I was chatting with the women in my childbirth class last night and all but 2 of them left work early (ie at 4-5 months) because they had a "gravidanza a rischio". They told me that if you get your doctor to give you such a note all prepartum testing if free! (I've had to pay hundreds of euros under the public system for my tests).
I remember a few months ago when I was diagnosed with a blood clotting disorder and started having to shoot up anti-coagulant drugs every day my medico di base asked if my gynaecologist had said I had a "gravidanza a rischio". I said "no" as he hadn't and I felt completely fine! Also I had no desire to leave work early as that really would have inconvenienced my coworkers and made things really complicated. Obviously, if my gynaecologist had prescribed complete bedrest that would have been a different story.
Anyway, I remember mschoen had a similar experience with her prenatal class. Are these women able to leave their jobs early because they supposedly have a "gravianza a rischio"? (even though none of them seem to have had any problems getting to class, going shopping or going on overseas holidays etc.) What exactly does "gravidanza a rischio" mean under the Italian system? Can anyone just get it or are you meant to be on strict bed-rest? And can you keep working but get the free tests if you're classified as a "gravidanza a rischio"? The women in my childbirth class acted like I was crazy not to ask my doctor to classify me as a "gravidanza a rischio". I guess I'm just a naive foreigner.. I thought that you'd only be a 'gravidanza a rischio' if you needed to be on strict bed rest and there was a risk to your pregnancy.
I'm at 38 weeks now anyway so it's all too late for me - but it might have been nice to do all those millions of blood/urine/other tests for free rather than shelling out 60-100 euro or so each time! Maybe next pregnancy...
Sounds like another way to take advantage of the sytem! An Italian friend of mine was able to take off a full year each for her two pregnancies, with pay (she went back to work when the amount fell below her standard of living). She got a doctor's certificate both times, saying she had to stop work. She seemed fine to me...
Posts: 935 | Location (City & State): From Lille to Torino | Registered: 12 January 2008
Well in the UK - where everything is free related to your pregnancy anyway, so I didn't have to pay for the anti-coagulant drugs - you would definitely have fallen into the "at risk" category! I'm amazed and awed that you didn't feel this way! Brava!
The blood and urine tests are free if you are italian here if you go to the Asl or any hospital where they do blood drawing don't you have the italian sanitary card thing? The only thing you should have to pay for is if you go to private clinics or maybe an amnio if you are younger than 34 or ultrasound if you go to a private studio otherwise all exams and blood urine tests are free to italians or foreigners who have their libretto. Gravidanza al rischio can be for many things,if you have a job where you have certain situations that could compramise your pregnancy, like a teacher at day care that would have to pick up kids or in a factory where they use certain chemicals or even if you have some kind of physical problem(even if it is minor)and you have to stand up all day.It doesn't just mean you have to lay in bed all day. It depends on your work environment and most important that you can't blame your work environment for any problem that you may have in pregnancy.
Originally posted by AmyAmy: The blood and urine tests are free if you are italian here if you go to the Asl or any hospital where they do blood drawing don't you have the italian sanitary card thing? The only thing you should have to pay for is if you go to private clinics or maybe an amnio if you are younger than 34 or ultrasound if you go to a private studio otherwise all exams and blood urine tests are free to italians or foreigners who have their libretto.
Not in Lazio. This must be a regional thing. I've done all of my blood/urine/other prenatal tests at ASL or at a public hospital and have paid a ticket of between 20 and 70 euro each time. And yes, I have my Italian tessera sanitaria. I also pay 92 euro each time to see my doctor at the public hospital (Fatebenefratelli). Rather outraegeous considering the amount of tax we pay!
I did all of my blood tests in public hospitals or with ASL (and I have the tessera sanitaria) and I averaged about 100 Euros every time I went. I'd have my doctor's impegnativa and often they'd spread them out over three 'tickets.' You know how the maximum ticket price is something like 36 Euros? I'd have everything on one impegnativa but often for some reason, they'd spread all the tests out over three tickets so I'd pay 108 Euros. I found very little 'free' in my pregnancy, quite frankly. The only private things I did were gynecologist visits. All testing was done with the state, and I paid several thousand Euros out of pocket. I'm tallying up everything now to give to my accountant so I can at least write it off on my taxes. When I have an exact total, I'll post it!
As for gravidanza a rischio, I think what happens is that many women pressure their doctors to get the note. I remember one woman in my prenatal class saying how she had to really bug her doctor to get the note as she had a long commute to work and wanted to stop working. In month three or four. She seemed to think this was absolutely justifiable, and finally did get the note. A friend of mine who is pregnant just stopped working in month six - also because she has a long commute to work. She is not someone whom I'd typically think of as wanting to rip off the state but she also seemed to think that a long commute was a justifiable reason to stop working. Another woman I know is a commessa in a women's clothing shop. She was classified as 'gravidanza a rischio' because the stockroom where she worked was down a long flight of stairs and as her job required her to go up an down stairs, she got a doctor's note and stopped working in month four. When she told me this, she also seemed to think this was normal and nothing to be ashamed of.
When I tell people that I didn't have any paid maternity leave, I sometimes mention that part of the reason nobody will hire me 'at my age' is because of all of the women who go on long maternity leaves with no good reason. I am almost always met with blank stares. As if they never made that connection before. Michelle
I also pay 92 euro each time to see my doctor at the public hospital (Fatebenefratelli). Rather outraegeous considering the amount of tax we pay!
Yes, my doctor was a state doctor seen privately for 101 Euros a visit at a state hospital. So I had to go through all of the crap bureaucracy of getting in and out of the hospital (it took about an hour just to get through accettazione each time) and line up outside a door in an overcrowded hallway, etc. All because I wanted to see the same person each time and not be visited by strangers during my pregnancy. Michelle
I thought that you'd only be a 'gravidanza a rischio' if you needed to be on strict bed rest and there was a risk to your pregnancy.
I know someone who got the note and then went on holiday to the Caribbean during her time off work.
I know another woman who left work right at the beginning - she was fine but had had problems with a previous pregnancy. I think I'd get bored for that amount of time at home.
I thought that you'd only be a 'gravidanza a rischio' if you needed to be on strict bed rest and there was a risk to your pregnancy.
I know someone who got the note and then went on holiday to the Caribbean during her time off work.
I know another woman who left work right at the beginning - she was fine but had had problems with a previous pregnancy. I think I'd get bored for that amount of time at home.
Once the "cow" hormones kick in, Delina, it's amazing how easy it is to just sit around, chewing the cud!!
I'm getting a bit bored at home and I've only been home for 2.5 weeks (since week 36 which is when I had to go on mat leave). Caribbean holiday sounds pretty good though - or maybe I could have visited my family in Australia!
On the other hand, can you imagine the disruption I'd cause to my workplace if in addition to the 11 months I'm entitled to now I had also taken, say 6 months off while pregnant? What would this say to my employers about how seriously I take my career (of course this would be completely different if I was on strict bed rest rather than sending them postcards from the Caribbean!)
When I had my second child ( my first was born in 1998 before the decreto) I paid nothing. The only thing was if I saw my doctor privately but for normal check ups, but I just learned when he was scheduled at the hospital and set my appointments around his schedule. Easy peasy.
Sounds to me like people in the big cities where there are massive public hospitals get lost in the shuffle while things seem to work better in smaller communities. I notice that decreto had things listed by week. I never had any kind of libretto della gravidanza (I know some regions have them - Lombardia, obviously doesn't) where I would have known what tests were meant to be done (for free) in certain weeks. So if glucose testing, for example, was free from week 24 to week 27, it seemed I got it done in week 28. It wasn't necessarily my doctor's fault. I only saw her every six weeks to every two months and then I had to wait around for my primary care physician to get around to getting the impegnativa done, which takes anywhere from one to five days. If I had had a checklist of what was meant to be done in what week, I could have better coordinated. But I only found out about the decreto late in my pregnancy when I asked why certain tests weren't 'esente' and was told that it was the wrong week. Like an idiot, I had just 'listened to my doctor' thinking she would be prescribing the right tests in the right order. I should have known better. And just from glancing at the decreto, I did many more tests than what were listed on there. Michelle
It seems strange that it woud be free in Tuscany and not in Lazio,I had to bring my positive pregnacy test to the Asl to then get my book where you tear out the pages for each exam that is listed by week, I looked at both of my books for the last two kids and the book says regione toscana,it seems like it would be a national thing. I had my first child in 1991 and there was no book but I didn't have to pay then eiter, they gave me a paper that said I was pregnant and exempt from paying.
Originally posted by AmyAmy: I looked at both of my books for the last two kids and the book says regione toscana,it seems like it would be a national thing.
Seems like it should be but it's not. We've talked about this before on the forum. Healthcare here is actually regional not statewide. People in Tuscany and Umbria seem to have fewer complaints as opposed to those of us in Lazio or Lombardia where there are very large cities. Just looking through my receipts, the only truly free things were the ecografie, though one of them I paid out of pocket privately because there was no place with the state system. Otherwise I paid for every single other test I did during pregnancy. I did not, however, pay anything for the hospital stay, thank God. Michelle
can you imagine the disruption I'd cause to my workplace if in addition to the 11 months I'm entitled to
I don't get the maternity entitlement here. One friend went back the day after her daughter's first birthday. Whilst someone else I know had to go back after 3 months, but then she said something about having 6 months to use up before her daughter's 3rd birthday (or do I remember that wrong?), in which case 3+6months plus holidays would take you up to a year I suppose.
DElina, From my understanding, it depends what type of contract you are on. Those lucky enough to have the permanent ones have big entitlements. Those on the short term/ temorary contracts get nothing (i believe).
The ONLY women I know who has worked through their pregnancies here are those on the short term contracts. When I was pregnant i worked up to 35 weeks (problem free), only left then to go overseas to have my baby on the last possible day travel was allowed. My boss (was working on a 'year' (= 8 month) contract at an english school) was v annoyed that it was a week before the end of the school year and asked me to delay - how was she to find a temporary teacher to cover 1 week .
NO mention was made of the fact you are supposed to stop after 7 mnths or whatever unless you have special permission. My baby was born 1 July and by september she was asking me when/ if i was coming back to work!!
My SIL is also on a short term contract and worked up to 36 weeks before the birth of her 3rd child. She was back at work 3 months later. She got NO maternity pay whatsoever. Neither did I, but my husband - good job/ contract - was entitled to 3 months of 'lattamente' (ha ha) in lieu of this.
As Mschoen mentions, most pregnant women seem to think this long/ early pregnancy leave is their right and don't link it to difficulties in childbearing age women finding employment. However, if they don't get paid anything, obviously that is another story.
Going a bit off track here (there is a point coming!!), but a few months ago i competed in some sports events. For years and years I have run marathons, done triathlons and many long distance endurance events outside of Italy. But in Italy, to do a HALF marathon, you need to 'pass' a sports medical. Only certain doctors were able to do these and the results are kept in their office (ie you don't even get a copy). When i asked why this was, the reply was that the state sometimes checked up on teh doctors to make sure the results were correct. There were serious consequences if anything was amiss.
All I was thinking at the time was why don't they do this for all the pregnant women who get off work so early in their pregnancy? I am sure in other countries doctors who falsified conditions etc would be struck off the medical register. If the doctors could only certify those who had serious/ obvious risks or otherwise ran the risk themselves of disqualification i am sure it would have a dramatic effect on these long pregnancy (not maternity!) leave periods.
Originally posted by AmyAmy: It seems strange that it woud be free in Tuscany and not in Lazio,I had to bring my positive pregnacy test to the Asl to then get my book where you tear out the pages for each exam that is listed by week, I looked at both of my books for the last two kids and the book says regione toscana,it seems like it would be a national thing. I had my first child in 1991 and there was no book but I didn't have to pay then eiter, they gave me a paper that said I was pregnant and exempt from paying.
Wow - lucky you. Here in Lazio I've never heard of a 'libretto' of this sort and like mschoen I paid a "ticket' for every single test (all of which I did at ASL or a public hospital) apart from ecografie.
No one ever mentioned to me that they would be free if I did them in a certain week! That Decreto is pretty surprising since I actually went to the main ASL office of central Rome to do most of my blood and urine tests and paid a ticket each time. Maybe Lazio somehow got an exception? Also, if it's only during certain weeks - neither of my gynaecologists nor my medico di base have said anything about having to do certain tests in certain weeks in order to get them for free... I just did them when my gynaecologist prescribed them and I assumed that everyone had to pay the ticket. I'm beginning to think that Rome is the worst place to give birth. Maybe if there's a next time I'll try to go to Holland and give birth there. Here you pay through the nose, everone is rude to you, there are long queues and inefficiency everywhere. The only warmth I've got has been when I've gone private ie. my midwife who I'm paying for privately. Oh and there's that 50-60% c-section rate and the fact that at many public hospitals they make you give birth in the lithotomy position.
Delina - I think your friend might have had to go back to work at 3 months as the usual scheme here is 5 months maternity leave total: 2 months off before the birth (unless you get special permission to work until one month before the birth like I did) and then 3 months after. All of this is at 80% pay and it's compulsory to take it. Then you get another 6 months at 30% pay which you can use at any time until the baby is 3 years old. This is if you have a permanent contract (like me! ). I don't know what happens if you have a fixed time work contract.
professoressavanessa - I love your idea of having the government do strict checks of doctors who write notes saying that these women have a "gravidanza a rischio" when they so obviously do not. It would never fly though - I seriously think a lot of Italian women think of pregnancy as a sickness.
I am sorry to hear things suck so bad in other places! I don't know anything about Rome,Ramona but I used to watch a program on Foxlife where they filmed one of the maternity wards in rome, I can't remember the name of the hospital or of the show(duh)but maybe someone here has seen it, its been on for at least 4 or 5 years. The hospital and doctors there seemed like they were really up to date. I seem to remember it is a pretty big hospital and looks like it may be downtown. I really liked the 2 gyns that were in charge, anyone know what I am talking about?
Oh yes - I know that show. I've seen it a couple of times too. It's filmed at San Camillo which is coincidentally where I plan to give birth. I did a lot of research and this hospital seems to be the most "up do date" of all the public hospitals in Rome (apart from the 45% c-section rate of course ).
I thought it was really interesting that in ROme they do not have the libretto di gravidanza so I did a search on Google. Yep, no libretto but from some of the links, they tell you to get a list of the required tests that are free if done on time and have the doc fill out the richieste in advance. But how are we supposed to knopw that? Really screwy system in Rome.
I never got anyone to try to do a csection on me, my third baby was a c section but that after 18 hours of induced and is a very long story but they did everything they could to avoid a c section even though I was also only at 33 weeks so I wouldn't worry too much, you are quite a burden to them if you have a c section, you must stay longer, you require certain things that natural birthers don't and the csection women are full of problems that you just don't have in natural childbirth. San Camillo, that's it, I hope you get the gyn that is a Roma fan, he seems really good!
Expats in Italy Forum 
I thought that you'd only be a 'gravidanza a rischio' if you needed to be on strict bed rest and there was a risk to your pregnancy.
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I'm beginning to think that Rome is the worst place to give birth. Maybe if there's a next time I'll try to go to Holland and give birth there. Here you pay through the nose, everone is rude to you, there are long queues and inefficiency everywhere. The only warmth I've got has been when I've gone private ie. my midwife who I'm paying for privately. Oh and there's that 50-60% c-section rate and the fact that at many public hospitals they make you give birth in the lithotomy position. 
). I don't know what happens if you have a fixed time work contract.