Tribune. In our country, perinatal care is organized into networks of professionals. This has several advantages: harmonization of practices, multidisciplinary discussion of care and, above all, orientation of mothers and / or newborns in maternity homes and neonatology services adapted to their medical problem. In each network, several levels of care are defined for the maternity hospitals: those of type 1, among which one observes the structures of smaller size, do not comprise units of hospitalization for the sick new-borns.
They are therefore mainly intended to assume low-risk pregnancies for the mother and the newborn. In 2016, they were 217 and accounted for 22.5% of births. Those of type 2 include a neonatal care unit and can therefore support situations with intermediate risk: this is the case, for example, care for a premature newborn of eight months, without a priori life risk. They numbered 228 in 2016 and accounted for 49.7% of births. Finally, type 3 facilities (67 in 2016, and 27.8% of births) benefit from a neonatal resuscitation unit and are therefore intended to deal with situations of high medical risk.
This network organization, like the one set up in the 1970s in Canada, has existed in France since the end of the 1990s. It involves transfers of mothers before birth so that the supervision of childbirth and care of the mother-baby pair be done in the most secure way possible. This communication between the institutions is at the base of this network operation. Regularly, debates, sometimes passionate, exist on the maintenance of certain structures and in particular type 1 maternities, when they are small. In 2016, 60 institutions performed fewer than 500 deliveries (of which 25 were under 300 and 35 between 400 and 499), and 151 between 500 and 999 deliveries.
An increasingly complex situation
In 2019, do type 1 maternities have their place in the perinatal landscape? The response of the perinatal professionals signing this forum is clearly yes. Type 2 and 3 maternity hospitals could not absorb all low-risk deliveries, which remain the majority of births. But there is a nuance: like any health facility, these maternities must be accredited. The quality and, above all, the safety of the care provided there must be guaranteed. Otherwise, the question of their durability can be discussed. Finally, the debate is not about type 1 maternities. It is more a matter of discussing, often on a case-by-case basis, the maintenance or not of structures with a low activity that are more exposed to operational difficulties, and that is there that the problem becomes more complex.