While the health minister presented her health bill on Wednesday 13 February, a sensitive issue is attracting attention, that of Bernay's motherhood.

In mid-January, Emmanuel Macron was questioned by mayors about the announced closure of this small maternity, vigorously defended by the local population.

She is a former midwife who does not hide her anger. Without departing from a certain sense of humor. " Of course, here we are in Normandy. But I find that on the future of motherhood, we abuse a little of our famous "P'têt ben that yes, p'têt ben that no! ". It has been months since the health authorities maintain the vagueness and uncertainty and it is unbearable Explains Edith Buffet, 65, who worked from 1978 to 1990 at Bernay Maternity Hospital.

The risky gamble of the government to reform health

This commune of the Eure, of 11 000 inhabitants, lives for almost a year a painful serial. With, as key players, the hospital staff, the population, the elected officials, the yellow vests, the Minister of Health and, recently, star guest, President Macron himself. A soap opera articulated around one and the same question: will the maternity of Bernay close?

A closure envisaged at the beginning of the week

For the moment, on the side of the authorities, the tendency is rather to p'têt ben qu' oui ". The chopper almost fell at the beginning of this week: according to the scenario envisaged by the Regional Agency of Health (ARS), it is this Monday, February 11th that the maternity of Bernay had to stop the deliveries.

But patatras, the affair took another turn with the first big debate organized by Emmanuel Macron with the mayors. It was the 15th of January, at Grand-Bourgtheroulde, in the Eure. More than 600 mayors face the head of state. And in the first row, Valery Beuriot who quickly called the guest of the day. " If tomorrow, motherhood closes, it will be a real disaster for moms Said the communist mayor of Brionne. Emmanuel Macon first replied that this closure was imperative, especially for security reasons. But relaunched at the end of the debate on the subject, he makes a concession, announcing a next visit of his health minister for " find a solution ".

The number of French maternities divided by three in 40 years

The arrival of Agnès Buzyn? A boon for the defenders of motherhood. Because in anticipation of this visit, which could take place next week, everything has been frozen … And in Bernay, everyone hopes that "Tata Buzyn"as it is now called here, will backtrack. And will save the maternity which, year after year, has always maintained above the bar of 300 deliveries a year – this famous threshold below which the health authorities consider it better to stop the activity of obstetrics. " We do not understand. In 2017, there were 407 deliveries. Last year, we certainly went down to 320 births. But this decline is largely due to the announcement of the closure, which discouraged many women from coming to our home "Says Dr. Ibrahim Makké, head of maternity and chairman of the Medical Commission Establishment (CME).

Amélie, 19, mother of little Sabryna since February 10, at Bernay./Lorraine Turci for La Croix

Amélie, 19, mother of little Sabryna since February 10, Bernay. / Lorraine Turci for La Croix

A non-certification in 2017

Why close a maternity hospital that performs more than 300 deliveries? " To better adapt the offer of care ", Repeat the LRA recalling that in 2017, Bernay hospital felt the wind of the ball. The High Authority of Health (HAS) then refused to issue its certification to the establishment. " But since then, all the points to improve have been. The hospital did the right thing to continue to treat patients well "Assures Jean-Hugues Bonamy, the centrist mayor of Bernay. " Never, in the past, have we had a serious incident at birth. This security argument is incomprehensible Says Dr. Makke.

The health bill wants to promote access to care

Aware that security is a sensitive subject, Laurent Charbois, the director of the Bernay hospital, weighs his words. " Our concern is that today there is only one full-time gynecologist-obstetrician at the maternity wardhe explains. All the others are substitute doctors who invest little in the work of teams. The problem is that if, one day, a serious and unexpected event occurs in the birth room, the whole team must react: doctors, midwives and nurses. It's better, then, to have a close-knit team that knows each other. A vision rejected by Annabelle Vincent, psychologist at the hospital and president of the association for the defense of maternity. " Our substitute doctors are perfectly integrated into the team "She says.

Annabelle Vincent, psychologist and president of the maternity defense association / Lorraine Turci for La Croix

Annabelle Vincent, psychologist and president of the maternity defense association / Lorraine Turci for La Croix

A local perinatal center

It remains to be seen whether it will change Agnès Buzyn's opinion that she wants to replace maternity with a nearby perinatal center. The idea is that the women of Bernay and the surrounding area are followed during their pregnancy in Bernay, before giving birth in Lisieux or Evreux, respectively 25 and 45 minutes by road. An unthinkable solution for Sara Féraud, a nurse for twelve years in the maternity ward. " Here, many women are in a precarious situation. Without resources and most often without means of locomotion. I have already seen women come to give birth on foot or moped. How will they, tomorrow, these women to go to Lisieux or Evreux? A concern shared by Valery Beuriot, the mayor who alerted Emmanuel Macron during the big debate. " Here, access to community-based care is the second most important concern of residents after purchasing power. And the closure of this motherhood is experienced as a rupture of republican equality ".

" second-class citizens "

In Bernay, the feeling is spreading to be " second-class citizens »,« outcasts »,« who, in the eyes of the technocrats, children can give birth on the side of the road ". On Tuesday morning, the words fuse in a corridor of the hospital where, at the invitation of the defenders of the maternity, gathered a dozen yellow vests. " The defense of public services has always been part of our demands Says Christian, a former automotive technical controller. Most retired people, " yellow vests from the beginning And who are convinced that after maternity, " it is the entire hospital that is targeted ".

A conviction shared by a part of the population who, for months, has been mobilizing for maternity and hospital. A " common good to defend », Say the inhabitants of which, nevertheless, all do not give birth on the spot. " It has been years since one in two Bernay women will give birth elsewhere "Says Laurent Charbois. A reality that can be found in many other cities that defend their local hospital. Specialists call this the "leak rate" to describe those patients who are deserting local structures. " The problem is that local GPs do not play the game and tend to refer their patients to hospitals other than Bernay ", Says Valery Beuriot.

"The main reason for this closure is economice "

What also relates, in the background, the story of Bernay's maternity is the reality of public hospitals today. And the obligation for them to prioritize activities that will generate revenue. " You must not be fooled. We are talking about security today. But the main reason for this closure is economice ", assures Hervé Maurey, senator and former mayor of Bernay. Because, in the eyes of decision-makers, Bernay's problem is the continued use of temporary workers to run a maternity hospital where activity no longer takes off. " Today, young doctors do not want to come to small hospitals. As a result, we have to call on replacements who, by the day, cost us 50% more than regular doctors "Says Laurent Charbois.

Against medical deserts, inefficient and costly measures

Now, it is exactly the same situation as the maternity of Lisieux. There too, there is only one full-time obstetrician and the management has temporary staff. But the maternity of Lisieux, it is not threatened. " With the current system of pricing, a hospital will receive around 4,000 € for each delivery. And we do 1,400 per year, which allows us to support the cost of temporary workers Explains Thierry Fassina, general secretary of the Lisieux hospital.

While Bernay Hospital, where the deficit is 4 million euros, the priority now is to develop an activity that meets the needs of the population but also generates stable and sustainable revenue. Geriatric care, for example. " Yes, of course, taking older people is essential. But how will we take care of an 80-year-old woman who has fractured the femoral neck if we lose our surgery? Asks Melissa Vieren, nurse and FO representative at the hospital, who already has the answer: Well, this lady, we'll do like moms today. We will send her to a hospital 20 or 30 kilometers from her home. "

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Landmarks

Two-thirds of maternity homes closed in forty years

More than two-thirds of maternity hospitals closed in France in the last forty years. There were 1,747 in 1972, 1,128 in 1981, 815 in 1996 and 544 in 2012. Despite this movement, the median access time of caregivers to care services remains stable – 17 minutes – with sometimes strong disparities . Thus 25% of the women of Corse-du-Sud are more than 39 minutes from the maternity.

Sometimes "leakage rates"This is how we designate women who are not going to give birth at the nearest maternity center. In 2012, according to the Court of Auditors, this rate was 41% at the maternity of Altkirch (Haut-Rhin), 29% at that of Issoire (Puy-de-Dôme) or 25% at that of Thiers , in the same department.

Pierre Bienvault, special correspondent at Bernay (Eure)

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