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Do I need an NICU for birth in Berlin? Hospital Levels Explained (Perinatalzentrum : Levels 1, 2, 3)

  • Writer: Anne Matei
    Anne Matei
  • Aug 27
  • 5 min read

Updated: Oct 28


baby premature NICU Berlin english-speaking doula anne matei

Do I need an NICU for birth in Berlin? Hospital Levels Explained (Perinatalzentrum : Levels 1, 2, 3)


You might have heard that it's safer to choose a clinic with a higher "Perinatalzentrum" level, but if you have a normal, healthy pregnancy, this isn't necessarily true. This is a very personal choice to make based on your wishes and what you feel comfortable with.


The key is to understand what these different levels of care actually mean, to understand what YOU need.


The bottomline?

If you're healthy and your pregnancy is low-risk, you can give birth in any setting, any hospital (Geburtsklinik) but also in a Geburtshaus (birthing center led by midwife) or even at home (more on this later).


However, basic clinics ("Geburtsklinik"), Gerburtshaus/home birth do not give you a direct access to a paediatrician and specialised equipments such as incubators etc. (this is however very rarely needed for a routine delivery.)


For a low-risk pregnancy, giving birth in a simple clinic or birth centre tends to be reasonably safe, with some advantages (less intervention, more natural vaginal births, perhaps better experience).


But you lose some margin of safety in the case of unexpected complications. The difference is especially important for first pregnancies.

Safe outcomes depend a lot on good risk assessment ahead of time, good staffing, good emergency transfer procedures.


What is a Perinatalzentrum? Is this the same as NICU?

The term NICU comes from the US and the German system is different.


In Germany, we talk about "Perinatalzentrum": a facility that combines obstetrics and neonatology to care for high-risk pregnancies, sick newborns, and premature babies. There are 3 different levels of facilities.


Levels of Maternity Care in Germany (and Berlin)


📍I mapped all clinics in Berlin and their corresponding levels of care here 📍


  • Maternity (Geburtsklinik): For normal, non-pathological pregnancies. They have no neonatal unit, and hence only accept low-risk pregnancies, at term (from 37 weeks of pregnancy onwards), sometimes 36 weeks.

 e.g. Maria Heimsuchung, Vivantes Urban, Havelhöhe


  • Perinatal Strong Focus (Level 3): "Perinataler Schwerpunkt" in german, here you can rely on a pediatric ward in emergencies. The perinatal focus is led by neonatologists and has ventilator-equipped beds but no specialized intensive care unit. Premature babies from 32+0 weeks of pregnancy with a weight of at least 1500 g can be cared for here.

e.g. Martin Luther, Immanuel Klink Bernau (Brandenburg)


  • Perinatalzentrum Level 2:

    Cares for pregnant women with an expected premature birth from the 29th week of pregnancy or an estimated birth weight of the child from 1250 g.

e.g Sana Lichtenberg, DRK Westend.


  • Perinatalzentrum Level 1 (Highest): Jointly managed by neonatologists and obstetricians. They have a delivery ward, operating room, and neonatal intensive care unit. They can accommodate premature babies with an estimated birth weight under 1250 grams or a pregnancy under the 29th week, triplets, prenatally diagnosed fetal or maternal conditions that foresee the need for immediate specialized intensive medical care for the newborn after birth. This particularly includes suspected congenital malformations.

 e.g. Charité Mitte, Helios Buch, St Joseph, Vivantes Friedrischain.


⚡Perinatalzentren are specialized for high-risk pregnancies.⚡


When should plan to give birth in a Perinatalzentrum?


This will be discussed with you providers (midwife, gynaecologist) who will make a very clear recommendation for you to go to a specific place based on your situation.

Usually people are sent to a Perinatalzentrum based on medical criteria such as:

  • You have a severe illness.

  • You experience pregnancy complications.

  • There are foreseeable problems with the birth.

  • You are having a premature birth before 32 weeks of pregnancy.

  • The estimated birth weight is under 1,500g.

  • There are malformations in the unborn baby.

  • There are foreseeable illnesses in the newborn.



What happens if my baby needs emergency care at birth?


Some people want to avoid a Perinatalzentrum (and opt for "simple"Geburtskliniks or out-of-hospital births) - because these centers are used to more pathological cases and they tend to have higher rates of interventions all together...This is a very personal choice to be carefully planned and discussed. So what happens in case something arises during birth?


Resuscitation (also called reanimation) is possible everywhere. So, if despite a healthy pregnancy, the baby has troubles at birth, any clinic (and any trained midwife in general), will be able to do first aid and resuscitation.  Outside of a Level 1–3 facility, there is usually no pediatrician on site and no specialized equipment, such as incubators. However, these are rarely required for a routine delivery.


It is said in the official Guideline from the German Society for Gynecology and Obstetrics (DGGG), that pediatricians, anesthetists, and other professionals (such as obstetricians and midwives) who care for women and children during childbirth but who do not regularly care for severely depressed newborns (i.e. are not neonatologists) should attend a high-quality neonatal resuscitation course every year.

Once the baby is stabilised, the hospital might need to transfer the child to higher level facility if they can't handle the baby further.


This also means you may be separated geographically from your baby for a given time.

While a higher-level center might be located farther away, they often try to work with local clinics to transfer babies closer to home when they are stable. .


Death of newborns at birth is a terrible event, but also occurs extremely rarely when the pregnancy is low-risk, from a healthy mother and healthy baby (which is the majority of people!). The 2023 QUAG report recorded approximately 1 death per 1,000 live births (0.1%) among planned home or midwife-led unit births in Germany (and 0 death of mothers). The average national Perinatal mortality rate in Germany has stabilised around ~ 0.6 %. But all this data need to be carefully interpreted. We can't compare apples with oranges.


🤍 If you have specific concerns about this, are anxious and worried, I really encourage you to discuss this with your providers, and trusted relatives/doula/partner to find your answers and make a decision that feels right for you about where to give birth. Remember that you can register at multiple places. Your plans can be flexible.


👉 Base your choices on facts, not fears

  • What are your hopes and fears regarding the different birth settings available to you?

  • How do you define safety : both physically and emotionally?

  • What worries you about your health, your baby’s health, or how the birth might unfold? Are these fears grounded in medical facts or past experiences, or are they mainly imagined?


✨ Make your decision from an informed place : combining research, open conversations with your partner, your care providers, and your doula, and most importantly, by listening to your gut feeling. ❤️


By Anne Matei, doula in Berlin

🤍Have a look at my services and book a free call if you are interested in working together.



Don't forget your safety card!

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SOURCES:

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.g-ba.de/downloads/62-492-3703/QFR-RL_2024-10-17_iK-2025-01-01.pdf

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.quag.de/downloads/QUAG_Bericht2023.pdf?utm_source=chatgpt.com


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