Independent Homebirth Midwives in France: The Persecution of a Profession

ABSTRACT

In France, although the vast majority of births take place in hospitals, some women prefer to give birth at home with the assistance of a midwife. In recent years, eight midwives attending home births have had their licenses revoked by the National Council of Midwives. In this article I discuss the complaints that led to seven midwives’ lifetime ban from practising, their reflections on why they were disbarred, and their perspectives on the technologization of childbirth. My goal is to understand why some independent midwives continue to attend home births without insurance, exposing themselves to disbarment and prosecution.

KEYWORDS:

• France
• home birth
• malpractice
• medical risk
• medicalization
• midwife

Acknowledgements

I would like to thank the anonymous reviewers for their insightful comments. Thanks are also Robbie Davis-Floyd and James Staples for their thoughtful feedback on earlier versions of this article. Thank you also Victoria Team, editorial office manager.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Since August 2013, eight midwives have been tried by the disciplinary chamber of first instance and have been banned from practicing.

2. In France, there are two statuses for health professionals: self-employed or employed (mixed.

practice is also possible). Independent midwives practice under their own responsibility and are paid on a fee-for-service basis.

3. https://www.has-sante.fr/upload/docs/application/pdf/2018-01/accouchement_normal_-_recommandations.pdf.

4. Oxytocin is the hormone that allows the uterus to contract. Injection of synthetic oxytocin usually forces labor to progress more quickly.

5. I refer here to the commodification and privatization of care (Bergeron and Castel 2015).

6. If the midwife is social security approved, the prenatal examinations, including ultrasound scans, are reimbursed at 100% of the French Social Security (UNSSF–Union Nationale et Syndacale de Sages-femmes [National Union of Midwives].

7. The ethno sociological perspective developed by Daniel Bertaux (2010) is an empirical approach.

and gives central importance to life stories.

8. The issue of consent was highlighted by ‘I did not consent’–a social network launched by Tumblr, a participatory micro-blogging platform: https://jenaipasconsenti.tumblr.com.

9. On 21 March 2014, a midwife denounced on a blog this procedure taught in some midwifery schools, consisting of stitching an episiotomy with a few extra stitches to “tighten” the vagina, for the supposed purpose of increased male pleasure during penetration. The radio columnist Isabelle Alonso reproduces on her blog a text by this independent midwife and the author, Agnès Ledig: http://www.isabelle-alonso.com/le-point-du- mari.

10. For the HAS in France, home delivery is possible for a child who presents spontaneously in the cephalic position between the 37th and 42nd weeks of gestation.

11. If the pregnancy extends beyond 42 weeks of amenorrhea. Post-term deliveries may increase fetal heart rate abnormalities, the risk of asphyxiation in utero, and meconium inhalation syndrome. http://gynerisq.fr/bibliotheque_docs/recommandation-du-cngof-sur-le-terme-depasse-et-la-grossesse-prolongee.

12. Complication is an unanticipated problem in a physiological pregnancy and delivery and may justify medical intervention.

13. The study by Janssen et al. (2009) shows that perinatal mortality rates are similar and that midwife-assisted births, both at home and in hospital, have a significant reduction in obstetric interventions.

14. The French Perinatal Plan 2005–2007, which refers to the experimentation of birth centers and their operation as a priority, gave the following definition: “Place of reception of pregnant women, from the beginning of their pregnancy until their delivery, under the exclusive responsibility of the midwives, as soon as this one appears a priori normal” (http://solidarites-sante.gouv.fr/IMG/pdf/Plan_perinatalite_2005–2007.pdf).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Rosanna Sestito

Rosanna Sestito is a PhD candidate in sociology at the University Paris-Nanterre of Paris (CRESPPA/GTM). Her research interest includes reproductive justice, gender, and technology and medicalization birth.