Work as a midwife in Germany: Hebamme recognition (2026)

• A completed midwifery qualification that is state-recognised in the country where you trained, plus proof that it allowed you to practise there (NRW lists this explicitly).
• Training that the authority finds equivalent to the German midwifery degree, or a passed knowledge test or completed adaptation period under § 59 HebG.
• German at B2 of the CEFR. Bavaria may require a specialist language exam, priced in its profile at €350; the authority tells you if you need it.
• Records of your practical midwifery training: births conducted, antenatal and postnatal cases and placement hours, translated into German. Bavaria asks for practical training records as a separate document.
• If midwifery was a post-nursing specialisation, transcripts for both the nursing and the midwifery course, since the authority looks at everything you studied.
• Evidence of personal reliability and health fitness, asked for at the later stage of the procedure and required to be recent.
• References from the maternity units where you worked, because the authority can count professional experience against the differences it finds.

Check your route with the route finder

• ApprobationState licensing authorities (Approbation)

  Doctors, dentists and pharmacists; nurses through professional recognition

  Read the registration guide

1. 1

   Check your training against the German midwifery degree

   Since the 2020 Midwifery Act, German midwives qualify through a dual degree that lasts six to eight semesters full time, with at least 4,600 hours, of which at least 2,200 are practical (§ 11 HebG). The authority compares your course with that, not with the old three-year vocational training. Short post-nursing midwifery courses tend to show differences in hours; direct-entry degree programmes usually come closer.
2. 2

   Build a clinical record before you apply

   Gather placement logbooks, birth registers or signed case lists that show how many births you conducted, how many antenatal examinations and how much postnatal and breastfeeding care you provided. The three care situations in the German knowledge test mirror these areas, and so does the authority's comparison. A record split by pregnancy, birth and postnatal period is far more useful than a single total.
3. 3

   Apply to the state authority for midwives

   In Bavaria the Bayerisches Landesamt für Pflege handles Hebamme recognition and accepts online applications; in NRW it is the central recognition office at the Bezirksregierung Münster; in Berlin, LAGeSo. NRW asks for proof that you were allowed to work as a midwife in the country where you trained and for references on your professional experience. The certificate of good conduct and medical certificate come later in the procedure, so do not order them first.
4. 4

   Receive the notice and read the competence areas

   For third-country training, Berlin, NRW and Bavaria each decide within four months of a complete file; EU qualifications under automatic recognition take at most three months. A notice of substantial differences names the areas concerned. Those areas shape which competence areas your oral exam draws on and what an adaptation period must cover.
5. 5

   Choose the knowledge test or adaptation period

   § 59 HebG gives you the choice. The knowledge test is an oral case of 45 to 60 minutes plus three practical care situations of up to 120 minutes each. The adaptation period lasts up to three years and combines university teaching with placements in hospitals, with freelance midwives or in midwife-led units (§ 52 HebStPrV).
6. 6

   Sit the three care situations

   The practical part covers pregnancy, birth and the postnatal and breastfeeding period. The birth situation takes place at a university with models and simulated patients; the other two are usually with real women and newborns in a hospital or university setting. Each failed part or care situation can be retaken once, and the state must let you sit the test within six months of the decision (§ 51 HebStPrV).
7. 7

   Reach B2 and any specialist language exam

   You need B2 German for the title. NRW lets you send the language certificate later; Bavaria may require a specialist language exam, and the authority contacts you if so. Practise German for birth-room communication, consent and handover, because the care situations are run in German.
8. 8

   Receive the Hebamme permission and plan your first post

   With equivalence or a passed measure, proof of German and the reliability and health papers, you receive permission to use the title Hebamme, valid in every state. You can then carry out the activities § 4 HebG reserves for midwives and doctors. Freelance practice needs further registration and insurance steps, so most people start in a hospital maternity unit.

• Kenntnisprüfung, oral part

  Under § 49 of the Midwifery Study and Examination Ordinance (HebStPrV): one case from competence area I (care in pregnancy, birth, postpartum and breastfeeding) plus at least two other competence areas, in a different care context from the practical part. It lasts 45 to 60 minutes before two examiners.

  Read the guide

• Kenntnisprüfung, practical part

  Three care situations (§ 50 HebStPrV): pregnancy, birth, and the postnatal and breastfeeding period, each up to 120 minutes. The birth situation is held at a university with models and simulated patients; the others are usually in a hospital or university with real women and newborns, though one may be simulated. Each failed part or care situation can be retaken once, and you must be able to sit the test within six months of the decision (§ 51).

  Read the guide

• Anpassungslehrgang (adaptation period)

  Up to three years (§ 59 HebG), made up of university teaching, clinical placements in hospitals, with freelance midwives or in midwife-led units, or both (§ 52 HebStPrV). The authority sets the length and content and it ends with an assessment.

• German is required: B2 of the CEFR in the Recognition Finder profiles for Berlin, NRW and Bavaria.
• Bavaria may also require a specialist language examination (€350); you do not book it yourself, the authority contacts you.
• NRW lets you hand in the language certificate later in the procedure.
• English tests such as IELTS or OET are not accepted instead of German.
• A2 is usually the minimum for a residence permit for recognition measures or the recognition partnership; the title itself needs B2.

Estimate your total cost

• Gathering a birth and case record from your training and employers: allow time, since logbooks often sit with colleges or hospitals abroad.
• Notice: within four months of a complete file for training outside the EU, EEA and Switzerland, and three months for EU qualifications with automatic recognition.
• Knowledge test: the HebStPrV requires states to let you sit it within six months of the decision; one resit per failed part.
• Adaptation period: up to three years under § 59 HebG, split between university teaching and clinical placements.
• German to B2, plus any specialist exam in Bavaria: usually the longest stage, and best started before you apply.

In municipal hospitals midwives are paid on the TVöD nursing table (Anlage E). These are the VKA's monthly gross table rates valid from 1 May 2026. Midwives with at least three years' training are in P 8 and midwives with a university degree in P 11; the entry step for P 7 to P 16 is step 2. Staff in P 5 to P 16 also receive a €141.82 monthly nursing allowance. Freelance income is not covered by these tables.

Monthly amounts

• P 8, step 2 (entry step)

  €3,701.21

  Midwife with at least three years' training (P 8, case group 3).

• P 8, step 3

  €3,862.80

• P 8, step 6 (top)

  €4,488.98

• P 11, step 2 (entry step)

  €4,419.71

  Midwife with a university degree, or a P 8 midwife doing equivalent work.

• P 11, step 3

  €4,557.30

• P 11, step 6 (top)

  €5,233.54

• Pflegezulage (nursing allowance)

  €141.82

  From 1 May 2026, for P 5 to P 16.

• Hospital maternity units (Kreißsaal) are the main employers: municipal hospitals on the TVöD, university hospitals, and church-run and private hospitals with their own agreements.
• Midwife-led units (hebammengeleitete Einrichtungen) and birth centres employ some midwives.
• Freelance practice is common in Germany for antenatal and postnatal care; it involves registration and insurance arrangements beyond the title permission, so check the rules in your state before planning it.
• Employers that support an adaptation period can help you find placements; ask early, because the adaptation period must cover pregnancy, birth and postnatal care.

• Most midwifery qualifications abroad are either a degree or a course of at least two years, which meets the training requirement of the recognition partnership (§ 16d(3) AufenthG). The employer must commit to enabling your compensation measure, which in midwifery means access to a labour ward and the three care areas.
• If you choose the adaptation period, part of it takes place at a university and part in placements, so check that the hospital sponsoring your permit for qualification measures (§ 16d(1)) works with a midwifery degree programme that can host you.
• After recognition, the permit you move to depends on your own qualification: § 18a AufenthG covers vocational training and § 18b covers academic qualifications, so a degree-trained midwife may have more options.
• The full list of visa routes, their conditions and the visa fee is on our Germany country guide.

1. 1

   A Gulf licence from the DHA, DOH, MOHAP, SCFHS, QCHP or another regulator does not transfer. The authority compares the midwifery training you completed with the German degree, wherever you now work.

2. 2

   Many midwives in Gulf hospitals hold nurse-midwife licences after a post-nursing midwifery course. The German authority looks at both courses, so bring transcripts for each, and expect more differences than a direct-entry midwife would have.

3. 3

   Gulf labour wards are often obstetrician-led. References that state how many normal births you conducted yourself, and your role in antenatal clinics and postnatal wards, help the authority credit your experience against the gaps it finds.

4. 4

   The usual missing document is a training logbook. Ask your college or first hospital for one early; a Gulf employer's letter rarely replaces it.

5. 5

   Ask each Gulf regulator that licensed you for a certificate of good standing, and check with the German authority whether it also wants a police certificate from your Gulf country of residence.

6. 6

   Postnatal home visits and freelance antenatal care are a large part of German midwifery and rare in Gulf hospital practice. Expect your exam or adaptation period to test that area.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

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