Attending midwives in crisis: Is obstetric care at the InnKlinikum threatened?

Attending midwives in crisis: Is obstetric care at the InnKlinikum threatened?

The new midwifery assistance contract came into force in Germany on November 1, 2025, and its effects are noticeable. Especially in Inn Clinic Altötting-Mühldorf, where 22 midwives currently work, many of them are thinking about quitting. The new contract could mean up to 30 percent less income for freelance midwives, which represents a massive financial loss for many.

A dramatic rethink is underway. The new contract provides for per-minute billing, which has a significant impact on the remuneration for care. Clinic director Thomas Ewald explains that the clinic itself has no influence on the regulations. “Midwives are an important part of obstetric care,” emphasizes Ewald, and the clinic wants to provide them with the best possible support.

A revolution in obstetrics

With the new midwifery assistance contract, the changes are clear: the remuneration for the first patient drops to 80 percent of the previous hourly wage, while the second and third patients are only remunerated at 30 percent. For the fourth patient there is no remuneration at all. In addition, surcharges for night and weekend services will be reduced from 20 to 17 percent, which is unbearable for many midwives. There is great uncertainty: according to Ewald, five to seven midwives are thinking about leaving obstetrics if they have to accept a 40 percent loss of earnings.

“The cuts are problematic,” says Levke Sahm, an experienced midwife. She warns of a possible supply shortage for families if the current conditions are not revised. In Bavaria, attending midwives currently attend 80 percent of births, which underlines the important role of these professionals in obstetric care. “We have a good knack for flexible working hours, and a permanent position is not an option for us,” she adds.

Midwifery assistance contract and its background

The midwifery care contract, which has existed since August 1, 2007, originally had the aim of securing obstetric care in Germany. The contract regulates the requirements for freelance midwives who work in hospitals and enables them to bill their services directly to health insurance companies. While attending midwives were previously able to charge 100 percent of their services for each woman, the new contract means significantly worse conditions. In exceptional situations, it used to be possible to get money to look after a third woman, but these regulations have been severely restricted.

The situation is made more difficult by the fact that the “InnKlinikum” itself is struggling with a deficit of 23.1 million euros. This makes it difficult for the clinic to pay out additional subsidies to the midwives. A collaboration with the Midwives Association is therefore essential to discuss these important changes in obstetric care.

“The current developments are a wake-up call for everyone involved,” says Thomas Ewald. The challenges that midwives face must be taken seriously. Because without them, obstetric care at the InnKlinikum cannot be maintained. At a time when demand for sensitive and individualized care is higher than ever, the industry is faced with profound changes.