What defines the purpose of our birth

Natural birth in the clinic - completely without a doctor - midwifery delivery rooms make it possible

In contrast to the usual delivery rooms, births in the midwifery delivery rooms often take place without medical interventions, such as contractions, perineal incisions or suction cups. However, if complications arise, a doctor is on the spot immediately.

Last year, more than 675,000 children were born in Germany - 98 percent of them were born in a hospital. Although many pregnant women would like to experience a natural birth as far as possible without additional medical interventions, a birth at home or in a birthing center, for example, is apparently not an alternative for most. "Many women want to give birth to their child in a clinic so that a doctor and the necessary infrastructure are immediately available in an emergency," says Prof. Dr. Friederike zu Sayn-Wittgenstein, nursing and midwifery scientist at the Osnabrück University of Applied Sciences. The desire for a natural birth in a clinic - is that a contradiction? "No, as the midwifery delivery room shows," says Professor zu Sayn-Wittgenstein. Because in Germany only around eight percent of healthy pregnant women experience a birth without medical intervention, i.e. without interventions such as contractions, perineal incision, suction cup or, for example, epidural anesthesia, or PDA for short, an anesthesia close to the spinal cord. It is different in the ten midwifery delivery rooms that are available at German clinics. Here women have a significantly greater chance of experiencing childbirth without any intervention. This has now been shown by a study supported by the Federal Ministry of Education and Research (BMBF).

Less interventions, more well-being

More than 1,200 healthy pregnant women took part in the study between 2007 and 2010. During pregnancy, they chose whether they wanted to give birth in the midwifery delivery room or in the usual delivery room. The study was carried out at four different clinics with a midwifery delivery room. 666 women chose the midwife-led delivery room and 572 women the medically-led delivery room. The result: 298 of the women who planned the birth of their child in the midwifery delivery room were transferred to the medically managed delivery room during the birth - this corresponds to around 44 percent. In almost half of these women, the desire for pain relievers was the reason they were referred to the usual delivery room. With regard to the health status of mother and child, there was no difference between birth in a midwifery delivery room or in a normal delivery room. "A birth in a midwifery delivery room is safe," emphasizes Professor zu Sayn-Wittgenstein. The results of the study reveal marked differences in the implementation of additional interventions: "The chance of ending the birth in the midwifery delivery room without intervention is more than two and a half times as high as in the usual delivery room." In contrast, women in the midwifery delivery room use complementary medical measures such as homeopathic remedies more often than women in the usual delivery room. There are also differences after the birth: mothers who gave birth to their child in the midwifery delivery room often only breastfeed. The well-being of women, both physically and mentally, eight weeks after giving birth in the midwifery delivery room is also better than that of those women who gave birth in the usual delivery room. The subjective birth experience is also rated more positively by the users of a midwifery delivery room. Professor zu Sayn-Wittgenstein: "Especially with regard to the current discussion about the subsistence level, our research project shows what great responsibility midwives have!"

Midwifery delivery rooms are not more expensive than the usual delivery rooms with at least the same quality of results. "We found that out in a separate cost-effectiveness analysis," says Professor Manfred Haubrock, a scientist who is also active in the research network. A considerable part of the savings potential in the midwifery delivery room is due to the fact that less costly interventions such as anesthesia procedures are carried out during childbirth and doctors have to be consulted less often. Midwife-managed departments have existed in Scandinavia, Great Britain and Australia since the beginning of the 1990s, and for a number of years also in Austria and Switzerland. In Germany, the first midwifery delivery room was opened in 2003 in the Bremerhaven Reinkenheide Clinic. There are now midwifery delivery rooms, among others. in Hamburg, Stuttgart, Velbert, Frankfurt am Main, Berlin, Osnabrück, Herrenberg and Bonn.

What is a midwifery delivery room?
The midwifery delivery room is a midwifery-led care model in the clinic, in which midwives care for healthy women during pregnancy, during and after childbirth, and in the puerperium. The midwives work independently and on their own responsibility. The midwifery delivery room does not replace the usual - medically managed - delivery room, but represents an extension of the clinic's offerings. Both departments cooperate closely with each other so that in the event of a complication, the woman can immediately be referred to the medical care of the usual delivery room. A birth in the midwifery delivery room is possible for healthy women with no or low risk classification.
A special feature of the midwifery delivery room is that the midwives look after the expectant mothers continuously and over a long period of time. Because contact between the families and the hospital's midwifery team is established during pregnancy. In this way, a trusting relationship can develop between the expectant mothers and the midwives. The midwives often continue to look after the mothers even after the birth.

Question to Professor zu Sayn-Wittgenstein: What is different about a birth in a midwifery delivery room? Because even in a normal delivery room, don't the midwives have the say?
"The structural measures and additional offers such as midwifery consultations enable families to get to know the midwives during pregnancy. The midwifery delivery concept aims to provide 1: 1 care during the birth. This is a crucial difference and increases this Well-being of women. In general, the focus of care is on a natural birth process. "

Contact Person:
Prof. Dr. Friederike zu Sayn-Wittgenstein
Midwifery Research Association
Faculty of Economics and Social Sciences
Osnabrück University of Applied Sciences
Post office box 1940
49009 Osnabrück
Tel .: 0541 969-2024
Fax: 0541 969-3765
Email: [email protected]