Planning of perinatal care policy in France: Organize continuity of care is a necessity and an emergency

Neonatal mortality in France has not decreased for 20 years and the last perinatal plan ended in 2007. An unprecedented demographic crisis is affecting all perinatal profes-sions. This crisis is contributing to the acceleration of maternity unit closures, particularly in private health care establishments. The territorial coverage by type 2 and 3 establishments, with the exception of Corsica, is satisfactory, but these establishments are saturated and offer deteriorated working and reception conditions. Their attractiveness is particularly low for mid-wives and nurses, professions where there are many vacancies. The population's expectations regarding childbirth are not being met either qualitatively or in terms of access to care. The particularly worrying situation of the overseas departments and regions could not be analyzed in this report. The implementation of an appropriate perinatal policy should be based on an increased reduction in the number of maternity units. These should be merged together with type 2 and type 3 establishments in the same territory whose structural and human resource constraints must guarantee both the safety and satisfaction of users while offering acceptable and sustainable working conditions. Only these large establishments could accommodate the most complex care pathways as well as the most physiological health pathways by reinforcing human resources and at the cost of architectural adaptations allowing the cohabitation of dif-ferent levels of care. These transformations will avoid the caricature of "baby factories" that is often made of large, saturated and therefore unwelcoming structures. The second lever of this policy is the pooling of public and private provision, which should be coordinated at the level of territories defined by the length of the journey to a type 2 or 3 facility to the benefit of families. This strategy requires complementarity between health establishments and commu-nity medicine. This has changed in 25 years due to the considerable increase in the number of midwives in private practice and the variety of their missions. Perinatal communities of proxi-mity with the actors of community care should define and coordinate health and care paths. These communities should have the appropriate means of face-to-face and remote consulta-tion and expertise, but also hospitalization facilities, particularly in the postpartum period, to encourage the development of the parent-child bond within the local community, as close as possible to the home. The longer journeys between home and the place of birth imposed by such groupings will require coordination between referents in the local perinatal commu-nity and recourse to medical transport, in particular Emergency Services. The development of hotel-hospital structures should also be an important element of the access to care system. These measures seem to be the only ones capable of alleviating the reality and the feeling of a perinatal desert by families and all those involved in perinatal care.& COPY; 2023 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.