House of birth

A Maison of Birth (MdN) is a place of reception, follow-up and childbirth constituting the showpiece of a specific die of follow-up of pregnancies and intended to the expectant mothers and for their family, since the pregnancy, the childbirth and postpartum remain within the framework of physiology.

MdN forms integral part of the perinatal network. Its operation rests on a relation between partnership with the various actors of this network and more particularly and a maternity partner . It is characterized by three elements:

  • the autonomous midwives as professional ensure for it operation and the whole medical responsibility, in accordance with legally recognized competences.

  • the accompaniment is total, i.e. it associates a woman (a couple) and a midwife (sometimes two) of the beginning of the pregnancy at the end of the postpartum.

  • the structure “House of Birth” is physically, juridically and administratively differentiated from its maternity partner. It can be located in its center or in the vicinity, since the transfer of the women can be done within times compatible with the urgency.

Situation in France

France is a country where MdN are not legalized yet. However of many projects were born.

The experimentation of the operation of Houses of Birth constitutes one of the four priorities of the Plan Périnatalité 2005-2007. A technical group pluriprofessionnel, in which appear of the representatives of the users resulting from collective CIANE and the UNAF, was set up by the DHOS (direction of the hospitalization and the organization of the care) at the beginning of the year 2005. It aimed to set up (ideally) for the end of 2006 schedule of conditions laying down the methods of this experimentation, and especially to fix a regulation framework of it.

Pilot sites were proposed: Paris, Nantes, Bordeaux, Rennes, Lyon…

These experiments will be surrounded by all the guarantees relating to the safety of the parturients, with legal and assurantielles guarantees as well as an evaluation of the results obtained. The results will be published.

At the beginning of 2007, associations of users feel however a sharp concern with the reading of account-returned who reveal an increasingly constraining schedule of conditions, eliminating from the start certain projects until removing any statistical relevance with the parameters taken into account in the evaluation of this experimentation. According to the criteria currently retained by the DHOS (among which “dependancy” of MdN to maternity partner), the number of eligible projects would be of 4 or 5, figure very low compared to Quebec (9 projects) for a country like France with more than 65 million inhabitants and one of the strongest birthrates of Europe (830 000 births). As comparison, there already exists in Germany more than 120 houses of birth which are not subjected to this condition of dependancy. In the same way, at the conclusion of its experimentation, Canada did not impose that MdN contiguous nor are integrated physically into their maternity partner.

See for more precise details:

  • Enjeux of the creation of Houses of Birth in the French context - Proclamation of the CIANE, March 13rd, 2007

  • Modeling of the calculation of the overall costs of a pregnancy in MdN, February 2007
  • Houses of Birth - the CIANE questions…

Controversies on name

The definition of the term “House of Birth” was the subject of many debates in the French-speaking world, which turn mainly around the management styles and of the localization of these establishments.

In April 2006, collective CIANE insisted on the fact that this name is reserved for establishments located apart from the perimeter of a hospital or a private clinic, in accordance with its use in other countries.

The term “Houses of Birth” was the subject of one deposit at the National institute of Industrial Protection (INPI) in 1999 by a national group of work gathering the Birth Federation and freedoms, the National association of the Liberal Midwives, the National organization of the Trade unions of Midwives and the Federation of European and International Public Service Unions of Midwives. (See motion). This group, holder of the definition of the term, would be legitimately entitled to prosecute those which usurp this name.

In November 2006, a project of common platform for the experimentation of houses of birth physically, juridically and administratively differentiated from their maternities partners was published. (See motion.)

At the beginning of 2007, the CIANE worries owing to the fact that the French experimentation is forwarded to the pure and simple validation, under misleading designation about “house about birth”, of managed “physiological poles” in a traditional way within the framework of the hospitals. It would draw aside from the start any idea of autonomous management of MdN succeeding, for the pregnancies at the weak risk, with a redistribution of the tasks between midwives and obstetricians. However, the fundamental point of the installation of MdN was of sparing a clear separation, so much from the point of view of the legal identity, operating rules and practices, between the houses of birth and traditional maternities.

Why a house of birth?

  • Although, since mists of time, the Accouchement always was held at the house, between women, the medical environment of the Western countries it gradually dealt with. Since the years 1960, the near total of the childbirth proceeds in hospital medium.

  • During years 1970, of the women sought to take again the responsibility and the control on several sectors of their life, of which the childbirth. The surmedicalisation of the pregnancies, as well as the work of some humanistic scientists, like the obstetricians Frédérick Leboyer, Michel Odent, max Ploquin etc contributed much to legitimate this step.

  • But the origin depends especially on the place.

    • Thus in the United States, the cause comes especially from a reaction vis-a-vis a surmedicalisation from the pregnancy and childbirth.
    • In Canada, the creation of these structures is closely related to the history of the occupation of midwife who was extinct since the beginning of the century. Quebec legalized the profession of the midwives in September 1999 after ten years of evaluation of their activity within pilot projects.
    • In Europe, the reasons are variable from one country to another.

  • the MdN die, in France, would be likely to generate considerable economies in the future: starting from the Canadian and German experiments, economic modelings carried out show that it is an economy of more than 750 euros per pregnancy which can result from it (for an average of 40 pregnancies annually followed by a midwife in MdN). In the long term and on minimum an annual basis of 25% of the births, that is to say 200.000 women likely to return in this die, one leads to more than 150 million euros per annum of economy. Even if these profits require a capital cost at the beginning, overall over ten years that should not exceed 50% of the economies generated in only one year. (See Modeling of the calculation of the overall costs of a pregnancy in MdN, February 2007)

Services offered

  • Followed maternity.

    • Followed antenatal personalized.
    • Childbirth (assistance throughout the process of childbirth).
    • Followed postnatal mother and baby.
  • collective antenatal Meetings.
  • collective postnatal Meeting.
  • Information center.

The services offered can of course vary according to the countries and from the houses of birth.

Houses of birth in the world

  • In the United States, the first house of birth ( birth center ) was founded in 1975, in New York; there is now more than one hundred.

  • In Europe, the movement was initially established in Germany (in 1987), then in Switzerland, Austria, Belgium, Sweden, Great Britain… A European network of houses of birth (Netzwerk Europa) was born in 1993.
  • In Quebec, it exists currently eight of these houses. They are attached to CLSC (local Center of Community services) under the authority of the ministry for the Health and the Social services of Quebec. A new house of birth should be born in Quebec in December 2007. There are currently 65 wise women who can practice according to the order of the wise women of Quebec.
  • In Quebec, the parents imply themselves often actively in their house of birth by the means of a committee of parents (e.g.: http://www.mimosa.qc.ca)

Random links:Albert Sarraut | Marcus Tullius Tiro | Victor Tissot | Henri Massé (iranologist) | Silvio Trentin