2024-05-06 15:53:07
In a maternity ward, in Sarlat, in Dordogne, in 2023. PHILIPPE LOPEZ / AFP
Should small maternity wards be closed? Give up structures that do not reach a certain threshold of deliveries per year, in the name of secure care, or leave establishments and services open, in the name of a territorial network as close as possible to future parents ? The question has regularly come up in the news for several decades, following tensions in the provision of care and alerts launched by caregivers and doctors.
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A report devoted to perinatal policy that the Court of Auditors made public on Monday, May 6, once again puts the subject in the spotlight by inviting public authorities to take it up. Officially, the Court of Auditors does not position itself “for” or “against”: ” It’s not our role “, argued its first president, Pierre Moscovici, to the press. “But it is urgent to take stock of the situation”, he defended, with a clear line: “In the trade-offs between accessibility and security, we recommend moving towards security. »
The provision of care is judged “unsuitable” to current issues: “The organization of care and the quality of care play a decisive role in the prevention of risks and damage in terms of perinatal health, particularly during childbirth and the aftermath of birth.considers the Court. However, the current situation does not meet the requirements for optimal security or efficiency in the organization. »
In the viewfinder: around twenty maternity hospitals – from Guyana to Corrèze, from Dordogne to Savoie via Ariège – which deviate from ” always “ at the minimum threshold of 300 annual deliveries, set in 1998 with regard to requirements for quality and safety of care. The rapporteurs go further: “The observation of the growing difficulties of maternity units ensuring less than 1,000 annual deliveries in attracting and retaining qualified personnel calls for a case-by-case analysis of the conditions for carrying out their missions. »
Main “poor” indicators
A speech which joins a report published at the beginning of 2023 – also cited by Mr. Moscovici – carried by Yves Ville, head of the obstetrics department at Necker hospital, in Paris, and distributed by the Academy of Medicine: he had relaunched the debates, judging “illusory to support” maternity units carrying out fewer than a thousand deliveries per year. The closure movement is in reality already underway: in forty years, the number of maternity hospitals has been divided almost in half, causing concern and opposition from many elected officials, caregivers and patients. Questioned on numerous occasions, the government has, until now, not made a clear decision. “The only course is to maintain the provision of local care on the condition of guaranteeing the quality and safety of care”we indicate in the entourage of the Minister for Health, Frédéric Valletoux.
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