The perinatal situation in Italy

AIMS Journal, 2008, Vol 20 No 2

Piera Maghella looks at Italy's maternity statistics

There are approximately 60 million people living in Italy. There are approximately 570,000 babies born every year and 600 places where births happen (88% in public places, 11.5% in private clinics and 0.17 at home - planned and unplanned). There is a great difference between the North and Central part of Italy and the South. 55% of women have their first pregnancy by the age of 31, 20% are foreign women.

Pregnancy

Normal pregnancy is cared for by an obstetrician in 75% of cases, only 5% of normal pregnancies are cared for by a midwife or a team of midwives. Women who want continuity of care have to go to a private obstetrician and in 47% of cases they choose an obstetrician who works in the hospital where they plan to have their baby. In a normal pregnancy women go to see an obstetrician approximately seven times and have six scans, although the Italian Ministry of Health advises three scans. 30% of women undergo invasive prenatal tests. 15% of women miscarry, especially in the first trimester.

Childbirth education

Nationally, 30% of women (40% in North and Central Italy and just 15% in the South) in their first pregnancy attend a course, which is usually held in a public health centre or hospital and organised by midwives and psychologists. The courses are approximately eight sessions, and are mainly concerned with giving information with some relaxation techniques. Publicly organised couples' classes and postnatal meetings and activities are very rare.

Approximately 10% of women resort to private courses and facilities, starting early in the pregnancy (in the first trimester), doing bodywork (yoga, stretching, belly dancing, tai-chi, aquatic body work and relaxation...). In the private sector, couples' classes, postnatal support and baby massage sessions are frequent.

Birth

Birth in Italy is very medicalised.

Most births take place in public hospitals. In the North, it is unusual to go to a private clinic. In the Emilia Romagna region, round Bologna, only 1.3% of women go to a private clinic to give birth, whereas in the Campania (Naples) region almost 50% of women go to private facilities. Home births (planned and unplanned) total 0.17%, and are usually done by private midwives. Women rarely get government refunds or receive public care for home births.

The caesarean section rate is around 40% nationally, with great differences between Bolzano (15%) and Naples(70%). Women prefer spontaneous vaginal birth to caesarean and 90% of women who have had a previous vaginal birth want the same again. 70% of women who have had a previous caesarean want a vaginal birth. The vaginal birth after caesarean (VBAC) rate is approximately 20%, mainly in public hospitals.

Epidural birth is a new issue, greatly publicised and encouraged by anaesthetists and the media.

The operative births, such as ventouse births, are 2%.

The data on episiotomies are not recorded nationally and only a few regions record the number of episiotomies, which is (for these regions) at around 50%, although it may be much higher.

For the last decade, women have been free to move in the first stage of labour, but 80% of women giving birth vaginally still have to be in the supine position.

Fathers or a relative are often present and involved during labour and birth. This trend is very high in the North and Centre and applies to approximately 93% of all vaginal births. In the South it is not yet so frequent. In caesarean births, on the other hand, fathers are not admitted, although the most common form of caesarean is under epidural.

The professionals present at a birth are: a midwife, an obstetrician, a paediatrician/neonatologist in 70% of births and an anaesthetist in the 50% of births.

The neonatal mortality rate is 3.15 per thousand.

Baby birth weights are as follows: 47.01% at 3300-3999g, 44.26% at 2500-3299g, 6.78% at 4000-6000g, 1.92% at 1500-2499g and 0.03% at less than 1500g.

Post partum

Women stay in hospital two or three days for a vaginal birth and three to five days for a caesarean.

This is the most unsupported time. After birth there is either nothing at all or very little. Home visiting by a midwife is very rare. Only a few health centres offer home visiting. There are some self-help groups offering space and support; La Leche League is one of the important sources of help for women.

Breastfeeding

The majority of women (94%) want to breastfeed their baby, but in reality only 31% are able to get the baby to the breast in the first two hours after birth, with great differences between the North (51%), Central Italy (29%) and the South (14%); and this is directly related to the type of birth women have. 90% of women breastfeed their baby during their stay in hospital, although often not exclusively. 31% of babies are exclusively breastfeed at four months and at six months only 5% are exclusively breastfed. Around 12% of children are still breastfed at one year.

In the period 2002 to March 2008 there were only 15 Baby Friendly hospitals, mainly in the North.

In the last decade many efforts have been made to support breastfeeding, with a large number of workshops run by professionals in almost every single hospital. Breastfeeding is now a very important issue to be developed with women and couples in birth preparation, but the situation is still quite sad.

References

Italian Ministry of Health Reports for the years 2004-2006