Allow women who live far from their maternity to give birth without worrying about the route to be taken: this is in essence the purpose of a decree published in the Official newspaper April 29. From now on, pregnant women who live more than forty-five minutes from their maternity ward by car will be able to be accommodated near it for “five consecutive nights preceding the term”, in order to be sure to be there at the right time. In the event of a pathological pregnancy, this accommodation may be extended up to 21 nights.
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This system must enable women not to fear arriving too late at motherhood. An approach welcomed by Professor Olivier Morel, head of the obstetrics and gynecology center at the Nancy hospital and member of the National College of Obstetrician Gynecologists of France (CNGOF).
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Now, women “and their companions and their other children, he advances, will be accommodated in a place less stressful than the hospital, either in a non-medical wing, or in a hotel approved by the Health Insurance”. The doctor sees “a very good first step but which calls for a second: longer accommodation, because five days is not enough”.
” A false good idea ” ?
Despite its laudable intention, the text nevertheless worries other health professionals, who consider it at least not applicable, or even a source of abuse. It thus constitutes a “fake good idea”according to Isabelle Derrendinger, president of the national council of the Order of midwives, who questions the method of calculating the deadline. “Five days before the end, that doesn’t mean anything”, she confirms, supporting figures.
According to data from the Épopé perinatal study (Obstetrical, perinatal and pediatric epidemiology) conducted by Inserm in 2016, only 0.4% of deliveries take place in the five days preceding the term, she argues. : “This measure will therefore only concern very few people”, unless we multiply induced deliveries, “in order to get into the nails of the five days”she worries.
The risk of further medicalizing births
A risk also identified by certain doctors including Professor Philippe Deruelle, head of the obstetrics gynecology department at the Strasbourg University Hospital. “If, of course, it is positive to try to remedy the problem of the remoteness of maternity wards, we will perhaps end up medicalizing births a little more, according to him. It is very possible that women will ask to be triggered more and more often. » This technique which consists in creating contractions by injections of oxytocin, the natural hormone of birth, or by the application of a prostaglandin gel allows a vaginal delivery.
“A large international study has established that labor can be safely induced between one week after the 8th month and one week after the 9th month”, specifies Philippe Deruelle. What convince medical teams to take the step more and more often, to combine the wishes of their patients and their service constraints? He does not rule out this hypothesis.
“A part of unpredictability”
Nevertheless, if such an evolution were to take shape, “it would constitute a setback in the rights of patients, Isabelle Derrendinger alert. I would find it extremely regrettable if women were to have some form of control imposed on this very special moment of birth. Childbirth always involves an element of unpredictability and denying it is a total contradiction with the rights of users guaranteed by the Kouchner law”.
Also, the Order of Midwives calls for the holding of general states of birth, “in order to tackle the causes of the problem – the policy of closing maternity wards for decades – and not its effects. The French must be able to say what they consider to be a birth and its human accompaniment in 2022 ”.