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Obstetricians defend safety of childbirth in Italy

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5481 (Published 04 October 2010) Cite this as: BMJ 2010;341:c5481
  1. Michael Day
  1. 1Milan

Six of Italy’s most senior obstetricians have claimed in an open letter to a national newspaper that their profession is under attack after the press coverage of a series of high profile neonatal incidents in which mothers or babies have died or been injured.

In August it was reported that a baby died shortly after a difficult birth at Rome’s Policlinico Casilino hospital. The parents say that a row between two attending doctors allowed fatal delays in care. And in September the press reported the deaths of two mothers, in Milan and in Matera, in the southern region of Basilicata, after multiple births.

In three other incidents in the past two months—two in Messina, Sicily, and one in Bergamo, near Milan—babies were born with brain damage after doctors allegedly argued over the need for caesarean deliveries.

However, in the open letter, published in La Stampa on 25 September, six professors of obstetrics led by Tullia Todros of Turin University have warned that “the media campaign that has exploded recently in our country regarding the safety of childbirth is projecting an image that is completely distorted from reality.” They write that “infant and maternal deaths in Italy are in line with those in all the other countries in the western world.”

Professor Todros, a consultant at Sant’Anna Hospital in Turin, told the BMJ that she and her colleagues felt under siege. “We do have a very high rate of caesareans in Italy. The problem is that parents are quick to lodge a complaint if you don’t perform a caesarean. Sometimes the complaint is made even if you simply wait longer to see if it is necessary.” And she added: “We’re constantly aware of the legal concerns. To some extent obstetricians in Italy feel under attack.”

This week the leading daily newspaper Corriere della Sera noted that Professor Todros was the only doctor “who has hit the headlines in recent months for a caesarean delivery that went well.” On 26 September her team successfully delivered a baby from a brain stem dead Somali woman, aged 28, who had been kept alive on a ventilator.

But there were also headlines in August when a child was born with suspected brain damage at the Policlinico hospital in Messina after two doctors present were said to have come to blows over the need for a surgical delivery. The mother then had a hysterectomy after the caesarean birth, which her husband claimed had been delayed by almost an hour and a half because of the “brawl.”

The argument over the need for caesarean delivery has been a constant theme. Italy already has one of the highest rates of caesarean delivery in the western world, at around 40% of births, considerably higher than World Health Organization guidelines of 10-15%. Professor Todros said that the tendency for many normal pregnancies in Italy to be managed by very specialised staff from the outset might also explain the high rates of surgical delivery.

But in their open letter the six specialists also warn that, with progress in general medicine and fertility treatments enabling many women with an “astronomically high” risk of complications to become pregnant, the neonatal mortality rates were not likely to fall, and the need for many caesarean sections would remain.

Notes

Cite this as: BMJ 2010;341:c5481

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