Guest post: Childbirth in France is both baby friendly and mom friendly

View on Eiffel Tower, Paris, France

A reader shared her childbirth experiences in France with me and I was fascinated. I thought my other readers would be interested, too, and she gave her permission for me to share this, though she prefers to remain anonymous.

I live in France, and after having given birth twice here, I thought you may be interested in hearing about my experiences with what I consider to be a true baby (and mommy) friendly hospital. Granted, I gave birth twice in the same hospital, so my sample size is limited but I can say my experiences were consistent both times, and with those I’ve heard of friends who’ve birthed at other hospitals as well as friends who work in maternal care in other areas of the country.

With my son, I knew we were going to formula feeding immediately, but I wanted to give him colostrum early on, a common practice here; they call it a “tetine d’accueil” – welcome nipple.

First of all, I was required to give birth at a real hospital, neither a home birth nor even a clinic were options for me. With my first pregnancy, my daughter, I stated that I didn’t want an epidural upon arrival at the hospital, and no one tried to change my mind otherwise. The midwives who admitted us and got us settled in were completely understanding, the only caveat was that I wasn’t eligible for the “natural birthing” suite, I had to stay in one of the “medical” birthing rooms. The hospital is equipped with 14 private birthing rooms (plus the natural birthing suite, which apparently sits empty most of the time), each with a private bathroom and shower, and about half have bathtubs as well.

I finally gave in to the epidural with my daughter, after over 24 hours of back labor, and with my son, I asked for the epidural as soon as we arrived at the hospital as things seemed to be progressing more quickly with him. Again, in neither situation did I feel coerced into one choice or another, and I truly felt the choice was up to me. In both cases, as we were waiting for me to dilate enough to start pushing, we were taken through a questionnaire asking about any special requests during the delivery – extended cord clamping, skin to skin (and whether it would be me or my husband to go first, what would happen if I was unable to interact with the baby immediately after delivery), who would pull the baby out (my husband or me – totally left that one up to him!), whether we wanted any special music or mirror so I could see what was happening, feeding choices, etc.. In each case, our answers were listened to and clarified, with it being made clear that our requests would be honored as much as possible, as long as neither I nor the baby were in any danger. Luckily, I had relatively problem free deliveries in both cases, with both babies arriving after minimal pushing.

Both of my births were attended by 3 members of hospital staff: a midwife (which here is a nurse who does additional training in midwifery), a nurse specializing in babies and a student midwife. I did not see a single “real” medical doctor either time as there was no need for one, although I was reassured knowing that there were several doctors on site for emergencies and the operating suite was just down the hall. Our daughter had to be taken away to the NICU for some breathing problems (having swallowed some amniotic fluid), so she was seen by a pediatrician within her first few hours and her father was allowed to stay with her the whole time. Our son had no problems, and we were left alone in the birthing room, lights dimmed, for at least his first 2 hours to begin to bond with the baby, perform skin-to-skin contact and try his first feeding (more on that in a moment) with the midwives and nurses only entering when we called them.

With my daughter I had planned to breastfeed; however, after several days she was screaming non-stop, I was miserable as I HATED the feeling of breast-feeding, wasn’t getting any sleep and was actually dreading taking my baby in my arms. The midwives checked her latch, and even tried to feed her with a little tube running from a formula bottle to my nipple so that she would be getting milk while thinking she was breast feeding. I realize now that she probably wasn’t getting enough to eat and the poor thing was hungry. In the end, it was actually one of the midwives who was honest enough with me to say just to give her formula, explained that it’s just as good and pointed out that if I’m this miserable now, continuing breastfeeding and trying to pump would only make me more miserable and that I’d regret it later if I didn’t enjoy this early time with my baby.

After talking it over with my husband (who was 100% supportive of formula feeding if that was what I felt was best), I said I would have him bring some formula in the morning. Imagine my surprise when she said no, that wasn’t allowed. The hospital actually provides ALL of the formula while the baby is there, so that they know exactly what the baby is eating and that it’s prepared properly. Throughout both of our hospital stays, all the formula both of my babies ate was provided, in 70ml pre-mixed, disposable bottles, with sealed sterilized disposable nipples. When giving birth to my son, I found out that the various formula companies rotate in providing samples to the hospital and the hospital isn’t allowed to recommend any one brand over another, they instruct new mothers to just buy any formula from the grocery store or pharmacy for “premiere age” – birth to 6 months, or of course to consult with a pediatrician or family doctor.

Luckily, we made the decision to switch my daughter to formula when she was not even 3 days old, so I don’t have a lot of guilt from thinking I starved my baby for very long; and I was struck by the concern that was shown for my psychological well-being, not just the health of the baby. This was also true with the other nurses and midwives who rotated throughout the shifts and later noticed we had switched to formula – no judgment or lecturing, mostly just comments that each mother needs to do what works for her, and even a few congratulations for being willing to make the decision so early for both mine and the baby’s benefit (yes, MY benefit was included in those comments).

With my son, I knew we were going to formula feeding immediately, but I wanted to give him the colostrum early on (yes, I realize the research on this is inconclusive but I figured it can’t hurt; this is actually a common practice here in France for mothers who don’t want to breastfeed, they call it a “tetine d’accueil” – welcome nipple J). The midwife who was going through our requests with us was completely supportive, helped us to get set up to do his colostrum feeding and then brought in the formula samples in case he was still hungry.

I stayed in the same maternity ward with both babies, which is comprised of private rooms with bathrooms, and space for the baby’s cradle as well as an extra pull out recliner for dad to sleep on if he so wishes. The maternity ward is staffed 24 hrs/day with midwifes and nurses specializing in infant care, with a pediatrician and OB-GYN on call. This was a university hospital, so there were several students of these varying specialties as well. Babies can stay with the mom in her room, or there is an optional nursery next to the nursing/midwife stations where babies can be left in their cradles for however long mom needs. With my daughter, the midwives were concerned that I wasn’t sleeping the first night or two and encouraged me to leave her in the nursery for a few hours. I refused, however I did leave the babies there when they were sleeping and I wanted to take a shower, and the nurses and midwives were completely non-judgmental and simply told me how beautiful the babies were J

With my daughter we were in the maternity ward for a week, as they were concerned that she may have an infection from the amniotic fluid she swallowed and they wanted to monitor her. Anytime a baby under a certain age is admitted to the hospital, one parent has the right to stay with them 24/7 so we spent 7 days in what I call “baby boot-camp” – I learned to change diapers, give her a bath, measure her temperature, burp her, you name it. There was always someone on call to answer silly questions and to help as much or as little as I wanted. With my son, we were only in the maternity ward for 4 days, which is the minimum for someone with my health issues as they wanted to monitor me afterwards. In fact, the shortest maternity ward stay possible here is 48 hours, and that’s only authorized in cases of non-first birth where everything has gone exceptionally well with a vaginal delivery and mom has no pre-existing medical conditions, but there is a mandatory follow-up home visit with a midwife within the first week of the baby’s life.

And how much did all of this cost, you may ask? My husband and I paid a total of about 15 euro when leaving to take my daughter home, and that was for 2 meals that my husband ordered at the hospital to eat with me. We also had to pay out of pocket for a follow-up test during her first month, and I was mentally planning to take money out of savings to cover it until she would be registered with the health care system which would reimburse us – imagine my surprise when the bill arrived for 11 euros!. I’ve been closely watching the health-care debate in the US, and I have a friend who gave birth this past December at a clinic that apparently sends mothers home within 6 hours of giving birth, even with a first baby. When my daughter was born I had no idea how to care for an infant, and I am eternally grateful for that week in the maternity ward where I was able to learn how to care for my baby without any pressure or financial stress from worrying about the cost. By the time we took her home, I was confident in what I was doing. I’m also grateful for the support in giving up breast-feeding so early as it allowed me to really enjoy my daughter in those precious first days and weeks rather than dreading every feeding.

This is all on top of the fact that I was put on medical leave with both of my pregnancies for the last 3-4 months. Medical leave is paid 50% by the state here in France, with my private employer health insurance topping off the rest until maternity leave benefits kick in 6 weeks before the due date (paid at 100% until 10 weeks after the due date – 16 weeks total). This meant that I was able to truly rest during the last few months, without worrying about finances or job loss. Medical and maternity leaves are very strongly protected by the labor law here, and the overall culture is such that an employee giving birth is something to be celebrated, not dreaded.

I was raised in Canada, so for me a public health care system just seems like the obvious way to go; I also spent several years working in the US, and although I had good health insurance through my employer, it was odd and unnerving to always have the spectre of being uninsured (if I were unemployed) hanging over me. I realize that we pay much higher taxes here in France and that the idea of “being taken care of” by the state is antethema to the US mindset. But I don’t mind the higher taxes so much, as I see what I get for paying them.

My kids are now 16 months and 3.5 months old (the close age difference was on purpose, however termination of the second pregnancy was presented as an option in case it was an accident) and thankfully in perfect health. They’re both fully covered by the social medical system here, meaning that all doctor and specialist visits, and part of all their prescriptions, blood tests and vaccines are covered by the state; the remainder is picked up by my health insurance through work. I honestly can’t imagine how families can survive and thrive living under a cloud of fear that any medical problem can send them into financial distress or even bankruptcy (and now, even leave them with a pre-existing condition that may put their health insurance further at risk).

  • Tiffany Aching

    Healthcare is one of the few things we’re good at in France (with mathematics and animation movies 🙂 ). I can also add that every woman gets fully covered pelvic and abdominal reeducation after the birth and that there are many state-subsidized specialized healthcare centers (“protection maternelle et infantile”) where new mothers can get advice on how to care for their newborns babies, get them regularly weighed, get advice on breastfeeding etc. by pediatric nurses.
    This might seem costly but the average cost of healthcare per person is actually lower in France than in the US (and many other developed countries), probably because free and accessible medicine is the best preventive medecine.

    That said, we are not immune to woo, and it seems to be growing. We have the equivalent of the “baby friendly initiative”, and some hospitals start to close night nurseries and pressure mothers to breastfeed. One of my friend who gave birth at the hospital where she worked at, and didn’t want to breastfeed, even had to call the hospital’s chief of staff to stop the midwives from nagging here with breastfeeding. Another was refused a maternal request c-section (she is very petite and thought, rightly so, as she finally had a crash c-section, that there was no way she could give birth vaginally).

  • StephanieJR

    For some reason, ‘welcome nipple’ amuses me.

    • Tiffany Aching

      I think the author means “tétée d’accueil” which must sound very similar to “tétine d’accueil” to english-speaking ears :). A more accurate translation would be “welcome feeding”.

      • StephanieJR

        Fun fact: I’m just starting to learn French (through Duolingo), which means more hilarity is to come.

  • imogen

    This was my experience at the women’s hospital in Melbourne, Australia. The delivery rooms are dimly lit, attended only by midwives unless there is a problem which there was with my baby and the (female) doctor had to come. When you arrive they tell you to make the room into your living room. There are couches, a fridge, you’re encouraged to bring things that will comfort you. There’s a huge adjacent bathroom with a giant jacuzzi tub for labour or waterbirth. I asked for an epidural and was given one but was never coerced. If anything they were more hesitant to dispense drugs than I would like… My care afterwards was amazing, too. Like staying in a hotel. Tonnes of breastfeeding support but it’s treated like a choice. You’re not encouraged to formula feed or breastfeed, you’re encouraged to make your own decision. My boyfriend and I had our own room with a double bed. Everything was provided, painkillers, vitamins, maxipads, baby blankets, food (for me).
    It was totally free. Completely covered by Medicare. I have no private health insurance and this was my experience in a public hospital.

  • Jules B

    This mirrors my experience in a Women’s hospital in Canada. With the notable exception of the absence of breastfeeding pressure (there was/is a lot of breastfeeding pressure where I live), and the fact that the author had the option of a newborn nursery (where I delivered, there was mandatory rooming-in, although the nurses were able/willing to take the baby in the cot if you needed a bit of rest etc). But otherwise, this all seems pretty normal to me…I take it that is not the case in the US?

    • Sue

      Health care cultures in Aus and Canada have a lot in common (I have worked in both systems).

      There can be a culture of woo amongst some Labour Wards – but I haven’t directly experienced it.

      Midwives in Aus have traditionally been specialist nurses, who do both the nursing care on Labor Ward and also deliver the babies, use medication and do suturing etc. There is now a direct pathway into midwifery without doing nursing, which, I must admit, I am very wary of.

      Since young women of childbearing age are generally healthy, it’s hard to see how you could get enough clinical experience of the abnormal (developing shock, sepsis, thromboembolism, diabetic complications) without having worked in the general hospital first.

      I can’t imagine working with a psychiatrist, an OB or a renal specialist who hadn’t gone to standard medical school and done a rotating internship prior to specialising.

      • AnnaPDE

        I have to say, the midwives in the hospital where I gave birth in Brisbane were mostly sensible, but a good amount of woo and lactivism was still present.
        The older midwife who explained how newborn babies would be evolved to sleep during the day and cry in the night because that’s when you need to stay awake and watch for wolves was a highlight.
        The young midwife who was absolutely steeped in lactivism and combined obviously contradictory and plain wrong claims with a refusal to get a bottle of formula was one of the low points.
        If the level of medical incompetence that was needed to make those claims is typical of the direct entry pathway, I’m not looking forward to her and her colleagues getting into maternity care.

  • Laura

    With a couple of exceptions, this sounds very like the medical care I got with both of my babies here in Utah. I wanted a natural birth with first and was supported in that, but when I wasn’t progressing and was in a lot of pain, I got an epidural without judgment. When I had my second, I decided to get the epidural as soon as possible and was supported in that as well. I was able to breastfeed both babies and had excellent lactation care, but I decided to give my second a little formula at first because I was so out-of-it after delivery. Again, there was no judgment; the nurse just went and got a little bottle for us to give her. When I asked for them to take baby to nursery, again, nobody judged me. They were happy to do it and let me rest. It ended up being a good thing she was in the nursery that night because her oxygen sats went nuts and they were able to take her to the NICU quickly.

    We still had to pay a good bit, but we thankfully have pretty good insurance so we were able to afford the bill.

    • Lurkerette

      I was just going to say the same thing! Intermountain FTW. They seem to have a good sense of supporting mom and baby (offering rooming in, but taking baby to nursery when I was on my own for a few hours, covering me & baby with a warm blanket when her temp was a shade low rather than removing her to the warming tray) in a way that encourages but doesn’t push “natural.” They didn’t offer a pacifier automatically but immediately brought me one when I requested it.

      Paid a lot more than 15 Euros! But that’s American health care coverage for you.

      • Laura

        I love Intermountain. If I have anymore babies, I don’t want to give birth anywhere else.

  • Mattie

    OT: Is there a lactivism bingo, cause I think I won

  • Sarah

    OT- Cathy Warwick is doing a mumsnet webchat on Tuesday, discussing postnatal care.

    https://www.mumsnet.com/Talk/mumsnet_live_events/2933267-Webchat-with-Cathy-Warwick-RCM-Chief-Exec-on-Tuesday-23-May-at-12-45pm

  • Steph858

    How can such progressive ways of treating mothers and babies come from the same country wherein many ‘professionals’ still cling to the Refrigerator Mother theory?

    • Mattie

      Maybe because the treatment of mothers and babies isn’t actually all that ‘progressive’ it’s fairly traditional, and that isn’t a bad thing

      • Daleth

        I think it’s actually because France is, in its own way, extremely feminist. I speak as a woman who is bilingual, lived there for half a decade, etc.

        For instance, they’ve never had the Victorian idea that pollutes our culture, namely that women are not and shouldn’t be intellectual or sexual beings. Quite the opposite! So it’s effortless for them to understand and respect the fact that, for instance, a woman might not want to breastfeed or might not want to take the risk of destroying her pelvic floor (and with it, her sex life). It’s her body, she’s thought about it and reached her own conclusions, and that’s that.

        • Mattie

          That’s good! I meant more that the way France does it is fairly similar to the way the UK used to do things, at least in some respects (well baby nurseries available, more time in hospital for new mothers) although yeh some stuff is pretty “radical” compared to the UK haha

    • Petticoat Philosopher

      Holy shit, really???

    • Daleth

      I have it on the authority of a prominent German academic psychologist that the reason French psychology is still so backwards is because they don’t engage with the international psychological community. They don’t write in English, don’t read the latest literature (which is, regardless of the nationality of the researchers, in English), and don’t attend international conferences.

      And I’m inclined to believe him for several reasons, not least because I was recently at a conference jointly put on by the psychology and [another field, omitted for privacy] departments of a major European university that French academics could have gotten to in a one-hour plane trip or a few hours by train, and none of them did–there were no French academics presenting or in the audience.

  • PrimaryCareDoc

    I’m jealous.

  • Bugsy

    I’ve felt blessed to have my second child in Canada (compared to my first son being born in the US), but wow…after reading this, I wish they were born in France!

  • Mel

    An unexpected perk of having Spawn in the NICU for four months was that my husband got to practice a lot of baby care under the eyes of nurses who had lots of experience teaching new parents.

    The staff loved having both parents involved if at all possible and my husband’s dedication in coming to see Spawn daily made him the darling of the NICU staff.

    The staff was so amazing. In fact, the nurses worked with me so that I could give Spawn most of his baths during the last month he was in the NICU; that meant a lot to me because I loved having one normal care thing to do for my son.

  • GiddyUpGo123

    Wow, amazing. I feel envious.

  • Christina Maxwell

    That was most interesting. I am left wondering why we can’t have all those great things in the UK!

    • Mattie

      money? It seems that the French system isn’t entirely socialised, if people in the UK were willing to pay part of the cost, we probably could have those things.

      • Sarah

        We pay more than part of it. Through taxation. There’s no reason we can’t have both a socialised system and massive improvement. Just not on 6%.

        • This is very similar to the way health care is set up in Israel. The most basic level of health care is paid for through the “Health Law” tax, which is deducted at source from income (birth is a bi different: it’s free, paid by the government. The ultimate provider of the funds for this is, obviously, everyone who pays income tax). However, various supplemental packages are available at affordable prices, and there is also the possibility of “going private” if one wishes and can afford it (some private health care is subsidized).. Americans seem to think that “socialized” systems mean being forced into inferior care without any choice. Nothing of the sort.

          • Young CC Prof

            Some Americans think that, due to carefully orchestrated propaganda campaigns by those who profit from the current system. Sometimes I hear people say things like, “What if I could go to the hospital for free, but pay extra for a private room?” like they’re the first person on the planet to ever think about such a thing.

        • Mattie

          Yeh, sorry, I meant ‘pay’ in addition to taxes, so like through private health insurance or savings or whatever. Of course, the better option would be for the government to spend more on healthcare overall lol

      • Daleth

        It seems that the French system isn’t entirely socialised

        Not sure what you mean by that. If anything the French system is more socialized than the UK system, in that there is no such thing as private health insurance or private hospitals (with the exception of the American Hospital just outside Paris, which as the name implies is mostly for expats).

        Literally the only way you can opt out of the national health system there is by getting treatment in another country. And the only medical treatment I’ve ever heard of a French person going abroad for is IVF with egg donation, since in France the rules on that are prohibitive, the clinics inferior, and the waiting lists impossibly long.

        • Mattie

          Sorry, the blog post suggested that the author ‘topped up’ her healthcare with private insurance?

          • Mattie

            Edit: My mistake, it seems the author paid out of pocket for a test for baby, and private health insurance topped up maternity leave 🙂

          • Daleth

            The private insurance available in France is supplemental to state insurance (hence the term “topped up”). For instance, the state plan that everyone has reimburses you 65% for every doctor’s visit (i.e., your copay is 35%), but you can buy a supplemental plan that may add 10-15% to that, making your copay only 20-25%. If the state plan gives everyone two home visits by a nurse after having a baby (I’m making this up, don’t know what the coverage is for nurses’ visits), maybe your supplemental plan gives you an extra two visits.

            But everyone who is legally resident in France and not subject to some sort of exception is covered by the same nationwide plan (exceptions: foreign students above age 28, expatriate executives, etc., may have their own special plans). And all doctors in France have their prices set by the state. When I was there (this was in the 90s), an appointment with a GP was the equivalent of about $20 and one with any type of specialist was about $30. Then you got refunded 65% of that. When I left they were just introducing a system where instead of waiting to be reimbursed, you got a sort of debit card that the doctor swiped in a machine to get paid, so you didn’t have to pay the doctor at the visit, and your copay went out automatically.

            The supplemental plans that are available depend on your situation: students have some plans they can choose from, employees of private companies another…

          • Mattie

            Thanks 😀

    • Dr Kitty

      Yep.
      The Uk is trying to fund the NHS on 6% GDP.
      Which NO-ONE else even attempts.

      The USA IIRC is 12% GDP and France is around 8%. Happy to be corrected, that’s just from memory.

      The reason the U.K. is trying to do this, of course, is because the stories are trying to have the NHS collapse in order to usher in private providers and end universal healthcare. This is not a secret, but no one is listening to the doctors and nurses who keep saying it.

      • Dr Kitty

        Tories. Not stories.

      • anh

        Dr. Kitty, do I have the right to insist my midwife screen me for GBS at 36 weeks?

        • Mattie

          https://www.nct.org.uk/pregnancy/group-b-streptococcus-gbs#WhatifIwanttobetestedforGBS So you can ask, but you can’t insist, you can pay privately?

        • Dr Kitty

          You can ask.
          You can also ask your GP if they will send a urine sample or vaginal swab for culture.
          Most GPs would be happy to take a query like that over the phone or by email, you wouldn’t necessarily have to make an appointment.
          Personally, I would be happy to accommodate such a request, because I don’t see a downside.
          But your own GP may feel differently.

          • Mattie

            Out of interest, would someone who had paid for a GBS test and screened positive be offered abx in labour, or would the test need to be repeated ‘through’ the NHS before they could offer abx? Sorry if that’s a daft question :/

          • Dr Kitty

            It would be a brave clinician who would ignore a result like that.
            Unless one had reason to suspect the lab of being unreliable, I’d go with the initial result, but again, that is my personal opinion, some people would probably re-test, but that would only add 4 or 5 days delay.

            I think of it like all the “wonderful” private health screenings people get. Often they test serum rhubarbs for no reason, get an abnormal result and then say to the patient “you need to discuss this with your own GP”.

            Most of the time, I’ll ignore it, because it’s not a clinically relevant result. Sometimes I’ll repeat the test and add in some more investigations to try and clarify the situation. Occasionally, the result alone is enough to warrant treatment (say a very high cholesterol, positive diabetes test or very abnormal thyroid result).

            For me, a urine culture growing GBS would definitely be in the last category.

          • Mattie

            Thanks that’s really interesting 🙂 do you have any thoughts as to the decision by the national screening committee to not bring in routine GBS testing? Are they working to outdated evidence or is it that even though their reasoning is sound, it would still be better to do it?

      • Christina Maxwell

        According to the OECD it was 9.9% last year, so no, it’s not that.

    • Sarah

      Because Tories.

  • Daleth

    Wonderful. That’s how it should be. A French friend of mine also had no trouble getting a maternal-request C-section in France. Another mom-friendly approach: respecting mom’s wishes! What a concept.