From the 1st January 2026, all women who give birth in the Czech Republic have the opportunity to request 3 home visits from a midwife.
This is huge news, it took almost two decades to get to a point where all women are offered this service. (The service did exist further in the past but was scrapped sometime after the revolution in 1989).
Although the option existed in legislation, the healthcare system had been set up in a way that left postpartum women in a limbo.
Up until recently, hospital midwives did not offer any visits. Women typically spent 3 days in hospital after vaginal birth (and 5 after operative delivery) and then had no care until the 6 week check-up with their gynaecologist. Babies receive care from community paediatricians but they rarely give home visits which means that women have to travel to the paediatrician’s office to have their baby seen.
Independent community midwives have always offered postnatal home visits, but these had to be paid out of the woman’s pocket.
Let me explain here the system of payments for healthcare:
Every person in the Czech republic has to have healthcare insurance. Those who work or are self employed have their health insurance payment deducted directly from their earnings. Children, students, retirees, disabled people, people out of work etc. typically have the insurance covered by the government. Foreigners residing in Czech Republic have private insurance arrangements.
Healthcare providers have to have contracts with health insurance companies on order to get payments for the healthcare services they provide. There is an approval process that the healthcare provider has to undergo to receive a contract with insurance companies. But only care specified and listed in legislation can be paid for. For midwifery, the only item on the list are antenatal and postnatal visits. Generally services which midwives provide in hospitals are bound to either a healthcare institution or a medical doctor’s prescription. A medical doctor’s prescription is also needed for midwifery home visits.
That means that if a woman wants home visits from her midwife, she has to ask a medical doctor to prescribe the visits for her, otherwise she can’t get these covered by her health insurance but has to pay the midwife cash.
Up until now, maternity hospitals did not provide any midwifery home visits and most doctors have been refusing to prescribe midwifery home visits. So women who wanted such service had to pay for it directly.
The insurance companies are mostly refusing to sign contracts with independent community midwives, claiming that there is no demand for the service. Resulting in the service being unavailable under the insurance covered healthcare.
From this year, all maternity hospitals are obliged to prescribe midwifery home visits for all women who wish to receive them. Either the maternity hospitals can now send midwives employed by them to do the visits or they can give a prescription to the women who can then book a visit from a midwife of her choice (given that the midwife has a contract with the woman’s insurance company).
It is rather shocking that up until now women in postpartum were left in this care-less limbo. But here comes the real shock. There is a backlash from a lot of prominent doctors against midwifery home visits.
The president of the Medical Chamber (a self regulatory body, mandatory for all medical doctors to join) has been publicly claiming that midwives are incompetent to look after women and babies in community and that this type of care is not needed at all and that community midwives have pushed for this to make easy money. He says that allowing midwives to look after mothers and babies in community is like returning to 19th century. In his ignorance he forgot that midwifery is a regulated profession, therefore what midwives are competent to do is formally recognised in the Czech Republic and EU and that all midwives actually have university education.
Meanwhile most women are happy to finally receive a little bit of community care after giving birth. Some hospital midwives are now learning to provide community care and independent midwives who have been providing community care since time immemorial now have an opportunity to share their expertise to the benefit of women and babies in the Czech Republic. Hooray!
Midwifery by Lenka 