When pregnant, practical questions arise very quickly and in particular that of choice of maternity. But, do we really have a choice? “”Yes !“Answers Lise Bartoli, clinical psychologist, specialized in perinatality, immediately. “”Women can give birth where they wish. It is to them that the choice of the geographical situation, the nature and the specificities of the establishment where they register“, she explains. Even if of course, Each maternity is different : they are cataloged in Three levels which indicate their degree of specialization. Only the so -called “at risk” pregnancies are automatically directed by their gynecologist to type 3 maternities. What are the Criteria to favor to choose maternity ? When to register? Who to ask for advice? We take stock.
Comfort and quality of management in Private maternity worker versus security in the hospital ? It’s a bit of the idea we have. In reality, what about?
Level 1 maternities
They support Simple pregnancies and deliveries, without complicationswhether you give birth to the low or by cesarean section. They can therefore accommodate the pregnancies led by term (up to the 38th week).
Level 2 maternities
They ensure the Management of average prematuritybetween 32 weeks and 38 weeks, as well as risk pregnancies or multiple. They have a neonatology unit with an intensive care service and a pediatric team in order to be able to take care of babies from birth from birth. In addition, the Level 2a has a neonatal pediatric service, while the level 2b Contains an intensive care and neonatal pediatric service that supports risky pregnancies and the threat of premature delivery.
Level 3 maternity
They support important prematuritybefore 32 weeks, as well as the serious pathologies of the child. They have a Neonatal resuscitation unit And allow the hospitalization of the baby at birth, without separating him from his mother. There is A level 3 maternity by department.
Do you think you are registering directly in a level 3 maternity for maximum precautions? “”It is not useful because in 80 % of cases, pregnancy is going well! So no need to go back to level 3 levels more“Recommends Dr. Marc-Alain Rozan, anyway,”Level 1 and 2 maternities are connected to each other, and each is itself linked to a level 3 maternity, at the center of the network“, He explains. In addition, we don’t always think about it but it is not because a maternity is classified in level 3 that it must have maternal resuscitation.”This classification was established according to the risks for the child and not for the mother. Also, in the event of complications for the mother during childbirth, it happens that it is transferred to a level 1 or 2 maternity, if it has an infrastructure more suited to the mother’s pathology“, Specifies Dr. Rozan.
Is motherhood sure?
The safety conditions have evolved a lot and everything is done so that healthcare establishments are as secure as possible.
Safety is obviously a major and essential criterion when you choose your maternity. But, reassure yourself, in the past 20 years, the security conditions have evolved a lot and everything is done so that the healthcare establishments are as secure as possible. For example, if childbirth is done as an operating room, the medical team has the obligation to state a series of 11 essential points for the patient’s safety. This checklist established by the High Authority for Health in 2010 “Allows the anesthesiologist and the doctor to check that they have the necessary medical equipment, that everything is sterilized, etc. All this did not exist 15 years ago. Today, security standards are very strict“, reassures Dr. Rozan. In addition, it must be said that if a motherhood works, it is that it is authorized to do so and that it meets a certain number of safety standards. Otherwise maternity is closed, quite simply. In addition, it is the high health authority which delivers their accreditations to maternities every 4 years. They allow to verify that the conditions of safety, quality of care and care of the patient are taken into account. Do not fully meet the requirements, maternities undertake to do the necessary to stand up.And it’s not uncommondeplores Dr. Rozan. For example in the department of Seine-Saint-Denis, 12 maternities have closed in the space of 13 years! “
Who will give me?
It all depends on the establishment you choose. In the private sector, you will be given birth by the obstetrician gynecologist on duty at the time of delivery. In other words, it will not necessarily be the doctor who followed you throughout your pregnancy who will take care of your delivery, contrary to what the future mothers sometimes think. Unless you request it beforehand and pay additional fees. “”But it is not assured 100 % either “, warns Dr. Rozan. “If your baby arrives earlier than expected and your gynecologist is on vacation, you will have to do without him …“”
In the public, you will be given birth by a midwife, even if an obstetrician on duty will always be there to take over in the event of a complication (Cesarean section for example). This can be a midwife you know because she has followed you during consultations or preparation courses for childbirth. However, there again, it may not be a guard on D-day and that another midwife assists you. Do not panic if his face is not familiar to you: they are all formed so that your childbirth takes place in the best conditions!
Finally, besides The doctor and the midwife (s) (s), the medical team also includes a caregiver, an anesthesiologist and a pediatrician. But know that in certain maternities (those that achieve less than 1,500 deliveries per year), the gynecologist, the anesthesiologist and the pediatrician are of penalty: it means that they are not there, but that they are supposed to be able to arrive in 20 minutes. This is why you should know that “You are not always guaranteed to have an epidural when you give birth in a small maternity. As it is on duty, the anesthesiologist cannot be there all the time“, confirms Marc-Alain Rozan. But beware, It is not because a maternity is less epidural than the quality of childbirth is less. It has nothing to do with it, especially since many women do not see any drawbacks to give birth without an epidural. If you really want to give birth under an epidural, then do not hesitate to request the establishment’s rate of the establishment and ask all the necessary questions when registering (is the anesthesiologist reachable easily? Can it be present in less than 20 minutes? …)
What is the cesarean level? And that of episiotomy?
Know that you are completely entitled to request the rate of cesarean or episiotomy practiced by the establishment, To reassure you or by simple curiosity. Do not hesitate to Compare maternities together Depending on the criteria that matter to you. You can request clear and precise information on these surgical acts. For information today, the average rate of cesarean is around 20-21 %, according to the last perinatal survey of INSERM (2017 study). The episiotomy rate It is around 20%, but can drop to less than 10%in certain maternities (for information, the Besançon University Hospital holds the lowest episiotomy record where it is only 1%).
See our classification of maternities where we give the most by cesarean section
When to register for maternity?
“”If you do not follow your usual gynecologist, it is better to go about it in the first trimester Because places are expensive, especially in large cities and even more in alternative clinics “details the specialist. Know that to register you will be asked for your first ultrasound or at least the blood result of your pregnancy test. However, even if it is very strongly advised to register because you will be expected and therefore much less stressed, no motherhood has the right to refuse you on the day of your delivery. From the point of view of the law, it would be considered as non-assistance to anyone in danger. In some regions such as Ile-de-France, you have to think about it as soon as the pregnancy announces. You can also visit several maternities if you wish to ensure the comfort of the places. But a very comfortable maternity unit with spacious rooms should not be your only criterion of choice.
How long is the stay at maternity?
The duration of the stay at maternity varies from 3 to 5 days, if the delivery was made by natural route. It will be 6 days if a cesarean has been carried out. Ask your maternity, because the duration varies according to the establishments.
How much does a delivery cost?
- For hospital delivery, it is health insurance that covers all costs. Translate: you won’t have to pay anything. An exception all the same if you want to have a single room. If possible, there will undoubtedly be an unresolved supplement. Ask your mutual insurance company to find out if it compensates for this surplus.
- If you give birth in a private maternity, it all depends if it is agreed or not. If it is unhewed, know that it applies higher prices than those in force. The costs remaining at your expense can therefore be very high and you will have to make the lead.
- If it is agreed and your doctor giving birthday is in sector 1then everything will be taken care of by social security. On the other hand, If it is in sector 2, He is in excess of fees (unless he is on duty) so you will have to pay the difference. This is valid for consultations with the gynecologist, for childbirth, but also for the anesthesiologist, and for the pediatrician. Added to this is the costs of staying at the night. Also, find out, before your admission, both with clinical maternity hospital to find out the fees practiced and with your health insurance fund to find out if the clinic you have chosen is agreed or not. Your complementary health can possibly cover any or part of these costs depending on the contract you have taken out. Good to know: The Ameli Direct service allows you to know the prices charged by doctor and by type of act, as well as the reimbursement of health insurance.
| Make your own opinion. Sometimes, depending on the department where we live, we just don’t always have The choice of maternity And so no questions to ask. Otherwise, the choice often depends on word of mouth. It is generally the gynecologist or the attending physician who recommends this or that maternity. Sometimes we trust the experience of friends or relatives. In short, all of this is in fact very subjective and personal. The whole thing is to keep in mind that medical criteria must always take precedence over the comfort criteria. Mixing both as is the case in maternity charts published in magazines and on the Internet, does not make much sense. “”In my opinion, these records are worth nothing medicalinsists Dr. Rozan. Their statistics take into account both the performance of the medical team and the hotel services, such as the cleanliness of the rooms or the quality of the meals. From the moment a maternity is open, it is that it provides quality medical care and that doctors do their job well, that’s all that matters“, He concludes. |
