1. Background: Midwife shortage and government stance (2026)
In 2026 the federal government acknowledged precise problems in midwifery care across Germany: a growing midwife shortage, gaps in maternity care and specific access problems for low‑income women. Despite this acknowledgement, critics from the Green Party say the government has not proposed concrete measures to stop the exodus of midwives from the profession.
Key figures and trends
Recent studies show nearly one in two midwives is considering leaving the profession. Many report economic pressure and increasing workload. Beleghebammen (community or freelance midwives who attend births) play a major role in birth assistance: they attend about 20 percent of births nationwide and up to 80 percent in some regions such as Bavaria. Financial stress and contract changes have already led to entire teams resigning.
2. The Hebammenhilfevertrag (midwife assistance contract) and its effects
The Hebammenhilfevertrag, which has not been adjusted since 2018 and was set by arbitration after long negotiations, determines how freelance midwives are compensated. Critics and the German Midwives Association (Deutscher Hebammenverband, DHV) say the contract’s payment rules drastically lower earnings for Beleghebammen and deepen supply problems in maternity care.
Contract specifics and the impact on remuneration
Under the current contract rules a Beleghebamme often receives 80 percent of the hourly base rate for the first woman and only 30 percent for the second or third woman under multiple‑birth coverage, despite retaining the same level of responsibility. The GKV‑Spitzenverband defends this by pointing to incentives for 1:1 care, but the DHV calls that justification an illusion because the promised additional payments rarely materialize for practising midwives.
| Situation | Compensation |
|---|---|
| Typical current payment for first woman | 80% of €74.28 per hour |
| Payment for second or third woman | 30% of €74.28 per hour |
| DHV demand | 100% of €74.28 per hour from the first woman; link to wage development |
| Reported practical loss | Up to 35% income reduction for some Beleghebammen |
Negotiation leader Ursula Jahn‑Zöhrens warned that the arbitration outcome and the resulting contract rules may mean the profession’s end for many colleagues. The DHV has called for immediate readjustment of compensation rules to prevent further exits.
3. Political response and criticism
Politicians and professional representatives have sharply criticized the lack of concrete government action. Green Party health spokespersons argue the government is ignoring the competence of midwives, the missing formal integration of midwives into the wider health system, and the failure to address mental health issues in and around pregnancy.
Mental health, screening and system integration
Greens stress that psychological illnesses around pregnancy are among the most frequent complications and have called for comprehensive, nationwide screening and better early detection. They say these measures should be combined with structural reforms that embed midwives more firmly into the health system so their work is recognised, supported and adequately paid.
4. Consequences for maternity care and families
The combined effect of low pay, an unfavorable contract and perceived government inaction risks a rapid deterioration of maternity care. The DHV warns of regionally noticeable care gaps and even a potential ‘birth assistance catastrophe’ if the contract is implemented as planned. Women with low incomes and families in regions that rely heavily on Beleghebammen are particularly affected.
Direct impacts to watch
- Loss of experienced midwives as many plan to leave the profession.
- Localized shortages in birth attendance—especially in areas where Beleghebammen cover a large share of births.
- Reduced continuity of care and increased pressure on hospital maternity wards.
- Greater access problems for low‑income pregnant women.
5. What needs to change: Practical recommendations
Stakeholders and the DHV propose a set of urgent measures to stabilise maternity care and retain midwives. These recommendations focus on fair remuneration, structural integration and targeted screening for perinatal mental health problems.
Actionable steps
- Adjust the Hebammenhilfevertrag so Beleghebammen receive 100% of the hourly rate from the first woman (instead of 80%), and tie remuneration to wage development.
- Ensure additional payments for 1:1 care are actually accessible in practice, not just theoretically available.
- Integrate midwives more formally into the health system to recognise competencies and reduce administrative barriers.
- Introduce nationwide screening for psychological illnesses around pregnancy and offer timely support.
- Prioritise maternity care in political negotiations and coalition discussions to prevent further erosion of services.
6. Conclusion
The situation in German midwifery is urgent: a clear shortage, deep financial pressure on Beleghebammen and a contract framework that many professionals say accelerates exits. The DHV and political critics urge quick policy adjustments to avoid regional breakdowns in birth assistance and to protect maternal health. Without compensation reform, better integration and systematic screening for perinatal mental health, maternity care risks becoming less accessible and less safe for many families.
