Midwifery remuneration, statutory health insurance and arbitration board – what will apply in 2025?
Yes, the remuneration we midwives receive is crap for everyone. The arbitration board's decision of April 2, 2025, on the new midwifery remuneration system doesn't change that much – in many areas, it even means cuts, and who will be hit hardest?
One thing in advance:
The arbitration ruling on the new midwifery assistance contract only affects freelance midwives who bill their services to statutory health insurance providers under Section 134a of the Social Code (SGB V). If you don't fall under this, you are not directly affected by this decision.
In contrast, the decision includes both freelance midwives in out-of-hospital maternity care (e.g. home births) and, for example, registered midwives who work freelance in hospitals.
The following critical areas for freelance midwives are particularly affected:
1. Reduced remuneration for midwives
The hourly wage decreases from €74.28 to €59.42
→ Corresponds to only about 80% of the previous rate
Applies to all services in the delivery room and around birth within the clinic if they are covered by the new contract (§ 134a SGB V)
2. Care of the second birth
Only 30% of the fee if you are also caring for a second mother!
→ That only corresponds to about €22 per hour – a massive cut
→ Mainly affects smaller clinics or services with only one midwife per shift.
Photo: Midwifery team Hofgeismar
3. One-to-one support
Is no longer fully reimbursed
→ In the future, only a limited portion of 1:1 care will be paid for, which will worsen individual care and make it economically unattractive
4. On-call duty
In many cases no longer sufficiently refinanced
→ Particularly problematic for midwives who are on call but are not allowed to attend every birth (e.g. in the event of short-term changes to plans by the hospital)
5. Pregnancy and postpartum care (indirect)
Not exactly shortened, but:
→ No new increase as in out-of-hospital maternity care
→ Costs increase , remuneration remains the same → actual deterioration
Outpatient midwives: Birth support
Under the new midwifery assistance contract, effective November 2025, midwives working outside of hospitals will benefit from improvements: The hourly rate for birth support will increase from approximately €56 to €74, with a flat-rate increase of 10% during the transition period (starting May 2025). These improvements apply exclusively to freelance midwives who provide out-of-hospital birth support—that is, those who actually attend births outside of hospitals. Midwives who work exclusively in pregnancy or postnatal care will not benefit from these increases.
And what about freelance midwives who provide prenatal and postnatal care? Yes, there are changes and financial challenges here too.
Billing in 5-minute units
Billing will be done in 5-minute increments of €6.19 each. This means, for example, that a 15-minute preventative care appointment will be reimbursed at €18.57. Compared to the previous flat-rate fee, this may result in lower revenue, especially for shorter visits. The previous flat rate of €40 will only be exceeded for visits lasting 40 minutes or more.
Material fee
The materials fee has been revised and is now only billable for one service per visit. This can lead to financial losses if multiple services are provided during a home visit, as additional materials are not reimbursed separately.
Telephone advice
Telephone consultations are still possible, but billing via SMS is not possible. The exact terms and methods of billing should be described in detail in the contract or accompanying documents.
Postpartum care
For postnatal care, a visit must last at least 35 minutes to receive compensation equivalent to the current level. Shorter visits result in correspondingly lower income.
Multiple birth surcharge
The previous multiple birth surcharge will no longer apply. Instead, an additional 10-minute block can be billed for visits lasting 60 minutes or more. This poses a financial challenge, especially when caring for twins or multiple births, as the additional effort is no longer reimbursed separately.
These changes could result in freelance midwives who perform home visits being financially disadvantaged than before. The new compensation structure could lead to income losses, particularly for those with efficient workflows and shorter visiting times.
Conclusion
The most affected are midwives , especially in
Births in the clinic
Caring for several women at the same time
On-call duty
Freelance midwives who work exclusively in pregnancy and postnatal care must be prepared for a home visit to last at least 40 minutes in order to receive higher remuneration than before.
Only out-of-hospital births are visibly better off