Doula Carolyn Hecken on 5 first trimester musts if you are pregnant in Munich

Carolyn Hecken is a birth doula serving pregnant women in hospitals, birth centres and homes. She helps women have a positive birth experience through emotional and physical support and tries to make labor and birth as comfortable and stress-free as it can possibly be. There are many health benefits to hiring a doula. In research studies doulas have been proven to decrease medical interventions and improve outcomes for birthing women.

Pregnant in Munich

Could you define for our readers the definition of a doula and the services a doula offers women?

As an English-speaking doula in Munich, I help expectant mothers, and their families, navigate the uncertainties of pregnancy and the unpredictability of childbirth in a foreign system. Throughout pregnancy, birth and the early days parenting a newborn, I provide emotional, physical, mental and informational support. Before birth, I meet with mums several times to talk about what to expect here in Germany, ways to cope with the intense sensations of birth, how to maintain a sense of relaxation and peace, how to approach the unexpected, and how to communicate clearly, effectively and amicably with health care providers, who may have a different set of cultural expectations with regard to the dynamics of the medical provider-patient relationship. This is exceptionally important because the better understood a mum feels by her midwife and/or doctor, the more likely she is to feel confident in the process of birth itself and the choices she makes as a mother giving birth.

In order to support a mum in feeling as prepared as possible, I help her to recognise and access her already existing skills, strengths and abilities that she may not have considered would be applicable in the context of birth. This helps her to connect more confidently with her instinctual ability to make the decisions necessary to bring her baby in to this world safely, calmly, and above all, lovingly. In my role as a doula, I do not perform any clinical tasks, interpret test results or make any evaluations about a mum’s health, her baby’s health or her birthing. Instead, my goal is to help facilitate opportunities for a mum (and her partner) to advocate for herself, voicing any wishes, needs and concerns she may have (“It looks like the midwife/nurse is preparing X. What questions do you have for her? Do you feel you need a minute to talk about it?”).

After a mum has given birth I stay until she has had a chance to cuddle and bond with her baby, including the first feeding and getting settled into her new room (if at hospital). I then meet mum several times to help her comfortably ease into life with a newborn. We talk about normal baby behaviour, changes in her body and her recollections of and feelings about the birth of her child. If she is in need of additional support, I help connect her with local experts (baby bonding specialists, midwives, doctors, osteopaths, lactation consultants like IBCLCs and more).

Why do women choose to work with a doula?

Here in Munich, mothers have been interested in working with a doula for several reasons. The first reason is the desire for support in communicating with the birth team both culturally and linguistically as many of the mums I have had the honour and pleasure of getting to know are expats. Quite a few mums have given birth before and like the idea of having calm, continuous support throughout giving birth. Unfortunately, due to the situation that German midwives are currently facing, and the mini “baby boom” in Munich, many of the dedicated doctors and midwives find themselves working ever longer and harder hours. While they still provide families in the Munich area with stellar care, their focus must include the clinical as well as administrative aspects of care.

How do people go about finding a doula, and how do they know if they are fully qualified?

There are many avenues to go about finding a certified doula. Currently, there are a large number of doula training organisations. If mothers would like to have a doula from a certain doula training organisation, she can use the individual site’s search function to locate a doula who has certified with that organisation. There are also a number of doulas who, while experienced, have chosen not to certify with any one organisation. I recommend meeting with a doula to get to know more about her, her experience, the philosophy of her certifying organisation and how she has supported families in the past. This can be helpful in getting an idea as to whether working with that particular doula would be a fit.  As doulas, we all want mothers to have the opportunity to work with a doula, with whom she connects with best.

Are there any associations for doulas in Germany?

Yes, there are two main certifying organisations: Gesellschaft für Geburtsvorbereitung (GfG) – Familienbildung und Frauengesundheit – Bundesverband, e.V. and Doulas in Deutschland, e.V.  You will also be able to find doulas who have certified with other international organisations (DONA, CBI, etc.).

How do you feel about using pain medication during labour?

I fully trust, respect and support a mother’s decision to choose whichever means of pain relief she has determined is necessary in order to give birth to her baby safely.

What labour coping techniques do you like to use?

A reassuring, calm presence and my hands (massage, counter pressure, etc.)

Do you feel there is adequate support for mothers in Germany in terms of caring for the baby and breastfeeding?

Yes and no. My impression is that it depends heavily on the region in which you live. Munich, in particular, has an extensive network of lactation support. However, it does not seem to be easily accessible for new parents. Many families rely on their pediatricians, OBGYNs and midwives for breastfeeding advice so it can also depend on how up-to-date these healthcare professionals are on the latest breastfeeding recommendations. Having a wider community of support by joining mum and baby groups, breastfeeding support groups and contacting an IBCLC can help ease some of the tension, uncertainties and challenges that may arise while learning how to breastfeed a baby.

What advice would you give to women from the international community who are preparing to have a baby in Munich?

1. Choose an obstetrician

Munich boasts a large selection of English-speaking gynecologists and/or obstetricians. To find one consult the list provided by the US Consulate General Munich, check out the various threads on Toytown Munich or join the Facebook group Parents in Munich to gain access to a whole range of English-speaking resources including a lengthy list of OBGYN recommendations. Another opiton would be to enlist the services of Katrin Nellis of Munich Horizon to assist you in navigating the very administrative and bureaucratic side of childbirth in Germany.

From the very beginning of your pregnancy up through weeks 39 to 41, your and your baby’s health will be monitored by your obstetrician and/or an in-practice midwife. You’ll receive a document called a Mutterpass in which all health information pertaining to your pregnancy will be recorded regularly. Should you travel at any point throughout your pregnancy, bring this document with you. If you need to stop in unexpectedly to see a doctor during your travels, s/he will have a general frame of reference to work from.

Toward the end of your pregnancy, your prenatal care may be transferred over to the clinic or hospital where you have chosen to give birth for additional monitoring. If you would like to know more ask your physician when s/he usually transfers care and for what reasons.

2. Choose a midwife for in-home postnatal care… immediately

German insurance covers the cost of midwifery care both before and after the birth of your baby. However, due to rapidly increasing demand, midwives offer primarily postnatal care and some even include one or two visits beforehand. Because the number of births in Munich is steadily rising and midwives across Germany continue to face a precarious insurance situation, it has become increasingly challenging to secure the care of a Nachsorgehebamme (postnatal midwives). Recently, expectant mothers have had little success finding one starting as early as 10 to 12 weeks. Search for a midwife available near you by entering your postal code on the Bavarian Association of Midwives’ website. The list provided on Parents in Munich may prove to be a helpful resource as well.

If you can’t find a midwife for postnatal care ask your Obstetrician. S/he may work with individual midwives or a group of midwives who may have some availability. Or you could visit the Dominikuszentrum located on Hildegard-von-Bingen-Anger 1-3 (North Munich) for drop-in consultations with a Nachsorgehebamme

3. Choose a home birth midwife, birthing centre, clinic or hospital.

A variety of birth options are available in Munich. Depending upon which option best suits you, you may not want to wait all that long before making a move to pre-register at your birth location of choice. In fact some clinics, birthing centres or home birth midwives may be nearly impossible to secure after your 7th to 10th week of pregnancy.

All hospitals, clinics and birthing centres offer information evenings on a monthly basis. This is a great way to learn about the options and services available as well as the philosophy of each obstetrics team. Be sure to bring questions to help you determine which option will be the best fit for you and your baby.

4. Register for a childbirth course

The cost of some childbirth preparation courses can be reimbursed by your insurance company. These courses are primarily those taught by midwives. As far as English-speaking childbirth preparation classes go, there are some available through the Counselling Centre for Natural Childbirth and Parenting, e.g., Pippagina and GentleBirth Munich.

5. Create your community of support

Most of us don’t live close to friends and families as our grandparents and parents once did. You may be the first of your friends or acquaintances to experience parenthood. Let’s face it, the more supported we feel, the better we feel. So start by building your system of support.

Secure the support of a doula to answer your questions throughout pregnancy, support you physically, mentally and emotionally during labor & birth and help you navigate the early postnatal days with confidence and ease.  You could visit a prenatal yoga class with YogaBee, take a breastfeeding class with Pippagina and/or visit a local La Leche League (mother-to-mother breastfeeding support) meeting. The Facebook group Positive Birth Group Munich also have bi-monthly meet-ups.

Please note that since publication of this interview Carolyn has relocated to Hamburg.