Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Subjective Evaluation of Perinatal Care Regulation

Academic journal article Journal of Prenatal & Perinatal Psychology & Health

Subjective Evaluation of Perinatal Care Regulation

Article excerpt

ABSTRACT: In France the policy of regionalization and organization of perinatal care is governed by a Decree issued in 1998, the objective of which is to improve prevention of premature births and perinatal risks. Within this context, forty-nine health professionals were interviewed by means of a qualitative questionnaire designed to evaluate implementation of the Decree. The present report is primarily an analysis of the mechanisms and psychosocial issues of over-medicalization of birth. This overmedicalization stems from the interacting effects of competence grading, linked to the grading of health facilities, and the process of pathologization / surgicalization / judiciarization of birth.

KEYWORDS: healthcare, perinatal care, hospitalization, surgical, birth, regulation, competencies, participation, control, network


Context and Interest of Subjective Evaluation of the Network by Professionals Specialized in Perinatal Care

Over the last twenty years or so, most industrial countries have developed guidelines on regionalization of perinatal care (Campbell, 1991). One of the important goals of perinatal regionalization is to improve morbidity and mortality outcomes of preterm and low-birth-weight new-borns by transporting pregnant women to maternity units that have a medical or neonatal environment suited to the risk incurred by mothers or babies.

France's performance lags behind that of other European countries when it comes to perinatal care (Blondel et al., 2001; Kollée et al., 1999), despite the arsenal of successive decisions on childbirth and on the development of perinatal techniques and antenatal diagnosis, such as the 1994 Perinatal Plan, the 1996 Edicts (Ordonnances) on health networks and the 9 October 1998 Decree on perinatal security. These measures instituted a policy of regionalization of perinatal care, which completely altered the previous system. Each maternity unit has been assigned a level of care (I, II, or III), and pregnant women are classified according to their 'risk level'. On that basis, pregnant women are referred to maternity wards with the appropriate medical environment to provide adequate care for them and their infants. The policy therefore also entailed the restructuring of maternity wards in relation to the level of maternal and paediatric care available in the institution.

One of the main features of the policy was the referral of women at risk of giving birth prematurely, to maternity wards classified as Level III (those with a neonatal reanimation service on site) or Level II (those with neonatal intensive care but no reanimation). 'Low-risk' women were to be referred to Level I maternity wards (those without a neonatal care service).

The international literature has shown that women's transfer to hospital (level III) before delivery increases the likelihood of highly premature birth (Hein et al., 1986; MacCormick et al., 1985; Peddle, 1983; Schlossman et al., 1997;Truffert et al., 1998). Moreover, several surveys in English-speaking countries have shown that women tend willingly to agree to 'light' perinatal care (Biro et al., 2003; Harvey et al., 2002; Mac Vicar et al., 1993; Turnbull et al., 1996). Yet the effectiveness of the policy of regionalization of care, as a whole, is still under discussion and has provided no conclusive evidence as to its validity (Truffert, 1996; Zeitlin et al., 1999).


How the Professionals of Perinatal Care Perceive the Decree: Pioneering Research in the Rhône Département (France)

Even though France has experience in the implementation of regionalization policies (Blondel & Grandjean, 1998; Dreyfus et al., 1998), few publications report the results in terms of efficacy on mothers' and infants' health (Cornet et al., 1998), and even less so in terms of perception of this health policy by users or health professionals (Naiditch & Weill, 1996).

We therefore considered it essential to examine how the health professionals in the sector under consideration perceive the objectives and implications of this network and, more precisely, the subjective effects it produces, and how they analyse the changes it triggers in the reorganization of their work, in their relations with one another and with the public concerned (parturient women, fathers, family), and especially in childbirth-related care. …

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