When I decided that I should write down my experiences and observations about the prenatal care system in Germany I naively thought that one post would suffice. By the time I had written up the first paragraphs I realized that, unless I split it up, I’ll end up with one super-long post. And who has the time to read that, right? Long story short, welcome to the first part of my brand new mini-series about prenatal care in Germany! This post is about what you can expect at the doctor’s office – from regular appointments to ultrasounds and various tests. Part two is about midwife care, and part three deals with birth preparation classes.
This and the following posts about prenatal care in Germany are based on my personal experiences during two pregnancies, combined with things I’ve read or heard about from friends and acquaintances. So keep in mind that it won’t always be 100% accurate for all cases and all corners of the country.
Prenatal Care in Germany: the First Steps
In Germany, as in many other countries, the first go-to person for all things pregnancy will be your gynecologist (Frauenarzt). In fact, it can be a good idea to drop by your doc once you decide that you want to have a baby. In a typical German fashion you may even get a checklist with all the things – and tests – that could be useful before attempting to conceive. Of course, it’s your personal choice whether to do them or not (and for some you might have to pay yourself as they are not covered by the health insurance), but it doesn’t hurt to at least make sure that all your vaccinations are up to date and to start using the right prenatal vitamins, e.g., folic acid which is crucial for the early development of the baby.
Once you’ve seen those two magical stripes on the home pregnancy test it’s time to call your gynecologist to make the first appointment. It can be the case that you won’t be seeing the doc before the 7th week of pregnancy, however, because it’s difficult to calculate the exact due date before that. On your first appointment you will get the Mutterpass (literally translated: mother’s passport): your most important document for the coming 9 months that contains all the relevant information about your pregnancy: all the appointments, tests, their results, as well as information about your health before and after the pregnancy.
Congratulations, you’re now officially pregnant!
The First Trimester
From the first appointment to the end of the second trimester (i.e., the 7th month) you’ll be seeing your gynecologist at least once a month. On each visit, your weight and blood pressure will be controlled. In addition, each time you’ll have to give a urine sample that will be checked for traces of protein, sugar, nitrite, and blood to detect possible health problems. Every other month you’ll also have to do a blood test to determine whether you have enough iron and, depending on the stage of the pregnancy, other tests. These include but are not limited to:
- Blood group & Rh factor
- Antibody test (determines whether your baby has a different Rh factor from yours)
- HIV test (optional but recommended)
- Immunity against rubella
- Immunity against toxoplasmosis
- Presence of cytomegalovirus
Although often recommended by gynecologists, the latter two tests are usually not covered by public health insurance.
On every visit, your doctor will check the growth of the uterus, as well as the movements and the heartbeat of the baby. This can be done by ultrasound but doesn’t have to be as public health insurance technically covers only three ultrasound screenings – one each trimester. While this is the minimum, the actual number of ultrasounds you will have is entirely dependent on your gynecologist. For example, my doc did an ultrasound on every single visit giving me the opportunity to actually see how the baby grows from month to month.
The most exciting appointment this trimester is the first-trimester ultrasound screening that takes place between pregnancy weeks 9 and 12 when your doctor will proof the development of the embryo and possibly give you a more exact due date. You might even get the first picture of your little one (and the little one is indeed little at this point – only around 4 cm long)!
In your first trimester, you’ll also have to make the choice for or against several additional prenatal examinations. My doctor offered me two tests: a nuchal translucency scan and amniocentesis (we decided not to do either). Both of the tests help to the determine the risk of chromosomal abnormalities with the difference that the nuchal scan is done by an ultrasound therefore it’s not invasive but is also less precise (meaning that given an abnormal outcome you’ll have to undertake other tests; in fact, the public health insurance doesn’t cover it because it’s not deemed accurate enough), whereas amniocentesis is highly accurate but invasive as it requires drawing a sample of your amniotic fluid (ouch!).
The Second Trimester
Just like during the first trimester you’ll be seeing your gynecologist on a monthly basis. Each time you drop by the doc your weight and blood pressure will be checked, you’ll have to give a urine sample, and expect at least one blood test during these three months. The doctor will continue to monitor the growth of the uterus, the movements, and the heartbeat of the baby, all of which will be duly noted in your Mutterpass.
Between pregnancy weeks 19 and 22 you’ll have the second-trimester ultrasound screening – the one appointment I was looking forward to the most. Why? Mostly because this is usually your first chance to find out the sex of the baby! Well, if you’re lucky, that is, and the little one cooperates. More importantly, the gynecologist will examine the overall development of the baby, look more closely at the internal organs (the heart, the lungs, the stomach etc.), as well as proof the amount of amniotic fluid, and the position of the placenta. Although it was important to find out that all of the above is fine and well, my most important moment of this ultrasound was hearing the baby’s heartbeat for the first time.
In the last weeks of this trimester, you’ll also have to do a glucose tolerance test to make sure that you don’t have gestational diabetes. This test is currently done for all pregnant women independent of the presence or absence of risk factors. The procedure is quite simple – you’ll have to drop by your doctor, drink a sugary fluid, wait for an hour, and give a blood test. If the result is fine (under 135 mg/dl), you’re all clear. If the sugar in your blood is too high you’ll have to do another test which requires not eating for 10-12 hours and giving blood before and after drinking the sugary drink. In case your glucose levels are too high also in the second test you’ll have to cut down on sweets and carbs and continue monitoring your glucose on a daily basis.
The Third Trimester
From the third trimester on you’ll have to have a check-up every two weeks, and in the last month of your pregnancy, these bi-monthly appointments will turn into weekly ones. You can choose to do a part of these check-ups with your midwife instead of your gynecologist (more on that in the next part of the series). For example, during my second pregnancy, I moved half of the appointments to my midwife and enjoyed the luxury of doing all the tests in the comfort of my own home.
For the most part, the third-trimester appointments are business as usual: weight, blood pressure, urine & blood checks, the growth of the uterus, as well as proofing of the movements and the heartbeat of the baby who’s growing by the day. From pregnancy week 30 or week 32 (depending on the doctor), your appointments will become a bit longer as the doc will start doing a CTG to monitor your uterine contractions and the heartbeat of the baby.
Between pregnancy weeks 29 and 32 you’ll also have the third mandatory ultrasound – the third-trimester screening. Your gynecologist will proof the functioning of baby’s internal organs, the position of the placenta, the amount of the amniotic fluid and, importantly, the exact position of the baby – it’s high time for it to be lying head down as there’s not that much place left for turning! As the doctor takes time to measure the baby, you’ll also get a more precise estimate of how much the little one weighs.
Last but not least, between the 35th and 37th week of pregnancy your doc will offer to carry out a smear to test for group B strep. If it’s positive, you’ll get antibiotics during labor to prevent the baby from getting infected as well. This test is covered by some, but not all, public health insurances. Check with your Krankenkasse!