Author: Gutsy Girl

You just realised that you have two lines on that pregnancy test…. That is great news!! I am sure you are happy but at the same time you are freaking out!! Trust me, I know this feeling!! A cocktail of elation, anxiety, giddiness and trepidation is what you are feeling. It does not matter whether the two lines were planned or unplanned. All women go through the same feelings when they are first confronted with those two lines, but hey when life gives you lemons….

Different cultures have different social and regulatory norms to deal with pregnancy and not one culture is superior to the other. All have their advantages and disadvantages. But let me tell you one thing, if you are in Germany, then the this society provides a really strong support system to pregnant women. Germany offers really good insurance coverage for pregnant women and also one of the world’s best countries for child care. It is hard to believe for adults since the medical system for adults has a lot of shortcomings. But trust me, when it comes to pre- and post-natal care, you could not have asked for a better system. 

In this article, I am compiling a few important things that you should know about pregnancy and the process of giving birth in Germany as an expat. I am from India and I gave birth in Germany and now I am a mother to a wonderful 18 month old boy. I hope this article helps you understand the system better and make you aware of things and resources that are easily available to you. Ladies, especially the pregnant ones, please do not freak out if you have missed out on doing some things on my list. The last thing you need to do is worry. The German system really cares about you all and especially the kids, so in the end everything will fall into place.

I will start off by listing some things that you should do as soon as you know that you are pregnant.

1. Finding a Frauenarzt (Gynaecologist) – Yaay! Congratulations on getting that second blue line on the pregnancy test! Don’t freak out, you will get a lot of help here in Germany. Firstly, you will have to find a gynaecologist (in case you do not already have one). You can start calling gynaecologists in your city and ask them if they have the capacity to take you as a patient. In case you are unable to find one, don’t worry you should call your insurance and they have to assign you a gynaecologist as soon as possible. In case you already have a gynaecologist, please schedule an appointment with them as soon as possible. During the first appointment, there will be an ultrasound to confirm the pregnancy. Once the pregnancy is confirmed they will provide you a mutter pass (maternity pass) which is an important document where they record and monitor all details of your pregnancy and it is recommended to carry it everywhere with you.
2. Getting a Bescheinugung (Receipt) – In the next step you should take a “Bescheinigung” from your Frauenarzt stating your due date. You need to send this to your insurance and also to your employer if you are working. I would recommend sending this to your employer only after the end of the first trimester. But be sure to check the contractual conditions in your company before making a decision.
3. Finding a Hebamme (Midwife) – Then comes a very important task of finding a Hebamme. Here is a website where you can look for Hebammes – https://www.hebammensuche.de. You will have to enter your pin code (Postleitzahl – PLZ) and the due date and the website will show you details of available Hebammes around your due time. It is better to start looking for a Hebamme immediately after your first ultrasound. Sometimes it might be hard to find a Hebamme. Especially if you are expecting a baby during summer holidays or during Christmas holidays. My baby boy was born in August and I was lucky to find just ONE Hebamme who was available during that time. 
4. Ultrasounds and tests – Be ready to pay for extra ultrasounds if required. Each ultrasound costs around 30-35 euros. If you have a normal pregnancy your insurance pays for three ultrasounds, one in each trimester. It is recommended to get a (NT-messung/NIPT test) in your 12th week of pregnancy just to rule out any chromosomal defects in the foetus. This is optional but since 2022 it is covered by the insurance. Another important test is a detailed ultrasound (organ screening) that is performed in the 20-24th week of pregnancy and is covered by insurance. It is important to perform this to confirm normal growth and development of your baby.
5. Geburtsvorbereitungskurs (Child Birth Preparation course) – Find and register for a “Geburtsvorbereitungkurs”. Your Hebamme will generally offer this course. However, in a situation that she cannot offer you this course, you can register for one offered by your hospital or you can look for one online. I would suggest that you take this course in your third trimester (around 30th week of your pregnancy) as you will forget a lot of things if you take it earlier. Most of the times the insurance pays for this course. However in certain cases you might have to pay for the course from your pocket. I attended an online course in English as I was pregnant during Corona times and here is the link for the same (https://www.pantakea.de/2013/09/23/geburtsvorbereitung-im-pantakea-vorfreude-auf-ein-kleines-abenteuer//). It was very informative and we liked it.
6. Finalising the hospital – In some parts of Germany, it is important to look for a hospital very early in your pregnancy. For example, in Munich you need to start your hospital search as soon as you know that you are pregnant. Whereas, in Brühl a small town in NRW, you don’t have to book it in advance. I recommend you to talk to your Frauenarzt or Hebamme about the way you want to give birth and which hospitals/birthing centres offer it. A good time to contact different hospitals is around 24th – 26th week of your pregnancy. There is also a possibility to go and visit the hospital and the birthing ward. I personally think that it is important to visit the hospital and see if you feel comfortable talking to the staff and also if you like the environment. If you have a good feeling then go for it… after all your little bundle of joy will enter this world in that hospital 😀 
7. Bureaucratic stuff – I would suggest to check with your company/institute if they provide support by offering free access to family consultancy services. I had access to pme Familienservice (https://www.familienservice.de/). I found the staff to be very friendly and they provided information about Elternzeit (Parental leave), Elterngeld (Parental benefits), Kindergeld (Child care benefits) and finding Kitas (daycare). I strongly suggest talking to someone regarding these topics as it will give you a clear picture of the childcare system in Germany. I would also suggest that you print and fill out all forms required for applying for Elternzeit (provided by your employer), Elterngeld (https://familienportal.de/familienportal/familienleistungen/elterngeld), and Kindergeld (https://www.arbeitsagentur.de/familie-und-kinder/infos-rund-um-kindergeld/kindergeld-anspruch-hoehe-dauer) before your due date. Generally, except for the date of birth and a few other things you can fill out all other necessary information. Commonly, you need to discuss and tell your employer your plans for Elternzeit. You are so busy once the baby has arrived that it is always better to be prepared with the bureaucratic stuff.
8. Trying to clarify Mutterschuzt/Mutterschaftgeld (Maternity Leave/ Maternity Benefits) – Mutterschutz is different from Elternzeit (Parental leave). When you are working and if you get pregnant you will have the right to stop working 6 weeks before the expected due date and this maternity leave will continue for 8 weeks after the birth of your child. After birth, you will be on Elternzeit but you will get maternity benefit which is paid by the statutory health insurance (Mutterschaftsgeld), and the employer (Arbeitgeberzuschuss) during the statutory period of maternity leave. Generally, taken together, these benefits are equal to the average earnings during the last three months before birth. In special cases, for example multiple or premature births, mothers will receive the Mutterschaftgeld for 12 weeks after the birth. For normal births, you will start receiving Elterngeld after your maternity leave of 8 weeks after birth is over. Link for Mutterschutz (https://familienportal.de/familienportal/familienleistungen/mutterschutz)

Here I am listing some important things to do once your baby is born.

1. Geburtsurkunde (Birth certificate) – As soon as any baby is born the state needs to be informed, this is called Gerburtsanzeige (birth announcement). For the birth of my son this was done by the hospital in which he was born. The hospital requested us these documents; passports, visas, birth certificates translated in german and marriage certificate to do the Geburtsanzeige. You need to talk to the hospital/birthing centre and understand how the birth registration process will work for you and what documents you will need. For getting the Geburtsurkunde (birth certificates), I had to call the “Standesamt” and take an appointment for getting the birth certificate. We as parents and our newborn child had to be at the Standesamt in person with our marriage certificate, passports, visas/Niederlassungserlaubnis and a filled form. Recently our city started offering online registration of birth. They will immediately give you three copies of your child’s birth certificate – one is for your documentation, one needs to be sent to the health insurance and one is for applying for Elterngeld.
2. Elterzeit/Elterngeld (Parental Leave/Parental Benefits) – As soon as you get the Gerburtsurkunde (birth certificate), complete the application forms for Elternzeit, Elterngeld and Kindergled and post them to the respective offices. In order to plan your finances better, it is important to know that the minimum and maximum sum that you will receive is 300 Euros and 1800 Euros. Generally, the Elterngeld that you will receive is 65% of your net salary. Something important to keep in mind is that even if the 65% of your salary is above 1800 Euros you can receive a maximum amount of 1800 Euros. Here is the link where you can calculate Elterngeld (https://familienportal.de/familienportal/meta/egr)
3. Rückbildung (Pelvic floor strengthening course) – I highly recommend you to take this course as it will help you strengthen your pelvic floor muscles and is fully covered by the insurance. And the cool part about this course is that you can train along with your baby and you don’t have to find a baby-sitter or a nanny while you attend this course. The exercises are designed in such a way that you can take your kid with you to the course or if you are doing it online you can do it along with your baby. Sometimes your Hebamme might offer you a course and sometimes you have to look for one online. It is recommended to do a course only when your feel ready and preferably not in the first 12 weeks (Wochenbett time) after birth.
4. Finding a Kinderarzt (Paediatrician) – Start calling Kinderarzt in your city town and ask if they can take your child as a patient. Also sometimes you can have an emergency on a weekend or on holidays; for such difficult times remember to already look for a Kinderklinik (Childers/Paediatric hospital) that you can reach easily and which is good. In Germany, there will be one Kinderarzt and Apotheke (Pharmacy) that is open on weekends and holidays. You can find the details on the internet. And always remember this important number “116117” where you can call anytime incase you have and any medical emergency.
5. Citizenship – Depending on how long you have been residing in Germany you can decide if you want your child to take the German citizenship. Here is the link where you can find out information about the eligibility of child for getting a German citizenship (https://www.bmi.bund.de/EN/topics/migration/obligation-one-citizenship/obligation-one-citizenship-node.html).
6. Applying for a Kita (Day care) – Ideally you should start finding out everything about availability of Kita (day care) in you city in the last trimester of your pregnancy. In most cities it is hard to find a Kita or a Tagesmutter. Each city has a centralised Kita allocation system. You need to register via the Kita Navigator and provide five different Kitas that are close to your house. I have heard form several parents that calling different Ktias helps. In my city we registered by the end of the calendar year that my son was born in and then they informed us if we were allocated a Kita by June/July. The Kita’s generally take new kids in August.

Disclaimer – I am just sharing my experience with you and not implying that you should follow everything that is stated in this blog. I believe each pregnancy is very different and each state and city in Germany might have something different to offer and it is important to do a little bit of research yourself. 😀

Handy links:

Hebamme – https://www.hebammensuche.de

Mutterschutz – https://familienportal.de/familienportal/familienleistungen/mutterschutz

Elternzeit – https://familienportal.de/familienportal/familienleistungen/elterngeld

Kindergeld – https://www.arbeitsagentur.de/familie-und-kinder/infos-rund-um-kindergeld/kindergeld-anspruch-hoehe-dauer

Elterngeld Rechner – https://familienportal.de/familienportal/meta/egr

Citizenship – https://www.bmi.bund.de/EN/topics/migration/obligation-one-citizenship/obligation-one-citizenship-node.html

Change is the only constant in life. Nothing is permanent. Life will change and some things will completely transform you and your life forever. Change is inevitable but the most challenging part about change is accepting it. Embracing change, especially sudden change, is the hardest challenge life throws at you.

It is rightly said by Henry Wadsworth Longfellow, “For after all, the best thing one can do when it is raining is let it rain.” Sometimes some things are beyond our control. One cannot stop the rain but accept the fact that it is raining. It is in your hands to either look at it with happiness and positivity or be sad and negative about it. One cannot stop unfortunate things from happening in life but one can choose their perspective of looking at it. Of course, everyone will face hardships in life but it is important to inculcate the habit of accepting these hardships and moving on. Accepting reduces stress and it is easy to find inner peace and happiness.

I had a hard time accepting a lot of things that happened to me in the last two years. I underwent two surgeries and was suddenly left with a big open wound that wouldn’t close. This meant taking care of the wound and I had to give up living normally. I was not ready to accept that at the age of 29 I would have to start wearing adult diapers due to faecal incontinence caused by the surgeries. It did not end here but I suffered from surgery induced IBS. This meant that I couldn’t eat normally. I had to give up on a lot of foods as I had become highly sensitive to them. This is a nightmare especially for a foodie who loves to cook and try different cuisines. I was not ready to accept that IBS had completely altered my routine. I was unable to start my day early, definitely not before 11. I had to cancel a lot of appointments and travel plans as I was just not confident about going out and eating and socializing with people. All of this happened to me within a span of one year. It was extremely hard to accept so many changes in such a short period of time. This had completely changed me! I had changed and I had to accept that. I was in denial of what had happened to me and was resisting the change. I desperately wanted my old carefree life back. I wanted a time machine so that I could just rewind and change the course of time such that I would never have to suffer those horrible months.

After months of crying and resisting the change, there came a point where I realized that the time wasted on resisting the changes in my life was not helping me. I was still unhappy. The only alternative that I had not tried so far was to accept the changes for what they were and live with the new “normal”. Of course, this is never an overnight decision nor is there a definite tipping point. It happens gradually and there are setbacks on the way. But finally, I have accepted everything that had happened to me. Somehow, somewhere within my conscience it finally registered. My brain started replacing the negative thoughts that I previously had regarding my situation with slightly positive thoughts. You realize the ultimate goal of life is to stay happy and positive. I was focused on a few closed doors but then I decided to look at the open ones which offered me new beginnings. I started looking at things differently and more openly. I started reorganizing my schedule around my health. I started making new dishes from ingredients that I could eat. I started scheduling meetings and appointments after 11 am. I adjusted my work timings accordingly. I started wearing adult diapers to work. Instead of being ashamed, I told myself that one needs a lot of courage to wear adult diapers and work or attend social gatherings. Now, I don’t wear them everyday, neither do I end up soiling my pants, but during my flare ups wearing one gives me courage to step out and face the world.

In trying to figure out what was wrong with me, I had a nine month break in my postdoctoral research. In academia the clock starts ticking as soon as you finish your PhD, in case you aspire to become a professor. In addition, it is important to bag a few grants and publications in a short time span. However, I had lost almost two years in recovering and getting back on track. This meant I had lost a considerable amount of time. I also realized that the career track that I had chosen was very demanding and with my health and my strict schedule it was going to be hard to survive in academia. I was at the peak of my career when shit happened literally and metaphorically. I had chalked out some future plans and was working really hard towards achieving them. I had a hard time accepting this set back in my career. The first set back is always the hard one. But now, finally, I have accepted it. I know I cannot get back the lost time. Instead, I have started looking at it differently. I have decided to work hard and do as much as I can do. Not to make big plans for the future but to live one day at a time. Just go with the flow. And this attitude has definitely helped me a lot! You don’t always need a plan. Sometimes you just have to let go, and see what happens.

Life is a roller coaster ride. It is full of happy and unfortunate events and one has to learn to embrace and accept them. It is definitely easier said than done. Moving on is very important as that is when you accept your condition and continue living. I have started believing that some things happen for a reason. I think some doors were closed on purpose as this gave me a chance to explore something new. It has also changed my perspective towards looking at unfortunate events in life. I think bad events are as important as the good ones as they unknowingly teach you very important lessons in your life.

Accept the situation and embrace the change. Upwards and onwards with a smile on your face.

“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.”

– Haruki Murakami

If you guys haven’t heard about a “Fistula”, you are one of the lucky ones. I hope that apart from this article, you never hear about it again!

Until two years ago, I myself had never heard about it. Up until 2018, I never had any digestive issues and used to hog on anything I could lay my hands on. However, midway through that year, I developed a swelling accompanied by throbbing pain, which turned out to be an abscess (a collection of pus). My doctor asked me to wait and see if it drained naturally, but over the next three days, it rapidly increased in size and showed no signs of healing. As the pain had become unbearable, he insisted that the abscess be immediately cut and drained. Midway through the operation, the doctors figured out that this was more than just an abscess and I had developed a fistula. Scientifically, a fistula is an abnormal connection (or a tunnel) between any two hollow organs. I had developed a tunnel that connected my rectum to my skin. The doctors operated on me and told me that they had removed the abscess and sealed the “tunnel”. This left me with an open wound, which would close naturally over time. However, after one and a half months of the surgery, when the wound was almost sealed, I started having severe pain in my lower abdomen. I wasn’t even able to sit. I repeatedly went back to the hospital but they always sent me home, saying that they had not found anything abnormal. However, the remaining abscess wound wasn’t healing and the pain was getting worse every day. I then decided to consult another surgeon. Just after one examination, he told me that it looked like in the first surgery the doctors had only drained the abscess, but left the actual fistula intact. The first surgeon had not sealed the fistula at all! This had caused a bigger abscess. The surgeon declared that they would have to operate again with the aim of removing a larger chunk of the infected tissue. This surgery was successful. This time the surgeon did actually seal the “tunnel” after the removal of the abscess. I was left with an even bigger open wound in the same region. I believed that I would heal and my life would come back to normal. I was happy believing everything to be over soon. The storm had passed! However, I wasn’t prepared for what was coming later.

Later I realized, it was just the beginning of the storm. During the second surgery, they had to remove a large amount of tissue. This meant that I now had to live with a big open wound right next to my anal opening (yes, I lost a chunk of my anal opening). Due to this excess removal of tissue, I started suffering from fecal incontinence for semi-solid stools. In the very midst of this began my second nightmare: I started having diarrhea. It never rains but it pours as they say!

These two problems combined, resulted in me shitting my pants on a daily basis. It killed my confidence to leave my house. Even within my own home I preferred to stay as close to the toilet door as possible. It took a toll on my job, social life and mental well-being. I started getting urinary tract infections. I started using adult diapers. I was literally crying every day and was scared to go anywhere. I just wanted to stay at home on the toilet!

It took me a few months to realize that I was intolerant to lactose and my body wasn’t able to absorb any nutrients. I had lost 14 kilos in 9 months. I was becoming weak both physically and mentally and no one was able to help me. Doctors suspected that I had some form of Inflammatory Bowel Syndrome (IBD), either Crohn’s syndrome or ulcerative colitis. However, all tests came back negative. All doctors kept on telling me that I was healthy, that this was temporary, and that I would be fine. However, nothing got better. This continued for almost 11 months.

Finally, there was a ray of hope. When I was in India, I met a doctor who suggested that I start physiotherapy in order to get control over my pelvic muscles and strengthen my core. I took his advice and started intense physiotherapy and slowly but surely started to see a change. The physiotherapy helped me strengthen my muscles, which meant I could hold it in slightly longer and I could move a bit further away from the toilet.

For the diarrhea, until then I had tried allopathy (helped me bit – but not effective over long term) and homeopathy (made my condition worse). Then in mid-2019, my second surgeon suggested that I try Ayurveda (traditional Indian medicine) and recommended meeting a famous Ayurvedacharya (an Ayurveda practitioner). He examined me and told me that I had surgery induced Irritable Bowel Syndrome (IBS) and this was the cause of my diarrhea and the failure of my body to absorb any nutrients. He prescribed some ayurvedic medicines and suggested that I take them for one year. In addition to the medicines, he asked me to follow a very strict diet. Finally, the trio of a strict diet, ayurvedic medicines and physiotherapy helped me with the diarrhea and fecal incontinence. The struggle is far from over and neither has the storm passed. But now it has become more manageable. I have more control. This storm has made me resilient and patient. I believe that such storms come into your life for a reason – they make you stronger and bolder. It is important that you believe and hope that after a nasty storm, there is always a calm and sunny day!

I could boldly face this storm because of the unwavering commitment of my husband, family and friends to my health. They stood by me like pillars and prevented me from falling down a deep black hole. I owe my health to all the doctors who were there to care for me whenever I was in pain.

In order to motivate me, my husband, being a Rocky Balboa fan, used to quote a dialogue from what I believe is the sixth movie in the series:

“Let me tell you something you already know. The world ain’t all sunshine and rainbows. It’s a very mean and nasty place and I don’t care how tough you are it will beat you to your knees and keep you there permanently if you let it. You, me, or nobody is gonna hit as hard as life. But it ain’t about how hard ya hit. It’s about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That’s how winning is done!“

– Sylvester Stallone, Rocky Balboa