Maternity care in France

I've been corresponding with an American woman who teaches at a midwifery college in France. I asked her about what maternity care is like in France. I think many of us Americans will be surprised at what really goes on there. We sometimes have this rosy vision of midwives in European countries, but the reality can be quite different than the picture we've had painted for us. She traveled to England for a HBAC after no midwives in France would accept her, as she discusses later on in her post. She has several American degrees, then went back and got an MA and PhD in France. She is currently a professor of psychology and does outside teaching in Paris, Nancy, and in Toulouse at the midwifery school, as well as occasional private practice and teaching jobs at international schools. Below are excerpts from our email conversations, reposted with her permission.

Although France has a great national health system, there is a lot that isn't said about it, in my opinion, that isn't great. Ironicaly, NPR did a piece on it this summer. I responded to them as follows:

As an expat living in France for the last 16 years, I always cringe when I hear NPR wax lyrical on the French health system. I will grant NPR (and the rest of the inhabitants of the US) that it is a decent system, its most perfect quality being that the extremely poor and disadvantaged can have access to care. But this doesn't tell the whole story, as your report failed to do as well. While providing comprehensive healthcare is an excellent goal, it isnt the only goal. Although the WHO does recognize that the French system is one of the best, its approach to maternity care is not well-regarded by the WHO. For example, France is a leader in performing excessive numbers of questionable interventions in birth (episiotomies, epidurals, cesareans, etc). I do research in the domain of maternity and breastfeeding, and not only does France have one of the lowest rates of breastfeeding in Europe (how can a good health system allow this?), it doesn't provide any constant or long-term support for mothers after the birth, like the German system does. Your report mentioned the baby nurses--their visits are limited to one visit post-partum! A woman must then motivate herself to go to well-baby clinics, but again, the focus is entirely on the baby, not the mother. So while France does provide excellent care for babies and pregnant mothers, I would submit that aside from the fact that your report glossed over a large number of unpleasant realities about the French system (too many to ennumerate in this comment), it isn't truly focused providing care for new mothers.

France is a VERY medicalized system. Teaching at the midwifery school I see it, and these women are on the fence about it. Some like the medicalizaton; some are horrified. But you have to take a step back and realize that people who are training to be midwives in France STARTED as medical students. After year 1, they do a big test and the best get to go onto medical school, the next best get to be dentists, the next best get to be physical therapists, and the next best can be midwives. In my opinion, a weird way to get people into midwifery to start with.

Toulouse is particularly medically oriented, and so the midwives trained here are little medical robots for the most part. I did direct the thesis of one woman last year who had done her internships in Lyon with an independent midwife (IM) and "discovered" what birth could be. She realized what a rarity she was.

The problem with IMs in France is that they no loner have insurance coverage for home births, not since 2001. There are a few who treat the quasi-legal area and go ahead and do home births ("Too late to transfer"...) but they are rare. And even those who do really, really pick and choose their clients. For example, with one previous c/s I was not an acceptable candidate for any IM here. Which is why I went to England for my hbac attempt. I found VERY supportive IMs there who, ironically, do not have insurance either but instead of letting the system wear them down, they have clients sign off when they engage an IM. Very different reaction from the French IMs.
Really, there are a few supportive midwives here, but they seem to have their hands tied. They won't do home births. They might do really good birth prep classes (which is part of the prenatal care; the classes can range from awesome to absurd depending who gives them). But that is it. And in the hospital or clinic, it isn't obvious who is a midwife and who is a nurse or baby nurse (puericultrice) or whatever.

And don't get me started on breastfeeding. Extraordinarily low rates. Really poor support. Rampant erroneous beliefs about breastfeeding (the biggest one is "breastfeeding will make my baby too dependent on me"... sigh... What is a baby if it isn't dependent??? And why would we want them to be anything but dependent at the beginning???) And extended breastfeeding, snort, we just won't go there, lol!!! (My younger daughter is nearly 3 and still has "nursies." My older daughter had them until about 3 as well. This current one may go longer, but reaction can be quite shocked. I ignore it for the most part.)

Maternity care here is like anywhere else. On one hand, it is a "normal" event but this has transformed it into a factory-style approach (go to hospital, get heplock, get induced/augmented/whatever, get epidural, if you don't progress, get a c/s). If a woman has a traumatic experience it is written off and she can't talk about it ("The most important thing is a healthy baby...") I also do PTSD research in birth here. And to think Odent came from France! But of course, it is obvious why he lives in England now, which is having its own woes with regards to birth and independent midwifery. But I think they will muddle through still providing women with what they want and need for birth. (Did you know that the UK is the *only* country to my knowledge that guarantees a woman the right to birth where she feels most comfortable, despite what medical opinion might recommend: be it home, hospital, a tree, wherever???)

There is such a dopey perception about France and midwifery, and then the fact that Odent came from here makes it an obligatorily "great" place to birth. But then he left, and the "real"countries to birth in are the Netherlands and England, in my opinion.