Italy

Maternity Care System

Author: Elena Skoko, HRiC Political Activism Coordinator in Italy

How do most people give birth in Italy?

The latest research has described the maternity care in Italy as excessively medicalized and directive, disregarding national and international guidelines and showing strong territorial and social disparities. In their prenatal care, 82% of women are assisted by a gynecologist, 3% by a midwife and 15% by “family counseling centers” (consultori familiari). Only 30% (North) and 22% (South) of women search for public assistance during pregnancy while the rest ask for private health services1. The general perception of Italian women is that the public service is less good then private. While this may be quite true when we consider comfort, waiting time, latest technological equipment and politeness, the outcomes of private pregnancy healthcare by gynecologists and childbirth in private hospitals show much poorer results in exchange of much higher expenses. National Healthcare Service offers free pregnancy care and childbirth assistance to all citizens, including illegal immigrants2,3

Typically, women will go to a gynecologist as soon as they discover the results of a pregnancy test. The assistance of a gynecologist is limited to the vaginal and ultrasound exam. Italian women will on avarage have 7 ultrasound exams during pregnancy, while the National Health Service offers 3 free of charge, and the new Guidelines on Physiological Pregnancy suggest2 exams4.  Visits at the gynecologist are usually short in time and information received. Some hospitals offer prenatal courses that last a few sessions were the hospital staff provide information about the things a mom should bring into the hospital, the services hospital will provide, such as the availability of rooming in, epidural anesthesia, single rooms, the possibility of having a partner or a person of choice (only one is allowed). The company of a mother’s assistant that is not a partner is not welcome in most of the institutions and the doula profession is still unregulated in Italy. Usually the hospital personnel insist on the importance of breastfeeding, yet the postpartum assistance to mothers and babies strongly depends on shifts, stress, time-tables and holidays. Mothers on many online dedicated forums and blogs complain of the inadequate and inconsistent help with breastfeeding, both by midwives and pediatricians. All women at the hospital prenatal courses receive detailed information about cord blood donation for humanitarian purposes (from the 19 national cord blood banks for allogeneic or heterologous use) or about storage for personal use (from the foreign cord blood banks, autologous use). No information is provided about the benefits of delayed cord clamping. Some hospitals do practice delayed cord clamping and cutting, but this decision is up to the head physician, a doctor or to the midwife on duty.

The most structured and detailed public prenatal care is offered by consultori familiari without charge. Mothers who participated in these prenatal courses have much better outcomes at birth5. The most dedicated care is offered by private professional midwives where visits are long and detailed, but they come with a cost and do not include medical services such as ultrasound and other medical exams. Even though mothers will receive most of the information about childbirth by family and friends (more then 40%), none of the indigenous or traditional knowledge survived, with the exception of some random and often contradictory advice about diet or favorable and unfavorable gestures, thoughts or actions. There is no visible trace of traditional indigenous midwifery in Italy. However, the knowledge of traditional midwifery and its spirit has been reclaimed by a branch of the Italian feminist self-help movement in the 1970’s6 where today’s prominent senior professional midwives come from. They had a mentor, Italian general medical practitioner and head physician, Lorenzo Braibanti, friend and follower of Frédérick Leboyer and author of the influential book “Nascere meglio”7,8. Midwives in Italy who wish to gain knowledge about international traditional art of midwifery and home birth can specialize after graduation at the recognized Scuola Elementale di Arte Ostetrica, founded by Verena Schmid.

What will be the assistance she will receive at the hospital is clear to a pregnant woman only when she enters to give birth, or better, when everything is over. The maternity wards are mysterious places surrounded by a veil of silence. Mothers coming out of the hospital, and for quite some time, are not able to describe their experience. In a recent survey conducted on 5,189 women in the years 2008-2011, about 50% of women declared that they received excellent assistance during childbirth, while very few (around 3%) expressed poor satisfaction9. However, the study shows that 3 months after birth 32.9% of women find themselves unsatisfied with the overall experience10. Some women feel cheated by the unfulfilled promises they received before entering the hospital compared with the treatment they received. These complaints might regard services that they may have paid extra for and they didn’t receive, such as rooming in, privacy, epidural, or immediate contact with the baby, breastfeeding support, spontaneous birth trial and more.  Study shows that 16,9% of women gave birth with epidural anaesthesia11, unfulfilling the request for anaesthesia that women expressed in 25.6% (national average), while in some hospitals 78% of women requested the epidural and not all of them received it12. The interesting data is that women who, 24 hours from the event, defined childbirth pain as “terrible/awful” were mostly the ones who gave birth by C-section (21.4%), followed by epidural (14.8%), while only 9.1% of women who had vaginal birth without anesthesia (no other interventions are mentioned) described it as awful. Similar results are shown regarding overall satisfaction and breastfeeding.

Most of the hospitals practice Active Management of Birth. Artificial rupture of the membranes (AROM) is frequent though not statistically monitored, and it is the same with the Kristeller maneuver. The rates of the augmentation of labor is officially 19.4% (for Italian women) and the rate of episiotomy is 43.6%13. Many midwives who work or worked at the hospitals state that these figures are underestimated. Women in Italy do not normally participate in the decision making about the episiotomy performed on them.  This is a skill all midwives have to master at the end of a 6 months internship prior to graduation, with a minimum number (at least 5) of episiotomies performed14. The numbers of obligatory surgical procedures that must be performed on birthing women during apprenticeship are higher for future gynecologists-obstetricians. Women generally are allowed to walk during the first stage of labor, but they are confined to the bed in the second stage where the lithotomy position is suggested or imposed. No other birthing position is allowed except in a few hospitals. Women are generally not allowed to eat or drink. Immediate cord clamping and cutting is the norm. Cord blood donation is promoted by state laws15,16,17. All women receive synthetic oxytocin for the prevention of the hemorrhage and cord traction as a routine, though data about this practice are not available. In the UNICEF “Baby Friendly” certified hospitals rooming in is usual, though not guaranteed18. Too many women complain their baby was taken away from them without or with poor explanations, in “baby friendly” as well as regular hospitals. Water birth is possible in several hospitals but severe conditions are imposed: the results of the mother’s exams must be impeccable19. The VBAC rate is 10.3% and breech births are delivered by C-section in 93.1%20 and similar cesarean results are present for twin deliveries.

In Italy almost all of births take place in public or private hospitals21. There were 534,186 births in the year 201222. 95.20% were attended by midwives23. The midwives are part of a medical team where the head obstetrician has a decisive role, however both the obstetrician and the midwife share the liability for the attended births. For home births data are few and often inconsistent. One source states there are 0.1% of births (about 500 per year) that take place in “other” settings[zotpressInText item=”{FENM9ZHQ}” format=”(%a%)“]. With great probability these other settings are to be considered as home births. However, the same source states that home birth is only about 0.04%. The associations of autonomous professional midwives argue that this figure is underestimated and that more then 1.500 children in Italy are born at home24. Proper statistics about home birth in Italy still need to be conducted. However, there are interesting studies on regional level that include some national data as well25. Public data about outcomes in 5 of the official birth centers are non-existent at this time26.

Vaginal birth without complications is the first on the list of the diagnosis-related groups (DRG) in the Italian hospitals, while births with cesarean section are at third place (data related to the year 2008)27. In other words, childbirth is the most frequent event happening in hospitals while cesarean sections are just two steps behind, with 38% of total births in the country, around 203,630 women in the year 201028. There is a great regional discrepancy concerning cesarean births: in Tuscany, for example, the rate is 23.2% while in Campania it rises to 59.3% in the year 2010[zotpressInText item=”{FENM9ZHQ}” format=”(%a%)“]. Overall, the cesarean rates, as well as other medical interventions at birth, mortality and morbidity of mothers and babies, are higher in the Center and South of Italy29. Several investigations have been conducted by the Italian Senate and Parliament on the topic of high cesarean rates in the country. The most incisive was the “Inchiesta Balduzzi” in 2013, where the Minister of Health and NAS (special military division monitoring health issues) declared that at least 43% of medical records regarding cesarean sections in Italy were false and serious criminal offences might have been committed in childbirth assistance in national hospitals (from personal injury to fraud on the National Health Care System (SSN) and falsification of a public document). The damage to the SSN may amount to 80-85 millions of Euros30. At the press conference, the former Minister of Health Mr. Balduzzi declared: “In front of the data that raise reasonable doubts on the legitimacy of certain behaviors, there is the duty to pursue the legal path.” The legal path has not been paved yet.

Even though the maternity mortality rates (4 per 100.000 live births in 201031) are low, putting Italy nearly on top of the list of countries with the best outcomes, according to the recent studies these data are underestimated for at least 63%, and “maternal near miss cases” (where consequences of birth did not end in death because of the efficient emergency assistance) are not being considered in the statistics32. The National Institute of Health (ISS) established the Italian Obstetric Surveillance System (ITOSS) where the results showed rates of maternal mortality being 11.8 per 100,000 live births.

When did birth move into the hospital?

In Italy birth moved massively into the hospital from the 1950’s on. However, many women who give birth today can recall their grandmothers giving birth at home assisted by a professional midwife or alone. We can say that in big cities in the 1930-40s, among both higher and lower social statuses, hospital birth was becoming quite frequent, while middle classes and rural areas still preferred homebirth. In the cities, women with higher social status preferred giving birth into the hospitals because it was modern, fashionable, it inspired trust and they were strongly influenced by social relations. Poor women would choose birth clinics because it was free of charge, more peaceful and reasonable than staying at home. Despite the memory of the puerperal fever33, due to hygienic practices and conditions inside the hospital was not that far behind, the overall idea of birth in the hospital being safer than any other option became more and more accepted and predominant. In the late 1970’s the independent profession of midwives was considered obsolete and it was transformed into an auxiliary profession34,35. Midwives were transferred to the hospitals as obstetricians’ assistants or to “family counseling centers” (consultori familiari), while home birth went underground. Today mothers and citizens in Italy reclaim their rights to freedom of choices in childbirth mostly through volunteer associations and social media. Homebirth is legal and it is becoming a visible option. Planned unassisted birth is also on the rise in certain areas.

What is the legal and economic status of midwives?

Autonomous independent midwives (ostetrica condotta), introduced as national healthcare profession in 1888, were abolished in 1978 with the institution of the Italian National Healthcare System (Law n. 833), only to be properly reestablished in 1999 with the Law 42/199936. The latest dispositions regarding the profession of midwives are stated in the Decreto Legislativo del 9 novembre 2007, n. 206, the ratification of the European Directive 2005/36/CE. Even though the latest legislation in many ways follows the European Directive, in other ways it limits the autonomy of midwives by stating that any assistance in pregnancy and birth by a professional midwife has to be approved by a medical professional attesting that the woman has a “normal” pregnancy. It as a fall back compared to the previous legislations. This issue has been addressed by HRiC in Italy and other Italian associations of independent midwives in the recent petition to the European Parliament.

The profession of midwifery has a complex history that reflects today’s state of the art. If it is true that a midwife is present at almost all births in Italy, it is also true that they follow only 3% of all pregnancies. More then 80% of pregnancies are followed by gynecologists37. Many women on their way to the hospital still don’t know that they will be assisted by midwives, and more than a few of them don’t even know the profession still exists. Generally, women giving birth in Italy are misinformed of their options and they are unprepared.

The economic status of midwives is an issue. One out of five newly graduated midwives will have a small chance to find a job in hospitals, few of them will be lucky to find a senior independent midwife to begin an apprenticeship with (non-official and not recognized professionally), others will have to emigrate abroad in order to find a job. Some will follow a political career inside of the Regional and National Registers of Midwives where non-practicing nurse-midwife qualifications are predominant. Some will dedicate their lives to research in midwifery and obstetrics. The independent midwives have the most perilous destiny as they face professional and economic uncertainty, though probably greater personal gratification that might compensate their passionate dedication.

Are there Out of Hospital (OOH) midwives and what is their status?

Home birth is a legal option and there are autonomous professional midwives who can assist women out of the hospital38. In some Regions homebirth is partially or totally reimbursed (Piemonte, Emilia Romagna, Marche, Provincia di Trento, Lazio) and in some hospitals midwives will assist women at home by prior request (L’Ospedale Ostetrico Ginecologico “Sant’Anna” in Turin)39.

Note by the author: The present article is an attempt to make a summary of the maternity care in Italy, however it is not to be considered exhaustive, faultless or complete. The author put maximum effort to motivate every statement with a proper reference; nonetheless there might be unintended errors or mistakes. We would appreciate if the readers wanted to suggest any further data or source in order to make the text better and offer the most complete information. We also invite you to signal any inaccuracy to italy@humanrightsinchildbirth.org. Thank you for your collaboration.


Statistics

Author: Elena Skoko, HRiC Political Activism Coordinator in Italy

Demographics

  • Population: 61,680,122 in July 201440
  • Working population: 25.66 million in 201441
  • Economic growths:   -0.8 % in 201442
  • Inflation rate: 0.467 % in May 201443

Birth Statistics

  • Live Births: 534,186 in 2012. 44
  • Maternal Outcomes
  • Newborn Outcomes
    • Perinatal Mortality Rate (22 weeks of gestation ending at 7 days after birth) : 3 per 1,000 live births in 201047
    • Neonatal Mortality Rate (first 28 days following the birth): 3 per 1,000 live births in 201048
    • Infant Mortality Rate
      •  3.31 deaths per 1,000 live births49
    • Fetal Mortality Rates & Stillbirths
      • Overall 4.7 per 1,000 live births50
      • ≥  28 weeks: 2.4 deaths per 1,000 live births51
    • Percentage of live births with a gestational age
      • < 32 weeks: 1.0% in 201052
      • 32-26 weeks: 6.4% in 201053
    • Percentage of very preterm babies born in the most specialized units as defined by national classifications of levels of care in 2010
      • Number of births 22-31 weeks GA (N): 583354
      • % born in Highest level: 83.1%55
    • Professionals providing care during pregnancy for Italian women(2008-2011)
      • Family Physician: 0.5%56
      • “Family Counseling Centers” (Consultorio familiare): 11.0%57
      • Midwife in the public hospital (not in the “Family Counseling Centers”): 1.1%58
      • Private midwife: 1.6%59
      • Private Gynecologist- Obstetrician: 44.7%60
      • Gynecologist- Obstetrician in public hospital paying private fee: 33.8%61
      • Gynecologist Obstetrician within the public hospital: 7.4%62
      • Births attended by 2014 skilled health personnel (%):  99.8% (institutional births)63
    • Distribution of births based on healthcare professionals present at birth (2010)
      • Gynecologist : 88.49 %64
      • Anesthesiologist: 44.95%65
      • Pediatrician and/or Neonatologist: 68.27 %66
      • Midwife: 95.20%67
  • Place of Birth
    • Public hospitals:
      • 91.5% in 2008-200968
      • 88.2 % in 201069
      • 92.8% in 2010-201170
    • Private Accredited hospitals:
      • 8.3% in 2008-971
      • 11.8% in 201072
      • 3.4% in 2010-1173
    • Private hospitals:
      • 0.1% in 2008-974
      • 0.4%75
      • 3.8% in 2010-201176
    • Home birth: 0.04% in 201077
    • Other: 0.02 % in 201078
    • Hospital Birth Info
      • Total hospitals: 531 in 201079
      • Public: 434 in 201080
      • Private accredited: 85 in 201081
      • Private non-accredited: 12 in 201082
      • Hospitals with NICU: 124 in 201083
    • Type of hospital by number of births per year:
      • 0-499 (135 hospitals): 7.10 % of total births84
      • 500-799 (131 hospitals): 15.58 % of total births85
      • 800-999 (57): 9.47 % of total births86
      • 1000-2499 (178): 48.24 % of total births87
      • 2500 +(30): 19.61 % of total births88
    • Birth Centers
    •  Homebirth
      • There are no official data for home births, however the estimation of the National Cultural Association of Midwives for Home Birth and Birth Centers (Associazione Nazionale Culturale Ostetriche Parto a Domicilio e Casa Maternità, http://www.nascereacasa.it) states that there are more than 1500 home births per year in Italy8990.
  • Mode of Birth
    • Normal Spontaneous Vaginal Delivery (NSVD) Rate: 62.3 % between 2008-201191
    • Total vaginal births: 64.5% between 2008-201192
    • Induced Labor Rate:
      • 19.4% (Italian); 12.8% (Foreign) in 2008-201193
      • 19.7% in 201094
      • 15.9% induction rate for 201095
    • Spontaneous Labor Rate:
      • 80.6% (Italian); 87.3% (Foreign) in 2008-201196
      • 80.3% in 201097
      • 67.0% in 201098
    • Episiotomy Rate: 43.6% between 2008-201199
    • Assisted Vaginal Delivery Rate (Forceps & Vacuum Delivery):
      • 2.2% in 2008-2011100
      • 3.4% in 2010101
    • Cesarean Delivery Rate
      • Chart coming soon
      • 35.5% between 2008-2010102
        • Urgent cesarean rate: 15.0%  between 2008-2010103
        • Elective cesarean rate: 20.5%  between 2008-2010104
      • 38% in 2009105
      • 17.1% of labors in 2010 were initiated with cesarean section (no attempt of labor)106
  • Vaginal Birth After Cesarean (VBAC) Rates/Bans
    • Public hospitals: 11.2 % in 2010107
    • Private accredited hospitals: 6.6 % in 2010108
    • Private non-accredited hospitals: 7.2 % in 2010109
    • Total VBAC: 10.3 % in 2010110
  • Breech Rates (in hospital)
    • Breech by spontaneous birth: 5.4% in 2010111
    • Breech by cesarean: 93.1% in 2010112
    • Breech by forceps: 0.1% in 2010113
    • Breech by suction: 0.1% in 2010114
    • Breech by other: 1.3% in 2010115

Legal Perspective on Maternity Care in Italy

Author: Alessandra Battisti, HRiC Legal Activism Coordinator in Italy & Regional Legal Activism Coordinator for Europe

Informed consent

The Italian Constitution recognizes  and guarantees the inviolable rights of the person  as an individual and in the social groups where human personality is expressed.

This supreme legal source statuesthat all citizens have equal social dignity and are equal before the law, without distinction of sex, race, language, religion, political opinion, personal and social conditions.  Personal liberty is inviolable and thehealthis  a fundamental right of the individual. No one may be obliged to undergo any given health treatment except under the provisions of the law that cannot, under any circumstances, violate the limits imposed by respect for the human person. In Italy there is not,  at the moment,  a specific law on informed consent but theright of the patient to informed consent is protected under the constitutional principles of liberty, equalityand human dignity. According to this fundamentalprinciples theItalian Supreme Court  has statedin many decisions that the patient has the right to self- determination in medical treatments.  Particularly the patient has the right to accept or to refuse the medical treatments after being fully informed on the diagnosis and all the possible therapeutic alternatives. Under the prescriptions of Code of Medical conduct the doctor has theethical duty to inform as much as possible the patientand should not realize any treatment without the previous consent of the patient.

Do women who give birth have the right to informed consent?

According to  the living legislation in Italy the women who give birth have the same right to informed consent as any other patient since the women have the same constitutional rights as any other individual.

The source where we can finddetailed  information about the right to informed consent in pregnancy and  childbirth is the National Health Institute official guidelines on cesarean section. The guide lines express strong recommendation to the care givers to respectwomen’s right to informed consent.

The guidelines are very accurate on the issue on the informed consent. The informed consent form  for cesarean section should record:

  1. the clinical indication for cesarean section
  2. the benefits and potential damages in the short and long term for the woman and the baby
  3. the way the intervention is realized
  4. the anesthesia techniques
  5. the consequences for future pregnancies and childbirth after a cesarean section

A woman that refuses a cesarean section has the right to a second opinion. Nevertheless the refusal of a cesarean section should be an option for a woman. Only in cases of extreme emergencies and when there is a real danger of death the cesarean section could be realized without the previous informed consent. Inany cases the care givers have the duty to recordevery single motivation that lead to a cesarean section decision.

Are there any specific legal sources on maternity protection in Italy?

Amongst the legal sources on maternity we can list the Ministerial Decree of 10 September 1988 that statues the right to exams freeof paymentduring pregnancy to fulfill an equal access to maternity care.

It is very important also the Agreement of 16th December 2010 called “Agreementamongst the Government and the Regions for the promotion of quality, safety and adequate care in maternity and for implementing strategies to reduce inappropriate cesarean sections.”

Are there any laws and regulation on Home Birth in Italy?

Home birth is a legal option in Italy, but it is not regulated in every Region. There is also a significant  discrepancy of options and access to reimburse  forwomen that differ  from Region to Region.

The following are the Regional Laws on home birth:

  • Region Emilia Romagna- Regional Law 8.1998. n26 regulating Hospital, Birth Centers and Home Birth
  • Region Piemonte: Resolution of 5.2002 n.80-5989 onways to access to a public reimburse for expenses related to home birth.
  • Region Marche:  Law n. 22/1998 on theRights of Birthing Women, newborn and babies in the Hospital
  • Region Lazio: President’s Resolution n. 29/2011 on Home Birth and Birth Centers.
  • Trento Province: Resolution n. 15077 of The Autonomous Province of Trento on Home Births

The Law of Region Marche is very interesting under a human right perspective since it affirms in the first article that the Regionpromotes the wellbeing of mother and baby during pregnancy, childbirth and postpartum and  promotestheaccess to information on maternity care assistance, ensures the freedom of choice about the place of giving birthand all related standards of safety. According to this law,  the Region is committed in reducing all the risk factorsthat influence rates of maternal and neonatal mortality and morbidity, the Region ensures the continuity of family relationship, of physical and psychological development of babies during the time they are in the Hospital. In the second articlethe sameregional law statesthatthe local public sanitary agenciesorganize seminarfor preparing women to childbirth and inform women on the possibility to give birth at home.

Italian Legal Sources

1.  Italian Constitution- (relevant article related to the right to informed consent to medical treatments, right to health and right to equality).

  • Article 2: “The Republic recognizes and guarantees the inviolable rights of the person, as an individual and in the social groups where human personality is expressed. The Republic expects that the fundamental duties of political, economic and social solidarity be fulfilled”
  • Article 3: “All citizens have equal social dignity and are equal before the law, without distinction of sex, race, language, religion, political opinion, personal and social conditions. It is the duty of the Republic to remove all the economic and social obstacles that, limiting freedom and equality, do not consent the full development of people as human beings and the effective participation of all workers to the political, social and economic organization of the Country.
  • Article 13: Personal liberty is inviolable. No form of detention, inspection or personal search nor any other restriction on personal freedom is admitted, except by a reasoned warrant issued by a judicial authority, and only in the cases and the manner provided for by law. In exceptional cases of necessity and urgency, strictly defined by the law, law-enforcement authorities may adopt temporary measures that must be communicated to the judicial authorities within forty-eight hours. Should such measures not be confirmed by the judicial authorities within the next forty-eight hours, they are revoked and become null and void. All acts of physical or moral violence against individuals subject in any way to limitations of freedom shall be punished. The law establishes the maximum period of preventive detention.
  • Article 32: The Republic safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent. No one may be obliged to undergo any given health treatment except under the provisions of the law. The law cannot under any circumstances violate the limits imposed by respect for the human person”

2.  Italian legislative Source on National Health Care System

  • Legge 833/1978 “ Istituzione del Servizio Sanitario Nazionale”- Law on Institution of National Health System

3. Italian Legislative Sources on Sanitary Professionals

  • Legge n. 42/1999, “ Disposizioni in materia di professioni sanitarie”, Law on sanitary professionals.
  • Legge n. 251/2000, “Disciplina delle professioni sanitarie infermieristiche, tecniche, della riabilitazione, della prevenzione nonché della professione ostetrica”, Law on the sanitary professionals, nurses and midwives.
  • Legge n. 43/2006, “Disposizioni in materia di professioni sanitarie infermieristiche,riabilitative, tecnico-sanitarie e della prevenzione e delega al Governo per l’istituzione dei relativi Ordini professionali” Law on the Sanitary professional. Nurses and Istitution of Professional Registers.
  • DM n. 739/1994, “ Regolamento concernente l’individuazione della figura e del relativo profilo professionale dell’infermiere” Regulations on the professional requirement of nurses.
  • Dlgs 206/2007, “Attuazione della direttiva 2005/36/CE relativa al riconoscimento delle qualifiche professionali, nonché della direttiva 2006/100/CE che adegua determinate direttive sulla libera circolazione delle persone a seguito dell’adesione di Bulgaria e Romania “, Law based on the Implemetation of European Directives Codice Deontologico Medico, Ethical and Deontologic Code of Medical Conduct
  • Codice Deontologico degli Infermieri, Ethical and Deontologic Code of Nurses Conduct.
  • Codice Deontologico delle Ostetriche del 2010, Ethical and Deontologic Code Midwife Conduct

4. Italian Sources on Maternity

  • Decreto Ministeriale – Ministero della Sanità – 10 settembre 1998 “Aggiornamento del decreto ministeriale 6 marzo 1995 concernente l’aggiornamento del decreto ministeriale 14 aprile 1984 recante i protocolli di accesso agli esami di laboratorio e di diagnostica strumentale per le donne in stato di gravidanza ed a tutela della maternità”- Ministerial Decree on exams free of payment during pregnancy
  • Legge n. 194/1978, “Norme per la tutela sociale della maternità e sull’interruzione volontaria della gravidanza” – Law on the social protection of maternity status and on the voluntary termination of pregnancy.
  • ACCORDO 16 dicembre 2010 , Accordo, ai sensi dell’articolo 9 del decreto legislativo 28 agosto 1997, n. 281, tra il Governo, le regioni e le province autonome di Trento e Bolzano, le province, i comuni e le comunità montane sul documento concernente «Linee di indirizzo per la promozione ed il miglioramento della qualità, della sicurezza dell’appropriatezza degli interventi assistenziali nel percorso nascita e per la riduzione del taglio cesareo». (Rep. atti n. 137/CU) (11A00319) (G.U. Serie Generale n. 13 del 18 gennaio 2011)- Agreement amongst the Government and the Regions for the promotion of quality in maternity care and for strategies to reduce inappropriate C- Sections.
  • Regional Law on Home Birth:
    • Regione Emilia Romagna, Legge Regionale 11.8.1998 n. 26- Norme per il parto nelle strutture ospedaliere, nelle case di Maternità e a domicilio.
    • Region Emilia Romagna- Regional Law regulating Hospital and Home Birth
    • Regione Piemonte, Deliberazione della Giunta Regionale 7 maggio 2002 n. 80-5989-
    • Region Piemonte: Resultion on ways to access to a public reimburse for expenses related to home birth.
    • Regione Marche, Legge regionale 27 Luglio 1998, n. 22 “Diritti della partoriente, del nuovo nato e del bambino spedalizzato” Law on the Rigths of Birthing Women, newborn and babies in the Hospital*
    • Regione Lazio, Delibera n 29 del 2011 del Presidente della Regione in qualità di Commissario ad acta sul parto a domicilio Decreto del presidente della regione Lazio su: Parto a domicilio e in case di maternità.
    • Region Lazio: President’s Resolution on Home Birth and Birth Centers.
    • Provincia di Trento: delibera della Provincia Autonoma di Trento n.15077 del 1998 e successive modificazioni/integrazioni sul parto a domicilio
    • Trento Province: Resolution of The Autonomous Province of Trento on Home Births

5. Decisions of Supreme Court

Some decisions-of Italian Supreme Court regarding the right to Informed Consent:

  • Corte di Cassazione sez III, 30 marzo 2011- the Supreme Court has stated that the right to informed consent and the of Human Dignity are protected under the Prescription of the Italian Constitution and the Nizza Charter.
  • Corte di Cassazione Sez III, 29 settembre 2009, n. 20806, the Supreme Court has stated that the informed consent is a contractual duty of the doctor.
  • Corte di Cassazione, sez III, 9 dicembre 2010, n. 24.853, the Supreme Court has stated that the subscriprion of a generic form does not mean that the patient has espressed a true informed consent

6. International Convention

  • CEDAW Convention for the Elimination of all Forms of Discrimination Against Women
  • Oviedo Convention for the protection of Human Rights and Dignity of Human Being with regards to the application of biology and medicine
  • WHO- World Health Organization

4. European Sources

  • CEDU European Convention on Human Rights
  • Charter on the Right of Women in Childbirth- European Parliament Resolution A2- 38/88 Link: (The document the Resolution on a Charter on the Rights of Women in Childbirth (C235/170) was published in the Official Journal of the European Communities number of 12-09-1988. You can access the digital version of the relevant Official Journal on EUR-Lex:http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:JOC_1988_235_R_0164_01&from=EN)
  • Charter of Fundamental Rights of the European Union signed in Nizza.

* Article 1: “the Region promotes the wellbeing of mother and baby during pregnancy, childbirth and postpartum; the Region promotes the access to information on maternity care assistance, ensures the freedom of choice about the place of giving birth and all related standards of safety. The Region is committed in reducing all the risk factors that influence rates of maternal and neonatal mortality and morbility, the Region ensures the continuity of family relationship, of physical and psychological development of babies during the time they are in the Hospital”.

Article 2: “The local public sanitary agencies organize seminar for preparing women to childbirth, and for living women all the information related to pregnancy, childbirth, newborn care, breastfeeding and artificial milk. The local public sanitary agencies inform women on the possibility to give birth at home and they give all the information on the assistance in Hospital, Birth Centers and Home Birth”.

Organizations

Author: Elena Skoko, HRiC Political Activism Coordinator in Italy

Are you an organization in Italy that would like to be listed here? Please contact the HRiC Italy coordinators at: italy@humanrightsinchildbirth.org

CreAttivamente Ostetriche

Innecesareo

  • National volunteers association for the prevention of unnecessary cesareans, promotion and support of VBAC, natural and respected birth and breastfeeding, post-cesarean and post-medical birth emotional support.
  • Location: Mantova
  • Website: http://www.innecesareo.it/
  • Email: innecesareo@gmail.com
  • Phone: +39/3335489414

La Goccia Magica

Rinascere al naturale


HRiC in Italy

November 2014 Update

 

Alessandra Battisti, Hermine Hayes-Klein and Elena Skoko

Human Rights in Childbirth in Italy started its activity in March 2014, after the lawyer Alessandra Battisti and birth activist Elena Skoko were appointed the role of Legal and Political Advocacy Coordinators for Italy. Since that date, they have been working on promoting human rights in the domain of maternity and birth on the national level working with single mothers, volunteers associations that support women and parents before, during and after childbirth, with professional midwives’ associations, governmental institutions, such as the Ministry of Health, lawyers, doulas, medical professionals and others in order to contribute to the creation of a national birth advocacy network and raise awareness of human rights issues in childbirth. They have translated the HRiC website in Italian and they developed the content for the country page, available in English and Italian, so to provide both national and international activists with data summary and a picture of the national maternity care system.

In collaboration with CreaAttivamente Ostetriche and Associazione Nazionale Culturale Ostetriche Parto a Domicilio e Casa Maternità, both associations of professional midwives, HRiC in Italy presented the Petition for the Autonomy of Midwives (general register n. 1930/2014, September 16th 2014) to the EU Parliament, submitting a complaint based on the non compliance of Italian law with Section 6, Article 42 of Directive 2005/36/EC of the European Parliament and of the Council.

HRiC in Italy organized the first Italian HRiC Conference in Rome on September 20th 2014 with more then 60 active participants, where the association of mothers “La Goccia Magica” from Genzano (Rome) expressed their issues concerning the active participation of mothers in the maternity care system, the university professor Salvatore Bonfiglio addressed the topic of human dignity in contemporary constitutionalism, and the lawyer Vania Cirese explained the informed consent in obstetrics. The conference hosted the Microbirth documentary premiere screening. Alessandra Battisti and Elena Skoko contributed to the Italian translation of the film.

HRiC in Italy participated to The Ministerial Conference on “Women’s health: a life-course approach” on 2-3 October 2014 in Rome, under the auspices of the Italian Presidency of the Council of the European Union. In that occasion Alessandra Battisti presented the HRiC international movement to the international and institutional audience, and addressed the issue of human rights in childbirth through the WHO statement on The prevention and elimination of disrespect and abuse during facility-based childbirth.

HRiC in Italy is working on the urgent issue of the promotion of cord blood donation in Italy, together with Ibu Robin Lim, a world-renown midwife and member of HRiC Advisory Board. In Italy, there is a strong governmental effort to promote the cord blood donation and the Bill on Promotion of Umbilical Cord Blood donation is actually being discussed at the Parliament. The Bill aims to promote the donation of babies’ cord blood under the premises that it is safe for mothers and babies while there are robust and growing scientific evidences, acknowledged by international scientific societies and organizations, of the ill effects of this practice, especially in connection to the timing of the umbilical cord clamping. These scientific evidences are not taken into consideration by the Government and the national laws. If the Bill becomes law, this promotion will be financed by the Italian State and it will become a national health priority. HRiC in Italy participated to the Conference on the Umbilical Cord and the Placenta held in Rome on October 17th 2014, where a working group of professionals, activists and parents has been formed to address the issue.

HRiC in Italy is addressing the burning question of high national cesarean rates and unnecessary cesareans by collecting information on institutional levels and giving support to mothers who suffered abuse and wish to place a claim. Though the Government declared that 43% of the performed cesareans were not necessary (Inchiesta Balduzzi in 2013), the question is not being actually addressed on public or political base, leaving the mothers and the babies uninformed and subject to abuse. Though efforts are being made on institutional levels to engage medical professionals in the unnecessary cesareans issue, the process is slow and it does not include women as active participants to the discussion.

HRiC in Italy participated to the 1st National Day of Good Childbirth (1a Giornata Nazionale della Buona Nascita) where mothers, citizens and professionals gathered to discuss human rights of childbearing women and the ban on HBAC issued by the Italian National Board of Midwives.

HRiC in Italy also works on the issues regarding the profession of the doula and in June 2014 presented Debra Pascali-Bonaro, international doula trainer and member of HRiC Advisory Board, to the Ministry of Health where the issue is being discussed in order to clarify the role of the mother’s assistant that is perceived in Italy as being in contrast with midwifery profession, and it is strongly opposed by national boards of midwives.

HRiC in Italy is looking for fellow volunteers. If you are passionate about maternity care and human rights of women and babies, please contact us at italy@humanrightsinchildbirth.org.


Local HRiC Contacts

Elena Skoko
Political Activism Coordinator

Alessandra Battisti
Legal Activism Coordinator for Italy & Europe

Contact HRiC Italy
italy@humanrightsinchildbirth.org


Although Human Rights in Childbirth (HRiC) endeavors to provide useful and accurate information, HRiC does not warrant the accuracy of the materials provided. Accordingly, this Web Site and its information are provided "AS IS" without warranty of any kind, express or implied, including but not limited to, the implied warranties of merchantability, fitness for a particular use or purpose, or non-infringement. Some jurisdictions do not allow the exclusion of implied warranties, so the above exclusion may not apply to you.  We reserve the right to make improvements and/or changes in the format and/or content of the information contained on the Web Site without notice.This information is provided with the understanding that Human Rights in Childbirth and its coordinators and partners are not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought.


Although Human Rights in Childbirth (HRiC) endeavors to provide useful and accurate information, HRiC does not warrant the accuracy of the materials provided. Accordingly, this Web Site and its information are provided “AS IS” without warranty of any kind, express or implied, including but not limited to, the implied warranties of merchantability, fitness for a particular use or purpose, or non-infringement. Some jurisdictions do not allow the exclusion of implied warranties, so the above exclusion may not apply to you.  We reserve the right to make improvements and/or changes in the format and/or content of the information contained on the Web Site without notice.This information is provided with the understanding that Human Rights in Childbirth and its coordinators and partners are not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought.

Citations

  1. Grandolfo, M. 2010. Il Percorso Nascita: Promozione E Valutazione Della Qualita dei Modelli Operativi. Principali risultati dell’indagine sul percorso nascita, Reparto di Salute della Donna e dell’Età Evolutiva. Url
  2. Vita di Donna. (2008). Donne straniere e extracomunitarie: assistenza sanitaria gratuita: DONNE STRANIERE E ASSISTENZA PUBBLICA. Url.
  3. Ministero della Salute. (2014). Assistenza alle donne straniere in gravidanza. Url.
  4. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (RapportiISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url
  5. Grandolfo, M. (2010). Il Percorso Nascita: Promozione E Valutazione Della Qualita dei Modelli Operativi.  Principali risultati dell’indagine sul percorso nascita, Reparto di Salute della Donna e dell’Età Evolutiva. Url
  6. Percovich, L. (2005). La coscienza nel corpo. Donne, salute e medicina negli anni Settanta,. Fondazione Badaracco – Franco Angeli Editore. Url.
  7. Braibanti, L. (1980). Nascere meglio. Editori Riuniti.
  8. Gioacchini, A. (2014). Personal Communication.
  9. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  10. Grandolfo, M. (2010). Il Percorso Nascita: Promozione E Valutazione Della Qualita dei Modelli Operativi. Principali risultati dell’indagine sul percorso nascita, Reparto di Salute della Donna e dell’Età Evolutiva. Url.
  11. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  12. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  13. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  14. Gazzetta Ufficiale. (1998). DECRETO RETTORALE – Modificazioni allo statuto dell’Universita. GU Serie Generale, 32. Url.
  15. Gazzetta Ufficiale. (2009). Disposizioni in materia di conservazione di cellule staminali da sangue del cordone ombelicale per uso autologo – dedicato. GU Serie Generale, 303. Url.
  16. Gazzetta Ufficiale. (2014). Modifiche e integrazioni – Disposizioni in materia di conservazione di cellule staminali da sangue del cordone ombelicale per uso autologo-dedicato. GU Serie Generale, 137. Url.
  17. Senato della Repubblica. Promozione della donazione del sangue da cordone ombelicale e della rete di banche che lo crioconservano, N 913 (2013). Url.
  18. UNICEF. (2013). Gli Ospedali Amici dei bambini in Italia. Retrieved September 14, 2014. Url.
  19. Parto in Acqua. (2007). Dove partorire in acqua? Retrieved September 14, 2014. Url.
  20. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  21. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  22. ISTAT. (2014). Annual Statistic Report 2013. Retrieved from http://www.istat.it/it/files/2013/12/Cap_2.pdf
  23. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  24. ANSA. (2014). Parto in casa un “lusso”, solo 1500 italiane l’anno lo fanno. [Home birth a “luxury”, only 1500 Italians do each year]. Url.
  25. Piffer, S., & De Nisi, M. (2007). Parto a domicilio in provincia di Trento. Trend e caratteristiche materno-infantili. Anni 2000-2005. Osservatorio Epidemiologico – Azienda Provinciale per i Servizi Sanitari. Url.
  26. Dolce Attesta. (2013). Parto: in ospedale come a case. Url.
  27. Italian Senate. (2010). Investigation conducted by the Italian Senate “Nascere Sicuri – Indagine conoscitiva sul percorso nascita.” Url.
  28. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  29. Italian Senate. (2010). Investigation conducted by the Italian Senate “Nascere Sicuri – Indagine conoscitiva sul percorso nascita.” Url.
  30. Turno, R. (2013). Il ministero della Salute denuncia truffe sui parti cesarei: sono troppi, quasi la metà ingiustificati. Italia & Mondo. Url.
  31. WHO. (2014). Italy – Health Profile. WHO. Url.
  32. Italian Senate. (2010). Investigation conducted by the Italian Senate “Nascere Sicuri – Indagine conoscitiva sul percorso nascita.” Url.
  33. Panza, C. (2013). Semmelweis e l’origine della febbre puerperale. Quaderni Acp, 20(1), 41–43. Url.
  34. Camera, M. M., & Mascolo, R. (2012). Le competenze infermieristiche e ostetriche. Libreria Universitaria, 58.
  35. Skoko, E. (2014). Mille storie contro una fabula. DONNA & DONNA Il giornale delle ostetriche, XX(84), 59–63. Url.
  36. Camera, M. M., & Mascolo, R. (2012). Le competenze infermieristiche e ostetriche. Libreria Universitaria, 58.
  37. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  38. Nascere a Casa. (2014). Nascere in casa si può. Associazione Nazionale Culturale Ostetriche Parto a Domicilio e Casa Maternità. Url.
  39. Tuttosteopatia. (2012). Parto a domicilio. Retrieved September 12, 2014. Url.
  40. CIA. (2014). World. Retrieved September 10, 2014. Url.
  41. ISTAT. (2014). Annual Statistic Report 2013. ISTAT. Url.
  42. Trading Economics. (2014). Italia – Tasso di Crescita annuale del PIL. Retrieved June 28, 2014. Url.
  43. Home Finance. (2014). Inflazione in Italia – indice dei prezzi al consumo (CPI). Retrieved June 28, 2014. Url.
  44. ISTAT. (2014). Annual Statistic Report 2013. ISTAT. Url.
  45. WHO. (2014). Italy – Health Profile. WHO. Url.
  46. Donati, S., Senatore, S., Ronconi, A., & Group, R. M. M. W. (2011). Maternal mortality in Italy: a record-linkage study. BJOG, 118(7), 872–879. Url.
  47. WHO. (2006). Neonatal and Perinatal Mortality Country: Regional and Global Estimates. WHO. Url.
  48. WHO. (2006). Neonatal and Perinatal Mortality Country: Regional and Global Estimates. WHO. Url.
  49. CIA. (2014). World. Retrieved September 10, 2014. Url.
  50. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  51. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  52. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  53. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  54. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  55. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  56. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url
  57. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  58. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  59. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  60. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  61. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  62. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  63. WHO. (2014). European Region: Italy statistics summary (2002-present). WHO. Url
  64. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  65. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  66. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  67. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  68. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  69. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  70. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  71. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  72. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  73. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  74. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  75. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  76. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  77. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  78. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  79. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  80. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  81. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  82. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  83. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  84. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  85. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  86. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  87. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  88. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  89. Econote. (2013). Nascere in casa: una scelta poco diffusa. Retrieved June 13, 2014. Url.
  90. ANSA. (2014). Parto in casa un “lusso”, solo 1500 italiane l’anno lo fanno. [Home birth a “luxury”, only 1500 Italians do each year]. Url.
  91. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  92. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  93. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  94. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  95. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  96. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  97. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  98. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  99. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  100. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  101. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  102. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  103. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  104. Lauria, L., Lamberti, A., Buoncristiano, M., Bonciani, M., & Andreozzi, S. (2012). Percorso nascita: promozione e valutazione della qualità di modelli operativi. Le indagini del 2008-2009 e del 2010-2011 (Rapporti ISTISAN No. 12/39). Roma: Instituto Superiore di Sanità – Centro Nazionale di Epidemiologia. Url.
  105. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  106. EURO-PERISTAT. (2013). European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010. PERISTAT. Url.
  107. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  108. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url
  109. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  110. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  111. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  112. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  113. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  114. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
  115. IMH. (2010). Certificato di assistenza al parto (CeDAP): Analisi dell’evento nascita – Anno 2010. Italian Ministry of Health. Url.
English
Deutsch
Italiano