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Midwives at the InnKlinikum: New regulations threaten obstetric care!
The new midwifery assistance contract in Altötting is causing uncertainty: loss of compensation and possible terminations are in the offing.
Midwives at the InnKlinikum: New regulations threaten obstetric care!
Last week there were heated discussions among the attending midwives at the “InnKlinikum” Altötting-Mühldorf. On November 1, 2025, a new midwifery assistance contract came into force, bringing with it far-reaching changes. The new contract, established by an arbitration board between the National Association of Statutory Health Insurance Funds and the midwife associations, is causing concern among the approximately 22 freelance midwives who work here. According to innsalzach24.de, your income could be reduced by up to 30 percent.
How will this affect obstetric care at the InnKlinikum? The new contract provides for billing based on the minute, which means that in future the midwives will no longer be paid per birth, but based on the time actually worked. This means there are some structural changes which, as announced by the GKV, are intended to improve care. However, it remains to be seen whether attending midwives will actually benefit from this. Above all, the reduced remuneration, which in the future will only be 80 percent of the usual amount for the first patient and even 30 percent for the second and third patients, is viewed critically.
Impact on midwives
“There’s something going on,” says Levke Sahm, one of the attending midwives. She perceived the new contract as a noticeable deterioration in remuneration compared to the previous conditions. Instead of generous surcharges for weekend and night shifts, which were previously 20 percent, they now have to make do with 17 percent. This leads to several midwives considering ending their involvement at the InnKlinikum. Up to seven of them have already indicated that they might give up their careers if they lose 40 percent of their earnings.
Although the clinics have no direct influence on the contract design, clinic director Thomas Ewald makes it unmistakably clear that midwives are an essential part of obstetric care. “Without midwives we cannot maintain obstetric care,” says Ewald. However, due to a deficit of 23.1 million euros, the clinic only has limited funds available to create additional incentives.
The role of attending midwives in Germany
Attending midwives, who act as freelance helpers, play a central role in German obstetric care. They currently look after more than 20 percent of births, although in Bavaria this proportion is as high as 80 percent. Their work is characterized by flexibility and self-determined rosters, as the midwives themselves emphasize. According to hebammenverband.de, it was previously possible to bill 100 percent of their services, which is now significantly restricted by the new contract.
The changes could have far-reaching consequences for the care of expectant mothers and their families. The decline in midwives could result in a supply shortage, which is already being observed with concern.
It remains to be seen whether freelance midwives will continue to be committed to their patients despite these challenges. The fact is: the future of obstetrics is in limbo, and the concerns and hopes of midwives are palpable.