Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives
•Previous analysis showed excess risk of peripartum maternal deaths in French private hospitals.•Our qualitative study shows organizational risk factors for poorer quality of care.•Some of these concern the work of midwives.•The division of labor threatens the maintenance of their competencies.•Tens...
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Veröffentlicht in: | Journal of gynecology obstetrics and human reproduction 2024-05, Vol.53 (5), p.102772-102772, Article 102772 |
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container_title | Journal of gynecology obstetrics and human reproduction |
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creator | Vassy, Carine Sauvegrain, Priscille Deneux-Tharaux, Catherine |
description | •Previous analysis showed excess risk of peripartum maternal deaths in French private hospitals.•Our qualitative study shows organizational risk factors for poorer quality of care.•Some of these concern the work of midwives.•The division of labor threatens the maintenance of their competencies.•Tensions with obstetricians can engender a loss of motivation and of vigilance.
In 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.
We 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.
Our 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.
The 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. |
doi_str_mv | 10.1016/j.jogoh.2024.102772 |
format | Article |
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In 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.
We 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.
Our 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.
The 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.</description><identifier>ISSN: 2468-7847</identifier><identifier>ISSN: 2468-8495</identifier><identifier>EISSN: 2468-7847</identifier><identifier>DOI: 10.1016/j.jogoh.2024.102772</identifier><identifier>PMID: 38518831</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Delivery, Obstetric - standards ; Female ; France ; Humanities and Social Sciences ; Humans ; Maternal health ; Maternal Health Services - standards ; Midwifery - standards ; Midwives ; Obstetrics - standards ; Organization of care ; Parturition ; Pregnancy ; Qualitative Research ; Quality of childbirth care ; Quality of Health Care - standards ; Sociology</subject><ispartof>Journal of gynecology obstetrics and human reproduction, 2024-05, Vol.53 (5), p.102772-102772, Article 102772</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Masson SAS.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c388t-cb17d7d6557563ebac9351cc83c059b2c23a69cdc7f548875fe4cd7db388efe93</cites><orcidid>0000-0003-1014-6655 ; 0009-0000-2591-2397</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38518831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04593439$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Vassy, Carine</creatorcontrib><creatorcontrib>Sauvegrain, Priscille</creatorcontrib><creatorcontrib>Deneux-Tharaux, Catherine</creatorcontrib><title>Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives</title><title>Journal of gynecology obstetrics and human reproduction</title><addtitle>J Gynecol Obstet Hum Reprod</addtitle><description>•Previous analysis showed excess risk of peripartum maternal deaths in French private hospitals.•Our qualitative study shows organizational risk factors for poorer quality of care.•Some of these concern the work of midwives.•The division of labor threatens the maintenance of their competencies.•Tensions with obstetricians can engender a loss of motivation and of vigilance.
In 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.
We 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.
Our 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.
The 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.</description><subject>Delivery, Obstetric - standards</subject><subject>Female</subject><subject>France</subject><subject>Humanities and Social Sciences</subject><subject>Humans</subject><subject>Maternal health</subject><subject>Maternal Health Services - standards</subject><subject>Midwifery - standards</subject><subject>Midwives</subject><subject>Obstetrics - standards</subject><subject>Organization of care</subject><subject>Parturition</subject><subject>Pregnancy</subject><subject>Qualitative Research</subject><subject>Quality of childbirth care</subject><subject>Quality of Health Care - standards</subject><subject>Sociology</subject><issn>2468-7847</issn><issn>2468-8495</issn><issn>2468-7847</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uctu1DAUjRAVrUq_AAl5CYsMfsSxg8SiqihFGqlS1a4tx75pPCRxaztTlY_gm3HIULFiY_ten4d9T1G8I3hDMKk_7TY7f-_7DcW0yh0qBH1VnNCqlqWQlXj9z_m4OItxhzEmktY1q98Ux0xyIiUjJ8Wv63CvJ_dTJ-cnpCeLHmc9uPSMfIeMDoDchEzvBtu6kPqleghurxOgzofyIfjOJTTmOkwLa85rXFCXQU8GPqMbF3_ERSz1gCwsBIgxm2WXg2u-HJ19cnuIb4ujTg8Rzg77aXF3-fX24qrcXn_7fnG-LQ2TMpWmJcIKW3MueM2g1aZhnBgjmcG8aamhTNeNsUZ0vJJS8A4qkwltZkMHDTstPq66vR5U_tCow7Py2qmr861aerjiDatYsycZ-2HF5rc_zhCTGl00MAx6Aj9HRRtRYcwJwRnKVqgJPsYA3Ys2wWrJTe3Un9zUkptac8us9weDuR3BvnD-ppQBX1YA5JHsHQQVjYM8XusCmKSsd_81-A1nfqyA</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Vassy, Carine</creator><creator>Sauvegrain, Priscille</creator><creator>Deneux-Tharaux, Catherine</creator><general>Elsevier Masson SAS</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>BXJBU</scope><orcidid>https://orcid.org/0000-0003-1014-6655</orcidid><orcidid>https://orcid.org/0009-0000-2591-2397</orcidid></search><sort><creationdate>202405</creationdate><title>Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives</title><author>Vassy, Carine ; Sauvegrain, Priscille ; Deneux-Tharaux, Catherine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c388t-cb17d7d6557563ebac9351cc83c059b2c23a69cdc7f548875fe4cd7db388efe93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Delivery, Obstetric - standards</topic><topic>Female</topic><topic>France</topic><topic>Humanities and Social Sciences</topic><topic>Humans</topic><topic>Maternal health</topic><topic>Maternal Health Services - standards</topic><topic>Midwifery - standards</topic><topic>Midwives</topic><topic>Obstetrics - standards</topic><topic>Organization of care</topic><topic>Parturition</topic><topic>Pregnancy</topic><topic>Qualitative Research</topic><topic>Quality of childbirth care</topic><topic>Quality of Health Care - standards</topic><topic>Sociology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vassy, Carine</creatorcontrib><creatorcontrib>Sauvegrain, Priscille</creatorcontrib><creatorcontrib>Deneux-Tharaux, Catherine</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>HAL-SHS: Archive ouverte en Sciences de l'Homme et de la Société</collection><jtitle>Journal of gynecology obstetrics and human reproduction</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vassy, Carine</au><au>Sauvegrain, Priscille</au><au>Deneux-Tharaux, Catherine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives</atitle><jtitle>Journal of gynecology obstetrics and human reproduction</jtitle><addtitle>J Gynecol Obstet Hum Reprod</addtitle><date>2024-05</date><risdate>2024</risdate><volume>53</volume><issue>5</issue><spage>102772</spage><epage>102772</epage><pages>102772-102772</pages><artnum>102772</artnum><issn>2468-7847</issn><issn>2468-8495</issn><eissn>2468-7847</eissn><abstract>•Previous analysis showed excess risk of peripartum maternal deaths in French private hospitals.•Our qualitative study shows organizational risk factors for poorer quality of care.•Some of these concern the work of midwives.•The division of labor threatens the maintenance of their competencies.•Tensions with obstetricians can engender a loss of motivation and of vigilance.
In 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.
We 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.
Our 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.
The 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.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>38518831</pmid><doi>10.1016/j.jogoh.2024.102772</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-1014-6655</orcidid><orcidid>https://orcid.org/0009-0000-2591-2397</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Delivery, Obstetric - standards Female France Humanities and Social Sciences Humans Maternal health Maternal Health Services - standards Midwifery - standards Midwives Obstetrics - standards Organization of care Parturition Pregnancy Qualitative Research Quality of childbirth care Quality of Health Care - standards Sociology |
title | Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives |
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