White paper in obstetrics: proposals to the future President of the Republic

This is the first time for the profession of a midwife. Seven representative organizations (CNOSF, CNSF, ONSSF, ANSFC, ANSFT, ANESF, CNEMa) have come together around a common project: a White Paper that brings together ten proposals aimed at women and men politicians for the next five years. ” In a complicated context for midwives but also for women and their families, it seemed fundamental to us to formulate proposals, accompanied by concrete actions, for midwives but also and above all for women, their health and their rights. Says their press release. Ladies and gentlemen, future elected officials, four areas are on the agenda.

Prioritize women’s sexual and reproductive health

In a France where 1 in 6 women does not have regular gynecological check-upswhere 60% of them have already given up gynecological care in their lifetime, even though a third of the morbidity of women of reproductive age is linked to sexual health problems, midwives are calling for a redesign of their function. If they are already an essential profession for women’s health, they want more than ever to be protagonists.

  • More rights for midwives

To this end, the White Paper proposes various initiatives. First of all, systematically mention midwives in all public health campaigns. Hence, the signatory midwives are asking to remove the limiting list of midwives’ prescriptions. In fact, at present, a midwife is more constrained than a gynecologist in prescribing drugs, medical devices and work stoppages. The maieutics also propose to develop a lengthy sexual health consultation, carried out by obstetricians and doctors, for adolescents, as well as for young adults.

It’s not about replacing gynecologists, but to adapt to the demands and needs of women in terms of health. ” The goal is not to claim prescription rights for the sake of claiming, but simply to be part of a thoughtful and efficient approach in terms of meeting the current health needs of women across all territories. Midwives are part of a prevention and primary care approach to be provided to the female population from adolescence to menopause. They exercise a regulated profession and could not prescribe treatment for ailments outside their area of ​​competence without being sanctioned by the authorities and their Order. Gynecologists are competent in fields of pathology very different from those of the obstetrician “, Underlines a representative of the 7 professional and trade union organizations that signed the White Paper.

  • Abortion at the center of tomorrow’s challenges

Since June 2016, liberal midwives have been able to perform medical abortions in their practices. After six years, many access difficulties remain (deadlines and places). ” They highlight the various studies and annual statistical data a highly variable abortion rate depending on the region and in certain areas. Due to the lack of competent professionals, the waiting times are too long. Reasons of geographical isolation, problems of insecurity, associated with a real ignorance of the organization of the health system and the territorial settlement of professionals, reinforce the difficulties of rapid access to care. It is clear that midwives are now becoming competent reference actors to accompany and take charge of medical abortions. Says the signatories of the White Paper.

According to the Decree n. 2021-1934 of 30 December 2021, the exercise of voluntary interruption of instrumental pregnancy in health facilities will be extended to midwives. This decision was also part of the White Paper.

Reorganize perinatal health

Since the 1970s, the number of maternity cases has continued to decline. A reality that, for our operators, hinders the quality of care and does not allow us to satisfy the wishes and needs of future parents. Midwives therefore urge us to rethink the care of women, parents and babies.

  • A woman, a midwife

For what you need strengthen staff and resources. The White Paper therefore proposes to review the perinatal decrees, to make the profession more attractive. ” The perinatal decrees of 1998 have become completely obsolete both from the point of view of safety standards in terms of premises, and from that of standards in terms of resources and professional skills. Says a midwife who signed the blank booklet we spoke to. In this sense, midwives, whatever their sector of activity, wish to benefit from healthy working conditions, not conducive to overwork or burn-out and whose pay allows them to live outside the sphere of precariousness. ” To increase the attractiveness of the profession, they must be fully recognized in their state of health to exercise their art in full autonomy, respecting their skills. Furthermore, the remuneration must also be commensurate with their responsibility. Then, the development of physiological units, birth centers must contribute to re-evaluate the work of the midwife both in health care facilities and in private practice. Furthermore, the White Paper aims to guarantee complete, coordinated and personalized support to pregnant women, from the pregnancy project to postpartum.

  • Develop alternatives to standardized childbirth

Today, most deliveries take place in a standardized way, sometimes to the detriment of the wishes of young parents. By strengthening maternity staff, midwives hope they can create real physiological units. They also aspire to ensure adequate and sustainable funding for birth and delivery centers in hospitals or at home, accompanied by a liberal midwife.

Promotion of women’s rights

  • For a better identification of obstetric, gender and sexual violence

The last few years have been the scene of the liberation of the feminine word, with great hashtags such as #Pay your uterus Where #EquilibriaTonPostPartum. However, despite having a prominent role in women’s health, midwives complain that they are not sufficiently trained in obstetric violence, but also in gender and sexual violence. For this reason, they aspire to make modules on violence compulsory from initial training and to enrich the offer of continuous training for all health professionals.

  • What about women with disabilities?

In addition, they also want to strengthen the initial training of midwives, so that they are able to provide the best possible follow-up to their patients with disabilities. ” We are not trained to handle patients with motor disabilities, unlike assistants and nurses. As midwives we must take care of all women and disability should not be a situation of marginalization of patients, even if France is a country far behind other European countries. Despite the legislative provisions, invalidity remains a cause of exclusion in terms of education, health, access to infrastructure, professional integration, but also social acceptance “, The community of signatory midwives shares.

Towards better recognition of the profession of midwife

The medical world is a vast world in which the midwife regularly fights to assert her place and field of action in the field of perinatality and reproductive health. »Regrets the authors of the White Paper. Currently, the profession of midwife is the lowest paid of all health personnel. Consequently, the White Paper wants to definitively recognize the medical character of midwives by reforming the statutes, in order to obtain remuneration accordingly. Finally, midwives want to introduce a sixth year of training, but also revise the programs of the first two cycles to better integrate the new skills, in particular.

Magicmaman supports the proposals of these seven organizations representing midwives at the dawn of this new five-year term. For better recognition of the profession. For more resources. So that women’s health is at the heart of tomorrow’s challenges.

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