This weekend I am in Italy, near Padova in the northeast, with a mixed group of midwives and childbirth educators. It was an interesting first day - working again with an interpreter, and hearing from the group members, who came from a wide variety of locations, about birth in their hospitals. So, what did I discover?

I already knew that birth was very medicalised, with around 70% of women choosing a private obstetrician for pregnancy and birth care. This leads to a national caesarean rate of 35 - 40% much of it repeat caesareans, as VBAC (vaginal birth afer caesarean) is not encouraged or supported as a general rule.

Pregnancy care often involves an ultrasound and a vaginal examination at every visit. I was quite surprised to hear this, and wondered at Italian women’s acceptance of repeated internals, which a procedure is not only lacking any evidence base, but one that is risky. It sounded unethical to me as well and I couldn’t help thinking of the sexual angle and the “softening up” of the women towards more invasive procedures that might occur later. It is certainly a way to keep Italian women in their place - submissive and accepting.....

I was more shocked to hear that applying heavy fundal pressure during the birth is also a standard practice. This is dangerous, unnecessary and painful, although I guess if women have epidurals they will at least not feel it. Italy is not alone in continuing this barbaric and outdated procedure - why do they persist when again there is no evidence to support it and it could cause the women excessive pain and potential perineal problems?

Routine episiotomy is the norm as well and I was told that even the smallest of skin tears will be stitched. This routine surgical procedure is so common that it is not even recorded by many hospitals on their data sheets, so there is no national compilation of this data. In effect, no-one knows the overall rate for episiotomy in Italy, and it appears that no-one considers it important enough to rectify. Episiotomy is the routine and ritualised mutilation of a woman’s sexual parts - how could this have become so acceptable (and invisible) in a society that considers itself modern and liberated?

I’ll probably be in for more surprises today, and I will certainly be raising some of these issues again in the hope if sparking some insights within this group at least. One agenda item that was clearly requested was ways of finding out what women wanted - they could start by accepting that women must be asked, and give informed consent before anything is done to them, especially intimate and far-reaching practises such as frequent vaginal examinations and the cutting of their vaginas. It could be an interesting day! Posted by andrea at October 03, 2004 03:31 PM