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.

中文翻译：

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法国私营营利性妇产科分娩护理的组织和质量：助产士非专业化的风险


在法国，2007年至2009年，私立营利性妇产科的围产期孕产妇死亡风险，尤其是因出血引起的死亡风险高于大学妇产科。我们的研究是 MATORG 项目的一部分，旨在描述这些私人诊所中分娩护理组织的特征，以分析它如何影响护理的质量和安全。我们于 2018 年在巴黎地区两家私人营利性诊所的产科单位进行了一项定性调查，采访了 33 名工作人员（助产士、产科医生、麻醉师、育儿助理和管理人员），并在产房观察了 20 天。组织社会学的视角指导了我们的数据分析。我们的研究区分了产科诊所护理安全的三个主要风险因素。医疗保健专业人员之间的分工威胁到助产士能力的维持，并使这些诊所很难留住助产士。助产士和产科医生的薪酬模式都会刺激双方过度工作，导致疲劳和警惕性降低。最后，一些产科医生的临床决策不是合议的，并且与助产士产生了冲突，助产士批评分娩的技术化。一些消极的助产士不再认为自己对患者的安全负责。私营妇产科的工作安排可能会使分娩护理的安全面临风险。劳动分工、人员调度/规划以及决策中缺乏合作增加了助产士非专业化的风险。