French healthcare reform after Covid pushes midwives to the brink

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                Bien qu'elles aient été en première ligne tout au long du pic de l'épidémie de Covid-19, les sages-femmes se sentent oubliées par les réformes de la santé adoptées par la France à la suite de sa crise des coronavirus.   
            

Une équipe de quatre sages-femmes (dont deux échographistes) et de quatre médecins généralistes ont tout mis en œuvre pour garantir sécurité et sérénité à la Maison des médecins de Pré-Saint-Gervais en Seine-Saint-Denis dans le Grand Paris. Trois salles d'attente spacieuses ont été dédiées aux femmes enceintes, aux patients présentant des symptômes de Covid-19 et une autre aux patients «traditionnels».

Midwife Adrien Gantois received her first patient at 9.15am with a relaxed smile last Saturday. He called her by her first name and knew her file by heart. “I am totally confident here, I even recommend the house to my patients,” Malyza, herself a general practitioner, told FRANCE 24.

In this clinic, located in the poorest department of France, the caregivers love the proximity with their patients, the long-term follow-ups and the individual stories. Those who work here do it by choice, doing everything they can to care for women at risk.

For many people, were still fair give birth to atenders’

Since the agreements on health reform in France, known as the Segur of health, were signed on July 13, Gantois gritted his teeth. Like many of his midwifery colleagues, he feels “despised” by Ségur.

” The Ségur was an opportunity to recognize the profession of midwifery and to promote it at its true value. It was a failure ”, deplores Gantois, private midwife for six years and president of the National College of Midwives of France (National College of Midwives of France). “In the collective imagination, we are still midwives. But we have evolved both in training and in competence, ”he said.

Adrien Gantois, midwife and president of the National College of Midwives of France, July 25, 2020. Sarah Leduc / France 24 © Sarah Leduc / France 24
    
Les sages-femmes complètent cinq années d'études, dont une année de médecine et quatre années de spécialisation en gynécologie et obstétrique. Ils peuvent alors effectuer des accouchements à l'hôpital et à domicile, ainsi que proposer un suivi de la grossesse, des soins post-partum, des avortements médicaux et une contraception, et répondre aux urgences.

In the middle of the morning, loud cries rocked the tranquility of the little house in Pré-Saint-Gervais. Behind closed doors, the distress of an expectant mother was palpable. Gantois had just detected that his cervix was too dilated, which carries a risk of premature birth. The diagnosis was confirmed by ultrasound. In less than 10 minutes, the emergency services took her to her maternity hospital. “His file has already been transferred,” said Gantois, once the crisis passed.

“The key to success is clear: we need to work hand in hand with hospitals to streamline procedures. And this also escaped the attention of the Ségur, which was not intended to reform the system, ”he said with regret.

” The Sisgur It’s a shame, ”Gantois said, raising another point that makes him bristle. “The fact that midwives are forgotten is a political and symbolic deficit that says a lot about patriarchy in France,” he said. »Midwives are respected in France. more advanced countries in terms of gender equality, where the importance of women’s health is recognized. ”

Cécile Caze, midwife coordinator of the Seine-Saint-Denis perinatal network, agrees. “We are 99% a female profession and, on top of that, we take care of women: it’s a double drawback,” she said.

Caze deplored the profession’s lack of political clout, with “only” 24,000 practitioners in France (against more than 700,000 nurses), they are rarely recognized and have been excluded from the profession. Ségur negotiations.

As part of the agreed reform, midwives – who are seen as part of the medical profession just like doctors and dentists – will receive a salary increase of € 183 (net) per month. But they deplore the persistent lack of recognition.

“When [Minister of Health] Olivier Véran says that the salary increases are the result of union negotiations, it must be remembered that the midwifery unions were not able to participate in the Ségur and that the other unions do not recognize the specificity of our profession, ”she said of remarks made by Véran in a television interview on France 2 last week, in which he insisted on the fact that the wise men- women had not been “forgotten” in the reform movement.

Need for rest and recognition

The lack of representation is all the more difficult to swallow since, like other medical professions, midwives have remained in post since the start of the Covid-19 crisis. “Women don’t stop giving birth during Covid,” said Caze, who, like Gantois, was part of the national crisis cell that worked throughout the lockdown.

Seine-Saint-Denis was one of the departments most affected by Covid-19 at the height of the crisis – with more than 200 pregnant women testing positive for the virus – and the Maison des médecins continued its mission relentlessly.

“We gave everything,” said Gantois. This included developing a coronavirus protocol, setting up teleconsultations, and continuing to provide emergency care and ultrasounds.

Masks were purchased from pharmacies, gowns were provided by the town hall and hairnets were donated by a physiotherapy practice.

“We were like reeds in a storm,” Gantois said. But their patients were able to count on them.

Diagnosed with Covid-19 in February – six and a half months after the start of her pregnancy – Rebecca was first referred to the emergency room and then prepared for delivery via teleconsultation and essential hospital care. “I was told the risk of fetal transmission is minimal, so I clung to that idea. The midwives reassured me, ”she said on leaving her post-partum follow-up consultation.

Seine-Saint-Denis once again exceeded the Covid-19 alert threshold with an incidence rate of 10.1 contaminations per 100,000 inhabitants in July, for the first time since the end of May. Midwives say they are more prepared than they were when the lockdown began in March. They are also more tired.

Since coronavirus restrictions began to ease in mid-May, in-person consultations have resumed under strict conditions and the schedule is full again.

“The next generation of the lockdown,” Gantois said with a laugh, his blue eyes smiling above his mask. But the mask does not hide his exhaustion. “I need a rest to be able to play in the second wave. I also need distance because the Ségur was the coup de grace. If we are not well, we cannot provide good care. And that’s what departments don’t understand. ”

This article has been translated from the original into French.