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Midwifery strike: the reasons for the anger
While the demands of the midwives go back several years, the strike began on October 16, 2013 with a sit-in in front of the Ministry of Health. It was indeed when the public health bill was announced that the mounting anger turned into a strike. After several meetings at the Ministry of Health, the midwives, partly grouped around a Collective in which several associations revolve (with a large panel bringing together students, executive midwives, hospitals and professionals), still did not feel not listened to. “We were absolutely not solicited, as midwives, on this public health bill. And when the ministry received the delegation present at the sit-in, we realized that midwives were totally non-existent in this project, ”explains Elisabeth Tarraga, Deputy Secretary at the National Organization of Midwifery Unions ( ONSSF). A mobilization then spread from Paris to the whole of France (in a more or less heterogeneous way) in the form of an indefinite strike.
Midwives’ claims
First, midwives claim the status of hospital practitioner. In practice, this involves registering the profession of midwife as a medical profession in the hospital in the same way, for example, as dental surgeons or doctors. Especially since this medical status of midwives exists in the public health code but does not apply in the hospital environment. The objective, as Elisabeth Tarraga explains in substance, is not only to see skills better valued (including a higher salary) but also to have greater flexibility within hospitals. Midwives say they are very autonomous in their various actions with women. However, the absence of a medical status blocks them in certain procedures, such as the opening, among other things, of physiological units. The stake is just as ideological as it is financial. But their requests extend beyond the hospital domain. Liberal midwives thus wish to be major players in women’s health careers and for this to be recognized by the status of first-resort practitioner.. The first resort includes all prevention, screening and follow-up care for a patient, excluding serious pathology, which meets criteria of proximity and availability. For them, women should know that they can consult a liberal midwife, who works most often in an office in town, for a smear for example. Liberal midwives wish to be recognized as an independent medical profession that takes care of the monitoring of low-risk pregnancies, childbirth, post-natal and as professionals who have the necessary skills for gynecological consultations for contraception and prevention.. “The government must work on a real path to women’s health. That we really define the first recourse with the general practitioner and midwives and the second recourse with the specialists ”, explains Elisabeth Tarraga. In addition, this would relieve the specialists who must also manage pathologies, and reduce the waiting time for a simple preventive consultation, she continues. But that would not define the obligation for a woman to consult a midwife rather than a gynecologist. Indeed, the status of first-resort practitioner is not a formal registration as an exclusive referent. It is rather the recognition of specific skills for consultations focusing on advice and prevention beyond the medical act.. “It is about giving women the possibility of an enlightened choice based on complete information”, proclaims Elisabeth Tarraga. At the same time, midwives fight for the continuation of the integration process, at the university, of midwifery schools, and better remuneration of student interns (relative to their 5 years of studies). For Sophie Guillaume, President of the National College of Midwives of France (CNSF), the midwifery battle can be summed up in one key word: “visibility”.
Midwives and doctors at odds?
Midwives want to weigh much more in a landscape dominated by gynecologists and obstetricians. But what do these doctors think? For Elisabeth Tarraga as for Sophie Guillaume, they are generally silent actors. Rather, they feel abandoned or even denigrated by the medical profession. However, the unions of gynecologists and obstetricians spoke during the strike. For Philippe Deruelle, Secretary General of the National College of French Gynecologists and Obstetricians (CNGOF), the movement is running out of steam and has become bogged down, over the months, in too many demands that scramble the initial message. “Some claims are legitimate and others are not,” he explains. So, for example, gynecologists and obstetricians do not support the first resort because, for them, it already exists via a sharing of skills between the different practitioners who can take care of women. They refuse that midwives obtain exclusivity in the follow-up of the woman, in the name, again, of free choice.. Especially since, for Philippe Deruelle, it is not only a question of visibility. He explains that, in some areas, there are more gynecologists than midwives and vice versa, while in others, the closest doctor, and the first point of contact even for early pregnancy, is the general practitioner. “The organization is based on the forces involved. Everyone must be able to be an actor of first resort ”, details the Secretary General of the CNGOF. Today, the College considers that the Ministry of Health has responded to the claims of midwives.
The midwifery battle will continue
For the government, the file is indeed closed. The Ministry of Health took a position, through its minister, Marisol Touraine, on March 4, 2014, and made several proposals to midwives. “First measure: I create the medical status of hospital midwives. This status will be part of the hospital public service. Second measure: the medical skills of midwives will be enhanced, both in the hospital and in the city. Third measure: new responsibilities will be entrusted to midwives. The fourth measure, then: the training of midwives will be strengthened. Fifth, and last measure, the revaluation of the salaries of midwives will take place quickly and take into account their new level of responsibility, ”thus detailed Marisol Touraine in her speech on March 4. However, if the term “medical status” appears in the words of the government, for the midwives of the Collective, it still does not exist. “The text does say that midwives have medical competence, but that does not define a status for all that”, regrets Elisabeth Tarraga. It is not the government’s opinion that remains firm on the decisions taken. “The legal process is now following its course, and the texts confirming the new statute will be published in the fall,” explains an advisor to the Minister. But, for the midwives gathered in the Collective, the dialogue with the government is as if broken off and the announcements not followed up. “Since March 4, Marisol Touraine has only discussed with the central unions. There is no longer any representation of the Collective, ”explains Sophie Guillaume. However, nothing is finished. “There are meetings, general assemblies, because there is always significant discontent”, continues the president of the CNSF. In the meantime, even if it is running out of steam, the strike continues and the midwives intend to recall it on the occasion of the one year of the movement, on October 16.