Colored route, safety distances, three spacious waiting rooms: one for pregnant women, one for patients with Covid-19 symptoms and a final one for “classic” patients. The team of four midwives, including two sonographers, and four general practitioners has put everything in place to guarantee a secure and serene climate in the Maison des médecins du Pré-Saint-Gervais, in Seine-Saint-Denis (93).
Saturday July 25, Adrien Gantois, midwife, receives his first patient at 9.15 am with a smile and relaxation. He calls her by her first name, familiar with her and knows her file by heart. It is a first pregnancy and each patient deserves to be surrounded, listened to and reassured. "Here, I have complete confidence, I even recommend the house to my patients," says France 24 Malyza, herself a general practitioner, who came from Montreuil.
In this town office, located in the poorest department of France, the caregivers like the proximity with their patients, the medium and long-term follow-up and the individual "stories". It is not uncommon to hear that we do not work in the "9-3" by chance. So everything here is done to protect women from external turpitudes.
"In the collective imagination, we are still midwives"
However, since the signing of the Ségur de la santé agreements on July 13, Adrien Gantois grits his teeth. Like most of his midwifery colleagues, he feels "despised" by Ségur. Certainly, the profession will benefit from a revaluation of 183 euros net per month. But this increase is adjusted to that of the paramedical professions, while midwives are part of the medical professions, just like doctors and dentists.
"The Ségur was an opportunity to recognize the profession of midwifery and to promote it at its fair value. It is a failure", regrets Adrien Gantois, midwife practicing in private for 6 years and president of the National College of midwives. women of France. "In the collective imagination, we are still midwives. But we have evolved in training and skills," he insists.
Midwives follow five years of studies, including one year of medicine and then four more specializing in gynecology and obstetrics.They can then provide deliveries in hospital and at home, but also pregnancy follow-up, postpartum care, medical abortions, contraception or gynecological follow-up. And of course, diagnose emergencies.
Saturday, in the middle of the morning, loud tears come to tear the tranquility of the small house of Pré-Saint-Gervais. Behind closed doors, the distress of a future mother is palpable. Adrien Gantois has just detected a neck that is too open, synonymous with the risk of giving birth too early. The diagnosis is confirmed on ultrasound. Less than ten minutes later, the Samu transports the patient to the emergency room of her maternity hospital. "His file is already transferred," said Adrien Gantois when the pressure subsides. "The key to success is there: we have to work hand in hand with hospitals. Streamline the care pathways. And that too escaped Ségur, which did not have the ambition to reform the system" , he regrets.
The profession not represented at Ségur
"This Segur is a disgrace," he adds, raising another point that makes him bristle. "The fact that midwives are forgotten is a political and symbolic fault that says a lot about patriarchy in France," he asserts. "Midwives are respected in more advanced countries in terms of gender equality, where the importance of women's health is measured."
Same analysis from Cécile Caze, midwife coordinator of the Seine-Saint-Denis perinatal network. "We are 98% a female profession and in addition we take care of women: it's double the trouble!", She quips. She deplores the lack of political weight of the profession which brings together "only" 24,000 people in France (against more than 700,000 nurses). In addition to the non-recognition of their status, she deplores their exclusion from the Segur negotiations.
"When Olivier Véran says that the upgrades are the result of union negotiations, it must be remembered that the midwifery unions were not able to sit in Ségur and that the general unions do not recognize the singularity of our profession", specifies -she, in response to the Minister of Health who assured France 2 on July 22 that "midwives are not at all forgotten".
Midwives, "reeds in the storm" of Covid-19
The pill is all the more difficult to swallow as, like other medical bodies, midwives have been on the bridge since the start of the Covid-19 crisis. "Women do not stop giving birth during the Covid", continues Cécile Caze, who participated, like Adrien Gantois, in the operational national crisis unit throughout the confinement.
Located in Seine-Saint-Denis, one of the departments most affected by Covid-19 during the peak of the health crisis, with more than 200 cases of pregnant patients diagnosed positive for the virus, the Maison des médecins du Pré- Saint-Gervais carried out its mission without interruption. "We gave everything", assures Adrien Gantois: drafting of a protocol, setting up of teleconsultation, continuation of emergency care and ultrasound scans with the means at hand - masks bought in pharmacies, canteen gowns made available by the town hall and charlottes given by a physiotherapy practice… "We were like reeds in the storm," Adrien ignites. But women were able to hang on to it.
Diagnosed positive for Covid-19 in February, six and a half months before her pregnancy, Rebecca was first referred to the emergency room and then benefited from preparation for birth by teleconsultation and the necessary face-to-face care: explained that the risk of fetal transmission was minimal, I clung to this idea. The midwives reassured me, "she explains, leaving her postpartum follow-up consultation.
Need for rest and recognition
At the end of July, while Seine-Saint-Denis is back above the vigilance threshold for Covid-19 - with an incidence rate of 10.1 contaminations per 100,000 inhabitants recorded in the week of 6 to 12 July, which had not happened since the end of May - the midwives confirm they feel a "shudder". They say they are more prepared than last March. More tired too.
Since the deconfinement, consultations have resumed under restrictive sanitary conditions and the schedule is not empty of pregnant women: "The future generation of confinement", laughs Adrien, whose blue eyes we can only see smiling, above the mask. But he doesn't hide his exhaustion. "I need a rest to be able to ensure in the event of a second wave. I also need a step back because the Segur was the coup de grace. If we are doing badly, we cannot follow up with good quality. can't understand the ministries. "
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