Having a baby in France Pregnancy and Childbirth

MINISTERE DE LA SANTE, DE LA FAMILLE
ET DES PERSONNES HANDICAPEES

John Ewens is an Occupational Therapist registered to practice in France with the Ministry of Health, of the Family and Disabled people. He is also registered to practice in the UK. He has extensive experience of health, disability and social care issues in both countries. Contact him in complete confidence on issues concerning you within-france

We were not prepared for having a baby in France, pregnancy and childbirth was not a consideration. We had arrived in France three years ago with our full compliment of three children. When we confirmed a short time later that another was on the way, it was a mixture of fear and concern. I should say here and now that, with hindsight, the complete episode from first finding out to arriving home with our baby was assured, comfortable, and clinically, ruthlessly professional

We had agreed that if my wife was uncomfortable with having a baby in France we would go to the UK to have it (the medical costs involved would still have been met by the French securite sociale as we were already registered with the French health system)

Mostly her concerns were about her own feelings of vulnerability associated with having a baby, compounded by the language issues, how could she make her needs understood. But there was also the unknown, what would the process of having a baby in France be like? Other factors, such as the fact that we had not planned for this pregnancy and our plans were going to have to be seriously modified also added to the pressures

Below is an outline of the various administrative demands that will need to be met, with links to relevant ‘official’ web sites so you can get to the information you will need to answer your own questions. I have also included some observations about the cultural differences we encountered, from pregnancy to childbirth and beyond, which will guide you to ensuring that you will be well prepared for having a baby in France

First Steps
Once my wife confirmed herself, with a pregnancy test from the pharmacy, we made an appointment to visit our doctor (GP). The GP issued us with a completed carbon form Premiere Examen Prenatal which, ‘officially’ confirms the pregnancy and is required to start the necessary bureaucratic trail, which will follow you throughout having a baby and beyond

Once this is sent to the necessary social security offices, you will be eligible for 100% of all medical expenses involved in having a baby in France

We sent the copies of the Premiere Examen Prenatal to our local social security offices, the Caisse de Allocations Familiales (CAF) and the Caisse Primaire d’Assurance Maladie (CPAM)

The CAF in turn sent us a Carnet de Maternite which, contains all the obligatory procedures involved in pregnancy and childbirth, as well as being a communications book between, you, your GP and all clinical staff involved in the care of you and your baby

The carnet de maternite contains carbon copies forms that will need to be completed by the medical staff, following each procedure (examinations, scans. etc), which will be required for the hospital to receive payments from the social security system for meeting medical costs and in preparation for ‘Prestations Familiales’ (family allowance/child benefits)
The whole setup is reasonably simple and will be explained to you at each stage

The carnet de maternite is required at each appointment related to your pregnancy, make sure you take it with you

Your Choice of Hospital and Gynaecologist
You will be able to choose which hospital and which gynaecologist you will see to follow you throughout your pregnancy through to childbirth. It would be prudent to try and have one close to your home, but if you are able to travel further to see someone recommended to you, you may be more comfortable with this

Obligatory Antenatal Examinations
There are seven obligatory antenatal examinations (there may be more examinations if there are additional factors involved). The first, during the third month of pregnancy, will be with your chosen gynaecologist
At this stage your weight, blood pressure and medical history will be taken, and usually there will be an internal examination of the neck of your uterus (my wife declined this last one, much to the chagrin of the gynaecologist)

You will be issued with a Declaration de Grossesse and also be given a prescription to visit a laboratory where blood samples will be taken to check for a range of conditions which may affect you or your baby

You will see your gynaecologist and usually visit the laboratory for blood tests monthly throughout the rest of your pregnancy. There will also be visits to your own GP as well. You will have between three and five scans (echographie) in total

You will also be able to meet the midwives - Sage-Femmes - (in France these are mostly based in hospitals, but some regions do offer home visits, even home childbirth), who will be involved in the pre and post natal care of you and your baby. These are usually attached to the Protection Maternelle et Infantile (PMI) which, will follow you and your child throughout the child’s development until the age of six (if you wish it to)

You will also be offered the opportunity to attend prenatal classes (useful, even if you have had children already, for a better understanding of the way having a baby in France works, for meeting people and improving your French)

A month or so before the due date you will also meet the anaesthetist to discuss your requirements or options for pain relief at childbirth

At the Birth
Your husband, friend, birth partner will be able to attend the childbirth with you. If you are to have a caesarean you will be required to remain in the post operative ward for two to three hours after so that the medical staff can assure themselves that you are recovering as you should be. The baby will not be allowed to enter the post operative ward, to minimise the risk of picking up an infection

You may want to arrange beforehand with your ‘partner’ to remain with the baby at all times to ensure that your wishes are met and you can concentrate on your recovery with peace of mind. It has been known, for example, that babies have been bathed and their Vernix washed off instead of allowing it to be naturally absorbed into the skin

Immediately After the Birth
Depending on the procedures carried out and the health of you and your baby, it is likely that you will remain in hospital for between five and ten days (my wife who had a caesarean, checked herself out on day four, once she had signed the necessary release form)

Once you are reunited with your baby you will be visited almost continuously by the hospital staff checking on you and your baby. Many of these visits are precautionary but you do not have to comply with their, at times, over protective approach

If you wish to wait until you are ready to give your baby its first bath, repeat this assertively each time someone is ready to whisk baby off. At this stage staff will wish to ensure that you do not over do it. It seems that every staff member visiting asks the child’s name, and they will appear surprised if you do not have one ready, even when you have just returned from the recovery room!

At times it will seem that half of the hospital staff are visiting you, try and remain focused on your plan about the kind of care you wanted and how much intervention you were prepared to tolerate. This can seem daunting at times as you are very likely to still feel extremely vulnerable, if you are able to have someone with you during the daytime visiting hours, you will feel much more empowered and in control

Registering the Baby
In France you will have just three days to register the baby’s birth. In our case the officer responsible for this was telephoning the hospital room (on a phone we did not even know was connected) to advise that there remained four hours left to record the childbirth

Whilst you are in the hospital you will be given a signed birth certificate Extrait d’Act de Naissance to take to the local Mairie (Town Hall) where the birth registration is carried out, the registration is known as the Declaration de Naissance. There are a number of things you will need to register the childbirth, including;

Extrait d’Act de Naissance
Birth certificates for mother, father and siblings
Marriage certificate (if you are married)
The full name chosen for the baby
Proof of address (utility bill. etc)
Passports

Registering the birth is free

Your baby will be issued a health book Carnet de Sante which will be used to follow the baby’s medical history in France

Use of Carnet de Sante
The first details to be entered will be the place, date and time of childbirth, the length, weight and Agpar scorings, this is done at the hospital or clinic
The Carnet de Naissance will be required for all subsequent medical related appointments for your child

In the first nine months there will be up to ten health checkups. Between ten months and two years old there will be up to three and until your child reaches six years old there will be up to two each year
The carnet de sante contains;

growth charts to record and track height and weight at various ages
Space for medical professionals to record interventions and immunisations
Prompts and calendar for checkups due, immunisations required
Useful contact numbers related to child welfare
Advice for parents on baby’s, children and adolescence

Immunisations
In France, as in most European countries, children are routinely immunised for preventable conditions. These start with BCG’s (for Tuberculosis) at about a month old and continue with immunisations throughout their young lives for;

Whooping cough
Tetanus
Polio
Diphtheria
Hepatitis B
Measles
Mumps
Rubella

Many of the vaccines will be offered as multiple injections, as with the MMR in the UK. Although some vaccines are deemed to be obligatory, not all parents vaccinate their children in France. Most schools though, will request to see certificated proof that the pupil has been immunised for Tuberculosis before allowing them to start school

Some considerations for Having a Baby in France

Decide what is important to you to have a safe, comfortable, time in hospital. If you have considered it beforehand it will be easier to stay assertive when you are ‘trapped’ in an unfamiliar, at times, intimidating clinical environment
Have a list of prepared names for your baby, the three day deadline comes very quickly
Consider how the name may be pronounced differently in French and English
Be prepared for a very medicalised clinical environment, with little of the more informal smiles, warmth and ‘banter’ you might find in the UK. Once you and baby are back in your room on the maternity ward this then changes, although still fastidious in their approach to caring for you and your baby, the staff are much more friendly and relaxed
Consider taking some of your own food (cereals. etc) or have someone bring some fresh food daily. Not all French hospitals offer a varied quality menu or the nutritional food necessary for a new mother to feed herself and her baby
Have a prepared bag with necessities for you and baby (this may be clothing, toiletries, telephone, clock, food, magazines. etc)
Have someone who will remain constantly with your baby if you are to remain in a post operative ward. Ensure that this person understands your wishes and can advise the medical staff of that (if you do not want the Vernix washed off. etc)
Let ALL staff know if you intend to breastfeed. If you have any difficulties initially with this do not be afraid to request immediate advice from a speech and language therapist or experienced friend. It is too easy at this time to be coerced into a route you will not be happy with

Useful Contact Addresses
Health and Social Security Online This is the site for the social security, ‘assurances maladie’, online. If you click on the ‘assures’ tab then type in your post code on the page that appears (green box, top right hand side) you will be able to go to the site of social security site in your area. You will be able to download document in a number of languages

Family and Social Security Online This is the web site for the CAF in France. Type the first two numbers of your post code in the ‘find my local CAF’ box to find the CAF office where you live. You will be able to calculate the likely amounts, of benefit. etc you will be entitled to within-france

Social Security Your Rights Use this link to another page within this site which, outlines your rights to various social security benefits and has further useful contact addresses

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