After Covid-19, Ségur de la santé treats “coup de grace” to midwives

On the front lines during the peak epidemic Covid-19, midwives feel forgotten by the agreement with Ségur de la santé. A “missed opportunity” to recognize this profession but still be mobilized daily for women’s health. Report to Maison des médecins du Pré-Saint-Gervais, in Seine-Saint-Denis.

Adrien Gantois, Midwife and President of the French National University, 25 July 2020, at the Maison des médecins du Pré-Saint-Gervais (Seine-Saint-Denis). © Sarah Leduc, France 24

Colored road, safety distance, three spacious waiting rooms: one for pregnant women, one for patients with Covid-19 symptoms and one last for “classic” patients. The team of four midwives, including two sonographers, and four general practitioners have put everything in place to ensure a safe and peaceful climate in the Maison des médecins du Pré-Saint-Gervais, in Seine-Saint-Denis (93). On July 25, midwife Adrien Gantois receives her first patient at 21.15 with a relaxed smile. He calls her by her first name, address and knows her file by heart. It is a first pregnancy and every patient deserves to be surrounded, listened to and insured. “Here I have complete confidence, I even recommend the house to my patients,” says France 24 Malyza, himself a general practitioner, who came from Montreuil.

In this city cabinet, located in the poorest department in France, caregivers like the closeness to their patients, the follow-up in the medium and long term and individual “stories”. It is not uncommon to hear that we do not work in “9-3” by chance. 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 has been whining his teeth. Like most of his midwife colleagues, he feels “despised” by Ségur. Of course, the profession will benefit from a revaluation of 183 euros net per month. However, this increase is adapted to paramedical professions, while midwives are part of the medical professions, such as doctors and dentists.

“Ségur was an opportunity to recognize the profession of midwife and to promote it to its true value. It is a failure,” laments Adrien Gantois, a midwife who practiced privately for 6 years and chair of the National College of Midwives of France. “In the collective imagination, we are still midwives. But we have developed in education and skills,” he insists.

Midwives follow five years of study, including one year of medicine and four others with a focus on gynecology and obstetrics.They can then provide hospital and home deliveries, but also follow-ups of pregnancy, care after birth, medical abortions, contraception or gynecological follow-up. And of course diagnose emergencies.

Saturday, in the middle of the morning, high tears will tear the peace in the small house Pré-Saint-Gervais. Behind closed doors, the future mother’s need is growing. Adrien Gantois has just discovered a neck that is too open, synonymous with the risk of giving birth prematurely. The diagnosis is confirmed by ultrasound. Less than ten minutes later, Samu transports the patient to the emergency room at her mother’s hospital. “His file has already been transferred,” says Adrien Gantois as the pressure drops. “The key to success is there: we have to work hand in hand with hospitals. Streamline healthcare pathways. And so did Ségur, who did not have the ambition to reform the system,” he laments.

The profession is not represented at Ségur

“This Segur is a sin,” he adds, picking up another point that makes him brush. “The fact that midwives are forgotten is a political and symbolic mistake that says a lot about the patriarchy in France,” he claims. “Midwives are respected in more advanced countries when it comes to gender equality, where the importance of women’s health is recognized.”

The same analysis from Cécile Caze, midwife coordinator for the Seine-Saint-Denis perinatal network. “We are 98% a female profession and we also take care of women: it is a double burden!”, She says. She deplores the lack of professional political weight that brings together “only” 24,000 people in France (against more than 700,000 nurses). In addition to not acknowledging their status, she regrets their exclusion from the Segur negotiations.

“When Olivier Véran says that the upgrades are the result of trade union negotiations, it should be remembered that midwives’ unions could not 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 insured France 2 on 22 July that “midwives are not forgotten at all”.

Midwives, “sharp in the storm” from Covid-19

Birth control pills are all the more difficult to swallow because, like other medical devices, midwives have been on the bridge since the onset of the Covid-19 crisis. “Women do not stop giving birth under Covid,” continues Cécile Caze, who, like Adrien Gantois, participated in the operational national crisis unit throughout the containment.

Located in the 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: preparation of a protocol, preparation of teleconsultation, continuation of emergency care and ultrasound examinations with available means – masks bought in pharmacies, canteens dresses available at City Hall and the charlottes given by a physiotherapy practice … “We was like sharp in the storm, “Adrien ignites. But women could hold on to it.

Diagnosed positively for Covid-19 in February, six and a half months before her pregnancy, Rebecca was first taken to the emergency room and then benefited from the preparation for birth by teleconsultation and the necessary face-to-face: “explained that the risk of fetal transmission was minimal, “I stuck to this idea. The midwives reassured me,” she explains, leaving her follow-up consultant after the birth.

Need for rest and recognition

At the end of July, when the Seine-Saint-Denis crossed the Covid-19 watchdog threshold – with an incidence of 10.1 pollutants per 100,000 inhabitants registered during the week of 6 to 12 July, which had not happened since the end of May – the midwives confirm that they feel a “tremor”. They say they are more prepared than in March last year. More tired too.

Since the end, consultations have resumed under restrictive sanitary conditions and the schedule is not empty for pregnant women: “The future generation of containment”, laughs Adrien, whose blue eyes we only see smiling, above the mask. But he does not hide his exhaustion. “I need a rest to be able to secure in the event of a second wave. I also have to go back because Segur was the state coup. If we do poorly, we can not follow good quality. The ministries can not understand.”