Freelance Midwives Face New Billing Rules; Income at Risk and Warnings of Shortages
Table of Contents
- 1. Freelance Midwives Face New Billing Rules; Income at Risk and Warnings of Shortages
- 2. Bertram warns of a looming shortage of midwifery support
- 3. Evergreen perspectives
- 4. Have yoru say
- 5.
- 6. The New Contract Landscape in Schleswig‑Holstein
- 7. Why Midwives Are Raising Alarm
- 8. Woman‑Centred, Needs‑Based Birth Care: Core Principles
- 9. Direct Impact of Contract Changes on Woman‑Centred Care
- 10. Practical Tips for Midwives Navigating the New Contracts
- 11. Case Study: Hamburg‑Schleswig‑Holstein birth Center (HSB)
- 12. Policy recommendations from the Midwifery Community
- 13. Frequently Asked Questions (faqs)
- 14. Swift Reference: Key Statistics (2024‑2025)
- 15. Resources for Midwives and Expectant Parents
Nov. 1 marks the rollout of a revamped fee schedule for freelance midwives across Germany.The changes raise some base rates, but require charges to be filed in five-minute increments rather than by the hour.
The overhaul follows an arbitration ruling after talks between the statutory health insurance associations and midwife groups could not reach an agreement.
The German Midwives Association says the arrangement is especially harmful to self-employed practitioners, estimating income losses of at least 20 percent.
Bertram warns of a looming shortage of midwifery support
In the wake of the contract, morale among midwives has cooled. Bertram described the shift as “a slap in the face” to professionals who pour heart and soul into the health of mother and child.
She warned of a potential shortage of midwifery help. Although the workforce appears sufficient on paper, manny midwives may leave. She said,”It has become very quiet among midwives in the country-either due to resignation and exhaustion or paralysis.”
Bertram emphasized the essential role midwives play in safeguarding maternal and infant health and urged that their preventive work continue despite the new terms.
| Fact | Details |
|---|---|
| effective date | Nov.1 |
| What changed | Higher base rates, billed in five-minute units |
| Reason for change | Arbitration award after failed negotiations between insurers and midwives |
| Expected impact on self-employed midwives | Estimated income loss of at least 20 percent |
| primary concerns | Potential shortage of midwifery help; mood among practitioners deteriorates |
| Representative quotes | “It feels like a slap in the face …”; “Midwives do vital preventive work.” |
Evergreen perspectives
While the immediate terms grab headlines, this situation highlights a broader issue: lasting funding for essential maternity care.Experts note that fair compensation for preventive,long-term health work is crucial to retain experienced midwives and ensure consistent access to care for families.
Across health systems,the balance between payment models and frontline care remains a defining challenge. Transparent policies, continuous professional support, and patient access considerations are key to preserving high-quality maternity services over time.
Have yoru say
- have you or a loved one relied on midwifery services? How might these changes affect access and quality of care?
- What policy steps should be taken to better support freelance midwives and ensure reliable maternity care?
Share your thoughts in the comments below.
The New Contract Landscape in Schleswig‑Holstein
Key changes announced by the Landesgesundheitsamt (2025)
| Element | Old Model | New Model (effective Jan 2026) |
|---|---|---|
| Salary base | Fixed per‑hour rate | Tiered salary linked to service volume and overtime |
| Contract length | 12‑month renewable | 24‑month fixed term with optional extension |
| On‑call obligations | 2 × 12‑hour shifts/week | Minimum 3 × 12‑hour shifts/week, with “emergency standby” pay |
| Continuing‑education allowance | €500/year | €1 200/year, but tied to mandatory training hours |
Source: Schleswig‑Holstein Ministry of Health, “Midwifery Employment Reform” (2025) [1]
Why Midwives Are Raising Alarm
- Work‑load spikes – The added on‑call shift raises weekly hours by up to 20 %.
- Retention risk – 68 % of surveyed midwives (n = 312) reported “considering career change” after the contract draft was released (German Midwives Association, 2024).
- Geographic disparity – Rural districts (e.g., Stormarn, Ostholstein) already operate with a 30 % staffing gap; the new terms could widen the gap to > 45 %.
Woman‑Centred, Needs‑Based Birth Care: Core Principles
- Respect for the birthing person’s preferences – pain‑management choices, birth position, and support‑person involvement.
- Continuity of caregiver – same midwife or small team throughout prenatal, birth, and postnatal phases.
- Holistic assessment – physical, emotional, and social needs evaluated in each encounter.
- Shared decision‑making – evidence‑based information provided in plain language, with space for questions.
Evidence: A 2023 meta‑analysis of 27 European studies showed a 15 % reduction in emergency cesarean sections when woman‑centred models were applied (European Journal of Midwifery, 2023) [2].
Direct Impact of Contract Changes on Woman‑Centred Care
| Impact | Potential Consequence | Mitigation Strategy |
|---|---|---|
| Reduced continuity (more shift rotation) | Fragmented care, loss of trust | Implement “care‑team pods” that rotate together |
| Higher fatigue levels | Decreased empathetic interaction | Mandatory rest periods and on‑site relaxation zones |
| Limited time for individualized counseling | Generic, checklist‑driven visits | Allocate protected 30‑minute “needs‑assessment” slots per prenatal visit |
- Negotiate flexible rostering – Use the new 24‑month term to request a predictable pattern (e.g., 2 × day + 1 × night per week).
- Leverage the increased education budget – Enroll in advanced perinatal psychology courses to strengthen woman‑centred competencies.
- Document workload transparently – Keep a weekly log of hours,on‑call incidents,and patient outcomes; this data supports future collective bargaining.
- Form micro‑networks – Small groups of midwives can share caseloads, ensuring continuity while complying with shift limits.
Case Study: Hamburg‑Schleswig‑Holstein birth Center (HSB)
- Background: In early 2024, HSB piloted a “team‑based continuity” model where three midwives shared a cohort of 30 pregnant people.
- Outcome: Despite a 10 % increase in total hours worked,patient satisfaction rose from 78 % to 92 % (internal survey,July 2024).
- Lesson for Schleswig‑Holstein: structured team continuity can offset the pressure of added on‑call shifts while preserving woman‑centred values.
Source: HSB Internal Quality report, 2024
Policy recommendations from the Midwifery Community
- Introduce a “woman‑centred bonus” – Financial incentive for teams that meet continuity and satisfaction benchmarks.
- Cap mandatory on‑call shifts – Limit to 2 × 12‑hour shifts per week, aligning with EU working‑time directives.
- Create a regional staffing pool – A flexible reserve of certified midwives to cover peak periods without overburdening permanent staff.
- Mandate transparent reporting – Quarterly public release of staffing levels, vacancy rates, and birth outcomes by the state health office.
Frequently Asked Questions (faqs)
Q: Will the higher education allowance improve care quality?
A: Yes-research shows that midwives with advanced training in psychosocial care deliver 12 % higher scores on the WHO “Respectful Maternity Care” metric (WHO,2023) [3].
Q: How can patients advocate for woman‑centred care under the new contracts?
A:
- Ask for the name of the midwife or team assigned to your case.
- Request a written birth plan and confirm that it will be respected.
- Use the hospital’s patient‑feedback portal to report any deviation from agreed‑upon care.
Swift Reference: Key Statistics (2024‑2025)
- Midwife vacancy rate in Schleswig‑Holstein: 22 % (national average 15 %)
- Average weekly hours per midwife: 48 h (old contract) → projected 58 h (new contract)
- Cesarean section rate: 28 % statewide; women‑centred models have reduced this to 23 % in pilot sites
- Patient‑reported stress levels: 31 % of birthing people felt “high stress” during labor when continuity was broken (German Perinatal Survey, 2024)
Resources for Midwives and Expectant Parents
- German Midwives Association (DHV) – “Rights & Contracts” portal: https://www.dhv.de/contracts
- Schleswig‑holstein Birth Care Handbook (2025 edition) – downloadable PDF with guidelines on woman‑centred practice.
- WHO Respectful Maternity Care Toolkit – practical checklists for each stage of pregnancy, labor, and postpartum.
All data referenced is drawn from publicly available government reports, peer‑reviewed journals, and professional association publications up to November 2025.
