What does a POZ midwife do and why is it worth choosing one?
A POZ midwife is a primary care (podstawowa opieka zdrowotna) midwife who has a contract with the NFZ, Poland's public health fund, and cares for women free of charge. She works at a clinic or in her own practice. Midwifery is an independent medical profession: a midwife is not a doctor's assistant but an equal member of the POZ team, providing obstetric, newborn and gynaecological care.
In pregnancy the POZ midwife provides free antenatal education, and after the birth she comes to your home for postnatal visits (wizyty patronażowe) and looks after you and your baby for 8 weeks. She also helps with breastfeeding, because standard lactation care is one of her duties. Every woman insured with the NFZ has the right to choose her own POZ midwife, but to use this care you must name her in a deklaracja wyboru (declaration of choice). Without a declaration you have no “own” midwife to call when you leave hospital.
From which week of pregnancy should I choose a POZ midwife?
According to the NFZ, free antenatal education with a POZ midwife is available from week 21 of pregnancy, regardless of who is looking after your pregnancy and whether you attend a szkoła rodzenia (antenatal classes). From week 21 to week 31 you can have visits once a week, up to 10, and from week 32 twice a week, up to 16, so up to 26 sessions in total.
You can, however, submit the declaration earlier, and there is no point waiting. The updated perinatal care standard provides for antenatal education to start at the beginning of pregnancy, and the person looking after your pregnancy, if they are not a POZ midwife themselves, must tell you about POZ midwife care and refer you to one. Ask at the clinic exactly when your midwife starts her visits.
Choosing before the birth also makes the start after the birth easier. The hospital sends the POZ midwife notice of the birth, and she should come for the first home visit within 48 hours of receiving it, not counting weekends and public holidays.
How do I submit a declaration choosing a POZ midwife?
You can submit the declaration in three ways: on paper at the clinic or at the practice of a midwife contracted by the NFZ, electronically with a qualified, trusted (zaufany) or personal (osobisty) signature, or via the Internetowe Konto Pacjenta (IKP, the online patient account). The declaration is free and you submit it separately for the midwife, independently of the declarations for a doctor and a nurse.
| Step | What to do | Where |
|---|---|---|
| 1. Check your current choice | See whether you already have a POZ midwife and at which clinic. | IKP or the mojeIKP app, section “Twoja Podstawowa Opieka Zdrowotna (POZ)” (Your primary health care) |
| 2. Choose a clinic and a midwife | Ask about getting there, phone contact and free places. | A POZ clinic or the practice of a midwife contracted by the NFZ |
| 3. Submit the declaration | Fill in the declaration choosing a midwife and confirm or sign it. | IKP: “Moje konto” (My account), then “Wypełnij deklarację” (Fill in a declaration), or on paper on site |
| 4. Check the status | Make sure the clinic has accepted the declaration, and if it was rejected, check why. | IKP: “Zobacz deklaracje” (See declarations) |
| 5. Save the contact | Note the midwife's phone number so that after the birth you can quickly let her know you are home. | Your phone, your pregnancy record card (karta ciąży) |
After you submit a declaration via IKP, the change should take effect within 7 days, but in practice clinics sometimes take up to 3 weeks to enter it. If you submit a paper declaration, your new choice will appear on IKP only after the clinic passes it on to the NFZ.
How many times a year can I change my POZ midwife for free?
You can change your POZ midwife free of charge and without giving a reason twice per calendar year. Each further change in the same year costs 80 zł. The limit applies to choosing a POZ doctor, nurse and midwife, and changing simply means submitting a new declaration at the chosen clinic or midwife's practice.
You will not pay for an extra change if:
- you move house,
- your midwife has stopped providing care at the chosen clinic,
- the chosen clinic has closed,
- the change is due to other reasons on the side of the clinic or the midwife.
A rejected e-declaration does not count towards the limit of free changes, because the choice did not go through. If IKP rejects a declaration with the reason “przekroczony limit e-deklaracji” (e-declaration limit exceeded), it means this is your third change in the year and you need to contact the clinic directly.
Does my POZ midwife have to be at the same clinic as my GP?
No. The Act on primary health care allows you to choose a POZ doctor, nurse and midwife at the same clinic or at different clinics, or to choose a midwife who is a provider in her own right, for example running her own practice with an NFZ contract. So you can stay with your family doctor (lekarz rodzinny) and choose a midwife elsewhere. You then submit the declaration at the place where your chosen midwife works, and your choice of doctor stays unchanged.
You are not bound by catchment areas either. You can choose any clinic in Poland that has an NFZ contract for POZ. In practice, though, it is worth having a midwife nearby, because after the birth she comes to your home, and in pregnancy you travel to the appointments. If a clinic is not listed in IKP, it probably does not have an NFZ contract for primary health care.
What can I do if a POZ midwife refuses or has no space?
A clinic may not accept your declaration, for example when the chosen midwife is on sick leave or already has so many patients that she cannot take on another. In the “Zobacz deklaracje” (See declarations) section of IKP you will see the status of the declaration and, if it was rejected, the reason.
If the clinic does not deal with the declaration within 7 days, it may be rejected automatically. In either case, call the clinic and ask why, and ask about another midwife at the same place. You can also submit a declaration at another clinic straight away, and a rejected declaration does not use up either of your two free changes.
If you are pregnant, do not put this off. If several attempts fail, ask the doctor looking after your pregnancy for help, as they should refer you to a POZ midwife anyway.
What should I look for when choosing a midwife, and what if I am not happy?
- Travel: how far away the practice is and whether the midwife comes to your address for home visits.
- Contact: on which number and at what times you can reach her. The POZ midwife is available on working days, Monday to Friday, 8:00-18:00, and for other matters she arranges a specific appointment with you.
- Breastfeeding: whether she has lactation experience or qualifications, if you plan to breastfeed.
- Antenatal education: whether she runs individual or group sessions, at her practice or at your home.
If things are not working out, first talk to the midwife or the clinic manager. You also have every right to simply submit a new declaration with another midwife. If you believe your patient rights have been violated, you can contact the Rzecznik Praw Pacjenta (Patient Ombudsman), whose helpline 800 190 590 is open 24 hours a day.
POZ midwife care does not rule out private care. Many women use the free NFZ visits and also book a midwife of their choice, for example for a breastfeeding consultation, longer postnatal care or one-to-one antenatal classes. You can find such a midwife on MyMidwife.
