The organization of midwifery practice for safe births

The condition of Italian obstetrics is manifesting alarming standards. The support given at childbirth is strongly medicalized. Italy has the highest rate of Caesarean sections in Europe. The increase in Caesarean sections is associated with poorer maternal and perinatal outcomes. Indeed after a Caesarean section maternal and neonatal morbidity increases. In 2010 the Italian Health Department sponsored a public awareness campaign encouraging the population to consider Caesarean section not just another birth option open to women but one that should be selected based on medical necessity. In the same year the Caesarean section guidelines and the physiological pregnancy guidelines were published with the aim to reduce inappropriate behaviour. These documents stress the importance of midwives in the physiological pathway and recommend the use of effective tools to ensure safe and appreciated care at birth. Other important steps have been the sharing of guidelines, the use of a partograph and the continuous training of professionals. The multidisciplinary discussion of the assisted cases and clinical audits have also been fundamental. The publication of an audit is a particularly important tool to allow women to make informed choices