In 2022, there would be nearly 23,800 midwives in France. A figure which has increased sharply since 2012. While 57% are employed in a hospital environment, 38% work in private practice.
Entirely serving women, the midwife has a very important role in the field of perinatal care. Find out what this health professional can do during pregnancy, childbirth and after as for perineal rehabilitation.
What services does a midwife offer?
Women have long consulted a gynecologist for their gynecological and obstetric follow-up. But in recent years, a more personal and accessible alternative has been offered to them: the midwife. This can work in a hospital environment, in private practice and/or in a PMI (Maternal and Child Protection) service.
Let's focus on the private midwife, who facilitates access to gynecological care, when gynecologists are rarely available. First, its main missions are routine checks of the female genital tract and the pregnancy monitoring.
She can also make prescriptions and certain medical procedures. Prescription and installation of contraceptive methods, cervicovaginal smears, screening and treatment of sexually transmitted diseases, medical abortion, etc. Of course, she also has an advisory role for patients.
However, the missions of a midwife are limited to prevention. In the event of a pathological situation, she must pass the baton to a gynecologist.
Pregnancy, childbirth and postpartum
Then, the liberal midwife is particularly useful during pregnancy – and after. It allows a more regular monitoring, with a proximity that expectant mothers appreciate. Often, a pregnant woman completes her visits to the gynecologist with special sessions with her midwife.
Concretely, this professional offers various services which extend from beginning of pregnancy until the first weeks of life of the baby.
The range of services varies and may include:
- Early prenatal interview (EPP), compulsory from the 4th e month of pregnancy.
- Birth preparation courses. These 7 sessions cover everything a future mother needs to know about pregnancy, childbirth and postpartum.
- Pregnancy monitoring, including ultrasound scans and baby monitoring. You must then contact a midwife and sonographer.
- Breastfeeding advice, lactation assistance.
- Delivery in the maternity ward, in a birthing center or at home.
- Postpartum follow-up. Health insurance reimburses 2 postnatal follow-up sessions (optional).
- Perineal rehabilitation, with or without probe.
Of course, it is even possible to discuss pregnancy with a midwife, even before conception.
Finally, during a delivery in an establishment, employed midwives accompany the patient during labor and throughout her stay. Some liberals also go to the delivery room to support the (future) mother.
Thus, dialogue with the midwife is essential to create a relationship of trust and benefit from tailor-made support.
Midwife, doula or gynecologist: who to choose to prepare for your birth?
A pregnant woman needs qualitative support during her pregnancy, particularly to prepare for childbirth. At this level, three professionals can be considered: the midwife, the doula and the gynecologist. But which one to favor?
What does an obstetrician-gynecologist do?
We have detailed the missions of a midwife. Let us now see those of the doctor specializing in obstetrics gynecology.
Both ensure the pregnancy monitoring, ensuring the well-being of the fetus and the mother. Cervical control, gynecological and obstetrical ultrasound, monitoring, etc.
But, as a doctor, only the obstetrician-gynecologist can take care of a pathological pregnancy. This includes multiple pregnancies, the threat of premature birth or even cases of gestational diabetes.
In addition, only the gynecologist can carry out difficult deliveries and use extraction instruments (forceps, suction cup, etc.).
On the other hand, the number of visits to the obstetrician is often very limit. This is why women like to complete them with a private midwife.
In addition, the gynecologist does not offer birth preparation sessions. If he can give advice and medical explanations, it does not offer practice. For more concrete and personalized support, the midwife is ideal.
The missions of a doula
Then you have the doula. Although this profession is still relatively little known in France, it has existed since ancient Greece.
Birth support specialist, a doula supports pregnant women and young mothers. She positions herself more as an advisor, physical and moral support. However, she is not capable of performing medical procedures because she did not study medicine.
A doula can therefore offer valuable advice and one concrete help. Creating an even more intimate relationship with the patient, she can even travel to the home and maternity ward. But she does not practice a medical profession and therefore in no way replaces gynecological follow-up.
Re-educate your perineum after childbirth
Finally, around 6 weeks after giving birth, it is recommended to re-educate your perineum. This time is necessary for the cervix to completely close, thus avoiding the risk of infection.
In practice, perineal rehabilitation sessions aim to work the set of muscles that constitute the pelvic floor . The objective is to remuscle this entire area that pregnancy (and vaginal birth) has weakened. This work then reduces the risk of urinary leakage, organ descent and other intimate dysfunctions.
Generally speaking, it is possible to do manual rehabilitation or with an electrostimulation probe.
- In the first case, it is Kegel exercises during which the woman contracts and relaxes the perineum. The variation in rhythm and intensity will gradually (re)tone the pelvic muscles. In addition, it is also possible to use a biofeedback probe to guide the sessions and monitor progress.
- Then, electrostimulation is rather reserved for very weak perineums, or even those with specific pathologies. It creates artificial contractions of the muscles of the perineum through electrical impulses.
The manual method can be done with a professional or alone at home. On the other hand, electrostimulation involves sessions with a qualified physiotherapist or midwife. Finally, note that gynecologists do not perform perineal rehabilitation , unlike some doulas.
The midwife, a professional dedicated to women
Thus, the midwife is a trusted professional who supports women throughout their lives. More especially during pregnancy, birth and maternity, it offers more personalized and regular monitoring. With her attentive ear and valuable advice, she wonderfully supports the work of the gynecologist.
