“The midwives treat us like women and not like patients, summarizes Charlotte, 37 years old. After all, pregnancy or gynecological follow-up are not illnesses. Like Charlotte, some women choose to turn to a midwife for their gynecological follow-up. And welcome it.
“Four years ago, I took childbirth preparation courses in a practice run by two brilliant midwives, in Montreuil (Seine-Saint-Denis), continues this former Ile-de-France resident, who settled a few years ago. month near Angers. I then learned that their skills went far beyond the period of pregnancy. I said to myself: “who better than women giving birth to other women all day long, could accompany me in all questions related to maternity, sexuality?”. In the middle of pregnancy, I therefore left my gynecologist to entrust my gynecological follow-up to them. »
More and more skills for midwives
Many French women are unaware of theextent of the skills of these caregivers. Beyond maternity, since 2009, midwives can provide gynecological follow-up for some women. “The midwife is the specialist in the health of women in good health, summarizes Isabelle Derrendinger, president of the National Council of the College of Midwives. We know the obstetric component well, less the gynecological follow-up at all stages of life.
Among young girls, it is theeducational and sexual life education, which includes the fight against violence against women, sexually transmitted infections (STIs), vaccination against the papillomavirus, contraception… From the age of 25, we recommend an annual gynecological consultation, which does not mean vaginal examination! But there is also life after the menopause, which does not rhyme with the end of sexual life and which we tend to assimilate to a pathology. »
Today, midwives also provide certain vaccinations (especially against Covid-19), addiction prevention, medical abortions and even medically assisted procreation in public and private assisted reproduction centres. Finally, novelty a decree of December 30, 2021 authorizes them to perform instrumental abortions, as part of a three-year experiment. “For the moment, the midwives submit applications for the call for projects, but in a few months, it will be a reality”, specifies Isabelle Derrendinger.
“Like two allied adults, each with their own expertise”
And for those who have chosen a gynecological follow-up by a midwife, there is no comparison. “She never subjects me to unnecessary or invasive examinations, illustrates Charlotte. She waits for my agreement before touching me and I am much more active during appointments: it is I who installs the speculum, in terms of discomfort, that changes everything! It is also a way of supporting the profession, of recognizing their great competence and their indispensable role in the lives of women. »
Anna, 37, has no children and does not want any. And turned three weeks ago to a midwife in the 14th arrondissement of Paris after three years of stopping gynecological follow-up. “The difference is listening,” she notes. Unlike anything I’ve experienced with other caregivers, I didn’t feel bombarded with questions. That didn’t stop her from giving me smear recommendations. » Forgotten the injunctions and paternalism? “She told me: I can follow you for years without ever examining you,” she enthuses. I felt that at all times, my consent would be respected and contrary to what one might think, it made me want to resume monitoring. She gives me back my place as a patient with my responsibility. Like two allied adults, each with their own expertise, me with my body, her with gynecology. »
A very different approach from what she had known before. “Between my 17 and my 27 years, I was on the pill and I have no memory of a gynecologist questioning this contraception, opening a discussion on the alternatives”, she regrets. It was after finding out, in particular thanks to the books of Martin Winckler, that she decided to switch to the IUD. “But it’s really because I was very determined that I was able to get it! “, she recalls.
“A rise in the use of midwives, but without being able to quantify it”
“We know that we have an increase in the use of midwives, but without being able to quantify it, recognizes Isabelle Derrendinger. I think women are going to turn more and more towards midwives. »
A phenomenon linked to issues of gender-based violence in gynecology? “No, answers the midwife, who participated in the work on this subject. We refuse to make obstetrical violence a problem of gender, generation or profession. On the other hand, being a health educator takes time. Midwives offer longer and more attentive consultations, according to women who confide in the networks. Undoubtedly our profession, because it is predominantly female, has appropriated the fight against gender-based violence. »
“Don’t panic, the midwives are there! »
Still, this gradual expansion of the skills of these caregivers is welcome in a context of drastic decline in the number of medical gynecologists (who do not give birth to women). While this specialty had simply disappeared at the boarding school between 1987 and 2003, places in medical gynecology remain low: from 82 for the promotion back to school in 2020, the figure should increase to 89 in 2023. No wonder that in some departments, in the provinces as in the Paris region, getting an appointment with a gynecologist becomes mission impossible.
To the point that a survey, conducted by the Ifop institute, 31% of 18-24 year olds surveyed say they have never been at one or gynecologist. “The consequences of the lack of gynecologists are multiple: very long delays, overruns on fees… but we simply forget to say: ‘Don’t panic, the midwives are there!’ “, reassures Isabelle Derrendinger. Who regrets that the government undertook in 2014 to communicate on the skills of midwives to citizens… “It has never been done! But the communication was done by word of mouth and social networks! »
Furthermore, the broadening of the skills of its healthcare professionals is likely to continue. Especially on endometriosis. “In the government announcements on the strategy to fight endometriosis, midwives are put in the front line, notes the president of the Order. I find it hard to see how because on the diagnostic side, the necessary examinations (hysterosalpingography, hysteroscopy) are not part of our skills and the therapeutic side, surgical in particular, is even less our domain! The only moment of intervention is identification: by identifying painful periods or difficult access to maternity. “Dossier to follow, therefore.