Gynecology and Obstetrics exchange in France: first contact with professional midwifery

Nahiman Assad Ferreira Saleh

IFMSA Brazil

In July of this year, I had the amazing opportunity to do an internship l at the Adolph Pinard Maternity in Nancy, France. The organization of the exchange helped me to meet equally and greatly both gynecology and obstetrics services in the maternity, as I stayed 2 weeks in each one of them, helping in consults and scrubbing in surgeries. My personal interests are more towards obstetrics and perinatal medicine; therefore, I researched more about these areas in France to see the similarities and differences between my home country and medical school. The similarities include the multi-professional care of the patient: doctors, nurses, midwives, psychologists and other health care professionals were always taking centralized patient care, working as a team to provide the best to the women. One of the differences, which is the main aspect I want to highlight in this report, is the midwifery career. 

In Brazil, for centuries, midwifery remained as an informal job, of which skills were passed orally from, usually, one generation to the other. These midwives, even nowadays, are mainly focused on the pregnancy and puerperium periods, as well on the newborn. They are not able to deal well with issues as contraception, pregnancy and delivery follow-up and even abortion. This profession in Brazil has starting to grow, in scientific, work-rights and regulation terms, only around 10 years ago. In France, however, midwifery seems to be a well established career and an indispensable role inside maternities all around the country.

During my exchange, I was able to watch some deliveries; most of them were cesarean sections (70%);The natural deliveries I watched, were always only handled by midwives; no doctors or nurses were in the room until the moment the baby was completely delivered, which was when the pediatrician would come.. Even if the labor values would get a little tricky, they would know how to manage it and also talk to the mom in a calm and encouraging way. They demonstrated to have as (and if I should risk, sometimes even better) knowledge about the way the pregnant body works as the doctors. In one of the c-sections I watched, it became necessary to perform an episiotomy: the “sage-femme” (midwife in French) made the local anesthesia, the incision and, after the delivery, stitched it back. For me, this was really surprising, because midwives in Brazil don’t have yet this independence. In Brazil, unfortunately, most of the credit of knowledge and procedures goes to doctors, which very often overshadows the role and credit of nurses and midwives. 

The sage-femmes in Nancy were always very respectful to me and tried their best to explain me the procedures and maneuvers they would do, relating to the physiology and anatomy of the pregnant woman’s body. Thus, they knew their role towards me, an exchange student from Brazil: trying to teach me something new or even help me revise something I had already learned before. This proves that the whole health care staff, not only doctors, have to be ready and welcome when they are part of a hospital that supports and make an IFMSA exchange alive. 

The technology level of the hospital, the price of the equipment or the highest degree of the tutor: none of that matters if the human resources of a staff involved in an exchange is not welcoming or ready to teach you something new. Midwives in France showed me that this career can be improved in Brazil and work side by side with the medical team, helping in pregnancy and puerperium outcomes towards mom and baby health care. I have to thank IFMSA and the Association de Carabins de Nancy for the great opportunity I had there in July 2019!