Baring all at the OB/GYN

Giving birth while living abroad can be a daunting prospect. The Local's new series Motherhood in the Fatherland follows expectant mum Sabine Devins as she negotiates the cultural quirks of having a baby in Germany.

Baring all at the OB/GYN
Photo: Josh Devins

Discovering how a foreign country ticks differently than your own can be fun part of living overseas, but doing it while naked certainly raises the bar a bit.

Back home in Canada, it took awhile to get used to the annual check-up that was required by my doctor for a birth control prescription. You lie under a paper sheet, look at the ceiling and five minutes later, you’re done. Then I moved to Germany.

A “routine” check-up in a foreign land can be anything but routine. All of a sudden, you’re dealing with a different culture and its particular quirks. I’m fortunate to at least speak German, since both of my parents are originally from Cologne. They moved to Canada two years before I was born and now my husband and I have done the reverse — even down to the having a baby two years after coming to Berlin.

Going to any doctor’s office in Germany starts off with a stop in waiting room, where I’ve noticed every new person walking into the room greets the patients already waiting. If it’s your first visit, you’ll want to bring along a German-English dictionary for the medical history questionnaire. Even if you’ve found a doctor that speaks English, this questionnaire will be in German and the nurses might not be able to help you out. Once you get called into the doctor’s office, you’ll start with a quick consultation regarding what you’re there for — whether its for birth control (Geburtenbeschränkung or the awful-sounding Antibabypille) or because — congratulations! — you’ve had a positive pregnancy test (Schwangerschaft).

When you move into the examination room, there is probably some sort of screen for you to undress behind, but don’t expect it to be private. If you’ve lived in Germany for awhile you’ll know Germans aren’t particularly shy about nudity. After disrobing, you walk over to the doctor’s chair in all your glory. This can disturb some expats on their first trip to a German obstetrician. Unlike a visit at home, I was not shielded from the sight of the examination by a paper towel. I sat in a chair and the exam began. Oh right. The chair.

While there is an examination table in most offices, for some visits you’re in a chair specially designed for gynaecological purposes. You sit down and recline, but you’re still face-to-face with the doctor, while all of those medical instruments remain in plain view. As is what he or she is doing down there. Oh — and German doctors seem to like to make conversation.

In North America, a normal pregnancy only gets the first ultrasound (Ultraschall) between 18 to 20 weeks, unless there’s some risk. But at 14 weeks pregnant, I’ve already seen Baby Devins twice. The ultrasound is used in Germany as a diagnostic tool. Even with your bi-annual check up, you can expect to get a vaginal ultrasound to check for growths in the uterus. The first time to confirm the pregnancy at six weeks while the second was to make sure all is going well.

As a result, I know we’re expecting just one baby and he or she is just fine. It’s very reassuring — especially in your first weeks of pregnancy when all you have for “proof” is a positive pregnancy test and that odd feeling you can’t shake. It’s not uncomfortable (a pap smear causes more discomfort) and totally worth being able to see your little one for the first time — or, God forbid, get an early cancer diagnosis.

There is also a difference in care between private and public insurance holders. While doctors will obviously see patients holding either card, those with private insurance will have more ultrasounds as well as other tests that are covered by their insurance.

Regardless of your insurance, during the first months of your pregnancy, the OB/GYN, or (Frauenärtzt/in), will expect to see you every four weeks. In the latter weeks, you’ll see each other every two. But don’t expect your doctor to be a familiar face in the delivery room. Most will take care of you throughout your pregnancy, but on delivery day, you’ll be in the hands of the doctor at whatever hospital you choose and your midwife (Hebamme), whom you’ll meet around week 30.

While North Americans such as myself might be a little shocked by the casual attitude toward waist-level nudity and vaginal ultrasounds, living abroad is about making adjustments to the local culture. Fiona Kamps, a German living in Vancouver, Canada, found herself equally flabbergasted when she had to visit the OB/GYN for the first time there. “It’s so primitive,” she said of her Canadian experience.

But those cultural differences are exactly what this regular column hopes to address. That way you can focus on the important things during your pregnancy in Germany – like whether you’ll have to name your kid Karl-Heinz or Dagmar.

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Immunisations and anal pharmacists

Motherhood in the Fatherland follows mum Sabine Devins as she navigates the cultural quirks of having a baby in Germany. In the latest instalment, she tackles immunisations and baby pharmaceuticals.

Immunisations and anal pharmacists
Photo: DPA

This month, my daughter reaches an important milestone: it’s her last round of immunizations until school age. It will be a relief for me to see her chubby little thighs bandage-free until she’s marching off to school with an overloaded Schultüte.

Luisa and her counterparts in North America and the UK are lucky to count going to the doctor as a fact of life. When a baby is born in Germany, he gets presented with a Babypass. Like my Mutterpass, the little book is a transportable medical file that mothers can take from doctor to doctor with her medical history. It also tracks baby’s development.

All of the check-ups, or Untersuchungen, are abbreviated to U1, U2, U3, etc. Luisa’s appointments are labelled on the front of her Kinderpass with what dates they should fall between, going all the way to April 2016. Each Untersuchung has a page for the doctor to fill out. It also leaves me with a handy little guide to how much Luisa has grown over the last year (it’s a lot!).

Most of the exams so far have been simple physicals. Making sure Luisa is growing properly and all her little parts with it. At the U3, there is an ultrasound to look for hip dysplasia — something that I find Germans to be disproportionately concerned with. As there is some hip joint issues in Luisa’s family medical history, she received an ultrasound at her U2, then again three weeks later, then with a specialist, and then again at the U3. The conclusion: “Her hips are just fine, we just like to be very careful when it comes to hip dysplasia,” said our doctor.

According to the International Hip Dysplasia Institute, hips that require treatment only occur in two to three children per 1,000.

What I do like about Germany’s scheduled medical care for babies is that they do immunizations a little later than in the English-speaking world. While Luisa’s friends in the US, the UK, and Canada all had their first round of shots at two months, Luisa didn’t get her first Impfungen until she was nearly four months. The first round is done in conjunction with the U4 check up, when Luisa is between two and four months old. Since her appointment was booked closer to the end of the fourth, that was simply when she got her first round.

As for the immunizations themselves, they are very much the same as what children in North America and the UK are given. Right now, Luisa has fighting power against tetanus, diphtheria, pertussis or whooping cough, polio, pneumococcus and hepatitis B. On the advice of my paediatrician, I skipped the Rotavirus immunisation and many German parents also leave out the Hepatitis B. After her last round, Luisa will also be armed against measles, mumps, and rubella.

Overall, there isn’t much difference between the care Luisa would get here versus there. But what is different in Germany is the at-home care and what Mamas keep in their at-home medical kit.

I’ve written before on the various uses of breast milk to cure these things, but that does come to an end and now those ailments lead me to the medicine cabinet.

For stuffed noses, we have saline solution. It’s hated by our little one and therefore seldom used. As Germany is the birthplace of homoeopathy, I can find all sorts of natural remedies. My favourite is called Osanit and they’re little pearls I use for teething pain. It’s main medicinal ingredient is chamomile. Whenever those gums start causing problems, babes are dosed with a few little pearls that they can roll around in their mouth and it seems to work. Life goes on. American mom Laurie has a similar product in her cabinet called Dentinox-Gel N, which also contains chamomile but in a gel format.

For those fevers, we use paracetamol, but its application is what makes our stash “very German”. The favoured method of dosing your child by the Mamas is Zäpfchen, or suppositories.

I wasn’t sure what to make the first time I realised what my doctor had prescribed after Luisa’s first round of immunizations in case of fever. But she was hot and miserable and so it happened and it was awful for everyone, but it did make her feel better. The next day I went to the pharmacy and asked for liquid paracetamol to give her instead.

The pharmacist was confused by my request. “But with the suppositories, you know she’s getting the right amount. You don’t have to worry about getting her to swallow it and once it’s done, it’s done,” she said, very pragmatically.

With the next fever, I took out a spoon and tried to get Luisa to swallow her medicine. It didn’t work. Her mouth clamped shut, she shook her head and sticky, orange-flavoured syrup got all over the floor. The practical German in me took over and we went back to the Zäpfchen. I’m now a convert.

I’m not the only one. British mum Tori told me she thinks they’re brilliant. “I would have never used them if I were raising Max [in England], but my husband, who is a doctor, was the one who stocked up the medicine shelf and at first I wasn’t so sure, but now they’re all I use.”

But others aren’t convinced.

When Laurie’s son has a fever, she uses liquid ibuprofen, which her pharmacist told her not to use until he was six months old. Before that, she had infant’s Advil and Triminic sent from the US. She also keeps American-bought Neosporin on hand. She also wishes that children’s acetaminophen were more available in the Fatherland.

English mum Susannah won’t touch the Zäpfchen. “Sticking things up a baby’s bum is not an idea I’d ever considered until I became a parent here. I would have no idea how to go about it, and would worry I was hurting her.”

Instead, she stocked up on the beloved English cure-all Calpol on her last trip home. “It’s poured liberally down English children’s throats from a very young age, whereas Germany seems less into plying babies with drugs,” she explained. “By extension, the German equivalents seemed less trustworthy in my mind: Irrational but true.”

She also has Calpol saline nose spray, as an assistant at her local pharmacy “raised her voice and eyebrows at my request for — what she called — a brutal product. She pretty much accused me of wanting to shoot drugs into my innocent child’s brain tissue.” But Susannah felt the German saline drops weren’t working and was delighted when she read “Suitable from birth” emblazoned on the English saline spray.

These days, we more readily turn to Google than our mothers to answer the million times we need to know: “Is this normal?” However, when it comes to comforts and cures, we turn back to what we know from childhood, whether it’s Laurie who goes for Neosporin to treat her son’s scrapes or Susannah who trusts one name to cure it all. Even if similar products are available in the German Apotheke, it’s just not the same as what we know.

And just because I use the Zäpfchen, doesn’t mean I wouldn’t be grateful for your tips on getting your babes to swallow their medicine.