Difference between a freelance midwife and an employed midwife

Difference between independent midwife and (employed) midwife: Continuity and individual care at risk

An independent midwife is a self-employed midwife who has a cooperation agreement with a clinic. She exclusively cares for pregnant women before, during, and often after childbirth. In contrast to employed clinic midwives, who work in shifts, the independent midwife enables 1:1 care. This creates a deep basis of trust, as the midwife ideally accompanies the birthing person throughout the entire period and knows their individual birth history precisely.

The difference between independent midwife and (employed) midwife in detail:

1. Care: While with a clinic midwife, personnel changes are possible due to the shift system during longer births, the independent midwife remains continuously at the woman's side.
2. Employment relationship: The independent midwife works autonomously and on a freelance basis, but utilizes the infrastructure and safety of the clinic premises.
3. Costs: The costs of childbirth are covered by health insurance companies. However, for constant availability, independent midwives charge a private on-call flat rate (usually between the 37th and 42nd week of pregnancy), which many insurance companies now reimburse at least partially.
4. Availability: Due to limited capacities, very early booking during pregnancy is necessary.

The current problem: The arbitration award, the new midwifery services contract, and structural disadvantage

Despite the proven benefits for the health of mother and child, the independent midwife model is under massive political and economic pressure. Current arbitration awards at the federal level have drastically worsened the framework conditions – especially for independent midwife systems in smaller clinics with fewer than 600 births per year.

This development leads to a restriction of freedom of choice: New bureaucratic hurdles and financial risks make it difficult for independent midwives to offer their services nationwide. This is expressly not a plea against clinic midwives, who form an indispensable pillar of care under often difficult shift work conditions. Rather, it is a critique of the political structures that endanger the diversity of care models.