"At 4.30pm I arrived at her house to find her relaxing on her bed, she said things were going slowly, like her first child (a homebirth with me). I checked to make sure she was ok, we listened to the babys heart and then I examined her. She was 2cm dilated, so she was rather disappointed and apologized for having called me out! The dad asked if he had time to go and collect their first child from school, explaining it would only take 20 minutes. I reassured him that he would have sufficient time. Half an hour later labour was strong and I felt it was advancing quickly."
What is the "normal" procedure in terms of check ups and scans for pregnant women in France? When do women need to choose their hospitals? Are they guaranteed a hospital of their choice or are they given a hospital as assigned by their gynecologist?
A declaration of pregnancy (declaration de grossesse) before the end of the 14th week of pregnancy. This states the beginning of pregnancy i.e conception date (DDG).This can be done by your GP (generalist) or midwife(sage-femme) or gynaecologist (gynecologist)/ obstetrician. Three scans (echographies) are normally requested and paid for by the social security, but be aware that the majority of radiologists will ask for extra payement (depassement dhonoraires). The scans are done routinely at 12, 24 and 32 weeks.
Check-ups are done routinely once a month. They are 70% reemboursed up to 26 weeks then 100% up to 12 days following delivery. Therefore if required or requested they can be done more frequently towards then end of pregnancy.
The estimated due date is at 41 weeks, so if you go post term, you will be monitored on alternate days by a midwife, and induction (starting labour artificially) is often suggested at 2 or3 days post term. You can freely choose who you want to follow your pregnancy; most women choose a gynaecologist/ obstetrician. Some doctors will follow the pregnancy but are not present at the birth. Some obstetricians try to be there for the birth. Few women seem to be aware that midwives can follow a pregnancy from the begining to end, writing prescriptions for blood tests, scans, doing the delivery and postnatal follow-up and 6-8 week post-natal check. Choosing a hospital or clinic is already done because your chosen obstetrician is affilliated to a private clinic. That doesnt mean to say you dont have the choice to deliver elsewhere, you can always go to a public hospital, or change to another private clinic or you change obstrician. Or you may be followed by a midwife who has access to a hospital or clinic where she can be called in to deliver you, or go in with you (plateau technique).
Do your midwifery services differ from the French system in any way?
Yes, I request to see my clients at home at least once between 34 and 37 weeks even if they are not intending to have a homebirth, just so I can find there place in the middle of the night. I share care of my clients with my college, who is french, but when working with clients who have limited or no french then I arrange to visit the client with my college. I aim to be available for their delivery but you never know! I dont do routine monthly vaginal examinations, they will be done if necessary. I do monthly checks until 30 weeks then fortnightly until term (41wks) if possible. Each check up takes around an hour as its an occaision to answer questions, allay fears and prepare for childbirth. All antenatal preparation is done individually, one couple or occaisionnaly two clients, but never large groups. Sometimes all care is given at home for women who cant get to my office, for this, charges vary. I expect clients to take responsibility for their own health, follow advice and take prescriptions as required; I do not encourage "coaching" and forced pushing at delivery, I do not choose the position for delivery.
How accommodating are the French public and private hospitals to natural births?
This varies greatly from region to region. It depends on the hospital protocol, the obstetricians experience, the midwives experience. A local hospital anaesthesist quoted to one of my clients that 86% of patients passing through their unit had an epidural. Epidurals are very well done (in most cases) and widely practiced.
What advice would you give a woman looking for a natural birth in France?
Ask the person who is following your pregnancy and will hopefully be delivering you what are their practices, the hospital rules regarding natural birth, and take time to discuss your birth plan with this person. If the reaction is negative then go with an open mind to see someone else. Consider a "plateau technique" or homebirth.
Are homebirths common in France?
No. Around 2% of the population have a homebirth. There are only around 60 practicing midwives and doctors in the whole of France who do homebirths.
What are the main reasons women choose to have a homebirth?
To have a natural childbirth in circumstances of the couples choosing.
What are people´s main concerns about homebirth?
By "people" do you mean medical staff? If so they are worried that every homebirth will be a medical dissaster. If you mean prospective clients then I would say, what would I do in an emergency, what are the risks and under what circumstances would I consider sending them to hospital, what it costs.
In what circumstances would you advise against a woman having a homebirth?
I work within the advised directives of the independant midwives in France, ie:- mums must be in a good health, having no medical condition that would put her or her baby at risk, which includes diabetes, high bloodpresure, over due by more than 1 week (42) or preterm (before 37weeks), also that the baby complies to be in a head down position and have no problems that would require immediate medical intervention, such as a major deformity. Living too far away from a maternity unit.
How many babies have you delivered here in France? Could you tell us the story of one of your homebirths?
Since 2005 I have delivered 200 babies in France. The mum, I will call her Olive, called me just after lunch to let me know that she had started contracting, nothing too strong but as she lives an hour and a bit away, she wanted to be reassured that I would be available. Having explained that I had nearly finished a visit and that I would prefer to come as soon as I had finished, as it was her second baby and things could speed up suddenly.
At 4.30pm I arrived at her house to find her relaxing on her bed, she said things were going slowly, like her first child (a homebirth with me). I checked to make sure she was ok, we listened to the babys heart and then I examined her. She was 2cm dilated, so she was rather disappointed and apologized for having called me out! The dad asked if he had time to go and collect their first child from school, explaining it would only take 20 minutes. I reassured him that he would have sufficient time. Half an hour later labour was strong and I felt it was advancing quickly. I was hoping that the dad would return soon, time flies whilst massaging Olives back, listening to the babys heart and filling in paperwork. Fifty minutes later and the dad returns to find Olive on all fours and pushing instinctively. Id given the mum oxygen as the babys heart rate had decelerated, but it picked up quickly between contractions, which were every 2 minutes! Olive moved onto the birthing stool. Labour was advancing quickly, already 8cm and pushing, the "waters" went and greenish fluid came shooting out. The dad, a real hero, was supporting Olive and on the otherside cuddling his little girl. In 5 minutes everything was over, a new healthy addition to the family. The surprise of what sex it was, was kept from me for another 1/2hr whilst the parents and big sister enjoyed the moment together. Nearly an hour passed, then with the baby breastfeeding Olive pushed out the placenta. I checked to see that its complete and there are no tears needing repair. Some time later I got to check over the little boy, then pass him back to his parents for more cuddles and feeds. The big sister (age 3) said she hadnt liked her mummy making so much noise but knew it was because her baby brother was being born," her baby!" I stayed for 2 to 3 hours to reassure that things went well. Then went home tired and happy with the plan of seeing them again tomorrow.
From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in France?
Having come across many non-French speaking mums-to-be their main concern is having a birth as they would like to, considering their own cultural background, anticipations and lack of understanding of what is expected of them here. Finding someone who can speak their language or at least one they can understand to prepare them for the birth, be it at home or hospital.
Do you work with any specific hospitals and if so can you recommend any in particular?
My work zone is rather large, and dont recommend any particular hospital, other than for safety reasons, the one nearest to you!
Do you also offer post-natal care to foreign mothers, if so what does this encompass?
Yes, I do offer postnatal care for all mums I have helped with a homebirth; which is adapted to the womens needs, babys needs, couples demands and my availability! Also to other mums on leaving hospital/ clinic or preferably beforehand to meet and discuss their needs. On average this means a daily visit up until 4 days then alternate to 8 days then at 3 weeks, 6 weeks and office visit at 8 weeks. Longer or more often if needing more support for breastfeeding or other worries. Post-natal reeducation will also be added to my work after updateing my training in May. Contraceptive advice. Permenant on-call if not on holiday!
Are there any baby groups / meeting places for new mums in your area? Can you recommend any?
La leche league as they have English support and give advice for parenting for breastfed and bottle fed babies.
Mamayaya in Nimes, for all kinds of social support , activites and training, and relaxing/pampering workshops.
MAMs in Montpellier for breast feeding support.
Yoga des maman (yogamontpellier.com) in English or French small or family groups.
Can you recommend any shops for maternity clothes and new born clothes / equipment?
leboncoin.fr for second hand and new baby equipment / clothes/ washable nappies.
Carrying shawls (escharpe de portage) jeportemonbebe.com et lalecheleague.fr
To contact Julie please email firstname.lastname@example.org