Childbirth in France
It is said that the declining birthrate in developed countries is not being stopped, but this time we will explain the situation in France regarding prenatal checkups and childbirth costs, which are said to be one of the important factors for wanting to have children.
Fertility rates in France and Japan
France has the highest birth rate among developed countries, with a total fertility rate of 1.84% (2020) compared to Japan’s 1.36%. The reasons for this high birth rate include comprehensive social security, comprehensive child allowances, and the ease of returning to society after giving birth.
Once you find out you’re pregnant…what’s the difference between France and Japan?
If you notice any signs of pregnancy, you can take a simple pregnancy test that can be purchased at pharmacies in France, just like in Japan. If you get a positive result, you can make an appointment with an obstetrician-gynecologist. Specialists in France require a reservation only, so in many cases you will have to wait about two weeks after making the reservation before you can see a doctor.
Prenatal checkups in France
Prenatal checkups are done once a month for pregnant women with no problems. For pregnant women with abnormalities, checkup dates will be specified.
In Japan, ultrasound examinations are done at every checkup, but in France, they are covered by medical insurance three times at 16, 26, and 36 weeks. If you choose the doctor and facility, you can also have an ultrasound examination every month at your own expense. Blood tests such as blood sugar tests and urine tests are done every month.
It may be surprising, but about half of private practice obstetrics and gynaecology doctors do not have ultrasound equipment. This is because France, which has a family doctor system, has a different system from Japan, and many doctors do not have fancy clinics or hospitals, but instead use a room in an apartment building or a shared office as their examination room. In clinics, the doctor handles all medical treatments by himself, and often does not even have a secretary. Also, due to the division of medical labor, ultrasounds and blood tests cannot be performed at the doctor’s clinic as in Japan, and doctors must go to a nearby examination facility or blood test facility with a prescription issued by the doctor to have them performed.
Prenatal testing in France
This is the most common prenatal test in France.
- Maternal serum markers
- Ultrasound examination, fetal cervical thickness measurement (NT)
- Quattro Test
- NIPT (New Prenatal Testing)
- Amniocentesis
Maternal serum markers
Maternal serum markers are used to test for chromosomal abnormalities such as Down syndrome by taking a blood sample.
Ultrasound
Ultrasound examinations are used to check the size of the fetus, the amount of amniotic fluid, heart disease, malformations, and fetal cervical thickness (NT). The reason for checking fetal cervical thickness is that it is said that a thicker cervical thickness indicates a risk of chromosomal abnormalities.
Quattro Test (Quattro Inspection)
This test combines the maternal age, maternal serum markers, and fetal cervical thickness measurement (NT) to determine the probability of fetal abnormalities.
NIPT (New Prenatal Testing)
NIPT (new type prenatal testing) is also a blood test, similar to maternal serum markers. Its unique feature is that it can detect chromosomal abnormalities in the fetus with high accuracy, with a sensitivity of 96.5% and a specificity of 99.9%.
Amniocentesis
A needle is inserted into the abdomen to collect amniotic fluid, which is then tested for chromosomal abnormalities. This is used to confirm the diagnosis.
Childbirth in France
French birth method
Nearly 80% of all pregnant women choose painless childbirth with epidural anesthesia. For pregnant women who choose natural childbirth, there are facilities that allow water birth or childbirth in the style of their choice. Even if you choose natural childbirth, you can switch to painless childbirth midway with the permission of the anesthesiologist.
As for childbirth, midwives are in charge of almost all pregnant women who have no problems. Midwives are also often in charge of outpatient prenatal checkups, and some pregnant women may only see an obstetrician-gynecologist a few times during pregnancy and childbirth. Midwives not only deliver the baby during childbirth, but also suture wounds in the perineum. Midwives can also prescribe certain types of medicines, such as vitamins and painkillers.
What to do in hospital during childbirth in France?
The timing of admission is exactly the same as in Japan, with women coming to the hospital when contractions are 10 to 5 minutes apart. If contractions do not come by the due date, they will be admitted to the hospital and undergo treatment to induce labor. The length of hospital stay is slightly shorter than in Japan, usually 4 nights and 5 days for first-time mothers and 2 nights and 3 days for multiparous women.
In many facilities in France, mothers and babies are never separated from each other from the moment they are born. After two hours of observation, both mother and baby return to their own rooms and begin life with their baby, where they begin breastfeeding day and night.
It depends on the facility, but in Japan, many facilities leave babies in the neonatal ward immediately after birth and overnight to allow the mother to recover and feed them with formula milk. However, in France, there are no neonatal wards for healthy babies, and they do not take in babies unless the mother wishes to be unable to look after her child or the mother’s health is unstable.
What is postnatal care like in France?
After being discharged from the hospital, you will be instructed to have a midwife visit your home twice a year to look after the baby and mother. The midwife will visit your home to check the baby’s health, weigh the baby, check the mother’s wounds, the condition of the breast milk, and the baby’s living environment. After that, you will visit the health center once a week for about a month to have the baby’s weight measured and to receive advice on any concerns the mother may have.
Just like in Japan, one month after giving birth, you will be examined by an obstetrician-gynecologist to check the wound and discuss family planning. During the family planning consultation, you will be prescribed oral contraceptives and receive treatment such as the insertion of an IUD (intrauterine device). In France, birth control treatments such as oral contraceptives and IUDs are covered by insurance, so many women (approximately 70%) use female-initiated birth control such as oral contraceptives and IUDs.
For the one-month checkup, the baby will be examined by a pediatrician, not an obstetrician-gynecologist. In Japan, obstetricians-gynecologists examine babies from the time they are born until they are one month old, but in France, babies are examined by pediatricians from the moment they are born.
Another thing that is incorporated into postpartum care is that pelvic floor muscle exercises by midwives are 100% covered by insurance. Pelvic floor muscle exercises are prescribed in the postpartum care instructions to train the pelvic floor muscles that were damaged during childbirth. Although it is optional, many mothers attend to improve urinary incontinence, prevent future urinary incontinence, and get into shape.
How much does giving birth cost in France?
What is the health insurance system in France?
France has a national health insurance system just like Japan. In Japan, you basically pay 30% of the medical expenses, but in France, the payment rate varies depending on the treatment. Employers are also obligated to pay private insurance for their employees, and many people are also enrolled in private insurance. Depending on the type of private insurance you have, your private insurance may cover things that are not covered by the national health insurance.
How much does infertility treatment, prenatal checkups, and childbirth cost in France?
In Japan, infertility treatment is finally set to become covered by insurance, but although a lump sum childbirth allowance is paid, pregnancy and childbirth costs are not covered by insurance, and medical check-ups and childbirth expenses can be a burden on the household budget.
In France, infertility treatment is covered by insurance, although the number of treatments is limited, and pregnancy and childbirth costs are also covered by insurance. Prenatal checkups by an obstetrician-gynecologist at a clinic from the early stages of pregnancy until the fifth month are covered by insurance at a 30% fee, and after the sixth month of pregnancy, checkups are performed at the hospital where the baby is scheduled to be born, and all are free at public hospitals. Subsequent hospitalization fees and painless childbirth fees are also free at public hospitals. Furthermore, if you are not a high-income earner, you will also receive a lump-sum childbirth allowance after childbirth.
How much does prenatal testing cost in France?
- Maternal serum markers: Free (covered by medical insurance)
- Ultrasound examination: Approximately 3,000 yen (medical insurance covers 30% of the cost)
- Quadruple test: Free (medical insurance applicable)
- NIPT (new type prenatal testing) - Free (if covered by health insurance) Self-pay 50,000 yen (390€)
- Amniocentesis: Free (if covered by medical insurance) Self-pay 50,000-110,000 (400-900€)
*As of March 2021, 1€ = 129 yen
Conclusion
There are many differences between giving birth in Japan and France, but I think there are good points to both.
It can be said that it is very important in every country for mothers and babies to have a safe and secure pregnancy and birth.
Article Editorial Supervisor
Dr Hiroshi Oka
NIPT specialist clinic, MD
Graduated from Keio University, School of Medicine
