How Is Perinatal Care in the US Compared to France?
Whether you are a French expat birthing in the US, an American expat birthing in France, or someone navigating a new healthcare system during pregnancy, this post is for you! Yes, we are going to talk about some of the differences between those 2 specific countries because, well, that’s my experience, but more than a list, I want to give you a new perspective: the way things are done where you live isn't the only way. And that's empowering!
A lot of medical recommendations and clinical practices aren't universal truths carved in stone. They're decisions made by healthcare systems, shaped by a balance of medical evidence, risk assessment, economics, and culture. They do vary from country to country. And if they can vary at the national level, that means there's often room for variation at the personal level too.
So let’s talk about it!
Toxoplasmosis Screening: Routine in France, Practically Unheard of in the US
This was one of the first things that surprised me when I became pregnant in the US.
In France, testing for toxoplasmosis is done every single month throughout pregnancy. It's standard. In the US, it's not routine at all. When I requested the test, my OB looked genuinely surprised.
So what is toxoplasmosis, and why does it matter? It's an infection caused by a parasite, Toxoplasma gondii, that most healthy adults will barely notice. But if you contract it during pregnancy, there is a chance of passing it to your baby and it can cause serious complications such as blindness or mental disability [1].
The main sources of infection are [2]:
Contact with infected cat feces (when changing the litter box for example)
Eating raw or undercooked contaminated meat
Consuming unwashed fruits and vegetables
Cats are very much a thing in the US. Raw or undercooked meat exists here too. So why isn't this screened for?
The answer comes down to incidence rates. In the US, an estimated 11% of the population aged 6 and older has been exposed to toxoplasmosis [2], compared to France where the estimate is around 50% [3], which means a higher immunization rate but also a higher risk of getting infected. The incidence of seroconversion (meaning, becoming infected) during pregnancy is estimated at 1.1/1000 in the US versus 2.1/1000 in France [4].
When I’m looking at the stats, one thing that comes to mind is, how did they compile those numbers since it’s hardly detected in the general population, not reportable in many American states and hardly screened during pregnancy in the US? But, this is another rabbit hole for another time… For now, the reasoning is that, because the baseline exposure, and therefore the risk, is considered low in the US, routine screening isn't deemed necessary or cost-effective.
That being said, if you're concerned, especially if you have a cat that goes outside, eat raw or undercooked meat, or consume fresh, unwashed produce, you can absolutely ask your provider to test you. You have that option. You just have to know to ask for it.
The Due Date Debate: 40 Weeks vs. 41 Weeks
Here's one difference that shapes the entire emotional experience of late pregnancy, and most people have no idea it's even a choice.
In the US, the estimated due date (EDD) is typically set at 40 weeks from the first day of the last menstrual period [5]. In France, it's set at 41 weeks [6]. That's a full seven-day difference in the same pregnancy, for the same baby! Research shows that the average time to birth from the last menstrual period is closer to 40 weeks and 5 days for first-time parents, and 40 weeks and 3 days for those who have given birth before [7].
So why does France use 41 weeks and the US uses 40? It's a somewhat arbitrary policy decision, made by different medical bodies at different points in time, with slightly different priorities in mind. And the downstream effects are significant. In the US, reaching 40 weeks without going into labor can feel like a crisis, for the birthing person, for their family, and sometimes for the medical team. Monitoring increases, conversations about induction begin, and doubts start to creep in. In France, reaching 40 weeks is considered normal, part of the process. This is surely a contributing factor to the difference between the induction rate: 31.9% in the US [8] vs 25.8% in France [9].
And this matters because anxiety and stress are not neutral in labor. And induction, while sometimes medically necessary and absolutely the right call, carries its own set of considerations.
So, keep in mind the estimated due date that has been given to you is just that, an estimate, and going past that date is OK!
The Anesthesiologist Consultation: Before vs. During Labor
In France, somewhere around your 8th month of pregnancy, you’ll have a dedicated consultation with an anesthesiologist [10]. You sit down together and review your health history, your risk factors, talk through preferences. You’re explained the risks and benefits of the different options and what happens in case of a cesarean. You have the time to ask questions and details about the process. You leave knowing what to expect.
In the US, unless you present risk factors, this conversation happens when you arrive at the hospital [11]. For a spontaneous vaginal birth, this will happen when you are already experiencing contractions, maybe even in active labor, since that’s when hospitals want you to arrive.
Try to picture it: you’re in the middle of contractions. You’re trying to breathe, cope and get through the intensity of the sensations. And someone is standing next to you asking you a bunch of questions about your medical history, reciting a list of risks and side effects, asking you to confirm your understanding and sign a form. Is that real informed consent?! That’s such a difficult moment to make clear-headed decisions in my opinion! It works beautifully for planned inductions and scheduled cesareans, where there’s time and space for the conversation. But for spontaneous labor, the timing is just challenging!
So, if you’re birthing in the US, bring your questions to a prenatal appointment with your medical provider and know you can request an appointment with an anesthesiologist working at the hospital where you plan to give birth. Have the conversation on your own terms! Also, pain medication is usually a topic addressed during childbirth education classes and your doula is here to help prepare as well.
The Cost of Having a Baby: The Biggest Culture Shock
I knew before coming to the US that healthcare was expensive. I was not prepared for how expensive.
In France, pregnancy and birth-related care are covered at 100% by the national health insurance (Sécurité Sociale) from your pregnancy declaration to 12 days postpartum. This includes prenatal visits, blood tests, ultrasounds, some additional testing if needed, childbirth education classes, the birth itself, postpartum care and even dental check-ups. No out-of-pocket. No deductible. You might have to pay extra fees if you’re using out-of-network providers or want a nicer postpartum room but some private insurance companies are covering those costs.
In the US, the picture is dramatically different. According to a 2025 analysis by the Peterson-KFF Health System Tracker using claims data from 2021–2023 [12], the average total health costs associated with pregnancy, childbirth, and postpartum care come to $20,416, including $2,743 in out-of-pocket costs even for people with employer-sponsored insurance. Costs vary significantly by delivery type: vaginal births average $15,712 in total spending ($2,563 out-of-pocket), while cesarean births average $28,998 ($3,071 out-of-pocket).
And the bills don't come in one neat package. You often receive separate invoices from the hospital, from your OB/midwife, from the anesthesiologist, from the pediatrician. It can feel overwhelming and disorienting when you're also in the newborn haze.
One drawback I see in the French system, which is working invisibly in the background, is that very few people are aware of what it really costs. But for families welcoming a baby, the financial protection is real and significant.
If you’re navigating birth costs in the US,talk to your insurance company prenatally. Understand your deductible, your out-of-pocket maximum, and whether your providers are in-network. And know that some costs, like asking for a longer hospital stay if you need it, can sometimes be advocated for.
Postpartum Care: Where the US Falls Shortest
This is the one that, as a doula, I feel most passionately about.
In France, hospital stay typically lasts 3-4 days. After discharge, a midwife can come to your home 2-3 times until 12 days postpartum for follow-up visits. Then you’re seeing your provider again around 6 weeks [14].
In the US, the standard postpartum hospital stay is 2-3 days [15], then next time you’re seeing your provider, if there’s no medical concern, is at a 6-week follow-up appointment. One. Single. Visit.
So much can happen in 6 weeks! And even after! A research study compiling data from 2010 to 2014 [16] shows that an average of 14.9% of severe maternal morbidity occurred after hospital discharge. In 2021, 14.1% of pregnancy-related deaths occurred 1-6 days postpartum, 29.2% 7-42 days postpartum and 28.1% 43-365 days postpartum [17].
New moms, and new parents in general, just need more support during the postpartum period! And this is one of the reasons postpartum doula support can make such a difference. We don’t replace medical care, but we are checking in, we are noticing warning signs, and we connect you to resources.
The Big Picture: You Have More Say Than You Think
I hope this post made you realize that the practices of any one healthcare system aren’t the objective truth of how pregnancy, birth and postpartum must be managed. They’re choices made at the policy level, based on a complex mix of evidence, economics, and culture. And just as those choices can vary from France to the US, they can also vary based on your individual circumstances, values, and preferences.
Knowing this gives you something important: the confidence to ask questions. To understand your options. To have real, informed conversations with your care provider rather than assuming that whatever is standard in your area is the only possibility.
You are the central figure in your pregnancy, birth and postpartum experience. The system is there to support you, not the other way around.
Love and strength to you!
References
[1] Centers for Disease Control and Prevention. People at Increased Risk for Toxoplasmosis. Updated February 14, 2025. https://www.cdc.gov/toxoplasmosis/risk-factors/index.html
[2] Centers for Disease Control and Prevention. Toxoplasmosis: Causes and How It Spreads. Updated February 14, 2025. https:/ /www.cdc.gov/toxoplasmosis/causes/index.html
[3] Agence Nationale de Sécurité Sanitaire (ANSES). Toxoplasmose. Updated November 27, 2012. https://www.anses.fr/fr/content/toxoplasmose
[4] Peyron F, Mc Leod R, Ajzenberg D, Contopoulos-Ioannidis D, Kieffer F, Mandelbrot L, Sibley LD, Pelloux H, Villena I, Wallon M, Montoya JG. Congenital Toxoplasmosis in France and the United States: One Parasite, Two Diverging Approaches. PLos Negl Trop Dis. 2017 Feb 16;1 1(2). https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005222
[5] American College of Obstetricians and Gynecologists (ACOG). How Long Does Pregnancy Last?https:/ /www.acog.org/womens-health/experts-and-stories/ask-acog/how-long-does-pregnancy-last
[6] May. Qu’est-ce que la date prévue d’accouchement (DPA) ? Updated April 22, 2025. https://www.may.app/blog/grossesse/calcul-date-accouchement/#:~:text=En%20France%2C%20la%20date%20de,d'a’%C3%A9norrh%C3%A9e%20(SA).
[7] Evidence-Based Birth. Evidence on: Due Dates. Based on Smith GCS (2001) study of ~1,500 pregnancies. https:/ /evidencebasedbirth.com/evidence-on-due-dates/
[8] Centers for Disease Control and Prevention. Births: Final Data for 2022. National Vital Statistics Reports. Volume 73, Number 2. https://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-02.pdf
[9] Santé Publique France. Enquête nationale périnatale : résultats de l’édition 2021. Published October 6, 2022. https://www.santepubliquefrance.fr/presse/2022/enquete-nationale-perinatale-resultats-de-l-edition-2021
[10] L’Assurance Maladie. Suivi mensuel de la grossesse à partir du 4e mois. Updated January 12, 2026. https://www.ameli.fr/assure/sante/devenir-parent/grossesse/grossesse-en-bonne-sante/grossesse/consultation-suivi-mensuel
[11] American Society of Anesthesiologists. Statement on Antenatal Anesthesiology Consultation. Published October 15, 2025. https://www.asahq.org/standards-and-practice-parameters/statement-on-antenatal-anesthesiology-consultation
[12] Peterson-KFF Health System Tracker. Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care. Based on 2021–2023 Merative MarketScan employer claims data. September 2025. https://www.healthsystemtracker.org/brief/health-costs-associated-with-pregnancy-childbirth-and-postpartum-care/
[13] L’Assurance Maladie. Grossesse : Démarches et accompagnement. Updated December 3, 2025. https://www.ameli.fr/assure/droits-demarches/famille/maternite-paternite-adoption/grossesse
[14] L’Assurance Maladie. Accouchement et retour à domicile : prise en charge et accompagnement. Updated January 28, 2026. https://www.ameli.fr/assure/droits-demarches/famille/maternite-paternite-adoption/accouchement-retour-domicile
[15] Cara Terreri. When Will You Leave the Hospital After Giving Birth? Lamaze International, September 15, 2021. https://lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/when-will-you-leave-the-hospital-after-giving-birth-1
[16] Jiajia Chen, PhD; Shanna Cox, MSPH; Elena V. Kuklina, MD, PhD; Cynthia Ferre, MA; Wanda Barfield, MD; Rui Li, PhD. Assessment of Incidence and Factors Associated With Severe Maternal Morbidity. JAMA Network Open. 2021;4(2):e2036148. https://pubmed.ncbi.nlm.nih.gov/33528553/
[17] Centers for Disease Control and Prevention. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees. Updated August 22, 2025. https://www.cdc.gov/maternal-mortality/php/data-research/mmrc/index.html?cove-tab=1
