The pregnancy test is positive, and now you have an appointment with your gynecologist. The upcoming prenatal check-ups during pregnancy often come with many questions: What exactly is being examined? Can you go to your midwife instead of the doctor? And who actually pays for these examinations? In this article, you’ll find answers to the most important questions, along with an overview of what happens at each appointment.
What preventive examinations are available?
Gesetzliche Vorsorge:
Every pregnant woman is entitled to medical examinations and advice, with the costs covered by statutory health insurance. In Germany, all recommended prenatal examinations are defined by the Joint Federal Committee of Doctors and Statutory Health Insurance Funds in the so-called maternity guidelines. These specify the scope of legally required prenatal examinations as well as the physician’s duty to provide advice and information to expectant parents. If you are employed, you are also entitled to time off work for these appointments. If you have private insurance, the prenatal care offered during pregnancy may differ from that provided under statutory health insurance. It’s best to ask your insurance company directly.
Individuelle Gesundheitsleistungen (IGeL):
In addition to these basic preventive examinations, which are available to every insured person, there are various individual health services (IGeL). They are performed either for medical reasons—such as a high-risk pregnancy or certain pre-existing conditions—or at the patient’s request. If the additional examinations are medically necessary, they are also covered by health insurance. However, if you choose to have them done at your own request, you will need to cover the costs yourself. One example of an individual health service is testing for specific immune antibodies. This examination is not relevant for every pregnant woman, but it can be useful for women in certain professions, such as in the medical field.
Prenatal diagnostic examinations, which specifically look for indications of possible malformations, chromosomal abnormalities, and hereditary diseases, are also considered individual health services. As part of statutory preventive care, they are performed only if the likelihood of a chromosomal abnormality is increased due to the mother’s age, if there is an abnormal medical or family history, or if abnormalities are detected in the child during an ultrasound examination. Some prenatal diagnostic procedures are viewed critically because they use invasive techniques, have uncertain detection rates, and carry certain risks. For this reason, your doctor is obliged to inform you in advance about the purpose, scope, and consequences of the examinations, possible psychological stress caused by the findings, and the risks of the procedure.
What happens during the legally mandated examinations?
During pregnancy, around ten preventive examinations are planned. Regular check-ups make it possible to identify potential risks for you or your baby early on and, if necessary, take appropriate measures. At the beginning of pregnancy, prenatal appointments take place once a month and include three ultrasound examinations ; from the 32nd week of pregnancy, they are scheduled every two weeks. Some doctors also see their patients every two weeks during the first few weeks of pregnancy. If you are expecting multiples, your babies’ development will be monitored more closely throughout the entire pregnancy. All prenatal check-ups can also be performed by your midwife; however, ultrasound examinations must be done by your doctor. You can also combine both options by alternating appointments with your midwife and your doctor. Especially in a high-risk pregnancy, regular examinations with your doctor, in addition to ultrasound, may be particularly advisable.
If you choose to have the examinations with your doctor, certain things will be examined during each check-up :
Monitoring of blood pressure and weight
Urinalysis for bacteria, protein, and sugar content
Palpation to assess the position of the uterus
Monitoring your baby’s position and heartbeat
Blood tests at regular intervals
The results of all examinations are documented in the maternity record.
All preventive examinations at a glance
1. Vorsorgeuntersuchung (nach dem positiven Schwangerschaftstest):
Confirmation of pregnancy (usually by ultrasound, which is not included in the three ultrasound examinations)
Determining your current week of pregnancy and calculating the due date (since the exact time of fertilization cannot always be determined precisely, the estimated delivery date may be adjusted later in the pregnancy)
Detailed consultation regarding your overall health, possible pre-existing conditions, and, if applicable, findings from previous pregnancies
Clarification of your vaccination status
Blood sample collection and determination of blood type and Rhesus factor
Antibody test for specific infectious diseases, urine test (test for syphilis infection), hemoglobin determination to detect iron deficiency, and urine examination for chlamydia
Advice on behavior, nutrition , and stress during pregnancy, behavior in the workplace, and an opportunity for you to ask questions (information about work-related risks and any potential work bans must be clarified with your employer or a company doctor)
Individual health services:
Blood test for toxoplasmosis, listeriosis, cytomegalovirus, and rubella (viral or bacterial diseases that can cause harm to the baby)
Just before your first check-up, you may have questions about the overall process. In the video, our LILLYDOO gynecologist Christian explains exactly what you can expect:
2. Vorsorgeuntersuchung (1. Trimester):
First ultrasound examination: If this was not possible during the initial check-up, your doctor will check whether the embryo has implanted in your uterus. This confirms the pregnancy with certainty. Your doctor can also determine whether you are expecting multiples.
Issuance of your maternity record
3. Vorsorgeuntersuchung (2. Trimester):
Listening to your baby’s heartbeat with a Dopton device (ultrasound), possible from the 13th week of pregnancy at the earliest
Individual health services:
Various prenatal examinations, such as blood tests to determine the likelihood of different chromosomal abnormalities. Your doctor can provide more detailed information about the options and risks of the different tests.
4. Vorsorgeuntersuchung (2. Trimester):
Regular examinations that take place at all appointments
Individual health services:
Monitoring of placental position by ultrasound
5. Vorsorgeuntersuchung (2. Trimester):
Second ultrasound: The doctor checks whether all organs are correctly formed. In addition, the position and structure of the placenta are examined, the amount of amniotic fluid is measured, and your baby is assessed. Usually, you can also find out the biological sex of your child at this point.
Individual health services:
3D/4D Ultrasound*, second toxoplasmosis and listeriosis test
6. Vorsorgeuntersuchung (2./3. Trimester):
Regular examinations that take place at all appointments
7. Vorsorgeuntersuchung (3. Trimester):
Oral glucose tolerance test for gestational diabetes: You should not eat or drink anything about an hour before the examination. You will be given a glucose solution to drink, and an hour later, a blood sample will be taken to measure how well your body processes the sugar.
8. Vorsorgeuntersuchung (3. Trimester):
Third ultrasound to monitor your baby’s growth and heart function, as well as the location of the placenta
From the 32nd week of pregnancy, prenatal check-ups will be every two weeks
Paid additional service:
9. Vorsorgeuntersuchung (3. Trimester):
Blood test for hepatitis B antigen detection (HBsAg): This checks whether you carry the hepatitis B virus and whether there is a risk of transmitting it to your baby. In this case, your baby can be immunized immediately after birth.
10. Vorsorgeuntersuchung (3. Trimester):
Regular examinations that take place at all appointments
Individual health services:
B-Streptococcus test (GBS screening, possible from the 35th week of pregnancy): B-Streptococcus bacteria can occur in the vagina or intestines, so your baby can become infected during birth if you carry them. The bacteria are harmless to you, but in newborns, they can cause infections such as meningitis or pneumonia. If the test is positive, you will receive antibiotics during labor to help prevent your baby from becoming infected. Although the test is not part of the statutory prenatal check-ups, it is recommended.
Ab dem errechneten Geburtstermin:
Check-up with CTG every two days
Statutory preventive examinations make it possible to regularly monitor your health and your baby’s development, helping to ensure that the pregnancy progresses without complications. Many expectant mothers also appreciate the opportunity to discuss questions and concerns with their doctor or midwife during scheduled appointments. At the same time, individual health services—and deciding which ones to choose—can quickly lead to uncertainty. Alongside the expert advice of your doctor or midwife, your own intuition also plays an important role in deciding which examinations you consider useful and which you do not.
We hope your pregnancy goes as smoothly as possible and wish you a wonderful time enjoying the anticipation of your baby!
*Ultrasound examinations that go beyond the three scheduled examinations and are not medically necessary, as well as CTG examinations before the estimated due date, are currently classified as individual health services and have been legally prohibited since 2021. The reason for this is the unclear effect of sound exposure on cells and tissues, as well as the potential risk of cell changes and harm to the unborn child.
