From pain management to the prevention of complications, pregnancy monitoring for French women is improving, despite an increased presence of risk factors.
Preparatory interviews, screening, care… Care for pregnant women is improving in France. According to the perinatal survey, carried out by Inserm and DREES, their monitoring is increasingly approaching official recommendations.
Risk factors persist during pregnancy … but according to the submitted report this October 11, the improvements are numerous. The only downside: bad reflexes that persist on the side of health professionals and patients.
Too much tobacco
First weak point: too many women smoke during pregnancy. One in five keeps this bad habit during gestation. That is as much as in 2010, despite repeated alerts from health authorities. Indeed, exposing the fetus to tobacco smoke promotes complications and miscarriages.
“We are already starting with an unfavorable framework, concedes Béatrice Blondel, who coordinated the study. The proportion of women who smoked before pregnancy has not changed since 2010. Then we can see that there are no more stoppages. Weaning is all the more difficult as only one in two parturients has received advice on smoking.
Beyond behavior, women themselves have more risk factors compared to 2010, the date of the last such survey. “The general context means that the fertile life of women starts later,” explains Béatrice Blondel to Why Doctor. The duration of schooling, the time before obtaining a stable job or being in a stable couple is lengthening. “
Thus, one in five expectant mothers is over 35 years old, against 19% in 2010. Here again, a late maternal age increases the risk of complications. More worryingly, the BMI of pregnant women continues to increase. 12% of them are obese and 20% overweight. And the situation in the overseas departments and regions (DROM) is even worse.
Respect for the rules
Territorial disparities also apply to health professionals. 28% of women benefited from an early prenatal interview… but this rate varies greatly depending on where the pregnancy takes place.
Béatrice Blondel puts forward two reasons for this: not all women are interested in this service. And “it is difficult to organize such an interview,” she underlines. We can see that this strongly depends on the regions, on the way in which the interview is organized and on the availability of women to go there. “
In terms of compliance with recommendations, however, all is not gloomy. Routine screening for diabetes is declining, for example, to reach 73% of women. A good reflex, since the authorities are now pleading in favor of targeted screening.
“These results demonstrate a concern not to perform too many procedures, to align with scientific knowledge and clinical practice recommendations,” says Béatrice Blondel. They are the benchmarks for practitioners and midwives. “
Better chosen acts
Likewise, the rate of amniocentesis has fallen sharply – from 9% to 3.5% – since screening for trisomy 21 is no longer recommended routinely after 38 years. The finding is just as positive in the labor room, where cesarean sections and episiotomies continue to decline.
There is still room for improvement, admits Béatrice Blondel. But overall, France is rather on the right track. “Episiotomies are performed in 20% of cases that did not require a cesarean,” illustrates the researcher. The European countries which are concerned about this question are between 10 and 20%. “
Result: the women are very largely satisfied with their care. And particularly welcome the pain monitoring. 88% of them say they are satisfied with the way their suffering has been treated.
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