients grow at the other end of the spectrum who demand perfect births and believe that errors, failures and human inaccuracy should never happen.

How such a way of thinking can be perceived as legitimate at all is due to a habitus that has been established since the beginning of medical technological progress, according to which the treatment of people with human beings is increasingly threatening to become an obedience and reading of measurement data and has already occurred in parts, since a diagnosis can no longer be made without a diagnostic device. There is no doubt that an imbalance has arisen between the art of healing and technically oriented diagnostics.

If you consider that big-city hospitals are profit-oriented companies, you can see the second major factor of influence: money.

Not that diagnostics and measuring instruments are not needed.

But if the people involved behave as if they were already in the courtroom, where can be expressed and outlived what is needed on a humane basis?

What is the answer to this question?

Are we infected by the fact that life and death must be controllable?

Is it true that we now believe that pain and death are unacceptable? Is something like "fate" an infamous word, which should not be kept in the mouth by a doctor?

„Risk minimization" is a term from the insurance industry and I suspect that „quality management“ also comes from the same direction. This strict, rigorous adherence to the standards of risk mitigation suffocates creativity. Without scientifically proving this and speaking from my own professional experience, I can only say that my mind becomes extremely sluggish when it comes to having to walk on cautious feet. Constant reassurance inhibits the drive to perform routine tasks and not to see one's human abilities appreciated, because devices take away one's thinking and interpretation, reduces one's own vigilance and at worst leads to boredom. The needs of people - such as recognizing signs of complications to be able to feel spiritual flexibility and responsibility in oneself towards each individual person exposed, to be able to inspire confidence through a well-founded knowledge of the processes in the human body and the interaction with the mind - are important.

In an environment where some people think they are too little and others too confident, I suspect that talents are slumbering or fall asleep rather than being awakened. If I have to memorize and actualize a list of instructions before I go to work, justify my actions in front of the supervisors or superiors, justify my concern not to make mistakes, inhibit me or make me feel insecure, it is more likely that I do not like all this and that I can only be convinced by self-deception that all this is correct and regulated for safety's sake. In addition, as a midwife, I do not only accompany a mother during a shift, I either catch the women in the middle of labour or at the beginning or the end of the birth of their children. Participating in the whole process is then rather dependent on chance, but not part of my own plan.

I think for understanding I needed to use this overdoing.

It would certainly be worthwhile to say that this is about “protecting life“. This is done by advertising and polishing the image of a sparkling clean hospital apparatus in the outside world. Where one sends the success rate speech to the world. Saving lives at all costs has a price.

The guilt issue, which seems to float over everything as soon as something goes wrong. The painstaking search for errors, the reconstruction of a course of action, the question of who is really responsible: a tormenting affair in which courts, experts, academics, concerned persons, witnesses and so on are consulted. How much energy and potential is invested in a thing where the last incalculable risk has to be taken into account. Where there's a lot of losers in the end. Who are the winners? The women who give birth? The midwives, the doctors? The hospital and its management? The insurance companies? Maybe it's the shareholders?

In the case of the midwife mentioned above, it is not the parents. Certainly not the midwife. The insurance company is not happy either. Is it the judge who finds such cases cheer up his life? Is it the society that says,"Well, that's right“, but at the same time pais for all this. Does anyone who deals with or has to deal with such matters actually has the impression that everyone has done a good job here?

Not me. As if this were all a gigantic job creation, in which countless hours of work and payroll were created and the machine practically keeps itself up and running and with each new case of compensation enforcement the contributions continue to climb, the daily rates are adjusted, the risk assessment begins anew.

It seems that everyone has quite a bit of respect for it and therefore it makes sense, superficially speaking, not to let legal disputes arise in the first place. Inevitably, avoidance strategies are needed and you don't really know where the starting point is, because a circle is closing. Shouldn't the plaintiffs be the ones who have insight and decide to deal with the consequences of a failed birth or operation and prefer to consult therapists or counsellors, family and relatives instead of lawyers. Or would the hospitals have to change their attitude? What about the health insurance companies?

In fact, it would need a fund through the community (society) where a family or a mother does not have to remain alone with all the consequential costs of harming her child or herself. A catchment basin, where it is not the fault that is being asked for, but where it is important that an accident has occurred and that one can cope with such an accident with humanity and the assumption of treatment costs of both physical and psychological nature.

I would like to hear, what you say and if Germany is similar to what happens in your country.

This article was for information and for help in deciding the location of birth. If this is still possible. When you are having the same mindset as I do than a hospital is probably not the right place.

Please complete it with English Websites which underline my article because my links are mostly German. Thank you.

I feel for all those women who have difficulties to find an independent midwife to support her. I feel deep sympathy and admiration for all the midwives who had helped children being born and left behind satisfied and proud mothers and families.

I wish I would live in a world where babies can be born in their homes and it would be just normal and not an „ideology“.

As for the most Links in the article the language is German, I apologize. Maybe I will take time to do research in English, but I will not promise.

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Credits for photo material:
Leandro Cesar Santana on Unsplash
Janko Ferli? on Unsplash
Daniel Frank on Unsplash
Oleg Savenok on Unsplash
Joel Filipe on Unsplash
Carlo Navarro on Unsplash
Muhd Asyraaf on Unsplash
JOHN TOWNER on Unsplash*