“How are you doing?” “Did you sleep outside again?” “We’re going to listen to the baby’s heart.” At the Montreuil hospital (Seine-Saint-Denis), a specialized unit takes care of vulnerable pregnant women in an attempt to stem infant mortality, which is particularly high in this department.
This personalized support unit (UAP) follows each year around 300 pregnant women in very precarious circumstances, who may be minors, weakened by addictions or even present psychological or psychiatric disorders.
The project was launched in 2018 as a response to infant mortality in Seine-Saint-Denis, which is particularly worrying.
Over the past ten years, this indicator – which measures the ratio between the number of children who died in their first year and all children born alive in that same year – has increased in France (3.7 deaths per 1,000 births), demoted from 5th to 18th place among OECD countries.
With 5.4 deaths occurring before one year per 1,000 births, the department of Seine-Saint-Denis, northeast of Paris, currently has the highest infant mortality rate in mainland France.
For the Ile-de-France Regional Health Agency, which finances the UAP project for the Montreuil intercommunal hospital center as well as four similar units in Seine-Saint-Denis and Val-d’Oise (at amounting to 700,000 euros per year in total), reducing infant mortality is a “priority”.
In 2014, two studies made it possible to identify the causes of this high rate: poor access to care but also the precariousness of populations.
– “Lost” –
“20% of our patients have gestational diabetes, linked to diet, therefore to insecurity,” underlines Bruno Renevier, head of the maternity department and head of the Montreuil UAP. However, it is a risk factor for pregnancy in the same way as hypertension, maternal obesity, chronic or infectious diseases, all favored by difficult living conditions.
Concretely, fetal death, cesarean sections and prematurity are increased by the vulnerability of women in the broad sense.
At the UAP, multidisciplinary teams, with longer consultation times, are trained to identify this vulnerability. Midwives, referring gynecologist, social worker, psychologist offer comprehensive care in a unity of places and times to limit interruptions in the course.
“These women are often lost in a care system that is too complex. As soon as we grab hold of one, we never let go,” assures Dr Bruno Renevier.
Galith Partouche, gynecologist in Montreuil, announces it straight away: his consultations are as much “social” as “medical”. “Many of the women I see are alone, migrants, fleeing forced marriage or violence,” she says.
– “In the street” –
That day, she received a 32-year-old woman, six months pregnant, with her husband and their 9-year-old daughter. They fled their village in Ivory Coast so that the little girl would not be circumcised there. From the start of the interview, the latter takes a nosedive. The doctor suggests that she lie down on the examination table for a nap.
“Since they arrived in France in July, the family has been sleeping in the street,” says the gynecologist.
So, during the consultation, she discusses with the future mother her upcoming blood tests, the appointment to be made with the anesthetist, asks about her back pain but also asks her if she can eat and if she has Please call 115 (Social Samu) to obtain emergency accommodation.
Then she accompanies the couple to the social worker’s office, who will help them with all their procedures.
The Montreuil UAP experiment is the subject of a study published this summer in the journal BMC Pregnancy and Childbirth: “It has been shown that being monitored in the unit halved the baby’s risk of prematurity” , summarizes Dr. Renevier.
With these encouraging results, “we hope to improve birth conditions in the region”, declares Laurence Desplanques, head of the perinatal – women’s health department at ARS Ile-de-France.
More than 1,000 women were able to benefit from such support last year.
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