L’entretien postnatal précoce et la prise en charge par les sages-femmes : étude qualitative sur les freins et les leviers rencontrés

Abstract

Introduction: The postpartum period is a critical one in psychological, emotional and social terms, and requires appropriate care to identify signs of psychological difficulties at an early stage. Postpartum depression affects between 15% and 30% of women, and suicide is the leading cause of maternal mortality (preventable in the majority of cases) during the postpartum period. Depression not only affects the mother, but also the newborn, the child and the future adult. In contrast to the postpartum period, pregnancy monitoring involves a large number of consultations. The early postnatal interview recommended since 2014 by the French National Authority for Health has been made compulsory in July 2022 in order to identify difficulties linked to parenthood and the first signs of postpartum depression. How do liberal midwives incorporate the early postnatal interview into the care of their patients?
Objective: The main objective is to identify the obstacles and levers to the implementation of the early postnatal interview and to explore different ways of approaching the recommended themes in order to improve clinical practice.
Material and method: An exploratory observational study in the form of semi-directive interviews was carried out with ten liberal midwives. Participants were recruited by email after random sampling. Data collection was concurrent with data analysis until data saturation.

Results: The main motivation for the midwives interviewed for the early postnatal interview was to detect maternal distress. They felt that they had a central role to play thanks to the special relationship with the patient that had been built up during the pregnancy. The practice of the early postnatal interview is heterogeneous, but the topics covered are similar. The obstacles identified were a lack of training, the absence of a network, patient interest and a lack of information, the absence of 100% maternity cover and low remuneration. Levers were found, such as patient satisfaction, the number of problems detected and the use of the Internet for effective communication.
Discussion: In an ever-expanding field of expertise, the midwife is now the referring midwife, reinforcing her main role in the postnatal interview, but this role is time-consuming and can complicate the interview itself. In order to enhance the value of this interview, more appropriate reimbursement would be necessary, as well as more appropriate training and an increase in the value of the procedure. There has been a lot of positive feedback from patients encouraging the practice of such an interview.
Conclusion: The deployment of the early postnatal interview is a public health issue. Better recognition of this procedure by both patients and healthcare professionals would enable it to be deployed more effectively. This recognition should be accompanied by an information campaign aimed at patients, in order to arouse their interest and make up for frequent absenteeism.