[For or against birthing centers: a survey of practitioners in the Isere area]

A questionnaire survey on the Birth Centers project was conducted among gynecology and obstetrics healthcare workers in the Isere area. The aim was to better understand the organization of the healthcare system operating around childbirth and to gather suggestions and criticisms concerning this project. Among the 451 people questioned, 42% answered, including 72.6% midwives and 21% physicians. The study was conducted in three phases: exploratory talks with practitioners, drafting the 37-iem questionnaire, and analysis of the answers around nine themes: health worker's information about Birth Centers, awareness of these structures, practice of birth preparation, advice given about practical aspects of Birth Centers, midwife skills, health workers satisfaction concerning the organization of the childbirth healthcare system, ways to improve management of birth in France, healthcare workers opinion about the project and social determinants. Healthcare workers were found to be poorly informed (only 20% were aware of Birth Centers). There was also a high rate of dissatisfaction concerning the current childbirth healthcare system (78%). Most of the responders (38 to 88%) agreed with the underlying principle of Birth Centers (no induction of delivery, early discharge with home care, better information about epidural anesthesia, choice of position during labor and childbirth...), but many discrepancies were found concerning discontinuous fetal monitoring during labor and lack of epidural anesthesia in Birth Centers. Eighty percent accepted the project, but 20% though that one or several physicians should be available in the Birth Center and 47% considered the project would not affect maternal and perinatal mortality/morbidity. This constitutes a bias concerning the health workers' approval of the project. As a result, before thinking about the installation of Birth Centers in France, it would be important to evaluate the project at experimental sites and provide sufficient information to gynecology and obstetrics healthcare workers. This information must concern midwife skills and the mission of birth Centers.