Pregnancy monitoring in France has changed its approach since the decree of November 11, 2023. Pregnancy is no longer just a series of ultrasounds and monthly consultations: the pathway now relies on enhanced coordination, with identified stakeholders and a precise screening schedule. Here, we detail the technical points that most general public guides do not address.
Referent Midwife: What the 2023 Decree Changes for Pregnancy Monitoring
Since the decree published on November 11, 2023, any pregnant woman can designate a referent midwife until the 5th month of pregnancy. This system, integrated in 2026 into the overhaul of the parentality pathway of the Health Insurance, allows for a single point of contact from the confirmation of pregnancy until 14 weeks after delivery.
The package is covered 100% under maternity insurance. The referent midwife ensures overall monitoring, coordinates with the maternity hospital and the treating physician, and takes care of postnatal prevention. We find in this system pregnancy information on Le Portail de la Santé that details the practical modalities of this coverage.
This role goes beyond traditional obstetric monitoring. The referent midwife becomes the pivot of the pathway, capable of prescribing biological tests, conducting mandatory prenatal consultations, and referring to a gynecologist-obstetrician only in cases of pathological pregnancy.
Ultrasounds and Prenatal Screenings: Schedule and Clinical Issues
Prenatal monitoring is based on three reference ultrasounds, each serving distinct objectives. The first, performed between the 11th and 13th week of amenorrhea, allows for dating, screening for Down syndrome by measuring nuchal translucency, and verifying embryonic vitality.
The second ultrasound, known as the morphological ultrasound, occurs around the 22nd week. It reviews all the organs of the fetus. It is at this stage that most major structural malformations are detected.
The third ultrasound, around the 32nd week, assesses fetal growth, the baby’s position, and the location of the placenta. A low-lying placenta at this stage requires reevaluation before delivery.
In parallel, screening for gestational diabetes (glucose tolerance test) is offered between the 24th and 28th week. Screening for toxoplasmosis involves monthly serology for non-immune women, a point often underestimated in general articles.
Teleconsultation During Pregnancy: Reimbursement Framework and Limitations
Teleconsultation has significantly progressed in pregnancy monitoring. According to a report from Health Insurance, the number of teleconsultation acts increased by 21.8% between 2023 and 2024. Remote consultations conducted by midwives, general practitioners, or gynecologists are reimbursed under the same conditions as in-person consultations.
However, we recommend distinguishing between what falls under remote monitoring and what requires a physical examination. A consultation for persistent nausea in the first trimester or for an administrative point lends itself well to video format. In contrast, abdominal palpation, measuring uterine height, and auscultating fetal heart sounds remain clinical acts incompatible with remote consultation.
Situations Suitable for Teleconsultation
- Renewal of prescriptions for folic acid or iron supplementation, when the biological assessment is already available
- Interpretation of analysis results (serologies, blood sugar) without a physical examination required
- Psychological support and birth preparation for women far from a maternity hospital
Physical Activity During Pregnancy: Updated Recommendations
Moderate physical activity is recommended throughout pregnancy in the absence of obstetric contraindications. Walking, swimming, and prenatal yoga remain the most documented practices in terms of benefits for glycemic control, prevention of pre-eclampsia, and reduction of lower back pain.
Absolute contraindications include symptomatic placenta previa, the threat of preterm labor, and premature rupture of membranes. Outside of these situations, we observe that sedentary behavior during pregnancy is an underestimated risk factor, particularly for gestational diabetes.
Points of Caution by Trimester
- First trimester: adjust intensity to fatigue, avoid sports at risk of falls or abdominal trauma
- Second trimester: prefer lateral position exercises after the 20th week to avoid compression of the inferior vena cava in supine position
- Third trimester: maintain gentle activity, monitor any signs of contractions or fluid loss during exertion
Perinatality in France: Documented Territorial Inequalities
A report from IGAS highlighted marked disparities in the organization of perinatal care across territories. The gradual closure of local maternity units creates areas where travel time to the delivery room exceeds thresholds considered safe. Inequitable access to prenatal consultations remains a major public health issue.
The referent midwife system aims in part to compensate for these imbalances, ensuring coordinated monitoring even when the affiliated maternity unit is far away. Teleconsultation plays a complementary role here, without being able to replace the territorial network of care structures.
Pregnancy monitoring in France relies on a precise medical framework, reinforced by the referent midwife system and the expansion of teleconsultation. The quality of this monitoring depends as much on the rigor of the prenatal calendar as on the healthcare system’s ability to cover the entire territory.