Grossesse, accouchement: où sont les voix des femmes ? Le compte-rendu.
Le 30 mars dernier, la rencontre-débat avec Martin Winckler et Renée Greusard, animé par Marie-Hélène Lahaye a fait salle comble à la Maison du Livre de Saint-Gilles. Plus de 120 personnes étaient présentes.
Le débat, d’une grande richesse, a questionné la place des femmes et la prise en compte de leur point de vue lorsqu’elles sont enceintes et qu’elles accouchent. Voici quelques idées et réflexions échangées.
Où sont les voix des femmes ?
Renée Greusard a écrit son livre Enceinte tout est possible parce que, lorsqu’elle était enceinte, elle a eu l’impression d’appartenir à tout le monde. N’importe qui s’est senti autorisé à lui donner des « conseils », comme si elle n’était plus une adulte. Les femmes sont infantilisées dès qu’elles sont enceintes.
Elle a fait le choix d’écrire à la première personne du singulier dans son livre. C’est le « je » de la femme enceinte actrice de sa vie contre toutes ces voix qui parlent pour elles avec leurs injonctions.
Pourquoi les femmes ne se rebellent-elles pas ? Pour Martin Winckler, les femmes enceintes se soumettent au médecin parce qu’elles sont deux, et elles craignent pour leur bien et celui de l’enfant.
Les femmes parlent souvent pour les autres et pas forcément pour elles. 70 % des patients sont des femmes. Dès qu’elles sont enceintes, elles sont considérées comme n’ayant plus de cerveau. Le collège des obstétriciens américain a émis une recommandation précisant que ce n’est pas parce qu’une femme est enceinte qu’on peut lui imposer des choses avec lesquelles elle ne serait pas d’accord.
Pourtant, les attentes et besoins des femmes sont divers. La péridurale sera importante et nécessaire pour certaines, la liberté de mouvements le sera pour d’autres. Leur prise en charge doit tenir compte de cette diversité. Il faut se donner les moyens d’un accompagnement avant tout basé sur l’humain et moins sur la technique
Le médecin lui-même est formé avec l’idée que s’il est mauvais, ses patients vont mourir. C’est un enseignement fondé sur la peur. Il en arrive donc à ne plus écouter les femmes. De plus, l’empathie des médecins qui diminue au fil de leur formation.
Il faut sortir de la peur. La peur des soignants, la peur des femmes enceintes.
La médecine de la peur est contrecarrée par l’appropriation de tous les savoirs : scientifique, profane, personnel. Et par la transmission de ces savoirs.
La formation des médecins ne leur apprend pas à écouter. Les voix des femmes sont pourtant la source qui permet aux soignants d’apprendre à soigner.
Pourquoi écouter les femmes ?
Des études montrent que les médecins interrompent leurs patients après 25 secondes en moyenne. Ils interrompent les femmes plus rapidement que les hommes.
Pourtant l’écoute est importante. Quand une femme demande avec insistance si on sait dater exactement une grossesse, l’écouter permet de comprendre qu’elle a un doute sur la paternité et donc de prendre en compte son ambivalence tout au long de sa grossesse. Si on ne sait pas l’écouter, on ne saura pas ce qui se cache derrière la question.
Pour bien écouter, il ne faut pas être dans le jugement, même quand une femme n’entre pas dans les clous. Le soin n’est pas qu’un geste technique.
Écouter les femmes permet aussi de prendre en compte leur douleur. Donc adapter les gestes techniques pour les rendre moins douloureux (par exemple la pose d’un DIU sans saisir le col de l’utérus avec une pince de pozzi).
A Sherbrooke et à Montréal, des patients partenaires sont entrés dans les facultés. Des patientes qui souhaitent s’impliquer dans l’apprentissage des futurs médecins, ont marqué leur accord pour être examinées par les étudiants. Elles sont inscrites sur une liste de rendez-vous et peuvent être appelées en fonction de leurs apprentissages. Elles peuvent néanmoins toujours refuser un rendez-vous. De cette façon, les patientes acceptent de se prêter au jeu de l’apprentissage pour les étudiants, y compris à l’entretien d’écoute.
L’écoute ne concerne pas que les professionnels. Il s’agit aussi de l’écoute de ceux à qui l’on se confie (amis, entourage, proches). Et de l’écoute de soi.
La pathologisation de la grossesse met le médecin dans la position d’être celui qui sait, et ne tient pas compte du savoir des femmes. Plus grave encore, les femmes substituent le savoir du médecin à leur savoir propre. Elles ne s’écoutent plus.
Une stagiaire constate à quel point il est difficile de rester humain dans un système qui attend du personnel qu’il fasse une toilette en sept minutes. Martin Winckler répond qu’il faut entrer en résistance. Y compris face à des formateurs irrespectueux, qui proposent aux étudiants de faire des touchers vaginaux comme bizutage.
L’importance de l’information.
Renée Greusard insiste sur l’importance de l’information sur la grossesse, l’accouchement et la parentalité. Il faudrait aussi informer les gens sur ce que c’est de devenir mère, sur la réalité des premiers jours avec son enfant.
L’information rejoint la notion de consentement libre et éclairé : les femmes ne savent pas qu’elles peuvent refuser les choses avec lesquelles elles ne sont pas d’accord.
Une décision éclairée, c’est une décision que l’on prend en connaissance des risques que l’on court.
L’information doit avoir lieu dès l’adolescence, pour mieux armer les femmes afin qu’elles puissent faire les meilleurs choix, y compris celui de ne pas avoir d’enfant.
A partir du moment où les adolescents et adolescentes sont capables de procréer, il est essentiel qu’une véritable information soit donnée aux jeunes. Martin Winckler rappelle que des rumeurs telles que « on ne tombe pas enceinte lors d’un premier rapport sexuel » circulent encore chez les jeunes. Si une jeune fille se retrouve enceinte, il est important qu’elle ait eu des informations, mais également que ses amies aient des connaissances sur le sujet.
Comment faire entendre les voix des femmes ?
Comment agir pour que les femmes fassent entendre leurs voix ? Il faut se parler, diffuser de l’information, tenir des blogs, réaliser des bandes dessinées, passer à la radio.
Il faut aussi communiquer ses ressentis, échanger horizontalement entre femmes. Il ne faut pas compter que sur l’institutionnel, que sur ceux qui détiennent l’autorité.
Les femmes plus informées doivent aussi aller vers les femmes plus fragilisées.
Il faut maîtriser le savoir et le transmettre.
La transmission mère-fille a été abordée par le public. Renée Greusard constate néanmoins que cette transmission autour de la grossesse et de l’accouchement ne se fait plus, et a été déléguée au pouvoir médical. Aujourd’hui, la transmission a plutôt tendance à se faire entre pairs (quantité de forums sur internet, discussions entre amies).
Comment communiquer sans être dans de nouvelles injonctions ? Martin Winckler suggère de partir des questions des femmes. Par exemple leur demander si elles ont des questions qu’elles se posent, des choses qu’elles ont envie de dire au sujet de leur grossesse ou de leur futur accouchement. C’est une façon d’entamer le dialogue et de transmettre les informations dont les femmes seraient en demande.
Pour une prise de pouvoir des femmes
Il y a beaucoup à faire pour sensibiliser les professionnels de la santé à l’empowerment des femmes par rapport à leur grossesse et leur accouchement. Une formation qui inclut une sensibilisation au genre et à l’égalité entre les femmes et les hommes est une bonne piste.
Le rapport de pouvoir entre les patient.e.s et les soignant.e.s doit changer au bénéfice d’une médecine basée sur les preuves et une confiance mutuelle, protégée des impératifs de gestion et des intérêts des compagnies d’assurance.
Une bonne idée suggérée depuis la salle : aller chez le gynécologue avec ses copines.
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