Gynecologists dispossessed of disappearing motherhood

Obstetrician-gynecologist for 40 years, including 31 years at the Esquirol Saint Hilaire clinic in Agen, with 10,000 babies born, Doctor Robert Nehamia is stunned by the closure of the clinic’s maternity ward. He sees himself definitively deprived of deliveries.

« I also speak on behalf of my colleague Dr. Mihaela Gradinaru, obstetrician-gynecologist, and pediatrician Georges Hallak who took care of newborns. We were all presented with a fait accompli, the announcement in the press in the first days of April. The roadmap negotiated between the CH and the clinic and signed by the presidents of the CMEs was already in place. Nothing was debatable and we were never concerted. Three years of care one day out of 2,402 deliveries in 2021 and I performed my last cesarean on Monday and the last end of pregnancy visits in mid-May ».

50% loss of activity

The judgment is acted. He affirms that the obstetrics gynecology team and the perinatal pediatrician who also consults at the clinic, have never been associated with the different phases of reflection, decisions and deadlines. “On the contrary in September 2021, the director Lionel Combes, faced with the rumours, seemed to affirm that the maternity ward would not close. It was very violent for our collapsed patients when we told them. Some do not want to give birth in the hospital. « is in defiance of our activity and the human being. In fact today, we no longer give birth here, we monitor pregnancies until the 8th month ».

Dr. Robert Nehamia fatally fears that his discouraged future pregnant patients would immediately prefer to be monitored at the hospital and a loss of 50% of his activity.

A joint letter addressed to the ARS of 47 did not influence the decision: « The ARS was still surprised at the lack of consultation, and then we were imposed a radio silence until the beginning of May and around May 9, we were informed that the activity was gradually stopping from May 25,” says Dr Nehamia. It is therefore a painful birth that this group of maternity wards represents, for this specialist who explains that he and his colleagues ensured personalized follow-up of pregnancies with a watch on pathological pregnancies with the help of 3D imaging and collegial meetings. with cardiologists, diabetologist and nephrologist. « We were left out of the decisions, we felt it coming and they refused to see us. But everything was in the boxes ». He evokes the shortage of liberal gynecologists in the agglomeration. « Our patients also came from Marmande, Fumel, Villeneuve, Valence d’Agen, Lectoure… Where will she choose to go?…. ».

Obstetrics, the pure heart of the profession

Questions and unknowns in the face of the dispossession of obstetrics until the end of the pregnancy, the financial burdens that run and the future of two secretaries for him. « The heart of our profession is obstetrics, childbirth ». He explains that the appointments were quick and that all the women were taken care of without exception.

His service has carved out a solid reputation for gynecological and functional surgery, which he practices, as well as the fight against infertility and cancer screening. « We had the confidence of pregnant women and above all we were there physically to give birth to them. We do not agree on the method, things were done in a hurry and haste, whereas usually everything is organizes quietly in the last trimester of pregnancy ». The clinic’s team of obstetrician-gynecologists continues to follow the parturients until the 8th month and then has to reluctantly hand over the medical records.

The obstetric block has closed, the 15 beds also in the maternity ward.

Long term vision

Lionel Combes, director of the Esquirol Saint Hilaire clinic, does not contest Dr. Nehamia’s point of view, but invokes the imperative need to reinforce the perinatal scheme in the light of the endemic difficulty of recruitment: « There is a lack of medical and paramedical personnel, specialists. Each of us had difficulty recruiting in our own corner and our gynecologists had been informed of this for several years. It seemed more logical to us to concentrate our forces and offer young specialists larger teams. and a larger structure that will be able to absorb 1,500 births per year ». The objective is to offer « a strong obstetrics centre, a state-of-the-art level IIB maternity unit » and a service which already accommodates very premature babies. The clinic’s perinatal scheme was considered fragile. Moreover, the retired Dr. Negui could never be replaced. He opposes a long-term vision. Five midwives and 10 childcare assistants join the hospital. « The health crisis has shown that we can work, private and public, in good intelligence, to avoid territorial difficulties. We are striving to make this happen as best as possible ».