dTwo reports, the European Perinatal Health Report and the annual report on the birth event of the Ministry of Health, take stock of the birth rate in our country. Offering important insights into the analysis of motherhood and the type of assistance we find in hospitals and clinics at the crucial moment of childbirth.
Maternal and child health in 27 EU states
The new and fifth report European Perinatal Health Report it is coordinated by INSERM (Institut national de la santé et de la recherche médicale – French national institute for research on health and medicine) with the contribution for Italy of Istituto Superiore di Sanità (ISS), ISTAT, Ministry of Health and the Bambino Gesù Hospital in Rome. The report analyzes maternal and child health over the period 2015-2019 on the basis of nine indicators in 27 EU Member States, plus Iceland, Norway, Switzerland and the United Kingdom.
Cesarean section and preterm birth: Italy is above the European average
The first important element concerns the stillbirth rate and the neonatal mortality rate. In Italy, in 2019, they were lower than the European average, while our nation recorded a number of caesareans higher than the average for the continent.
The median caesarean rate in 2019 in Europe was 26%, while in Italy the percentage was 33% of which 12.3% planned and 20.7% performed in an emergency. Although Italy still has a high caesarean rate compared to the European average, it should be noted that its reduction has been going on for years, reaching 31.2% in 2021, however maintaining a wide variability between 50% in the Campania region and the 19-21% of the regions of Tuscany, Valle D’Aosta, Friuli Venezia Giulia and PA of Trento.
Births before term of pregnancy (37 weeks) are also higher in Italy than in the rest of Europe. In 2019 they concerned 7.5% of those born in Italy with a decrease of one percentage point compared to 2015. The European median rate was 6.9%, with a range between 5.3% and 11.3%.
Advanced maternal age
Advanced maternal age at childbirth varies greatly across Europe, both between countries and over time. In Italy, 34.4% of women who give birth are over 35 years old, one of the countries with the highest value together with Portugal (33.2%), Ireland (39.4%) and Spain (40.0%). In these countries, the proportion of women aged 40 or over also exceeds 7% and is equal to 8.8% in Italy.
Multiple pregnancies in 2019 were 1.6% of the total number of Italian births, in line with the European average value of 1.6%. In the five-year period examined, the rate decreased in all European countries probably thanks to the more frequent transfer of a single embryo in the case of assisted reproduction techniques, with the aim of improving maternal and neonatal outcomes.
The annual report on childbirth
The annual report on the birth event published by the Ministry of Health and drawn up by the Certificate of Assistance in Childbirth (CeDAP) confirms some elements and adds others. Among the additional elements, the facilities where you give birth: 8 out of 10 mothers do it in public and equivalent healthcare institutions (62.8% in facilities with at least a thousand births per year, 7.1% in facilities with less than 500 deliveries per year). 11.4% give birth in nursing homes and only 0.2% in another care facility, at home, etc.
Decline in births, also applies to foreign women
The decline in births, a hackneyed topic, also concerns foreign citizens who have so far compensated for the structural imbalance. Fertility remains almost constant compared to previous years: in 2021 the average number of children per woman is 1.25 (compared to 1.46 in 2010). The highest levels of fertility are in the North in the Autonomous Provinces of Trento and Bolzano and in the South in Campania and Sicily. The least prolific regions by far are Sardinia and Molise. In 2021, approximately 19.9% of deliveries were related to mothers with non-Italian citizenship, a phenomenon that is more widespread in the areas of the country with a greater foreign presence, i.e. in the Centre-North.
How many visits and ultrasounds in pregnancy
In 91% of pregnancies, the number of obstetric visits performed is more than 4, while in 75.9% of pregnancies, more than 3 ultrasounds are performed. The percentage of Italian women who make their first visit after the first trimester of pregnancy is 1.9% while the percentage rises to 10.2% for foreign women.
Women with medium-low education and under 20 years of age have their first visit later, after the 11th week of gestation.
Prenatal diagnosis, the trend is decreasing
As part of invasive prenatal diagnostic techniques, an average of 3.4 amniocentesis was performed for every 100 deliveries. At a national level, the sampling of the amniotic fluid was carried out in 8.68% of the cases for mothers over 40, showing a decreasing trend in the last three years.
In 95.4% of cases, a woman has the child’s father beside her at the time of delivery (excluding caesareans), a family member in 3.4% and another trusted person in 1.2%. The presence of a trusted person rather than another appears to be influenced by the geographical area.
How much does a newborn weigh at birth
0.8% of those born weigh less than 1,500 grams and 6.0% between 1,500 and 2,500 grams. In tests to evaluate the vitality of the newborn using the Apgar index, 98.6% of newborns reported a score between 7 and 10 5 minutes after birth.
Pma, which one and for whom
The use of a medically assisted procreation technique (MAP) is carried out on average in 2.9 pregnancies out of 100. The most used technique was in vitro fertilization with subsequent transfer of embryos into the uterus (IVF), followed by the in vitro fertilization by cytoplasmic sperm injection (ICSI).
The age of new mothers and the (excessive) recourse to caesarean section
The rather advanced age of new mothers is confirmed: the average age is 33.1 years, that of the foreigners is 31. And it confirms the excessive use of cesarean births, albeit with signs of a slowdown, in line with the indications of the Guidelines for the promotion and improvement of the quality, safety and appropriateness of assistance interventions in the birth process and for the reduction of caesarean sections. The cesarean section is the master in accredited nursing homes. Caesareans are 44.6% of deliveries against 29.5% in public hospitals. IEd is more frequent among Italian women than foreign women: caesarean section is used in 27.4% of births of foreign mothers and in 32% of births of Italian mothers.
Robson’s classification and use of caesarean section
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