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I. Legal Status of Doulas

Doulas are not recognized as a profession under French law.[1]  The services that doulas can legally provide in France are strictly limited to nonmedical assistance, or else they risk being charged with the illegal practice of medicine.[2]  The charter of the main doula organization in France, the Association Doulas de France (Doulas of France Association), includes the following statement:

Our care complements those of the midwife or doctor and in no way replaces the medical monitoring of the mother during her pregnancy and childbirth. We are not therapists and do not perform any medical acts.  We do not give any kind of medical consultations, or exams, or advice.  Doulas do not have the competence required for the medical monitoring of a pregnancy or birth.[3]

Additionally, the Charter states that a doula may not assist a mother or parents who are not also being monitored by a doctor or midwife, nor may doulas be present during labor and birth without a midwife or doctor also being present.[4]  Since the services of doulas are not recognized as health care services in France, they are not covered by the French national health insurance scheme.[5]

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II. Legal Status and Regulation of Midwives

In contrast to doulas, midwives (sage-femmes) are a recognized medical profession in France.  Indeed, the Public Health Code states that the medical monitoring of any pregnant woman, including prenatal and postnatal medical examinations, should be conducted by a medical doctor or a midwife.[6]  Midwives must refer to a doctor in cases where there is a maternal, fetal, or neonatal pathology, and in cases of obstructed labor,[7] but otherwise, midwives are authorized to diagnose and monitor a pregnancy, to prepare the mother for birth, to deliver the baby, and to dispense postnatal care.[8]  They may also administer vaccinations and prescribe certain medicine within the scope of their authorized medical practice.[9]  The services of midwives are paid for by the French national health insurance scheme.[10]

Midwives must be admitted to the tableau de l’Ordre (board of the Order) of their geographic area to legally be able to practice.[11]  The tableau de l’Ordre is a list of authorized practitioners maintained by the Ordre des sages-femmes (Order of Midwives), the professional organization of midwives.[12]  Midwives are thus organized and regulated in the same way as medical doctors, who also must be admitted to the tableau de l’Ordre of their own professional organization, the Ordre des médecins (Order of Physicians), to legally practice medicine.[13] Midwives are also legally required to have a midwife diploma, or an equivalent diploma from another European Union Member State.[14]  Possession of this diploma is a requirement to be admitted to the tableau de l’Ordre mentioned above.[15]  A midwife diploma represents at least five years of post-secondary education. The curriculum begins with the Première Année commune aux Etudes de Santé (PACES) (Common First Year of Healthcare Studies), which is a year of studies common to future midwives, doctors, and pharmacists.[16]  If their grades are good enough by the end of this first year, aspiring midwives must successfully complete at least four years in a midwife school.[17]

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Nicolas Boring
Foreign Law Specialist
May 2019


[1] Roger Henrion, Les Doulas: une profession émergente ? [Doulas: An Emerging Profession?], Rapport au nom de la Commission X (Maternite – Enfance – Adolescence) [Report in the Name of Commission X (Maternity – Childhood – Adolescence)], Academie nationale de médicine [National Academy of Medicine] 8 (June 10, 2008), http://www.cngof.fr/briefcase/Juridique/Obstetrique/080619_doulas_acad-med.pdf, archived at https://perma.cc/UA75-RSRR.

[2] Id.

[3] Charte [Charter], Association Doulas de France [Doulas of France Association] (Mar. 3, 2008), https://doulas.info/association/charte/, archived at https://perma.cc/7K3R-62YL.

[4] Id.

[5] Maternité : déclaration, prise en charge et feuille de soins [Maternity: Declaration, Coverage, and Treatment Form], Ameli.fr (website of Assurance Maladie, the French national health insurance scheme) (May 7, 2019), https://www.ameli.fr/sage-femme/exercice-liberal/presciption-prise-charge/situation-patient-maternite/maternite, archived at https://perma.cc/3382-H8EC.

[7] Id. art. L41-51-3.

[8] Id. art. L4151-1.

[9] Id. arts. L4151-2, L4151-4.

[10] Maternité : déclaration, prise en charge et feuille de soins [Maternity: Declaration, Coverage, and Treatment Form], supra note 5.

[11] C. santé publique, arts. L4111-1, L4112-1, L4112-5.

[12] Missions et structures [Missions and Structures], Ordre des sages-femmes [Order of Midwives], http://www.ordre-sages-femmes.fr/ordre/fonctionnement/missions-structures/ (last visited May 14, 2019), archived at https://perma.cc/8RZF-3CY4.

[13] C. santé publique, arts. L4111-1, L4112-1, L4112-5; Qu’est-ce que l’Ordre [What Is the Order?], Conseil national de l’Ordre des médecins [National Council of the Order of Physicians] (Oct. 2, 2012), https://www.conseil-national.medecin.fr/qu-est-ce-que-l-ordre-1206, archived at https://perma.cc/47BW-BQ6Q.

[14] C. santé publique, arts. L4111-1, L4151-5.

[15] Id. art. R4112-1.

[16] Les études de santé [Healthcare Studies], Ministère de l’Enseignement supérieur, de la Recherche et de l’Innovation [Ministry of Higher Education, Research and Innovation] (Feb. 4, 2019), http://www.enseignementsup-recherche.gouv.fr/cid53276/les-etudes-de-sante.html, archived at https://perma.cc/54VK-Z7ZZ.

[17] Id.

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Last Updated: 11/01/2019