midwife

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Midwife (from Old High German  Hev (i) anna  , 'ancestor / grandmother who lifts / holds the newborn'; hyphenation: Heb-amme / pronunciation: ˈheːp-amə, ˈheːbamə ) - technically also Obstetrix (from Latin obstare , stand-by ) and earlier also Wehmutter , is the job title for non-medical persons who advise and care for pregnant women or women who have recently given birth during pregnancy, childbirth , during the puerperium and even later. In Germany, male midwives held the professional title of obstetrician until the end of 2019 .

history

antiquity

Pharaoh's Daughter - The Finding of Moses by Edwin Long

Midwife is one of the oldest female professions. Temple paintings of the triplet birth of the pharaohs children of the Egyptian sun god Re from the third millennium BC are one of the oldest testimonies of midwifery.

At the beginning of the story about Israel's exodus from Egypt into the land of Canaan promised to the parents by the God Jehowáh , it says in Exodus :

“And God did good to the midwives; and the people increased in number and became very strong. And it was because the midwives feared God, so he made them houses. "

It can already be seen in the Old Testament that the work of midwives is not just a solidarity-based help that women provide to one another, but a social institution of specialist women. In ancient times it was the custom that only women could become midwives who had already given birth themselves but who, because of their age, could no longer become pregnant themselves. This custom was intended to ensure that midwives were available at all times and that their own birthing experience enabled them to provide obstetrics . The essential tasks of the midwife during Socrates' lifetime included stimulating and reducing labor , delivering the child, marriage mediation and abortion . Socrates names analogues for all these activities in his pedagogical method, maeutics . What is meant is that one helps a person to gain knowledge by asking suitable questions to induce them to find out the relevant facts for themselves and thus to “give birth” to the insight. Socrates compared his art of conversation with the midwifery art practiced by his mother Phainarete. In contrast to midwives, according to Socrates, there is also the judgment of the fruit, whether it should stay alive and be reared or not - a right that the father exercised in Athens at this time. Even with the Romans, the family fathers alone determined whether the newborn baby placed at his feet by the midwife was worthy of life. If he picked up the child and let his feet touch the ground, he became a member of the family and society. If this did not happen, it was abandoned on the Aventine Hill or on the Columna Lactaria (English column of milk, also known as the baby column). The new skills of midwives were dear to the Greeks and Romans. If one of the numerous slaves or dancers of the upper class became pregnant, their owners paid close attention to a good delivery. Because offspring drove up the price of women. The first midwifery textbook Gynaikeia was written around 117 by Soranos of Ephesus . This textbook was reissued around 220 by the Greek doctor Moschion. For the first time, it summarized the standards of obstetrics and thus significantly advanced the subject. It is believed that Soranus compiled his work from the traditions of midwives, after all, doctors were not allowed to touch the female genitals and not be allowed to attend a birth.

The Proto-Gospel of James , probably written around the middle of the 2nd century AD, reports on the occasion of the birth of Jesus that one of the two midwives present, Salome, wanted to examine the virginity of Mary, whereby her hand withered, but healed again when Jesus touched the diaper - a motif that was also represented in art, e.g. B. around 543/553 on an ivory relief on the Maximianskathedra in Ravenna or by Robert Campin around 1420/30.

middle Ages

At the end of the 11th century the doctor Trotula of Salerno wrote several works, including a. Passionibus Mulierum Curandorum (also known as Trotula Major ), a treatise on gynecology . In the European Middle Ages, midwives were increasingly obliged to meet moral theological requirements. It was their duty to personally baptize all newborns and to carry out emergency baptisms in the event of infant death during childbirth. If they were called to an unmarried woman giving birth, they had to research and report the ancestry of the newborn baby. If they gave birth to a disabled child, they had to report the mother. From 1310 the midwife was obliged by the church to baptize and take an oath to live a Christian life. With the same oath, they renounced both magical and abortion drugs. For this they were allowed to donate both baptismal and death sacraments. In the oath of the midwives of the city of Aachen it says:

"As long as I am a white woman, I should be faithful and gracious to my Lord Proffion (pastor) and announce all secret children to my Lord Proffion and the holy message and not carry any outside the city of Aachen or elsewhere to baptism."

In the late Middle Ages, professional regulations for midwives were created. From the 14th century, midwifery oaths are documented, which served the obligation of commercial midwives. In 1452 the first midwifery ordinance was issued in Regensburg. This created the status of sworn midwife and organized uniform training. From this time onwards, prohibitions and commands regulated the work of midwives in more and more regions. In 1491, the Ulm Midwifery Ordinance , which was drawn up for a long time by the medical officers Hans or Johann (es) Stocker (* around 1454; † 1513; city doctor of Ulm; author of Ulmer Wundarznei ), Johannes Münsinger and Johannes Jung, was approved only after examination their training and practical knowledge by doctors requires:

“The midwives should faithfully and diligently help the poor and the rich; even after the birth they should devote all care to mother and child. "

Early modern times

Midwives and witch hunts

Some writings have stigmatized midwives: After Pope Innocent VIII recognized the doctrine of witches in 1484, the Dominican Henricus Institoris wrote in the book Hexenhammer : "No one harms the Catholic Church more than midwives."

Contrary to popular belief, scientific witch research has long disproved the thesis that in the late Middle Ages and modern times , wise women, healers and midwives in particular were victims of witch hunts. Among the female victims, midwives and healers had no higher proportion than other groups of women. According to the Trier historian Franz Irsigler , of the approximately 800 female trial victims in the Trier area, documented for the 16th and 17th centuries, only three midwives were burned as witches.

Renaissance

Fig. From Chapter 4: A woman giving birth in a birthing chair.

The work The Pregnant Women and Midwives Rosengarten , published in 1513, was written by the doctor Eucharius Rösslin the Elder . It is the first important handbook on obstetrics in Germany and is based in particular on the works of Soranos of Ephesus. The 13 chapters contain 25 woodcuts made by Erhard Schön on which different child positions and a birthing chair are shown. Numerous new editions made the book the standard work for midwives for a long time. In 1568 Prussia decreed that midwives were no longer allowed to work drunk, since births in early modern times were often celebrations at which people ate and drank heavily. In the late Renaissance, midwives again fell victim to persecution. In Cologne alone, for example, almost all of the city's midwives were burned as witches between 1627 and 1639. The reason given here was the idea of ​​the fetus as an "inviolable fruit of God". The possible influence of the midwife on the fetus before, during and after the birth and the possible consideration of wishes of the expectant mother, such as a (late) abortion, contradicted this idea.

17th-19th century

In 1608, the French midwife Marie Louise Bourgeois published a textbook on obstetrics (midwifery book), which she had to defend against her male medical colleagues. When a patient dies of puerperal fever, which was not yet named, the midwife, who is the French heir to the throne, Louis XIII. on the world had helped fight off numerous hostilities. By scientifically documenting the methodology of her profession, she paved the way for obstetrics from the Middle Ages to the modern era.

Justine Siegemundin published another important midwifery book of the 17th century under the title Die Kgl. Prussian and Chur-Brandenburgische Hof-Wehemutter 1690. It appeared in several editions. In this first German textbook for midwives, Justina Siegmund described all the abnormal birth situations and suggested solutions. The book achieved a large number of copies and, due to the precision and the concise style of its author, was considered the standard work of midwifery teaching. She invented the "double handle" with which the birth is made possible when the child is lying sideways. The description and pictorial representation of the child's inner turn with the help of a noose is famous. When the Siegemundin reported on her experiences as a midwife in the 17th century, it was an unusual act that was hotly debated by doctors of the time.

In rural areas in particular, there was still a lack of qualified midwives in the late 18th century. The bailiff Carl Gottlieb Engel from Birkenfeld reported in 1784:

“So far there has not been an appointed, much less instructed, certified and sworn midwife here, but there are 3 to 4 women here, of whom this soon would have assisted those giving birth in child needs. But in the meantime the most suitable of these, namely the Schuz relative Caspar Schippel's wife, has been sent to Rentweinsdorf for training and, according to the testimony of the local physician, is to be recommended as the sole midwife for the localities of the baronial office in Birkenfeld. "

In Neustadt an der Aisch , from the 17th century to 1933, only two urban "nurses" were ever recorded.

In 1784 midwives had to complete training with the Rentweinsdorf doctor Hoffmann, which was subsidized by the poor. Only a few women answered, partly because of the poor solvency of the poor families with many children. For the first trained midwife in the area, the "Schipplische Eheweib" Maria Margaretha Schippel, a separate payment arrangement was made to secure the livelihood. In neighboring Wonfurt , the community paid the only trained community midwife a fixed salary and provided equipment such as “birthing chairs” .

In April 1779, academic obstetrics began in Jena, when the Accouchierhaus (from the French accoucher de “to be released from sb./sth.”, Meaning “to come down, to give birth”) was opened. After Göttingen it was the second maternity hospital in Germany. Its establishment had been decided the year before by Duke Karl August von Sachsen-Weimar-Eisenach (1757-1828), his minister Johann Friedrich Hufeland the Elder (1730-1782) and the Jena medical professor Justus Christian Loder (1753-1832). In 1817 a midwifery school opened in Eisenach. “The opening of the maternity centers in Jena (1779) and Eisenach (1817) meant a centralization of midwifery training that was previously unknown in Sachsen-Weimar-Eisenach. A fact that doctors and state theorists alike welcomed. "

In 1818 the first midwifery order regulated midwifery in the Kingdom of Saxony . In 1836, the Kingdom of Württemberg introduced the responsibility of municipalities for obstetrics by law. The community was responsible for the availability of a midwife; if necessary they were to be trained at their own expense in public midwifery schools - which were connected to a birthing center. But much earlier, Duke Ulrich von Württemberg admonished "that our senior and subordinate officers should appoint and accept pious, merciful, God-fearing and experienced women for such matters." And here, too, they should be examined beforehand and "researched," whether she […] was sufficiently knowledgeable, and learned, including the buechlin, the women's large garden called sampt other Hebammenbuechlin […] diligently read. ”On September 22nd, 1890, the first German midwives' day took place in Berlin with over 900 women. This was mainly about income. For since obstetrics became a compulsory subject for doctors in Prussia from 1850, midwives only earned starvation wages. The congregation also called for thorough disinfection in delivery rooms and birthing rooms . Contact infections with bacteria through the unwashed hands of the doctors, which cause the dangerous childbed fever , were detected by Ignaz Semmelweis as early as 1846 , but his findings were not recognized for decades.

How much doctors' attitudes towards obstetrics had changed at the beginning of the 19th century is shown in a letter from Marburg professor of medicine Georg Wilhelm Stein from 1801, in which he stated that academic teachers had to make the limits of their craft clear to midwives.

In 1886, assistant doctor Winter, who worked at the Royal Women's Clinic in Berlin, founded the Allgemeine deutsche Hebammen-Zeitung .

20th century to the present

In the 20th century the birth rate in clinics increased. The Reich Midwives Act of 1938 enacted state recognition of midwives and gave preference to home delivery . The midwives (as well as the pediatricians and the maternity wards in the clinics) were obliged to report malformations and diseases of newborn children and to observe the families.

In 1954 the English gynecologist Grantly Dick-Read invited midwives, doctors and journalists to a small private cinema in London and showed them a color film of female patients in the last phase of “natural birth” in his Johannesburg practice. This film was the first documentary proof that childbirth is not pain, but work and a completely normal and natural process. The women gave birth to their children without expression of pain, without fear or restlessness. At the 6th  Lindau Psychotherapy Week in 1955, under the motto of the Hamburg gynecologist Rudolf Hellmann, “More to the soul” in obstetrics was made a binding requirement.

The number of home births in Germany has decreased since the 1950s. One of the main reasons for this was that, since 1968, the cost of the birth has been covered by health insurance companies.

In the United States, midwife Ina May Gaskin and other midwives founded The Farm Midwifery Center in 1971 , one of the first out-of-hospital midwifery centers in the United States. The centre's methods were developed on the recommendation of the American College of Obstetricians and Gynecologists . Family members and friends are usually present and encouraged to play an active role in the birth. The center has been shown to have an extremely low rate of medical interventions and consistently good births for nearly forty years.

Home births supervised by midwives have been an exception in Germany since the 1970s. In some industrialized countries, the frequency of caesarean sections has increased significantly in recent years. In 2010 there were 209,441 caesarean sections in Germany, which corresponds to 31.9 percent of all 656,390 deliveries in hospitals. For comparison: in 1995 there were 131,921 caesarean sections and thus a share of 18 percent. In 2000 there were already 160,183 caesarean sections out of a total of 746,625 deliveries. This corresponds to an increase in the caesarean section rate of 31 percent by 2010, with a simultaneous decrease in all deliveries of 12 percent. There are regional differences. In Saxony, only every fifth child is born by caesarean section, in North Rhine-Westphalia (where 22 percent of children were born by caesarean sections in 2000) it was already 32 percent in 2012. New study results determine that in 2010 the rate of Caesarean sections in the districts and independent cities in Germany varied between 17% in Dresden and 51% in Landau in the Palatinate (three times as much). In Austria, almost every third baby was born by caesarean section in 2012 (31.5 percent), twice as often as 15 years ago. In some maternity clinics, the rate of caesarean sections is over 50 percent. The 'International Association of Gynecology and Obstetrics' ( FIGO ) expressed its criticism of this development in 1998.

"At present, due to the fact that there are no clear advantages, performing a caesarean section is not ethically justified for non-medical reasons."

In 1995, a textbook was published by midwives for midwives in Germany ( Midwifery. Textbook for pregnancy, childbirth, postpartum and work ). Midwifery training has been offered as a degree program in Austria since the 2006 winter semester and since 2008 in Switzerland.

Since the millennium, the premiums for the professional liability of the freelance midwives to the insurers have risen sharply and drive the midwives into existential need. The annual fees amount to over 6,800 euros (as of August 2016). An increase to 7600 euros for 2017 is expected. The premium increases are not due to increased claims , but are justified "by significantly higher amounts of damages and recourse claims by the social insurance institutions for medical treatment, care and pension payments" and the significantly longer life expectancy of children with birth defects.

As the historian Nina Verheyen emphasizes, the great responsibility that midwives bear has not - as in other professions - led to a high income, but rather to high insurance costs that a midwife has to bear himself. The very low pay in this area is "not the result of very poor performance, but of poor lobbying ".

Many midwives now limit themselves to childbirth preparation and postpartum care. Many have given up an important field of their work, obstetrics. In 2014 there was a lack of midwives everywhere in Germany for postpartum care, preventive care and childbirth care. Among other things, this acute undersupply also restricts the right to freely choose the place of birth: maternity wards and birthing centers are closing, freelance midwives are giving up (such as on Sylt).

On World Midwives Day 2010, the German Midwives Association launched a public e-petition . The demands were:

  • Preservation of local and low-threshold obstetric care and improvement of care for mothers and newborns,
  • Preservation of the freedom of choice of the place of birth for women,
  • Maintaining and expanding the supply of midwifery assistance,
  • Raising fees and salaries to a level that corresponds to the high level of responsibility that midwives assume.

After the subscription period expired on June 17, 2010, there were 105,386 electronic and 80,970 written signatures. Long after the subscription deadline, the German Bundestag received mail from all parts of the population. In total, over 200,000 people supported the midwives in their demands for a public e-petition.

Support groups formed throughout Germany (such as midwifery support , rescue of the midwives or parents' protest ), various demonstrations , vigils followed in recent years. Well over 430,000 people signed another petition to the Federal Government and Health Minister Hermann Gröhe "Save our midwives" since December 20, 2013 . However, although “comprehensive obstetrics” and “appropriate remuneration for midwives” are concerns of the grand coalition , the liability problem has not yet been resolved. In 2014 there was no offer of insurance and this would amount to a professional ban for freelance midwives. In addition to home birth midwives, all freelance (occupational) midwives who work in birth centers and clinics are also affected.

The number of midwives and obstetricians in Germany rose between 2001 and 2011 from around 16,000 to around 21,000. The proportion of part-time employees in hospitals rose. In 2013, a total of around 17,700 midwives worked as freelancers , of which 5410 (also) offered freelance obstetrics. In 2012, around 2,000 freelance midwives and obstetricians were working in hospitals. In a survey, around two-thirds of midwives and obstetricians said they only offer clinical obstetrics.

A midwife was present in 99.2 percent of hospital births in Germany in 2013. Of these, 88.8 percent were clinical midwives and 11.2 percent external midwives.

To form a name

Postage stamp (1956) from the series Helpers to Mankind

The word midwife is one of the few job titles that not only have a generic feminine , but even have no masculine. The synonymous terms Obstetrix , Wehemutter , Ammfrau , Sage femme and Midwife are feminine. Midwife from Old High German heb (i) ana , Middle High German heb (e) amme , is derived from hevan " heben " and ana " ahnin ", and describes the grandmother of the newborn.

In Germany in 1987 the term maternity nurse was introduced as a masculine term for people who work as midwives. The law on the reform of midwifery training repealed this regulation on January 1, 2020. The job title “midwife” now also applies to male professionals. In the draft law this was justified by the fact that the name maternity care worker was misleading. Maternity care only includes part of the midwifery work. Therefore, the male job title gives the impression that male midwives are not on an equal footing with their female colleagues.

Section 1 of the  Midwifery Act in Austria also prescribes midwives for male professionals: "The professional title midwife will therefore apply to both genders", since no constructive proposal for a male professional title was found, and since the explicit reference to the validity for both genders due to Art 7 of the Federal Constitutional Law (equality principle) and because of the EU Equal Treatment Directive to implement the principle of equal treatment for men and women with regard to access to employment, vocational training and career advancement . Shapes like "midhammer" are not allowed.

Areas of responsibility

Prenatal care

With the exception of ultrasound examinations, midwives are allowed to perform the full range of standard prenatal care , as offered by gynecologists, if the pregnancy is uncomplicated . H. from determining the pregnancy to issuing the maternity card to examinations with the CTG or the Pinard tube , smears, advice, etc. In addition, midwives offer pregnant women a wide range of advice and assistance with pregnancy problems. These include, for example, back pain, insomnia, coming to terms with traumatic birth experiences and general fears and fears of the pregnant woman in connection with the birth. In birth preparation courses , midwives provide a wide range of information and carry out practical exercises with the pregnant women on relaxation and breathing techniques that can be helpful during childbirth.

Obstetrics

In Germany and Austria, a midwife leads the normal birth from the onset of labor completely independently and on her own responsibility without a doctor (according to Section 4, Paragraph 1, Clause 2 (HebG / D) and Section 3, Paragraph 1–2 of the Midwives Act (HebG / Austria)). According to these laws, there is a duty to consult a midwife. This means that a doctor may only give birth without a midwife in an emergency. However, in a hospital with a gynecological clinic, a doctor must be present at the birth in order to meet the requirements of the guidelines.

In Austria, according to Section 3 (1) HebG / Ö, there is a so-called obligation to consult with pregnant women and not with doctors.

The midwife supports the woman giving birth in processing the contractions and must be able to recognize when the course of labor becomes pathological and, if necessary, be able to decide whether medical intervention is necessary. In the case of a spontaneous delivery, the midwife should be able to respond to special requests, e.g. B. the birth position of the woman in labor. In the event of irregular births, the midwife must be able to provide help independently in emergencies (e.g. with shoulder dystocia ) or, if necessary, to assist the doctor, including for caesarean sections .

The field of activity immediately after the birth includes the assessment of the newborn, the care and all necessary examinations of the mother and the newborn immediately after the birth, including the child screening examination U1.

Postpartum care

Care and monitoring throughout the puerperium of the newborn and child include advice and help on appropriate care and nutrition for the newborn , help with breastfeeding / breastfeeding advice, and treatment of breastfeeding problems. Other tasks include monitoring the regression processes and wound healing of birth-related vaginal and perineal injuries. Midwives also offer postnatal exercise , advice on social problems, and the prevention and detection of mental illnesses in connection with the birth process ( postpartum depression ).

Family midwives

A special area of ​​responsibility for midwives with additional qualifications is the care of families with medical and / or social risk factors. Family midwives look after families in special circumstances. This can be families with underage mothers / parents, for example, but also those with addiction problems or with single parents. Family midwives look after children - beyond the usual care period of a midwife - up to their first birthday. The background to this work is the avoidance of a potential child welfare risk.

Since 2006, these midwives have been prepared for their additional tasks in advanced training courses (at federal state level). They are employed by health authorities , independent welfare organizations , foundations, etc. or work freelance on a fee basis as employees of the youth welfare office .

In 2012 there were around 1,500 family midwives in Germany. Between 2012 and 2015, the federal government supported the work of family midwives with 177 million euros. This is considered to be one of the most sensible measures to support poor parents.

Others

Another field of activity before the birth is education and advice on the methods of family planning , in some cases midwives are also happy to be engaged by schools on a freelance basis for educational classes. The midwife's field of activity in the hospital also includes assistance and support in the event of abortions , miscarriages and stillbirths . The midwife is becoming more and more important in the field of nutritional advice. The diverse experiences gained from visiting different families enable women to receive good advice. Many midwives nowadays use alternative treatments such as acupuncture , homeopathy and laser therapy to treat pain before, during or after the birth . Midwives are also expected to make an initial assessment of whether a newborn is considered a “ screaming child” . Empathetic, empowering and soulful care are among the tasks of the midwife. During follow-up care, the child's weight development , which is also monitored by the doctor, is important.

Since the birth and the mother-child relationship is a very profound change in the life of a woman or a couple, which can lead to varied changes and problems, it is recommended and often necessary that women receive comprehensive early care from a midwife take advantage of.

The work of midwives in England in the 1950s is addressed by the BBC television series Call the Midwife .

Employment relationship

Freelance midwives

Freelance midwives work freely in prenatal care, home births and postpartum care and breastfeeding assistance. In many countries, the remuneration for this activity is paid by the health insurance companies with which the midwives settle directly. In addition, the freelance midwife can work as an attending midwife . In doing so, she works in a clinic , comparable to attending doctors . A steadily growing area of ​​work is prenatal care, partly in cooperation with gynecologists in a joint practice . There are also birthing centers and independent out-of-hospital facilities supervised by midwives.

In 2016 there were around 24,000 midwives in Germany, 1,776 of whom were self-employed.

Contractual relationship with the cost bearers in Germany

The contractual relationship with the cost bearers in Germany has been regulated since August 1, 2007 in the contract for the supply of midwifery assistance according to Section 134a of the Social Code Book V. The contract partners are the two midwifery associations in Germany ( German Midwives Association and Association of Freelance Midwives in Germany ) on the one hand and the National Association of Statutory Health Insurance Funds on the other.

This contract regulates:

  • the details of providing the insured with billable midwifery services
  • the remuneration for midwifery services
  • the billing of midwifery services
  • an agreement on the use and remuneration of materials and drugs
  • the participation of the midwives in this contract

It applies to all midwives who are members of one of the two associations, as well as to non-members if they have submitted a declaration of membership of the contract.

In 2010 the liability insurances increased their contributions from approx. 450 € / year to approx. 3,700 € / year. The reason is the increased costs for personal injury. This puts the midwifery profession at risk, as these insured sums are disproportionate to income. The midwives' association and other interested parties submitted a petition to the Bundestag. Of more than 4,000 freelance midwives, around ten percent canceled their insurance at the beginning of 2011. From July 1, 2012 the costs rose again and amount to 4200 € / year. Even after unsuccessful negotiations with the health insurance companies, the Federal Ministry of Health saw no “need for legislative action” in 2012. The rising insurance premiums are to be reimbursed in full to independent midwives. As of July 1, 2013, the premiums for BfHD members increased again by 10 percent. It amounts to 4,480 euros a year. As of July 1, 2014, the approximately 18,000 midwives of the DHV can also expect an increase in the double-digit percentage range.

The Nuremberg announced in February 2014 to withdraw from the last two consortia insurance for midwives as of July 1, 2015. As a result, the insurance market threatens to collapse. However , midwives are not allowed to work without professional liability insurance . To solve the problem, the German Midwives Association proposes the introduction of a state-financed liability fund. Furthermore, a generally higher remuneration for midwives is under discussion. Health Minister Hermann Gröhe in particular is calling for this to compensate for the rising costs of liability insurance.

On July 1, 2015, the contributions to professional liability insurance for freelance midwives who work in obstetrics rose to 6,274 euros per year. In June 2015, the German Midwives Association counted 150 freelance midwives who had given up their profession.

According to the Association of the German Insurance Industry, around 100 personal injuries were asserted against freelance midwives and maternity attendants in Germany in 2006 and 2011. The number of major personal injuries, with a loss of more than 100,000 euros per year, was put at an average of 12. Between 2003 and 2012, the mean claims expenditure for major personal injuries in the case of birth defects rose by an average of 6.6 percent to most recently 2.6 million euros.

Employed midwives

Employed midwives usually work three shifts in clinics . The main area here is the delivery room, but midwives are also often used in the maternity ward and in the children's clinic. As an alternative to a job at the hospital is also possible, in a non-hospital birth place to work. The main difference is that the focus is not only on the birth of the child, but care continues after the birth. In this case, it is also referred to as an aftercare midwife.

The remuneration of the midwives is regulated in the collective agreement. This varies depending on the carrier of the hospital and is about the same as a nurse's salary .

Men in the midwifery profession

Since 1985, men have also been allowed to practice midwifery in Germany and Austria; In both countries, the professional title of midwife is also legally stipulated for men.

In Switzerland, training and professional practice are also possible for men.

In Austria there has been a midwifery student since 2016, in Germany there were three practicing male maternity carers in January 2013. In Belgium there are at least ten. In the Netherlands there are more than 50.

education

Austria

In Austria, in the course of the Bologna Process, the transition to university training with an academic degree took place. In the winter semester of 2006, the first classes started at the FH Joanneum , the Salzburg University of Applied Sciences and the Krems University of Applied Sciences. In the following year, the first class began at the FH Campus Wien with the bachelor's degree in midwives.

Germany

There are 58 midwifery schools in Germany, each attached to a clinic. The training lasts three years and consists of a 1,600-hour theoretical and a 3,000-hour practical part. The school theory part consists of a. from obstetrics, anatomy , physiology and pediatrics . The practical part of the training mainly takes place in the clinic in the delivery room , on the maternity ward, in the children's clinic and in the operating theater. It is possible for a nurse to shorten the training to two years.

After a change in the law on June 19, 2008, there is no longer a minimum age for admission to a midwifery school .

The training ends with the state exam. This exam consists of an oral, a written and a practical exam (including the birth of the exam). The prerequisite for training is a secondary school leaving certificate with at least two years of vocational training or secondary school leaving certificate.

So far, the trainees only get to know the work of a freelance midwife in a two to four-week day school. For this reason, an internship with an independent midwife after training is often recommended, especially if home births are to be offered. Employment offices and midwifery schools provide information on the exact course of training and the remuneration, which is based on the applicable collective agreements.

Efforts are underway (as of 2019) on the part of midwives to raise education to university level. In particular, the amended EU Professional Recognition Directive 2013/55 / ​​EU also requires changes in German midwifery training. In August 2019, the midwifery associations made positive comments on the draft law on the Midwifery Reform Act, which was passed on November 22, 2019 ( Federal Law Gazette I, p. 1759 ). They consider the upgrading of German midwifery training through academization and raising it to a European level as groundbreaking.

Switzerland

Midwifery training in Switzerland was transferred to the tertiary level and since autumn 2008 has included a bachelor's degree at a university of applied sciences. Training locations are Bern , Geneva, Lausanne and Winterthur . Those who successfully complete the bachelor's degree are entitled to hold the title of Bachelor of Science [FH] midwife . The bachelor's degree is recognized in Switzerland, is compatible with Europe and is internationally recognized as a university degree.

Previously, the midwife training was at higher technical schools , the last training began in 2007 and will expire (status: 2010). "Catch-up courses" are offered so that HF ​​graduates can also take the path to a technical college degree.

See also

literature

About the job profile today:

  • Angelica Ensel: Midwives in the field of conflict of prenatal diagnostics - between demarcation and compassion. Midwife Community Aid , Karlsruhe 2002, ISBN 3-934021-10-7 .
  • Angelika Ensel, Silke Mittelstädt: Prenatal diagnostics and midwifery work. Ethical questions and areas of conflict in the care of pregnant women, childbearing women and women who have recently given birth. 1999.
  • Shirley R. Jones: Ethics and Midwifery Practice. Huber, Bern 2003, ISBN 3-456-83931-6 .
  • Eva M. König: Prenatal Diagnostics. A working aid for midwives and everyone who advises pregnant women. Midwife Community Aid Karlsruhe e. V., 2000.
  • Christine Lammert: Psychosocial counseling in prenatal diagnosis. A practical guide. Hogrefe, Verlag für Psychologie, Göttingen 2002, ISBN 3-8017-1645-7 .
  • Barbara Maier: Ethics in Gynecology and Obstetrics. Decisions based on clinical case studies. Springer, 2000, ISBN 3-540-67304-0 .
  • Eva Schneider: Family midwives. Taking care of families with risk factors. Mabuse-Verlag, Frankfurt 2006, ISBN 3-935964-53-6 .

Historical-cultural debate:

  • Silke Amberg: Midwifery regulations in German cities around 1500. (PDF; 680 kB) Freiburg 2003. A critical examination of the history of midwives and the midwifery regulations around 1500.
  • Sibylla Flügge: Midwives and healing women: Law and legal reality in the 15./16. Century. 2000, ISBN 3-86109-123-2 .
  • Rosalie Linner: Always on the go. Memories of a country midwife. Rosenheimer, 1993, ISBN 3-475-52765-0 .
  • Angela Gehrke da Silva: As a midwife in Brazil. The adventurous life of a brave woman. Urachhaus publishing house, Stuttgart 2003, ISBN 3-8251-7418-2 .
  • Kirsten Tiedemann: Midwives in the Third Reich. About the professional organization for midwives and their professional policy. Mabuse-Verlag, Frankfurt am Main, 2001, ISBN 3-933050-69-3 .
  • Marianne Grabrucker: About the adventure of childbirth - the last country midwives tell. Life and work reports of the last country midwives. Fischer, 1989, ISBN 3-937524-17-7 .
  • Dominik Groß: “Deprofessionalization” or “Paraprofessionalization”? The professional development of midwives and their status in obstetrics in the 19th century . In: Sudhoffs Archiv , 83/2, 1998, pp. 219-238
  • Martina Fahnemann, Gereon Schäfer, Dominik Groß: The development of the midwifery profession under the influence of scientific, medical and ideological influences (1800–1945) . In: Dominik Groß, Gertrude Cepl-Kaufmann, Gereon Schäfer (Ed.): The construction of science. Contributions to the history of medicine, literature and science , Kassel 2008 (= studies of the AKWG, 3), ISBN 978-3-89958-418-9 , pp. 213-237.
  • Irmtraut Sahmland: midwife / midwifery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte . De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 540 f.
  • Hans-Christoph Seidel: A new 'culture of childbirth': the medicalization of birth in the 18th and 19th centuries in Germany. (Phil. Dissertation Bielefeld) Franz Steiner, Stuttgart 1998 (= Medicine, Society and History , Supplement 11), ISBN 3-515-07075-3 .
  • Marie-France Vouilloz Burnier : Midwives. In: Historical Lexicon of Switzerland .
Reports

Web links

Commons : Midwives  - Collection of pictures, videos and audio files
Wiktionary: Midwife  - explanations of meanings, word origins, synonyms, translations
Wiktionary: Obstetrix  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Charlotte Franke : History of the midwife. Venerated as saints, demonized as witches . In: Süddeutsche Zeitung , July 29, 2012.
  2. ↑ Till Magnus Steiner: One of the oldest trades in the world. An Old Testament appreciation of the midwifery profession .
  3. ↑ Manuel Sattler: Socrates as a midwife !? Retrieved February 24, 2014.
  4. ↑ Gernot Böhme: The Socrates type. ; Suhrkamp, ​​Frankfurt am Main 1988, ISBN 3-518-57925-8 , p. 134.
  5. ↑ L. Höpfner: Deutsche Encyclopädia or General Real dictionary of all arts and sciences , 6th volume. Barrentrapp son and Wenner, Frankfurt am Main 1781.
  6. ^ F. Stadelmann: Education and instruction with the Romans . Verlag FH Schimpff, Trieste 1891.
  7. ↑ Maria Paula Segoloni: Concordantiae Gynaeciorum Muscionis . In: Alpha - Omega: A series, lexicons, indices, concordances on classical philology . Olms-Weidmann, Hildesheim / Zurich 1993, ISBN 3-487-09787-7 , p. 149.
  8. ↑ Marlies Buchholz: Anna Selbdritt: Pictures of a powerful saint. Langewiesche Nachf. Köster, Königstein i. Taunus 2005, ISBN 3-7845-2113-4 , pp. 58-70.
  9. ↑ Karin Maringgele: Trotula . In: Association for the social history of medicine (ed.): Virus - Contributions to the social history of medicine 3 ; LIT-Verlag Vienna, 2004, ISSN  1605-7066
  10. ^ HJ Groß: Contributions to the history of the Aachen empire . Kaatzer Verlag, Aachen 1894
  11. ↑ Imrtraut Sahmland (2005), p. 540.
  12. ↑ A. Schneider: Citizenship, Law and Professional Studies for Specialized Professions in Health Care . 6th edition, Springerverlag, Berlin 2003
  13. ↑ Jürgen Martin: The Ulm surgeon Johannes Stocker and his nosologically structured pharmacopoeia. In: Würzburg medical history reports. Volume 5, 1987, pp. 85-95.
  14. ↑ Jürgen Martin: The ›Ulmer Wundarznei‹. Introduction - Text - Glossary on a monument to German specialist prose from the 15th century. Königshausen & Neumann, Würzburg 1991 (= Würzburg medical-historical research. Volume 52), ISBN 3-88479-801-4 (also medical dissertation Würzburg 1990).
  15. ^ Gundolf Keil : Stocker, Hans. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil, Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1361.
  16. ↑ Ilse Schulz: Sisters - Beguines - Masters. Hygieia's Christian Daughters in a City Healthcare. A contribution to the history of nursing and medicine. 30 documents . Universitäts-Verlag Ulm, Ulm 1992. ISBN 3-927402-61-3
    Ilse Schulz: Blown traces. Women in the city's history . Süddeutsche Verlagsgesellschaft, Ulm 1998. ISBN 3-88294-264-9
  17. ↑ Werner Tschacher: Kramer, Heinrich (Henricus Institoris) . In: Gudrun Gersmann, Katrin Moeller and Jürgen-Michael Schmidt (eds.): Lexicon for the history of witch hunt . In: historicum.net; July 2008
  18. ↑ J. Hansen: Sources and studies on the history of the witch madness and the witch hunt in the Middle Ages . Bonn 1901; Reprint Hildesheim 1963
  19. ↑ Walter Rummel : Wise Women as Victims of the Early Modern Witch Persecution?
  20. ^ Hans Ottomeyer, Rosmarie Beier-de Haan, Hexenwahn , preface to the exhibition in the German Historical Museum, Berlin
  21. ^ Franz Irsigler: midwives, healers and witches
  22. ↑ Britta-Juliane Kruse: New discovery of a handwritten preliminary stage of Eucharius Rößlin's midwifery textbook “The pregnant women and midwives Rosengarten” and the “women's booklet” Pseudo-Ortolf. In: Sudhoffs Archiv 78, 1994, pp. 220-236.
  23. ↑ Eucharius Rösslin: Gynaecia Mustionis , the midwifery catechism of Mustio (German and Latin) & Eucharius Rösslin's "Rosengarten", volumes 1 and 2 ed. By Helmut H. Hess. Haag and Herchen, Frankfurt a. M. 1997. ISBN 3-86137-568-0
  24. ↑ Martha Schad: Women who moved the world . Pattloch Verlag, Munich 2000. ISBN 3-629-01628-6
  25. ↑ Günther Geiling: Field name card has pilot character. In: mainpost.de , April 3, 2013.
  26. ^ Max Döllner : History of the development of the city of Neustadt an der Aisch up to 1933. Ph. C. W. Schmidt, Neustadt a. d. Aisch 1950, OCLC 42823280 ; New edition to mark the 150th anniversary of the Ph. C. W. Schmidt publishing house, Neustadt an der Aisch 1828–1978. Ibid 1978, ISBN 3-87707-013-2 , p. 528.
  27. ↑ Quoted from Thomas Schindler: Time travel through the Haßberge and the Main Valley. Historical Association of the District of Haßberge e. V., Supplement 8, ISBN 3-938438-16-9 , p. 25.
  28. ↑ From the Accouchierhaus to the Perinatal Center ; ( Memento from April 25, 2012 in the Internet Archive ) University of Jena, accessed on February 24, 2014.
  29. ↑ Stefan Wolter: "... does not force me to go where I should be forgotten of all modesty". From the beginnings of the Jena maternity hospital. In: Christine Loytved (Ed.): From the Wehemutter to the midwife. The establishment of midwifery schools with a view to their political value and their practical use. (= Women's health. Volume 1). Osnabrück 2001, pp. 79-96.
  30. ↑ Ibid., P. 81
  31. ↑ Law on the binding nature of the municipalities with regard to obstetrics of July 22, 1836, in: Government Gazette for the Kingdom of Württemberg 1836 No. 34, p. 312f.
  32. ↑ Duke Ulrich von Württemberg: First Police Order of June 30, 1549, midwives . In: G. Zeller (Ed.): Collection of the Württemberg government laws . tape 1 . Tübingen 1841, p. 160 .
  33. ^ Heinrich Fritsch : General German midwife newspaper. In: Centralblatt für Gynäkologie. Volume 10, No. 43, October 23, 1886, pp. 697 f.
  34. ↑ Grantly Dick Read: Birth is Labor . In: Der Spiegel . No. 23 , 1955, pp. 30-37 ( online ).
  35. ↑ Melanie B. Weber: The 10 best reasons for a home birth ( Memento of the original from November 10, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . ten.de. The best lists; October 11, 2011 @1@ 2Template: Webachiv / IABot / www.zehn.de
  36. ^ Lectures of the 1st Congress of the German Midwives Journal (DHZCongress) from September 7th to 8th, 2012 in Hanover
  37. ↑ Almost a third of all hospital deliveries by caesarean section ( memento of the original from November 15, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. ; Press release No. 098 of the Federal Statistical Office of March 19, 2012 @1@ 2Template: Webachiv / IABot / www.destatis.de
  38. ↑ Share of deliveries by caesarean section rises to almost 30% ( memento of the original from June 10, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Press release of the Federal Statistical Office of February 7, 2007 @1@ 2Template: Webachiv / IABot / destatis.de
  39. ↑ Fact check caesarean section . Caesarean section births - development and regional distribution . Bertelsmann Foundation, 2012
  40. ^ Düsseldorf: The number of caesarean sections is increasing . dpa article on RP-Online from December 23, 2013.
  41. ↑ Every third birth with caesarean section. The caesarean section is becoming increasingly popular, but it has secondary problems for both mother and child. In: Kurier.at , November 23, 2012.
  42. ↑ FIGO, Committee for the Ethical Aspects of Human Reproduction and Women's Health: Statement of the Committee on the publication of the present ethical guidelines 1998 . In: Obstetrics and Gynecology , 59, 1999, pp. 123–127
  43. ↑ Christine Geist, Ulrike Harder, Gisela Kriegerowski-Schröteler, Andrea Stiefel: Midwifery. Textbook for pregnancy, childbirth, postpartum and work . Walter de Gruyter. Berlin / New York 1995. ISBN 3-11-013764-X . 5th edition October 2012
  44. ↑ hebamme.ch ( Memento of the original dated February 22, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.hebamme.ch
  45. ↑ a b Midwives: Working for liability. Spiegel Online, June 25, 2012.
  46. ↑ Midwives ask for help . ( Memento from August 29, 2016 in the Internet Archive ) br.de, contribution from August 14, 2016
  47. ↑ Insurance costs for midwives . Bundestag.de, March 18, 2014.
  48. ↑ Bernd Kramer: Achievement at work: How unfair is that? In: time online. April 18, 2018. Retrieved April 28, 2018 .
  49. ↑ Map of undersupply with midwifery help . Hebammenverband.de, June 26, 2014.
  50. ↑ Obstetrics: Lawyers conquer the delivery room . FAZ.de, May 11, 2014.
  51. ↑ Successful e-petion: More than 200,000 people support midwives in their demands
  52. ↑ Dear Mr. Gröhe (@ gröhe) Save our midwives
  53. ^ Concern for comprehensive obstetrics In: Bundestag.de , March 20, 2014.
  54. ↑ Obstetrics is about to end In: Die-Tagespost.de , November 7, 2014.
  55. ↑ a b German Bundestag (ed.): Answer of the federal government to the minor question from the MPs Cornelia Möhring, Birgit Wöllert, Sabine Zimmermann (Zwickau), other MPs and the DIE LINKE parliamentary group. - Printed matter 18/738 - Economic situation of midwives and obstetricians . No. 18/900 , March 21, 2014, ISSN  0722-8333 , p. 4, 12, 13 ( bundestag.de (PDF)).
  56. ↑ German Bundestag (ed.): Answer of the federal government to the small question of the MPs Birgit Wöllert, Sabine Zimmermann (Zwickau), Katja Kipping, other MPs and the parliamentary group DIE LINKE. - Printed matter 18/2249 - Development of the Caesarean section rate . tape 18 , no. 2365 , August 18, 2014, ISSN  0722-8333 , p. 11 ( bundestag.de (PDF)).
  57. ^ Meyers Enzyklopädisches Lexikon , Volume 31, p. 1168; according to Allmer
  58. ↑ § 3
  59. ^ RV 1461, XVIII GP, page 27
  60. ↑ Section 4 (1) sentence 2 HebG / D
  61. ↑ The chance lie . In: Der Spiegel . No. 20 , 2015, p. 66-73 ( online ).
  62. ↑ Midwives and obstetricians - number in Germany up to 2016 | Statistics. Retrieved May 5, 2018 .
  63. ↑ Laura Ihme: Parents association alarmed: number of midwives is falling. Retrieved May 5, 2018 .
  64. ↑ Contract for the supply of midwifery help (Germany)  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 58 kB)@1@ 2Template: Toter Link / www.saechsischer-hebammenverband.de  
  65. ^ Association of Midwives , accessed on February 2, 2012.
  66. ↑ Claus Peter Müller: Midwives: Helping giving birth is no longer worthwhile. Frankfurter Allgemeine Zeitung, June 29, 2010; Retrieved February 2, 2012.
  67. ^ Message on welt.de of July 28, 2012 , accessed on July 28, 2012.
  68. ↑ "Let action follow words, Mr. Gröhe!" Press release of the German Midwives Association from February 20, 2014.
  69. ↑ Midwives fear for existence: liability insurance before the end. February 17, 2014, accessed April 2, 2014.
  70. ↑ No solution in sight for midwives yet. Retrieved April 2, 2014.
  71. ↑ Professional liability insurance for midwives
  72. ↑ Liability premiums rose again. Existential fear midwives. ( Memento from July 5, 2015 in the Internet Archive ) At: Tagesschau.de. July 2, 2015, accessed July 6, 2015.
  73. ↑ Career and prospects as a midwife. Retrieved December 15, 2017 .
  74. ↑ a b "You are not what they expect" . In: Midwife Forum , ISSN  1611-4566 , pp. 619-622.
  75. ↑ § 3
  76. ↑ § 1 Midwifery Act
  77. ↑ Midwife with a beard: In Switzerland, the first maternity nurses are in training . Neue Zürcher Zeitung , March 20, 2005
  78. ↑ Children fetch with a cool head
  79. ^ Midwifery Forum, 8/2008
  80. ↑ Directive 2013/55 / ​​EU of the European Parliament and of the Council of November 20, 2013 amending Directive 2005/36 / EC on the recognition of professional qualifications and Regulation (EU) No. 1024/2012 on administrative cooperation with the help of the internal market Information system ("IMI Regulation")
  81. ↑ Open letter from the midwifery associations on the academization of the midwifery profession. In: www.hebammenverband.de. August 23, 2019, accessed September 14, 2019 .
  82. ↑ Website of the Swiss Midwifery Association - Training section ( Memento of the original from February 22, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.hebamme.ch
  83. ↑ Training as a midwife from 2008 at the University of Applied Sciences (PDF; 142 kB)
  84. ↑ Bern University of Applied Sciences, 16 midwives graduated ( Memento of the original from September 24, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 29 kB) @1@ 2Template: Webachiv / IABot / www.gesundheit.bfh.ch
  85. ↑ Universities of Applied Sciences in Switzerland ( Memento of the original from January 21, 2011 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.hebamme.ch
  86. ↑ Ursina Hulmann: Further training midwives catching up. Interview Regula Hauser ( Memento of the original from April 18, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Zurich University of Applied Sciences, accessed on February 24, 2014. @1@ 2Template: Webachiv / IABot / www.gesundheit.zhaw.ch