Natural Birth in the Military

[Dwmama]

My husband is in the military and chances are for our next child we will be on a base in Germany. Does anyone know what my options would be as far as having a natural birth? Anyone know where I could look online for more info?

[dlm194]

Hmmm... I don't know for sure since I use civilian providers but Tricare does cover midwives and homebirth if you want!

[katerkat]

I think it depends where you are -- and I don't know about Germany. Here, my base clinic doesn't do births, so I got to choose an off-base provider and I think there were midwife options. I have a friend who had her son at Ramenstein; I could ask her.

[Monica]

It will depend on where you are, what services the MTF provides, the attitude of your PCM, are you Tricare Prime? or Tricare Standard? Are your community options acceptable to Tricare ie are the midwives that work in civilian birth centers or do homebirths CNM's? Tricare does not pay for lay or licensed midwives. You can have a natural birth at an MTF if you and your dh are well researched, adament about your wishes throughout labor, and can find an OB/midwife that is supportive. It may be harder than going to a civilian midwife but it can be done. You may also find that in order to have the control you want over your birth, you might have to pay out of pocket for the midwife that you want.

[miriam]

Good luck with your choices.

[wannabe]

Be aware when you're picking a provider that the episiotomy rate in Germany is insane.

[MamaTaraX]

I know quite a few people who have had natural births in military hospitals, one was a twin birth in fact. The bedside manner of the staff was crappy but beyond that, they did have the natural births they wanted. I'd check around and see about midwives and homebirth (if homebirth interests you) in Germany.

Namaste, Tara
mama to Doodle (7), Butterfly (2), and Rythm (due at home 1/06)

[wombat]

I'm Tricare Prime but in USA and Tricare covered my homebirth with a CNM. It ended in a hospital VBAC at a civilian hospital but everything was covered 100%.

People on base and in MTFs are very ignorant about homebirth and what Tricare does/doesn't cover. Call your Tricare regional headoffice direct and ask to speak to someone in medical management. They are the people that authorise treatment outside of MTFs.

Be prepared to hit your head on a few brickwalls but it can be done. Took me 7 weeks of info gathering and 3 weeks of pushing my application through the system.

If your MTF doesn't provide a necessary medical service then Tricare pretty much has to authorise civilian care. So be careful what you ask for. Eg. my MTF has midwives on staff so no good me asking for a midwife. But they don't do homebirths so I asked for that.

ETA: my first birth was in a military hospital. If you're adamant about not wanting an IV, epidural... it can be done. It's just hard though if you run into 'problems'. I was FTP, after 24 hours had only gone from 5 to 7cm. With the OB I felt like I had no options. Not their fault, they were doing their standard OB 'care'. I just think if I'd had a midwife it could have been different. They didn't push me into a c/s directly but I had no more options. BTW this MTF has midwives but they didn't work weekends. They also had low episiotomy rate too, no formula propaganda, LCs on staff, rooming in for baby and husbands. it was very progressive compared to civilian hospitals in the area but it was still a hospital, kwim?

[counterGOPI]

hmm not sure. i had a natural birth on base here at langely

[ashleyhaugh]

here in germany, there are only a couple of military hospitals, most posts have clincs, but thats it. everybody i know that has had kids over here (i dont have kids yet) either gave birth at laundstuhl (its in kaiserslautern) or at a german hospital. ive heard the german hospitals are great. there are a few other military hospitals, i think theres one in wurzburg and heidleburg, but im not 100% on that

[MistyB]

My son was born at Landstuhl (LRMC)...I planned on birthing with a German midwife but my membranes ruptured at 32 weeks so I was risked out. Email me if you want with any questions you have and I can give you all of the info I know of.

I would totally birth with a german midwife if possible. They rarely attend homebirths because they really don't need to. All birthing centers are in hospitals and they are the equivalent of american free standing CNM run birth centers. From what I know, their epidural and episiotomy rates are still traditionally very very low. Midwives attend and deliver almost every birth. OBs are only used in cases where a CS in necessary, the mom is at high risk or there are complications. They don't really have labor and delivery nurses at german hospitals...just midwives. They may have a few kranken schwesters (nurses) but the midwives are in charge.

I was going to get a non availability statement to be exempted from getting care at Landstul...basically to be considered an overflow patient who was permitted to birth within the German system witht he cost totally covered. I toured several German birthing centers and they were all pretty much the same...which is 100% better than a military hospital.

Landstuhl is very outdated in terms of how the L&D floor is run. They still use the multiple room set up where you will likely be in 3-5 different rooms between check in, laboring, birth, postpartum. They had no LDRP (allin one suites) at the time. The Drs were very NOT friendly, the bedside manner by and large SUCKED even though 1 or 2 and a CNM on staff were wonderful. I had a great birth there but only because I hid out on a post partum floor at night and labored until I was in transition. Had they have even known that I was back in labor...my birth experience would have sucked.

I was the only woman I know that birthed there that was tear free...most other moms had a 2nd-3rd degree due to epi cuts..I know of 2 moms with 4th degree tears. Their C section rate was not super crazy at the time as they usually encouraged vaginal epidural birth with episiotomy.


http://www.hebammensuche.de/
http://www.midwiferytoday.com/international/germany.asp
if you want a german midwife...these are the places to find a provider!

[MistyB]

And she is likley enrolled in Tricare Europe which is different than standard or prime.

[milk_maker]

I have never been impressed with military health care or hospitals and was horrified by WOMACK's (Ft. Bragg, NC) c-section rate, screwups, and number of fetal demises so I hired a homebirth midwife.

I'd definitely look into birthing in a local hospital even if it means you get your prenatal care on base and then go to a local emergency room (scout out the best of course) when you're in active labor. Tricare will have to pay because it's an "emergency" and you will get a birth in a good hospital.

Just an idea....

[Thmom]

I can't offer any real advice but want to share a very positive story...
I have a client who's dh is military and they are using the base hospital. She had to have her birth plan approved by the head nurse so she asked me to come with her.
I was prepared for a horrible experience. She wasn't requesting much on her birth plan but still, civilian hospitals can be a pain and I've heard even worse about military...
well the head nurse was AWESOME!! She even said she was glad to see she has a doula and took all of my cards! lol They don't have a nursery so rooming in is mandatory, they have birth balls and encourage moms to walk the halls. They didn't even plan to do a heplock unless it was necessary! We spent about an hour chatting with her and she was so nice and really was happy to see someone wanting a natural birth.

[SAHMinHawaii]

I dont have any advice for germany..but i had two natural births in a military hospital in hawaii. I cannot say enough good things about my midwives and my nurse. The midwifery program always has a nurse with natural childbirth experience help out. I delivered both of my girls without any tears. I didnt have an iv or even a hepblock. I pushed in any position i wanted to without the use of val salva(counting). They had birthing balls and a birth tub but i didnt get a change to use it the last time. This past birth i discharged 12 hours after delivering without any problems from anyone. I pulled my daughters out myself, nursed them while still attached, didnt cut the cord for a while. My daughters never once left my site. I even coslept with them, i refused to have them in the plastic bassinet. I would deliver there again in a heartbeat, but this next baby will be a homebirth because the last baby came so quickly. Know what you want going into it, be assertive..and don't take no for an answer. Also..don't go in until you are close to pushing stage and they wont have a chance to bother you. Best of luck!
Jessica

[mamachandi]

My 110 lb sister had both her 10 lb babies natural in a german hospital-she did not want to have them in a military hospital. She did have an episiotomy for 1 though!

[Dwmama]

Thanks ladies for all your advise.

We know we are going to be at Schweinfurt. Now it is my understanding that the nearest military hospital is about an hour away. But there is a German one in town. So does that mean women usually go to that German one and then the military pays for it? Or do you have to drive an hour?

[wombat]

You'd need to ask Tricare about that. Where I am I have to use MTF if I'm within a certain number of miles, I think it's 40miles.

An hour doesn't sound too bad to me in terms of travelling there. My homebirth midwife was an hour away from me.

Don't do anything without checking it with Tricare or you could end up footing the bill.

[Monica]

LOL in my opinion there is a huge difference between you having to travel an hour in labor to get to a hospital and your midwife having to travel an hour to your home. Sorry the above comment struck me as funny - In my experience an hour in a car in active labor would be the worst hour of labor for me. The 15 min (3 ctx) I did with my last child in the car were the worst 15 min of my labor.

[Dwmama]

Thanks ladies. Last time we lived 3 minutes from the birth center. So I can't imagine going a whole hour in the car. Especially since my labor moved so fast last time. But I guess my question was more, "Is that what they expect you to do?" Wombat said she thought it was within 40 minutes which still seems like a drive to me. Also what if it is the middle of winter and the roads are closed? I guess I just need to talk to someone with Tricare or on the base.