While a majority of pregnancies are “physiological”i.e. without pathologylperinatal care should not be structured ” uniquely “ around the “very complex situations”argues the national college of midwives. In a recommendations report, he proposes “ three courses » monitoring adapted to the level of risk.
Faced with increasing infant mortality in France*, the government recently asked experts to make recommendations by June. Tuesday March 17, the national college of midwives (CNSF) published its report. Today, “a couple can consult a midwife, an obstetrician-gynecologist or a general practitioner”but it is common “that midwives follow pathological pregnancies and obstetrician-gynecologists follow physiological pregnancies”notes the CNSF, which recommends better identified roles, corresponding “to everyone’s skills”.
Adapted support
Environ “80% of pregnancies are low risk”observes the CNSF. In his 76-page report, he therefore proposes creating three distinct pathways: “Low risk, at risk and pathological”. Low-risk monitoring, which remains to be defined, would be carried out mainly by midwives in a “diversified offer of birthplaces” (maternity centers, birth centers or homes), suggests the college. The other two levels of risk “involve specific support” in “multidisciplinary teams” (gynecologists-obstetricians, pediatricians, anesthesiologists-intensivists, etc.) according to him.
The National College of Midwives also recommends “to set up dedicated spaces” low-risk and strengthen the number of midwives and childcare assistants in maternity units with a high volume of births to “avoid overmedicalization of childbirth” not requiring it.
In terms of prevention, the CNSF suggests making it compulsory at the start of pregnancy « with prenatal care » and the “designation of a reference midwife”. He also calls for the systematization of preconception consultation, which remains poorly understood and therefore too little carried out. It also calls for “strengthening the role of the co-parent”, in particular by allowing the future father “to be absent for all of the obligatory follow-up medical examinations”, and by encouraging his reception by arranging maternity rooms.
Postnatal follow-up must also be closer to “the mother and parenting support”and cover “at least the child’s first six months”. Finally, it calls for salary increases, particularly for units responsible for obstetric emergencies or technical childbirth procedures, and to facilitate “access to a mixed city-hospital activity” to midwives.
*France is one of the European Union countries most affected by infant mortality, while it was among the best ranked in the 1990s. Between 2011 and 2024, infant mortality increased from 3.5 deaths per 1,000 children to 4.1, according to INSEE. And this increase is mainly due to deaths of babies in their first month of life.
To find out more: Report of concrete recommendations for an expected reform, National College of Midwives.
