Your guide to a positive birth within the German maternity care system

When expecting a baby in Germany, learning about the maternity system and making informed choices about your birth experience can feel complicated, especially for international families. Most births take place in hospitals, which often operate under time pressures, strict protocols, and limited staff availability. Because the system is designed to serve many people, it may not always be tailored to your personal needs or pace.

It's not always easy to find a balance between trusting professional expertise and staying actively involved in your own birth! As a doula in Berlin, I know birth goes best when you are prepared and informed. Writing a birth plan is a powerful key that will support your dream of having a positive birth. 

Why a birth plan matters

A birth plan (Geburtsplan) is a written document that reflects your wishes, choices, and intentions for labour and birth. While it is not a binding legal document, it is a powerful communication tool. More importantly, the process of writing it helps you clarify what truly matters to you.

During the intensity of labour, it can be hard to think clearly, especially in a new language or an unfamiliar environment. Preparing in advance gives you the ability to advocate for what you want, even under intense pressure.

How and when to write your plan

Most parents start their birth plan around the seventh or eighth month of pregnancy. I recommend setting aside time together as a couple, for example, three sessions of an hour, to do some research and discuss your priorities.

Here are some tips that will help you develop and write your plan.

• Learn about birth: Learn about the physiology of labour and local hospital procedures. To this end, you might attend a childbirth preparation course (Geburtsvorbereitungskurs). These are often fully refunded by German health insurance. You can also read books, listen to podcasts, or get the support of a doula. For specific questions, talk with your midwife (Hebamme), the birth setting staff (during a Geburtsplanung) or attend Information Evenings (Infoabende) at clinics.
• Keep it concise and accessible: Aim for just one to two pages, and ideally in both your language and German, so hospital and midwifery staff can also understand it.
• Share it: Keep an extra copy in your hospital bag and share it with your care team in advance. Have it easily accessible during labour.
• Write it yourself: Looking at existing templates online for inspiration can be helpful to get you started, but make sure the final version is truly coming from your personal reflection.

What to include in your birth plan

Each birth plan is unique, and different people will put more or less focus on different areas. However, these are all good things to consider in advance and put into your birth plan.

Place of birth and support

Where do you plan to give birth: a hospital, birth centre (Geburtshaus), or home? If choosing a hospital, consider which one best fits your preferences and why.

Support Team

What role do you expect your partner and/or doula to play? Simple things others can help with include supporting you with breathing, massages, putting music on, dimming lights and so on.

Comfort and pain management

Consider both medicated and non-medicated methods. Medicated pain management can include epidural, opioids and nitrous oxide (Lachgas), while examples of non-medicated methods include acupuncture, massages, breathing techniques and hypnosis.

Make sure you understand the risks, benefits, and practical implications of each medicated option. For example, an epidural often requires continuous fetal monitoring, limits mobility and is associated with a longer pushing stage.

Mobility and positions

Movement helps labour flow. Ask your team under which specific conditions your mobility might be restricted. Ask about props that could support movement, such as a birthing ball, or a birthing rope Gebärseil.

For the pushing stage, explore upright or forward-leaning positions. These utilise gravity and maximise pelvic opening, which evidence shows supports better progress, greater comfort and less risk of tearing than lying flat.

Common interventions

Inform yourself about common interventions in Germany and form a preference about what you would consent to and under which conditions. I would encourage you to learn about: epidurals, cervical exams, CTG monitoring, usage of synthetic oxytocin, instrumental extraction (forceps, vacuum), episiotomy, c-sections and inductions.

Your first choices as parents

Form your opinions on the key decisions that need to be made during the first hours of life, such as cord clamping, skin-to-skin contact, breastfeeding in the "golden hour",  routine newborn checks, Vitamin K, and initial screenings.

Hospital stay

Think about when you would like to leave the hospital. You can request an ambulant birth (ambulante Geburt) to go home the same day if all is well. This might be influenced by your likelihood of getting a private room or family room (Familienzimmer) to room in with your baby and partner, compared to a shared room.

Preparing for the unexpected 

Since birth is unpredictable, consider adding a Plan B section. This can outline your wishes in case of an unexpected turn, such as a cesarean during labour.

Knowing your rights and advocacy

In Germany, you have the fundamental right to be informed about every medical procedure and to refuse it if you choose. I often share with my clients a simple “Safety Card” they can keep in their Mutterpass.

The BRAIN acronym, which you will find on the card, is a practical way to assess any intervention offered during labour and help you make your decision calmly. Even just knowing how to ask for clarification and time can make a huge difference when things get intense. Keep these phrases handy:

• Ist das dringend, oder können wir besprechen, welche Möglichkeiten wir haben? (Is this urgent, or can we talk about what choices we have?)
• Ich möchte bitte verstehen, warum das nötig ist. (I’d like to understand why this is necessary.)
• Welche Alternativen gibt es? (What alternatives are there?)
• Ich möchte etwas Zeit zum Nachdenken. (I’d like some time to think about it.)

Preparation clears the path for a positive experience

Every parent deserves to feel informed, respected, and supported. Regardless of where and how you plan to give birth, taking the time to prepare your birth preferences and learning how to advocate for yourself can make all the difference in achieving a positive, empowering experience.