"In general, the system is good, but things have changed a lot in the last years and there are still bad news for the future. The independent midwives situation is very hard in the moment in Germany and only political measures can change this. In the last years midwives who offer birth services, had to pay increased liability fees and many of them had to quit their jobs. The Beleghebamme( offering continuous support during pregnancy, birth and postpartum time for a hospital birth) is almost a memory and in many regions there are no longer homebirth midwives or birth centers to serve women who want such births. The finishing stroke came in the beginning of 2014, when independent midwifes found out that no insurance company accepts their liability insurances anymore starting 2015, meaning that there will be no more homebirths, birth centers, postpartum visits, subsidized childbirth education classes and another courses for mom and baby. What will happen with the right of women to choose the place where to birth? What about educating expectant parents and restorative gymnastic for moms? Who will tell the new moms that they are doing well what theyre doing? Mothers, fathers, midwives, doulas and birth activists have already started petitions and protests, hopefully we will have a resolution in the next period of time. " (SP, April 2014)
What is positive birth and when/why was it founded?
Positive Birth Movement was founded in October 2012 by Milli Hill, a mother of three small children and a freelance columnist, from the U.K. Milli thought that many women do NOT have currently positive births and that by sharing information, we might empower each other, thus facilitate change. Well, her attempt ended in a network of 176 groups worldwide, including ours in Hamburg, Germany. This tells a lot about its necessity and success. According to Positive Birth Movements website: www.positivebirthmovement.com, positive birth means ...a birth in which a woman feels she has freedom of choice, access to accurate information, and that she is in control, powerful and respected. A birth that she approaches, perhaps with some trepidation, but without fear or dread, and that she then goes on to enjoy, and later remember with warmth and pride. The aim of the organization is to challenge the epidemic negativity around childbirth by bringing women together, support them and empower them to approach birth differently.
What is a positive birth group and whereabouts in Germany do you meet?
Currently, there is only one Positive Birth group in Germany and I hope to see more in the near future. Positive Birth Group provides a free monthly meeting where we inform and empower international women living in Hamburg for having joyous pregnancies and birth experiences. New mothers attend our meetings too, telling their positive stories, which is a great thing! So many times pregnant women hear horror stories about birth nowadays and this is not helping them. Not to mention that often, international women find camaraderie and new friends in our group, a community that supports each other! We meet in Hamburg at Mütterzentrum Hohenfelde, Cafe Mütze - Ifflandstraße 69 (im Hinterhof), 22087 and we announce the meetings via our Facebook group: https://www.facebook.com/groups/positivemovementhamburg/, where we also share articles, thoughts and encouragement for our members.
Is positive birth mainly for Expats in Germany or do many German mums attend the sessions?
Positive Birth Hamburg was initiated by Emma Vassalo, an Australian woman, mother of two, doula and massage therapist who lives in Hamburg. She saw the international womens need for extra support in dealing with a new culture, language and medical system, so the first meeting took place in December 2012. Ive found Positive Birth myself in September 2013 and I decided to join and contribute. By the end of the year 2013, Emma proposed me to take over the group, as she is traveling to Australia for one year. So here I am, Simona Pickhardt, born in Romania, living for almost 4 years in Hamburg, mother of three, doula and Hypnobabies®Instructor. In a typical session, we have a topic that we discuss or simply listen to everybodys thoughts and stories, dispel concerns, exchange information about childbirth, health providers and places of birth and of course having a great time knowing each other. We had an atypical meeting in January, when weve painted pregnant bellies...that was fun! The attendees are women from all over the world living in Hamburg. I remember that one there was also a German woman among us. The meetings are open and free for anyone who want to come, but we use English as communication language.
How do you feel attending the positive birth groups can help a mother during labour?
Well, I think the most important element in our meetings that can help pregnant moms is hearing positive birth stories from other moms. In our culture, we hear most of the time from different channels (media, doctors, even from our well-intentioned relatives and friends) not so encouraging things about childbirth. In the last century, we were conditioned to believe that childbirth is a dangerous, medical event in a womans life, which is not entirely true. Most of the women have healthy, risk-free pregnancies, all they need is encouragement, support and education, which we hopefully provide within our meetings and Facebook group.
You also work as a hypno doula could you define for our readers the definition of a hypno-doula and the services a hypno doula offers women?
Well, I am a doula and a hypno-doula and I would like to define both. A doula is a non-medical trained professional who provides physical, emotional and informational support to women in late pregnancy, during birth and postpartum time. During labor, the doula will make non-medical suggestions such as breathing, relaxation, positioning, will provide massage or special techniques that help alleviate discomfort. Studies show that when doulas are present at birth, women have shorter labors, fewer medical interventions, fewer cesarean sections and healthier babies. Birth partners find doulas great too, because they become more relaxed and confident in their abilities to help the mother. Doulas meet with parents prior birth few times, have continuous contact via telephone and email and offer an on-call status 14 days before estimated dues date and 14 days after this date. She stays with the birthing mom from the onset of labor, until 3 hours after birth. Doula will make a postpartum visit in the next few days/weeks after birth and will offer resources, information and encouragement to the new parents in this very special time of their life. A hypno-doula is a special trained doula that assists families who choose to use hypnosis for childbirth. No matter what method they will practice, a hypno-doula is aware of the special language used during birth, makes sure that the atmosphere is calm and quiet and uses special tools and cues to maintain the mothers state of hypnosis. Hypnobabies® is the only organization that certifies hypno-doulas and I am also one of the only two Certified Instructors teaching the 6 weeks/3 hours a week childbirth education course in Europe. You can learn more about this here: www.hypnodoula.de.
Why do women choose to work with a doula?
As 95% of births in Germany take place in a hospital, the need for continuous and emotional support is very obvious. Either they are expecting their first child or they want to make a difference the next time around, the doula is that best friend whos main interest is that mothers wishes are met. Of course midwives are wonderful assisting births in hospitals in Germany, but sometimes caring for more women at once or changing shifts, do not permit them to offer continuous support. While doctors and midwives take care of mothers and babys medical well-being and intervene if complications arise, doulas are there mothering the mother, assuring her emotional comfort.
How do people go about finding a doula, and how do they know if they are fully qualified?
Interested moms find doulas online or throughout word of mouth. The first meeting is usually free, giving everyone the possibility to see if they click together. By asking many questions, the parents will find out if the doulas skills and experience are what they are looking for.
Are there any associations for doulas in Germany?
Yes! I was trained as a birth doula by Melanie Schöne, the founder of Doulas in Deutschland e.V. (http://www.doulas-in-deutschland.de/). Another association is GfG e.V. (http://www.gfg-bv.de/).
When you first got involved in childbirth support, what did you aspire to provide for women and has this changed?
I first thought to become a doula when I was pregnant with my third child in 2012. My goal was a VBAC (vaginal birth after cesarean) and all information gathered was pointing out the importance of having a doula present at birth. Although I was doing something different professionally before, the idea of becoming a doula was growing constantly in my heart and this is how Ive found Melanie Schöne and her wonderful course made in collaboration with Debra Pascali-Bonaro on behalf of DONA International, one of the most prestigious ( and the first) doulas organizations in the world. The birth of my son was such an intense and empowering moment in my life, that I decided few months later to take also the Hypnobabies Instructor training in St.Louis, Missouri, U.S.A. I wanted to help another women to have at least the same experience as I did or even better! I wanted to show women that education and informed decisions are the best decisions and how we give birth matters! This havent changed until now and my desire to educate and train myself in this domain has been growing ever since my son was born.
What advice would you give to women from the International Community who are preparing to have a baby in Germany?
First of all, gather from time all information on the matter. There are many online resources for expats as Facebook groups and forums, where people can get answers. Find a midwife, doctor or doula who speak English or your native language. Take an independent childbirth education course (not a hospital one) or if language is a problem, ask your English speaking midwife/doula to provide books, materials and articles on this topic. If in Hamburg, look for Positive Birth Movements meetings! And stay confident! When you start to inform yourself, youll see how easier all becomes.
How do you feel about using pain medication during labour?
As long as the mother is making an informed decision, knowing all benefits and risks for her and her baby, that is perfectly fine. We are different as humans and we perceive discomfort in different ways. Birth is an unpredictable event and some babies choose challenging positions to be born, that can make labor longer or more intense. Sometimes an epidural can be just the right thing to help an exhausted mom to get some rest, in order to have her baby.
What labour coping techniques do you like to use?
Dont be mad at me, but having a background in hypnosis and being a NLP freak makes me a little bit nervous about the termcoping techniques. Have you heard of the Nocebo effect? Telling someone that they will experience excruciating pain or that they will need to cope, is creating exactly that unwanted result. Because theyll expect it. Lets call them tools. :-) First of all, address the fear and this, before birth... ASAP! In 1949 a British doctor, Grantly Dick-Read, was describing in his book Childbirth Without Fear the Fear/Tension/Pain cycle. She observed that women who werent afraid of childbirth, would have easier, uncomplicated births. Women who fear childbirth or having severe pain activate the fight/flight response through the hormone adrenaline, which produces actually more pain, it can slow down labor or stop it altogether. Using affirmations, surrounding yourself with positive, supportive people will make a difference. A powerful tool in clearing fear is hypnosis or self-hypnosis. Imagine the mind as a computer, with many files and programs that run automatically, our belief systems. In a hypnotic state, moms can re-write the software childbirth in their subconscious minds, accepting more easily positive suggestions. Use your hypnosis during labor! A side effect of using hypnosis during labor is deep relaxation. The uterus is a wonderful muscle who works beautifully when the mom is perfectly relaxed, without extra tension from adrenaline. When the mother is relaxed, she breathes well, bringing the optimal amount of oxygen to her baby, therefore the birth is progressing well and the baby is not stressed. Hydrotherapy! I loved water at my last birth and many women do. Warm water promotes relaxation and when choosing a waterbirth, the mother has the possibility to move freely and and more easily. Changing positions in childbirth is essential in helping the baby to descend, thus water is a perfect medium to move. If the baby will be born in water, there are less perineal tears and the probability of an episiotomy is 0%!!! Change positions. Some positions like squating, sitting on a birth stool, sitting on all fours or even standing promote descent of the baby and help her to eventually turn if necessary to be in an optimal position for birth. Your doula can use a rebozo ( a shawl/scarf) to try to turn the baby. Avoid laying on your back or sitting on your tailbone! Double-hip squeeze is a technique that you can learn in a childbirth class ( or not... :-( ) and can be applied by the birth partner, midwife or doula. Many women report that they feel much more comfortable when this technique is used. Massage is a great tool, although some women may not like to be touched during labor, even if they liked massage before. Aromatherapy. Good, quality essential oils can make a difference in the birthing room. Try lavender for relaxation and peace, peppermint for nausea, frankincense to promote progress and lemon for refreshment.
What is your opinion of the pre- and post-birth services for women in Germany?
In general, the system is good, but things have changed a lot in the last years and there are still bad news for the future. The independent midwives situation is very hard in the moment in Germany and only political measures can change this. In the last years midwives who offer birth services, had to pay increased liability fees and many of them had to quit their jobs. The Beleghebamme( offering continuous support during pregnancy, birth and postpartum time for a hospital birth) is almost a memory and in many regions there are no longer homebirth midwives or birth centers to serve women who want such births. The finishing stroke came in the beginning of 2014, when independent midwifes found out that no insurance company accepts their liability insurances anymore starting 2015, meaning that there will be no more homebirths, birth centers, postpartum visits, subsidized childbirth education classes and another courses for mom and baby. What will happen with the right of women to choose the place where to birth? What about educating expectant parents and restorative gymnastic for moms? Who will tell the new moms that they are doing well what theyre doing? Mothers, fathers, midwives, doulas and birth activists have already started petitions and protests, hopefully we will have a resolution in the next period of time.
What percentage of mothers opt for a natural and/or home births?
I cannot give you exact numbers, because I couldnt find actual and accurate information. All I know is that in Germany 95% of the births occur in hospitals and the rest are homebirths or birth center births. The c-section rate is somewhere between 30 and 33%, which is very high (WHO recommends a maximum 15%), but I cannot say which are elective, planned or unplanned surgeries. Ooups...did I say elective? Although this term doesnt exist in medical records, because health insurance companies wouldnt pay for that, there are women who actually choose to have a c-section and convince their health providers to find a reason, and that mostly out of fear of childbirth... :- That is why I say FEAR is the big elephant in the room that has to be seen at first. And many natural births in Germany have a lot of medical interventions from different reasons, but most of the time, lack of patience from health professionals and mothers lack of confidence in her own body are the only reasons. That is a shame, because womens bodies are made for giving birth and use of routine medical procedure lead often to complications. Homebirth and birth center birth are (still) great options for women with healthy pregnancies. I believe that there are a lot of misconceptions about that in the western world and I urge every woman to inform herself about this, because the warmth of their own home or a homey atmosphere, without scrubs and septic smells, might be just the right choice for them. Homebirth and birth center midwives are highly medical qualified personnel and they do a rigorous screening prior birth in order to qualify for such a birth.
If a mother opts for a home birth do you deliver the baby or do you work alongside a midwife? If so do you have specific midwifes with whom you work?
Doulas are not medically trained professionals, thus they do not perform medical tasks as vaginal exams or deliver babies. Homebirth midwives are incredibly skilled people with tones of knowledge and experience and they are in charge with that, otherwise it is considered to be an unassisted birth. If the birth is imminent and the midwife is not present, I would call 112 and guide the birth partner what to do. I am in contact with a homebirth midwife and I hope to see more homebirths in the near future.
How do you help mothers after the birth?
Usually, immediately after birth there is a sacred time when I step back and let the family to enjoy their little one. This golden hour is essential for bonding with the baby, offering her the first impression about this world: she is welcomed, loved and protected. When the baby and mother are ready, I help the mother to establish breastfeeding, I make sure she eats something and I can make pictures with the entire family. I leave after 2-3 hours having the parents permission and I get back with a phone call in the next days. I make myself available for providing resources or more information if needed and I visit the family after few weeks, when I bring a birth report and a small gift for the baby.
Do you feel there is adequate support for mothers in Germany in terms of caring for the baby and breastfeeding?
There is a lot of support and resources for mothers in Germany, but they have to inform themselves prior birth: take a comprehensive childbirth education course, choose a midwife, choose a place of birth - these have major impact on future incomes in terms of breastfeeding and caring for the baby. Many hospitals in Germany are Baby-Friendly Hospital Initiative, a program launched by WHO and UNICEF in 1991 that promotes good practices for a good start in breastfeeding. That means that immediately after birth, the baby is placed on mothers chest and not separated for the next 1-2 hours. Such hospitals have rooming-in, where the baby is staying all the time with the mother and she doesnt get any other fluids, but breastmilk. You could ask in case of an cesarean, to be able to see the actual birth, by lowering the green sheet that stands in front of you and that the baby is placed on your chest immediately after birth. This is called family centered cesarean and has been proven to have immense benefits for bonding and establishing a good breastfeeding relationship. Inform before birth if your hospital is willing to accommodate your wishes and has this qualification. Baby-Friendly Hospitals have special trained lactation consultants in the staff, with the IBCLC credentials, ask for them if you encounter difficulties. Midwives are the good soul of childbirth and motherhood in Germany and make sure you find one before birth, for the postpartum visits. Even if you have your fifth child, there is also nice to hear reassuring words and feeling supported in this very sensitive time in a womans life. La Leche League in Germany (http://lalecheliga.de/) is a great resource for breastfeeding moms and there are also independent lactation consultants who offer their service for free.
SP, April 2014
And remember: a positive birth is a good beginning for you, as a mother and your baby. Make sure you prepare for this day as you did for your wedding day, because it is a day that you will remember for the rest of your life!