Monday, May 28, 2007

Visites à domicile

If you read my previous post, know that this morning I made the decision for myself and for the baby to try and keep all the events in Seattle as far from my mind as possible.

Life goes on, I'm still at home resting, and what better to keep my mind on positive subjects than blogging? It at least satisfies my need to find someone to talk to, albeit through a rather one-sided conversation.

I've become more and more familiar with the French medical system over the last few months. Despite complaining about the over-medicalization of pregnancy and birth (and I believe most western countries, with the possible exception of the Netherlands, are guilty of this), I'll have to say that the experience has been wonderful.

If I need to see my gynecologist, I can call his office and often get an appointment the same day. If he's not available, I can call his cell phone and he's happy to give me advice, even talk to a pharmacist directly if need be. Since I've been followed by a different gynecologist associated with the hospital, things are a little less straightforward -- she is, unfortunately, only available once a week -- but I can hardly complain.

Best of all, it's all practically free. My private health insurance covers everything the state health insurance doesn't, and that's usually no more than the co-pay I'd be responsible for even if fully insured back in the States.

When I was put on pre-maternity leave last week after my monthly visit to the hospital, my doctor arranged to have a midwife visit me at home. I knew that in France doctors still made house calls, and had even benefited from the service when a particularly unpleasant stomach flu had me doubled-over in bed the day after Christmas back in 2003. It was just like in old American movies: the doctor arrived in the middle of the night and was greeted by my concerned family, then was quietly shown in to see me. He sat on the edge of my bed with his big black bag on his knees. He asked me a few questions and left my husband with a laundry list of medications to pick up at the pharmacie de garde.

This morning the midwife arrived in much the same way, with a calm, reassuring tone and her own big black bag. I was a bit worried despite my earlier bravado, and in the days since I'd been given orders to stay at home and rest had been growing anxious. After all, I reasoned, I wouldn't have been instructed to stay in bed as much as possible without a valid reason. The midwife confirmed what the doctor had told me, the baby is positioned in such a way that there is an increased risk that I go into labor early, but if I take it easy for the next three weeks everything should be fine.

I paid just under 50€ for the visit, about ten euros more than I would have were it not Pentecost Monday, still officially a holiday for the Sécurité Sociale. It will be fully reimbursed by my private insurance. In the US, I'm not sure such a visit would have been possible. It likely would have been prohibitively expensive, and certainly would not have been proposed and coordinated by the hospital.

I asked the midwife about birth preparation courses, since the ones run by the hospital seemed a bit less thorough than I'd like. She understood me right away.

"Are you planning to have an epidural?" she asked, and when I said that no, I wanted to try and avoid one and use breathing and relaxation techniques as much as possible, she told me she knew just what I needed. She gave me the name of another local midwife who specializes in natural birthing techniques, and I quickly called to sign up for three classes.

This is what health care is about. Yes, the French system has its problems, and is running a deficit like everywhere else in the world, but something fundamental about serving patients is understood and built into the system. We need to fight to keep it that way, and if that means adding a real co-pay more substantial than the symbolic one euro added last year, I am more than happy to pay.

After all, I want a midwife available to visit at home should petit need one when it's time to bring the next generation into the world, thirty or so years in the future. And in the meantime, I will be more than comforted to know that there are pediatricians who make house calls.

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