What to Expect When You're Expecting in France - Pregnancy in France
Being pregnant for the first time can be incredibly stressful, never mind in a country where you are not familiar with the healthcare system! Rest assured, France has a very high standard of care for pregnant women, and you will be well taken care of over the next 9 months!
Confirmation of Pregnancy
The first step is to have your pregnancy confirmed. You can go to a gynaecologist (gynecologue) or a midwife (sage-femme), or a generalist (medecin traitant). If you’ve never been to a doctor/gynaecologist/midwife in France, then the best place to find one is through the service Doctolib.
On Doctolib, you can often book an appointment online, so no scary telephone calls in French! You can also filter by ‘languages spoken’, although in our experience sometimes doctors can exaggerate their language prowess a little, so don’t always expect the level of English to be 100% fluent in all cases. We also keep a list of English-speaking practitioners which you may find useful.
On a side (but important) note, midwives (sage femmes) in France can provide a full spectrum of the same level of care for women without major diseases and for uncomplicated, non-pathological pregnancies. They offer the same follow up and consultations and write prescriptions. They also provide pre-natal / parenting classes and sometimes offer specialised ones: swimming pools, hypnobirthing, relaxation, yoga, pilates etc. Midwives can choose to become "échographistes" as do OB-GYNs.
Midwives complete highly competitive first year of medical school before they go on to do 5 more years of schooling to become a midwife (6 year degree). They work autonomously and provide women's healthcare throughout their lives, before, during and after pregnancy but also for sexual health. They are specialists in women's health with or without a pregnancy and physiology of pregnancy & childbirth. If you are having availability issues booking OB-GYNs, do consider looking for a midwife instead to get access to the same healthcare.
The doctor or midwife will ask you a number of questions - be prepared to give the date you last had your period (date des dernieres regles). If you are not seeing a healthcare provider who operates ultrasound equipment, then they will normally refer you for a dating scan (échographie de datation). This is done vaginally because of how small the baby is at this stage, so don’t be too surprised!
It is up to you to book the appointment for your ultrasound appointments. You can either find a centre, or check with your local hospital (again, you can find results for your nearest place on Doctolib).
You will then have to return to your healthcare provider with your results confirming the stage of the pregnancy, and have your first official pregnancy consultation.
During the course of your pregnancy, you will have to attend 7 Consultations monthly during pregnancy + 1 pre-pregnancy appointment to discuss your wants and needs, your mental health, any worries you have (Entretien Prénatal Précoce) + 1 POST natal appointment to discuss how you felt about the birth, how parenting is going, etc (Entretien Post-Natal Précoce)
First Prenatal Appointment
During your first consultation, you will be given a prescription (une ordonnance) to have certain blood tests (prise de sang) performed:
Your blood group & rhesus factor (détermination du groupe sanguin et du rhésus). They will do this even when you already know it, this is normal procedure in France.
Search for certain illnesses - rubella, hepatitis B, toxoplasmosis, syphilis (rubéole, hépatite B, toxoplasmose, syphilis)
HIV test (VIH) (this is recommended, but labs cannot legally test for HIV without your consent)
It will be up to you to find a blood testing centre (laboratoire analyse). There are lots of these around, and again DoctoLib will help you locate one close to you.
1st Official Ultrasound
You will also have to have your first out of three official ultrasounds. This is to check on the growth of the pregnancy and also to take measurements for use in risk assessment for Downs Syndrome in utero and will be carried out when you are between 11 and 13 weeks pregnant. You will also need to have some more blood tests performed, and the results will be combined to give your baby a probable ‘risk’ factor.
If your baby is deemed to be ‘at risk’, further testing will be offered (including non-invasive prenatal screening that is recommended but not compulsory) and/or amniocentesis (testing of amniotic fluid) if you are deemed very high risk
Declaration of Pregnancy
Your doctor or midwife will have to declare your pregnancy for you to receive full maternity health insurance coverage & rights during the course of your pregnancy. They must declare before the end of the 3rd month - this is a procedure they can do online, and it is usually done at the second appointment.
If you have applied for social security coverage in France, but have not yet received your carte vitale, then they can give you a paper copy of this form. You will need to send the pink sheet to your health insurance CPAM (Caisse Primaire d'Assurances Maladie) or MSA (Mutualité sociale agricole) and 2 blue sheets to the CAF (Caisse d'allocations familiales) by post.
Information from the social security
Upon reception of your pregnancy declaration, your social security will send you further personalised documents about what to expect.
You will receive a file with a timeline telling you what medical examinations you will need, and when, as well as the date you can stop working.
You are responsible for booking all of your own medical appointments, and should also think about where you’d like to give birth.
Second Prenatal Appointment
This appointment will take place in the 4th month of your pregnancy. You will be able to start organising your antenatal appointments, to help you prepare for parenthood and the birth itself.
If you are not immune to toxoplasmosis, then you should expect to be given a repeat prescription for blood to be taken every month.
Third Prenatal Appointment
This appointment will take place in the 5th month of your pregnancy and continues to measure the growth of your child. During this month, in a separate appointment, you will also go for your second official ultrasound (échographie morphologique). They will verify that your baby is developing as expected, and at this point, they will also be able to tell you the sex (if you want to know!).
Fourth Prenatal Appointment
This appointment will take place during the 6th month of your pregnancy. You will have blood tests performed for a few things again, like antigen testing (dépistage de l'antigène HBs), blood count (numération globulaire), and searching for irregular antibodies (recherche d'anticorps irréguliers).
You will also have to have a test if you have risk factors for gestational diabetes (overweight, over 35 years of age, family history, or a history yourself of having a very large baby or gestational diabetes) at some point between the 24th and 28th week of your pregnancy. This involves visiting a blood centre without eating beforehand (à jeun) they will take blood, you will drink some horrible glucose drink, and they’ll test you again 1 hour after, and a final at the second hour.
If you have gestational diabetes, your doctor or midwife will contact you & advise you where to go for finger pricks to test blood sugar and try to control it with a diet. If that fails, you will then be prescribed insulin by an endocrinologist. Normally the diabetes clinic in a hospital, where you will be given extra appointments and followed for the remainder of your pregnancy.
Fifth Prenatal Appointment
This appointment will take place during the 7th month of your pregnancy. You can also start to book your birthing classes (préparation a la naissance et la parentalité). You have the right to 7 sessions in a group or 1-to1 with your doctor or midwife.
Sixth Prenatal Appointment
This appointment will take place during the 8th month of your pregnancy. During this month you can also expect to have your third official ultrasound. This ultrasound will look at the baby’s growth, position in your womb, and quantity of amniotic fluid.
Important to note - outside of pathology, the recommended practice is to have 3 ultrasounds only. Some healthcare providers provide and charge for one at every appointment but this is not necessary. You may not get reimbursed for additional ones as this is outside the recommended practices. Echo first trimester: 11-13 weeks and 6 days Echo second trimester: 21-23 weeks and six days Echo third trimester: 31-33 weeks and 6 days
Pre-anaesthetic consultation
You will also need to book a pre-anaesthetic appointment this month. This is compulsory, even if you do not want to have an epidural. In case of complications during the birth, they need to have this in place.
Seventh Prenatal Appointment
Your seventh and last prenatal appointment will take place in the 9th month of your pregnancy. If you have not yet had a second determination of your blood type then you will be back to the blood testing centre again!
Your doctor or midwife will also discuss with you any foreseeable problems. , if your baby is breech, you will need a pelvis scan which measures your pelvis to make sure the baby can pass through, even in a breech position. You will be offered either vaginal or c-section and risks /benefits should be explained before making this decision. You should be aware that elective caesareans for non-medical reasons are not commonplace in France, with only 20% of all live births being caesareans.
Costs
The 7 mandatory consultations will be covered at 100% of the basic costs by your health insurance (CPAM or MSA).
Ultrasounds are covered at 70% of the convention rate until the 5th month, then at 100% afterwards.
Remember this does not necessarily mean it is 100% free. if you see a practitioner who charges more than the conventional rate paid by your social security fund, then you will need private health insurance (une mutuelle) to top up and pay the extra costs (dépassement d'honoraire).
Even if you do not have a mutuelle in place, you will typically find any extra fees are not excessive.
Childbirth, epidural and a hospital stay (up to 12 days) are also covered at 100%.
You can expect to pay extra if you want a private room (chambre particulière). Expect prices in the region of €60 per night for a public hospital, and up to €100 for a private clinic, and an extra fee of around €15-25€ per night if you want your partner to stay with you on a camp-bed.
Final Notes
Post-natal appointments like breastfeeding help and pelvic floor physiotherapy (réedcuation du perinée) (if you don’t want to have worsening incontinence) are extremely important so please take full advantage of them. Also, if you leave early from the hospital (sortie précoce), there can be an option for a house visit by a midwife to see you and baby.
Some useful links:
Health insurance CPAM (general regime including auto-entrepreneurs): https://www.ameli.fr/assure
Health insurance MSA (agricultural workers): https://www.msa.fr/lfp
For financial aid & child support Caisse des Allocations Familiales (CAF): https://caf.fr/
This article was researched and written by our content queen, Kay Donaghy, a proud Scottish mother of 3 beautiful and cheeky children, all of whom were born in France! Special thanks also to Lara Hollingworth for her insight into midwifery in France.