Prenatal care and maternity records

In Germany, pregnant women with statutory health insurance can have a prenatal check-up every four weeks. They are offered every two weeks as of the 32nd week of pregnancy. All examinations are voluntary. More regular check-ups are possible if there are certain risk factors or health problems.

Almost all of the prenatal examinations can be done either by your doctor or your midwife. Exceptions are the ultrasound scans and blood tests for the child's Rh factor - only doctors are allowed to do them. Standard prenatal care in Germany includes three ultrasound scans, done around the 10th, 20th and 30th weeks of pregnancy.

Particularly at your first appointment, your doctor or midwife will ask you detailed questions about

• existing or past diseases,
• other symptoms,
• diseases in the family,
• particular physical, mental, or social stresses, such as at work or in the family,
• any medication you take, and
• your lifestyle (such as consumption of alcohol or tobacco).

They will also ask you about how any previous pregnancies went, such as whether the children were born naturally or via C-section, or if you have ever had a miscarriage.

The estimated due date is noted in your maternity records. It is calculated

• either based on your last menstruation
• or, if you know, the date of conception.

The week of pregnancy and the predicted due date can be assessed more accurately during the first ultrasound scan. If needed, the due date can be updated in the maternity records.

Every prenatal check-up includes

• blood pressure measurement,
• weight,
• feeling the abdominal wall to check where the uterus is,
• listening to the unborn baby’s heart sounds, and
• checking the baby’s position.

If needed, any physical changes like water retention (edema) and varicose veins can be examined, too.

A gynecological examination via the vagina is done at the first appointment as well. That is only necessary at the following check-ups if you have certain symptoms.

A urine sample is taken at every appointment and tested for protein and sugar to check for signs of metabolic disorders or kidney disease.

The urine sample from the first appointment is also tested for chlamydia. That is a sexually transmitted disease that can affect the pregnancy and the child.

Blood is taken at one of the first prenatal appointments to

• detect your blood group and Rh factor.
• Antibody screening: Your blood is tested for antibodies that react against the unborn baby’s blood. The screening is repeated between the 24th and 27th week of pregnancy.
• Test to see if you are protected against rubella, such as by vaccination, if you don't already know.
• Test for syphilis: A note is only made that the test has been done, not of the result.
• Measure hemoglobin levels. This examination is done at every prenatal check-up as of the 6th month of pregnancy.
• A blood test for HIV is offered, too. Here again, only a note is made in your maternity records that the test has been done, not of the result.

A blood test to find out the child’s Rh factor is possible as of the 12th week of pregnancy if the pregnant woman is Rh negative and is only expecting one child. The Rh factor tells whether the mother's and child’s blood is compatible if it is mixed during birth, like if the placenta or umbilical cord is damaged.

Every pregnant woman who doesn't have diabetes can be tested for gestational diabetes between the 25th and 28th week of pregnancy. For the first test, you drink a glass of water with glucose dissolved in it. One hour later, a sample of blood is taken from a vein in your arm to determine the blood sugar level. If the level is found to be high, a second test is done.

A hepatitis B test is offered as of the 32nd week of pregnancy.

Tests for toxoplasmosis, cytomegaly, listeriosis, and streptococci are an option if there is a risk that you have been infected. In Germany, statutory health insurers will then cover the costs of the tests. Otherwise, you will have to pay for these tests yourself as what are known as individual health care services (IGeL). Some doctor’s practices recommend these tests even if there is no suspected infection. It is then a good idea to ask what advantage they offer.

All pregnant women are offered three ultrasound scans:

• between the 9th and 12th week of pregnancy
• between the 19th and 22nd week of pregnancy
• between the 29th and 32nd week of pregnancy

The main purpose of the ultrasound scans is to work out how old the unborn baby is and to check how it is developing. During the scans, your gynecologist will check the position of the placenta and how much amniotic fluid there is. They will measure the baby and listen to its heartbeat. Ultrasound scans can also show the sex of a child.

If an ultrasound scan finds abnormalities or uncertainties, further examinations can be carried out to clarify things.

Vaccinations against influenza and whooping cough are recommended for pregnant women. Your doctor or midwife can advise you on them.

You can discuss any other questions you might have at any time during prenatal check-ups. Your doctor or midwife will normally address the following subjects:

• Diet, such as getting enough iodine.
• Stimulants, such as the effects alcohol and smoking can have on your child and what might help you to avoid both.
• Medication: It is important to always discuss any medication you are using with your doctor.
• Prenatal courses, such as prenatal gymnastics and birth preparation.
• Cancer screening, including screening for cervical cancer.
• Oral hygiene: It is particularly important that pregnant women take care of their teeth and gums.

Lots of questions that might come up during pregnancy don't involve health first and foremost. Pregnant women and their partners can always contact a pregnancy advice center. You can discuss things like financial or legal questions there, as well as any other concerns or problems you might encounter in connection with the pregnancy. The Federal Centre for Health Education (BZgA) lists possible subjects you can seek advice about and offers an information center search function.

You can also find a table summarizing this information here: Prenatal check-ups (PDF)