A summer air hovers over the Pink City. In mid-October, the Toulouse thermometer displays a temperature that flirts with 30°C. It’s not just on the banks of the Garonne that summer goes into extra time. At the maternity hospital of the CHU Paule de Viguier, the lack of midwives plunges the staff back into their summer torments, forced to adapt to the reduced workforce. A situation far from being isolated in French maternity wards.
Usually, the planning puzzle is reserved for the months of July and August, because of the holidays. But this year, for lack of applications for replacements, difficulties strike again for All Saints’ Day. Despite returning from vacation and the recruitment of twelve midwives at the Toulouse University Hospital, two half-days of acupuncture consultations (out of four usually) will be canceled for two months. “Except recruitment, we are obliged to extend this arrangement until the end of December, because the period is very tense”justifies Nathalie Laurenceau, coordinator in maieutics.
These restrictions are causing concern within the service. “This means that we will still withdraw staff, acupuncture, preparations for birth to put midwives back in services in tension, such as childbirth blocks”dreads Johanne Reynaud, midwife in the Toulouse establishment, member of the Unsa union and the Union of Midwives (UNSSF). “It is not with lightness of heart that we are eliminating these activities [d’acupuncture], assures Nathalie Laurenceau. We preferred to operate this way so that everyone had their holidays.
The situation is all the more worrying as Toulouse is a department in an “intermediate zone”, according to data from the Regional Health Agency (ARS) of Occitanie dating from 2017 and cited by France 3. “For this summer, we managed to close the schedules with accuracy”, notes Stéphanie Mothe, member of the Council of the midwives of Haute-Garonne. But according to her, it was a long process.
“At the moment, we are going to see the students on internship with us to tell them what we have to offer them next summer”, explains Nathalie Laurenceau, who is obliged to see far. A recruitment policy has been put in place, with immediate hiring on permanent contracts, integration at the second level rather than the first, for a first salary of around 2,200 euros net. “It’s still not huge after five years of studyshe concedes, but six months ago, we were at 1,900 euros”. Paul Guerby, gynecologist and head of department at Toulouse University Hospital, agrees: “We try as much as possible to be attractive, because we know that if we don’t do that, we are heading straight for disaster.”
Nearly 700 kilometers away, in Montreuil (Seine-Saint-Denis), the executives of the André Grégoire hospital also had to resolve to reduce the airfoil, even more drastically. From November, the number of registrations of pregnant women at the maternity ward will be reduced to 270 per month, excluding high-risk pregnancies. Ordinarily, the number of births is not limited. In November 2020, this maternity ward saw the birth of 358 babies. In November 2021, the number of registered births was 333. For the month of November 2022, 238 women are already registered (as of October 20).
This option has become, over the weeks, the only possible outcome. Since the start of the school year, he has been “decided to concentrate the activity of midwives in the delivery room”regrets Patrick Daoud, pediatrician and head of the hospital centre. “But even with this mode of operation, we can’t do it. We are therefore forced to close a wing of diaper suites and we are going to try to hold on by setting up an ultra-early exit program, within 24 hours” after childbirth.
Seine-Saint-Denis is particularly affected by the shortage of midwives, with an average of 67 practitioners per 100,000 inhabitants in September 2022, when the national average stands at 139 midwives per 100,000 inhabitants, according to the ARS from Ile-de-France (in PDF). A particularly derisory rate when, less than four metro stations away, in Paris, the rate is almost three times higher (194 midwives per 100,000 inhabitants).
This lack of personnel goes beyond the borders of Ile-de-France and Occitania. The National Council of the Order of Midwives warned on October 13 about the number of radiations of professionals of working age (people who leave the Order to retire or retrain), which exploded ( +112% in the first half of 2022). “This phenomenon contributes to further degrading the quality and safety of care but also the conditions of practice, thus leading midwives and students to flee the profession”warns the Order in its press release.
However, despite the difficulties encountered by the profession, it is increasingly sought after by women who give birth. For nearly 40% among them, it was a maieutician who was the main person responsible for monitoring in the first six months of pregnancy, in particular in the liberal sector, notes an Inserm study published on October 6. And this figure has increased significantly since 2016, notes the institute, in a context where the number of gynecologists who practice in private practice continues to fall at the same time.
“When I left school ten years ago, we really had to show that we were motivated to work in the hospital, because there were a lot of requests. Today, we are no longer everything in this situation.”
Stéphanie Mothe, member of the Council of the Order of Midwives of Haute-Garonneat franceinfo
What worries midwives the most is that this shortage is recent and unprecedented in its magnitude. “For years, the watchword was to reorganize the services with constant staff. It was very complicated. We managed, but no FTE [équivalent temps plein] wasn’t unlocked”remembers Johanne Reynaud. “Today recruitment is open, but there are no more midwives applying.” Same observation in Montreuil, where Patrick Daoud assures that within his service, beyond recruitment, he seeks above all to limit the bleeding. “That’s why we limit registrations [pour accoucher], he justifies. We are very careful.”
If the discourse is so pessimistic, it is because the medium-term situation seems to be at an impasse. In addition to the difficulties in recruiting, the profession is facing a vocation crisis “unpublished”. “At the start of the 2022 school year, nearly 20% of places in the second year of midwifery studies remained vacant”, alerted on October 13 the National Council of the Order of Midwives and the National Association of Student Midwives (ANESF). And this, not to mention the reform currently being studied in the National Assembly to introduce a sixth year of study in the midwifery course.
In Montpellier (Hérault), eleven students missed the call for this start of the 2022 school year compared to the previous one, noted Véronique Lecointe, director of the site and president of the National Conference of Teachers in Maieutics (Cnema). A situation attributed to the reform of access to medical studies, implemented in 2020, but not only.
Even once integrated into the curriculum, many midwifery apprentices jump ship. “This afternoon, I received a student, who is entering the first year of the second cycle. He told me that he was stopping. He said to me: ‘The hospital, I can’t take it anymore. ‘” And the director adds: “In a mid-semester report, out of 30 students, seven have already told us that they would ask for the bridge to do medicine in the third year”. Renunciations which make Véronique Lecointe draw a very dark observation: “I regularly tell my students: ‘You have the right to come dressed in black, to say that you are in mourning for the job you are going to do'”.