Criticism of New Midwifery Services Agreement: Midwifery Practice in the Middle

Subject: The slow death of midwifery practices, which make a significant contribution to healthcare

In recent months, much has been said about the situation of self-employed midwives in light of the new fee schedule. Now, eight midwives from the "In der Mitte" midwifery practice in Hanover want to draw attention to themselves. The new fees have been approved and have been in effect since November 1, 2025. We are appalled and deeply concerned about the existence of our practice, as the new fee schedule threatens us with significant financial losses.

This year we celebrated our 30th anniversary and looked optimistically into the future. The last fee schedule was seven years ago, and we were promised an increase of up to 30 percent. However, due to negotiations that dragged on for years, we were granted a five percent increase on all positions in May 2025. Tensions among midwives grew. Now, the new fee schedule effective November 1, 2025, has been presented to us. It includes many changes.

We are eight self-employed midwives with all rights and obligations regarding our professional practice. In addition to taxes, health and pension contributions, liability insurance, professional association, midwifery association membership fees, and the prescribed 40 hours of mandatory continuing education every three years—which are not sponsored and entail loss of earnings, travel costs, participant fees, and room and board—we run a practice with two employed office staff and one cleaning person on a mini-job basis. We are an interdisciplinary health center for pregnant women, mothers, fathers, and children. We offer birth preparation and postnatal exercise classes led by us. We also collaborate with other professional groups who offer baby massage, PEKiP, parent-child courses, Pilates, pelvic floor diagnostics, osteopathy, first aid, etc., at our premises. Open consultation hours take place three times a week, and a baby meeting once a week. Furthermore, we have a team meeting every two weeks to exchange ideas and stay up-to-date. Every eight weeks, we treat ourselves to a 1.5-hour supervision. We work at a high standard, which benefits our clientele.

The financing of the practice is covered by our rental deposits, the hourly rental to the aforementioned professional groups, and by percentage contributions from the courses we lead. It is here that the new fee schedule reveals an incalculable financial disaster for us. Until October 31, 2025, our terms and conditions with course participants stipulated that they had to transfer a so-called security deposit equal to the course fee within 14 days of their course registration. After the course ended, we billed the attended hours to the respective health insurance companies. Any missed hours were deducted from the security deposit, and the remaining balance was refunded to the participants. Over the past 30 years, we realized very early on that there was no other way. If people sign up for courses for which they don't have to pay anything out of their own pocket (which is by no means true: it is a health insurance benefit and is financed by all of us with our contributions), there is a great "danger" that participants either don't show up at all or miss classes due to vacation, fatigue, lack of motivation, illness, family celebrations, etc. Women with a small baby are always extremely busy. They only had to contribute €25. This procedure has now been prohibited by the health insurance companies under penalty with the introduction of the new fee schedule.

You couldn't be more misogynistic! It's unbelievable that we are treated like businesswomen everywhere, but now we are defamed in the most egregious way. We are appalled, especially since the health insurance companies incur no costs. It cannot be that we are not compensated for missed hours. This does not happen in any gym, yoga class, Pilates class, further training, or workshops. Without advance payment, no contract is concluded here. By the way, doctors sometimes charge €40 for missed appointments. Was there an outcry from the health insurance companies there too?!

Another example in the new fee schedule: telephone consultations with pregnant women and mothers must last at least five minutes but no longer than ten minutes. Phone calls are an important anchor for many women to avoid unnecessary doctor and clinic visits. With the new contract, a signature is required for this. If we have already concluded the care, we are instructed by the health insurance companies to send the woman a stamped envelope for a signature. According to the health insurance company, the woman should not incur any costs. Furthermore, SMS and messages via messenger and email are no longer reimbursed, which is rather a step backward in the digital age and also meets with incomprehension from women.

Like all professional groups, we are groaning under inflation, constantly rising social contributions, and a staggered rent agreement for the practice rooms. Every freelancer must finance their absence from work due to vacation and illness from their remuneration. Approximately 60 percent of our gross salary goes to the aforementioned bodies. We were promised an increase of up to 30 percent; instead, we now have a contract that is partly interspersed with outrageousness and infantilization.

We enjoy our profession and are proud of our practice, where women, men, and children feel comfortable and are very well looked after. We run the risk that, for the reasons mentioned, midwifery practices will no longer be able to operate profitably, which would entail a great loss regarding health education in the context of pregnancy, parenthood, and child health development. We are highly trained women and work holistically. Under these conditions, there is a danger that midwives will withdraw from course work given the uncertain payment for courses. These gaps will then be filled in the future by self-taught individuals who do not necessarily have the qualifications and must be paid privately.

Society must ask itself how much women's health is worth to it. We were on a very good path, but the new fee schedule is a severe setback for women's health. We thank you for taking note of our practice's problems and ask you to advocate for us in the relevant committees.

On behalf of all midwives who run a practice, we remain with kind regards
The Midwifery Practice In der Mitte