Give birth in a birth center, abroad

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Cross-border births in birthing centers: the risks of care

While waiting for the vote of the French law authorizing the opening of birth centers, you can in theory give birth in already existing structures, abroad. Problem: the primary health insurance funds sometimes refuse coverage. 

The opening of birth centers in France looks a bit like Arles. We talk about it often, we announce it regularly but we don’t see anything coming. A bill to authorize them will be considered by the Senate on February 28. This text had already been voted in November 2010 as part of the Social Security Finance Law (PLFFSS) for 2011. But it was then censored by the Constitutional Council. The reason: he had no reason to appear in the PLFSS.

Crossing the border to better choose your childbirth

A few hospital birth centers have already opened in France, on an experimental basis. They are few in number. In some border departments, expectant mothers only have a few kilometers to travel to take advantage of foreign structures and have their babies under the conditions they have chosen. In “baby-friendly” maternities (when there is none in their department), in a birth center or at home but with a midwife practicing abroad. In Germany, Switzerland, Luxembourg. At the time of the free movement of goods, people and services in the European Union, why not? However, the care of these births is a bit of the lottery, with significant financial consequences.Free choice of childbirth can come at a high price.

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Birth centers, or physiological poles in a hospital environment, leave the expectant mother more free to move around and accessories help her manage the contractions.

Four years ago, Eudes Geisler gave birth in a German birth center. Since then, she has been entangled in a legal imbroglio with the CPAM of her department, Moselle, and has still not obtained reimbursement for her childbirth. Her first child was born in the clinic in 2004. “It didn’t go badly but… the maternity ward was under construction, I gave birth in the emergency room, I did all the work alongside the workers who painted, there had 6 or 8 deliveries at the same time. The midwives were running all over the place. I didn’t want the epidural but since I was in pain and I didn’t know if what I was going through was normal, that I was not accompanied, I ended up asking for it. They pierced my water bag, injected synthetic oxytocin, and nothing explained to me. ” 

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Living in Moselle, giving birth in Germany

For her second child, Eudes does not want to relive this experience. She wants to give birth at home but cannot find a midwife. She discovers a birthplace in Sarrebrück in Germany, 50 km from her home. “I forged a very good bond with the midwife, the place was very friendly, very cocoon, exactly what we wanted. During the pregnancy, the young woman is followed by her general practitioner to be able to be supported. She asks for prior authorization from social security for the birth center. A month before the birth, the verdict falls: refusal.Eudes seized the conciliation commission. New refusal. The national medical adviser is seized and drives the point home. The Social Security Court dismisses Eudes’s claim for reimbursement and gives him a little lesson in the process. “We obviously cannot blame Mrs Geisler for having preferred to give birth in a birth center in Germany rather than in a maternity hospital in Lorraine (…) However, it is a pure choice.

 personal convenience (…) and one can thus reproach Ms. Geisler for having wanted to make the community of the insured persons support a choice of pure personal convenience. Such behavior

 is not eligible. However, the cost of this childbirth, 1046 euros, is significantly lower than the cost of a traditional delivery in the hospital with a stay of 3 days (basic package: 2535 euros without the epidural). Eudes appeals in cassation. The court annuls the judgment and sends the case back to the Nancy social security court, which ruled in favor of the young woman. The CPAM then appealed. The Court of Appeal declared the appeal inadmissible. The story could have ended there. But the CPAM decides to appeal in cassation both against the court of Nancy and against the court of appeal. 

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The judicial stubbornness of social security

In this story, the judicial stubbornness of the CPAM (from which we are awaiting the answers) seems difficult to understand. “How to explain it other than by an ideological bias incompatible with its public service mission? »Asks the Interassociative collective around birth (Ciane). To assimilate the choice of a natural childbirth there a personal convenience and to make a legal argument of it can seem to be part of a rather retrograde vision of the birth, at a time when mothers deplore more strongly over-medicalization and where most health professionals advocate “reasoned medicalization”.  This particular case also raises the question of the status of birthing centers and the legislation on cross-border care.  Care reimbursable in France and carried out in a country of the European Union is covered by social security under the same conditions as if they had been received in France. For scheduled hospital care, prior authorization is required (this is the E112 form). A childbirth in a German hospital, for example, can be taken care of but requires prior authorization from the CPAM. For birth centers, it is more complex. Their status is ambiguous. It is difficult to say if this is hospital care. 

“In this case we are really in the appreciation of the rules, underlines Alain Bissonnier, legal officer at the National Council of the Order of Midwives. Since this is a birthing center, there is no hospitalization and it could be considered that it is outpatient care, therefore not subject to prior authorization. This is not the position of the CPAM. The dispute is over 1000 euros and this procedure will ultimately cost health insurance money. In the meantime, Eudes is subject to two appeals in cassation. “I put my finger in the gear and so I have no choice but to defend myself.”

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Other mothers get form E112

Myriam, residing in Haute-Savoie, gave birth to her third child in a Swiss birth center. “I had no problem with taking charge even though the agreement was late. I sent a letter with a medical certificate, with the articles of law and I justified my choice. I have not heard back. I finally received a response telling me that the analysis of my situation was underway, the day after my delivery! When I received the invoice from the birth center, 3800 euros for the overall follow-up, from the 3rd month of pregnancy until 2 days after giving birth, I sent another letter to the security. They replied that in order to establish the famous E112 form, it was necessary to provide details of the services. The midwife sent this detail directly to the security. In total I had a remaining charge of 400 euros. ” Another department, another outcome.

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