03 February 2009

First Impressions; Flashback to Munich Part I

WARNING: This is a really long post about pre-natal health care.

When I was pregnant with Max, I was considerably more ambitious about recording my pregnancy experience than I am this time; I kept a journal as well as sent various emails to all of my family about our experience. Here is an edited snippet from an email about my first impression of pre-natal and labor and delivery care in Munich.

"We finally found an Obstetrician. In Germany, they (the proverbial they) recommend that you pick where you want to give birth, and then find the doctor. We went to an orientation at the Frauenklinik Roten Kreuz (the women’s Red Cross hospital). It was amazing. It was a beautiful hospital, very clean and all the latest technology. They have an on-site NICU. The doctors are all highly regarded, and they are one of the few hospitals that have been able to maintain a highly qualified and full nursing staff despite the nursing shortages. The hospital is number three in the country for obstetrics.

Hindsight: Reading between the lines, many of our friends and family were concerned that the "socialized" health care in Germany would be a detriment to the quality of care I and my new baby received. I went a bit overboard in reassuring everyone that I was getting care on par with the care in the States.

They use the latest technology in Cesareans which has the shortest recovery time. And they have all the pain medicine available should you choose to use them. However, pain medication is not encouraged.

Hindsight: Again, I had to reassure everyone that I was getting the best care. While it's true that they try to encourage you to have the baby naturally, my midwife was the first to suggest the epidural to me. I was only half way through the labor, and she could tell that I wasn't dealing with the pain well. I have a very low threshold for pain, and a high intolerance for discomfort. She read me very well, and I don't regret the epidural at all. I received the epidural six hours into the labor at two cm dilated. I fell asleep immediately after the epidural, and when I woke up I was fully dilated, and ready to go.

Every birth is assisted by a doctor and a Nurse Midwife.
Hindsight: While this was true, it was really the Nurse Midwife who did all the work. The only reason the OB ever came in to the room was to make the episiotomy. They have doctors on hand for complications, but they don't do the brunt of the work for the majority of the births.

They have eight birthing rooms with all kinds of birthing assistance. Over the bed is a rope/towel thing hanging from the ceiling to help you situate yourself. There was a birthing ball, a birthing stool, and they recommend all kinds of different ways to help ease the pain. They also have three birthing tubs, which they highly recommend using to deal with the pain of labor. They offer aroma therapy, homeotherapy and an extensive library of music for you to play during the birth. They encourage you to bring anything from home that will make you comfortable from candles and scents to music.

Hindsight: The only thing I really took advantage of was the birthing tub, and the minute I got out of the tub, the pain got 10xs worse. This time around, I'm hoping to stay in the tub longer, because I really do believe that it is much better for pain management.

Standard of care is to stay in the klinik for three to four days afterwards. They have lactation consultants to help you learn to breast-feed, and a special nursing room with the gliding rocking chairs and nursing pillows. They also have a room with a glass ceiling so you can see the stars, where they encourage you to use the time to bond as a new family. If they have the space, they’ll let you have your own room and the father can stay overnight.

Hindsight: This paragraph highlights the best parts about my hospital stay. Max and I spent four days in the hospital afterwards. I only had a roommate for half the time I was there, and Paul, Max and I spent a lot of time in the atrium once my roommate moved in. The nurses were so fabulous too. I would have given up breastfeeding if it wasn't for the encouragement and support I had received from them. Afterwards I sent all the nurses chocolate as a Thank You.

Oh and they have classes before and after the pregnancy that are free of charge. They have everything from your “crash course” on birthing to back building exercises and gymnastics. They also have a class after the birth to help you get back in shape.
Hindsight: The classes aren't really free of charge; your health insurance pays for them. However, it was still really fabulous to have them available. We went to a different pre-natal class, which was lead by an English speaking midwife. I didn't take advantage of the post-natal get back in shape class, but I've gotten mixed reviews on its quality. For health insurance to pay for it, you have to enroll three months after giving birth, and the quality of the class depends on the midwife leading it. My friends who attended the classes, all said that it was pretty low-impact, which I guess is good if you just recently had a baby. However, I'm generally only into high impact exercise classes like spin and kickboxing.

And, if you’re really alternative you can get acupuncture for 15 Euros to help you with the discomforts of late pregnancy. I’m not that adventurous, though if I get desperate, we’ll see.

Hindsight: I didn't take advantage of this, but I have friends who did and really thought it helped them.

The hospital is amazing, and the doctor that gave the orientation is going to be my doctor He told us that most of the doctors and Nurses speak English, and they will make sure that we have English speakers in the birthing room with us. If a shift ends in the middle of your labor, they actually take an hour with the next staff person to get them up to speed."

Hindsight: This wasn't true at all. All of the doctors spoke very good English, but only a few of the nurses knew more than a few words. However, it wasn't difficult to communicate with my Midwife at all. She was one of the most experienced midwives in the hospital, and though she didn't speak a lick of English, and we spoke very little German, we had no problem communicating with her. She was really awesome, and came to visit me after the birth of the baby in my hospital room. We also had no problem communicating with the nurses despite the language barrier.

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