I Am Joe’s Blog:

January 13, 2010 • 2:38 PM

Having Our Baby in France

When Morgen and I announced that we’re expecting a baby, we were surprised and somewhat baffled at the large number of people who almost immediately asked, “So, are you going to have the baby in France?” That seems like such a silly question that I almost don’t want to dignify it with an answer, but I think that the frequency with which we’ve been asked and the strength of our reactions both say interesting things about what people assume.

Before I go any further, let me be completely clear and unambiguous. Yes, we’re going to have the baby in France!

I’ve been trying to think of a good analogy for how this question sounds to us. It’s almost like asking, “Do you mean to tell me that after everything you went through to get this job, and all the long hours you put in at work, you’re actually going to accept a paycheck from your employer?” That seems so nonsensical that I can’t fathom why anyone would ask, except to make a joke. But clearly the people asking whether we plan to experience childbirth in France aren’t kidding!

On a few occasions, I’ve inquired as to what prompted this question, and at other times I’ve had to make educated guesses. Although I don’t entirely understand this phenomenon yet, I’ve been able to piece together a few common threads.

But I Knew Someone…
A couple of times, people have mentioned to me that they knew (or knew of) a pregnant woman who was living overseas but who came back to North America to have her baby, and apparently this is a frequent enough occurrence that it’s built up some sort of precedent in the collective unconscious. I imagine the thinking goes, “If so-and-so did it, then she must have had a very good reason, and since you’re smart, you probably know what that reason is and will therefore do the same thing.”

Surely some significant percentage of these women had extenuating circumstances. Maybe they were living abroad on a short-term basis anyway, and felt this was a logical reason to curtail their stay. Perhaps they were living in underdeveloped areas with poor medical facilities and were uncomfortable with the associated risks. Or maybe their situation was such that there was an important legal, financial, or logistical reason not to stay put when they gave birth. I can’t say, but since women have successfully given birth in all parts of the world for many millennia, it seems to me that flying to another country for the occasion would be a rare exception, rather than the rule! (Besides, even if we did want to do so for some reason, we couldn’t afford to—but more on that in a moment.)

The Homing Instinct
One reason people ask if we’re staying here to have the baby—and, undoubtedly, the main reason many women return to their country of origin to give birth—is the expectation that a woman will naturally want to be at home, and ideally surrounded by family and friends, when she delivers and in the early months of motherhood. That’s certainly reasonable as far as it goes, but it rubs us the wrong way because it implies that France isn’t our home!

We moved to France in mid-2007, and we’ve lived here ever since. I understand that some people move to another country temporarily or experimentally, leaving what they regard as their “real” homes behind, but we have no home other than our Paris apartment. If we ever were to move back to North America, it wouldn’t be a matter of going home, but instead of finding a new home. Although I don’t categorically rule out the possibility of doing that some day, the fact is that we’re happy here now, and see no compelling need to move anywhere else in the foreseeable future. So, we very much do want to be near home during and after the birth, and that doesn’t require us to go anywhere!

Of course, even though we’ve made lots of good friends here in Paris, it’s true that most of our family members, and older friends, will be inconveniently located on other continents. We’ll miss having them here (as we always do) and very much hope to arrange visits in one direction or the other (hint!) as soon as we can. But those relationships didn’t prevent us from moving here in the first place, and we think of this special event as just another part of our lives that, unfortunately, we can’t share with all of our loved ones.

Other people worry about citizenship. I’m an American; Morgen is Canadian by birth but also has U.S. citizenship. If our child is born abroad, our friends worry, will he or she be able to be an American and/or Canadian citizen? Yes, absolutely. Although laws regarding citizenship vary from one country to the next, the general principle is that a child inherits the parents’ citizenship(s). In some cases, the child also acquires citizenship of the country in which he or she is born, if different. In our particular circumstances, U.S. citizenship for the child will be automatic, and Canadian citizenship more or less a formality. (According to legislation passed recently in Canada, a child born outside the country to a Canadian parent can have Canadian citizenship but can’t pass that citizenship on to his or her own children, unless they’re born inside Canada.)

French citizenship is a bit trickier. Since we’re not French citizens, the child isn’t automatically French, but can obtain citizenship at the parents’ request, if still resident in France, at age 13. (That’s just one path, however; see other options also exist.) So, in theory, our child could eventually have citizenship in three countries. Apart from having to deal with a considerable amount of paperwork, juggling passports, and the irritation of potentially not being able to pass on Canadian citizenship to a future generation, I see nothing to worry about there. (In fact, quite the reverse: if we want our child to have the option of French citizenship, giving birth here is certainly the simplest way to get it! And we do think that’s a tremendous advantage.)

In fact, I can think of only one notable way in which we as expatriate parents may be limiting our child’s future options by giving birth here in France. As things currently stand, one cannot become President of the United States unless born on U.S. soil (even if born to American parents and therefore a U.S. citizen from birth). I’ve always found this rule somewhat baffling, and one occasionally hears talk about a movement to relax it. (For example, when Arnold Schwarzenegger became governor of California, he tried for some time to build support for changing the rules so that he could one day run for President, but the effort failed to generate much public enthusiasm.) I wish I could say I will feel very sorry about imposing this career limitation on our offspring, but I think other potential occupations are sufficiently numerous and interesting that none of us need lose any sleep over the matter.

Insurance and Healthcare
Yet another reason for asking us this question, and the one that leaves me most puzzled, is the idea that having our baby in France somehow puts us at a disadvantage when it comes to healthcare. Nothing could be further from the truth!

First of all, there’s the minor matter of health insurance. In a nutshell: we have it here, but we don’t have it (and couldn’t, at this point, get it) in the United States. Perhaps that would be immaterial to someone with enough cash to pay for expensive medical procedures out of their own pockets, but that’s not us!

Like most people in France, we’re enrolled in the national health insurance program, l’Assurance Maladie (a part of the country’s social security system); we also have a mutuelle, or third-party “top-up” plan that pays for pretty much anything not covered by the standard insurance (such as a private room at the hospital). None of this is free; a considerable percentage of our income goes to pay for our health coverage. But it’s less expensive, on the whole, than what we paid in the United States for private health insurance. And crucially, the whole notion that one may be denied insurance coverage, or lose existing coverage, due to a preexisting condition or treatment that turned out to be inconveniently expensive, is utterly unknown here. Nor do French people worry that they’ll encounter sudden, massive increases in their insurance rates or bump into an arbitrary cap on benefits.

But back in the States, we’d be up a creek. I have no employer that could enroll us in their corporate insurance program, so we’d have to purchase private insurance. Alas, my wife has a pretty obvious preexisting condition! Even if we somehow managed to get health insurance, it probably wouldn’t cover pregnancy or delivery. And God forbid that there should be any expensive complications; we could be paying off hospital bills until the child goes to college! Perhaps the healthcare reforms being contemplated in the United States will eventually change all this, but our baby can’t wait for the politicians and insurers to come to their senses. (Even in Canada, which has a variety of socialized healthcare, my wife wouldn’t be able to get coverage until she’d reestablished residency, which would mean a three-month wait.)

[Update: @schollem pointed out that some U.S. states, including California, don’t allow insurance companies to treat pregnancy as a preexisting condition. That’s good to know, although Morgen and I have each had the experience (with different insurance companies, both in California) of being turned down for new private policies on the basis of other preexisting conditions that were utterly trivial. Although we managed to appeal those decisions successfully, it makes me think insurance companies are looking for any possible excuse not to provide coverage, and something tells me they’d try extra hard in our case!]

Leaving aside the issue of money, France consistently ranks first in the world (or very close) in healthcare quality. Although I realize everyone has different experiences, we’ve received uniformly helpful, prompt, and competent medical care here. We like our obstetrician and midwife a great deal (they even speak English, a lovely bonus), and our clinic even has a really expensive machine that goes “Bing!” which inspires a great deal of confidence.

(Update) Language Issues
Right after I initially posted this, @cutestmidget brought up a good point:

REALLY interesting post! only 1 thing missing – the reason I ask the question : “do you feel your french is good enough?”

i’m fluent but it’d worry me that things might go wrong & all french wld fly out of my head (& that’s me with a french hubby!)

Our French is passable but nowhere near fluent, and especially sucky under pressure! I can easily imagine that if we felt completely unable to communicate with our healthcare professionals, that alone might make us consider traveling to an English-speaking country to give birth, despite all the other issues. However, we’ve both had various medical procedures done here and managed to get through everything OK even with the language barrier, and since the medical group we’re with has several English-speaking practitioners (two ob/gyns and at least one midwife) we like and trust, this issue doesn’t cause us any undue stress.

But I guess my feeling is that if you choose to live in a foreign country, dealing with the language is just one of those things you sign up for. We’ve had to face other stressful situations in which our lack of fluency made things worse, but if we weren’t willing to put ourselves through that, I don’t think we’d be living here at all.

(I was sorely tempted to give a smart-ass response, such as: “Morgen knows all the French she needs to give birth—the words for ‘push’ and ‘epidural’ and ‘Aaaaaeeeeiiiioooowwww!’—so she should be in good shape!” But that would be completely insensitive and wrong, so I’d never say that…)

The Hexagon of Life
I’d be lying if I said we weren’t the least bit apprehensive. But I think most of our anxiety is of the same sort all future parents feel, and not specific to being in France. What it all comes down to for us is that we live here. Moving here was difficult, and staying here often is, too. But we endure all the hassles, by choice, because we love Paris so much! We expected that the rewards of living here would far outweigh the inconveniences, and we’ve found that to be true. We’re excited about passing on to our child our fondness for all things French, and envious of the many opportunities he or she will be afforded by her multicultural, multilingual upbringing. And there’s no better place than Paris to get celebratory pastries after the blessed event!