Tag: Healthcare

Comparing to most other European countries, France has a higher birth rate.  This is partly due to the maternity benefits that French families are enjoying.  Social security covers all the cost beginning from the 6th month of pregnancy (unless you choose private hospitals/clinics). Besides that, pregnant women get one time free dental examination, and 8 lessons of preparation for the childbirth, which is the focus of this post.

I just finished all the 8 lessons earlier this week!  In my case, my sage-femme (midwife) in the hospital referred me to this SF liberal who gives lessons (most importantly, she speaks English).  It’s a one-on-one class.  I don’t know if it’s always like this in Grenoble, or it’s because I don’t speak French.  Each class is one hour.  The first class, or meeting, was for the SF to gather information of us, and to schedule the other 7 classes.  I had two classes every week.  The topics were:

• When to go to the hospital (for delivery), signs of the labor
• Breastfeeding
• What will happen in the hospital (on the delivery day), the process of labor
• Breathing, exercises using the birthing ball
• What can go wrong
• Practice how to push
• Life after the childbirth, the recovery, what will my body be like

Of course, we also discussed the questions and concerns that I had.  For example, she also helped me to look through the list of things to prepare for the delivery day (I will talk about the list in another post).  One hour is actually very short.  We often finish before we notice 🙂

I think the classes are very helpful, because she’s familiar with that hospital, and she can explain everything to me in English!  Before the classes, I knew nothing, and I was a little scared.  Especially that there’s the language barrier… what if I could not understand them, and I did not know what to do… what if there’s a decision to be made…  Now I feel much better!  After finishing the classes and watching a video of the maternity at the hospital, I have an idea of the whole process, who will be there with me, and where it will take place.  In addition, now I have confidence that they will do the best for me, that they will keep the delivery as natural as possible, that they will only do what’s necessary, and that they will not push me to do the cesarean section just because of their personal schedules.

Again, the classes are covered by social security, so don’t miss out this benefit.    You will always learn something!  Of course, it will be better if the husband can be there as well, especially for the exercises using the birthing ball.  The SF is right – it makes a bit difference if the husband hears things from other people.

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CAF stands for caisses d’allocations familiales, and it belongs to social security system.  Declaration of pregnancy to CAF (and to the health insurance company if you have mutuelle) is necessary.  Theoretically it needs to be done before 14 weeks, but sometimes it’s just impossible.   For me, it’s almost 25 weeks.  The form, so called “nous attendez un enfant”, was from the sage femme or midwife.   She wrote the DDG and signed it.  Then I filled the personal information including the temporary social security number, and mailed the form to CAF.  (BTW, two copies of the form mailed to CAF, and one copy mailed to the health insurance company.)  Actually the distance from our home to CAF and to La Poste is similar.  But I suppose going through La Poste is faster than making a RDV (appointment).

About two weeks after mailing out the form, we got our CAF number.  And since then, our “conversation” with CAF has been going on and on.  They have requested these information/documents in separate mails:   (1) more personal information (declaration de situation); (2) birth certificate; (3) declaration of income in 2015; (4) residence permit (sejour).  I always try to respond as soon as I can, then there’s long wait.  Now I am still waiting for them to process the documents I sent three weeks ago, and I don’t know what they will ask for next time.  Anyway, it’s interesting.

CAF is slow, but who is not?  At least CAF helps people.  It gives financial help to families in need.  Students without income can get assistance on housing (Aides au lodgment).  And in the case of pregnancy, CAF gives “prime a la naissance” to families to welcome their babies, and babies can get monthly allowance afterwards!  These benefits are granted and calculated based on the situation of the family.  We are not expecting anything, because we are very grateful for the health insurance already.

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Here is what I know about the healthcare system in France.  Everybody register with a family doctor – a généraliste.  In most cases, people go through the family doctor for treatments so that the cost will be properly reimbursed.  I heard it’s also easier to get an appointment with a specialist through the family doctor.  In the case of maternity, however, it’s not necessary to go through the family doctor.  We don’t have a family doctor, and we went directly to see a sage-femme (midwife).

People go to laboratories to do various tests and scans requested by doctors or other healthcare professionals.  There may or may not be laboratories in or close to the hospital.   Seems like laboratories are independent from hospitals.  People can have their own choices of laboratories to have the tests done.  In my case, the SF gives me a paper, which lists the blood test and urine test to be done.  She uses a hospital stamp, and also signs on the paper.  In the laboratory, I give that paper and my health insurance card to the register.  And then, they will take samples for the tests, and give me an instruction about how to get the results online.  By the way, they will confirm my birthday, because it’s the password to access the results online.

Similar to the laboratories, pharmacies are also independent from hospitals.  There are so many pharmacies around the city.  Just show them the prescription paper and the health insurance card.  Depends on the type of medicine, the reimbursement percentage varies.  I have had Fe and vitamin D supplement, which are 100% covered by social security and mutuelle.  In comparison, for the pain reliever (to take during the irregular contractions at home), only 15% is covered.

One important thing if you do not have the carte vitale yet.  After all, it takes months to get the carte vitale, even with best luck!  The temporary social security number on the health insurance card (from mutuelle company) should work as well!  But some people in the laboratories and pharmacies may not know that!  For me, the first visit to the laboratory took me more than half an hour to register.  Partly due to the language barrier, but mainly because she did not know about the temporary social security number.  At last I took out the form of Declaration of Pregnancy that I was about to mail to CAF, and somehow she believed in that form (filled by us) more than the health insurance card.  After that, my visit to the same laboratory has been easy and fast, although they still ask me whether I have the carte vitale every time I go.  Similar things also happened to me in a pharmacy.  People in one pharmacy insist to see the carte vitale.  So I went to a different pharmacy, where people (not all) there know what to do.

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In France, échographie is typically done three times during the whole pregnancy.  First in the 3rd month; second in the 5/6th month; third in the 8th month.  I did the first échographie in China.  Actually I did three times in China… within one and a half months.  They only checked very briefly though (a couple of minutes), probably because it’s the early stage.

After the first meeting with my sage-femme (SF), it’s the right time for me to do the second échographie.  It was done in the same hospital, CHU.  The purpose was to estimate the delivery day, and to examine if there’s any abnormality.  A SF and a student performed the échographie.  The student speaks some English 🙂

It took more than half an hour!  They did very careful examination, and explained to us what we were looking at.  Suddenly, they asked us whether we wanted to know the sex of the baby.  We nodded.  Un garçon!  A boy!  Although we were not sure how they could tell, we were quite excited.  In the end, they provided a detailed report containing many photos.  Due to the positioning of the baby, they could not get everything that they needed.  Plus, the size of the baby seemed smaller than expected (based on DDR).  Therefore, they suggested to do another échographie, which was done in the following week.  Also, they said the first échographie done in China should be more accurate to estimate the DDG, so a translated report would be helpful.  In fact, there’s only one measurement in the Chinese report – LCC.  Based on that LCC, the SF estimated a new DDG, and she thought the size of the baby was okay.  We were kinda relieved.

I did the third échographie at 33w+3d.   Again, the SF measured a lot of things, and everything seemed normal.  The calculated weight of the baby was ~1900g (25~50% in their database).  The positioning of the baby was good, which I was very pleased to know.

Oh, I forgot to mention that after the second échographie, they somehow could construct a photo of the baby’s face.  Will our baby truly look like that?

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After getting our temporary social security numbers and mutuelle numbers, the first thing we did was to make an appointment with a sage-femme (SF) in the hospital.  A friend helped us with that as we cannot speak French.  Grenoble is not very big, so we could get an appointment pretty soon (a week from the call).

It took us 10 minutes to find the hospital… Then, we went to the Accueil.  The lady there cannot speak English, but we slowly got what we needed to do.  There’s a room with several counters, and they are calling numbers (later we knew it’s the registration place, where the payment is taken care of).  People outside are waiting to be called in.  So we also got a number.  When it’s our turn, we went in and showed that we had an appointment with XXX.  There’s a young lady who speaks English, so she helped to put in all the information.  Basically she only asked for my passport and the health insurance info.  After that, she printed out a paper that has many stickers with my name and date of birth.   We were glad that we could use the health insurance (social security takes care of 70%, and mutuelle pays for the rest).

Paperwork was done.  We went to the consultation section.  There’s a small Accueil.  Again we said we were here to see XXX, and we showed the paper with stickers.  We were then pointed to a waiting area.  Around the agreed time, somebody came to the waiting area, and called my last name.  She was the SF!  Luckily she speaks a little English!  Since it’s our first meeting, she asked a lot of questions about our medical history and our families.  She also checked my condition (blood pressure etc.).  In the end, she gave me a list of tests need to be done in a laboratory, scheduled the next meeting, and asked us to go to that small Accueil to schedule an echography.

After that first meeting, we are kinda familiar with the hospital and the processes: where to register, where to wait, and where to schedule for appointments.  Then, after the pregnancy proceeded to the seventh month, the registration place put a pink note on the paper with stickers.  They told me that I did not need to register any more – just go to see the SF or doctor.  So, it seems like the registration place only deal with payment.  Since social security covers all the cost after the 6th month of pregnancy, no registration is needed.  For each meeting, the SF takes away one sticker, not the whole paper.

Up till now, we have had four meetings with the SF.  During the meetings, she checks my weight, blood pressure, tummy, and listens to the heart beat of the baby.  She logs all the information and the results of laboratory tests into the computer.  For me, I ask questions, and I tell her how I feel.  She prescribes Fe (every month), vitamin D (once), blood test -sugar (once), urine test -sugar/protein (every month after the 6th month), and blood test -toxoplasmose (every month).  Everything seems going well.  She also introduced us to a SF liberal for the classes (100% covered by social security), and gave us a lot of information on how to prepare for the big day, for example, what number to call when the time comes.  She is really helpful!

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Although our choice is a public hospital (Centre Hospitalier Universitaire Grenoble Alpes), we still don’t know whether it’s a good choice or not.  All I can say now is that I found that hospital so far so good 🙂

We did a lot of research online, and we asked a few friends about their opinions.  Private hospitals, or clinics,  tend to have better services such as single rooms and faster appointments (less patients).  More importantly, you will have designated sages-femmes and/or doctors, so you will be taken care of by somebody you are familiar with during the whole pregnancy.  In comparison, sages-femmes and doctors in public hospitals work in shifts.  You cannot guess who will be receiving your baby.  You might even be surprised by the presence of students in case of a university hospital.  Public hospitals cannot guarantee you a single room either.

In terms of money, the cost in public hospitals is almost fully covered by the social security in France.  Private hospitals/clinics are more expensive, but I don’t know how much more.  Actually, we have complementary health insurance (mutuelle), so even if we chose a private hospital/clinic, the cost would be largely covered, I guess.  The cost is not a deciding factor for us.

What makes public hospitals stand out and made us decide to go to a public hospital is that they are more capable of dealing with emergencies.  In fact, private hospitals/clinics do transfer you to public hospitals when something unexpected happens.  This transferring process just does not sound good to me.

To us, safety is far more important than better service.  However, I sometimes think that *maybe* the private hospitals/clinics do a better job in tracking the pregnancy because they can and do spend more time with the patient.  But don’t forget that sages-femmes/doctors in public hospitals may be more experienced as they receive much more babies every year.

Nevertheless, luck is important!  People get good or bad experience everywhere.  Right now, I feel good.

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We came to France in the end of November, 2017.  At that time, I was already more than four months pregnant.  We worried about getting health insurance in France, because the work contract is only six months.  But we came anyway.

One of the first things we did after arriving at Grenoble was making an appointment with the insurance company on campus.  For whatever reason (could be a mistake?), they approved our application!  That lady gave us a list of documents to be prepared, and asked us to go back in two weeks.  One of the requested documents is the birth certificate.  Of course, it has to be in French.  Therefore, my husband needed to have his family book translated by a court translator.  Other documents are easy to prepare.  After two weeks, we submitted all the documents to that lady.  Things seemed going well.

Another week went by.  One day, we received letters from that insurance company.  Each of us got a carte d’adherente, which contains the temporary social security number and the mutuelle number.

At some point, the insurance company requested the birth certificate again.  And this time, in addition to my husband’s birth certificate, I also submitted mine, which is prepared in China (translated and legalized).

The insurance company mailed us a few time – about my pregnancy.  They introduced all kinds of benefits we have.  They kept us well informed!  They have our bank account number, but we did not see any charge – until about two months after getting the carte d’adherente, we received the bill.  It turns out that the first three months is free, and they will start to charge in March.  In the same letter, they also included the payment that they made to the hospital and the laboratory from where I received service.  Not a penny from our own pocket ~

Ten days after the bill, my husband got a letter, which says he has been assigned a new social security number.  So not a temporary number any more.  A few days later, another letter came in to request a photo for making the Carte Vitale (the so called green card).  We mailed out the photo as soon as we can.  Last Saturday (2~3 weeks after mailing out the photo), we got the card!  However, I have not been assigned a new social security number, yet.

So, for my husband, it took like three months to finally get the Carte Vitale.  I guess it is fast?

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