The serious dysfunctions observed at the maternity hospital in Dourdan led the ARS to suspend its activity. This case revives the debate on safety in small maternity hospitals.
The death of an infant in the maternity ward of the Sud-Essonne hospital in Dourdan is reviving the debate on safety in maternity wards. In fact, this maternity unit is a level 1 establishment. Since a decree of October 9, 1998, French maternity units have been classified into three large groups according to the level of care provided to newborns. The objective of these texts was to improve the safety of births by directing mothers to the level structure adapted to their pregnancy.
“Underfunded” level 1 maternities
Level I corresponds to the obstetric units which take care of normal pregnancies, divided equally between private clinics and public establishments. Level II maternities are equipped with a neonatal unit and a distinction is made between IIa and IIb depending on the presence or absence of intensive care beds for newborns. Level III concerns high-risk pregnancies, it is almost exclusively public hospitals with a neonatal intensive care unit and an adult intensive care unit. But, “we underfunded level 1 maternities and the act of normal childbirth. As a result, these maternity hospitals have gradually found neither birth attendants nor patients, so we have closed them ”, confided last February Dr. Bertrand de Rochambeau, obstetrician-gynecologist in Marne-la-Vallée (77) to why actor. Level 2 and 3 maternities therefore now provide 70% of deliveries in France, according to the 2010 perinatal survey against 63% in 2003. However, 80% of deliveries take place under normal conditions.
Safety of care depends on the number of deliveries
In addition, some of these level 1 maternities deliver fewer deliveries than the average. However, as Professor Guy Vallancien wrote in 2006 in a report on “The evaluation of the safety, quality and continuity of surgical care in small public hospitals in France”, “the relationship between the quality of acts and the operating volume per hospital and per surgeon have been the subject of numerous Anglo-Saxon publications. The results show a significant difference in mortality depending on the volume of operative procedures depending on the hospital and in a hospital depending on the surgeon himself. “
While no French data has evaluated this phenomenon, France has become aware of this problem since, in 1998, a decree aimed at improving the safety of care at birth was published. It imposed the cessation of activity of the maternities most “at risk”, those carrying out less than 300 deliveries per year. The maternity of Dourdan assured, it seems the double. But with some 600 deliveries per year, this service is now a small maternity hospital. In fact, the average number of deliveries per maternity unit has practically tripled in thirty years, going from 528 in 1975 to 1,357 in 2007.
20% of small maternities closed in 10 years
The movement to close small maternity hospitals was therefore massive. According to a study by the Ministry of Health published in 2012, between 2001 and 2010, a fifth of maternity hospitals closed, while at the same time the number of deliveries increased by 5%. However, this drop in the number of maternity hospitals did not translate into an increase in travel time for expectant mothers. The very exceptional risk of giving birth on the road has therefore not increased. Half of women take less than 17 minutes to give birth. The proportion of deliveries carried out more than 30 minutes from home is stable (23%).
In addition, small maternities are not necessarily doomed to closure. The very media story of the Carhaix maternity hospital provides a good example. On March 30, 2008, all the inhabitants of the small Breton town took to the streets to protest against the relocation of maternity and surgical services from the hospital to Brest. A mobilization that lasted 8 months, with demonstrations and petitions, with a single objective to maintain health services in Carhaix.
The example of the Carhaix maternity hospital
Today at Carhaix hospital, the services that were threatened with closure are still there and especially in operation. Indeed, following the mobilization, the Carhaix Hospital Center finally merged with the Brest University Hospital.
By merging the 1er July 2009, the small establishment benefited from a large-scale investment plan. More than 1.7 million euros have been invested in Carhaix in 3 years. New equipment has been purchased in several departments, the infrastructure has been improved, and above all the nursing teams have been strengthened thanks to professionals from the Brest University Hospital who came to lend a hand to the Carhaisian teams. Bernard Dupond, director general of the CHRU de Brest interviewed by pourquoidocteur in July 2012, confided that “Thanks to the merger, today for a woman, giving birth in Carhaix does not constitute risk taking. “
In Dourdan, there is no question for the moment of closing or even of merging with another establishment. Thomas Talec, the director of the maternity unit, told the microphone of Europe 1 that “the emergency procedures were reviewed immediately and the nursing staff will be increased without delay. Job interviews are scheduled for next week because our very firm desire is to reopen the maternity hospital in a month ”.
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