🧩⚖️ Perinatal Care in France: indicators in decline, a fragmented organisation, but 6 very operational reform axes to put women, babies, and midwives back at the centre of care pathways. #PerinatalCare #healthpractices
🔎🤝 From pre-conception to post-partum at 6 months: this report from the CNSF proposes concrete levers to structure prevention, secure early discharges, and strengthen territorial coordination in perinatal care. #Midwives
🔍➕ The report is directly useful to midwives (all modes of practice), maternity managers, coordinators of perinatal networks, PMI teams, and ARS to rethink perinatal pathways based on a precise diagnosis of current shortcomings and concrete proposals for reorganisation, from pre-conception to post-partum at 6 months.
It enables health executives, establishment management, or local elected officials to have structured and quantified arguments to defend a local offer, rebalance the role of maternity units, and develop birth centres and home follow-ups.
Associative and social actors (shelter structures, parenting support associations, health mediation) can find a framework to better articulate their actions with health systems and identify blind spots (precariousness, homelessness, violence, mental health).
Source: 📒 Reorganisation of Perinatal Care – Report from the National College of Midwives of France
📜🔗LINK
1. ANALYTICAL SUMMARY
Context and perinatal issues
The report starts from a finding repeated by several national institutions: France is experiencing a deterioration in its indicators of infant mortality, neonatal mortality, and maternal morbidity, placing it now behind several reference European countries such as Norway, Sweden, Finland, and Denmark. Between 2015 and 2024, infant mortality rose from 3.5 to 4.1 deaths per 1,000 live births, while maternal mortality is estimated at 11.8 deaths per 100,000 births, with a significant proportion of deaths deemed avoidable. The French perinatal system is characterised by strong hyper-medicalisation, a weakened network of maternity units (a threefold reduction in the number of maternity units since the 1970s), and insufficient coordination between actors and territories, with fragmentation of entry points and breaks in the continuity of care. The report focuses on the organisation of care (excluding medical demographics and paediatrics) and on the pivotal role of midwives in re-establishing perinatal care around physiology while taking into account the increase in risk factors (precariousness, obesity, maternal age, exposure to pollutants).
Operational contributions for practices
The document proposes six structural axes: antenatal prevention (including pre-conception consultation and prenatal prevention assessment), clarification of the antenatal pathway according to risk level, strengthening postpartum follow-up up to 6 months, reorganisation of birth locations, territorial coordination, and institutional evolution of the midwifery profession. It details, for each axis, reasoned recommendations (for example, generalising early prenatal interviews, securing early discharges, developing birth centres, clarifying the role of the lead midwife, creating territorial perinatal health projects) and proposes identified concrete actions. The report relies on a collective methodology (four working groups, documentary review, cross-readings) to formulate measures consistent with the findings, aiming for realistic implementation by institutions (ministry, ARS, establishments, local authorities). It thus offers a coherent framework for local or national action plans, combining scientific arguments, field feedback, and international comparisons.
2. KEY POINTS OF THE DOCUMENT
The deterioration of perinatal indicators places France in a concerning situation compared to other European countries, with an infant mortality rate of 4.1 per 1,000 births in 2024 and a maternal mortality rate of 11.8 per 100,000 births, of which more than half is deemed related to inadequate care. (p. 11-12)
The report highlights a fragmentation of the antenatal pathway, with a multiplicity of entry points (midwives, obstetrician-gynaecologists, general practitioners) and still very insufficient use of structuring tools such as early prenatal interviews (conducted for only 36.5% of women in 2021) and the lead midwife. (p. 12-14, 24)
The reduction in the number of maternity units (1,747 in 1972 to 471 in 2021) and the concentration of 8 out of 10 births in type 2 and 3 maternity units have consequences for accessibility, transport safety, and length of stay, without systematic home support, contributing to an over-medicalisation of pregnancies that are predominantly physiological. (p. 14‑16, 45‑47)
The report proposes a clear structuring of the pathways for 'low risk', 'risk', and 'pathological', with a primary care role for midwives in low risk, an explicit gradation of risk levels, and differentiated antenatal and postnatal pathways that are clear for women and professionals. (p. 27‑31, 33‑37)
It puts forward strong recommendations regarding places of birth: separation of delivery rooms into low and high risk areas, national development of birth centres, regulation of home births, better financial recognition of obstetric procedures, and recognition of gynaecological-obstetric emergencies on par with general emergencies. (p. 45‑52)
3. ACTION POINTS FOR LOCAL STAKEHOLDERS
Structure a prenatal prevention pathway that systematically includes pre-conception consultations (when possible), early pregnancy declaration, prenatal prevention assessment, and early prenatal interviews, by specifically identifying resource midwives in the area. (p. 20‑24)
Establish, at the level of each territory (health territory, living area), a formalised perinatal health project, constructed with maternity units, CPP, PMI, private practitioners, health transport services, and associations, including a dynamic mapping of services and monitoring indicators. (p. 53‑55, 61‑64)
Strengthen and organise post-partum follow-up, anticipating early discharges from pregnancy, scheduling home visits by midwives, integrating screening and management of post-partum depression, and coordinating with paediatric follow-up and social services for situations of vulnerability. (p. 33-41, 43)
Develop birth centres and agreements with reference maternity units, while defining strict eligibility criteria, transfer protocols, and a balanced network across the territory, to provide a safe alternative for low-risk pregnant women seeking a less technical environment. (p. 50-52)
Invest in training and interprofessional cooperation: cross-training for midwives/gynaecologists/general practitioners/child health services/social workers, building shared procedures (low-risk pathways, identifying vulnerabilities, transfers), using secure interoperable digital tools for information sharing. (p. 29-30, 56-60, 64)
4. ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of perinatality ➡️🔗https://pratiquesensante.odoo.com/5-1-perinatalite
Public Health France. "Report on perinatal health surveillance in France". Recent updates (data up to 2022-2023). URL :https://www.vie-publique.fr/files/rapport/pdf/286390_0.pdf(verified accessible March 2026).
Senate. "Perinatal health and its territorial organisation: the Senate presents 16 recommendations". Information mission on the future of perinatal health (2024). URL :https://departements.fr/sante-perinatale-et-son-organisation-territoriale-le-senat-presente-16-recommandations/(verified).
5. CROSS-SECTIONAL ANALYSIS — PRACTICAL VALUES IN HEALTH
Literacy: the report remains very technical, but proposes to structure tools such as early prenatal interviews and preventive prenatal assessments, which can be adapted to improve women's understanding of their pathways. (p. 20‑25)
Empowerment: emphasis is placed on respecting birth plans, the choice of place of delivery (birth centres, supervised home births) and continuity with a designated midwife, which strengthens women's decision-making autonomy. (p. 24‑26, 50‑52)
Participation: the document mentions the inclusion of users in territorial cooperations and the co-construction of perinatal projects, but does not detail systematic user participation mechanisms (patient committees, etc.). (p. 53‑60)
Community health: the collective dimension appears through territorial perinatal health projects and the joint mobilisation of health, social and associative actors, but the explicit notion of community health is not developed as such. (p. 53‑55)
Ethics: the report addresses biases related to hyper-medicalisation, social inequalities in access to care, maternal and neonatal safety, and calls for better alignment of care with needs, which implies ethical reflection on the proportionality of interventions. (p. 11‑16, 52)
Human rights: it emphasises equitable access to quality perinatal care across the entire territory and the legitimacy of women's choices regarding their place of birth, which aligns with the principles of inclusion and equality. (p. 18, 45‑52, 54)
Intersectorality: the text recommends partnerships between hospitals, local authorities, maternal and child health services, health transport, social and community structures, particularly for situations of vulnerability, early discharges, and mental health. (p. 33‑41, 53‑61)
Partnership: it formalises models of collaboration (territorial projects, agreements between birth centres/maternity units, the role of perinatal DSRs, coordination between city-hospital-PMI, lead midwife), although detailed contractualisation remains to be developed locally. (p. 50‑55, 55‑60)
Combating discrimination: the report mentions the effects of vulnerability, homelessness, and territorial inequalities on perinatal health, but addresses gender, origin, or sexual orientation discrimination only implicitly; it nevertheless recommends fairer and non-stigmatising organisations. (p. 11‑12, 37‑39)
6. EVALUATION OF THE RELIABILITY OF THE RESOURCE
Scientific relevance: the report is produced by a learned society (CNSF), relies on numerous recent institutional reports (Academy of Medicine 2023, Court of Auditors 2024, Senate report 2024, ENCMM) and mobilises national and international epidemiological data, making it a scientifically robust resource, even if the details of the numerical references are concentrated at the beginning of the document. (p. 10‑12, 72)
Operational relevance: the text is strongly action-oriented, with a very detailed diagnosis, structuring axes, recommendations, and 'identified actions' for each theme (prevention, pathways, birth locations, territorial coordination, valorisation of actions), making it directly usable for local planning, negotiation with institutions, and internal reorganisation of services. (p. 19‑41, 45‑52, 53‑69)
7. MCQ — 5 QUESTIONS
PART 1 — Questions without answers
Question 1 (organisation of indicators) – Source: p. 11‑12
In 2024, what is the infant mortality rate in France mentioned in the report?
a) 2.3 deaths per 1,000 live births
b) 3.1 deaths per 1,000 live births
c) 4.1 deaths per 1,000 live births
d) 5.4 deaths per 1,000 live births
Question 2 (early prenatal interview) – Source: p. 24
According to the report, what proportion of women reported having benefited from an early prenatal interview in 2021?
a) 56.5%
b) 46.5%
c) 36.5%
d) 26.5%
Question 3 (network of maternity hospitals) – Source: p. 14‑15
Which statement best describes the evolution of the number of maternity hospitals in France between the 1970s and 2021?
a) The number of maternity hospitals has remained relatively stable, around 1,700 establishments
b) The number of maternity hospitals has doubled to meet growing demand
c) The number of maternity hospitals has been reduced to a third, reaching 471 establishments
d) The number of maternity units has slightly decreased, from 800 to 650 establishments
Question 4 (birth centres) – Source: pp. 50-52
What role is attributed to birth centres in the report?
a) Structures intended for high-risk pregnancies with on-site resuscitation
b) Structures run by midwives for low-risk pregnancies, linked to a hospital
c) Social accommodation structures for pregnant women in severe precariousness
d) Obstetric emergency units located outside the hospital
Question 5 (midwives) – Source: pp. 17-18, 66-67
What major direction regarding the profession of midwife is highlighted by the report?
a) Reducing the role of midwives in maternity in favour of obstetricians
b) Limiting the practice of midwives to only preparation for birth
c) Recognising midwives as primary care professionals and strengthening their pivotal role
d) Primarily directing midwives towards administrative and management functions
Order of correct answers (expected): c / c / c / b / c
PART 2 — Commented correction
Question 1: In 2024, what is the infant mortality rate in France mentioned in the report?
✅ Correct answer: c) 4.1 deaths per 1,000 live births
📝 Explanation: The report reminds us that infant mortality has not decreased since 2015 and indicates that it reaches 4.1 deaths per 1,000 births in 2024, placing France above the European average. Source: pp. 11-12.
Question 2: According to the report, what proportion of women reported having benefited from an early prenatal interview in 2021?
✅ Correct answer: c) 36.5%
📝 Explanation: The early prenatal interview, mandatory since 2020, remains underutilised: the 2021 perinatal survey cited by the report indicates that only 36.5% of women benefited from it, with significant territorial disparities. Source: p. 24.
Question 3: Which statement best describes the evolution of the number of maternity units in France between the 1970s and 2021?
✅ Correct answer: c) The number of maternity units has been reduced by a third to reach 471 establishments.
📝 Explanation: The report specifies that there were 1,747 maternity units in 1972, compared to 471 in 2021, representing a reduction by a third, with an impact on the distances between home and maternity units and the concentration of births in type 2 and 3 facilities. Source: p. 14-15.
Question 4: What role is attributed to birth centres in the report?
✅ Correct answer: b) Structures run by midwives for low-risk pregnancies, linked to a hospital.
📝 Explanation: Birth centres are presented as structures for low-risk pregnancies, run by midwives, adjacent to a gynaecology-obstetrics facility through agreements and direct access for transfers. Source: p. 50-52.
Question 5: What major direction regarding the profession of midwife is highlighted by the report?
✅ Correct answer: c) Recognise midwives as primary care professionals and strengthen their pivotal role.
📝 Explanation: The report emphasises the full recognition of midwives in hospitals, the explicit integration as primary care professionals, and the enhancement of their central role in low-risk pregnancies and prevention. Source: p. 17-18, 66-67.
8. FREQUENTLY ASKED QUESTIONS (FAQ)
Who is behind this report and what are its main objectives?
Answer: The report is produced by the National College of Midwives of France (CNSF), based on collective work from several working groups and a literature review, with the aim of establishing a shared diagnosis of the current organisation of perinatal care and formulating coherent and operational reform recommendations. (p. 2-3, 9-10)
What are the main issues identified in perinatal care in France today?
Answer: The report highlights the deterioration of indicators (infant and maternal mortality), territorial inequalities in access, fragmentation of the care pathway, hyper-medicalisation of childbirth, and the weakening of the maternity network, with a concentration of births in highly technical facilities. (p. 11-16, 45-47)
How does the report propose to improve prevention before and during pregnancy?
Answer: It recommends strengthening pre-conception consultations, promoting early declaration of pregnancy, systematising prenatal prevention assessments and early prenatal interviews, and clarifying the role of the midwife as the reference for low-risk follow-up. (p. 19-24)
What developments are proposed for post-partum follow-up?
Answer: The report emphasises the need for structured follow-up from postpartum to the child's 6 months, integrating the mother's health (including postpartum depression), parenting support, breastfeeding, and coordination with paediatric follow-up and social services, particularly in the context of early discharges. (p. 33-41, 43)
What does the report say about the organisation of birth places?
Answer: It proposes to maintain safety while respecting physiology, through a separation of low and high-risk areas, the development of birth centres, consideration of home births, and better financial and institutional recognition of obstetric activities and gynaecological-obstetric emergencies. (p. 45-52)
How should territorial coordination be strengthened?
Answer: The report recommends the development of territorial perinatal health projects, the involvement of Regional Specific Devices, multidisciplinary cooperation, consideration of health transport, and the development of interoperable digital tools for information sharing among stakeholders. (p. 53-56, 61-64)
What are the implications for the midwifery profession and its training?
Answer: The text highlights the need to recognise the role of midwives as primary care professionals, to enhance their hospital, private, and community careers, to strengthen training in prevention, coordination, and research in midwifery, and to adapt organisations to make their practice more attractive. (p. 17-18, 66-69)
9. REWRITING IN EASY TO READ LANGUAGE
EASY TO READ TITLE
Perinatality in France: how to better organise care for women and babies.
FALC Analytical Summary
Context and Issues
In France, more babies and mothers have health problems than before.
Other European countries have better outcomes for pregnancy and childbirth.
Maternity units are fewer in number and sometimes very far from home.
Care is sometimes too technical for uncomplicated pregnancies.
Women see many different professionals and get lost in the process.
Midwives are on the front line but their role is not always clear.
Operational Contributions
The report proposes changes to better support women and babies.
It starts before pregnancy, continues during pregnancy, and after birth.
It suggests better use of certain important appointments such as the prenatal interview.
It aims to give midwives a clear role as a point of reference.
It calls for more suitable places to give birth, such as birth centres.
It requests that stakeholders in the same area work together for families.
Key Points FALC
Key Point 1: Baby mortality is no longer decreasing in France and remains too high.
Key Point 2: France has many fewer maternity units, often very large and highly medicalised.
Key Point 3: Important preventive appointments are not offered enough to women.
Key Point 4: Midwives can monitor uncomplicated pregnancies and should be better recognised.
Key point 5: Birth centres provide a quieter place to give birth with a midwife, while remaining close to the hospital in case of problems.