Investigating the benefits and challenges of including bereaved women in research: a multifaceted perinatal audit in a socially disadvantaged French district

Objectives To describe experiences including interviews with bereaved women in a clinical audit.Design The data come from an audit of all stillbirths and neonatal deaths at ≥22 weeks of gestation in Seine-Saint-Denis, a disadvantaged French district in 2014. We included bereaved women using a questionnaire that also contained open-ended questions administered in an interview format by a midwife-investigator several weeks after the death. The study included a referral protocol for bereaved women with unmet needs revealed during the interviews. A psychological support for the three midwife-investigators was set-up, in the form of a support group.Setting The 11 maternity hospitals in the district.Participants 218 women (227 deaths).Analyses Data come from medical records, maternal interviews, the reviews of the audit’s expert panel and written narratives of their experiences provided by the midwife-investigators. Quantitative data were analysed statistically, and qualitative data thematically.Results One-third (75) of the women agreed to an interview, but acceptance ranged from 6% to 60% by maternity unit. Characteristics of respondents and non-respondents were similar. Members of the audit’s expert panel reported that 41% of the interviews contained new information relevant to their assessment. Of the women interviewed, 35% were referred to a medical professional, psychologist or social worker. Midwife-investigators’ experiences illustrated the benefits of a support group with three main themes identified: improving their interactions with bereaved women as well as medical teams and protecting their psychological well-being.Conclusion These results showed that including interviews with bereaved women in audit designs was feasible and provided valuable information on women’s care and social circumstances that were not available in medical records. They also highlight the importance of implementing referral protocols for the bereaved women, used in over one-third of cases, as well as providing support for study investigators

Les parturientes « africaines » en France et la césarienne : Analyses sociologiques d’un conflit de quatre décennies avec les équipes hospitalières

Dans cet article sont documentés les taux de césarienne constamment élevés, sauf dans les années 1980, des femmes nées en Afrique subsaharienne accouchant en France. Bien que leurs causes de migrations, conditions de vie en France et états de santé ne soient pas stables, elles représentent un groupe « homogène », réifié, dans les discours des soignants qui les catégorisent comme « Africaines ». Le choix d’étudier la césarienne est dû au fait que ce type de soins est une source de conflits entre les équipes hospitalières et les parturientes qui est révélatrice de phénomènes sociaux, et du fait qu’il a fait l’objet d’une littérature tant médicale qu’anthropologique et ethnopsychiatrique. Surtout, son étude sociologique dans le cadre d’une thèse m’a permis d’illustrer, en croisant méthodologies quantitative et qualitative, les processus d’ethnicisation et de racisation des patientes par les soignants de périnatalité. Est donc ici documenté en quoi l’usage de ces concepts permet une déconstruction du « bon sens » médical dont j’étais moi-même imprégnée dans ma pratique de sage-femme clinicienne. Grâce à cette approche, étayée d’une critique réflexive et enrichie des opinions de femmes interrogées, semblent se dessiner des possibilités d’amélioration de la qualité des soins à dispenser à ces femmes dans un contexte national où l’accouchement « normal » reste l’accouchement par les voies naturelles.This article documents the very high C-sections rate of African women in France, except for the 1980 decade. Although the global context of their immigration in France, living conditions and health status are in constant evolution, they are still considered as a homogenous group of « Africans » for the medical staff. C-section as a cure is a recurrent source of conflicts, showing part of the social context in France. If a guideline has allowed the C-section rate to decline in the 80s, its recommendations are not followed any more. Both a qualitative research (interviews of care providers acting in maternities, interviews of patients, and time of participant observation) and a quantitative research (statistics about 2 200 deliveries in a Parisian maternity in 2006), have been used. A cross perspective is adopted, facing the construction of otherness by medical staffs and the perception of discrimination expressed by the women. Then, from the sociological analysis through the concepts of ethnic and racial categorizations, ways to improve the quality of care for these migrants’ women are emerging.Documentaremos en este artículo la tasa de cesáreas en constante crecimiento, salvo durante los años 1980, de las mujeres nacidas en África subsahariana que dan a luz en Francia. Aunque las causas de la emigración, las condiciones de vida en Francia y los estados de salud no sean generalizables, esas mujeres representan un grupo « homogéneo » cosificado, en el discurso de los trabajadores de la salud que las catalogan como « africanas ». Decidimos estudiar la cesárea ya que este tipo de intervención es una fuente de conflictos entre equipos hospitalarios y parturientas, que revela fenómenos sociales, y porque ha sido objeto de la literatura médica, antropológica y etnopsiquiátrica. Más aun, su estudio sociológico en el cuadro de una tesis, nos permitió ilustrar, mediante el cruce de métodos cuantitativos y cualitativos, los procesos de etnización y de racialización de los pacientes por los trabajadores de la salud perinatal. Aquí documentamos cómo el uso de dichos conceptos permite la deconstrucción del « sentido común » médico del cual nosotras mismas estábamos impregnadas en tanto que parteras clínicas. Gracia a esta óptica, apoyada por una crítica reflexiva y enriquecida por las opiniones de las mujeres interrogadas, se pueden percibir las posibilidades de mejoramiento de la calidad de la atención médica que se da a las mujeres en un contexto nacional en el cual el parto « normal » es un parto por vías naturales

Différence de traitement et traitements différientiels (les trajectoires de soins des femmes "africaines" en maternité publique)

PARIS7-Bibliothèque centrale (751132105) / SudocSudocFranceF

Investigating the benefits and challenges of including bereaved women in research: a multifaceted perinatal audit in a socially disadvantaged French district

International audienceObjectives: To describe experiences including interviews with bereaved women in a clinical audit.Design: The data come from an audit of all stillbirths and neonatal deaths at ≥22 weeks of gestation in Seine-Saint-Denis, a disadvantaged French district in 2014. We included bereaved women using a questionnaire that also contained open-ended questions administered in an interview format by a midwife-investigator several weeks after the death. The study included a referral protocol for bereaved women with unmet needs revealed during the interviews. A psychological support for the three midwife-investigators was set-up, in the form of a support group.Setting: The 11 maternity hospitals in the district.Participants: 218 women (227 deaths).Analyses: Data come from medical records, maternal interviews, the reviews of the audit's expert panel and written narratives of their experiences provided by the midwife-investigators. Quantitative data were analysed statistically, and qualitative data thematically.Results: One-third (75) of the women agreed to an interview, but acceptance ranged from 6% to 60% by maternity unit. Characteristics of respondents and non-respondents were similar. Members of the audit's expert panel reported that 41% of the interviews contained new information relevant to their assessment. Of the women interviewed, 35% were referred to a medical professional, psychologist or social worker. Midwife-investigators' experiences illustrated the benefits of a support group with three main themes identified: improving their interactions with bereaved women as well as medical teams and protecting their psychological well-being.Conclusion: These results showed that including interviews with bereaved women in audit designs was feasible and provided valuable information on women's care and social circumstances that were not available in medical records. They also highlight the importance of implementing referral protocols for the bereaved women, used in over one-third of cases, as well as providing support for study investigators

Prendre soin des « mères africaines ». Une étude des relations racialisées dans les maternités françaises et italiennes

Starting from the findings of their doctoral research based in Italy and in Île-de-France region, the authors have analyzed the racialization processes to which women of sub-Saharan origin are subjected in both contexts. They have shown how such processes translate into the construction of an idealized figure of the “African mother” usually understood by a number of health providers as easier to take care of and “close to nature”. Their subsequent research work, focused on the contemporary migration crisis and the arrival in Europe of sub-Saharan women with more precarious social profiles, mainly of Nigerian origin, led the authors to re-examine the representation that health professionals have about patients of sub-Saharan origin. A reconfiguration of racialized relations vis-à-vis the “African mother” emerges in the medical encounters between French and Italian caregivers and Nigerian women, often involved in the forced prostitution market. The incompatibility of the good mother figure and that of prostitute, as well as the sentiment of discomfort health providers feel because of the unsafe and precarious lifestyle these women undergo, represent – according to the authors – a thought-provoking frame for the analysis of what makes and unmakes stereotypical visions about mothers of sub-Saharan origin, as well as the changing dimension of differential care these women experience

Quelles sont les causes de la mortalité périnatale et infantile élevée en Seine-Saint-Denis ? Consultation des professionnels du département par un processus Delphi

International audienceObjective: In Seine-Saint-Denis, stillbirth and infant mortality rates are markedly higher than in other French departments. Before implementing an audit on stillbirths and neonatal deaths in 2014, we carried out a Delphi consensus process with healthcare providers to generate research hypotheses.Materials and Methods: A Delphi process in 3 questionnaires was conducted in 2013 with 32 healthcare providers (pediatricians, obstetricians, general practitioners, midwives, social workers, psychologists, pediatric nurses) and user representatives. The first questionnaire asked open questions about why mortality rates were higher and possible solutions to remedy the situation. In subsequent questionnaires, the panel ranked factors identified in the first questionnaires by importance.Results: One hundred and thirty factors were identified from 42 pages of text responses in the first round. From these, the 75 most highly ranked were grouped into 14 main topics organized around three themes: 1) more underlying health problems in the population, 2) access and organization of care, 3) the health consequences of poor socioeconomic conditions. Coordination of care, provider and patient communication, and access to care were highlighted.Conclusion: The Delphi consensus process identified a wide range of hypotheses for the higher mortality in Seine-Saint-Denis which are adapted to the local context and based on the concerns of health practitioners.But: En Seine-Saint-Denis (SSD), les taux de mortinatalité et de mortalité infantile sont très élevés par rapport aux autres départements français. En amont d’un audit en 2014 sur tous les cas de mort-nés et de décès néonatals dans ce département, nous avions mené un processus Delphi auprès des professionnels y exerçant pour étayer les hypothèses de recherche.Matériel et méthodes: Un processus de consensus Delphi en 3 questionnaires a été mené en 2013 auprès de 32 professionnels et 3 représentants des usagers. Le premier questionnaire interrogeait les processus qui peuvent expliquer ces taux élevés et les solutions à proposer pour y remédier. Les 2 questionnaires suivants ont permis de classer les facteurs identifiés au 1er tour.Résultats: Cent trente facteurs ont été identifiés grâce aux 42 pages de réponses au 1er tour. Les 75 retenus par le panel ont ensuite été regroupés en 14 thèmes principaux organisés autour de trois axes : 1) l’état de santé maternelle et infantile en SSD ; 2) l’offre de soins dans le département et ses dysfonctionnements organisationnels ; 3) les conséquences sur sa santé des mauvaises conditions socioéconomiques d’une partie de la population. La coordination des soins, la communication entre les professionnels et les usagers et l’accès aux soins ont été particulièrement soulignés.Conclusion: L’enquête d’opinions par processus de consensus Delphi a permis d’identifier un large éventail d’hypothèses quant à la mortalité infantile et périnatale élevée en SSSD, adaptées aux préoccupations des praticiens

Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives

International audienceObjectiveIn France, in 2007–2009, the risk of peripartum maternal mortality, especially the one due to hemorrhage, was higher in the private for-profit maternity units than in university maternity units. Our research, a component of the MATORG project, aimed to characterize the organization of care around childbirth in these private clinics to analyze how it might influence the quality and safety of care.Material and methodsWe conducted a qualitative survey in 2018 in the maternity units of two private for-profit clinics in the Paris region, interviewing 33 staff members (midwives, obstetricians, anesthesiologists, childcare assistants and managers) and observing in the delivery room for 20 days. The perspective of the sociology of organizations guided our data analysis.Findings/resultsOur study distinguished three principal risk factors for the safety of care in maternity clinics. The division of labor among healthcare professionals threatens the maintenance of midwives' competencies and makes it difficult for these clinics to keep midwives on staff. The mode of remuneration of both midwives and obstetricians incentivizes overwork by both, inducing fatigue and decreasing vigilance. Finally the clinical decision-making of some obstetricians is not collegial and creates conflicts with midwives, who criticize the technicization of childbirth. Some demotivated midwives no longer consider themselves responsible for patients' safety.ConclusionsThe organization of work in private maternity units can put the safety of care around childbirth at risk. The division of labor, staff scheduling/planning, and a lack of collegiality in decision-making increase the risk of deprofessionalizing midwives