I am a childbirth educator from the US and have just been living in Italy for a year now. Now that we're somewhat settled, I would really love to put together a childbirth education course for English speakers. However, I need to know what women can expect when they enter the hospital and if they will be allowed to use the tools I teach.

It would be very helpful for me to hear what your experiences have been like giving birth in Italy. What options did you find and how did you feel about the quality of care? What was your birth like? Really, any information at all would be extremely helpful.

Here is my story:
DH and I decided on a private GYN and went in every month for a checkup (our choice). I had told him (he worked at the hospital that I had chosen) and filled out the required forms in order to do the epidural.
At 6.30am the contractions started at less than 10minutes apart, and by the time that I got to the hospital to do the NST (I was a week overdue) at 8.30-9am, they were every 5 minutes. They said nothing and sent me home. An hour later by 12.30, I could not take it anymore and went again to the hospital where they looked at me and said that they were not the right contractions (I knew very well tho that they were 'the right ones') and when I insisted, they checked and said that I was 4cm dilated. Within the next 30minutes, I was at 5cm and so on until 7cm and then he decided that he did not want to come out yet, and went back up. They kicked me out of the sala parto and made me walk for I dont know how long, and put me on an IV (cant think of the name of what they gave me) to help along the contractions.
Anyways, at 18.50, I had a wonderful baby boy set in my arms, if only for a minute before taking him away. The OB who was following me thru out the delivery had said at one point that she wanted to prepare to do a massage (to avoid the episiotomy(sp??)). The next thing I knew, the doctor (NOT my OB) was cutting me. This same doctor had also done some type of movement (starts with a K) where she put her forearm across me and leaned on me really hard... I knew from the look on the other doctors faces that this was NOT ok'd beforehand.
Oh yeah, when I was still at the 4cm, I asked for the epidural and they laughed at me and said that I was too far along, and they can only do it up until 3cm. I have heard that this is the normal response from several other people, so I think that they like to send you home until it is too late to do the epidural.

Kanga,
I think you are going to have your work cut out for you in figuring out the system here for pregnant women. I went through an entire pregnancy here and despite a great deal of research, I was still quite confused at the end of my pregnancy (I had my baby Jan. 11 in Milan). Each region is different. Actually, each city is very different. Why not go to your local consultori familiari to get more information about how pregnancy is handled in your area and about the differences in hospitals, etc.? It is quite likely that most of the information you may have about giving birth in the U.S. will not apply here. During my pregnancy I spoke with many girlfriends in the U.S. about their pregnancies and realized that my experience here was absolutely nothing like theirs. Good luck to you!
Michelle

P.S. Short-ish version of my long labor story. I started labor at home around dinnertime. Got to the hospital at 11 p.m. as contractions were very close together and very strong. I was made to wait in the hallway for an hour in a wheelchair, which was horrible as I was outside where the visitors were and people knew I was in labor and were staring at me - waiting for me to pop, I guess. I didn't get into the maternity ward until an hour or so later and was told that because of overcrowding issues I was being sent to another hospital (a hospital I had NEVER even heard of despite having done tons of research on all the hospitals in the area). This was incredibly traumatizing as I'd done prenatal classes at this hospital, my gynecologist worked there and I had all my forms ready to get an epidural there (many hospitals don't even offer it but this hospital does provided you take various medical exams and jump through a bunch of hoops beforehand) but I was in too much pain to protest. When I think about how nasty this midwife was to me in that moment, I still get tears in my eyes. She obviously didn't take bedside manner courses at nursing school! Fortunately, my water broke right then and there, they checked me and realized I was too far along to be sent elsewhere. I labored all night in a back storage-type room until a delivery room opened up. All seemed to be going well by morning. I was dilated 10 centimeters and the baby had come down - but then they realized his head was 'posterior.' A debate among doctors and midwives ensued where they tried to decide if the baby could come out that way. An ultrasound was done and they still were unsure. By this point my epidural (which had never really kicked in, to be quite honest) had been turned off because they thought I was going to be pushing and that the whole thing would be over quickly. They had me push for several hours until it was determined we were making no progress. I was offered a C-section (I have to admit that it wasn't forced on me - the final decision was mine) and was so exhausted and traumatized at that point, that I took it. The five-day hospital stay was fine. It certainly wasn't the Hilton but I got OK care (had to beg an beg for pain meds only to be given acetominophen). I thought my baby got excellent care in the nursery and in the end, I'm glad I picked that hospital. If I ever have a baby again, I'll probably beg, borrow and steal to have insurance do it in the U.S., however.

This is yet another non-reassuring childbirth thread.

Anyway - I'd suggest that you check out the two very long childbirth threads on this site- just do a search for "birth".

I agree with the others though - Italy is at the same time over and under regulated. While there are millions of laws on everything they are selectively applied according to the whim of the bureaucrat, police officer or (in this case) doctor or ostetrica. So, it's unlikely you'll find the same kind of protocols which would be normal at a US hospital.

I've heard that Trento is a great place to give birth though, probably because it's closer to Northern Europe.

quote:

Originally posted by Ramona:
This is yet another non-reassuring childbirth thread.

Dont worry hun. I gave birth here in Roma and it was fine. I had a c section (I notice that you are concerned about this in another forum) however that was in the end my choice through great pain and fear. I had a very difficult pregnancy and was well cared for here by both the private gynaecologist and the public hospitals (and I was several times at obstetric pronto soccorso in the middle of the night). I was due to give birth at San Pietro fatebenefratelli which looked great and said that they aim for a natural birth if at all possible, I also attended their antenatal classes. However I decided to give birth at the casa di cura, città di roma once I got past 33 weeks as San Pietro would not allow H2b to stay other than visiting hours (My Italian is not at all fluent) and also brought baby to you on an timetable at set hours of the day for feeding and I wanted rooming in. Città di Roma was good, I was well cared for, the ostetriche are lovely and if you are on a ward you pay 25 euro a night to give birth there, though I think you need also to have a contact in the form of a doctor there.

Certainly the experience of pregnancy care here in Italy and what I know of it in the UK are worlds apart, the procedure and the tests you have to do are very different etc. However the UK health system has a LOT of problems and certainly the maternity care in the area I formally lived in is ranked as POOR. Here in Italy it varies enormously, at best it is however better than the UK and to do some aspects privately do not cost anywhere near as much. Also I am positive that my baby's life was saved by my taking a low level of oral tocolytic to stop severe cramps and contractions from about 20 weeks. This would NEVER have been prescribed in the UK, I dont think they even give tocolytics in this form.

I also found that everyone who treated me was very kind and the main confusion for me was the difference in systems here from home and the massive language barrier which meant that H2b had to be at every appt as I was scared to misunderstand or not ask something impt.

Ramona, do you have a good consultant? are you paying privately? Seriously dont worry, you will be fine.

Thanks for your posts.

I am surprised at all the bureaucracy that everyone seems to be encountering (ha ha)... Why should I be surprised? As with everything here, it seems that if you have an inside into the system, things become very clear.

All joking aside... thank you very much for sharing your stories. Even in the US, birth experiences and the standard of care vary widely. This is the main reason why there are independent childbirth educators like myself. Often times the classes offered at hospitals teach you how to be a good patient and not much about the birth experience, it's normalcy or information to make informed choices.

Also, I agree that one should not get discouraged. I know several people who have had really wonderful birth experiences here in Italy. Same goes for my friends in the US. And it usually boils down to being able to make informed choices. If the mother is treated with respect and given real information about what is happening and what her options are, generally people come away from the experience feeling good. Go figure... women still want to be treated with respect, even when they are pregnant and birthing babies!

Kanga: I wish that we lived closer and that I had you over a year ago! The pregnancy went well, all of the visits went well (except for the GYN telling me that I needed to go on a diet.. I gained 2 1/2 kilos a month no matter what I ate, so I ate what I wanted) and the coarse at the hospital (done by an OB) went really well. I was convinced that this was a great place, and that I would have a great, 'normal'(by our american standards) birth and hospital stay. Now, dont get me wrong, all of the OBs were GREAT! They kept me informed, tried to make me as comfortable as possible, and were very uptodate I guess as far as births (massage vs. cutting, positions, etc). However the doctors were horrible. They were too busy to give us the time of day, treated us like , and many of the patients cried thru most of the 3 days in the hospital.

Diana: Sometimes all we need is confidence from the people around us that everything will be fine. Sorry to hear about the trauma you experienced after the birth. But I'm encouraged by your comments about your experience overall. I guess I'm confused about the different medical professionals that women see during the process. I've heard midwife and OB used interchangeably, and there are labor nurses I suppose, now you are telling me about the doctors... I'm guessing these are just general physicians who monitor postpartum women after birth for signs of infection?

I live in the far north, but the kids and I spend a lot of time in Amalfi (during school holidays) where my in-laws are from... perhaps this is closer to where you live?

quote:

Originally posted by Ramona:
This is yet another non-reassuring childbirth thread.

Ramona,
I haven't posted much about my experience for the exact reason that I didn't want to freak anyone out. At the end of the day, it wasn't that bad because I knew exactly what to expect. Everything that happened to me (facing hospital overcrowding, laboring in a corridor, dealing with indifferent hospital staff, etc.) I was prepared for and when some of my worst fears came to fruition, I just dealt with things because nothing shocked me at that point. I'm glad I had educated myself. What was most important to me was that my baby get good care, and he got excellent care. At one point, it was feared he had a heart problem (he is fine - no heart problem) and he was whisked off to a baby cardiologist quickly and the situation was taken care of professionally. The hospital has since gone out of its way to follow up with us and make sure all is well with my baby, so overall I can't complain. If I ever get pregnant again, I'd like a more 'human' experience for myself and that's why I'd like to do it in the U.S. where people seem to form more personal relationships with their doctors and nurses. And have more choice. I've struggled quite a bit with some post-partum issues that perhaps would have been avoided if I'd had a happier and less confusing pregnancy.
Michelle

You may not have to go to the US for that relationship with your care provider during pregnancy. I personally know of two women, one in Rome and one in Trento who hired homebirth midwives for their care and both had truly wonderful experiences going this route. This is also often the path yielding the most satisfied mothers in the US as well...

Well, I have to say, the stories here are not overly reassuring. I'm holding out hope though that my experience will be a good one. So far, my private OB/GYN seems very good and the times I have had to go to the hospital (for a morphological ultrasound and a fetal ecocardiogram), I have been treated with respect by both the nurses and the doctors. Keeping my fingers crossed that this is a good sign.

MB,
I hope you have a wonderful experience. It sounds like you're off to a good start! I'd suggest a good pregnancy/birth book to round out your information (The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger or The Thinking Woman's Guide to a Better Birth by Henci Goer are both excellent).
-Kanga

hi Kanga
I had a birth here in hospital which was not what I wanted having had 2 homebirths in the UK.
Also being a qualified UK midwife and later a health visitor which you may or not know what a health visitor/specialist public health nurse is. I worked with many families in the UK I was absolutely appalled at the'care' here.
The reason I give you my background is because I do have professional experience too in this field.

Practices that are not research based and frankly contradict well documented reseach, such as what I have gathered for example routine episiotomy for primips, I was given an enema- can you believe it , apractice that was stopped in the UK about 20 years or more ago.
I could continue and recite practices I would not expect to happen in third world countries but seem common place here.
Policy on pain relief also varies from place to place. Don't assume it is your choice- there may be no choice.

My experience was incredibly disempowering. I would really love to see some changes.

Thank you Farfalle for summing it up on the part about our choice. What we have the right to have (even under Italian law)has nothing to do with what we will get.
I had done a lot of reading in books (american and italian) and in italian magazines on child birth, etc. I knew what the laws were, but I knew how things really went.
I insisted that my husband be allowed in with me, and my OB tried to fight for me with it. However he was continuously kicked out by the one doctor that I had had the other problems with. When the time came to start pushing, the 'doctor' came in and said that I should sstart pushing... I told her that I was not doing anything until my husband was there. She looked around and acted like, 'well, why is he not here' and got frustrated. She then went out to let him in the room.

That is the frustrating thing about the system here. It seems that if you have an "in" (or are lucky) then you get treated with respect that every woman deserves. I would love to see some changes too. I would love to host speakers such as Andrea Robertson to come speak about best practices and woman centered care. I would love to apply the guidelines put forth by the coalition for Improving Maternity Services http://www.motherfriendly.org/ to hospitals in Italy.

A huge job, I know. But I'm just one person and in my mind, I thought by starting with education, by telling women about what they SHOULD expect, at least informing them of best practices, than more and more women would start to demand better treatment. It seems that the vast majority of people just accept the standard of care and work on dealing with it instead of changing it (another inherently Italian trait)

farfalle,
did you try to arrange for a homebirth here? I homebirthed my last child in the US and can't imagine doing otherwise if I got pregnant again.

I also want to say that I'm not against epidurals. I am just as outraged when women are bullied into not getting the pain relief that they feel they need. With my first birth (in a hospital) it was comforting to me going in, knowing that I could get pain relief if I needed it. It took away some of the fear I felt going into uncharted waters. I didn't want it pushed on me (the standard procedure at the hospital I was at) and my midwife knew that. She shielded me from the hospital staff and made sure that no mention of drugs entered my labor environment. She supported me with massage, counter pressure, changing positions, walking... and she observed me to see how I was handling the contractions.

Anyway...

This thread has been great for getting me brainstorming. I would be interested in forming an online support group on this topic (I guess that's where this is heading)... and pulling in the Italians I know also interested in this. Hopefully my Italian will get better so I can move this into the local dialog eventually.

quote:

Originally posted by di&andrea:
Thank you Farfalle for summing it up on the part about our choice. What we have the right to have (even under Italian law)has nothing to do with what we will get.
I had done a lot of reading in books (american and italian) and in italian magazines on child birth, etc. I knew what the laws were, but I knew how things really went.
I insisted that my husband be allowed in with me, and my OB tried to fight for me with it. However he was continuously kicked out by the one doctor that I had had the other problems with. When the time came to start pushing, the 'doctor' came in and said that I should sstart pushing... I told her that I was not doing anything until my husband was there. She looked around and acted like, 'well, why is he not here' and got frustrated. She then went out to let him in the room.

Your husband's not allowed in there with you?

Kanga, it sounds like we need an online support group after what I've been reading. I have to admit, it's gotten me a bit nervous.

http://www.motherfriendly.org/resources/10Q/

This is a good place to start. It's 10 questions to ask and comes with explanations about why the question is important. Sometimes it's scary to learn the truth, but I think it's better than being in the dark and being surprised or feel powerless on your labor day.

MB and Ramona, I gather that you are currently pregnant. I wouldn't let the discussion on the board make you scared. I would think about it as an opportunity to get a leg up on the system and be proactive about your care during the following months. I know this is against the grain as most people just accept their doctors as preaching the gospel truth (and many physician expect this kind of reverence), but I would do it anyway if I were in your shoes.

I think there are care providers in Italy who do want the very best for women and I think you can find them. And by asking these questions, perhaps you will be encouraging them to also fight a few battles for you.

I'm all for online support... we could start the thread here, or in the Health thread. Any suggestions? My limitation is that I have not been through the system and have very little concrete advice about how to work it. I know about best practices and how women should be treated during pregnancy and labor... Perhaps I'll call on my english speaking Italian friends in Rome (one is a LLL leader) to chime in here.

words of encouragement...

Just wanted to let you all know that I just had a conversation over lunch with someone who's wife gave birth here in Italy. They had a great experience, complete with a midwife who stayed with them during the ENTIRE labor and birth of their child. He participated fully and was allowed to cut the cord. He stayed with the child after the birth and they were allowed to room in with their son during the hospital stay. This was at a hospital with 5 women per room, but they chose to go there anyway because of the good treatment from the staff.

It is not too much to be treated with respect. THAT should be the standard of care and anything else shouldn't be tolerated and should be reported.

I saw that CIMS had a conference recently about how to get hospitals to become mother friendly... I'm planning to contact them to see if they can give some advice to us.

Also, I might get a friend to translate the http://www.motherfriendly.org/resources/10Q/ 10 questions into Italian and see if they will post it on their web site (they have a Spanish and a Czech version)

Kanga,
I commend what you are doing and more people like you are needed here in Italy. But if I were you, I'd get a really good overview of what the situation is really like in the specific area where you'd like to offer courses. Again, the consultori are great resources. I suggest all pregnant women find their local consultorio familiare and take advantage of the services offered there. I didn't find mine until after my baby was born, unfortunately. I am now taking a neonatal massage class there with my baby, and it is very helpful and absolutely free.

I would just make sure that the information you'd be giving women here is relevant to the real situation. I've noticed that Italian women tend to have NO expectations at all and don't seem to be shocked by things, such as being robbed in the hospital and left abandoned in corridors. The hospitals are so underfunded and understaffed in some cases that it's just not realistic to expect the kind of treatment one would get in a private U.S. hospital. U.S. maternity wards have become almost like wellness centers (a friend just told me of the free champagne breakfast buffet where she gave birth!) and women have very high expectations for the care they will get. My best friend just gave birth in the U.S. and said her hospital had eight delivery 'suites' and only three were being used while she was there. She never saw another mother or heard another baby cry the whole time she was there.

The hospital where I gave birth here in Milan has three delivery rooms and delivers on average six babies a day, so you can all do the math...I stopped reading the U.S. pregnancy books about midway through my pregnancy. They just had very little relevance to the experience I was having here. They all spoke of things, such as a birthing plans, etc. But the reality here is that the hospital would have laughed at me had I shown up with a plan of my expectations for care. I was lucky just to be admitted and allowed to labor in a back room. Here the mentality is 'It's free. Beggars can't be choosers.' Of course that isn't to say women shouldn't fight for a better system. But I see very little motivation (and shockingly very little indignation) on the part of Italian women.
Michelle