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L’accouchement “naturel”: “crédible?

Face aux demandes de plus en plus fréquentes d’accouchements le plus naturels possible, des soignants s’alarment car ils ne sont pas toujours réalisés dans de bonnes conditions.
byLa rédaction
octobre 12, 2022
4 minute read
main de bébé et papa
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Accoucher à la maison, le plus naturellement possible, pourquoi pas, à condition que cela soit bien préparé et qu’il n’y ait pas de risque de complications. En revanche, quand les parents l’ont préparé à la va-vite, parfois seulement en se renseignant sur Internet, et parfois sans prendre en compte les potentiels dangers, c’est prendre un gros risque. C’est pourtant de plus en plus fréquent, et cela inquiète les soignants.

Une forte augmentation des demandes d’accouchement à domicile et naturels

Auprès de BFM TV, plusieurs experts expliquent avoir vu le nombre de demandes pour accoucher à domicile ou naturellement augmenter. Selon l’Association professionnelle de l’accouchement accompagné à domicile (APAAD), le nombre de familles suivies pour préparer un accouchement à domicile a augmenté de 115 % entre 2019 et 2020. Le rapport souligne que cette hausse “aurait pu être bien supérieure”, sauf que “l’offre professionnelle n’était pas suffisante”. Par conséquent, “énormément de femmes ont été refusées soit du fait du manque de moyens, soit du fait de demandes trop tardives, ou insuffisamment mûries”. Face à cela, “le nombre de couples qui se tournent vers des accouchements non assistés augmente lui aussi considérablement, la plupart du temps en raison de l’absence de sage-femme disponible”.

Les parents sont également de plus en plus nombreux à souhaiter un accouchement le plus naturel possible. “Il y a une véritable aspiration pour le “tout naturel””, explique le Pr Yves Ville. Lui-même voit “de plus en plus de femmes revendiquer qu’on ne médicalise plus l’accouchement, et refusent le déclenchement de l’accouchement”. “La grossesse n’est pas une maladie, les femmes ont donc une tendance naturelle à penser qu’elle ne doit pas nécessairement être médicalisée. C’est devenu fréquent qu’on nous dise : “Je ne suis pas malade, tout va bien, et le bébé sortira quand il aura envie de sortir””, explique-t-il.

Des accouchements non assistés mal préparés

“Les couples ont cette volonté de respecter le rythme physiologique de la naissance”, analyse Caroline Combot, sage-femme, pour BFM TV. Elle ajoute : “Ça ne pose pas de problème en soi. Le hic, c’est que depuis le Covid, mes collègues et moi voyons de plus en plus de couples qui ont ce projet mais ne veulent plus qu’il soit médicalisé. Ils préparent ça dans leur coin, s’organisent et glanent des conseils sur des groupes Facebook dédiés à ça”.

Si la grossesse n’est pas une maladie, elle n’est pas anodine non plus, souligne, Amine Saïd, médecin généraliste urgentiste à l’hôpital de La Timone. “Certains pensent qu’à partir du moment où c’est naturel, c’est sans risque. Alors certes, cela est faisable mais pourtant une femme qui accouche seule dans sa baignoire, ça peut être extrêmement dangereux si ça n’est pas préparé ou si les conditions ne sont pas réunies”, rappelle le soignant.

Une défiance vis-à-vis du milieu médical

“Cette nouvelle tendance survient en réaction à la médicalisation assez intense de la grossesse qui était privilégiée entre la fin des années 1970 et les années 1990, avec des recommandations en faveur de consultations nombreuses et d’échographies systématiques. Maintenant, on est dans un courant très sceptique à l’égard des messages médicaux. Les femmes se disent “qu’est-ce qu’on vient m’embêter avec de la médecine alors que c’est un phénomène naturel qui s’est très bien passé pour mes amies ou unetelle sur Internet”. Aujourd’hui j’ai l’impression qu’on croit parfois plus les copines qui ont accouché dans le foin et pour qui ça s’est bien passé que le médecin qui vous dit de faire attention parce que vous avez 43 ans, vous avez fait une FIV et un diabète pendant votre grossesse, ce n’est peut-être pas très prudent d’aller jusqu’à 41 semaines“, déclare le Pr Ville. Le Dr Amine Saïd constate aussi “une défiance grandissante des patients à l’égard de la médecine conventionnelle mais aussi de l’industrie pharmaceutique”.

De nombreuses familles souhaitaient déjà vivre des accouchements plus naturels avant la pandémie, mais la défiance vis-à-vis de la parole médicale a augmenté depuis. “La crise Covid a servi de catalyseur parce que les médecins n’étaient pas d’accord entre eux sur les questions liées à la pandémie. De fait, ils ne parlaient pas d’une seule voix et ça a brouillé les messages scientifiques”, explique Amine Saïd. Raphaël Veil, médecin qui effectue une recherche sur la question, confirme : “La parole des experts s’est diluée au sein d’un brouhaha médiatique.” Résultat, il y a actuellement “une forme de relativisation de l’expertise qui se mêle à une confusion entre les faits et les opinions”.

Pour ces soignants, la parole des professionnels de santé a parfois autant, voire moins, de valeur que l’avis de n’importe qui, par exemple les influenceurs. “L’influenceur va me parler de ce sujet avec aplomb, j’ai l’impression de connaître cette personne, je m’identifie à lui. Une confiance s’est installée bien qu’elle n’ait aucune qualification médicale donc je vais lui faire confiance. Au final, sa parole a la même crédibilité que celle d’un professionnel de santé et c’est très frustrant”, déclare le Dr Saïd.

Des difficultés d’accès aux soins

Plusieurs des experts interrogés par BFM TV expliquent également que l’essor de l’accouchement naturel et à domicile, et en général au recours aux médecins alternatives, peut avoir un lien avec les difficultés d’accès aux soins. Fautes de pouvoir obtenir un rendez-vous, les patients se tournent vers Internet pour trouver des conseils. Dans le cas des naissances, Caroline Combot indique : “C’est quelque chose qu’on retrouve beaucoup dans certains territoires éloignés des maternités comme les zones frontalières ou en montagne. Ça nous préoccupe énormément que certains ne veuillent plus être accompagnés par un professionnel de santé et préparer ça eux-mêmes avec des conseils trouvés ici et là… C’est du bricolage et c’est prendre le risque d’un drame tout à fait évitable”.

Certains parents préfèrent ainsi s’entourer de doulas ou de coachs en périnatalités, qui n’ont pas de formation médicale, pour accoucher à domicile. Un problème pour Yves Villes, qui souligne que ce “n’est pas adapté à toutes les femmes et toutes les grossesses, surtout quand on sait que l’âge moyen des femmes enceintes se décale progressivement vers les 35-44”, âge où le risque de complications augmente.

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