gms | German Medical Science

Background and research question: In Germany, statutorily insured patients are entitled to midwifery care in the outpatient sector during pregnancy, birth, postpartum and breastfeeding period. Research suggests that not all midwifery services are sufficiently available, accepted and equally accessible to all in all regions. The German health care system includes a service guarantee (in German “Sicherstellungsauftrag”) to ensure health care provisioning, for example obligating physicians themselves to provide adequate care in the area of Statutory Health Insurance-accredited medical care.

Goal: It was researched whether the instrument of a service guarantee for midwifery care in the outpatient sector could improve care in childbirth.

Methodology: To assess the potential of a service guarantee the “Framework for development and evaluation of complex interventions” was applied. In this regard a context analysis was conducted using a literature review and guided expert interviews from the perspectives of different stakeholders. Six studies, as well as fifteen expert opinions, studies and reports on midwifery care commissioned by the federal states and the federal government, about fifteen other documents (laws, regulations, textbooks, websites, etc.), and six interviews were evaluated.

Result: Evidence shows that for high-quality maternal and newborn care midwives should provide midwife-led continuity care to all women, and where as physicians should be consulted only in case of risks. Germany does not achieve this high-quality care because prenatal care by midwives is not accepted and often not available, so it is not guaranteed that all women can comprehensively receive all care essential services from a midwife or a team of midwives. Socioeconomically disadvantaged women are overall less likely to receive midwifery care. Accordingly, changes in care and service structures are needed to facilitate access and increase acceptance, and thus achieve comprehensive care by midwives. The National Health Goal “Childbirth related Health” also requires for improving the provision of midwifery care. A corresponding service guarantee could support the development and establishment of suitable structures. However, its opportunities and risks depend on its design, and there are apparent obstacles and uncertainties. Midwives themselves seem to have reservations about regulatory professional structures and the system change from physician- to midwife-led prenatal care required for comprehensive primary care by midwives would involve overcoming major obstacles.

Relevance: A service guarantee for midwifery care in the outpatient sector could be a suitable instrument for improving obstetric care as also required in the National Health Goal “Childbirth related Health”.

Conclusion: A service guarantee for midwifery care in the outpatient setting shows potential, provided it is designed appropriately and uncertainties and obstacles are overcome. For this purpose further research by a team including relevant stakeholders is needed.

Ethics and conflicts of interest: This abstract was written in the context of a master’s thesis. The study design received a positive vote from the Ethics Committee of Heinrich Heine University Düsseldorf on April 13, 2023. The research was financed by own resources. There are no conflicts of interest.

The PDF file of the poster submitted for the meeting is available in German as Attachment 1 [Attach. 1].