Berlin – The phone call quickly turns into an incendiary speech, delivered by a doctor on the other end of the line. She works in obstetrics at one of the 51 hospitals in Berlin. She does not want her name or that of her employer to be published. For her, it is not about herself or her delivery room, but about the situation with hospital births in the city in general, and that is catastrophic, says the doctor. She uses a language image: “We drink up and try to get the water out of the boat with a ladle. Somebody has to turn off the tap upstairs. ”That somebody, it becomes clear in the course of the conversation, is politics, the Senate.
Once again, the health system is on the verge of collapse in an important area because it is trimmed for efficiency and cost containment and leaves little room for maneuver. Corona has already presented obstetrics with challenges. “Now the strike at the state clinics is causing more patients to come to us for delivery. More than we can take in with a clear conscience, ”says the doctor. It is important to her: “For me, it is not about the employees returning to their workplace without having achieved anything, but rather that the decision-makers finally act. Immediately. “
Vivantes Neukölln is reducing its birthing activity
In the Vivantes Clinic Neukölln, the maternity ward is already working to a limited extent. The reason, however, is not the strike, emphasizes the state-owned company. Rather, a lack of staff makes this step necessary. In the clinic, the usually around 300 deliveries per month would be reduced by ten percent for the time being, but affected women would be referred to other clinics.
Immediate action – this is what the nursing staff at Vivantes and the Charité demand; They are demanding a collective bargaining agreement that stipulates compensation for time off in the event of understaffing. Understaffing seems to be the norm at the moment. This is shown by the doctor’s descriptions. “The ambulances do not accommodate the pregnant women,” she reports. Again and again, and currently more and more frequently, your ward has to log off from the fire brigade control center because there are no free beds and there is a lack of staff who can look after patients. “We are still hit by ambulances, including women who are at risk of premature birth. Even if we say that there are no more ventilation places available in neonatology. “
Only recently did the doctor have to react quickly again when critical cases came one after the other, imminent premature births. “It feels like being in a field hospital,” says the doctor. “You have the feeling that at some point you have to start triaging.” To choose for which mothers the scarce staff and material are made available and for which not.
The doctor’s clinic, like other houses with maternity wards, is struggling with a shortage of specialists: “We have had an acute midwife problem for years,” she says. In a report published shortly before the outbreak of the pandemic, the IGES Institute documented the deficiency on behalf of the Federal Ministry of Health. Representative selected maternity clinics and their midwives were surveyed on the situation in 2018. Accordingly, more than every third clinic had to reject a pregnant woman with labor at least once during the survey period. According to extrapolation, this affected around 9,000 expectant mothers on average. “Such bottlenecks occur primarily in maternity clinics in large cities, while midwives in rural areas are often under-utilized,” says the report.
Around 70 percent of the midwives surveyed consider one-to-one care for childbirth to be appropriate. In fact, on average, a midwife looks after three women at the same time during a normal shift. During childbirth, the ratio is one to two. On days with an unusually high number of births, 85 percent of midwives care for more than three women in parallel in the delivery room.
“Obstetrics cannot be planned,” says the Berlin doctor on the phone. “You keep certain capacities available, which are sometimes exceeded.” But the situation is now extremely tense. “If the overall level goes up by ten, 15 percent, then you are much faster and much stronger in the red. You lose the overview, safe support can no longer be guaranteed. “
In the doctor’s hospital, they tried to find internal solutions, to occupy free beds in other wards, to temporarily deploy nurses who had not previously worked in obstetrics. You saved the boat from sinking with the ladle. Even during the pandemic and waves of infection. Pregnant women infected with Corona had to be isolated, but here too there were bottlenecks and other departments had to help out. As far as possible. The children’s department mostly asked for understanding, as they had been more than busy with daily operations. So in an emergency, the rule applied: women who tested positive went to the isolation ward, their babies to neonatology.
“We’ll just manage it,” says the doctor, “with a bit of luck and because all of our colleagues work at 150 percent, but we can’t hold out for long.” For example, a midwife recently had three days off, was During this time, asked five times to help out, employees had to be moved back and forth on the roster. Where this leads in the end, the survey by the IGES Institute indicates, namely time pressure in the delivery room. 40 percent of midwives criticize the fact that the natural course of labor is medically interfered with too quickly. Every seventh birth, 15 percent, ends with a caesarean section. 70 percent of those questioned are in favor of fewer inductions of labor, against permanent access, perineal incisions, and opening of the amniotic sac.
Many midwives are considering saying goodbye to inpatient deliveries forever. 85 percent name the high workload as a basic or non-specialist tasks, documentation, cleaning, delivery services. 60 percent reduce their workload because they keep the passion in their job. “That’s always the problem in healthcare,” says the doctor. “It is built on the fact that we all do our job with passion. That we have a high degree of identification with our profession. And that if there is a strike, we normally only keep this strike brief and not so violent for the patient’s sake. “
This time it is different, the strike has been going on for a month without any decisive political intervention. The Senate must act immediately, demands the doctor, otherwise he will be complicit. And then she says a sentence that should wake her up, politics: “People are afraid to come to work. Nobody wants to be there on the day on which a woman dies in childbirth because of the tense situation in the delivery room. “This is only a question of time:” Not a question of months or weeks, but rather of days. “
Editor’s note: An earlier version of the text said Vivantes would close his maternity ward for months. This refers to earlier reports and was denied by Vivantes. It is correct that the clinic is reducing the number of around 300 births per month by ten percent. High-risk pregnancies would continue to be cared for.