REPORT. In Nevers, “we must fight to attract midwives” and no longer let mothers give birth far from home

Under a white sun of early spring, Amélie Lechon and Amilchar Ponsart stroll in front of the maternity hospital of the agglomeration of Nevers Pierre-Bérégovoy (Chan). After a few days of stress, the two Neversois get some fresh air. Amélie’s belly is perfectly round, under her white patterned blouse. The arrival of their daughter is imminent. “The contractions started at midnight”says the young woman, a catheter in her arm, Wednesday, April 20. “At first, I was very anxious about being transferred to another maternity ward. But in the end, I was told that I could be taken care of here.”

Because the birth of their daughter could have taken an unexpected turn. Between April 11 and 19, the Chan maternity hospital had to close for more than a week, for lack of midwives in the service. The reason: widespread burnout. After trying weeks which pushed them to consult their doctor collectively, the 13 midwives and the midwife – a man who practices this profession – of the service were put on sick leave. A situation all the more delicate as it is the only maternity hospital still in operation in the department of Nièvre.

If it was still possible to give birth in an emergency at the Nevers maternity hospital, in the presence of a gynecologist and an intern, once the work was over, the women and their infants were immediately transferred to the surrounding establishments. Without a midwife, it is impossible to provide postpartum and newborn care. As for future mothers whose labor had not started, they were immediately referred to another place.

For the luckiest, direction Moulins (Allier) or Bourges (Cher), the nearest towns, located 45 minutes away by car. Others had to be transported to Auxerre (Yonne), or even to Dijon (Côte-d’Or), two and a half hours away, after a journey on the winding roads of the Morvan massif.

Even if the trips were made by ambulance and supported by the Chan, those of the relatives were not. “At the start, we had no idea where I was going to be transferred.continues Amélie Lechon. If my cervix had not been opened enough, I would have been transferred to another maternity ward. And given the fuel prices, Mr. could not have followed me”. Amilchar nods: “I was very stressed. It was a magical moment that I didn’t want to miss.”

“For a week, we crossed our fingers so that a solution could be found and that I would be taken care of here, in Nevers.”

Amélie Lechon, mother-to-be in Nevers (Nièvre)

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At Chan, an emergency solution was finally found on Tuesday, April 19. Local elected officials, the management of the establishment and the ARS activated themselves and alerted the Minister of Health, Olivier Véran, to mobilize the health reserve. Until the end of May, eight midwives and five nurses are strengthening the workforce. But the situation is not sustainable, believe the midwives. In a few weeks, six nurses will reinforce the workforce, but for the time being, no midwifery specialist has been found.

How did the situation get so tense? In this medical desert, many midwives have left the service since the start of the school year in September 2021. Other departures, at the end of 2021, have weakened the team. So much so that in mid-April, the pace became untenable. Only two midwives now work each day in the service (against five previously), which is legal, underlines the management of the hospital. For health professionals, responsible in the event of a problem, this does not, however, ensure the safety of staff, nor that of mothers and their babies.

“At the start of my mandate, in 2017, there were 25 midwives in the service and they did a whole host of activities, such as preparation for childbirth and post-birth consultations”remembers MP Perrine Goulet (LREM), who has been following the file for a long time. “Then, the management of the hospital preferred to refocus their activity on childbirth. Gradually, tasks were eliminated and some midwives then left to practice elsewhere. Thus leaving, over the months, the team reduced to the legal minimum.

Anne, one of the midwives still in post, remembers the day too many, just before her sick leave. The department in which she was assigned was “well filled”. His health manager lent him a hand, putting aside his supervisory role. “Suddenly, they come to pick me up in the maternity ward saying to me: ‘There is a caesarean section and a delivery at the same time, you have to go and pick up the baby from the block’she says, still moved. In these cases, we do not think and we go for it. But behind, we leave alone the service for which we are responsible, with the risk that something happens to a mother or a baby. It’s not comfortable at all, we feel guilty.”

“It’s a vicious circle: we stress, we have trouble sleeping, we start a day again being tired, then we do our 12-hour day, which regularly overflows.”

Anne, midwife at the Nevers maternity hospital

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At his side, his colleague Morgane abounds: “It’s fine… Until the day when it won’t. This time, luckily it went well, but what about the next one?”

To remedy this situation, the management of the hospital has been trying to recruit for months. No success, she says. In addition, 30 nursing positions also remain to be filled. And everything is done to attract new professionals. On the hospital side, the starting salary has been increased. Applicants are even offered coverage for the first three months of their rent.

On the side of local elected officials, we are also struggling to attract young graduates. The mayor of Nevers, Denis Thuriot (LREM), has set up a system to convince working people, including caregivers, to adopt his municipality: the Winin bad English, for “Welcome to Nevers”. Working people wishing to go green can benefit from the first six months’ rent paid by the city and tailor-made support for spouses who follow the movement.

“The goal is to work over timeexplains the chosen one, with a precise aim which is the installation. It’s to seek out people who weren’t necessarily thinking of Nièvre, and have them try it for six months.” The seduction operation has already allowed, according to the mayor, the arrival of a few dozen couples.

“We will have to fight to attract midwives to our services. To offer them sport and culture at preferential rates, for example.”

Perrine Goulet, LREM MP for Nièvre

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The department also tries to attract students with scholarships offered to interns and future midwives. According to the senator of Nièvre, Patrice Joly (PS), speaking during a session of questions to the government on October 8, 2020, the number of general practitioners decreased by 27% between 2010 and 2017 in the department. “This is one of the largest drops observed in France. Today, there are less than seven for 10,000 Nivernais”.

These shortages do not only concern this territory. According to Caroline Combot, secretary general of the National Organization of Midwives’ Unions (ONSSF), what is happening in Nevers could very well have happened in another maternity ward. “At the national level, there are no more midwives, she warns. Between 2014 and 2016, there were no more positions available for midwives, which led many of them to leave the profession. Then there was a boom in the liberal profession, so many left hospitals to set up on their own.

Not to mention the many students who abandon their course even before obtaining their diploma, put off by the unattractive working conditions: salaries which, at the start of their career and after six years of study, do not exceed 2,155, 67 euros gross monthly, nights on call, work on weekends and public holidays, increasingly heavy administrative tasks. In July 2021, a report from the General Inspectorate of Social Affairs (Igas) warned of attractiveness of hospital positions for midwives (PDF) who “has been considerably reduced, illustrated by the reduction considered to be substantial in the number of applications”.

Not enough to reassure, for the time being, the midwives of the Pierre-Bérégovoy hospital who have gradually returned to work in recent days. “Nothing is won and we know that there is still a long way to go”, warns Alice, one of the service members. Newly hired staff will need to be trained and a new team rebuilt. “For the moment, we know that the recruitment prospects for midwives, even those who leave school in June, are going to be complicated”, emphasizes Morgane. With a source of concern: a retirement is planned for this summer.