Maternities have been closing for forty years. Faced with the acute crisis of medical demography, should we accelerate the movement? The recurring question has been causing a stir again for ten days – and the adoption by the National Academy of Medicine, at the beginning of March, of a report on “Planning a policy on perinatality in France” worn by Yves Ville, head of the obstetrics department at the Necker hospital in Paris, and about fifteen other academicians.
Made public while many small structures – such as in Guingamp (Côtes-d’Armor), Autun (Saône-et-Loire) or Sedan (Ardennes) – are mobilizing to remain open, the document has thrown a stone into the pond judging “illusory to support” maternities carrying out less than 1,000 deliveries per year.
Out of a total of 471 maternity hospitals spread across the country – including 452 in mainland France – 111 sites are placed in the spotlight: level 1 structures (on a scale of three), taking care of risk-free pregnancies, almost all located in the “geographical diagonal of the void”, and all or almost all in a situation of “severe demographic tension”. “80% of these maternities close erratically, have recourse to massive temporary work and sparse lists of guards”, argues Doctor Ville, defending a change of scale “in the name of the safety of mother and child”.
The rapporteur recommends “regroupings”with a transfer of means and human resources from level 1 maternities to levels 2 and 3. “There is no question of condemning all these sites, he said, follow-up before and after pregnancy could still be provided there, but women would no longer give birth there. »
Many elected officials, associations or unions of caregivers recall that maternity wards in France were three times more numerous forty years ago. That the “closing threshold” invoked has continued to evolve, passing, over the years, from 300, to 500, and today to 1,000 deliveries. Or that security is not self-evident in the “baby factories”. This issue is resurfacing as many learned societies warn of the alarming situation of the perinatal care system, and the rise in the infant mortality rate..
“This report has the merit of emphasizing the quality of care in the delivery room, delivery rooms which become true medical deserts”, reacts Joëlle Belaisch Allart, president of the National College of French Gynecologists and Obstetricians. “But will closing maternity wards solve the problem of the attractiveness of our professions? I doubt “, nuance this doctor, defending “attractiveness measures” finance and improving working conditions.
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