Homebirths are still very much a rarity in France (less than 1% in 2003) although more and more women seem to be
considering this option for a multitude of reasons. My aim here is to give you a brief idea of
the main elements that made me first consider a homebirth, what a homebirth will involve, how to organise one and to
give you a brief account of my experience in November 2003. I will admit to a biased view on the advantages of homebirths
but my objective isn't to convince you that this is the right choice for everyone (because I'm certain that this isn't the
case), but rather to dispel a few myths and give some practical pointers.
Why choose a homebirth?
Or perhaps more appropriately, why not? Homebirth is the norm in many countries with over 90% of the world's children
being born at home - and this is not a phenomenon that applies only to undeveloped countries: a third of Dutch women opt for
a homebirth. In the majority of cases, where mother and baby are fit and healthy it would seem absurd to admit them to hospital
as if they were patients in need of treatment – childbirth is not an illness! But in a country which is very proud,
and rightly so, of its medical facilities it is sometimes difficult to avoid the over-medicalisation of routine events. Compare
the treatment you would receive for the flu from a British and French doctor: a British doctor may well be rather annoyed
that you would make an appointment for something so banal in the first place and then advise you to go to bed with an aspirin.
A French doctor is most likely to prescribe 4 or 5 different remedies. In this context, is it surprising that something as
natural as giving birth is subject to what many women feel is overly intrusive and unnecessary examination? When a problem
does occur then we are all pleased to have an efficient health system to detect and treat any problems but this is not the
case in the overwhelming majority of pregnancies.
Giving birth the way I want to
Moving
The days of having no choice about how we give birth, even in a hospital are, thankfully, behind us but birth plans
are still relatively unheard of in French hospitals and too often ignored when they do exist. Different medical institutions
do of course vary in their approaches but the chances are that the monitoring equipment and drip the staff will insist on
using will greatly limit your ability to move around and change positions as labour progresses. Studies show that labour is
faster and less painful when the mother has the opportunity to walk, crouch, and move her pelvis rather than remaining in
a horizontal position (using gravity would seem logical). It's only since the beginning of the 20th century that
obstetricians have encouraged women to lie down during childbirth to make gynaecological examinations easier for them.
Pain relief
Epidurals have made childbirth much more bearable for many women and appropriate pain during childbirth is essential
but not everyone takes this option. Epidurals are almost systematically given in many French clinics (between 80 and 100%
in the majority) and women who have previously decided to avoid the use of medication (concerns about the lack of research
into the effects of the drug on the baby, a desire to feel the baby being born, wanting to remain as active as possible and
recognise the need to push) are frequently encouraged to choose an epidural at the last minute. There is no doubt that it
is easier to deal with a woman who has received an epidural than one who may require several different aids (massage, support,
help to move around, encouragement). I wouldn't question a woman's right to change her mind and opt for pain relief but I
would put into question the staff's motivation in some cases.
Induction
French hospitals and clinics, although not nearly as under-funded as their British equivalents, have their share
of staff shortages and bed shortages too. In this context it becomes convenient to have the opportunity to manage the timing
of labour arrivals to avoid staffing problems and night call-outs. Pregnancy not being an exact business, it isn't easy to
predict with any degree of certitude when we are likely to have those first contractions and only around 21% of women actually
give birth at 40 weeks. Many others will go over term by 2 weeks or more with no harm whatsoever for the baby (with regular
monitoring after the expected date has been and gone). We do not know enough about foetal development to know why some babies
may need a little extra time in the womb but my attitude would be 'nature knows why so leave well alone'. Unfortunately, this
situation can be difficult to manage from the clinic's point of view that may well have you scheduled for a certain date and
fears a backlog of overdue mothers. In that case, it is certainly convenient to insist on an induction. There is no doubt
that there are certain cases where this becomes medically essential for the health of mother and baby but if monitoring shows
no reason to induce then surely we should have the option of waiting. Many clinics will refuse (from personal experience and
that of many friends) to allow as little as 24 hours prolongation before they decide to induce using artificial hormones.
Environment
It was important for me to consider the baby's feelings in all this too! I wanted him to have the best possible
welcome. I tried to imagine the difficult transition from 9 months of semi-darkness and muted sounds to the noisy, bright
lights and collection of unfamiliar, masked faces of the hospital delivery room. To ensure a gradual, gentle arrival I felt
that I could best provide the necessary ingredients at home with soft music, candles, a minimum of people (my partner and
our midwife) and so make this experience a little less of a shock to little Teilo. And of course, this new environment he
would discover would become familiar; there'd be no sudden change after a few days on leaving the clinic and a new phase of
adaptation to deal with.
A state of mind
More than anything else I felt that this was my body, my baby, our birth and that for things to go as smoothly
as possible, I should be able to choose what happened, when and how. I wanted to be able to move as and when I felt like it,
eat or drink if I wanted to (you are often asked not to eat or drink in hospital in case a caesarean is necessary although
modern anaesthetics do not necessarily carry any risks with a patient who has a full stomach), get in and out of my bath,
go to the loo (a catheter is often standard practise in clinics), yell if I wanted to without worrying about people's reactions
(the neighbours had been warned!) and feel comfortable in a familiar environment.
It was also an important choice for my partner who was able to participate completely in the birth of our son (holding
me, talking, singing, laughing) and to take 5 minutes out in the garden to have a fag or call a friend or have a snack.
This was our birth and we (me, partner and baby) should be able to go through the experience in the way we felt
was right for us.
How to organise a homebirth
The first step is to contact a 'sage femme libérale' who practises homebirths. There are currently only around
30 in the whole of France (including one 'sage-homme' in Paris apparently)! Ideally this would be the person who would help
you prepare for the birth too. You still need to have a doctor to 'declare' your pregnancy as midwives do not as yet have
the right to do this (rather bizarrely). Your prenatal classes are reimbursed by the ' sécu' as for a hospital birth, as are
your pelvic floor classes (réeducation du périnée) after you have obtained a prescription at your 8 week postnatal check up
with the gynaecologist. You will receive the standard 152 euros for the birth (regardless of whether it's a homebirth or hospital
birth) but things become more complicated from there on. The sage-femme will fix a price with you for the birth and postnatal
care (generally 7-10 days of daily home visits) which is not covered by the sécu. Having said that supplements you may choose
in hospital (private room, TV, certain painkillers) aren't covered either so you may not be as out-of-pocket as you might
at first imagine. I would advise checking out the situation with your 'mutuelle' and speaking to a sage femme libérale who
would be able to help you calculate the costs.
What happens on the day?
I saw my midwife for checkups and preparation once a month until the 8th month and then once a fortnight
until my due date. She also came to my flat a month before the birth to check she could find the address easily and to make
sure I had all the equipment I needed (she provided a list: nothing complicated, eg towels, thermometer, old sheets). If you
should go overdue (as I did) your midwife will come to visit you on a regular basis to check on both you and baby and advise
going into hospital for an induction should that become necessary. When the big day comes you call your midwife and depending
on your contractions (and your state of mind!) she will come ready with all the medical equipment (eg Doppler, sterilising
equipment, instruments), comforting words and reminders of your pain management techniques! Her role is then one of medical
surveillance and one of supporting you in the appropriate way: actively if necessary or fading into the background and monitoring
events as appropriate.
My experience
I was 10 days overdue, huge and a bit fed up. Yann, my partner, and I had gone to the beach for a walk in the afternoon
to stop me fretting about having to go into hospital to be induced. At 8 o'clock that evening I realised I didn't fancy eating
my supper: a sure sign that something was up – I'd been hungry for just over 9 months. The contractions started in a
totally un-textbook fashion (every 10 minutes, every 20, every 5) much to my amazement. It didn't happen like this in my baby
books. I called our midwife Odile a couple of times from a nice warm bath and finally asked her to come at 10pm. She supported
me and encouraged me when I needed her, suggested changes of position, reminded me of how to breathe yet made herself invisible
when she saw that Yann and I could cope. She monitored our progress without me even realising it. When Teilo was born at 5.17
in the morning she handed him straight to me for a feed and then for a cuddle with Yann. Once all the checks had been done
and the 3 of us were tucked up in bed, Odile went for a well earned kip on the sofa and helped me take my first steps as a
new Mum (bathing and dressing Teilo, cleaning his cord and so on) a few hours later.
It was an amazing experience but then isn't every birth? However, I really feel that the three of us went through
it in the best possible conditions and in the calmest, most pleasant environment possible. Yann is still seeing an osteopath
for the damage I inflicted on his back while suspended from his neck during the more painful contractions but he says he wouldn't
have had it any other way! As for Teilo he's a strapping lad (4k400 at birth) and a happy chappy.
Further information can be found at the following websites:
http://naitre.autrement.free.fr
http://www.homebirth.org.uk (one of the best English sites. There
are lots and lots more)
http://www.maman-naturellement.fr
http://maternage.free.fr
http://www.perinatalite.info (with a list of the rare sages
femmes libérales who undertake homebirths)
For those concerned about the medical 'risks':
http://www.fraternet.org/naissance/docs
http://www.midwiferytoday.com/articles/intofire.asp
http://www.naissance.ws/docs/homebirth-fr.htm
