France Overhauls Perinatal Care to Reduce Preventable Maternal Deaths and Infant Mortality
France is undertaking a significant reorganization of its perinatal care system, aiming to address stagnating infant mortality rates and a concerning number of preventable maternal deaths. The initiative focuses on shifting from a risk-centered approach to one prioritizing the overall journey of women, from preconception through postpartum care.
Rising Concerns and the Need for Change
Despite advancements in medical care, France’s infant mortality rate has not declined in two decades and now surpasses the European average. Alarmingly, approximately 60% of maternal deaths in France are considered preventable, often due to organizational shortcomings . This has prompted the government to commission a review of the system and the National College of Midwives of France to develop its own set of recommendations.
Three Pathways for Pregnancy Monitoring
A central proposal is the creation of three distinct pathways for pregnancy monitoring: low risk, at risk, and pathological. This structured approach aims to improve clarity for patients and optimize the roles of healthcare professionals. Currently, the system often sees midwives managing complex pregnancies while obstetrician-gynecologists handle low-risk cases.
Under the new model:
- Low-Risk Pregnancies: The majority of pregnancies (approximately 80% are considered “physiological,” meaning without major complications) would be primarily monitored by midwives in maternity wards, birth centers, or at home.
- At-Risk and Pathological Pregnancies: These cases would be managed by multidisciplinary teams including specialists and hospital services.
Reducing Medicalization of Physiological Pregnancies
The reforms emphasize reducing the overmedicalization of normal pregnancies. Recommendations include establishing dedicated “low risk” spaces within maternity wards and expanding the availability of birthing centers. This reorganization seeks to respect the natural process of childbirth while maintaining patient safety. An increase in the number of midwives and childcare assistants, particularly in busy facilities, is similarly crucial.
Strengthening Prevention, Postpartum Care, and Co-Parental Involvement
Beyond pregnancy monitoring, the proposed changes address gaps in prevention, postpartum support, and co-parental roles.
- Prevention: Systematizing preconception consultations and mandating a prenatal check-up from the start of pregnancy, with a designated referent midwife.
- Postpartum Care: Extending support until the child is six months old, including new consultations and improved identification of postnatal depression.
- Co-Parental Role: Facilitating the co-parent’s presence during medical examinations and adapting reception conditions in maternity wards to better support both the mother and child’s development.
A System-Wide Transformation
The National Confidential Enquiry into Maternal Mortality (ENCMM) has recorded 1,800 maternal deaths in France since 1998 . Around 100 women die each year in France from causes related to pregnancy, childbirth, or their aftermath . The National College of Midwives of France advocates for a comprehensive transformation of perinatal care, focusing on improved prevention, guidance, and continuity of care. These recommendations are expected to influence government decisions in the coming months.
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