A report by the head of the maternity department at the Necker hospital in Paris, Yves Ville, considers it necessary to “regroup” small maternity wards “in the name of the safety of the mother and the child”. Can these establishments close and why?
“It’s hard to hear but we have to group together the small maternities.” This is the conclusion of the report presented by Yves Ville, head of the obstetrics gynecology department at the Necker hospital, in Paris, before the Academy of Medicine, Tuesday February 28, 2023. The specialist and 14 of his colleagues looked into the question of maternities which, for some, struggle to keep their heads above water. It is especially the smallest maternities that are the subject of fear because the doctor and academician is categorical about the fate of a hundred small obstetric services as reported The Parisian : “We must bring together 100 maternities in France in the name of the safety of the mother and the child. If we do not do this, we are heading for disaster”.
A solution must be found urgently according to him, as much for future parents as for health professionals because the maintenance of these maternities “is illusory, in the long term, they will end up closing”.
Why should maternities close?
One and the same cause is responsible for the risk of closure of certain maternities and the already recorded lowering of the curtain of several establishments: the lack of personnel. The number of obstetrician doctors and midwives is no longer sufficient to meet all needs and hold all services, according to Yves Ville. The healthcare professional explains in The Parisian that in places, maternity wards have already reduced the working hours by closing a few days a week. Schedule arrangements to which are added other moderately satisfactory solutions: “We practice fewer deliveries there, we lose experience, which is dangerous. To continue to shoot, they call on temporary workers. This organization in the form of patches does not ensure the safety and quality of care.”
What future for small maternities?
Suffering from the lack of personnel and gradually neglected by future parents who most often approach large medical establishments – of type 2 or 3 – the hundred or so small maternities are not condemned to closure. If the head of the maternity department at the Necker hospital in Paris maintains that “we can no longer continue to give birth” in these services, he explains that these maternity units could only be responsible for monitoring large pre and postpartum births through transfers. young mothers a few hours after birth. This is one of the lines of thought envisaged by Yves Ville in his report which calls for “the adoption of an ambitious perinatal plan is an emergency and a public health priority”.
Small or large maternities, what are the differences?
If they are distinguished by the size and the number of beds, the maternities also differ according to the services available on the site. There are three types of maternity wards: those of type 1 only have an obstetrics department, those of type 2 can offer neonatology care (2a) or have access to intensive care in neonatology (2b). Finally, type 3 maternity wards offer both an obstetrics, neonatology and neonatal intensive care service in addition to a neonatal resuscitation service.
The closure of maternity wards, the subject divides
Barely shared before the Academy of Medicine, Yves Ville’s analysis divides. “We are completely against it”, reacted strongly Michèle Leflon, president of the national coordination of the defense committees of local hospitals and maternity wards, in the columns of the Ile-de-France newspaper. His main argument? The lengthening of distances and travel times for pregnant women, insisting: “It is a terrible anguish for women to give birth far from home!”
Many small maternities are found in rural areas, far from major hospitals, and sometimes in medical deserts. No longer scheduling deliveries in these establishments would therefore mean that future mothers would have to drive more than 30 or 45 minutes to give birth in a larger maternity ward. But to this argument, the 15 authors of the report, including Yves Ville, respond: “89% of births would take place at most thirty minutes from the nearest maternity hospital, 3% more than 45 minutes away, i.e. an increase of 1.8% and 0.9% over one hour.”