Small maternities: should they be closed?

► “It’s heresy from the point of view of women’s safety”

Michele LeflonPresident of the National Coordination of Defense Committees for Local Hospitals and Maternities

Our coordination remains opposed to the closure of small maternities. To say that all women must give birth in large centers is heresy from the point of view of their safety. This amounts to taking into account only security between the moment of entry into the maternity ward and the moment of exit. But this does not take into account pregnancy as a whole. Pregnant women may need sometimes urgent consultations. If the nearest maternity ward is two hours’ drive from their home, they will hesitate to move, especially when they have no easy means of transport, for example because their husband uses the family car to go to work.

There are also regular accidents related to transport time at the time of childbirth. No territory is immune. For us, closures are all the more an aberration as medical progress has made it possible to better select high-risk pregnancies, and therefore to direct the women concerned to major centres. It’s a bit silly to force all women to give birth in large centers, when these large maternity hospitals are not necessarily able to accept all deliveries. This type of situation can also lead to problems, as we have seen in the Paris region. There is therefore no reason not to leave level 1 maternities (those for deliveries a priori without risk, editor’s note) in all the territories.

The debate is not new, it comes up regularly in the news. In our view, this is part of a desire to save money, more than a medical and health logic. A number of maternities are currently in the hot seat. When we look at the arguments given to support their closure, it is a question of the lack of personnel. But it is not the same socio-professional category that is lacking everywhere. In Guingamp, in Brittany, they talk about the lack of midwives; in Autun, in Burgundy, the lack of paediatricians; in Ganges, in Occitania, the lack of gynecologists; in Sedan, in the Ardennes, the lack of anaesthesiologists… Shortages have been constructed to lead people to say: “You see, the maternity ward must be closed! »

These closures are also a factor in the deconstruction of a territory. You are not going to attract young couples, who plan to have children, in places that are an hour’s drive from a maternity hospital. It should be half an hour or 45 minutes, at the most. This affects the whole of France and the question of maternity wards mobilizes a lot, we can clearly see this through our coordination.

► “We don’t have enough specialists to run the small maternities”

Israel Nisandgynecologist-obstetrician at the University Hospitals of Strasbourg, former president of the National College of French Gynecologists-Obstetricians (CNGOF)

I am not in favor of maintaining small maternities. In these establishments, there is no anesthetist, no pediatrician and no operating room. Today, they have a threshold of 500 births per year, which corresponds to one or two births in 24 hours. With this frequency, a gynecologist-obstetrician loses his expertise.

These small maternities should not be closed, but transformed to become local perinatal centers (CPP). The latter are already present in around twenty regions in France, where the nearest maternities are not sufficiently accessible. Women can follow up on their pregnancy there and, for example, have their ultrasound check-ups done there. In these structures, on-call midwives may be present to ensure an emergency delivery. But, in the majority of cases, the mother-to-be can go to a slightly more distant maternity ward, where she will be accompanied by the medical team necessary for the smooth running of the birth.

Hospital transport systems can also be set up. For example, for those who live in inaccessible places in the Alps, it would be necessary to install a kind of hospital hotel near the hospital in Grenoble, where the price of the nights would be low, and reimbursed by Social Security. So the mother-to-be could come to this hotel only ten days before her due date. Thus, it would be close to a maternity hospital capable of hosting childbirths.

Removing small maternities does not mean saving staff, to do so would be to the detriment of women’s health. Specialists from small maternities could then join the largest structures. We are already understaffed in small establishments and the problem will get worse. Young specialists do not want to settle in an isolated place to join a team of three people. In addition, with about one delivery per day, the young specialists do not practice enough and end up getting bored and leaving.

In France, 50% of births do not go as planned. That is to say, they require a caesarean section, the use of forceps or the resuscitation of the mother. In a maternity ward, you have to be able to respond to a total emergency in two minutes, to have the blood needed for a patient who is hemorrhaging, for example, and this is not the case with small maternity wards. Each death in childbirth is an absolute disaster, and this tragedy affects 80 women in France each year. We cannot be both for the safety of mothers and children and against the closure of small maternity wards.

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