Health and care
Illegal Drugs and Medication Abuse
Throughout pregnancy, the baby is directly connected to your bloodstream. It is supplied with all important nutrients via the umbilical cord. However, substances that can harm the baby also enter the body via the same route. These include, for example, toxins from exhaust fumes or other dangerous chemicals. This also applies to cigarettes, alcohol, pills, or any illegal drug you might ingest. But what do the substances do to an embryo or fetus? When is there a risk of permanent damage that could affect your child? Where can you find help to keep yourself and your pregnancy as safe as possible?
Check-Ups During Pregnancy
To ensure that you and your developing baby are well looked after during pregnancy, you are entitled to regular check-ups. The costs for this are covered by your health insurance. You should definitely make use of these check-ups to avoid any unnecessary risks for you and your baby. The results of all your check-ups and screenings will be recorded in your maternity record (Mutterpass), which you will receive at one of the first examinations.
What Does a Midwife Do?
A midwife can be there for you starting from the beginning of your pregnancy. As your personal contact person, they will advise and support you during this time. They can provide help with pregnancy-related difficulties and can also take care of a large part of your pregnancy check-ups. Midwives support you during birth and are also there for you and your baby during the postpartum period. Some work freelance, while others are employed in hospitals or midwifery practices. Only a few men are employed in this profession. They are called ‘maternity nurses’ in German. The services of the midwife or maternity nurse are paid for by health insurance as part of the statutory care for pregnant people as midwifery assistance. Please note that midwives usually do not offer all services. A midwife who carries out preventive examinations or postpartum care does not necessarily offer birth support.
‘Der Mutterpass’: A Record of Prenatal and Natal Care
The German maternity record (Mutterpass) is an important document that will accompany you until the birth of your child and beyond. You will receive it from your gynaecologist or your midwife as soon as your pregnancy has been safely established. Your maternity record lists the check-ups and screenings that are specified in the German maternity guidelines (Mutterschaftsrichtlinien) and are paid for by statutory health insurance. The results of all check-ups are entered in your maternity record. These data provide information that is important for birth and postpartum care. This documentation is also helpful in the event of another pregnancy. The information recorded in your maternity record is very important in case of medical emergencies during pregnancy. That's why you should always have your maternity record with you!
Maternity Record (Mutterpass) Pages 2 and 3: Lab Tests
Blood tests and screenings for infection history are documented on pages 2 and 3 of your maternity record. This will include your blood type, your Rh factor, antibody tests and infection history. You can find the information under the German heading that translates to ‘Laboratory tests and rubella protection’. It also tells you if you've been vaccinated against the flu.
Maternity Record (Mutterpass) Page 4: Previous Pregnancies
All important data regarding previous pregnancies will be entered on the fourth page of your maternity record (Mutterpass). This is where your gynaecologist or midwife notes, for example, how your previous births went and records the weight and sex of your babies at birth. There is also a checklist of counselling topics on this page of your maternity record. These help your doctor or midwife structure consultations and give you comprehensive information.
Maternity Record (Mutterpass) Page 5: General Medical History
At your first check-up, your doctor or midwife will take a general medical history and make note of any general findings. This means you will be examined and asked some questions about your health, medical history and life. This information is entered on page 5 of your maternity record (Mutterpass). Results of previous tests or screenings are also included.
Maternity Record (Mutterpass) Page 6: Special Findings During Pregnancy
Doctors or midwives will note any special findings that they observe during the course of the pregnancy on the sixth page of your maternity record (Mutterpass). They are referred to as special findings. This refers to results from tests or screenings and general findings. They affect your health as well as the fetus's. Detection of a multiple pregnancy would also documented here. The list of possible special findings includes 26 items. As is the case during your first check-up, your pregnancy will be classified as a high-risk pregnancy if any of the points applies. Ask your doctor or midwife to tell you exactly what the impact of this would be.
Maternity Record (Mutterpass) Pages 7 and 8: Gravidogram
The gravidogram chart is a structured overview of the course of your pregnancy. Your gynaecologist or midwife will note down important results form all of your check-ups on this double page. This helps them keep a good overview. The first two columns of the gravidogram chart record the dates of your check-ups as well as the week of gestation. This number again can be updated again in the third column. A correction may be necessary, for example, after an ultrasound examination. Healthcare providers can then better assess how far the pregnancy has really progressed.
Maternity Record (Mutterpass) Page 9: Risk Check List and Cardiac Activity Findings
Particularities concerning your health are noted on page 9 of your maternity record (Mutterpass). Under a German heading that translates to ‘particularities of check lists A and B’, you will find notes on the two so-called ‘risk check lists’, which you will find on pages 5 and 6 of your maternity record. For example, the person doing your screening will note whether you have chosen to have an amniocentesis due to your pregnancy being considered a high-risk pregnancy. They will also note whether any specific blood tests were done or if they discussed a particular topic with you.
Maternity Record (Mutterpass) Pages 10 - 12 and 14: Ultrasound Examinations
Your doctor will perform three ultrasounds over the course of your pregnancy check-ups. The dates fall between the 8th and 12th weeks of pregnancy, the 18th and 22nd weeks of pregnancy and between the 28th and 32nd weeks of pregnancy. During an ultrasound scan, also called a sonography, you can see images of the fetus through on a screen. This experience can be a happy one and may strengthen your bond to the baby. The examinations are important from a medical point of view. Doctors can see exactly how the fetus is developing and can take action if something is wrong.
Maternity Record (Mutterpass) Page 13: Standard Curves
There is a diagram on page 13 in your maternity record (Mutterpass). It gives an overview of how your baby's growth is developing. Your doctor can enter the results of ultrasound examinations here. The distance from the crown of the head to the rump is measured in early pregnancy. Later, the diameter of the head and the diameter of the belly will be measured. The diagram for the growth curves is divided into three zones, and a separate curve is drawn for each. The thick centre line in each of these areas shows where so-called ideal value is. Above and below this line are two other lines, which are somewhat thinner. All entries between these marks indicate normal development. However, the values of these norm curves apply to women of European ethnicity. Development is always assessed individually by the people responsible for your medical care.
Maternity Record (Mutterpass) Pages 15 and 16: Final Check-Up
All important data relating to the delivery and the weeks afterwards are entered on the last two pages of your maternity record (Mutterpass). This information affects both the mother and the baby. This final report is called epicrisis in medical terminology.
The Initial Meeting With Your Midwife
Congratulations, you've found a midwife and your first meeting is coming up. They will be a great help to you during pregnancy, birth and the time after. The initial meeting is for you to get to know each other and find out if you can trust each other. Bring your health insurance card and your maternity record (Mutterpass) to your first meeting. This way the midwife can see the results of all the check-ups your doctor has carried out since the beginning of your pregnancy. You probably have a lot of questions about pregnancy, childbirth and the early postpartum period floating around in your head. You'll be able to clarify some of this in the initial meeting. The meeting lasts about an hour.
Childbirth Preparation Courses
A childbirth preparation course helps you to prepare upcoming birth as well as the time afterwards. In the course, you will get detailed information about the birth process, about birthing positions, about breathing techniques, and about pain management. You can also ask all the questions you have about pregnancy, birth and the period after the birth. This will make you feel more confident and less anxious. Perhaps there is someone close to you who will be with you during the birth. Then it is good if they are also present at the birth preparation course. This way they can better support you during the delivery. Birth preparation courses are also a good opportunity to meet other parents-to-be and to exchange ideas with them.
Individual Health Services (IGeL-Leistungen)
During pregnancy you are entitled to ten to twelve check-ups and consultations. Your health insurance will have to cover the cost of this. So you already have good care for you and your baby. In addition, you can have other tests and examinations done that your health insurance does not have to pay for. They are called individual health services and shorted to ‘IGeL’ in German. In most cases, you'll have to pay for them yourself. But there are exceptions. Therefore, it is best to ask your insurance company if you would like to use any IGeL services.
Prenatal Testing: Many Tests and Many Decisions
You want to experience your pregnancy in peace and as free of worries as possible. At the same time, you may want to know before the birth whether your baby is healthy and have a guarantee that you can make the right decisions as early as possible in case of a bad test result. This is exactly what prenatal testing is all about. With the help of several types of tests and examinations before birth, gynaecologists can look for indications of disease or fetal malformation. Part of it is part of the normal prenatal care examinations. However, there are a number of additional prenatal diagnostics procedures that belong to what are known as ‘individual health services’, often shortened to‘IGel services’ (IGeL-Leistungen). You usually have to pay for these additional services yourself. In certain cases, however, health insurance companies will cover the costs.
Prenatal Testing Procedures
Is my baby okay? Will it be born healthy? These questions are asked by many people who are pregnant. In fact, today there are many procedures that can be used to check whether there are indications of certain diseases or fetal malformations. You usually have to pay for some of these prenatal examinations yourself. Some gynaecologists recommend that older pregnant people over the age of 35 should have such examinations. It may also be that your doctor finds certain abnormalities during the three regular standard ultrasound examinations and advises you to have further examinations. Below you will find descriptions of the most common methods of prenatal testing. Before any of these tests, you must receive medical clearance and genetic counselling in accordance with the Genetic Diagnostics Act. Doctors must have special, additional training for this. It is very important that you take time after the consultation to think about it and inform yourself well.
Medication during pregnancy
If you need to take medication during pregnancy or while breastfeeding, it is important to discuss this with your doctor. If you are prescribed different medications by different doctors, it is helpful if one of these people has an overview of everything you are taking. This means, for example, that your gynaecologist should know about all the medications you are taking. This also applies to medications you've been on for a long time without any problems. You can then work together on a medication strategy to treat the condition that keeps any risks to the fetus to a minimum. You should also tell your doctor about any other medicines, vitamins or nutritional supplements you are taking. This is true even if they are sold without a prescription in drugstores, health food stores or pharmacies.
Dental Care and Treatment
Not only do your teeth become more susceptible to cavities during pregnancy, but you are more at risk for bleeding gums and inflammation as well. This is due to altered hormones. They ensure that your body us supplied with more blood, and this includes your gums. The downside is that it makes your mouth more susceptible to bacteria. However, you can protect your teeth by caring for them thoroughly and intensively. The best way to do this is to brush them two or three times a day with a soft-bristled toothbrush and a toothpaste that contains fluoride. Additionally, you should floss between your teeth daily to thoroughly remove all food debris and plaque. This is important for preventing serious gum and tooth bed inflammation or infection. Especially bad gum disease is called periodontal disease and in serious cases can even lead to a premature birth or a miscarriage. This is caused by an inflammatory substance that can trigger contractions and thus initiate labour.
Cold or Flu During Pregnancy
Catching a cold during pregnancy is nothing out of the ordinary. In most cases, it passes quickly. The best things to do are simply common home remedies like plenty of tea, rest and sleep. But if, in addition to a cold, you also have a severe cough, severe pain, or a fever, you should seek medical attention. It is true that harmless viruses are usually behind a cold. Sometimes, however, the trigger can be a real viral flu, short for influenza. This can be more severe than a common cold and can lead to pneumonia or other complications. Taking antibiotics does not help with colds, because they are ineffective against viruses. However, if the symptoms are severe, painkilling or fever-reducing medicines may be helpful. However, you should never take medication on your own, but only after consulting with doctors or midwives. They know which treatments are suitable for pregnant people and won’t harm the pregnancy.
HIV or Hepatitis During Pregnancy
HIV stands for Human Immunodeficiency Virus. This is a pathogen that damages the immune system- your body's own defenses. People who are infected with HIV can develop AIDS. This is a disorder of the immune system that prevents the body from defending itself properly against bacteria, fungi or viruses and can cause serious illness. Without treatment, HIV can be passed on to the baby during pregnancy, birth or breastfeeding. The same applies to hepatitis B and hepatitis C. These infections are also caused by viruses and are transmitted through blood or other body fluids, for example when using drugs with contaminated syringes. Approximately one in ten to one in six people living with HIV also have hepatitis C. Hepatitis B is also more common in individuals with HIV. Doctors can use drugs to prevent pregnant people from passing on HIV, hepatitis B or hepatitis C to their baby.
Smoking and Alcohol Consumption While Pregnant and Breastfeeding
It’s no secret that smoking and drinking alcohol are not particularly healthy. But maybe cigarettes, beer, or wine are just an indulgence that you don’t want to give up. Though you might see things differently once you find out you're pregnant. After all, smoking cigarettes and drinking alcohol isn’t just harmful to yourself, but can also harm your baby while you’re pregnant. But what do the substances actually do during pregnancy? And what can you do to resist the temptation to smoke or drink alcohol as much as possible at this time?