Question 1358 — women

Summary

Ms. Huguette Tiegna draws the attention of the Minister of Health and Prevention to the care of pregnant women, from pregnancy to childbirth, in rural areas. Between 2000 and 2017, the share of women of childbearing age living more than 45 minutes from a maternity ward increased. This overall observation, corroborated by the various measurement tools that can be used, results from two opposite effects: the evolution of the The distribution of women of childbearing age across the territory has rather led to them being brought closer to maternity wards but, at the same time, many maternity wards have closed since 2000 and this latter effect prevails. At the department level, the situation is contrasted: accessibility is deteriorating in Lot, Nièvre and Cantal, where the effect of maternity hospital closures on access time is significant; conversely, the share of women far from maternity wards is reduced in the two departments of Corsica and in the Alpes-de-Haute-Provence, because more of them live near the establishments. The decision to close maternity wards in France has often been based on considerations of safety of care: the maternity wards which close are smaller and those which remain are larger. They achieve more of deliveries and they have specialized in the care of high-risk pregnancies, such as type 3 maternity wards. Accessibility to the latter is stable between 2000 and 2017 even if, in eleven departments, women of childbearing age all live more than 45 minutes from a maternity ward of this type. In a context where the methods of monitoring pregnant women have evolved since 2007 with, among other things, the reduction in the number of maternity centers before 2017 and the experimentation of birth centers, it seems necessary to develop an efficient network plan for the care and support of pregnant women for the years to come. As a reminder, birth centers, managed by midwives, are adjacent to a health establishment with which they enter into an agreement, which guarantees better quality and safety of care in the event of complication or need for transfer. They offer women less technical support for pregnancy, childbirth and postpartum monitoring; on the other hand, they do not provide accommodation for parturients and their newborns, nor care for obstetric emergencies. Only pregnant women at low risk of pregnancy and childbirth are affected by these structures. As such, the experimentation of birth centers received a positive assessment: it established in particular that the safety of care was permanently ensured and that it even improved during the experiment, the birth centers having made adjustments in the care to better respond to emergency situations. In addition, the principles of care, eligibility, reception time for parturients, monitoring of the mother and the newborn were respected. Likewise, support for parenthood has been particularly developed in the projects. Thus, she asks him how he intends to adapt the French birth rate policy to new practices for monitoring pregnancy and childbirth and whether he plans to implement a new plan for efficient networking of care provision for pregnant women in the territories.

Machine translation from French. The official text remains authoritative.

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