HAVING A BABY
You're going to have a baby! But you've just moved to France and don't know a soul-no friends, no doctor and your French is limited or non-existent.
Where do you begin? Of course, you will need to select a physician, find the hospital or clinic where you would like to have your baby, decide how you are going to pay for it all and find out what to do to make sure that your nationality passes on to your child.
Before selecting a physician, ask your doctor back home for a recommendation. You can get a referral more often than you would believe. Otherwise, you can get a list of qualified doctors in your area by asking at your local hospital. If you know beforehand where you would like to give birth, ask that institution directly, and they will tell you who on their staff is accredited. If you are at a total loss, the non-profit organisation Message has a comprehensive reference list. Broken down geographically, the list also indicates whether a doctor is bilingual. Once you have selected one, make an appointment to see him or her as soon as possible. If you do not like your choice, do not hesitate to look elsewhere.
In the US, all physicians are addressed as "Doctor." This, however, is not the practice in France. Here a doctor is addressed as monsieur or madame unless he or she teaches at the hospital, in which case you would use the title professeur.
Physicians and facilities are either conventionnés or non-conventionnés under the French social security system. This does not mean that their skills are in any way different; it just means that the fees of a doctor who is conventionné will be within the social security norms, whereas one who is non-conventionné may have higher rates and you will have to pay more out of your own pocket.
Your physician's accreditation will determine where you can deliver. It is important to reserve a room for your expected due date as soon as possible. Expect to make some trade-offs between comfort (physical and environmental) and the medical care and facilities offered. You should be aware that if you want to be seen by the top French specialist, who will probably be a professeur, he or she will not have available the privileges offered in a private, non-conventionné facility where the environment (room, decor, food, welcome, etc.) is more pleasant.
If you are to deliver in a French public hospital, social security will cover almost the entire cost of your stay. If you have a mutuelle, you will usually have no bill to pay when you check out of the hospital (other than for the telephone). Few hospitals have private rooms in maternity wards, though semi-private facilities are fairly common. Most will give you a list (usually very long) of items you will be required to bring with you as they do not supply them.
For Anglo-Saxons, it is quite a shock to find out you must bring your own towels, soap, baby clothes, baby soaps and creams. Some even require you to supply your own hair-dryer to dry your episiotomy stitches! Do not assume the staff will speak English.
The care may be good, but public hospitals don't always meet Anglo-Saxon ideas of a sterile environment. On the other hand, public hospitals can often provide the best care for your baby, particularly if you are anticipating any difficulties or unusual circumstances, like twins or premature babies. There are two well-known public hospitals in Paris that specialise in difficult or unusual births, and offer the best possible care to babies who may need incubation or special attention. These are Hôpital St-Vincent de Paul, where you can stay in the same room with your baby if it has to be incubated; and the Baudelocque wing of the Hôpital Cochin. You need to get on the waiting list for these hospitals as soon as possible, however, since care this good (paid for by the government) is obviously in great demand. On the Côte d'Azur, ex-pats swear by the Princess Grace Hospital in Monaco.
You will have a better chance of getting into one of these hospitals if you have a doctor who consults with them, although he will not deliver the baby. If you start at a private clinic and complications arise after the birth that require special care, your baby might be sent to one of the specialised hospitals anyway. If you expect this you might be better off starting out at one of these two hospitals.
If you have chosen a clinic, remember that clinical care is more expensive than a public hospital. If it is conventionné by the social security system, your stay will be covered. If it is not conventionné, your complementary insurance should cover most of the additional costs. Private and semi-private rooms are usually available. Any extras like baby's clothing will not be provided, and English is not always spoken.
The American Hospital in Neuilly-sur-Seine is a fully staffed private hospital, non-conventionné. Ninety percent of the staff are bilingual. In order to deliver at the American Hospital, your physician must be on the staff. If he or she is not and you wish to deliver there, you can make an appointment with one of the obstetricians on staff. Your physician will be allowed to be present and visit you, although he or she is not permitted to prescribe any medical treatment or perform any medical act during your stay. If you are covered under US Blue Cross, the Hospital can bill them directly. Most US insurance companies will cover the majority of expenses (except private room and telephone). However, reimbursements do not arrive until after your departure. French mutuelles will also cover some of the cost. If you want to have your child there and are concerned about the cost, you can discuss the charges beforehand. To get a better idea of what is involved, call the Welcome Service on 01.46.41.27.27.
The Hertford British Hospital was established in 1879 to provide English medical care for those living in France. The hospital was accredited by the French Social Security system in 1977 and is therefore considered part of the assistance publique network. The big difference is that although it is a French hospital, there is always at least one bilingual obstetrician or gynaecologist on staff.
If you are employed, and covered under the French social security system, you must declare pregnancy to your local caisse by the end of the third month. Your physician will give you the necessary form. The social security office will then send you a carnet de maternité, which has forms to fill out after mandatory check-ups, and information such as the amount of time you are entitled to for maternity leave.
Under French law, you must have four physical examinations prior to delivery: at the end of the 15th week, during the sixth month, the first two weeks of the eighth month and the first two weeks of the ninth month. The amount of pre-natal leave you are entitled to is based on the number of children you already have and to how many you are giving birth. If you already have one child, you are required to take the six weeks prior to your due date off, as well as the 10 weeks following the birth (16 weeks if you have twins, 22 weeks if you have triplets). If this is your third child, you must leave your job eight weeks before the anticipated birth date, and you are entitled to 20 weeks of leave after the birth. If you breast-feed, you are entitled to leave based on the number of months you do so. During your entitled leave, the French government will pay up to 84 percent of your base salary. The difference can be paid by the mutuelle, depending on which your employer selected.
If you are working and pregnant, you have legal rights vis-à-vis your employer. For example, you may break your work contract without having to give advance notice (or reimburse your employer for the lack of advance notice given). By law, an employer cannot use your pregnancy as a reason for not hiring you, for breaking a work contract during a trial period or for transferring you to another location. You are required to advise them of your pregnancy, and if your employer fires you for whatever reason, you have 15 days to prove that you are pregnant in order to reverse the decision.
If you or your spouse are not citizens of France, be sure that you do the necessary to ensure that your child will be entitled to your nationality. The American and British Embassies give information on how to register your child's birth with them.
After the birth
If you return to work, you have several options for child care. You could place your child in a crèche (either family-style or municipal), where trained staff take care of the child while you are at work. If you plan to do so, you must reserve the child's place in the third month of your pregnancy and re-confirm it regularly.
If you need to run errands and don't want a babysitter just for an hour or two, check out the halte-garderie in your neighbourhood. The first few times you take your baby, you are required to stay to help them adjust to the new environment. There is also a mother's helper rotation system where you lend a hand with the children. The amount of time you have to help depends on the halte-garderie.
Regardless of what you decide to do, be sure to get feedback from other mothers who use the crèche, and spend some time there to see if you are comfortable with the environment and the people. If you go the nanny/mother's helper route, always remember to ask for references and be sure to check them out. The time you spend is a worthwhile investment for your peace of mind.