France’s post-Covid healthcare reform pushes midwives to the brink
Although they were on the front lines throughout the peak of the Covid-19 epidemic, midwives feel forgotten by the healthcare reforms France adopted in the wake of its coronavirus crisis.
A team of four midwives (two of whom are ultrasound specialists) and four general practitioners has done everything possible to guarantee safety and serenity at the House of the Doctors of Pré-Saint-Gervais in Seine-Saint-Denis in greater Paris. Three spacious waiting rooms have been dedicated to pregnant women, patients with Covid-19 symptoms and another for "traditional" patients.
Midwife Adrien Gantois received his first patient at 9:15 am 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.
At this clinic, located in the poorest department in France, the carers like the proximity to their patients, the long-term follow-ups and the individual stories. Those who work here do so by choice, doing everything they can to care for at-risk women.
To many people, ‘we're still just birthing attendants’
Since agreements on France’s healthcare reform, known as the Ségur de la santé, were signed on July 13, Gantois has been gritting his teeth. Like many of his fellow midwives, he feels "despised" by the Ségur.
"The Ségur was an opportunity to recognise the profession of midwifery and to value it at its true worth. It was a failure," lamented Gantois, who has been a private midwife for six years and is president of the National College of French Midwives (Collège national des sages-femmes de France). "In the collective imagination, we are still birthing attendants. But we have evolved in both training and competence," he said.
Midwives complete five years of study, including a year of medicine and four years of specialisation in gynaecology and obstetrics. They can then perform hospital and home births as well as offering pregnancy monitoring, postpartum care, medical abortions and contraception, and responding to emergencies.
Mid-morning, loud crying rocked the tranquillity of the little house in Pré-Saint-Gervais. Behind closed doors, the distress of a mother-to-be was palpable. Gantois had just detected that her cervix was too dilated, which carries a risk of premature birth. The diagnosis was confirmed by ultrasound. Within 10 minutes, emergency services had whisked her away to her maternity hospital. "Her file has already been transferred," Gantois said, once the crisis had passed.
"The key to success is clear: We have to work hand in hand with the hospitals to streamline procedures. And that, too, escaped the attention of the Ségur, which did not aim to reform the system," he said with regret.
"The Ségur is a disgrace," said Gantois, going on to raise 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 asserted. "Midwives are respected in countries more advanced in gender equality, where the importance of women's health is recognised."
Cécile Caze, midwife coordinator of the Seine-Saint-Denis perinatal network, feels the same way. "We are 99 percent a female profession and, on top of that, we take care of women: it's a double disadvantage," she said.
Caze deplored the profession’s lack of political weight, with "only" 24,000 practitioners in France (compared to more than 700,000 nurses) they are rarely recognised and were excluded from the Ségur negotiations.
Under the agreed reform, midwives – who are considered part of the medical profession just like doctors and dentists – will receive a pay rise of €183 (net) per month. But they deplore the persistent lack of recognition.
"When [Minister of Health] Olivier Véran says that the wage increases are the fruit of trade union negotiations, we have to remember that the midwives' unions couldn’t take part in the Ségur and that the other unions do not recognise the specific nature of our profession," she said about comments made by Véran in a France 2 television interview last week, in which he insisted that midwives had not been “forgotten" in the push for reform.
Need for rest and recognition
The lack of representation is all the more difficult to swallow because, like other medical professions, midwives have remained on duty since the beginning of the Covid-19 crisis. "Women don't stop giving birth during Covid," said Caze, who, like Gantois, was part of the national crisis unit that worked throughout the lockdown.
Seine-Saint-Denis was one of the departments most affected by Covid-19 during the peak of the crisis – with more than 200 pregnant women testing positive for the virus – and the House of Doctors continued its mission without pause.
"We gave it everything," said Gantois. That included developing a coronavirus protocol, setting up teleconsultations, and continuing to offer emergency care and ultrasound scans.
Masks were bought at pharmacies, gowns were provided by town hall and hair nets were donated by a physiotherapy practice.
"We were like reeds in a storm," Gantois said. But their patients were able to rely on them.
Diagnosed with Covid-19 in February – six and a half months into her pregnancy – Rebecca was first referred to the emergency room and then prepared for the birth by teleconsultation and essential in-patient care. "I was told that the risk of fetal transmission was minimal, so I clung to that idea. The midwives reassured me," she recounted as she came out of her postpartum follow-up consultation.
Seine-Saint-Denis once again surpassed the alert threshold for Covid-19 with an incidence rate of 10.1 contaminations per 100,000 inhabitants in July, for the first time since the end of May. The midwives say they are more prepared than they were when lockdown began in March. They are also more tired.
Since coronavirus restrictions began easing in mid-May, in-person consultations have resumed under strict conditions and the schedule is full once again.
"The future generation of the lockdown," laughed Gantois, his blue eyes smiling above his mask. But the mask doesn't hide his exhaustion. "I need rest to be able to perform in case of a second wave. I also need some distance because the Ségur was the coup de grâce. If we are not OK, we can't provide good care. And that's what the ministries don't understand."
This article has been translated from the original in French.
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