I am having mixed feelings about the medical treatment I'm getting here during pregnancy. For the most part, I like my doctors and I think I'm getting OK treatment but I feel I've really had to fight to get it and it has required a lot of effort, patience and time spent nauseated in long lines. Above is a (small) sampling of the medical documents I've collected just over the last two months. Each of those represents a test or some bureacratic thing I've had to take care of, typically requiring two or more trips someplace (where I've, yes, had to stand in a long line). I have no illusions about the U.S. health care system being a utopia, but in my experience (always having had insurance), getting health care was so easy in comparison.
For one thing, doctors in the U.S. have telephones. My doctor here has no telephone so anything I need to get done (a prescription, a referral, making an appointment) has to be done in person during the random two-hour window her office is open several days a week. She has no secretary so entering her office is an every-man-for-himself affair with a crowd of people in the waiting room vying for the doctor's attention every time she opens the examining room door to let a patient out. Positives: going to the doctor costs nothing and she's a good doctor. Negatives: it's absolute chaos and something that would be resolved with a quick phone call to the nurse or receptionist in your doctor's office in the U.S. can take hours or days because of the need to come back multiple times.
To avoid this chaos with a gynecologist, I pay out of pocket to go private. Fortunately my gynecologist does have a phone and I can call and make an appointment. This gives me the peace of mind of knowing I have an actual appointment every four weeks or so and that I will always see the same doctor. She keeps no record of me though and I am responsible for maintaining my own records (see above) and updating her on my history every time I come in. Were I to use public health care, I may see a different doctor every time and there would be no chance to develop a personal relationship. Though I've developed a personal relationship with my gynecologist, she will not be present at the birth of the baby and I will for all intents and purposes give birth with strangers.
This was worrying me as were several other things I had heard about the hospitals, so I took them up with her yesterday at my 16-week appointment. Among the things I had heard was that the hospitals here were overcrowded, that it was possible to be turned away in labor if there was "no room at the inn," so to speak, or that they may accept you but then put you on a gurney in the corridor where you would be in labor if there are no beds available. This happened to my upstairs neighbor and several other Italian women I've talked to. I had also heard that getting an epidural was next to impossible.
My gynecologist was blunt and to the point. She told me straight up to not "romanticize the birthing experience because you will only be disappointed." Basically what she said was that the hospitals here lack the "human aspect" but are technically good, and I should be concerned with how good the care is and not how pretty the hospital is (and they are quite institutional and ugly as I've seen on my recent visits...). She said there is somewhat of an assembly line aspect to the maternity wards but that is because this is public medicine open to everyone and the hospitals are not in the business of trying to impress anyone or attract "clients." As for an epidural, she told me not to get my hopes up. She said that Italian hospitals were "badly organized for the epidural" because there is typically only one anesthesiologist on call and nine times out of town that person is tied up in the operating room or dealing with emergency situations and has no time to adminster epidurals to pregnant women. She said I'd be better off doing yoga beforehand or learning self-hypnosis.
When I asked her to recommend a hospital, she basically said, "That's the beauty of this system. You can go to whatever hospital you like when labor starts." Well, I actually don't see that as an advantage and it feels so impersonal. I'd like to have more of a plan than that and not just flip a coin to decide upon a hospital when contractions start. For someone with control freak tendencies, I find this system not so much "liberating" as disorganized. I don't see the ability to go give birth with the strangers of my choice in an anonymous corridor in a hospital I may have never seen before in my life as this great freedom. I was not happy with many of her answers but I was happy with her honesty.
I'm having a hard time relating to friends who have given birth in the U.S. because their experiences are so different than mine (no birthing suites with DVD player and Jacuzzi tub here, no guaranteed epidural, no privacy) yet I can't relate to Italian women either because they just accept that this is the system here and have no expectations for it to be any better. One Italian friend spoke enthusiastically of the hospital where she gave birth saying, "There were only four of us to a room and it was so nice because we had the bathroom right in the room." (She said the only "downside" was that the suitcase she had brought with all of the nice new things for her baby had been stolen). Up to then, I didn't realize that in many hospitals, you are in a big room with a lot of other women and the bathrooms are not in the room. You have to pad down the hall with your toiletry kit. When I've asked Italian women if this lack of privacy bothered them (having other women in their room and often a roomful of their visitors with no curtains between the beds) none of them seemed phased. Not to mention that some women "pay off" the nurses (500 Euros or so) to get little extras or "special treatment" that would be considered standard treatment elsewhere in the world.
I'm really just trying to wrap my head around all of this...
****All of my ranting about not getting DVD players or birthing tubs or being in homey wallpapered private suites with quilts and rocking chairs during labor made me forget another crucial detail to come out of yesterday's exam: it's definitely a boy! The kid was flaunting his, uh, manliness for the ultrasound screen to the point where I overheard Cristiano last night telling someone - "Te lo giuro. E' tutto pisellino!" Please! Is that any way to discuss an unborn baby?
For one thing, doctors in the U.S. have telephones. My doctor here has no telephone so anything I need to get done (a prescription, a referral, making an appointment) has to be done in person during the random two-hour window her office is open several days a week. She has no secretary so entering her office is an every-man-for-himself affair with a crowd of people in the waiting room vying for the doctor's attention every time she opens the examining room door to let a patient out. Positives: going to the doctor costs nothing and she's a good doctor. Negatives: it's absolute chaos and something that would be resolved with a quick phone call to the nurse or receptionist in your doctor's office in the U.S. can take hours or days because of the need to come back multiple times.
To avoid this chaos with a gynecologist, I pay out of pocket to go private. Fortunately my gynecologist does have a phone and I can call and make an appointment. This gives me the peace of mind of knowing I have an actual appointment every four weeks or so and that I will always see the same doctor. She keeps no record of me though and I am responsible for maintaining my own records (see above) and updating her on my history every time I come in. Were I to use public health care, I may see a different doctor every time and there would be no chance to develop a personal relationship. Though I've developed a personal relationship with my gynecologist, she will not be present at the birth of the baby and I will for all intents and purposes give birth with strangers.
This was worrying me as were several other things I had heard about the hospitals, so I took them up with her yesterday at my 16-week appointment. Among the things I had heard was that the hospitals here were overcrowded, that it was possible to be turned away in labor if there was "no room at the inn," so to speak, or that they may accept you but then put you on a gurney in the corridor where you would be in labor if there are no beds available. This happened to my upstairs neighbor and several other Italian women I've talked to. I had also heard that getting an epidural was next to impossible.
My gynecologist was blunt and to the point. She told me straight up to not "romanticize the birthing experience because you will only be disappointed." Basically what she said was that the hospitals here lack the "human aspect" but are technically good, and I should be concerned with how good the care is and not how pretty the hospital is (and they are quite institutional and ugly as I've seen on my recent visits...). She said there is somewhat of an assembly line aspect to the maternity wards but that is because this is public medicine open to everyone and the hospitals are not in the business of trying to impress anyone or attract "clients." As for an epidural, she told me not to get my hopes up. She said that Italian hospitals were "badly organized for the epidural" because there is typically only one anesthesiologist on call and nine times out of town that person is tied up in the operating room or dealing with emergency situations and has no time to adminster epidurals to pregnant women. She said I'd be better off doing yoga beforehand or learning self-hypnosis.
When I asked her to recommend a hospital, she basically said, "That's the beauty of this system. You can go to whatever hospital you like when labor starts." Well, I actually don't see that as an advantage and it feels so impersonal. I'd like to have more of a plan than that and not just flip a coin to decide upon a hospital when contractions start. For someone with control freak tendencies, I find this system not so much "liberating" as disorganized. I don't see the ability to go give birth with the strangers of my choice in an anonymous corridor in a hospital I may have never seen before in my life as this great freedom. I was not happy with many of her answers but I was happy with her honesty.
I'm having a hard time relating to friends who have given birth in the U.S. because their experiences are so different than mine (no birthing suites with DVD player and Jacuzzi tub here, no guaranteed epidural, no privacy) yet I can't relate to Italian women either because they just accept that this is the system here and have no expectations for it to be any better. One Italian friend spoke enthusiastically of the hospital where she gave birth saying, "There were only four of us to a room and it was so nice because we had the bathroom right in the room." (She said the only "downside" was that the suitcase she had brought with all of the nice new things for her baby had been stolen). Up to then, I didn't realize that in many hospitals, you are in a big room with a lot of other women and the bathrooms are not in the room. You have to pad down the hall with your toiletry kit. When I've asked Italian women if this lack of privacy bothered them (having other women in their room and often a roomful of their visitors with no curtains between the beds) none of them seemed phased. Not to mention that some women "pay off" the nurses (500 Euros or so) to get little extras or "special treatment" that would be considered standard treatment elsewhere in the world.
I'm really just trying to wrap my head around all of this...
****All of my ranting about not getting DVD players or birthing tubs or being in homey wallpapered private suites with quilts and rocking chairs during labor made me forget another crucial detail to come out of yesterday's exam: it's definitely a boy! The kid was flaunting his, uh, manliness for the ultrasound screen to the point where I overheard Cristiano last night telling someone - "Te lo giuro. E' tutto pisellino!" Please! Is that any way to discuss an unborn baby?
16 comments:
This is my first post to you. Hi, I'm Amy from florence, been in Italy since 1996 and had my son here in 2001. I can relate to everything you have to say because I thought them all myself. I ended up choosing a hospital just outside florence (20 minute drive no traffic) becuase it had a good reputation. Towards the end of my pregnancy a friend talked me into a private clinic not far from home what for 3000 euro I could have a private room with bathroom, and a water birth and a labor room fitted with birthing chair, ropes and balls, etc. She'd had both her children there and both were C-sections. The clinics only take you if you are considered low risk, which I was ( a perfect text book pregnancy). At 37 weeks, my usually very active child slowed way down to the point where I'd have to poke at myself very hard to convince myself that he was alive. I went to the clinc at 5 pm where they hooked me up to a monitering machine and then told me the doctor wasn't there but I should return at 8 pm. On my return they did an utrasound and told me I had one "profoundly sleeping baby". They then put me back on the moniter that checks fetal heart rate and movement. I sat there for two hours only being monitered by nurses. The heart rate was constantly low and there was little no movement. At one point my normally very low blood pressure shot to 110/140. Through all of this I was never seen by a doctor. When the doctor finally showed at 10.30 he looked at the info and said my child was in severe fetal distress and I need to be transfered to the nearest hospital in an ambulance. They could not do anything with me because I had not been admitted and I was now an "at risk" pregnancy and they couldn't touch me. I refused to go nearest hospital since they had recently had staph infections oin the nursery. I signed a waiver and had my husband drive me to the hospital I had originally chosen. I ended up having an emergency C-section and my child was whisked away to the pediatric hospital miles away where he spent 2 weeks in intesive care. And the moral of this story... choose a hospital that has everything you might need in case of an emergency. I can't tell you the horror I exprerienced having my child taken from me. I saw him for 30 seconds and not again for another 5 days. It was a nightmare! If you must give birth in Italy, go for a structure that is equipped for any emergency. In the end private rooms and hotel service mean nothing when life is at risk. I should have sued that clinic that left me in limbo for over 5 hours. They should have sent me to a hospital immediately. At least mine has a happy ending. My son suffered no permanent damage and it is all now a distant though unpleasant memory.
Amy,
You are absolutely right. I visited a private clinic here and my husband and I decided against it because there is no neonatal unit. Yes, aesthetically it was nicer than the hospitals but health has to come before private rooms and birthing balls. I've found a hospital that may be a "via di mezzo" in that it's a real hospital with a neonatal unit (though not as fully equipped as some of the larger hospitals) but it has a softer, kinder approach and puts a strong emphasis on mother-child bonding. Thanks for your comment. It's really helpful. I'm glad all turned out well for you.
Wow... Michellanea, I cannot begin to say how insightful your post was for me!
I've worked for many, many years in neonatal intensive care units and prenatal genetics in California, and am organizing my move to Rome where I plan to study medicine.
Amy, I'm glad your baby is well, because far too many babies in a similar situation are not so lucky, I was fearing the ending, and I'm glad it was a happy one!
Wow, I guess for the Italian women who give birth here, the only way to think of it is... you can't miss what you've never had. If, and I mean IF I ever were to have a child here, I don't know how I would deal because I had all of those extra luxuries when I gave birth to both of my girls back in NJ. It's a whole different ball park here.
Congrats on the confirmation of the baby's sex! As for Cristiano's comment, "Te lo giuro. E' tutto pisellino!" I think that is just so cute!
Luckily, Amy's story has a happy ending. I agree with her that how hospitals handle emergency situations is by far more important than the 'luxuries.'
Congratulations on your boy! Your H's commment was really funny - men! (eyeroll)
Reading about your experiences and those of professoressa on expats in italy I've thought a bit about the whole situation (also, not to put too fine a point on it - my OH and I are thinking about having a kid ourselves soonish) and it seems to me that the best thing to do is tuck away those ancestral memories of private rooms, showers, epidurals etc. in order to be as non-stressed as possible when the time comes. I know it must be hard though. It can also be so frustrating dealing with the Italian health care system when you've experienced other better functioning public systems - my friends who've had babies in Australia have had all the things you mention (private rooms, birth tubs etc.) and they were public patients. You really start to wonder what they do with all our health tax euros here in Italy!
My OH had a good suggestion for me when I moved to Italy which is to get rid of notions of "fairness" because it's just stressful thinking about corruption, or disorganization or waste in the public sector. I'm still working on this though!
If I ever have a kid here I've thought I might hire a private doula who works at a public hospital to support me and advocate for me through the birth. Have you thought about something like that?
Farfallina,
Good luck with your studies. It is quite a different system here and I'm sure you will have lots of interesting observations.
Giulia,
Yeah, if you decide to give birth here, don't expect any luxuries...And don't forget to bring your own toilet paper and watch your bag! :)
Kataroma,
I think my doctor's little speech was the tough love I needed to let go of my fantasies of birthing suites and epidurals. I'm here now and will have to take what I can get. It does make me angry when I think of how much we pay in taxes though and I don't understand why "public" has to mean "ugly." As you said, in other countries, it's not like that.
As for the comment, I was quite surprised. It's a little frat boy-esque for my husband who is not given to making comments like that. Definitely deserves an eyeroll.
Our daughter was born in the Yale health system (my husband was a PhD student at the time) which seems to be a via di mezzo. During my prenatal visits (relatively few) I saw each of the OB/GYNs once, since when the time came I would get whoever was on call. I disliked the idea of a male doctor for birth, but there was only one among the (12? 16?) staff, and I never even saw him.
I don't recall caring much about or even noticing the doctor while I was in labor - Enrico was there, on his feet rubbing my back for 24 hours, and that's what counted.
I shared a room afterwards. The food was lousy. The nursery was crowded and the floor extremely noisy. Ross and I were fine and we went home two days after the birth. I did not want an epidural, because the idea of a needle in my spinal cord gives me the willies (even more now that my father-in-law has died probably as a result of a botched epidural).
Re. your doctor, are you sure you can't call her? My family doctors in Milan and Lecco would always take a call during office hours - which makes sense when there's something they can do by phone (e.g. prescribe for the ennesima sinus infection) that saves both of us an office visit.
Another eye-opening post. Are there doulas or midwives in Italy? Not that I'm suggesting to opt out of the hospital visit but its not like you're going be benefiting from an epidural.I've had several friends who have had the birth at home. They wanted the comfort and privacy of home and the personal relationship with the midwife.
A boy! :-)
Deirdré,
I know I'm being a big baby but I'm a baby about doctors and hospitals (luckily have spent very little time in hospitals...). Feeling "comfortable" and good bedside manner tend to put me more at ease and quiet that urge to flee - yes, I've jumped off an operating table before but that's another story. Being neglected and parked in a corridor would totally freak me out not because I'm a princess who thinks she deserves the corner suite but because I'm a Nervous Nelly. But, whatever, I'll have to deal. I'm slowly moving into the acceptance stage...
Ms. Violetta,
I think there are midwives or doulas here but I don't know how one gets in contact with one. I've done Internet searches but this is Italy not the U.S. and so there are very few websites with this information (or they seem to be targeted at "How to become a doula" and not where to find one). I was planning on asking at whatever hospital I end up choosing because it is something that absolutely interests me.
Congrats on the baby boy! Boys are the best if I do say so myself...(having 2 myself! :) ).
I really, really relate to all your fears...as you know. I guess in situations like this we need to sort of "let it go" or else we will drive ourselves nuts! Just think of all the women in the world that have healthy babies everyday in far worse places and conditions (if that helps).
Wow, you jumped off an operating table?! You must have been majorly freaking out! Again, I understand. When I had my two surgeries last summer I wanted to jump from the table too! The only thing that was stopping me was the first time I had an epidural and couldn't feel my body from the waist down and the second time my legs were strapped into stirups!
Michelle, you know you have my sympathy. I just had some blood work done yesterday and tomorrow I have to go back to my doctor's office to get some impegnative for next week's test. I'm always waiting in a line for something.
As you know, I've put all of my expectations out of my mind, and I just expect the delivery and clinic stay to be unpleasant. That way I'm prepared, there's no point in obsessing anymore, and if it isn't too bad I'll be pleasantly surprised. I have spent some time thinking about women in worse situations, as Autumn mentions, and that helps me too.
Congratulations on the pisellino. Back when our ultrasound looked more like the baby was a boy, N reacted in a similar way and I was surprised too, because he's not usually like that. I'm not the kind of person who likes to make much of gender differences, but it did seem like an essentially masculine response.
I had both my sons at a large Roman public hospital. I have no idea who the doctor was that delivered either, but my husband was with me, I remember that very clearly.
Then I was in a room with four other women, bathroom down the hall, small sink in the corner. Three days e via.
Actually it was good to be able to go over the whole ordeal with strangers who had just been through the same thing -- trust me, your husband, family and friends really don't want to know... Female bonding at its best if you let it happen.
I have heard several stories from foreign friends like the one from Amy. There is never a completely risk-free pregnancy and emergency c-sections need things like an anaesthesiologist in the vicinity and emergency neonatale care.
So, just lower your creature comfort expectations (in the end, who cares) and concentrate on the available care 360 degrees.
I should have been turned down by my chosen hospital for my second child because they were full, but it was too late and they had to rush me into the delivery room -- that's one way to get into the hospital of your choice! Only thing was that I had to wait until 10:00 the next morning in the hallway to have a vacant bed. But I had a nice chat with the African women in the barella next to me who was amazing.
As Emma Bombeck once said, "the problem with having a baby is that then you have it."
It doesn't sound like the most idyllic circumstances under which a woman would like to have a baby, but I will tell you what my doctor told me as I was about to undergo a c-section to birth my twins.
This is YOUR story. Don't let other people's unpleasant experiences be YOUR experience. The birthing process will be all that YOU want it to be.
I've had three screaming kids (including the twins) in the US. The first one was in the private room with the CD blaring Bruce Springsteen. The second came in a cold, sterile operating room. The end result of both was the same: three healthy babies.
I completely understand your trepidation and fears, but try not to lose sight of the only issue that really matters: you're going to have a baby! And having a healthy baby trumps private rooms, CD players and good food any day.
Oh, and one more thing: get the epidural. That better be the first word of Italian you learn in this process, sister. I birthed a baby without one and I have struggled with holding it against that kid for every day of his 11+ years.
Cupcake - I think the point is that here epidurals are not usually (or at least not always) available.
kataroma
kat - I think the point is you should bribe the highest medical officials to get yourself one.
:)
Yeah, michellanea should definitely have that bustarella handy as she checks into the hospital!
kataroma
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