“There is a real disillusionment with the profession”: midwives on the verge of breaking up

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After years of silent anger, midwives are making their voices heard. Since the end of September, they have multiplied strike movements to demand an improvement in working conditions, better remuneration and recognition of their status. Monday, November 22, an agreement was signed between the government and the majority of unions. The Ministry of Health has announced a salary increase of 500 euros net monthly, as well as the establishment of a sixth year of study. A revaluation which, however, will not be fully perceived by all midwives.

In detail, it includes 183 euros already paid from the Ségur de la santé, 240 euros in medical practice bonus, which midwives working in the local public service will not benefit from, as well as 78 euros related to the revaluation of the grids, which will not be paid to private sector professionals and contractual hospital public service employees. Insufficient announcements for a part of the profession which regrets that the question of working conditions has not been addressed.

A just-in-time daily life

All over France, midwives on the verge of breaking up continue to mobilize. Pantea Mask Ferry is one of them. A midwife for twenty years, she works as a liberal and part-time in a private clinic in Île-de-France. Although on strike, she was requisitioned and therefore continues to receive patients at the maternity ward. Glancing quickly at her watch, she makes an observation that almost becomes a habit.

"It's 2 p.m. Since 8am this morning, I haven't been able to go to the toilet, haven't drank a single drop of water, haven't eaten and, besides, I won't have time. I have eight patients, three of whom have been sent to the delivery room. I take care of all consultations and have to manage emergency arrivals. Until 8 p.m., I have to take care of everything, all by myself. There is no nurse to bring me the files, or to disinfect the equipment, there is no nurse to take the samples or take the blood pressure, nothing. The midwife does everything, right up to the secretariat.” Whether they are salaried or liberal, hospital or territorial, this everyday life in tense flow, many of them tell it.

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Despite all the good will and the efforts made, the lack of staff obviously affects the patients. “We work in such extreme conditions that some sometimes end up having abusive behavior,” regrets Johanne Reynaud, a graduate since 1999. Today in the orthogenics department (support for voluntary terminations of pregnancy), she occupied numerous positions, including several years in the delivery room. Convinced that the question of staffing is the basis of the safety of women and newborns, she campaigns like many for the establishment of the practice of "one-to-one", one midwife per woman. “When you have several patients giving birth at the same time, you will inevitably have to make choices. Some will therefore wait alone, sometimes for several hours. Where is humanity?” asks Johanne Reynaud.

This lack of time to devote to patients is all the more problematic as the heart of the profession is human relations. Many of them have the bitter impression of not having the means to practice their profession. “There is a real disillusionment with the profession. We're here to provide support, but we don't have the means. We are only sprinkling”, despairs Anne-Valérie Pruniaux, midwife for maternal and child protection (PMI), a service under the Departmental Councils in favor of a vulnerable public. Homeless, undocumented, women victims of domestic violence, young minors, imprisoned or interned women… They provide pregnancy monitoring for women in a wide variety of situations. Establishing a real bond of trust is all the more important.

Crisis of vocation

In such conditions, professionals are concerned about the consequences of this lack of attractiveness. They are thus numerous to abandon the hospital, which crystallizes the most discontent. “On average, a midwife leaves the hospital after four years, explains Laura Faucher, president of the National Association of Student Midwives (ANESF). We are also seeing more and more students who, as soon as they obtain their diploma, turn to the liberal profession. An observation correlated by figures from the Department of Research, Studies, Evaluation and Statistics (DREES). In 2012, 20% of midwives practiced in private practice, in 2021, they are 34%.

Laura Faucher is also very concerned about the increasing number of dropouts and the state of the mental health of midwifery students, which continues to deteriorate. According to the latest ANESF "Student well-being" survey, in 2018, 70% of students had depressive symptoms, 80% suffered from increased stress since entering training and 27 % had already thought about stopping their studies or changing careers. A new survey is underway and the figures look even more worrying. “We have dropouts in all schools. They occur mainly in the third year, which coincides with the acceleration of internships and therefore the discovery of the reality on the ground. Because of the lack of staff, students find themselves in situations in which they should not find themselves,” laments Laura Faucher.

A concern for the future of the younger generations shared by Johanne Reynaud. “Our job, we love it, and I'm sad to see students give up because they don't see a future. This is what we are fighting for, for the younger generations and for women.” Especially since, paradoxically, their skills are constantly being extended. Preventive gynecological follow-up, prescription of contraception, gynecological ultrasound procedures, voluntary termination of pregnancy by medication… Their role goes far beyond follow-up and childbirth.

A synergy of expectations

Midwives believe, however, that their place could be even greater. “Currently, once the baby and the mother are physically saved, there is no one there. This is a mistake, because the midwife has a role to play in the aftermath, in parenthood, or in the prevention of postpartum depression. We now know that suicide is one of the leading causes of maternal death in the first year. Even recently, we learned of the death of a young mother in our sector,” says Anne-Valérie Pruniaux. Finally, their desire is to return to a core business more focused on support and prevention.

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Among many future parents, too, a realization seems to have taken place in the face of a feeling of dehumanization of pregnancy. The various controversies around obstetric violence and a desire to regain control of this moment, push some women to seek alternatives, for a more intimate and personalized childbirth. Home birth in particular has experienced a certain upsurge since confinement. The Professional Association for Accompanied Home Birth (APAAD) thus observes in its 2021 report an increase in requests of 16% for the year 2020.

Another sign of this change is the popularity and development of birth centers throughout France. The public authorities have just authorized the creation of twelve new structures over two years, bringing their number to twenty. These places allow women who have a low-risk pregnancy to give birth without hospitalization and in a natural way, with the support of a referent midwife from the beginning of pregnancy until postpartum.

For midwives, practicing in a birthing center allows them to return to their primary missions. A midwife who has worked for two years in one of these structures observes: “I don't think I will go back to a hospital one day. Here, the relationship with the patient is not at all the same. The overall support, and the fact of not having several births at the same time, gives us time to get to know each other. This may be decisive in the treatment.”