Del Ponte Hospital: among the best birth centres in Italy

Over three thousand births with only 7% of them caesarean and almost one-third of natural births by “Cesarine” women.These are the figures from the Hospital Del Ponte of Varese that have been made public by the Italian National Agency for Health Services (AGENAS) and included in the 2016 edition of the National Programme Outcomes (PNE).

The neonatal garrison Giubiano has earned second place at the national level. The Ministry of Health entrusts, in fact, to the Agency the evaluation of effectiveness and efficiency of the Italian hospital system that is judged based on 150 indicators of care processes and outcomes in the main clinical areas, including perinatal.

On the issue of birth, the main indicators are the percentage of primary Caesarean sections (i.e. procedures performed on women who have not already been previously subjected to caesarean section) and the proportion of women with previous cesarean section who give birth naturally. It is well known, that the Caesarean section should be limited to cases with specific clinical indications otherwise it involves, compared to natural childbirth, major risks for the woman and for the child.

It is on these indicators that the Varese birth point showed a performance excellent, ranking first among the 41 Italian motherhood with more than 2,000 deliveries per year for the low number of births with primary cesarean section. If one considers the 177 obstetrics departments  in the Italian territory with more than 1,000 deliveries per year, the Del Ponte is in second place with the hospital in Lecco for the small percentage of cesarean delivery (6.8% if you adjusts the raw data based on the complexity of the subject), after the hospital of Carate Brianza with 5.4%. Very good results also regarding the percentage of women with a previous cesarean section giving birth naturally in the next pregnancy, which in the Del Ponte Hopsital is 28%, compared to a national average of 8%, and it is a figure that has been growing steadily in recent years. Also for this indicator when considering the 47 hospitals that have assisted at least 300 women with a previous cesarean section, the Maternity section of the Del Ponte is the one with the highest percentage of women who give birth naturally.

“This achievement is the result of a constant work of review and analysis of the cases, the sharing of clinical pathways and guidelines are constantly updated according to the progress of medical knowledge and adapted to our specific care. The desire to pursue with determination the improvement of care and analyse their criticism is not always obvious in the health sector and the huge disparities of different birth centres compared to the indicators considered by the PNE are evidence,” said Prof. Fabio Ghezzi, Director of SC of Obstetrics and Gynecology of the Filippo Del Ponte Hospital. “Here we are a group of specialists dedicated to maternal-foetal medicine that not only follows the expectant mothers in the path of pregnancy, but also evaluates carefully the mode of delivery that is most appropriate even in the most complex cases. In the evolution of the medical and obstetric assistance of society, the cesarean section went from being a curative procedure to being considered as a personal choice on how to give birth. Women need to be informed that childbirth surgery is not without risks as too often is thought. It is necessary to communicate to the citizens the culture of quality of care and its assessment because the probability of giving birth naturally or in the operating room should only depend on the needs of women and their unborn children, not those of the center to which they are addressed, as now too often occurs.

Precisely in order to protect the physiology and restrict medicalisation where inappropriate, we strive to differentiate the care pathways of women with low-risk pregnancies from those of pregnancies with risk factors: For the first, the management straight from the pregnancy is entrusted to midwives, which subsequently work autonomously keeping labour conditions of absolute safety and appropriateness. The respect of the times, the thrifty and prudent use of labour accelerated interventions, intermittent monitoring of the foetal heartbeat, work on into labour positions are the heritage of the midwife and indispensable tools if you want to avoid unnecessary cesareans.”

“In centres like ours, a reference for the management of high-risk pregnancies,” underlines Dott. Massimo Agosti, Director of Maternal and Child Department of ASST Sette Laghi, “it is important to emphasise that the skills to assist the natural birth even in the situation where the caesarean section are guaranteed seems to have become almost routine in our country, such as twin pregnancies (almost 100 in 2015 to Del Ponte, 20 of which ended with vaginal birth) or premature births (about 40% were born without resorting to Caesarean section). The logistical and organisational context is certainly helpful: in our mother-child centre the H24 presence of a multidisciplinary team on site (dedicated anaesthesiologists, two gynaecologists, midwives, neonatologists) provides the ability to minimise the time of activation of the operating room and intervention in case of emergency obstetric and perinatal. This prevents the caesarean section from becoming a “curative” surgery rather than preventive, meaning that it is only done in case of any complications during labour, possible but not certain, if difficulties are encountered while dealing with an emergency intervention.”