Good news for women in Italy as C-section rate falls

There is good news for mothers and their unborn babies: the rate of caesarean sections in Italy is coming down.

In 2014 25.7% of first-time births in Italy were by caesarean section, down from 28.3% in 2010 according to figures from the national agency for regional health services (AGENAS) collated under its 2015 national outcomes evaluation programme (PNE).

The figure remains well above the World Health Organisation’s ‘recommended’ rate of 10-15%*.

However, it is a considerable improvement in a country where medical choices can be dictated as much by financial expediency (caesarean sections have a higher economic return), organisational considerations (caesarean sections can be planned around rigid staff schedules) and fears of malpractice lawsuits (caesarean sections are often recommended by doctors to avoid labour complications particularly in older women, even though paradoxically statistics show they present a greater risk to mother and child) as by considerations of what is best for the patient.

In absolute terms in the last four years approximately 32,000 women in Italy have been ‘spared’ a first-time caesarean section that was not medically justified, with a consequent lower risk of having a surgical delivery second time round.

There are still huge discrepancies between northern and southern regions and even within the same region, with rates in individual hospital structures ranging from a minimum of 5% (in the northern Lombardy region) to 95% (in southern Campania).

Generally speaking, with the exception of Liguria northern regions have an average rate of below 20%.

All central and southern regions except Tuscany come in well above this figure, with the average rate in Campania stable at 50%.

VBAC (vaginal birth after caesarean) merits a discussion of its own.

In Italy it is a commonly held belief among women (and the medical community apparently does little to contradict them) that if their first delivery is by caesarean section then all subsequent deliveries must be too, even in the absence of medical indications making surgery strictly necessary.

Consequently, many women at their second pregnancy are denied the possibility of trying for a VBAC and having what can be not only a safe but also a hugely empowering birth experience.

In 2014 in Italy only 6% of mothers who had their first child by caesarean section delivered vaginally second time round, according to AGENAS figures. However, here again there are big regional discrepancies, with VBAC practiced successfully in only 1% of second deliveries in the south and in 20% of cases in the northern Veneto region.

The differences in the figures suggest that the issue is as much a cultural as it is a medical one.

And, like all cultural battles, it needs to be fought with information and awareness-raising, starting from those most directly concerned: mothers and their unborn babies.

* In a new study published this year the WHO concluded that at population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.