After having constitutionalized the voluntary termination of pregnancy, the government intends to rewrite the decree taken on December 17, authorizing midwives to perform instrumental abortions.
This practice, also called surgical abortion, consists of a rapid instrumental intervention to aspirate the embryo or fetus located in the uterus.
It represents 22% of abortions performed in 2022, compared to 38% for medical abortions, according to the latest INED study on the subject.
Nearly three months after its publication, the Minister responsible for Equality of Women and Men, Aurore Bergé, announced the rewriting of the decree in
Le Parisien
.
This modification of the text comes after a large number of midwives denounced conditions that were too restrictive for practicing instrumental abortion.
To the point of preventing, according to them, the expansion of access to abortion, as initially desired.
This text aimed to respond to the lack of practitioners who perform abortions, in a context where demand is increasing.
In 2022, 232,000 abortions were performed in France, compared to 216,000 in 2021.
In fact, the decree allows midwives to perform instrumental abortions, but only in the presence of a specialized doctor,
“an obstetrician-gynecologist and an anesthetist-resuscitator”
in the health establishment.
But also a doctor
“with training and experience”
in the management
of “arterial embolizations”
.
If midwives denounce these conditions as being too strict, specialist doctors see them as a secure and essential health framework in the event of complications.
“Extremely rare”
complications
For a large number of midwives, these prerogatives are not considered necessary.
“The procedure for abortion is not that complicated.
We are already used to carrying out procedures with similar technicalities, such as inserting the IUD,”
says Caroline Combot, president of the main midwives' union, the ONSSF (National Trade Union Organization of Midwives).
The midwife also refutes the obligation to have an
“embolization tray”
nearby , a radiology service which can intervene to treat possible bleeding after the procedure.
Caroline Combot nevertheless recognizes that a safety framework must be established for the good of patients' health, and in particular to react in the event of complications.
Agreements are also
“established with nearby maternity wards”
if necessary, she specifies.
But these complications
“remain extremely rare.
They are less frequent than during childbirth
,” compares the president of the union.
The midwife also believes that these prerogatives hinder
“women’s accessibility to abortion”.
“Not all hospital centers have obstetrician-gynecologists, resuscitation anesthetists or embolization trays.
Preventing us from performing abortions there reduces access to it for many women
,” she laments.
Caroline Combot also mentions the
“low number of practitioners who practice abortion”
.
The number of gynecologists actually fell by 52.5% between 2007 and 2020, or 1,022 fewer doctors in 13 years, reported Var senator Françoise Dumont in 2021.
Aurore Bergé's announcement on the rewriting of the decree therefore appears to be good news for midwives.
“We are delighted
,” rejoices Caroline Combot, president of the main midwives’ union, the ONSSF (National Trade Union Organization of Midwives).
But the liberal midwife admits remaining
“cautious”: “We do not yet know how the text will be rewritten and if the terms will be modified”
.
Also read “The round cheeks of a teenager, flooded with tears”: the poignant speech of a senator before the vote on abortion
“We must be able to act quickly”
All these prerogatives denied by the midwives had, however, been justified by the Ministry of Health in the columns of Le
Monde
last December, as an
“essential safety requirement in the event of an incident requiring rapid surgical intervention”
.
For their part, other professions in the medical sector concerned by the practice of abortion say they are in favor of maintaining these conditions.
If midwives speak of extremely rare complications, the president of the national union of anesthetists-resuscitators, Anne Geffroy-Wernet, warns of the risks of serious complications.
“Instrumental abortions performed under general anesthesia can be followed by hemorrhages or perforation of the uterus
,” warns the anesthetist-resuscitator.
“In these cases, we must be able to act quickly
,” continues the anesthesiologist-resuscitator who thinks that it is necessary for a specialist doctor not to be far from a midwife when she is performing an instrumental abortion. .
Professor Michaël Grynberg, gynecologist-obstetrician, shares this view.
“We must increase access to abortion, but not just anyhow
,” he says.
“If midwives are best placed to provide additional hands, their studies in gynecology are not complete.
We must maintain a framework with a sufficient technical platform
,” he explains.
Also read: “The constitutionalization of abortion will not erase Emmanuel Macron’s other constitutional failures”
For the moment, no additional information has been announced by Aurore Bergé's office, neither on the date of republication of the decree, nor on the modifications which will be made to it.
“All we are asking is to have the same prerogatives as general practitioners
,” asks Caroline Combot.