Rural assisted births face imminent peril, farmers caution
The German midwifery sector is facing a potential crisis, with over 80% of clinics where midwives work on a contract basis anticipating significant reductions in activities or resignations due to income losses. This follows the implementation of a new midwifery contract, effective from November 1, which affects around 190,000 self-employed midwives in Germany.
The new contract, criticised by the German Midwives Association (DHV) and the German Federation of Rural Women (dlv), contains drastic cuts that result in significant income losses for contract midwives, despite their unchanged high responsibility. Services for further births, for example, are only remunerated at 30%, and services for parallel births will only be partially remunerated under the new contract.
The DHV and the dlv have demanded mediation through the Federal Ministry of Health, calling for an immediate independent review of the economic consequences of the new contract. They fear a potential shortage of midwives, particularly in rural areas, with the dlv President, Petra Bentkämper, warning of a potential supply collapse in these regions.
In support of the demands made by the German Midwives Association, the Landfrauen have advocated for clear signals and swift corrections from the authorities. They also support the demand for immediate renegotiation of the contract terms for the on-call system. Almost 40% of hospitals with a contract system expect their obstetrics department to close, and almost half of contract midwives want to leave obstetrics within the next six months.
The new contract's billing services terms have also worsened for midwives, with a surcharge for one-to-one care only granted if the midwife is continuously present at least two hours before and two hours after the birth. This requirement, coupled with income losses, has led to noticeable supply gaps, even if entire departments don't close.
The DHV has criticised that the new regulation will lead to significant income losses in practice and potentially endanger the entire contract system. All contract midwives expect income losses, with 93% anticipating significant restrictions on their work.
Both the DHV and the Landfrauen are urging the Federal Ministry of Health to intervene in the crisis and review and revise the contractual conditions for midwives to ensure the continued provision of essential midwifery services, particularly in rural areas.
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