The doors to delivery room three open and close. But Naomi Hampl stays with her, standing very close to the pregnant woman. The 34-year-old had contractions every five minutes the day before, but her cervix is barely an inch open. Wearing a white patterned hospital gown, she sits on the wide couch, her feet on a small step. Your voice is brittle. She hardly got any sleep at night. “The problem is that she now has severe pain and hardly any strength,” says Hampl in front of the room. She called the ward doctor, he should put an epidural on the 34-year-old, an anesthetic for the pelvis.
But first comes the next woe. The woman squeezes Naomi Hampl’s hand until the fingertips turn white. She lets out muffled sounds with her mouth open. “Breathe deeply through your nose and out through your mouth for a long, long time,” she says in English in a calm, humming voice to the woman, whose native language is not German. “You’re doing very well.” Naomi Hampl holds her shoulders throughout. But who takes so long to look after the other pregnant woman she is caring for at the same time?
Sometimes the supervision ratio is 1:4
This is a question midwives who work in the delivery room ask themselves all the time. Who needs your help more urgently? Just don’t overlook anything. Helping new people to be born every day is undoubtedly a dream job. But it is also a shortage occupation. On average, a midwife takes care of three women giving birth at the same time. That makes a Scientific report from the IGES Foundation 2020. When the delivery room is busy, 85 percent even look after three to four women. The deficiency is not new: Yes In 2015 almost every second clinic had problems, vacancies to occupy. Meanwhile missing after one Survey of the German Association of Midwives (DHV) an average of 1.6 midwives per clinic.
“It’s just incredibly touching every time.” The more exhausting and difficult a birth, the greater the relief afterwards, says Hampl. “I sometimes have tears in my eyes.” An average of eight children are born in the maternity clinic in downtown Munich in 24 hours. The 23-year-old Hampl with the dark corkscrew curls has been working at the Ludwig-Maximilians-Universität (LMU) clinic for three years. But she, too, repeatedly struggles with the balancing act between claim and reality. “One goes into the profession to strengthen women during childbirth and to support them mentally.”
In delivery room three, the doctor sticks a thick needle with a thin tube into the pregnant woman’s back. With gentle pressure he tries to get between the vertebral bodies and a little upwards. But it doesn’t work, he can’t get any further without the woman being in pain. After the second attempt, he brings in the senior physician. Although she was injected with a local anesthetic, the woman felt something “like little electric shocks,” she says. Her legs are shaking and she is gritting her teeth. Naomi Hampl tries to calm her down. “We’ll take care of you, you can do it,” she says. The senior doctor’s second attempt is successful. Finally. Naomi Hampl advises the 34-year-old to eat a little and get as much rest as possible. It is now important that the cervix can also relax and thus open further, explains the midwife.
Less control, more extreme weather
She comes across as confident, like someone who has mastered her craft, even though she only completed her exam last year. But births remain something archaic that man cannot control. “The woman’s body and the child decide for themselves when the time has come,” Hampl also tells the pregnant woman. Your year was the last to be trained at the midwifery school, in 2021 it was converted to a subject. The high proportion of practical work was retained, with female students regularly accompanying Hampl in her work. You will learn how to palpate the cervix, guide labor breaths and do the baby’s first exam.
On this Tuesday at the beginning of August, 4 p.m., it is unusually quiet in the maternity ward. A baby was born shortly after starting work with a colleague, and two other women are still in the early stages of labor. Nevertheless, there is a lot of bustle in the open ward room on the corner. Naomi Hampl takes care of the documentation and enters every step of the treatment in the patient file. In between, she keeps looking up. A large screen transmits the babies’ heartbeats and the pregnant women’s labor curves from the delivery rooms. The first is currently empty, there is a large over-the-corner bathtub. The other four are each equipped with a treatment couch, ropes from the ceiling, mat and wall bars.
Three shifts, 365 days a year
When Naomi Hampl is on the early shift, she gets up at five in the morning to be there in time for the handover. She can be divided into up to three night shifts in a row, that’s how it’s regulated at the LMU-Klinik, followed by a day of rest. “The lack of rhythm wears you down sometimes.” On the first day of training, the headmistress told them that they would no longer be able to spend many Christmases, weekends and birthdays with their families. Hampl is currently studying midwifery as a part-time job so that she can also teach later, apart from shift work.
A career starter, regardless of whether she is studying or with an apprenticeship, earns around 3200 euros gross in Bavaria, which varies depending on the federal state. There isn’t much money left over when you consider that a two-room apartment in Munich costs around 1,300 euros. In comparison, doctors earn about 4,700 euros in their first year of work after completing their basic studies, which is 1,500 euros more than midwives.
When birth follows birth after birth
The main reason for the staff shortage lies elsewhere, says Ulrike Geppert-Orthofer, President of the German Association of Midwives (DHV). “With so few staff, it’s simply not possible to look after women adequately.” Again and again they had to leave the woman giving birth alone to take care of other patients. Even in the so-called active birth phase, when the cervix is already four centimeters open. Instead, the DHV calls for one-to-one support in this phase. “It has been scientifically proven to lead to better outcomes and fewer interventions,” says Geppert-Orthofer. The model even made it into the coalition agreement of the traffic light government. But a year later, the workload hasn’t changed.
One day after the visit to the delivery room, Naomi Hampl’s night shift is understaffed and a colleague is ill at short notice. “Then we had five full delivery rooms for two and two women sitting in the aisle.” Layers like this also sap your strength, says Naomi Hampl. If only birth follows birth, “then you are only there to prevent complications”. On average, once a week, she is asked if she can step in for an additional service. Would she recommend the job to her little sister? “If you do it with passion and conviction, then yes, but otherwise you can’t handle the load,” she says.
Physical and psychological violence in obstetrics
“We could use and hire ten additional midwives immediately,” says Sven Mahner, head of the LMU women’s clinic. The only thing missing was the trained specialists. In a survey by the DHV, 85 percent gave “too high a workload” as the main reason why they were thinking about leaving obstetrics. But the shortage not only burdens the midwives, it also harms the mothers. The WHO criticizes that the Caesarean section rates have almost doubled in the past 30 years Has. Critics also suspect the accounting system of the clinics with the health insurance companies. Caesarean sections are quick, and clinics can still charge more than natural births. Due to the hectic atmosphere in the delivery room, the women would have more stress and there would be more frequent birth arrests.
In the ward room of the LMU clinic, a colleague of Hampl’s tells about an article about violence in obstetrics. For about ten years there has been “Roses Revolution Day” as a sign of protest. Pregnant women who have had traumatic experiences lay red roses in front of the respective delivery rooms. “I just hope that something like this never happens to us,” says the midwife. According to the WHO, about 40 percent of mothers are affected by abusive behavior, physical or psychological violence. On the other hand, the numbers of IGES report, according to which 86 percent nationwide are satisfied with the midwife care in the delivery room. For the DHV President, this is a sign that it is not the work of the midwives, but the working conditions in the delivery room that are responsible for the negative experiences during birth.
Five centimeters can be a real step forward
In delivery room three, Naomi Hampl is now visiting a different woman than when she started her shift. The exhaustion has drained from her face. Her husband got food from the canteen, she noisily bites into the nectarine that was served for dessert. The PDA seems to be working. “Can you turn the sound back on?” she asks, pointing to the contraction recorder. She can no longer feel the contractions, but from the constant rushing and gurgling she at least knows that something is happening in her stomach. “I’d like to examine you now,” says Naomi Hampl. Agreed. The woman nods. Hampel puts on a sterile glove, puts her left hand on her stomach and gently feels her way towards the cervix with her right hand. “I can already feel my head,” she says, while looking at the 34-year-old with a crooked head.
And? “Five centimeters,” says Hampl, “that’s real progress.” She now has to sell it to her patient, who had counted on seven. She needs ten to give birth. Half full or half empty, her job is always about keeping motivation high.