Subscribe to Lemonada Premium for Bonus Content

On our first stop in the “healthcare world tour,” we travel to Germany, where midwives are a legal right, childcare is subsidized, and parents are reimbursed for childcare costs. We’ll shadow a midwife on a home visit to newborn twins and their parents, and meet an American mom who left the U.S. to reap the German benefits. But is it too good to be true? We’ll learn what challenges midwives are up against, like a labor shortage that could upend the care they’re able to provide.

Uncared For is presented by the Commonwealth Fund, a nonprofit foundation making grants to promote an equitable, high-performing health care system. Learn more at CommonwealthFund.org.

SuChin Pak is our host. Muna Danish is our supervising producer. Giulia Hjort is our producer and Rachel Lightner is our producer and audio engineer. Isaura Aceves is our associate producer. Mix help from Kristin Mueller. Music is by Andrea Kristinsdottir. Jackie Danziger is our VP of Narrative Content. Our story consultant is Kaya Henderson. Fact-checking by Naomi Barr. Executive producers are Jessica Cordova Kramer and Stephanie Wittels Wachs.

Follow SuChin on Twitter and Instagram at @suchinpak. Stay up to date with us on Twitter, Facebook and Instagram at @LemonadaMedia.

You can also get premium content and behind the scenes material by subscribing to Lemonada Premium on Apple Podcasts.

Want to become a Lemonada superfan? Join us at https://joinsubtext.com/lemonadasuperfan.

Click this link for a list of current sponsors and discount codes for this and all other Lemonada series: lemonadamedia.com/sponsors.

To follow along with a transcript, go to www.lemonadamedia.com/show/ shortly after the air date.

A previous version of this story stated that Caitlin’s son died after a few days at home. The episode has been edited to reflect the fact that he passed away immediately after birth.

Transcript

SPEAKERS

Caitlin Vestal, Paulina, Isabella, Katarina, SuChin Pak

SuChin Pak  00:00

Please note that this episode contains descriptions about pregnancy loss. Please take care while listening.

SuChin Pak  00:56

This is what the reality sounds like from many new parents in the US. For me. Well, I took all the prenatal classes. I watched the video of live births toward the hospital where it was going to deliver and then BAM baby is here and ouch ago. I just kept thinking where was the class on how breastfeeding can leave you totally demoralized? Or how about the class on what to do on night number one when you can’t get your baby to stop crying. You’re left to deal with the giant abyss of parenthood may be entirely on your own. In Germany, though, new parents are treated a bit differently. Last summer, the UNCARED FOR team took a trip to Berlin, Germany, we wanted to see how parents and children are cared for and a country that ranks really high in health care accessibility and equity. What you’re hearing is Berlin based midwife, Katarina Reich, introducing us to two of her clients, Isabella and Bjorn. Four and a half weeks earlier, Isabella and Bjorn welcomed identical twins, Mats and Carl to their family of three. On home visit number two after Matson, Carl’s birth, Katarina invited us along to shadow her doing her midwife thing. The sarcasm may not be translating here, but by biggest room Isabella really means smallest. What used to be their laundry room is now furnished exclusively with baby gear, two cribs, a changing table, a rocking chair and a sign that says double treble leftover from the recent baby shower. This is where Katarina does all the baby weighing, Mats the older one by seven minutes is up first.

Katarina  03:34

So this is normally what we just weighed them in so they were just as a little bags that I’ve got like plenty of them, different size, different colors, so just to make it a little nicer.

SuChin Pak  03:45

Katarina rolls baby mats into a colorful sling with the scale on top. It’s kind of like those pictures you see in kids’ books of storks carrying a baby wrapped in a blanket.

Katarina  03:56

So it’s 460. So it’s another 80 in two days.

SuChin Pak  04:05

Isabella is happy to hear baby mats is getting bigger and stronger by the day. But weighing newborns is really just the tip of the iceberg during a postpartum home visit from the meticulous Katarina.

Katarina  04:18

I’m having a look at his fingernails now. They haven’t been that red last night. It will disappear by itself. But will be in the next few days?

Isabella  04:32

But anything that I need to watch out for when cutting?

Katarina  04:36

I wouldn’t shorten them for now. Just wait until it was up by itself.

SuChin Pak  04:40

Isabella is asking about cutting her baby’s fingernails, which is universally terrifying for all new parents. It’s a small example of the hundreds of questions a day that come up even when you’ve had a kid before.

Katarina  04:53

Sometimes you just have a pile of questions. And then it’s nice to just sit down for an hour or an hour and a half with the midwife. Just talk it all through, and all the options you have for whatever’s coming up.

SuChin Pak  05:05

And it’s all the more helpful when this person you’re contacting approximately 100 times a day is someone who you really trust.

Katarina  05:13

It’s just giving the sense of security somehow so that you always have somebody to turn to.

SuChin Pak  05:22

We spent the first two episodes of this series taking stock of what’s wrong with our maternal care system in the US of how the quintessential American birthing experience is riddled with inequities and barriers that impede our medical care. This week on our first stop in the maternal health care world tour, we’re in Germany, where midwives like Katarina are illegal, right for every expecting parent in the country. This is UNCARED FOR. I’m your host SuChin Pak. Like the US, Germany’s healthcare system is a hybrid, meaning it has both private insurance and government funded care. But most Germans get their primary care through the public system. And with good reason, Germany’s health care system is one of the highest performing in terms of equity, meaning it has much smaller income related disparities than other countries. And it also ranks highly in access to care, which includes both affordability and getting care on time, the US ranks at the bottom of the heap for both something many of us have probably experienced firsthand. But what does all this equity and accessibility talk really mean for your health? Well, it’s like what you just heard someone coming to your house for a care visit, or having low co-pays and out of pocket costs. In fact, Germany actually abolished co-pays for physician visits in 2013. And these strengths are very apparent in Germany’s approach to maternal care starting with midwives.

Katarina  07:16

So before, I’m living in Berlin, I’m working as a freelancer midwife, kind of schedule my own daytime how to work with whom I want to work, and I’m a midwife since 10 years now.

SuChin Pak  07:28

That’s Katarina, who we heard caring for Isabella’s newborn twins earlier. Ever since she was three years old. Katarina knew she wanted to become a midwife.

Katarina  07:39

Yeah, kind of a childhood dream. Since I was going to preschool this was like the only thing I was talking about, like helping bringing babies to the world, but it never changed to be honest, it’s been always the same. So even like in high school was always the wish to be a midwife.

SuChin Pak  07:54

Katarina is what’s known as a freelance midwife or the […], meaning that she works independently but has a contract with a local hospital, where she assists births. One of Katarina’s key roles as a midwife is meeting a pregnant person where they’re at literally, both in the prenatal period, and for up to three months after birth. Catarina is there making home visits regularly to make sure her clients and their babies are staying healthy.

Katarina  08:27

I’m trying to get to know those families as soon as possible when they get pregnant. And then mainly I’m there whenever they get out of the hospital. Seeing them really the first day of home to see how’s the baby doing, how’s the breastfeeding, changing diapers for them showing how to carry a baby how to pick up the baby.

SuChin Pak  08:46

Multiply Katarina by about 26,000, and you’ve got a country of midwives equipped to ensure good birth and postpartum outcomes. And remember, the right to have Katarina by your side during pregnancy and after birth, is actually written into law in Germany in something called the midwives act. To an American, it might sound completely shocking to learn that the norm in Germany is for the entire country’s birthing population to be entitled to a midwife, and that these services are actually covered by health insurance.

Katarina  09:23

No matter if it’s a private insurance, or just a normal health care insurance you get by the government, you can always have a midwife.

SuChin Pak  09:31

This is wildly different from how we do it in the US. First of all, just having a baby in our country from pregnancy to postpartum care, averages out to nearly $19,000 With out of pocket costs averaging about $3,000 For those with coverage, so even thinking of adding an extra cost to that bill seems outrageous, especially when midwifery services feel so siloed From the rest of maternal care in hospitals. In fact, compared to other high income countries, the US has the lowest supply of midwives and OB-GYN per capita, and only about 8% of births are attended by a midwife. And midwives are so much more in the background than doctors, which isn’t the case in Germany.

Katarina  10:23

The midwives are the ones taking like full responsibility of the birth itself. The doctors are only there when there are any complications or when they have to make a caesarean. Or say five to 10 minutes before the baby is about to be born. But other than that, you’re always covered with just midwives over here and the doctors in the background.

SuChin Pak  10:43

But one thing that’s universal no matter where you give birth, becoming a parent is really overwhelming.

Isabella  10:50

You just go home with a blown mind like, wow, yeah, how am I going to do this was no one being here like 24 hours a day.

SuChin Pak  10:59

Enter Katarina.

Katarina  11:02

Depending when the baby sleeps, we’ll take care of the mom first. Checking their breasts, checking the uterus, checking the bleeding stitches that have been done to help her recover as quick as possible. With the baby, it’s mainly showing them how to clean them properly, what to watch out for, that they latch on properly when they want to be breastfed. Checking the diapers showing them how to change diapers, how to dress them. Probably weird for someone who has a baby for the first time, because you have just that little human being that can’t do anything and that you have to take care of. So it’s kind of overwhelming for lots of families.

SuChin Pak  11:38

It is overwhelming and unrelenting. I remember when my son was born, he had jaundice. And the treatment was for me to pump as much milk as possible. The second I got home, so I had to learn how to breastfeed and pump every few hours all day all night on my own. Then he kept getting rashes all over his head the first few weeks, and we were just really scared that maybe he was in pain or we had done something wrong. The questions, the worry, they’re endless. In Germany, people have midwives like Katarina to answer these questions. Usually Katarina takes on eight to 10 prenatal or postnatal clients at a time, which means she’s making 6 to 8 home visits per day. And these can take about an hour each not including the time to and from each home. On this Tuesday morning, Isabella and her twins are up first.

Katarina  12:35

We tend to a belly last time so those straight belly muscles are quite far apart, and it helps the muscles to just recover quicker.

SuChin Pak  12:44

Katarina is explaining a kind of belly taping that helps the muscles recover after pregnancy. By the way, at this point, we’re about 50 minutes into a home visit that ended up lasting almost an hour and a half. And even though it can take a long time, Katarina knows that time is what makes all the difference when it comes to quality care.

Katarina  13:05

How does it feel?

Isabella  13:06

I don’t feel it a lot. When I was taped during the pregnancy, I had a continuous strain and it didn’t feel good, but this one’s really, really feels good. So that’s good. Yeah, drinks a lot, or it’s a lot. That’s true. I think there might be some more in there.

SuChin Pak  13:36

Isabella and Katarina is easy going back and forth. Reminds me of my own relationship with my postpartum doula Brandi. There’s a level of trust and chemistry between these two that can’t happen in a 10 minute doctor’s appointment. Their close knit relationship started about five years ago, when Isabella and Bjorn gave birth to their first child, Lyn, and found themselves asking those typical first time parent questions.

Isabella  14:02

It starts with how to change the diaper from okay, so in in what succession do you actually put on the clothes? It’s the real basic stuff because you’ve never done it yourself.

SuChin Pak  14:13

One of the basics that Isabella struggled with in those early days of parenthood was breastfeeding.

Isabella  14:19

I always assumed that breastfeeding would be so intuitive because everyone is just like, oh, breastfeeding is the most natural thing that you can do. And it was just not intuitive. And I mean, she drank but I had so much pain because basically she didn’t latch on correctly, but I didn’t know that because I you know, obviously didn’t have any experience. And in one and a half weeks’ time, there can be a lot that goes wrong. So I was really happy that Katarina came in for the rescue.

SuChin Pak  14:51

This sort of easily accessible parenting guidance in person over text and over the phone. Saved Isabella many trips to the doctor during her first parenting rodeo.

Isabella  15:03

it was just so much more natural to just, you know, turn to my midwife and say everything is just bleeding is cracked, like everything is just hurting a lot like what can I do?

SuChin Pak  15:14

So when Isabella got pregnant with the twins, she knew exactly who to call.

Isabella  15:19

You really do have a great memory with talk the first time you were like, Yeah, and you had this issue, and I remember that it was that and I was like, okay, so this has been four years ago. Like, how is she doing that? I mean, obviously, you’re not just having three women each year that you take care of. So I was really flabbergasted.

SuChin Pak  15:41

Katarina has a special knack for remembering every little detail about her clients pregnancies. But this time around, there were no breastfeeding problems to speak of. Isabella’s twins latched on immediately.

Isabella  15:53

5As if you hadn’t had anything for days, appropriately, very fun to listen to the different sounds that they’re doing.

SuChin Pak  16:17

So we know that Germany is doing a number of things right, they’ve managed to create a system of accessible, equitable, free maternal care that’s protected by law. Midwives like Katarina are paid to be thoughtful, trusting and easy to communicate with. Now, let’s think about this in the context of how we do things in the US, it doesn’t matter what stage of pregnancy you’re at, whether you’re a third trimester or just days after birth, you’re basically required to get to your provider’s office on your own, which can be especially difficult for lower income folks with less work flexibility, or fewer transportation options. In the US, as many as 40% of new parents don’t attend a postpartum visit. Compare this to what’s now sounding like a birthing utopia in Germany, someone you’ve gotten to know over time, visits you at home, checks up on you and your baby, and answers any questions you have, no matter how silly they might seem to you. And this person continues to check up for days, weeks and months. This continuity of care often translates into a Rolodex of repeat clients for Katarina who want that quality of care for every one of their pregnancies.

Isabella  17:38

I mean, obviously, you’re more insecure with the first kid you have more questions, definitely. But what I really found helpful was during this time, it was more focused on also myself and what I can do to sort of, you know, get back on my feet a bit quicker.

SuChin Pak  17:54

For Katarina, a large part of being a midwife, is about lifelong relationships.

Katarina  18:01

It’s not just a job, it’s so much more, I think it’s like to just get back so many good vibes from the families and the kind of growing into this together.

Isabella  18:11

Yeah, in the end, you have the feeling that you didn’t have a midwife, but you actually had a friend who coached you through this whole situation.

SuChin Pak  18:22

It’s impossible to ever be fully prepared for bringing a baby home for the first time. The loneliness, you might feel the difficulty of breastfeeding, that disconnection from who you used to be. It’s all this stuff on top of the day to day details of taking care of a baby. That creates a kind of stress that was for me, really paralyzing. And I had a postpartum doula. I can’t overstate how important this type of contact is, with someone whose only job is to help you adjust to parenthood, especially when you feel like you’re failing at your most important job. After the break, a difficult birth story from a woman in Texas, who eventually made her way to Germany.

Caitlin Vestal  19:21

Once upon a time, I was a birth doula and a yoga teacher with a really strong focus on prenatal yoga. So like, moms and pregnancy, were kind of like my whole life for a very long time.

SuChin Pak  19:33

That’s Caitlin Vestal. Back in 2014. Caitlin and her husband Charles lived in Austin, Texas, where Caitlin worked as a birth specialist. It was an exciting time because they were preparing to become parents themselves.

Caitlin Vestal  19:48

I was really excited to be pregnant because I supported so many people doing this. And so much of like doula work is like talking about how it’s empowering and how birth can be empowering And before anything even went wrong, like it was not empowering. I was so exhausted; I was so tired. I was just like; I don’t know how I can do this.

SuChin Pak  20:13

Like most soon to be parents, Caitlin was feeling all the physical fields of pregnancy. But there was one side effect that she wasn’t expecting.

Caitlin Vestal  20:24

It was April 1, of course, I know the day actually. My husband had been out of town for the weekend. And I started having cramps. And then in the bathroom, there was bright red blood. And I was like, okay, shit, this is not good.

SuChin Pak  20:41

Caitlin had just had our 20 week scan showing a clean bill of health for her baby. So the last thing they were expecting was this.

Caitlin Vestal  20:51

I have had spotting before. So there’s so much of like, it’s fine. It’s fine. It’s fine. It’s totally fine. It’s fine. It’s no big deal. It’s fine. But it’s not fine. Right. And like cramping is really common. But the thing that you always hear is like if there’s cramping and blood, you call someone immediately.

SuChin Pak  21:08

But the someone she chose to call was not her OB-GYN. Right before Kaitlyn started experiencing any sort of complications, she had hired two midwives, Laurie and Julia, to help her through the birthing process. In the US, it isn’t all that common to hire midwives, because they can get expensive if your insurance plan doesn’t fit the bill. But Caitlin knew she wanted that extra support during her first pregnancy.

Caitlin Vestal  21:38

And so I went to my midwife. And, you know, her office was like at her house, right? So you’re like at her house on the couch. And she puts on her headlamp, gets her speculum, and it’s just like swabbing so much blood.

SuChin Pak  21:53

So Caitlin immediately called her husband, and together, they rushed to the hospital to visit her OB-GYN who she didn’t exactly have a great relationship with.

Caitlin Vestal  22:04

And this awful shitty doctor was just like, yeah, so you know, you’ve probably heard something called incompetent cervix, which is the name of this condition, incompetent cervix. And a lot of birth workers. And like maternal health advocates have said, maybe we should change this name, because it really implies pretty horrible things. And it was like one of those really like, super meta moments because like I had to translate to my husband what that meant, because like, I knew that it’s this really rare condition. And I knew what this meant at that moment.

SuChin Pak  22:43

What this meant was that Caitlin and Charles, we’re about to be facing some difficult decisions ahead. Normally, the cervix starts to open up and soften late in the third trimester, getting ready for the baby to pass through the birth canal. But with Caitlin’s condition, this meant that her cervix was dilating early, basically, her body was getting ready to give birth at 20 weeks, way too early for a viable birth.

Caitlin Vestal  23:11

So when this happens, the sort of like last ditch effort that is a possibility is that they can put something in your cervix, Hollister collage, which is literally like they stitch up your cervix, and hope it stays like that is all they’ve got. Basically, they were like, do you want to do this or not? And I was like, well, is it going to work? And they were sort of like..

SuChin Pak  23:34

Caitlin’s shrugging here, not exactly the sort of reaction you want to get when you need answers.

Caitlin Vestal  23:40

We were just like in this hospital room, like screaming and freaking out because we had no actual guidance on what to do. And I was like, just calling my midwife like on the slide to be like, this is what they’re saying, what should I do?

SuChin Pak  23:53

After 24 hours of monitoring, Caitlin’s cervix kept dilating, and her doctors were now convinced that a sir claws would no longer work. Caitlin’s only other option was to induce labor, meaning she would deliver at around 20 weeks with almost no chance of the baby surviving. At the end of the day, though, inducing was a way for Caitlin to safely find her way out of this heartbreaking ordeal. This probably would have been Caitlin’s choice had the state of Texas not intervened in her medical care. Only six months earlier, a Texas law had gone into effect that made abortions illegal after 20 weeks. And by now Caitlin was just at that point in her pregnancy.

Caitlin Vestal  24:41

And then my high risk OB had to come back in and basically be like, sorry, we can’t touch this. Like this technically, would be a termination after 20 weeks. Even though it’s just inducing labor.

SuChin Pak  24:58

According to Caitlyn hospital staff were afraid that inducing labor would now be legally perceived as an abortion, and they weren’t prepared to take the risk. It goes back to that chilling effect we talked about in the last episode, that providers just out of the fear of being sued, might be reluctant to offer abortion care. So Caitlin found herself in an impossibly difficult situation.

Caitlin Vestal  25:23

The option was to stay in the hospital until it happened, or it was to go home. And then they wanted me to come back when it happened. And of course, again, like I’m like, on the phone with my midwives being like, this is what they’re saying, and this is what’s happening, what should I do. And my midwife who had lost two babies was like, We can do this at home.

SuChin Pak  25:45

So Caitlin, and Charles took their midwives advice, they went home and waited for their son William to arrive with no plans of returning to the hospital.

Caitlin Vestal  25:55

And then my labor started that night. But it started and then it stopped. Which is like a really common thing that happens, like when women aren’t ready to have a baby. And it took 10 days for it to happen, which was, obviously like the worst 10 days of my life.

SuChin Pak  26:13

For 10 grueling days, Caitlin and Charles waited for William to be born. But in the chaos and trauma of it all. She had the support team she needed by her side.

Caitlin Vestal  26:24

The first night, my midwives both came over, they brought their sleeping bags, and they just lay down on the floor and waited for me to have the baby. And then we all woke up in the morning. And we’re like, Well, that didn’t happen. By that last night, I was just like, fucking do something. I cannot do this anymore.

SuChin Pak  26:42

So Caitlin’s midwife naturally induced labor. And a couple hours later, William was born, feet first, with his tiny eyes sealed shut. William passed away in his parents bed. And Caitlin and Charles were left to sift through an especially traumatic kind of grief.

Caitlin Vestal  27:04

Some days, I would get out of bed, and some days, I was like, what’s, what is the point like, I cannot do this. I had this moment where I was like, I guess I’m done with this world. And it was such a weird sort of non sequitur thought, but I was just like, I’m done. And I was also like, I don’t want to see a pregnant person ever again in my life. You know, that’s how you feel in those moments.

SuChin Pak  27:27

But the entire time Caitlin’s midwives who didn’t accept any payment from her, were there to pick up the pieces they cleaned up, helped make funeral arrangements, and did all of the things that parents grieving the very unexpected loss of their baby don’t have the energy to even think about?

Caitlin Vestal  27:45

I mean, I don’t know what I would have done if she hadn’t been my midwife, it would have been a completely different experience.

SuChin Pak  27:55

Caitlin needed some time to recover from this traumatic ordeal. But two years later, she and Charles were ready to try again. They got pregnant and Caitlyn gave birth to a healthy baby boy named Orson, he’s five. Now.

Caitlin Vestal  28:10

I don’t even describe this kid, this, we’re always like, we love his weirdo. We just kind of have this weird roommate who like, eats raw tofu and talks about Pokémon all day. he’s kind of a freak.

SuChin Pak  28:26

And this little weirdo who likes to eat raw tofu, made Caitlyn and Charles reevaluate things, like their decision to live in a country where Caitlyn had to undergo such a painful experience, to receive quality health care. Not to mention that they were learning very quickly how expensive it was to raise a child in the US. So when Charles got a job offer in Berlin, the families started weighing their options.

Caitlin Vestal  28:53

And so we were like, kind of making this decision if we were going to do it or not. And we found out that childcare here was free. And I think we were both kind of like, would we rather stay here? Or would we rather be in a place where we have free childcare.

SuChin Pak  29:09

And that was that when Orson was only 18 months old, the family made their big move to Berlin.

Caitlin Vestal  29:17

I feel like we don’t have a strong like familiar or friend support system here. But we’re supported by the system in a way that no American is.

SuChin Pak  29:28

Because in Germany, the kind of support that Caitlin experience through her midwives is built into their systems of care, meaning, you never have to call your midwife on the slide when you’re at your doctor’s office, because they’re central to your care. After the break, we’ll follow Caitlin’s journey abroad. To learn about the other ways Germans are taken care of long term from well compensated parental leave to free childcare.

Caitlin Vestal  30:06

What happened is when I got here, I was like, what do I do with this kid?

SuChin Pak  30:10

That’s Caitlin Vestal again.

Caitlin Vestal  30:12

I don’t actually know anything here like, oh my god, what have we done. We move to a foreign country. I speak the very tiniest amount of German that is not actually functional. What have we done?

SuChin Pak  30:24

When we left off with Caitlin, she and her family had moved to Berlin, anticipating some pretty high child care costs in the US, but they were having some trouble adjusting to their new normal.

Caitlin Vestal  30:36

And my friend, she was like, Oh, well, they just go hang out with the chameleon syndrome. And I was like, what’s that? Tell me? So I just like went over there with the stroller. And I walked in and was like, What is this place? That’s not like it’s like the fanciest or like, most glorious building or something, right? But it’s like, he can just play over there. Well, I drink a coffee.

SuChin Pak  31:05

This place that Caitlin’s talking about the Familienzentrum is a cross between a daycare and a multicultural community center that’s free to the public and common throughout Germany. Our team was curious about this community center. So we drove over to take a look for ourselves. And turns out, it sort of looks like a glorified gray Lego block with bright yellow windows and doors. The real beauty lies in the kids drawings and hand painted tiles on display throughout the center.

Paulina  31:37

On the evenings or after weekday. It’s really full, like in a normal day, like […] or something.

SuChin Pak  31:46

That’s Paulina […] an early education expert Caitlin’s local Familienzentrum.

Paulina  31:52

In this side, we have a playground for big kids. And then the other side, we have a playground for smaller kids. Here we have usually dancing classes or theater classes.

SuChin Pak  32:04

Paulina took us on a tour of the Familienzentrum showing us where the kids play, dance and have their big theater stage debut.

Paulina  32:13

This is more or less like the heart of the Familienzentrum where people can just come with their kids and play with them. Somewhere that is not the house.

SuChin Pak  32:23

This center is in the heart of Kreuzberg, a neighborhood where at any given moment, you can hear dozens of different languages being spoken. And for these families, the center is an essential part of their day to day.

Paulina  32:36

We have groups of people who we lend the rooms to. And then we have Russian groups. We have Ukranian groups, we have Colombian groups, we have French, Turkish Farsi, they come here and they take language classes, and they can leave their kids here. And then we have these two women who help us take care of the kids. While the mothers are learning German.

SuChin Pak  33:05

There’s a lot to love about the Familienzentrum. Want to meet your neighbors find them here. Do you and your kid want to learn a new skill, take a class here, need to talk to a personal issue, talk to a social worker on staff. All of these perks are doubly important when you are lower income, adjusting to the language barriers and juggling more than just one job to keep your family fed. For Caitlin, the Familienzentrum was a place for her to recharge her energy, while giving Orson the space to release his.

Caitlin Vestal  33:41

We did like this art class. And we did a singing class in this class where he could just run around in this ball pit that he would play in which I’m sure is disgusting. But like, Oh my God, it was great. I am forever kind of like, grateful to it. Because it just was truly for me. It was like a lifeline. When I really didn’t I did not know what to do.

SuChin Pak  34:04

In many ways, the structure of the Familienzentrum was quite the shift for Caitlin’s family compared to her childcare experience in the US.

Caitlin Vestal  34:13

There were to places like this, and you had to be a monthly member. And it was kind of similar, but it was like not well thought out. There were no social workers working there. Right? It was just like this weird empty space that you could go and like, make some bad coffee, and like let your kid play. But we paid, we paid a membership fee to do that. So when we got here in the Familien center was free I was just like, I don’t understand.

SuChin Pak  34:41

This would probably be the reaction of most Americans learning about the Familienzentrum for the first time, it was 100% My reaction to first of all, I can dump my kid in a ball pit for a couple of hours for free so I can get a mental break. Great. Sign me up. Social workers on staff to talk through my worries about integrating into German culture as an immigrant again for free. Now that really sounds like a system of wraparound care I could get down with. But the reality in the US is so painfully far from that.

Caitlin Vestal  35:15

Daycare was literally like bankrupting us. One day a week was $800 a month, there’s no way we were going to be able to afford a full week, like a full five days a week of daycare, like it just wasn’t going to happen.

SuChin Pak  35:28

On average, American parents spent $1,100 a month on child care. Since we’re talking numbers, Germany allocates over 18,000 and annual public spending per child on early childhood care. In the US, only 500 bucks, making it a major outlier among similar countries. That’s a shame because we know there are clear health benefits for kids who attend early care and education programs. These programs are linked to improved nutrition for kids higher immunization rates, and better access to preventative care. In Berlin in 2018, part of the regional governments substantial funding for childcare meant abolishing fees for […], which is the German equivalent of daycare.

Caitlin Vestal  36:18

I honestly like can’t now imagine my life without having had that free childcare. It’s such a different mentality. Like here, it’s like a civic right, like all kids deserve a place at […]. And I’m still kind of like an American, like it’s free. Oh, my God. Even though of course, it’s not like our taxes are really high here.

SuChin Pak  36:44

For example, if you are raking in a little under 60,000 euros per year, in Germany, you’d be taxed at around 40%, that is high, considering an equivalent salary would be taxed at about half that in the US. But most of the taxes you pay go to the elaborate German Social Security system, which guarantees all citizens can live comfortably, even if they’re sick, disabled, unemployed, or retired.

Caitlin Vestal  37:12

And again, it’s not free, it’s in the taxes, but like I’m okay with that. I’m very, very okay with that. Because that means that my taxes are also helping someone else go to […] like someone who doesn’t make as much money as we do.

SuChin Pak  37:27

Caitlin’s willingness to pay higher taxes so that everyone can stay healthy and supported regardless of their income bracket. That’s the mentality that we don’t hear much in the US, a country where roughly 8% of people are uninsured, largely because of high insurance costs. When it comes to Germany, its wraparound services don’t stop at what tax provide for the entire population.

Isabella  37:53

So maternity leave is one thing you can take up to three years of maternity leave or parental leave for each kid.

SuChin Pak  38:00

That’s Isabella, again, with a truly gob smacking piece of info.

Isabella  38:05

So now having twins, I could take up to six years of parental leave or being out of the job with having a guarantee that my employer has to provide me with an equal job when I return.

SuChin Pak  38:19

Yes, you heard that correctly. All German parents, including moms and dads, get all of that time off to be with their newborns and get used to this new phase of life. And they’re not punished for it. Granted, it’s not all paid leave. But it is job security. The closest thing we have in the US are state by state paid leave policies. But that’s only in 11 states. Then there’s a Federal Family and Medical Leave Act, which provides eligible workers with up to 12 weeks of unpaid leave. Even still, nearly 54,000 birthing people in the US lose their jobs every year because of pregnancy discrimination. And in Germany, it doesn’t stop there.

Isabella  39:03

In Germany, you are not allowed to work eight weeks after your due date. So it’s sort of you know, protecting the mother. And in this time, you’re not allowed to get less money. So these first two months or three months, you will get your full pay. And after that you will get up to 67% or I think it’s locked at 1800 euros. And with twins. It’s 2100.

SuChin Pak  39:30

Yep, when taking parental leave in Germany, you can actually get an allowance for up to 14 months after your child’s birth. You’re also given a monthly stipend of a little over 200 euros per child to cover child care costs until your kid turns 18. It’s kind of like you’ve just done one of the hardest things in your life and you’re about to drop so much money on this human and the government is like we see that and we acknowledge it. But Germany’s progressive are also based in plain old economics. In the early to mid-2000s, the German government started rolling out a host of family policies designed to tackle the country’s low birth rates. And they really worked. In 2021, Germany saw over 100,000 more births than in 2010. Now, I know it seems like Germany has a lot figured out, and they do. But there is one snag that has come up since this influx of newborns, and it threatens one of the strongest pillars of what’s keeping their population safe and healthy.

Isabella  40:38

Just a couple of years ago, the insurances have made life so hard for midwives in Germany. So they have to have a special insurance, which costs up to I think, 7000 or 10,000 euros You know, it’s made life so hard for midwives, but also for women who would like to have this kind of special support.

SuChin Pak  41:07

This special support that Isabella is talking about goes back to something we mentioned earlier, when a birthing person wants their own midwife to attend their birth, they have to pay extra. But so to the midwives. Over the last 20 years, these liability insurance premiums have increased more than tenfold. And these rising costs have led to maternity ward closures and less independent midwives attending births. In the past seven years, the German government has started reimbursing a percentage of these insurance premiums. But according to Katarina, it can take a lot of paperwork and time to get this money back.

Katarina  41:45

And this just makes it so hard because the money you get out of a birth is the same amount I was earning six years ago, but the insurance is not the same.

SuChin Pak  41:57

Thanks to these rising insurance costs, the amount of available midwives in Germany has decreased. And this shortage of midwives put stress on both the providers and their clients.

Katarina  42:09

Nowadays, you have like 8 woman during labor or being induced or just having issues during pregnancy. And you have two, if you’re lucky, three midwives in one shift, and they have to take care of all of this. And obviously, this makes you miss out on what’s happening in the next room.

SuChin Pak  42:27

Rising costs, burnout, labor shortages. These all sound like very American problems, don’t you think? The difference though, is that when a robust system like Germany’s is faced with these kinds of challenges, they’re already better equipped to come up with solutions, because they’re starting from a stronger foundation, one that’s much more equitable and accessible than ours. We have a lot to learn from a country that puts people first, not just when it comes to maternal care, but throughout all systems of care, parental support, early childhood care. All of this felt like a breath of fresh air, especially to one American. Here’s Caitlin again,

Caitlin Vestal  43:11

I’m not like they’ve cracked it like they’ve done it. It’s the perfect system. But is it better for a very large segment of society? I wouldn’t have to guess. Yes.

SuChin Pak  43:21

So if Germany isn’t perfect, Is there anywhere that is? Next time we’ll travel to the Netherlands, a place that ranks high in happiness and health care. And we’ll meet the literal fairy godmothers of postpartum care available free of charge to everyone.

CREDITS  43:58

UNCARED FOR is a production of Lemonada Media. I’m your host SuChin Pak. Muna Danish is our supervising producer. Giulia Hjort is our producer. And Rachel Lightner is our producer and audio engineer. Isaura Aceves is our associate producer. Mix help from Kristin Mueller. Music is by Andí Kristinsdóttir, Jackie Danziger is our VP of narrative content. A story consultant is Kaya Henderson. Fact checking by Naomi Barr. Executive Producers are Jessica Cordova Kramer and Stephanie Wittels Wachs. This season of Uncared For is created in partnership with the Commonwealth Fund. There’s more UNCARED FOR with Lemonada Premium subscribers get exclusive access to bonus content, like interviews with health experts, midwives and doulas. Subscribe now in Apple podcasts, follow UNCARED FOR wherever you get your podcasts or listen ad free on Amazon music with your Prime membership.