Monday, 25 April 2016

Maternity Care In France

Medical care during pregnancy in France has a reputation for being excellent. As this is my first experience of maternity care anywhere, I can't really make any comparisons, but I'm prepared to believe it. However, like so many other things in this country, it takes a little time to figure out the system before you get to experience the excellence, so for what it's worth, I thought I'd share my experiences here.

As with other kinds of medical treatment, you have a lot of choices in France. The price of having choices is, of course, that you have to take responsibility for your own decisions, and there is also a fair amount of paperwork to be filled out (with accompanying deadlines), which for a rookie like me was a bit stressful, especially in my exhausted and somewhat emotional first-trimester state.

When I first found out I was pregnant, I actually already had an appointment lined up with a gynaecologist, so I phoned my GP to check if there was anything else I needed to do, and she gave me a prescription for the blood test which would confirm the pregnancy. Her secretary told me I would need this to send to the CAF and the sécurité sociale, which was to be done by the end of the first trimester.

From what I understand, the initial pregnancy consultations can be done by a gynaecologist, a midwife or your GP. If the gynaecologist is also an obstetrician, he or she can "follow" your pregnancy beyond the fourth month, as can a midwife. Midwives in France either practise at maternity hospitals and clinics, or as sage-femmes libérales, but hospital care, at least at my maternity unit, seems to start from the fourth month, so if you want to take the midwife option earlier, you have to find your own libérale one.

Most people I know have had their pregnancies followed by their gynaecologist, but my strange experiences with mine ended in me cancelling my 3-month appointment and stressing massively about what to do next. Understanding Frenchman sensibly suggested, after a week or so of being on the receiving end of my stressing, that I went to see my very nice GP to ask for advice, and that is what I did. One twenty-minute appointment later and I was feeling much more in control of the situation. The key things I learned from her were:

- although you can do the déclaration de grossesse as soon as you have the lab report showing that you're pregnant, it's fine to wait until after the 12 week scan, as you have up to week 14 to get it signed by a doctor and send it in.

- you don't have to travel all the way across town and pay a fortune to get a decent scan, as the weird gynaecologist had told me. My GP was able to recommend an excellent radiologist in our arrondissement and I got an appointment no problem.

- if you live in Paris DO NOT (as the weird gynaecologist advised me) WAIT UNTIL AFTER THE SCAN TO SIGN UP FOR THE MATERNITY CLINIC. It's more a case of peeing on the stick and contacting the hospital as soon as that magic line appears. (OK, I'm exaggerating, but not by much. We are lucky to have several good sector 1 units nearby and when I contacted them at around 10 weeks, two of the three were already full.)

Once I had a place at the maternity unit, I chose to have all my appointments there from 4 months onwards apart from the scans, as they do midwife consultations and also run ante-natal classes, but you can continue to see someone outside for a certain number of weeks, depending on what type of health professional they are. One option which doesn't seem to be widely used is seeing a GP - I asked mine a few pregnancy-related questions in the course of other appointments and she seemed a bit surprised. I have the impression that most women in Paris tend to see someone more specialist, and as a result, GPs are less used to dealing with pregnancies than a UK doctor or a French one in a more rural area might be.

I've been very happy with the midwife consultations I've had so far, as the midwives have all seemed both  professional and approachable, and I like the idea of getting to know the people who may be around for the actual birth. However, I can also see some advantages in seeing a gynaecologist (if you happen to have one who isn't weird!). One is that the hours for the midwife appointments are quite limited and have resulted in me having to take a few half-days off work. Although you are legally entitled to do this, given that my mutuelle would also cover the cost of a Sector 2 gynaecologist where I could get appointments after work, I felt a bit bad about missing all that time. Also, despite my weird experiences at the first two appointments, the gynaecologist had the equipment in her clinic to do a couple of very early scans, and it was nice to have some evidence that there was a baby in there and know that everything was OK at those early stages.

That's probably enough for now. More to follow as my experience progresses!

3 comments:

  1. This is really interesting for me to read because when I was pregnant in Canada, I kept on wondering what the process would have been in France. None of my friends had kids then, and my mom's last experience had been in 1992 when she had my brother.

    In Canada, I followed the motion. I had no clue what to do. I first saw a GP to confirm I was pregnant, then I was referred to a gynecologist at the hospital, where I had Mark. We don't have maternités here. The closest concept was a French-speaking hospital in Ottawa, but I turned down the offer because it was really far from where we live and I didn't feel the need to communicate in French (plus I would have had to translate for Feng anyway).

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  2. Very interesting! I'm just getting started on all this of course. The secretary at my work was unaware that absence is authorized for the mandatory pregnancy appointments... I kind of can't believe this hasn't come up before me?

    Otherwise I'm sure Paris is a bit different from province, as with most medical things (we typically have a year's wait for ophthalmologists here), but things have been pretty simple as far as appointments and doctors and blood tests (btw no one ordered a blood test to confirm my pregnancy---my GP just trusted the urine test). We chose my OB pretty easily on a recommendation from a friend who is a doctor, so that made things simpler.

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    1. A friend had a similar problem at her work ... I think they were just trying it on!

      Glad everything is going well for you, and yay for things being straightforward!

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