The midwifery project – Germany

Last time I have posted on the #Hebammenprojekt it was almost one year ago, I had to take some perspective about all why I saw and wrote about the midwifery project.

I’m coming back to you today to talk about the midwives that works in hospitals in Germany, more specifically about those who I met outside of hospitals. I’ve written officially to German Hospitals and also to the Midwifery bound, but just had negative answers. That’s fine since I’m not a journalist, neither a health professional. I’ll be talking about the questioning of why pregnancy is treated by the health system as if it was a sickness.

This is it’s my first photography project and it is its second part. It couldn’t have materialized without the help of the midwives that I met in Germany during my trip, from October 2016 to January 2017.

There are so many things to say about what I saw and heard during those months, that I decided to publish it in parts. So, after my first post that I wrote on the 5th May of last year, here is Part two, with pictures that I have taken in Leipzig in November 2016.

Disclaimer: I’m not a midwife, not a physician, not a statistician neither a journalist. All I’m writing here is my personal view and my personal conclusion. I’m just a citizen who is concerned.

Is pregnancy an illness ?

Nowadays the health system made a significant progress compared to last decades or to the beginning of the 20th century. The rate of maternal deaths decreased all over the world, especially in rich countries where it decreased by more than the half (eg: Germany & France) during the last 25 years. It’s due to the modern scientific understanding of the causes of maternal mortality. This ratio is a sensitive and relevant indicator of the care and quality of women’s health. In most studies, they pointed to the access, quality and trainee of the professional healthcare services that evolved.

Evolution of maternal death between 1990 to 2015 – Source World Health Organization

During my project I’ve been observing a lot the midwives during their duty, many questions came to my mind. Why most of them are not working in hospitals anymore ? / Is the pregnancy an illness? / and any other questions that i’ll be talking about later in other posts.

This question about pregnancy came to my mind while doing the second part of the project. When I met Anja in Leipzig. A midwife who’s working in a hospital, but at the same time she was doing home visits for pre and post natal care.

Unfortunately, at the end of the week that I’ve spent in Leipzig, I’ve lost a memory card with the photography of most patients that we’ve visited Anja and me during postnatal visits. Only the two last patients that we’ve visited remains …

Pregnancy is not an illness

It depends on the point of view; for example for the health insurance yes, it’s kind of an illness or a “physiological occurrence” for that it’s a good point to get all the medical acts fees reimbursed. The rules can change from a country to another one. In France, for example, your doctor has to report the pregnancy to the insurance. Then the pregnant woman is getting her fees refunded at 100% (from the 1st day after her 6th month to the 12th day after the delivery). It’s really good compared to other countries. But there’s something that makes me vigilant and this question is coming to my mind: Is there an over medication or misuse of the health care during pregnancy ? I admit it’s better to over use the medical health system rather than to not have access to it at the required level . But there’s alternatives, as always. In Germany, the role of the midwife is central, it’s mandatory to do take care of your pregnancy through the help of a midwife. During my project I have visited two birth houses (Geburtsahaus). Which is a birth center that presents a more homelike environment than a hospital labor ward, typically with more options during labor. Compared to France they have made a good step into this alternative, it’s existing for more than 50 years. There, the midwives are doing all the required monitoring in a reasonable way and offers an atmosphere where the pregnant couple feels comfortable and especially not as if you were sick. For midwives, pregnancy is not an illness. It is something natural and it should be handled in the most natural way. It’s one of the most natural thing to be pregnant and to give birth. But for sure when we figure out that there will be some complications we manage it before it’s getting more complicated. Most of the birth house are less than 10 minutes from a hospital with emergency obstetrics care.

I remember one midwife told me once, have you noticed that every time they show a woman giving birth on TV (movies, TV shows, documentary …) it’s always a woman who’s screaming having pain and in a messy labor room. This image is not good and it’s building a stereotype. Yes for sure if the epidural exists and it’s not offered for fun, it could be painful to give birth, but the image that the media are sending us is pain and suffer. The result of this, is having pregnant woman asking for a comfort c-section, over medication during pregnancy or kind of building fear and negative image of it. At this point I didn’t talked about the pregnant woman’s point of view, some will say yes, it’s a man who’s kind mansplanning about pregnancy, giving lessons or talking about something he will never have to deal with directly with his body… But as I said it before, it’s just a point of view, my point of view. I’ll be happy to have your feed back on what I wrote.

Let me talk about the pregnant woman’s point of view;

Side effects of pregnancy

While I’m writing, I checked about this question on the web, everyone knows that the internet has tried to answer all the questions 🙂 and for sure there was asked if pregnancy was an illness.

I’ve found many testimonies of women answering that. Some affirming it is an illness when some says pregnancy is not an illness. some talking about the side effects of pregnancy. Which I’m agreeing more with. Yes the women’s body is changing during the process of pregnancy, it’s normal, there’s a little human growing inside. Many changes occur and the body has to adapt some women are living this process really badly while some others enjoying it and finds it really nice to be pregnant. Some works until the last week or their pregnancy some not. I mean the morning sickness, being tired constantly, having breast pain and many other side effects could turn the pregnancy to a hard process. But I think Itself, the pregnancy is not an illness. The human body is not a machine so all what I have to say is to not feel guilty or to try to enter a certain frame. Specially that I’ve noticed so many women are sharing their pregnancy experience through Instagram or social networks, even men (like me) are starting to talk about it :p. Maybe it’s a good point to have all this information. Some people turn it into a funny thing, while some are ringing the bell on conditions of pregnancy and how we consume the medical system as a product.

For example, a few weeks ago I worked  for a big pharma group,  so I had to do a learning about the “Pharmacovigilance”. What I’ve learned when it came to pregnancy was a bit disturbing. They said for ethical reasons we are not allowed to test medicines on pregnant women before putting it on the market. But we are very welcome to have some feedback from them. When the Dr’s are giving them prescriptions of medicines for certain sickness, there’s no studies made about sides effect on pregnancy. So it means the test is just running outside the lab on a biggest panel ! sounds like they just test medicines on pregnant women and it falls in this “consumer/product” thing.

There’s many things that are wrong, but I do have the hope that people are opening their eyes on this. Still, people from low incomes or in poor countries still don’t have access to this kind of information.