Friday, May 27, 2011

French Healthcare Experience #3: Pregnancy

As D-Day (delivery day) approaches - 9 days and counting at the time of this posting - now is as good a time as ever to jot down some of our thoughts about being pregnant on the ex-pat planet.

One of the first differences I noticed right away is the "laissez-faire" attitude of the French healthcare providers. When we had our miscarriage last year and then were having difficulties getting pregnant again, every healthcare provider I talked to here in France had the attitude of, "miscarriages happen. You were able to get pregnant before and it will happen again so why are you so worried? Stop worrying and you'll get pregnant again." I didn't have supplements offered to me or blood work done. Just wait and see. And my type-A control-freak brain has had a hard time adjusting. And that laissez-faire attitude continues even with the pregnancy. Both our generaliste (PCP) and my gynecologue have understood that this was a new experience for us and offered to order tests that are not routinely performed here because I asked. Usually they hand over the lab order with a smile and a "don't worry so much" remark. And when I went back to my OB for a refill of my prenatal vitamins in the 2nd trimester I was told to just eat lots of fruits and vegetables and that the vitamins are only necessary in the first trimester as they contain high levels of folic acid.

One of the biggest differences here is the dating of the pregnancy. In the US, pregnancy dating based on 40 weeks from last menstrual period. Since women don't conceive until 2 weeks or so after their last menstrual period, you are considered 4 weeks pregnant by the time you've missed your first period. In France, they use a 41 week dating system. I'm not really sure why, but my educated guess is that the 40 week system is based on the average woman having a 28 day cycle so that conception occurs 2 weeks after the last menstrual period. But that, in general, it is not uncommon for a woman to have a longer cycle, upto 35 days or more, so the French account for this in their calculation. In anycase, my US and French due dates, as I mentioned in my previous post, are one week different. And this has caused me lots of confusion when talking with medical professionals. Especially since the ultrasound software here appears to calculate due date based on the US system so all of the ultrasounds that I have had here (5 total) list the baby's due date as June 20 or 21 even though my medical chart says June 28. Confusing. But, in the end, the baby will arrive when he's ready. Or, at the very latest, not much after the 28th as the French do not like women to go past their due dates. In fact, if the baby is not here by the 28th, we have been instructed to go to the hospital for a non-stress test and likely induction (because school holidays begin on June 30 so lots of medical professionals will go on vacation beginning in July).

One thing that I have been fortunate to find are some good sources of self-care. Sean has been awesome at using his flexible work hours to give me some me-time. I've been going to prenatal yoga every Thursday night since the beginning of February and an American friend of mine started teaching belly dancing classes two weeks ago. Sean also bought me a prenatal massage giftg certificate for my birthday in January which was amazing! And he's taken a few half-days off so that I could attend a monthly creativity workshop (hosted by the amazing Concetta and Dianne at the Bordeaux-USA club) or just relax on the couch for a bit.

As for the delivery, we still have yet to see how this goes but, in general, babies are delivered almost exclusively by mid-wives (sage-femmes) who are assisted by nurses in the hospital or birthing centers. (We do have a few friends who have had home births but this is very rare here). This differs in the US where most hospitals that I know of staff nurses to assist during labor and then the doctor comes for the actual delivery though a woman can choose to have her pregnancy followed and labor assisted by a mid-wife. We'll know more about how the French system works in practice after the little one decides to make his appearance but we've been told that, at the hospital where this baby will be born, there is 1 mid-wife per 5 beds in the maternité (maternity ward) and that we will only see a doctor in the event of a c-section or significant complication. Also, while this is changing a bit, the majority of women (80% according to my mid-wife) have epidurals and the mid-wives at the hospital may try to "encourage" me to have the epidural soon after arrival as it makes their life easier in being able to monitor the several women in their care. But, again, this is dependent on the individual midwife and how crowded the maternity ward is when we get there. The midwife who runs my child birth classes told me to just be firm and direct when we get to the hospital about our wishes. And that, by law, the midwife has to do what we want. So, Sean and I are making sure we're on the same page since, I have a feeling, because of the language issues, I'll be asking him to be doing most of the talking at the hospital while I'm in active labor.

A benefit here has been the French government's subsidization concerning children. First and foremost you are supposed to notify the CAF (Centre d'Allocations Familiales, there is no US equivalent for this, it is the governmental department responsible for paying out mother's money and subsidizing education/child care) of your pregnancy before the end of your first trimester. The CAF then uses their information about your income, number of children, etc, to determine whether you quality for a Prime de la Naissance (basically a signing bonus for delivering a baby to cover the expenses associated with setting up your home for a newborn) and an allocation mensuelle (a monthly allowance for which you are eligible for each child up until the age of 3 years). It is probably the one benefit of the salaries in France being so low compared to our salaries in the US is that we actually qualify for these. We received the one-time prime of around 900 euros (about $1200) and will receive an allocation of 150 euros (about $175) a month for the new child. Plus, they subsidize Owen's daycare so that we only paid 30 centimes (about 50 cents) an hour (though he is only allowed to go for 12 hours a week). So, we complain about a lot of things in France but this is not one of those things (although if you want to hear me complain about this just ask about our experience with the paperwork we had to fill out for the CAF).

And a funny anecdote about being pregnant here has been more social in nature. In particular, the French have a very different sense of personal space than Americans. I ran into an acquaintance of ours, when I was about 6 months pregnant. "He is growing a lot," she said, patting my belly. "And so are you," she continued, patting my boobs. And she is not the only one who has felt it appropriate to comment on my bustline.

Now back to the waiting...

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