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PEOPLE@HES-SO – Annuaire et Répertoire des compétences
PEOPLE@HES-SO – Annuaire et Répertoire des compétences

PEOPLE@HES-SO
Annuaire et Répertoire des compétences

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Gaucher Laurent

Gaucher Laurent

Compétences principales

Public health

Health, sports, wellbeing

Midwifery

Epidémiologie

Mental Health

Clinical evaluations

  • Contact

  • Recherche

  • Publications

  • Conférences

Contrat principal

Haute école de santé - Genève
Avenue de Champel 47, 1206 Genève, CH
HEDS-GE
Domaine
Santé
Filière principale
Sage-femme

Laurent Gaucher est un sage-femme et chercheur engagé dans l'amélioration de la qualité des soins lors de l'accouchement et la promotion de la santé mentale maternelle. Avec plus de dix ans d'expérience, tituralaire d'un master, d'un doctorat et d'une Habilitation à Diriger les Recherches, il occupe un poste de Professeur Assistant à la Haute Ecole de Santé de Genève, en Suisse, et continu d'exercer comme sage-femme des hôpitaux en salle de naissance à l’Hôpital Femme Mère Enfant (HFME) des Hospices Civils de Lyon. Il coordonne le laboratoire GENMIR (GENeva MIdwifery Research unit), une unité de recherche dédiée à l'avancement des connaissances dans les sciences sages-femmes (https://www.hesge.ch/heds/laboratoire-genmir).

Laurent Gaucher est responsable de plusieurs modules d’enseignements en santé publique auprès des étudiants sages-femmes en formation initiale et continue. Il supervise plusieurs thèses de sciences en lien avec ses axes de recherche (https://www.theses.fr/138022577).

Administrateur du Collège National des Sages-Femmes de France, il a activement contribué à l'élaboration de lignes directrices cliniques pour les sages-femmes en France, encadré des étudiants, mené des essais contrôlés randomisés et obtenu des financements pour des projets de recherche innovants. Le travail de Laurent Gaucher témoigne de sa passion pour faire avancer le domaine de la maïeutique (i.e. l’art et les sciences sages-femmes).

Axe de recherche
Bien-être physique, mental et sexuel en postpartum associé aux pratiques et expériences de soins

Publications
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Google Scholar ID: k3peaw4AAAAJ

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En cours

SOCRATES : Stress Of Co-parents Related to A Traumatic Experience of Birth across Switzerland

Rôle: Collaborateur/trice

Financement: Swiss National Science Foundation (SNF)

Description du projet :

Field and Responsibilities: Methods of Epidemiology and Preventive Medicine, led by Laurent Gaucher and Susanne Grylka.

Context: The negative impact of childbirth on the well-being of mothers and co-parents during the postpartum period is understudied. Mental, physical, and sexual health issues are common during this time. Mental health is of particular concern, with rates of postnatal depression and childbirth-related post-traumatic stress disorder affecting 13% and 4.7% of women, respectively.

Rationale: There is a detrimental gap between the typical postpartum monitoring period (56 days in Switzerland) and the potential long-term impact of the quality of care during childbirth on parental well-being (up to one year postpartum). This project aims to address this lack of reliable and population-based data in Switzerland.

Materials and Methods: A national prospective cohort study will be conducted across all cantons of Switzerland. It will include data on all births in Swiss maternity units (N=98) over a three-week period, representing a representative sample of the population (N=3200 births). Self-administered questionnaires will assess mental and physical health and quality of life up to one year after childbirth.

Expected Results and Impact: This study will provide new knowledge about the health and well-being of parents up to one year postpartum, thereby helping to improve perinatal health policies. It will identify factors related to the quality of care that impact parental health and well-being after childbirth and recommend evidence-based measures to improve the quality of care and organization of maternal care.

Equipe de recherche au sein de la HES-SO: Gaucher Laurent

Partenaires académiques: Grylka Susanne, ZHAW

Durée du projet: 01.03.2024

Montant global du projet: 1'000'000 CHF

Url du site du projet: https://app.dimensions.ai/details/grant/grant.13742596

Statut: En cours

SpeaK study : A pilot randomized controlled trial to evaluate the effect of a Peer-support MHealth Application on the risK of postnatal depression

Rôle: Collaborateur/trice

Description du projet :

Le contexte : Le postpartum, période de récupération physique et psychique après un accouchement, est une période durant laquelle la qualité de vie physique (e.g. douleur, sommeil), psychologique (e.g. sentiments positifs, image corporelle, …), sociale (e.g. entourage, activité sexuel, …) et environnementale (e.g. accès aux soins, accès aux informations en santé, …) peut être altérée. Cette altération peut aller jusqu’à provoquer une dépression. Or le suicide est l’une des deux premières causes des décès maternels dans les pays à hauts niveaux de revenus. Les applications digitales peuvent contribuer à améliorer l’information des mères vis-à-vis de ces risques. Le soutien par les pairs peut contribuer à réduire l’auto-stigmatisation des mères vis-à-vis des souffrances qu’elles endurent et favoriser le recours aux soins en santé mentale par l’accès à une communauté en ligne anonyme.

L’objectif : L’objectif principal de cet essai clinique randomisé sera de comparer, avant et après intervention, l’évolution du score moyen de dépression du postpartum d’un groupe de mères qui utilisent l’outil HaploCare (groupe intervention) à l’évolution du score moyen d’un groupe de mères bénéficiant de soins courants uniquement (groupe contrôle).

Importance : Ce projet pilote permettra de faire avancer la recherche sur le bien-être mental des mères et de comprendre si l’accès à une communauté en ligne réunie autour de santé mentale périnatale est associé à une amélioration de la santé mentale des mères.

Equipe de recherche au sein de la HES-SO: Gaucher Laurent , Pichon Swann , Pulh-Leavy Emma

Statut: En cours

2025

Birth plans :
Article scientifique ArODES
developing a shared medical decision aid tool

Morgane Goetz-Fu, Laurent Gaucher, Cyril Huissoud, B. De la Fournière, C. Dupont, Marion Cortet

BMC pregnancy and childbirth,  2025, 25, 306

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Résumé:

Objective(s) : Birth plans appeared at the end of the twentieth century, enabling women to express their expectations towards childbirth. This reflects a rising demand for patients to take a proactive role in their medical care. This study aimed to collaboratively develop a medical decision aid with expectant mothers to prepare them better for the events surrounding their child’s birth. Study Design : Five topics frequently addressed in birth plans were identified by both patients’ associations, using semi-structured interview with representatives of women’s associations, and professionals, using an online poll. Initially, work groups with perinatal care professionals drafted items designed to guide expectant mothers in developing their birth plans and actively participating in childbirth decisions. Subsequently, we used a modified Delphi-consensus in three rounds to retain the most relevant items. The first two rounds engaged a multidisciplinary team of professionals, while the third involved expectant mothers from two maternity wards in Lyon, France. Items that received a rating between 3 (good value) and 4 (excellent value) on a 4-point scale by more than 75% of participants were deemed consensual. The study assessed inter-rater agreement using the Fleiss kappa score. Results : The professional work groups proposed a total of 124 items distributed across five themes: analgesia during labour, drug administration before and during labour, events in the delivery room, initial neonatal care, and perineal protection. Ultimately, 65.3% of the initial 124 items were deemed relevant by both the experts and the expectant mothers. Notably, the most significant differences in consensus centered around analgesia and the complexity of information. Non-medicinal analgesic methods were favored by mothers-to-be but not by professionals. Conversely, detailed information on delayed cord clamping were favored by experts. Conclusions : A modified Delphi consensus was used to create with expectant mothers a decision aid tool to help them write their birth projects, addressing five main topics that are frequently reported in the literature. We now need to test this tool in clinical practice to assess its relevance in routine obstetrics consultation.

2024

Étude transversale de l’association entre le vécu de l’accouchement et l’analgésie péridurale
Article scientifique ArODES

Céline Chérion, Claudine Martin, Laurent Gaucher

Sages-Femmes,  2024, 23, 6, 49-55

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Résumé:

Une expérience négative de l’accouchement peut entraîner des conséquences graves pour les mères, comme l’état de stress post-traumatique et la dépression post-partum. En France, malgré l’efficacité de l’analgésie péridurale, 10 % des femmes expriment une insatisfaction concernant la considération de leur douleur par les soignants. Une enquête a été menée dans 25 maternités afin d’évaluer l’association entre le recours à l’analgésie péridurale et la satisfaction des mères vis-à-vis du comportement des soignants en salle de naissance. Bien que l’analgésie péridurale ne semble pas influencer de manière significative la satisfaction globale, la prise en compte de la douleur demeure un enjeu en son absence. L’adoption de méthodes non médicamenteuses pourrait améliorer ce vécu.

Mothers’ and caregivers’ experiences of COVID-19 restrictions during postpartum hospitalisation :
Article scientifique ArODES
a cross-sectional survey in France

Sarah Louis, Anne Rousseau, Louise Mercier, Mireille Chamly, Laurent Gaucher

BMC pregnancy and childbirth,  2024, 24, 686

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Résumé:

Background : Transmission of SARS-CoV-2 highlighting the importance of social distancing guidelines. Following a series of lockdowns and the widespread vaccination of the European population, many countries began to lift these restrictions. During this period, while some parents yearned for emotional support and family presence, others found that the solitude facilitated by the restrictions was beneficial for bonding and breastfeeding. In France, postnatal stays are generally longer than in other countries, and the limited availability of home-based follow-up care, combined with pandemic isolation measures, further complicated perspectives on visitation restrictions. Therefore, the objective of this study was to assess the satisfaction of mothers and caregivers regarding these visit restrictions in French maternity settings during the COVID-19 pandemic. Methods : We conducted two multicentre descriptives surveys across five French maternity wards (three in Paris and two in Lyon) from June 1st to July 15th, 2021. Participants included mothers, selected based on criteria such as French-speaking, at-term birth (≥ 37 weeks), and hospitalisation with their newborn, as well as caregivers working in the postpartum units. Satisfaction with visitation restrictions was assessed using a four-point Likert scale, which was then dichotomised into “mostly satisfied” versus “mostly dissatisfied” for the analysis. Multivariable logistic regression models were used to identify factors associated with satisfaction. Results : We analysed complete responses from 430 of the 2,142 mothers (20.1%) and 221 of the 385 caregivers (57.4%) who participated during the study period. The majority of mothers (68.8%, n = 296/430) and caregivers (90.5%, n = 200/221) declare themselves satisfied with the policy of restricting visits to maternity wards. The main source of mother’s satisfaction came from a quieter stay, but they regretted the absence of their other children. Conclusions : Maternity visit restriction policies were largely supported by mothers and caregivers, especially when partners and siblings were allowed. Revisiting these policies, along with the postpartum stay length, may improve care, though further evaluation in non-pandemic settings is needed.

The challenge of adopting a collaborative information system for independent healthcare workers in France :
Article scientifique ArODES
a comprehensive study

Laurent Gaucher, Céline Puill, Sophie Baumann, Sophie Hommey, Sandrine Touzet, René-Charles Rudigoz, Marion Cortet, Cyril Huissoud, Pascal Gaucherand, Corinne Dupont, Frédéric Mougeot

Scientific reports,  2024, 14, article 11429

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Résumé:

This study aimed to explore the perception of an underutilised collaborative information system through qualitative research, utilizing semi-structured, in-depth interviews with independent midwives and physician. PROSPERO, is a collaborative information system designed to bridge the communication gap between community-based healthcare workers and hospital-based care teams for parturients in Lyon, France. Through 27 semi-structured in-depth interviews with midwives, obstetricians, and general practitioners, we identified key themes related to the system’s adoption: implementation challenges, utilisation barriers, interprofessional dynamics, and hidden variables affecting system use. Participants recognised the potential of PROSPERO to improve information sharing and care coordination but expressed concerns about the system’s integration into existing workflows, time constraints, and the need for adequate training and technical support. Interprofessional dynamics revealed differing perspectives between hospital and independent practitioners, emphasising the importance of trust-building and professional recognition. Hidden variables, such as hierarchical influences and confidentiality concerns, further complicated the system’s adoption. Despite the consensus on the benefits of a collaborative information system, its implementation was hindered by mistrust between healthcare workers (i.e. between independent practitioners and hospital staff). Our findings suggest that fostering trust and addressing the identified barriers are crucial steps towards successful system implementation. The study contributes to understanding the complex interplay of factors influencing the adoption of collaborative healthcare technologies and highlights the need for strategies that support effective interprofessional collaboration and communication.

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care :
Article scientifique ArODES
a French Delphi survey

Anne Rousseau, Sophie Baumann, Jennifer Constant, Sylvie Deplace, Olivier Multon, Laure Lenoir-Delpierre, Laurent Gaucher

BMJ open,  2024, 14, 5, e085621

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Résumé:

Objective Delineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care. Design Based on the literature and experts’ insights, we identified a list of gynaecological and obstetrical care practices suitable for teleconsultation. A three-round Delphi consensus survey was then conducted online among a panel of French experts. Experts using a 9-point Likert scale assessed the relevance of each teleconsultation practice in four key domains: prevention, gynaecology and antenatal and postnatal care. Consensus was determined by applying a dual-criteria approach: the median score on a 9-point Likert scale and the percentage of votes either below 5 or 5 and higher. Setting The study was conducted at a national level in France and involved multiple healthcare centres and professionals from various geographical locations. Participants The panel comprised 22 French experts with 19 healthcare professionals, including 12 midwives, 3 obstetricians-gynaecologists, 4 general practitioners and 3 healthcare system users. Participants were selected to include diverse practice settings encompassing hospital and private practices in both rural and urban areas. Primary and secondary outcome measures The study’s primary outcome was the identification of gynaecological and obstetrical care practices suitable for teleconsultation. Secondary outcomes included the level of professional consensus on these practices. Results In total, 71 practices were included in the Delphi survey. The practices approved for teleconsultation were distributed as follows: 92% in prevention (n=12/13), 55% in gynaecology (n=18/33), 31% in prenatal care (n=5/16) and 12% in postnatal care (n=1/9). Lastly, 10 practices remained under discussion: 7 in gynaecology, 2 in prenatal care and 1 in postnatal care. Conclusions Our consensus survey highlights both the advantages and limitations of teleconsultations for women’s gynaecological and obstetrical care, emphasising the need for careful consideration and tailored implementation.

Midwifery research in France :
Article scientifique ArODES
current dynamics and perspectives

Priscille Sauvegrain, Clémence Schantz, Anne Rousseau, Laurent Gaucher, Corinne Dupont, Anne Alice Chantry, CNSF (Collège National des sages-Femmes de France – French National College of Midwives)

Midwifery,  2024, 131, 103935

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2023

Pelvic exam in gynecology and obstetrics :
Article scientifique ArODES
french guidelines for clinical practice

Xavier Deffieux, Anne-Cécile Pizzoferrato, Laurent Gaucher, Christine Rousset-Jablonski, Camille Le Ray

European journal of obstetrics & gynecology and reproductive biology,  291, 131-140

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La HEdS Genève s'engage pour la santé mentale périnatale
Article professionnel ArODES

Dany Aubert-Burri, Laurent Gaucher, Arabelle Gautier, Catia Nunno Paillard, Chantal Razurel

Obstetrica,  12, 56-57

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Résumé:

La Haute Ecole de Santé de Genève (Heds Genève) présente dans cet article différents projets et formations à destination des (futurs) parents et sages-femmes autour de la santé psychique. Elle invite également les sages-femmes et professionnel·le·s de la périnatalité à y prendre part et à les diffuser auprès des publics concernés.

What do mothers think about their antenatal classes? :
Article scientifique ArODES
a mixed-method study in Switzerland

Valérie Avignon, Laurent Gaucher, David Baud, Hélène Legardeur, Corinne Dupont, Antje Horsch

BMC pregnancy and childbirth,  23, article 741

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Résumé:

Problem : Research so far has evaluated the effect of antenatal classes, but few studies have investigated its usefulness from the perspective of mothers after birth. Background : Antenatal classes evolved from pain management to a mother-centred approach, including birth plans and parenting education. Evaluating the perception of the usefulness of these classes is important to meet mother’s needs. However, so far, research on the mothers’ perception of the usefulness of these classes is sparse, particularly when measured after childbirth. Given that antenatal classes are considered as adult education, it is necessary to carry out this evaluation after mothers have had an opportunity to apply some of the competences they acquired during the antenatal classes during their childbirth. Aim : This study investigated mothers’ satisfaction and perceived usefulness of antenatal classes provided within a university hospital in Switzerland, as assessed in the postpartum period. Methods : Primiparous mothers who gave birth at a Swiss university hospital from January 2018 to September 2020 were contacted. Those who had attended the hospital’s antenatal classes were invited to complete a questionnaire consisting of a quantitative and qualitative part about usefulness and satisfaction about antenatal classes. Quantitative data were analysed using both descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. Findings : Among the 259 mothers who answered, 61% (n = 158) were globally satisfied with the antenatal classes and 56.2% (n = 145) found the sessions useful in general. However, looking at the utility score of each theme, none of them achieved a score of usefulness above 44%. The timing of some of these sessions was questioned. Some mothers regretted the lack of accurate information, especially on labour complications and postnatal care. Discussion : Antenatal classes were valued for their peer support. However, in their salutogenic vision of empowerment, they did not address the complications of childbirth, even though this was what some mothers needed. Furthermore, these classes could also be more oriented towards the postpartum period, as requested by some mothers. Conclusion : Revising antenatal classes to fit mothers’ needs could lead to greater satisfaction and thus a better impact on the well-being of mothers and their families.

Surgical management of a loss of pregnancy in the first trimester :
Article scientifique ArODES
patient experience and influencing factors, a prospective observational study

T. Toutain, C-A. Philip, L. Bollon, M. Cros, A. Fraissenon, C. Dupont, Laurent Gaucher, J. Haesebaert, Erdogan Nohuz, M. Cortet

Journal of gynecology obstetrics and human reproduction,  52, 6, article 102602

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Résumé:

Objective : Describe the “patient experience” regarding care provided during the surgical management of a loss of pregnancy in the first trimester and identify the factors influencing this experience. Material and methods : It is an observational prospective study conducted in two type III, academic, maternity wards in Lyon, France, carrying out 8,500 deliveries per year. Adult female patients, having undergone a suction curettage for a loss of pregnancy in the first trimester from 24 December 2020 to 13 June 2021 were inculded. The “patient experience” was assessed using the 15 questions of the Picker Patient Experience (PPE-15) questionnaire, and research was conducted on factors influencing the patient experience. The main outcome was the percentage of patients reporting a problem in response to at least one of the PPE-15 questions. Results : 58 out of 79 patients (73% CI [62-83]) reported at least one problem with their care. The largest proportion of problems was raised in question about “Opportunity for family/loved ones to talk to the doctor” (76% CI [61-87]). The lowest proportion of problems was raised in question about “Treated with respect and dignity” (8% CI [3-16]). No factors influencing the patient experience were identified. Discussion : Almost three out of four patients reported a problem in the experience as a patient. The main areas of improvement reported by patients were the participation of their family/relatives and the emotional support provided by the healthcare team. Tweetable abstract : Better communication with patient families and emotional support could improve patient experience during the surgical management of a loss of pregnancy in the first trimester

Examen pelvien en gynécologie et obstétrique :
Article scientifique ArODES
recommandations pour la pratique clinique

Xavier Deffieux, Christine Rousset-Jablonski, Adrien Gantois, Thierry Brillac, Julia Maruani, Laurent Gaucher

Gynécologie obstétrique fertilité & sénologie ,  51, 6, 297-330

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Résumé:

Objectif : Élaborer des recommandations pour l’examen clinique pelvien en gynécologie et obstétrique. Matériel et méthodes : Un groupe de travail multidisciplinaire de 45 experts a été constitué, comprenant des représentants d’associations de patients et d’usagers du système de santé. L’ensemble du processus de ces recommandations a été mené indépendamment de tout financement. Il a été conseillé aux auteurs de suivre les règles du système GRADE® (Grading of Recommendations Assessment, Development and Evaluation) pour évaluer la qualité des preuves. Les limites potentielles de faire des recommandations fortes en présence de preuves de faible qualité ont été soulignées. Le comité a étudié 40 questions dans 4 domaines pour les femmes symptomatiques ou asymptomatiques (urgence, consultation gynécologique, maladies gynécologiques, obstétrique et grossesse). Chaque question a été formulée dans un format PICO (Patients, Intervention, Comparaison, Résultat) et les éléments de preuve ont été détaillés. La revue de la littérature et les recommandations ont été réalisées selon la méthodologie GRADE®. Résultats : Le travail de synthèse des experts et l’application de la méthode GRADE ont abouti à 27 recommandations. Parmi les recommandations formalisées, 17 présentaient un accord fort, 7 un accord faible et 3 un accord professionnel. Treize questions ont donné lieu à une absence de recommandation en raison du manque de preuves (pas de réponse dans la littérature). Conclusions : Les 27 recommandations ont permis de préciser quand un examen clinique est requis pour différentes situations cliniques gynécologiques et obstétricales. Ces recommandations intéressent tout professionnel impliqué dans la santé des femmes. La nécessité de réaliser un examen clinique chez certaines patientes dans certaines situations a été fondée sur des preuves scientifiques. Des recherches supplémentaires sont nécessaires pour étudier les avantages dans d’autres situations.

Disrespect during childbirth and postpartum mental health :
Article scientifique ArODES
a French cohort study

Emma Leavy, Marion Cortet, Cyril Huissoud, Thomas Desplanches, Jessica Sormani, Sylvie Viaux Savelon, Corinne Dupont, Swann Pichon, Laurent Gaucher

BMC pregnancy and childbirth,  2023, vol. 23, article 241

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Résumé:

Background : While the World Health Organisation (WHO) warned about mistreatment, disrespect and/or abuse during childbirth as early as 2014. This same year a social media movement with #payetonuterus brought to light the problematic of obstetrical violence in French speaking countries, and more specifically on issues of disrespect. The experience of care is an integral part of the quality of care, and perception on inadequate support during labour and loss of control in labour are some of the most frequently reported risk factors for childbirth-related post-traumatic stress disorder (CB-PTSD). Therefore, it seems crucial to study the associations between disrespect during childbirth and the mental well-being of mothers. Methods : We performed a multicentered cohort study using auto-questionnaires within a French perinatal network. The main outcome was women’s report of disrespect during childbirth measured by the Behavior of the Mother’s Caregivers – Satisfaction Questionnaire (BMC-SQ) 3 days and 2 months after childbirth. CB-PTSD and Postpartum Depression (PPD) were assessed 2 months after childbirth using respectively the Post-Traumatic Checklist Scale (PCLS) and the Edinburgh Postnatal Depression Scale (EPDS). Results : This study followed 123 mothers from childbirth to 2 months postpartum. Among them, 8.13% (n = 10/123) reported disrespect during childbirth at 3 days after childbirth. With retrospect, 10.56% (n = 13/123) reported disrespect during childbirth at 2 months postpartum, i.e. an increase of 31%. Some 10.56% (n = 13/123) of mothers suffered from postpartum depression, and 4.06% (n = 5/123) were considered to have CB-PTSD at 2 months after childbirth. Reported disrespect during childbirth 3 days after birth was significantly associated with higher CB-PTSD 2 months after birth (R2 = 0.11, F(1,117) = 15.14, p < 0.001 and β = 9.11, p = 0.006), PPD at 2 months after childbirth was positively associated to reported disrespect in the birth room, 3 days after birth (R2 = 0.04, F(1, 117) = 6.28, p = 0.01 and β = 3.36, p = 0.096). Meanwhile, PPD and CB-PTSD were significantly associated 2 months after childbirth (R2 = 0.41, F=(1,117) = 82.39, p < 0.01 and β = 11.41, p < 0.001). Conclusions : Disrespect during childbirth was associated with poorer mental health during the postpartum period. Given the high prevalence of mental health problems and the increased susceptibility to depression during the postpartum period, these correlational results highlight the importance of gaining a deeper awareness of healthcare professionals about behaviours or attitudes which might be experienced as disrespectful during childbirth.

Barrier measures implemented in French maternity hospitals during the COVID-19 pandemic :
Article scientifique ArODES
a cross-sectional survey

Anne Rousseau, M. Dubel-Jam, Clémence Schantz, Laurent Gaucher

Midwifery,  March 2023, vol. 118, article 103600

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Résumé:

Objectives : The objectives of this survey were 1) to describe the changes over time of barrier measures in maternity units, specifically, co-parent visits and women wearing masks in birth rooms, and 2) to identify potential institutional determinants of these barrier measures. Design : We used an online questionnaire to conduct a descriptive cross-sectional survey from May to July 2021. Setting : All districts in mainland France. Participants : Midwife supervisor of each maternity unit. Measurements : Primary outcomes were “banning of visits” in the postnatal department during the first lockdown (March–May 2020), and “mandated mask-wearing in birth rooms” during the survey period (May–July 2021); the independent variables were maternity unit characteristics and location in a crisis area. Co-parent visits were considered only during the first lockdown as they were mostly allowed afterwards, and the wearing of masks was studied only during the survey period, as masks were unavailable for the population during the first lockdown. Results : We obtained 343 responses, i.e., 75.2% of French maternity units. Visits to the postnatal department were forbidden in 39.3% of the maternity units during the first lockdown and in none during the study period. Maternity hospitals with neonatal intensive care units were the most likely to ban co-parent hospital visits (adjusted OR 2.34 [1.12; 4.96]). However, those were the maternity units least likely to encourage or require women to wear masks while pushing (adjusted OR, 0.31; 95% confidence interval [CI], 0.11–0.77). Maternity units in crisis areas (i.e., with very high case counts) during the first lockdown banned visits significantly more often (adjusted OR, 1.68; 95% CI, 1.05–2.70). Key conclusions : Our study showed that barrier measures evolved during the course of the pandemic but remained extremely variable between facilities. Implications for practice : Maternity units implemented drastic barrier measures at the beginning of the pandemic but were able to adapt these measures over time. It is now time to learn from this experience to ensure that women and infants are no longer harmed by these measures.

Evaluation of midwives’ practises on herpetic infections during pregnancy :
Article scientifique ArODES
a french vignette-based study

Adrian Mrozik, Yann Sellier, Déborah Lemaitre, Laurent Gaucher

Healthcare,  2023, vol. 11, no. 3, article 364

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Résumé:

Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise.

Avenues for measuring and characterising violence in perinatal care to improve its prevention :
Article scientifique ArODES
a position paper with a proposal by the National College of French Midwives

Priscille Sauvegrain, Clémence Schantz, Laurent Gaucher, Anne Alice Chantry, CNSF (Collège National des sages-Femmes de France – French National College of Midwives)

Midwifery,  Janvier 2023, vol. 116, article 103520

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Résumé:

Background : France is somewhat behind other countries in its consideration of the issue of violence in perinatal care. Its consequences on maternal, but also neonatal and infant health are recognised internationally. Nonetheless, research and data measuring its frequency and its determinants are inadequate, and the relevant definitions are not always consensual. In this context, we, as midwives and researchers in public health and as members of the National College of French Midwives, seek to propose a scientific and clinical contribution to this debate. Aim : We propose avenues for measuring and characterising violence in perinatal care. Our objective is to quantify and characterise the situations of violence in perinatal care in population-based studies and based on the perceptions of each woman questioned. Discussion : This proposal for questions, simplified compared with those currently in used in the international scientific literature, has the advantage of focusing reflection around three categories: inappropriate medical care, inappropriate human behaviours in care, and sexual abuse. It should also allow the identification of the contexts of care during which violence may be experienced, as well as the categories of health-care workers concerned. Conclusion : It seems important to us to distinguish these situations, causal and context, for they require different responses if we hope to reduce the frequency and the effects of violence in perinatal care in the future. We propose questions that could also be used in clinical situations by midwives and other clinicians.

Qualité et expérience des soins du prénatal au postpartum
Thèse de doctorat

Gaucher Laurent

2023,  Lyon : Université Claude Bernard Lyon 1.  66  p.

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2022

Expériences de la téléconsultation par les sages-femmes libérales françaises pendant la crise du COVID-19
Article scientifique ArODES

Sophie Baumann, Laurent Gaucher, Ines Mahrez, Sylvain Gautier, Anne Rousseau

Santé publique,  34, 6, 821-832

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Résumé:

Contexte : Dans le contexte de la pandémie COVID-19, le gouvernement français a autorisé la pratique des téléconsultations pour les sages-femmes à partir du 20 mars 2020. Une enquête par questionnaire menée auprès de 1 491 sages-femmes libérales a rapporté que 88,5 % d’entre elles avaient mis en œuvre cette pratique. Nous avons donc souhaité explorer leurs motivations et la façon dont elles ont intégré cette nouvelle modalité d’exercice dans leur pratique. Méthodes : Nous avons mené 22 entretiens semi-directifs auprès de sages-femmes libérales ayant mis en place des téléconsultations depuis leur autorisation. L’étude, réalisée entre mai et juillet 2020, a pris fin lorsque la saturation des résultats a été atteinte. Une analyse de contenu a permis de dégager les récurrences et les exceptions dans le discours. Résultats : Les principales motivations des sages-femmes libérales à proposer des téléconsultations étaient de maintenir l’accès aux soins pour les femmes et préserver leur propre activité professionnelle. Elles pointaient un certain nombre de limites, parmi lesquelles la question du secret professionnel et de la garantie de la confidentialité, ou encore l’inégalité d’accès aux soins en lien avec la fracture numérique. L’intégration de la télé- consultation dans leur pratique a permis de mettre en lumière et valoriser le travail d’accompagnement réalisé par les sages-femmes jusqu’à présent peu visible et reconnu. Conclusion : Les sages-femmes se sont rapidement approprié les téléconsultations qui ont, depuis le confinement, été pérennisées. Cet outil permet une aide à la continuité des soins, mais pose également de nouvelles questions d’égalité d’accès aux soins.

Pregnancy, mental well-being and lockdown :
Article scientifique ArODES
a nationwide online survey in France

Laurent Gaucher, Chloé Barasinski, Corinne Dupont, Chantal Razurel, Swann Pichon, Emma Leavy, Sylvie Viaux Savelon, Marion Cortet, Nicolas Franck, Frédéric Haesebaert, Julie Haesebaert

Healthcare,  2022, vol. 10, no. 10, article 1855

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Résumé:

The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March–7 April 2020). The main outcome measure was mental well-being measured by the Warwick–Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score–matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women’s well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being.

Entretien postnatal précoce :
Rapport ArODES
préconisations pour la pratique clinique

Eléonore Bleuzen, Sarah Benjilany, Adrien Gantois, Myriam Kheniche, Nathalie Baunot, Sophie Guillaume, Nathalie Piquée, Priscille Sauvegrain, Laurent Gaucher

2022,  France : Editions du Collège des Sages-femmes de France,  9 p.

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Childbirth experience, risk of PTSD and obstetric and neonatal outcomes according to antenatal classes attendance
Article scientifique ArODES

Valérie Avignon, Baud David, Laurent Gaucher, Corinne Dupont, Antje Horsch

Scientific reports,  2022, vol. 12, article 10717

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Résumé:

Antenatal classes have evolved considerably and include now a discussion of the parents' birth plan. Respecting this plan normally results in a better childbirth experience, an important protective factor of post-traumatic stress disorder following childbirth (PTSD-FC). Antenatal class attendance may thus be associated with lower PTSD-FC rates. This cross-sectional study took place at a Swiss university hospital. All primiparous women who gave birth to singletons from 2018 to 2020 were invited to answer self-reported questionnaires. Data for childbirth experience, symptoms of PTSD-FC, neonatal, and obstetrical outcomes were compared between women who attended (AC) or not (NAC) antenatal classes. A total of 794/2876 (27.6%) women completed the online questionnaire. Antenatal class attendance was associated with a poorer childbirth experience (p = 0.03). When taking into account other significant predictors of childbirth experience, only induction of labor, use of forceps, emergency caesarean, and civil status remained in the final model of regression. Intrusion symptoms were more frequent in NAC group (M = 1.63 versus M = 1.11, p = 0.02). Antenatal class attendance, forceps, emergency caesarean, and hospitalisation in NICU remained significant predictors of intrusions for PTSD-FC. Use of epidural, obstetrical, and neonatal outcomes were similar for AC and NAC.

The challenge of care coordination by midwives during the COVID-19 pandemic :
Article scientifique ArODES
a national descriptive survey

Laurent Gaucher, Corinne Dupont, Sylvain Gautier, Sophie Baumann, Anne Rousseau

BMC pregnancy and childbirth,  2022, vol. 22, article 437

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Résumé:

Background : As part of a decades-long process of restructuring primary care, independent (also known as community) healthcare workers are being encouraged to work in groups to facilitate their coordination and continuity of care in France. French independent midwives perform about half of the early prenatal interviews that identify mothers' needs during pregnancy and then refer them to the appropriate resources. The French government, however, structured the COVID-19 pandemic response around public health institutions and did not directly mobilise these community healthcare workers during the lockdown phase. These responses have raised questions about their role within the healthcare system in crises. This survey’s main objectives were to estimate the proportion of independent midwives who experienced new difficulties in referring women to healthcare facilities or other caregivers and in collaborating with hospitals during the first stage of this pandemic. The secondary objective was to estimate the proportion, according to their mode of practice, of independent midwives who considered that all the women under their care had risked harm due to failed or delayed referral to care. Methods : We conducted an online national survey addressed to independent midwives in France from 29 April to 15 May 2020, around the end of the first lockdown (17 March–11 May, 2020). Results : Of the 5264 registered independent midwives in France, 1491 (28.3%) responded; 64.7% reported new or greater problems during the pandemic in referring women to health facilities or care-providers, social workers in particular, and 71.0% reported new difficulties collaborating with hospitals. Nearly half (46.2%) the respondents considered that all the women in their care had experienced, to varying degrees, a lack of or delay in care that could have affected their health. This proportion did not differ according to the midwives’ form of practice: solo practice, group practice with other midwives only, or group practice with at least two types of healthcare professionals. Conclusions : The pandemic has degraded the quality of pregnant women’s care in France and challenged the French model of care, which is highly compartmentalised between an almost exclusively independent primary care (community) sector and a predominantly salaried secondary care (hospital) sector.

How midwives implemented teleconsultations during the COVID-19 health crisis :
Article scientifique ArODES
a mixed-methods study

Anne Rousseau, Laurent Gaucher, Sylvain Gautier, Ines Mahrez, Sophie Baumann

BMJ open,  2022, vol. 12, no. 4, article e057292

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Résumé:

Objectives : Our primary and secondary objectives were to measure and understand the determinants of independent midwives' implementation of teleconsultations and their intention to continue these in the future. Design : A two-phase mixed-methods approach: (1) quantitative data to measure factors determining the initiation and continuation of teleconsultation, collected by an online survey from 29 April to 15 May 2020, at the end of the first COVID-19 lockdown, followed by (2) qualitative data to understand these determinants, by interviewing some participants in May–July 2020 to explore the quantitative findings in more detail. Setting : Mainland France. Participants : The target population comprised independent midwives currently practising in France. Primary and secondary outcome measures : The primary and secondary outcomes were binary variables: implementation of teleconsultations, and intention to continue them. The qualitative results provided the themes explaining these decisions. Results : We obtained 1491 complete responses from independent midwives, that is, 28.3% of French independent midwives, and interviewed 22 volunteers among them. Among the 1491, 88.5% implemented teleconsultations and 65.8% intended to continue them. Both individual and organisational factors favoured implementation of teleconsultations: older age (adjusted OR (aOR): 0.40, 95% CI: 0.28 to 0.58), female gender (aOR: 6.88, 95% CI: 2.71 to 17.48), married or living with a partner (aOR: 1.67, 95% CI: 1.10 to 2.52) and working in a group practice (midwives only—aOR: 2.34, 95% CI: 1.47 to 3.72; multiprofessional group—aOR: 1.75, 95% CI: 1.16 to 2.64). The qualitative analysis did not identify any new factors but helped us to understand the satisfaction better: midwives adopted telemedicine for their patients' access to and continuity of care, to maintain their professional activity and income, and to limit the risks of infection. Conclusion : Personal and organisational factors motivated the implementation of teleconsultation during the pandemic, but maintaining it raises technical, regulatory, and ethical issues.

Consultation de gynécologie à destination des personnes lesbiennes ou trans :
Article scientifique ArODES
retour d’expérience

Céline Puill, Axelle Romby, Laurent Gaucher

Santé publique,  2022, vol. 34, hors-série no. 2, pp. S223-S230

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Résumé:

Contexte : L’accès aux soins gynécologiques pour les lesbiennes et les personnes trans est un enjeu de santé publique. Le Checkpoint, antenne communautaire du centre gratuit d’information, de dépistage et de diagnostic (Cegidd), a créé une consultation dédiée à ce public dans une approche communautaire. Méthodes : Retour d’expérience de la sage-femme responsable de cette consultation par l’analyse des données issues des dossiers médicaux et des rapports administratifs. Résultats : Cent consultations ont été conduites pendant les 30 mois de l’expérimentation. Ces consultations étaient au bénéfice de femmes lesbiennes (76 cas) et d’hommes trans (17 cas). Elles offraient un moment d’écoute, d’anamnèse, d’examen clinique, d’examen de dépistage, de traitement préventif et d’orientation. Leur durée variait de 50 minutes à 1 heure 30. Les motifs de consultation étaient souvent multiples et les personnes reçues étaient 38 % à déclarer avoir été victime de violences. Conclusion : L’adaptation du déroulement des consultations serait susceptible de favoriser l’accès aux soins gynécologiques des lesbiennes et des hommes trans. Un temps institutionnel de formation, de réflexion et de travail en réseau avec les professionnels et les communautés concernées semble indispensable à la réussite de ce type d’offre de soins.

2021

Soins primaires et COVID-19 en France :
Article scientifique ArODES
apports d’un réseau de recherche associant praticiens et chercheurs

Sylvain Gautier, Marine Ray, Anne Rousseau, Clarissa Seixas, Sophie Baumann, Laurent Gaucher, Julien Le Breton, Tiphanie Bouchez, Olivier Saint-Lary, Aline Ramond-Roquin, Yann Bourgueil

Santé publique,  2021, vol. 33, no. 6, pp. 923-934

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Résumé:

Introduction : L’épidémie de COVID a présenté un défi majeur pour les acteurs et les organisations des soins primaires en France. L’objectif de ce travail réalisé par le réseau de recherche ACCORD, associant praticiens et chercheurs, est de décrire et d’analyser en interprofessionnalité les adaptations et organisations précoces des acteurs des soins primaires durant le premier confinement. Méthodes : Ce travail confronte du matériel quantitatif et qualitatif. Les données quantitatives résultent d’une exploitation croisée des six enquêtes en ligne réalisées par le réseau ACCORD, entre mars et mai 2020, auprès des médecins généralistes, sages-femmes et structures pluriprofessionnelles en France. Ces données ont été enrichies d’échanges collectifs pluriprofessionnels et pluridisciplinaires, conduits en groupes focaux lors d’un séminaire dématérialisé. Résultats : Durant la période considérée, une baisse importante de l’activité en soins primaires a été constatée. Les acteurs ont été nombreux à adapter leurs organisations pour concilier risque épidémique et maintien de l’accès et de la continuité des soins. Les sources d’information utilisées par les professionnels se sont avérées très variables. La crise a révélé des réseaux d’échange et de collaboration importants au niveau des territoires. Conclusion : Face à la crise sanitaire, les acteurs des soins primaires ont adapté leurs organisations et leurs pratiques de façon précoce et diversifiée, soulignant l’importance des organisations préexistantes et des collaborations à l’échelon territorial.

Conservative management or cesarean hysterectomy for placenta accreta spectrum :
Article scientifique ArODES
the PACCRETA prospective study

Loïc Sentilhes, Aurélien Seco, Elie Azria, Gaël Beucher, Marie-Pierre Bonnet, Bernard Branger, Lionel Carbillon, Coralie Chiesa, Catherine Crenn-Hebert, Michel Dreyfus, Corinne Dupont, Jeanne Fresson, Cyril Huissoud, Bruno Langer, Olivier Morel, Sophie Patrier, Franck Perrotin, Pierre Raynal, Patrick Rozenberg, René-Charles Rudigoz, Francoise Vendittelli, Norbert Winer, Catherine Deneux-Tharaux, Gilles Kayem, PACCRETA Study Group, Laurent Gaucher

American journal of obstetrics and gynecology,  2022, vol. 226, n. 6, pp. 839.e1-839.e24

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Résumé:

Background : Placenta accreta spectrum is a life-threatening condition that has increased dramatically in recent decades along with cesarean rates worldwide. Cesarean hysterectomy is widely practiced in women with placenta accreta spectrum; however, the maternal outcomes after cesarean hysterectomy have not been thoroughly compared with the maternal outcomes after alternative approaches, such as conservative management. Objective : This study aimed to compare the severe maternal outcomes between women with placenta accreta spectrum treated with cesarean hysterectomy and those treated with conservative management (leaving the placenta in situ). Study Design : From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. Results : Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19–0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. Conclusion : Among women with placenta accreta spectrum who underwent cesarean delivery, conservative management was associated with a lower risk of transfusion of >4 units of packed red blood cells within 6 months than cesarean hysterectomy.

Women’s dissatisfaction with inappropriate behavior by health care workers during childbirth care in France :
Article scientifique ArODES
a survey study

Laurent Gaucher, Cyril Huissoud, René Ecochard, René-Charles Rudigoz, Marion Cortet, Lionel Bouvet, Laetitia Bouveret, Sandrine Touzet, Françoise Gonnaud, Cyrille Colin, Pascal Gaucherand, Corinne Dupont, AURORE Group

Birth : issues in perinatal care,  2021, vol. 48, no. 3, pp. 328-337

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Résumé:

Background: Quality care during childbirth requires that health care providers have not only excellent skills but also appropriate and considerate attitudes and behavior. Few studies have examined the proportion of women in Western countries expressing dissatisfaction with such inappropriate or inconsiderate behavior. This study evaluated this proportion in a sample presumably representative of French maternity units. Methods: This prospective multicenter study, using data from a self administered questionnaire, took place in 25 French maternity units during one week in September 2018. The primary outcome measure was mothers' self- reported dissatisfaction with blatantly inappropriate behavior (ie, inappropriate attitude, inadequate respect for privacy, insufficient gentleness of care, and/or inappropriate language) by health care workers in the delivery room. The secondary outcome was their self- reported dis-satisfaction with these workers' inconsiderate behavior (ie, unclear and inappropriate information, insufficient participation in decision- making, or deficient consideration of pain).Results: Of 803 potentially eligible women, 627 completed the questionnaire after childbirth; 5.62% (35/623, 95% CI: 3.94- 7.73) reported dissatisfaction with blatantly inappropriate behaviors and 9.79% (61/623, 95% CI: 7.57- 12.40) with inconsiderate behaviors. The main causes of dissatisfaction reported by women in this survey were the inadequate consideration of their pain and the failure to share decision- making. Conclusions: Most of the women were satisfied with how health care workers behaved towards them in the delivery room. Nonetheless, health care staff must be aware of women's demands for greater consideration of their expressions of pain and of their voice in decisions.

Le vécu de la prise en charge en salle de naissance :
Article scientifique ArODES
une étude qualitative comparative

C. Devos, Laurent Gaucher, Marion Cortet, F. Gonnaud, R. Ecochard, P. Gaucherand, C. Dupont, C. Huissoud

Périnatalité,  2021, vol. 13, no. 3, pp. 142-149

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Résumé:

Le but de cette étude était d’étudier le vécu des mères insatisfaites de la prise en charge en salle de naissance en le comparant avec celui de mères satisfaites, à partir des données recueillies par évocations hiérarchisées dans l’Étude du Vécu de l’Accouchement (EVA). Il s’agissait d’une étude qualitative, contrôlée par témoins, en population, réalisée au sein de 25 maternités françaises d’un même territoire (Réseau AURORE). Les expressions recueillies par l’évocation hiérarchisée, appelées verbatim, ont été regroupées en sous-thèmes, thèmes et méta-thèmes. Le critère principal de jugement était le pourcentage de patientes ayant cité au moins un mot appartenant à un sous-thème. Six cent quarante-deux mères ont été incluses dans l’étude EVA. Soixante et onze mères ont répondu « insuffisamment » et/ou « pas du tout » à au moins un des items du questionnaire de satisfaction. Elles ont toutes été incluses dans notre étude et constituaient le groupe de cas (insatisfaites). Le groupe témoin (satisfaites) appariés comprenait 144 mères. Le sous-thème de la peur a été significativement plus évoqué par le groupe de mères insatisfaites que par le groupe témoin (42 versus 22 %, p = 0,02). Concernant le sous-thème de la douleur, aucune différence significative n’a été observée entre les deux groupes (45 versus 33 %, p = 0,09). Les résultats incitent à porter plus d’attention à la réassurance des mères en salle de naissance. Identifier les mères inquiètes en cours de grossesse et au moment de l’accouchement doit être une priorité pour les soignants.

Qualité des soins en salle de naissance et perspectives des mères
Thèse de doctorat

Gaucher Laurent

2021,  Lyon, France : Université de Lyon.  150  p.

DUPONT Corinne, GAUCHERAND Pascal, COLIN Cyrille

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Résumé:

En France, le ratio de mortalité maternelle était de 10.3 décès pour 100 000 naissances vivantes (IC95% 9.1-11.7) entre 2010 et 2012. D’une part, ce ratio n’a pas évolué depuis 10 ans et, d’autre part, les soins ont été jugés « non optimaux » pour 60% des décès analysés par le Comité National d'Experts sur la Mortalité Maternelle. En parallèle, des comportements inappropriés de certains soignants envers les femmes ont été mis en exergue par les médias en France sous le qualificatif de « violence obstétricale ». Ces deux thèmes, la morbi-mortalité maternelle et les comportements inappropriés des soignants, sont intégrés dans le concept de qualité des soins pour les femmes et les nouveau-nés défendu par l’Organisation Mondiale de la Santé. Elles constituent les deux composantes de ce concept, à savoir l’offre de soins et l’expérience des soins, qui ont structuré le plan de cette thèse. Le premier travail de recherche de cette thèse était centré sur l’identification de perspectives d’amélioration de l’offre de soins en salle de naissance à partir du cas particulier de l’hémorragie du postpartum. Le second travail portait sur l’évaluation de l’expérience patiente des soins liée aux comportements des soignants en salle de naissance. Enfin, le troisième et dernier travail de cette thèse portait sur l’auto-mesure des résultats de santé rapportés par les mères à partir de l’évaluation de leur lien à leur(s) enfant(s). En conclusion de cette thèse, les interventions pour améliorer la qualité des soins en salle de naissance semblent largement orientées vers une standardisation de l’offre de soins sans nécessairement avoir démontré leur efficacité. Or, pour les mères, la principale source d’insatisfaction du comportement des soignants concernait le manque de prise en considération de leur parole pour adapter les soins à leurs attentes. Les mères qui témoignaient de leur insatisfaction étaient aussi celles qui présentaient un résultat de santé mentale le moins satisfaisant dans le postpartum.

Adaptation of independent midwives to the COVID-19 pandemic: A national descriptive survey.
Article scientifique

Sophie Baumann, Gaucher Laurent, Yann Bourgueil, Olivier Saint-Lary, Sylvain Gautier, Anne Rousseau

Midwifery, 2021 , vol.  94

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Résumé:

Objective: The main objective of this survey was to identify how independent midwives, mainly working in primary care, adapted their practices at the beginning of the COVID-19 pandemic in France. Our assumption was that this practice adaptation would vary according to both geographical area (timing of pandemic effect) and whether they practiced alone or in a group.

Design:We conducted an online national survey of independent midwives in France from March 16–23, 2020.

Setting: All districts in mainland France and the overseas territories.

Participants: Respondents from the population of all independent midwives working in France.

Measurements and findings:The primary outcome measure was the proportion of midwives reporting that they had adapted their practices to the context of the COVID-19 pandemic, and the rank, in order of frequency, of the postponed or cancelled activities.

Results: Of the 1517 midwives who responded, i.e., 20.3% of the independent midwives in France, 90.6% reported adapting one or more of their practices . The main adjustment was the postponement or cancellation of consultations deemed non-essential, listed in descending order: postpartum pelvic floor rehabilitation (n = 1270, 83.7%), birth preparation (n = 1188, 78.3%), non-emergency preventive gynaecology consultation (n = 976, 64.3%), early prenatal interview (n = 170, 11.2%), and postnatal follow-up (n = 158, 10.4%).

Key conclusions: Without guidelines, each midwife had to decide individually if and how to adapt her practice. Postpartum pelvic floor rehabilitation and birth preparation have been strongly affected. The results of this national survey indicate that a large majority of midwives have adapted their practices, independently of the local course of the pandemic, and that this reduction of contacts with women raises questions in this period of anxiety about intermediate-term adaptations to guarantee the continuity and safety of care.

Implications for practice:This study's results can be used to develop tools to handle cancelled consultations. Video, also called virtual, visits and coordination between independent practitioners and hospitals are probably the major challenges in the current context.

2020

Comportements inappropriés des soignants en salle de naissance : une étude qualitative comparative — résultats préliminaires
Article scientifique

Chloé Devos, Gaucher Laurent, Cyril Huissoud

Périnatalité, 2020

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Inappropriate Behaviour by Healthcare Workers during Childbirth Care: a Qualitative and Comparative Study — Preliminary Results
Article scientifique

Chloé Devos, Gaucher Laurent, Cyril Huissoud

Périnatalité, 2020 , vol.  12, no  4, pp.  201-202

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Dissatisfaction of women with induction of labour according to parity: Results of a population-based cohort study
Article scientifique

Corinne Dupont, Pauline Blanc-Petitjean, Marion Cortet, Gaucher Laurent, Marina Salomé, Bruno Carbonne, Camille Le Ray

Midwifery, 2020 , vol.  84

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Résumé:

Objective

To determine the factors associated with dissatisfaction in women whose labour was induced, according to parity.

Design

Prospective population-based cohort study.

Setting

Seven French perinatal health networks including 94 maternity units

Participants

Among 3042 consecutive women who underwent induction of labour (IoL) with a live foetus from November 17 to December 20, 2015, in participating maternity units, this study included the 1453 who answered the self-administered questionnaire about their experience of IoL at two months post-delivery.

Measurements

The associations between women's dissatisfaction at two months post-delivery and the characteristics of their pregnancy, labour, and delivery were assessed with multivariable logistic regression models. Analyses were stratified for nulliparous and parous women. Multivariable mixed models were used to take a random effect for the maternity unit into account.

Findings

The response rate was 47.8% (n = 1453/3042). Overall, 30% of the nulliparous women were dissatisfied (n = 231/770) and 19.7% (n = 130/659) of the parous women. The specific independent determinants of dissatisfaction for nulliparous women were antenatal birth classes that failed to include discussion of IoL (OR: 2.68, 95% CI [1.37; 5.23]) and lack of involvement in the decision-making process (OR: 1.92, 95% CI [1.23; 3.02]). For the parous women, a specific determinant was a delivery that lasted more than 24 h (OR: 4.04, 95% CI [1.78; 9.14]). Determinants of maternal dissatisfaction common to both groups were unbearable vaginal discomfort (respectively, OR: 1.98, 95% CI [1.16; 3.37] and OR: 4.23, 95% CI [2.04; 8.77]), inadequate pain relief (respectively, OR: 5.55, 95% CI [3.48; 8.86] and OR: 9.17, 95% CI [5.24; 16.02]), lack of attention to requests (respectively OR: 3.81, 95% CI [2.35; 6.19] and OR: 5.01, 95% CI [2.38; 10.52]), caesarean delivery (respectively, OR: 5.55, 95% CI [3.41; 9.03] and OR: 4.61, 95% CI [2.02; 10.53]) and severe maternal complications (respectively, OR: 2.45, 95% CI [1.02; 5.88] and OR: 5.29, 95% CI [1.32; 21.21]).

Key conclusions and implications for practice

To reduce dissatisfaction in nulliparous women, IoL should be discussed during antenatal birth classes and women should be made to feel that they shared in the medical decision to perform IoL. For parous women, care providers should inform them that the duration of delivery may exceed 24 h. Continuous support for all women during IoL should pay closer attention to vaginal discomfort, pain and women's requests. Postpartum discussions with mothers should be arranged to enable conversation about the experience of unexpected events.

Decision-delivery intervals: Impact of a colour code protocol for emergency caesareans.
Article scientifique

Marine Le Mitouard, Gaucher Laurent, Cyril Huissoud, Pascal Gaucherand, René-Charles Rudigoz, Corinne Dupont, Marion Cortet

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020 , vol.  246, pp.  29-34

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Résumé:

Objective

Assess the impact of implementation by simple distribution of a “colour code” protocol for emergency caesareans on the course over time of the “decision-delivery interval” (DDI) and neonatal outcome.

Design

Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward? was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency.

Results

The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code.

Conclusion

The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.

2019

Non-clinical interventions to prevent postpartum haemorrhage and improve its management: A systematic review
Article scientifique

Gaucher Laurent, Pauline Occelli, Catherine Deneux-Tharaux, Cyrille Colin, Pascal Gaucherand, Sandrine Touzet, Corinne Dupont

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2019 , vol.  240, pp.  300-309

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Résumé:

Postpartum haemorrhages (PPHs) account for around 200 deaths per year in the developed regions of the world. However, the efficacy of pharmacological and clinical interventions to prevent or manage PPHs is well established.

Our objective was to determine the effectiveness of non-clinical interventions targeting healthcare professionals, organisations or facilities in preventing PPH or improving its management.

We conducted a systematic review using the PRISMA four-step model. The MEDLINE and Cochrane databases were searched up to March 2019. Inclusion criteria were interventional studies, published in English of French language, aiming to reduce PPH outcomes for women in hospitals, regardless of study design. The studies' methodological quality was assessed according to the Cochrane EPOC criteria.

We found 32 studies that met the inclusion criteria. None met all the methodological quality criteria. Six types of non-clinical interventions were identified: guideline dissemination, audit with feedback, simulation, training, clinical pathway and multifaceted interventions. Eleven studies reported a significant reduction in PPH rates and/or its complications, five studies reported a significant increase and 16 studies no significant results.

The heterogeneity of the studies prevents us from identifying an effective non-clinical intervention in reducing PPH rates.

2017

Oxytocin administration during spontaneous labor: guidelines for clinical practice. Chapter 2: indications of oxytocin according the first and second stages of spontaneous labor
Article scientifique

Gaucher Laurent, Camille Le Ray

Journal of Gynecology Obstetrics and Human Reproduction, 2017 , vol.  46, no  6, pp.  479-487

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Résumé:

Objectives: to assess the effectiveness of oxytocin administration during spontaneous labor. 2 Material and methods: This systematic review was conducted by searching the Medline and 3 Cochrane databases and the websites of relevant learned societies through March 2016. Search terms 4 included first or second stages of labor and oxytocin. Two reviewers independently assessed the 5 eligible studies. Only the articles specifically assessing oxytocin alone were selected (assessments of 6 oxytocin with another intervention, especially amniotomy, were excluded because studied separately 7 in these guidelines). The performance criteria selected were frequency and intensity of contractions, 8 duration of labor, and rates of spontaneous vaginal, operative vaginal and cesarean deliveries. 9 Results: We included and analyzed 22 original studies and 2 meta-analyses. The routine use of 10 oxytocin is not recommended during the latent phase of the first stage of labor, that is, before 5-6 cm 11 of dilation, regardless of dilation speed (Grade B). In cases of labor dystocia with ruptured membranes 12 during the active phase of the first stage of labor, that is, when dilation speed is less than 1 cm/4 h 13 between 5 and 7 cm or less than 1 cm/2 h above 7 cm, oxytocin can be used to increase uterine activity 14 (Grade C), although its effect on mode of delivery has not been demonstrated (LE3). In cases of labor 15 dystocia with ruptured membranes, it is recommended that oxytocin be administered at the diagnosis 16 of dystocia, that is, after 4 hours of failure to progress between 5 and 7 cm dilation or after 2 hours of 17 failure to progress after 7 cm, to improve uterine activity, with appropriate maternal and fetal monitoring (Grade B). Routine administration of oxytocin during the second stage of labor is not recommended, in view of its side effects (Grade B). On the other hand, if the second stage is prolonged beyond 2 hours, oxytocin administration is recommended to correct the absence of progress (professional consensus). No scientific evidence justifies a recommendation for routine oxytocin administration in cases of occiput posterior or transverse positions (professional consensus).
Conclusion: Oxytocin administration improves uterine activity without decreasing the risk of cesarean section or operative vaginal delivery. Given the lack of up-to-date scientific literature and its low overall level of medical evidence, there is no adequate basis for recommending the routine administration of oxytocin during spontaneous labor in the absence of labor dystocia, regardless of the stage of labor.

Recommandations pour l’administration d’oxytocine au cours du travail spontané. Chapitre 2 : indications de l’oxytocine au cours du premier et du deuxième stade du travail spontané
Article scientifique

Gaucher Laurent, Camille Le Ray

La Revue Sage-Femme, 2017

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Recommandations pour l’administration d’oxytocine au cours du travail spontané. Texte court des recommandations
Article scientifique

C Dupont, M Carayol, C Le Ray, C Barasinski, R Beranger, A Burget, A Chantry, C Chiesa, B Coulm, A Evrard, C Fischer, Gaucher Laurent, C Guillou, F Leroy, E Phan, A Rousseau, V Tessier, F Vendittelli, C Deneux-Tharaux, D Riethmuller

Gynécologie Obstétrique Fertilité & Sénologie, 2017

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Recommandations pour l'administration d'oxytocine au cours du travail spontané. Texte court des recommandations
Article scientifique

Corinne Dupont, Marion Carayol, Camille Le Ray, Chloé Barasinski, Rémi Beranger, Antoine Burguet, Anne Chantry, Coralie Chiesa, Bénédicte Coulm, Anne Evrard, Catherine Fischer, Gaucher Laurent, Camille Guillou, Fabienne Leroy, E Phan, Anne Rousseau, Véronique Tessier, Catherine Deneux-Tharaux, Françoise Vendittelli, Didier Riethmuller

La Revue Sage-Femme, 2017

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Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial
Article scientifique

Corinne Dupont, Norbert Winer, Muriel Rabilloud, Sandrine Touzet, Bernard Branger, Jacques Lansac, Gaucher Laurent, Antoine Duclos, Florent Boutitie, René-Charles Rudigoz, Cyrille Colin, OPERA group

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2017 , vol.  215, pp.  206-212

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Résumé:

Objective

Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes.

Study design

A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome.

Results

The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p = 0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p = 0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p = 0.01). No differences were found between psychologist-backed and the other units.

Conclusions

The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166)

Enjeux académiques et managériaux d'une refonte du programme pédagogique d'initiation à la recherche pour les manipulateurs d'électroradiologie médicale (MERM)
Article scientifique

Catherine Dionisi, Gaucher Laurent

Le Manipulateur d'imagerie médicale et de radiothérapie, 2017

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2016

Accouchement inopiné extrahospitalier : prise en charge et facteur de risque
Article scientifique

Marine Billon, Gilles Bagou, Gaucher Laurent, G Comte, Michele Balsan, René-Charles Rudigoz, Corinne Dupont

Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 2016

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2012

Évaluation de l’impact des revues de morbi-mortalité en obstétrique : revue de la littérature
Article scientifique

Corinne Dupont, Pauline Occelli, Thomas Fassier, Gaucher Laurent, Cyrille Colin, Patrice Francois, Catherine Deneux-Tharaux, René-Charles Rudigoz

Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 2012

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2023

La recherche maïeutique en Suisse et en France
Conférence

Gaucher Laurent

Journées nationales de la Société française de médecine périnatale - 52e, 18.10.2023 - 20.10.2023, Lyon

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Midiwives’ approaches to management of expulsion
Conférence

Gaucher Laurent, Caroline Matteo

World Congress of Gynecology and Obstetrics - FIGO - XXIVe, 09.10.2023 - 12.10.2023, Paris

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A digital peer support tool to prevent postnatal depression
Conférence
a forthcoming RCT - [Poster de conférence]

Pulh-Leavy Emma, Pichon Swann, Sonali Quantius, Gaucher Laurent

Journée de la recherche du D-PGO, 01.06.2023 - 01.06.2023, Genève

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Entretien post-natal précoce
Conférence

Gaucher Laurent

Journée 2023 du Conseil Départemental de l’Ordre des Sages-Femmes du Rhône, 01.06.2023 - 01.06.2023, Lyon

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Clés pour une expérience positive de l’accouchement
Conférence

Gaucher Laurent

Journée Obstétrique de Beaulieu, 11.05.2023 - 11.05.2023, Genève

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Recommandations pour la pratique clinique du CNGOF
Conférence
examen pelvien en gynécologie et obstétrique

Gaucher Laurent

Les Journées Sages-femmes, 30.03.2023 - 31.03.2023, France

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Administration de l'oxytocine pendant le travail spontané
Conférence
recommandation pour la Pratique Clinique 2016

Gaucher Laurent

Journée de l'ASINCOPROB Haute-Corse, 24.03.2023 - 24.03.2023, Bastia

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Entretien post-natal précoce
Conférence
les préconisations du CNSF

Gaucher Laurent

Journée 2023 du Réseau Périnatal de Bourgogne, 10.03.2023 - 10.03.2023, Bourgogne

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Planification des retours à domicile après la naissance :
Conférence ArODES
évaluation clinique et économique du suivi d’un million de dyades mère–enfant pendant un an

Alexandre Caron, Anne Rousseau, Anne-Claire Brisacier, Laurène Courouve, Laurent Gaucher

Gynécologie obstétrique fertilité & sénologie 

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2022

Comportements inappropriés des soignants en salle de naissance
Conférence

Gaucher Laurent

Congrès de périnatologie, 02.12.2022 - 02.12.2022, Belgique

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Lien Ville - Hôpital
Conférence
impact sur les pratiques

Gaucher Laurent, S. Hommey, R. C. Rudigoz, M. Cortet, C. Huissoud, J. Haesebaert, S. Touzet, P. Gaucherand, C. Dupont

Journée inter-réseaux de périnatalité, 25.11.2022 - 25.11.2022, Lyon

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Approche physiologique, quelle(s) définition(s) ?
Conférence

Gaucher Laurent

Séminaire approche physiologique de la grossesse en CHU, 06.10.2022 - 06.10.2022, Lyon

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Vécu des restrictions COVID en postpartum
Conférence
premiers résultats

Sarah Louis, Gaucher Laurent, Anne Rousseau

Accoucher en temps de pandémie de covid-19, 08.06.2022 - 08.06.2022, France

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Coordination des soins par les sages-femmes pendant la pandémie de COVID-19
Conférence
une enquête descriptive nationale

Gaucher Laurent, Corinne Dupont, Sylvain Gautier, Sophie Baumann, Anne Rousseau

Les Journées Sages-Femmes, 31.03.2022 - 01.04.2022, France

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Un système d’information collaboratif femmes-ville-hôpital
Conférence

Gaucher Laurent, Céline Puill, Sophie Baumann, René-Charles Rudigoz, Marion Cortet, Cyril Huissoud, Cyrille Colin, Sandrine Touzet, Pascal Gaucherand, Corinne Dupont, Frédéric Mougeot

Les Journées Sages-Femmes, 31.03.2022 - 01.04.2022, France

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2021

Ville-Hôpital
Conférence
travailler ensemble

Gaucher Laurent

Congrès national de la sage-femme libérale, 25.11.2021 - 25.11.2021, France

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Qualité des soins en salle de naissance et perspectives des mères
Conférence

Gaucher Laurent

Midi Ra&D Santé, 14.09.2021 - 14.09.2021, Genève

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