Update of criteria for out-of-hospital births in Germany – how to deal with higher than low risks in obstetrics

Abstract

After births at midwife-led birth centers, as well as home births, were included in the Social Security Statute Book (§134a SGB V), and thus became covered by the German national public health insurance, contract negotiations on flat rate costs followed. Consequently, the quality management section concerning allocation criteria for out-of-hospital births required an update, which needed to be as evidence based as possible. Many countries have a catalog allowing choice in place of birth, but these are often not published in scientific journals and thus cannot be identified by usual research tools. This article includes a link to an overview table with twelve columns, representing current practice in eleven countries (for Germany, two catalogs, from different settings, are included). These catalogs have been found through literature studies (often as links to the homepage of the ministry responsible) or by direct correspondence. Obstetrics worldwide faces the same problems in terms of how to cope with higher than low risks. The overview table shows how very similar the solutions really are, and thus helps to define how responsibility can be shared effectively between midwives and obstetricians. The specific regulations concerning quality management in the contract between self-employed midwives and the German Public Health Insurance will be updated on this basis.