Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Geneva, Western Switzerland, Switzerland.
Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, 69008, Lyon, France.
BMC Pregnancy Childbirth. 2022 May 25;22(1):437. doi: 10.1186/s12884-022-04772-2.
As part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey's main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care.
We conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March-11 May, 2020).
Of the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives' form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals.
The pandemic has degraded the quality of pregnant women's care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector.
作为长达数十年的基层医疗重组过程的一部分，独立（也称为社区）医疗工作者被鼓励以小组形式工作，以促进他们在法国的协调和护理连续性。法国的独立助产士进行了大约一半的早期产前访谈，以确定母亲在怀孕期间的需求，然后将她们转介给适当的资源。然而，法国政府围绕公共卫生机构构建了 COVID-19 大流行应对措施，在封锁阶段并没有直接调动这些社区医疗工作者。这些应对措施引发了关于他们在危机中的医疗体系中角色的问题。本调查的主要目的是估计在大流行的第一阶段，独立助产士在将妇女转介到医疗保健机构或其他护理人员以及与医院合作方面遇到新困难的比例。次要目的是根据他们的实践模式，估计认为所有受照护妇女因转介护理失败或延迟而面临风险的独立助产士的比例。
我们于 2020 年 4 月 29 日至 5 月 15 日期间，针对法国的独立助产士进行了一项在线全国调查，当时正值第一次封锁结束（2020 年 3 月 17 日至 5 月 11 日）。
在法国注册的 5264 名独立助产士中，有 1491 名（28.3%）做出了回应；64.7%的人报告在大流行期间在将妇女转介到卫生机构或护理提供者、特别是社会工作者方面出现了新的或更大的问题，71.0%的人报告在与医院合作方面出现了新的困难。近一半（46.2%）的受访者认为，他们所照顾的所有妇女都不同程度地经历了护理的缺乏或延迟，这可能影响了她们的健康。这一比例与助产士的实践形式无关：个体实践、仅与其他助产士的小组实践、或至少与两种类型的医疗保健专业人员的小组实践。
大流行降低了法国孕妇护理的质量，并对法国的护理模式提出了挑战，该模式在几乎完全独立的初级保健（社区）部门和以工资为主要形式的二级保健（医院）部门之间高度分工。
