Max's birth story: experience giving birth as an American expat in Munich, Germany.
Before we begin, let me just state never in a million years did I think I would be one of those women documenting their birth story, much less to sharing it with the world. Before experiencing labor and delivery myself, my thought process was two-fold: 1) who cares to read this (apart from my mother) and 2) don’t you want to forget most of it?
And I still think the same. I have discovered, nevertheless, my experience giving birth as an American in a foreign country is indeed interesting and/or helpful to others and I am hoping I can provide insights into what to expect when giving birth in Germany because indeed this is one of those things I never could have dreamed I would be doing in a foreign country.
I am now a year post-birth and to be honest, parts are still hard to revisit. This is evidenced by how I wrote this post in spurts, the beginning about five weeks after Max’s birth, the middle about 12 weeks, and the final edits here a year later on the cusp of my baby turning one. Indeed you forget a lot of the details over time, some of this surely because you want to forget, while other of it is just minute details. While I am not one of those women who loved being pregnant and/or giving birth (yes, they exist), I am now one of the cheeseballs who says it is all worth it for your baby.
This is probably a good time to leave a note on my perspective: I gave birth at 33-years-old and am American. Most of my anticipated birth experience was formulated by the experiences of my American contingency. The majority of my American friends already have children, while my German friends are just getting started. This aligns pretty well with norms of each country, since Americans on average have children earlier than Germans: the mean ages of women birthing their first child are 29.2 and 31.3 years respectively (source: OECD family database, 2020).
Leading up to the birth I received a multitude of tips and advice. While some pregnant women could do without the unsolicited advice and relentless check-ins, I appreciated hearing the various experiences from all these mothers I admire. Personally it helped me mentally prepare myself for what was to come:
On boding with the baby: from “it will be the best day of your life” to “it’s ok if you don’t immediately fall in love with them; they are a stranger you need to get to know for a bit”.
On childbirth: from “childbirth is not as bad as they make it look in the movies” to “I’d rather have a C-section”
On the first weeks at home: “after about six weeks you’ll have it figured out enough” to “whatever people tell you, it’s worse”
Before I go any further, I think it is important to provide some contextual information around my delivery. No woman or pregnancy is the same and various factors result in different birth experiences:
First pregnancy
Low-risk patient
Publicly insured with TK
Hospital: Klinikum Rechts der Isar in Munich, Germany
Gestational age: I was past my due date (German: Entbindungstag) with no cervical ripening or dilation at 41+1 and gave birth at 41+2 following induction
Epidural (German: PDA) requested in advance
COVID measures were still in place
Selecting a Hospital as an Expat in Germany
First you should note the title, selecting a hospital. While there are other options for giving birth in Germany, such as birthing center (German: Geburtshaus) or a home birth, these were not options for me personally so they were not considered.
In the Munich mommy groups on Facebook, there is so much discussion about which hospital to choose. The fact of the matter is you cannot go wrong in Munich; the healthcare is top-notch and let’s be real, giving birth is routine. Thus I will keep this part brief because it was not a huge energy-consumer for us. I chose Rechts der Isar due to the following reasons:
Recommendation from my OBGYN (German: Frauenarzt)
Possibility of a private room
Positive experiences there from family and friends
Teaching hospital
Neonatal ICU (NICU)
Registering to Give Birth at the Hospital
Registration was as easy as an email, which I appreciated tremendously since despite my extensive time in Germany, I still hate making phone calls in german. They replied with a registration appointment about 6 weeks before the due date, where I was examined by a midwife (German: Hebamme), who took my vitals and documented everything from my pregnancy file (German: Mutterpass) in a new patient file for the hospital, and physician, who performed an extensive ultrasound, described what to do when I go into labor (or not) and answered any questions. My primary questions were about availability of private rooms and the epidural. I was given documents where I could pre sign-off on the epidural and the extra costs of the private room (€60/day). The appointment took about an hour and I was out with some information sheets and a sticker in my Mutterpass with numbers to call at the hospital in case of questions or emergency.
Induction
At the registration appointment, I was instructed to call the hospital should I surpass my due date by a week. After my due date, I was visiting my Frauenarzt every-other-day, so she offered to call the hospital once I was approaching a week overdue and secured an appointment to be examined at the hospital on a Monday when I was 41+1.
I showed up at the labor and delivery unit (German: Kreißsaal) Rechts der Isar at 10:00, where they performed a quick exam like my OB would, checking my cervix and performing an ultrasound. There was still no progress, so they indicated that by Wednesday (41+3), I should come back for induction. I was over being pregnant at this point, and suggested we just go for it now. They said let’s do it, since they had capacity and couldn’t predict what Wednesday might look like. You always need to call the Kreißsaal before you head to the hospital. There is a possibility they may not have capacity, and would then direct you to another hospital.
For induction, I was offered pills to kick things off. I have issues swallowing any pill over the size of a half centimeter, so I requested to see the pills and they were horse pills, so I asked if there was another method. Fortunately there was and I was offered a pessary of Dinoprostone instead. An IV was also inserted at this point, although nothing was administered until some hours later.
Once I had the IV and the pessary, I was sent upstairs around 11:30 to pre-labor & delivery area where I was checked into my room. Although I had requested a private room, nothing was available so I was placed in a three-bed room with one other woman who was already experiencing contractions. Some nurses came by to administer a COVID test and fill some additional paperwork, but otherwise I was left waiting with the instructions to come back downstairs to the Kreißsaal every few hours, or when I was experiencing regular, intense contractions.
Since it wasn’t planned that I stay that day, my husband went home to gather my hospital bag and get tested for COVID. He returned to the hospital to keep me company during the visiting hours (16:00 - 20:00 due to COVID protocols). When he departed for the evening, I was was still not in labor and just relaxed watching “This Is Us” on my iPad. When I said goodbye, we were anticipating that he would be back sometime in the morning.
Some time later, my roommate went down to labor and delivery and never returned, so I had the room to myself. Around midnight I started experiencing my first contractions. Then around 01:00 I was starting to feeling the pain and decided to walk back downstairs to the Krießsaal to check activity on the electronic fetal monitor. I remember being surprised that I just wasn’t always hooked up to the CTG in a room, but instead had to walk downstairs to get checked, but alas when you give birth in a different country, you need to accept that things might be done differently.
I laid on the table for about 20 minutes while on the monitor and in the background could hear the screams and cries of women in labor. I texted my husband that it sounded like a torture chamber and that I seriously hoped these women were doing it without drugs because I had not anticipated that level of pain - or, building upon the advice I’d heard, it wasn’t like in the movies, it was worse. Once my monitor was complete, the midwife informed me that while indeed these were contractions, they needed to be stronger and more regular to be admitted to the Kreißsaal. In the meantime I should go back up to my room and try to sleep a bit and come back again later. At this point I was ready for some pain killers, but waddled back upstairs and tried to tough it out a bit longer (and block on the horrific cries I’d been hearing).
I definitely could not sleep, but I rode out the contractions until 03:00 when I went back downstairs for another exam and a strong request for the epidural. The midwife offered me either a warm bath or something in my IV, but said it was not time for the epidural yet. I chuckled at the idea of a warm bath helping the intense pain I was feeling and opted for the IV. Following the next round with the fetal monitor, the midwife informed me that I could call my husband to come because I was finally getting admitted to L&D about 15 hours post-induction.
My Birth Story: Going into Labor in Germany
My husband arrived at the hospital around 04:00 while I was checked into my delivery room. Shortly after it was time for my epidural. I was so relieved to see the anesthesiologist, after already experiencing a couple hours of intense pain in my back from the contractions. The epidural didn’t hurt a bit and I felt instant relief. At this point I was about 5 centimeters dilated and while I could still hear some screams from other women in labor, I was comforted by my husband and epidural.
The midwife would come to check on us regularly. My husband occasionally would step out to top off the parking meter, which expired every two hours (LOL). Otherwise we were hanging out until around 09:00 when things really started to heat up and the midwife was there to stay. My contractions felt really strong and the epidural did not seem to be doing its thing anymore. I requested the anesthesiologist come back to increase the dosage. She returned at some point but said she needed to determine whether or not the needle was in correctly by inserting some of the medication directly into my IV. She promised to return in a bit to see if it worked. I felt near instant relief and was hopeful we could get the epidural to the right dosage.
At 10:00 sharp tickets for the first ever NFL game in Germany went on sale. As a big fan of American football, I just knew I had to be there, which was evidenced by the fact that I remembered the ticket sale during labor. Plus I was welcoming any distractions from the pain, but sitting number 668,303 in line I gave up hope pretty quickly. Fortunately my attempt for Taylor Swift tickets a year later was more successful. I digress...
Back to the labor: at this point my sense of time and memories have faded (thankfully), but at one point the anesthesiologist did come back, but she did not top off my epidural per my wishes. There wasn’t really any rationale. In Germany is they want you to feel the pain (ok, that is dramatic but they do in fact want you to feel the contractions = pain). It was getting pretty close to go time, so instead the midwife suggested I go for a walk to speed things up (the fact that I could theoretically go for a walk should tell you everything about how this epidural was not at the level I would have liked).
I was not up for a walk, so they administered oxytocin to finally push me over the edge.
As said in the intro, I will skip the gory details. Not long after the Oxytocin drip began, it was time to push. A friend told me it feels like taking the worst poop of your life, and for those wondering what labor feels like I can confirm that is oddly accurate. After an hour-and-a-half or so of pushing in a few different positions and realizing yep, I sound just like those women earlier in the torture chamber, Maximilian was out and crying and I felt… relief. It was about all I could feel after hours of wake time and exhaustion from the labor. All those happy emotions came later though, I assure you.
Max was immediately wrapped in a blanket and placed on my chest. After about 10 minutes, Markus cut the umbilical cord and they weighed, measured, and cleaned him. He was given back, I was stitched up, the doctor noted he detected an infection in my uterus, and then we were left in peace to relax for a couple of hours before they brought in my hospital bed and wheeled us up to postpartum care.
Things that surprised me / you may find noteworthy about the labor:
It was only myself, my husband, and the midwife in the room. The doctor showed up for the last 20 minutes.
I could eat and drink the whole time leading up to the birth.
My husband assisted during the labor, which again won’t go into gory details, but he played a pivotal role.
I gave birth in the clothes I showed up at the hospital in. I could have changed into a gown I suppose, but it was never explicitly offered.
The doctors all spoke english, the midwives were about 50-50, and the nurses likely did not. Thus some knowledge of german is very beneficial.
Postpartum Care after Giving Birth at a Hospital in Germany
I spent three days in the hospital after giving birth. The hospital standard was 48 hours, but I required antibiotics via IV to fight off a uterine infection they discovered during delivery, which extended my stay to 72 hours. These days are mostly characterized by checkups on both mom and baby (U1 & U2), as well as a quick crash course baby care, such as taking temperature, diaper changing, and breastfeeding. I was also visited by a physical therapist to check my abdominal muscles and teach me some rehabilitation exercises to continue once I returned home.
I spent most of the time “alone” (see: roommates) since my husband was restricted to visitor hours (15:00-19:00) under the COVID-19 protocols that were still in place. This somehow bothered me less than I thought it would, as I just spent time getting to know Max, while Markus could at least get some rest at home. Already in the hospital I knew I had an angel baby on my hands. While I already learned the cries of certain babies, I barely knew the cry of my own as he was just enjoying cuddles and snoozes. From the beginning, I was feeling like one lucky mama.
Postpartum Care Rooms
Since it was a different area (German: Wochenbett) of the hospital, I was promised they would check on a private room for the recovery days. Unfortunately there was still no private room. I am publicly insured but we had signed a release to pay cash for the private room (€60/night), but unfortunately the nurse checked and said there was no availability.
The nurse also mentioned that even if there was, they prefer to keep the rooms free in case someone with private insurance needs it since these clientele are pretty upset when they pay for private insurance and cannot get a private room. Alas… my advice would be to tip them upfront and I am pretty sure you would get a room (I passed this advice onto a colleague and it worked for her) as they were SO appreciative of our generous tipping, which we did not think was anything extravagant. We tipped €75 to the midwives at the labor and delivery station and €50 to the postpartum nurses. I guess most people are giving them little gifts of tea and lotion, but from my experience cash is very appreciated and goes a long way.
Anyway they did at least put me in a Wochenbett room with only one other roommate (as opposed to two). In the room, I had my hospital bed, a Babybay® for Max, a bedside cart, and a locker. There was also a table and chairs, a changing table with a warming lamp, and lockers full of everything you and the baby may need. On that note: you really don't need much besides a change of clothes, some toiletries, and an extra long charging cable for your phone. There was also a balcony off of the room. The restrooms, including toilets and showers, were all located in the hallway outside of the room. There was also a coffee, tea, and water station in the hallway.
Rooming In
Rooming in was the go-to method in Germany. As far as I knew, there wasn’t a nursery for the healthy babies. All babies were in the Babybay® positioned next to their mother’s bed. If you need some rest, I would say you are a bit SOL unless your partner is there to take over. For showering or using the restroom, you could roll the baby bed to the nurses’ station and they would watch over the baby while you did your business. You could also ask your roommate, which leads me to my next topic.
Roommates
A roommate postpartum was just not something I could ever imagine doing until I did it and being honest I still find it off-putting. Postpartum ain't pretty and to share that with a stranger, and their partner, did not generate pleasantries. At the same time, it wasn’t THAT bad, but I think your chances of meeting your bestie here are low. I had two roommates during my three night stay in postpartum care. My first was a very young Russian woman, who did not speak much german or english. It was her second child, she was nice enough, and we kept it to simple exchanges. After she checked out, it wasn’t long until they filled the room again. This time it was a German woman all the way from Karlsruhe. She’d had a planned C-section and her baby was in the NICU awaiting a heart surgery. I couldn’t believe the hospital had her sharing a room, with me and my healthy baby, but sure enough she was my new roommate. You already feel bad sharing a room with any disturbance you may cause, e.g. with babies crying as you both try to figure out breastfeeding, but this scenario added to the roommate guilt since her baby couldn’t even be with her.
Summertime
It was the midst of summer and oh was it HOT. I am from Texas and generally have a high heat tolerance, but there was no AC or any sort of cooling mechanism in postpartum care (note: there was AC in the delivery room) and it was sweltering. I am not a sweater, but asked the staff to change my sheets at one point mid-stay because my bed was just drenched. To generate some airflow, everyone left their balcony doors, alongside their main door into the hallway, open. This helped cool things down, but ultimately it did not help anyone sleep because you could hear all the babies in the ward crying all night.
Daily Routine
Rounds started early in the morning. Around 5:30 the nurse would come check on us. Soon after breakfast would be delivered and the doctor would visit around 7:00. This would repeat again around 10:00 until there was a quieter period until the evening, allowing you to rest and then enjoy the time with visitors. The food was atrocious (see photos below), so for dinner my husband would typically bring takeout from somewhere nearby. Other interruptions included visits from the physiotherapist and appointments with the pediatrician (German: Kinderarzt) down the hall.
Food
The food was pretty atrocious. Sometime during the day, personnel would also come to read out 3 options for dinner and record my preference. I remember being excited about my pasta order only to be left wondering how on earth they cooked their fettuccini to achieve such a grotesque consistency. Breakfast and lunch were typically a variation of sliced cheese, bread, and something else disappointing. Fortunately this hospital's location in a bustling neighborhood allowed me to indulge in takeout deliveries via my husband, such as pizza and the best reward, sushi!
And for what it’s worth, here is are my takes on the categories of advice I received leading up to the birth:
On bonding with the baby: It wasn’t the best day of my life, and it may not be yours, but oh was it the best year. Just know that you will bond with your baby, all in your own time.
On childbirth: It is by far the most grueling thing I physically have experienced, but I got through it and you will too. I highly recommend accepting any and all pain relief and to not be too set on a particular birth plan. Your health and your baby's health are the top priorities!
On the first weeks at home: You can do hard things! You are prepared for the hard stuff, but you are not prepared for how much you will love this child and the the lengths you’ll go to ensure this baby’s wellbeing. Your partner will find the lack of sleep much more defeating than you will and that’s ok.
And something no one prepared me for: You are going to feel more connected with women around you and you may also experience feelings of guilt because you didn’t understand what those before you went through and didn't know how to properly be there for them. It’s ok though; you’ll pay it forward in the future.
And today my son turns one! I can only agree with other parents who say the time really does fly. I don't mean this to put this societal pressure on anyone to cherish every moment because some truly are hard, but try to soak up the good ones. The birth for me was not one of those, and I am ok with that; there were plenty more moments to follow from the second I met you, Maximilian!
Did you give birth in a foreign country? How was your experience?
