the weeks in an interview with midwife Katharina Kerlen-Petri
Katharina Kerlen-Petri has been a midwife in Berlin since 1989. She has worked in clinics and as a freelance midwife, still has her own practice in Berlin-Neukölln and is also politically active. In her private life she is the mother of three adult children.
Lea: Dear Katharina, I am very pleased that we are talking about a topic today that does not get enough attention, even though many pregnant women have had experiences with it: postpartum care after miscarriages or stillbirths. Statistically, around one in three pregnant people has had to deal with these issues in some way - whether through early or late miscarriages, stillbirths or the birth of sick children. My first question is to what extent midwives can actually provide support during miscarriages and, if so, how exactly does this work and what support can you offer in such situations?
Katharina: Yes, they can. And that is exactly why it is important that midwives provide support from the very beginning, regardless of how the pregnancy is going. Of course, I don't want a pregnant woman who contacts me to immediately hear: "Yes, that can still go wrong." But on the other hand, it is also difficult when pregnant women only look for a midwife late. Unfortunately, there is a shortage of midwives in Germany, and I often receive messages from pregnant women in the twelfth week with the same sentence: "I'm writing so early." I can only reply: "I'm sorry, but that's too late." Or they say: "I wanted to wait until the first three months were over before I looked for a midwife." I completely understand that personally, but it is important to me to stress that we midwives provide support from the very beginning and can also support a miscarriage, which is unfortunately not well known. That was one of the reasons why I put it on my website. When pregnant women write to me in the fifth week and say: "I don't know, somehow this all seems way too early to me," I write back: "Yes, I totally understand. It's important to take your time and realize that something is changing in your life now. And I'm here, no matter what happens."
Lea: Many pregnant women have fears in the first few weeks of pregnancy. The questions remain: What if things don't go well? How do I know if everything is OK? Oh God, what do I do then? Do I have to do anything? Are there any options? These are questions that you can't just turn to your gynecologist or talk to friends about, but there is also the option of intensive support from a midwife if you deal with it early on. I think many people don't know that, and that's why I thank you very much for explaining and emphasizing it so clearly.
Katharina: I've noticed recently that there are more discussions on social media about how pregnant women deal with the topic. For example, do they talk about it in the first twelve weeks and if so, who do they share it with? Or do they choose to keep it to themselves? I think a lot has changed here. In the past, this topic was not discussed at all, but now there is a bit more openness about it, I think. I personally respect every decision and approach of the pregnant woman in this matter. Every pregnant woman has to decide for herself how she wants to deal with it.
Nevertheless, I always try to encourage the pregnant women and say: "Yes, if you are experiencing this loss, then it might be nice if a friend knew about it and can support you in your pain." And this is where the midwife comes in as a professional companion. The midwife can play an important role and provide support in such situations. She can be sensitive, respond to the emotional needs of the pregnant woman and help her to deal with the loss. It is about creating a trusting and safe environment in which pregnant women can share their feelings and worries without fear of judgement. Every pregnant woman has the right to the type of support that is best for her and midwives are ready to accompany this process in a sensitive and professional way.
Lea: Yes, absolutely. I remember a touching moment when a friend called me and said: "Lea, I've been pregnant for six weeks. Nobody knows about it. I don't want to talk about it because I'm too scared. But I want at least one person to know in case it doesn't work out. That way, if I have a miscarriage, I don't have to tell them that I was pregnant." Luckily, this friend never experienced a miscarriage, but I still found it very touching and it fits well with what you just said.
Katharina: Exactly. And I think there is another important aspect: I have often heard pregnant women on the phone who are completely confused after a miscarriage, because it almost always happens like this: you go to the gynecologist with bleeding or other symptoms, and you get out of there so quickly that you can't even look because from a medical point of view it is quite clear that there is no longer any pregnancy. Then you get a referral to the clinic and you have to sort out everything else there. This is not a bashing of gynecologists, it simply reflects the current system.
It is therefore really important to me to emphasise that midwives can support miscarriages differently. There are already doctors who take a different approach, such as "Doctors for Choice" in Germany, who say that the hasty route of referring the child to a clinic for a curettage should not always be the only option. In addition to medication, there is also the option of waiting and letting the body do its thing on its own. And it is important to me that pregnant women are informed about the options they have.
This is where midwives come in, especially when waiting. They can offer the right support and have the opportunity to accompany a pregnant woman through a miscarriage. I do this fairly regularly and it can sometimes take four weeks or more for the body to fully process the miscarriage. During this time, continuous support is essential. And the best thing about it is that this support is covered by health insurance. I would like to stress that this is not my own mission, but it is simply an important part of our work as midwives to sensitively accompany pregnant women in such situations.
Lea: Thank you for formulating that so clearly again. It is so important to know that pregnant women are entitled to this and that this is also taken into account in the system and can be billed. This means that pregnant women do not have to hope that someone will be well-disposed towards them, but can count on the professional support of the midwife that they are entitled to. It is an important part of midwifery work not to leave pregnant women alone in such moments, but to support them in their individual situation and offer them trustworthy support. What I find pretty shocking, however, is that there is currently no statutory maternity protection after early miscarriages. This means that pregnant women often do not have the opportunity to take sufficient time for physical and mental recovery after a miscarriage. In many cases, they return to everyday life the very next day without there being any statutory protection for this.
Katharina: Yes, I think it is precisely this point, that there is no maternity protection, that means that women in labor are often pushed back into everyday life very quickly after miscarriages and stillbirths, and sometimes they even think that it might not be such a bad thing to be distracted. In such moments, it is my role as a midwife to encourage them to pause, even if it may be painful at first. Midwife care is an advantage here, because even if there is no maternity protection, I can help the pregnant women to become clear about what has happened and how they can deal with it through regular visits.
I'm quite strict about this, to be honest, and I try to encourage women giving birth to take sick leave in any case. Even if they say they're fine and would rather carry on, I explain to them that a week's holiday is often not enough to adequately deal with the emotional and physical processing. Of course, I don't do this with a wagging finger, but rather try to encourage and support them. Although it's sad that women giving birth themselves have to ask for it, I think it's important that they take sick leave to have time for physical recovery. As a midwife, I can then offer supportive measures, such as foot massages or abdominal massages, to help them relax and create rituals.
This way I can give women giving birth the feeling of being cared for, even after an early miscarriage. This is even more important in families with children already present, as women giving birth often feel like they have to function and feel responsible for their children. These women giving birth in particular sometimes say that their children distract them and that that is the most important thing. But then they realise that it is not enough and that they also need time for themselves.
Lea: We have now mainly talked about early miscarriages - but these can occur both in the early weeks of pregnancy and later. Up to the 24th week of pregnancy or when the fetus weighs up to 500 g, in Germany they are still called miscarriages, after which they are referred to as stillbirths, which enjoy more legal protection and maternity rights. The distinction may seem arbitrary, but it nevertheless has important effects on the legal and emotional care of the affected women in labor. You have accompanied many women in labor with late miscarriages and stillbirths, how have these experiences influenced your work as a midwife?
Katharina: Death is always difficult to grasp, and in cases like this, when life is so young or ends shortly before birth, it can be particularly difficult. Modern medicine has equipped us with many options and technologies, but it cannot protect us from everything. Many pregnant women feel that once they have survived the first critical weeks or prenatal diagnosis, everything is fine and nothing can go wrong. I sometimes wish that we had an understanding of humility in relation to life, that we could acknowledge that we cannot control everything, no matter how advanced our technologies are.
It is not my intention to stir up fear at all - but rather to draw attention to the fact that life can take unpredictable turns and that we should be aware of this. It is important that pregnant women are hopeful, but also that they face the reality that life does not always turn out the way we imagine. When children die in the womb of a pregnant woman, these are particularly stressful situations and stillbirths require comprehensive support.
Lea: For some pregnant women, it can be helpful to prepare for a stillbirth by, for example, creating birth plans that record their wishes and ideas for the birth process. This can give them a certain level of control and self-determination, even when dealing with such a stressful situation.
Katharina: Yes, it is really difficult and often a very stressful situation for the women giving birth and their families. In some cases, they are literally forced into a pre-determined process without enough space for their individual needs and wishes. Society and the medical system are not always adequately prepared to deal with these situations and there is often a lack of support and understanding.
As a midwife, it is important to me to communicate to women giving birth their options and thereby enable them to make an informed decision. Unfortunately, staff shortages in many clinics are a problem that can affect the quality of care. Women giving birth who experience a late miscarriage or stillbirth need intensive support and a safe space to process their grief and pain. Clinics should provide more resources and special rooms for these situations. It is sad that clinics' advertising is often only focused on "happy babies" instead of also highlighting support for loss and grief. This shows that there is still a lot of work to be done to raise awareness and sensitivity to such issues in society.
What I also think is really important to stress is that after a late miscarriage or stillbirth, there is actually a postpartum period that is accompanied by physical changes and processes. During this time, it is particularly important to receive appropriate medical care and support that goes beyond simple follow-up examinations. The physical and hormonal changes, such as milk production, can be very stressful for women who have experienced a late miscarriage. It is useful for midwives to be there to support them and help them deal with these physical and emotional challenges.
Lea: I would like to talk to you about a third topic - postnatal care after the birth of sick and disabled children. In your experience, what special needs do parents have during this time and how can they be supported?
Katharina: The postpartum period after the birth of a child with health challenges is a very special time that can be very intense for the parents and the entire family. The most important thing in such situations is to offer sensitive and comprehensive care that responds to the individual needs of the family. The postpartum period is a time of regeneration and transition, in which families need time and space to adapt to the new situation and to recover. In my view, it is essential to show parents that they are not selfish when they take care of themselves, but that it is an act of self-care and self-protection.
Midwives can also help reflect on what support is really helpful and beneficial and what seems more stressful or inappropriate. You act as a mediator and mirror, encouraging parents to express their needs and feelings and helping them to make the best possible decisions.
Lea: Thank you for all this insightful and sensitive information. If you could give all parents something about the postpartum period - regardless of whether they have given birth to healthy, sick, living or dead children - what would it be?
Katharina: The postpartum period is a very special time with individual challenges that can be mastered if you prepare for them. I like to compare it to a mountain tour: nobody would climb a 1,000-meter peak without preparation and equipment. It's the same with the postpartum period - it requires good preparation and support.
I think it's important to talk about it beforehand and plan how you want to spend this time as a family. The postpartum period offers the opportunity to adjust to the new situation and strengthen this special bond. It's completely normal that the postpartum period can be overwhelming. Accept these feelings and get help if you need it. Asking for support is not a sign of weakness, but a sign of self-care and strength. Even if there are moments when you think, "Whose idea was it to have a child?", the postpartum period can be a wonderful and enriching time. There is room for closeness, love and a special connection with your child.
Prepare yourself mentally for the postpartum period during your pregnancy and think about how you want to spend this time. Make sure you take time for each other and be patient with yourself and your child. Don't let external expectations or comparisons unsettle you. Every postpartum period is unique and there is no "right" or "wrong" postpartum period.
Lea: Thank you for the interview!
