title: Perinatal care regionalization and acceptability by professionals in France.
abstract: BACKGROUND
  For twenty years, most of industrial countries developed recommendations on regionalization of perinatal care. Perinatal regionalization is particularly aimed at improving morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the maternity units having a medical or neonatal environment suited to the risks incurred by mothers or babies. Perinatal regionalization cannot be effective without being well accepted by the majority of professionals. The objectives of this study were then to identify professionals'expectations and objections to perinatal regionalisation and to compare them from a professional group to another one.
  
  
  METHODS
  Professionals of 3 French perinatal networks were under consideration: the Rhône, the Auvergne and the Gard-Lozère networks. The study included two stages: 1) a psychosociological qualitative study, based on professionals'interviews, aimed at identifying main concerns of professionals and developing a questionnaire; then 2) an epidemiological quantitative study, using this questionnaire within French networks. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation aspects and to the setting up of maternity units care levels, risk of loss of professionals' competence and prestige, consequences on medical practices, on inter-professional relationship, on work organization and financial aspects, and related to the new role of 'private practice'professionals, legal consequences.
  
  
  RESULTS
  The response rate of the epidemiological study was 80%. The results permitted to construct 8 dimension scores describing the reasons of poor acceptability of regionalization. After taking into account the age, the sex, the network and the juridical status of the institution, the study revealed a significant poorer acceptability of regionalization by most of medical specialty groups (anesthetists, obstetricians, midwives and "private practice" professionals) compared with neonatologists, or by "private" professionals (professionals working in private clinics and "private practice" professionals) compared with professionals working in university or community hospitals. The study described also network setting up conditions related to its functioning.
  
  
  CONCLUSIONS
  By identifying clearly professionals 'objections and expectations, this study should facilitate improvement in the organization of studied perinatal networks.
authors.affiliation: Service de Biostatistiques des Hospices Civils de Lyon, 162, avenue Lacassagne, 69003 Lyon. sandra.david@chu-lyon.fr
authors.forename: S
authors.initials: S
authors.lastname: David
authors.forename: C
authors.initials: C
authors.lastname: Durif-Bruckert
authors.forename: J P
authors.initials: JP
authors.lastname: Durif-Varembont
authors.forename: D
authors.initials: D
authors.lastname: Lemery
authors.forename: G
authors.initials: G
authors.lastname: Masson
authors.forename: P
authors.initials: P
authors.lastname: Scharnitzky
authors.forename: O
authors.initials: O
authors.lastname: Claris
authors.forename: N
authors.initials: N
authors.lastname: Mamelle
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D005602:France; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D010360:Patient Transfer; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D012041:Regional Medical Programs / Q000458:organization & administration*; D011795:Surveys and Questionnaires