Homebirth and the National Health Service in Italy. A qualitative study in the Emilia-Romagna Region

Patrizia Quattrocchi, PhD

ABSTRACT
Introduction: Medicalization of birth has increased all over the world in the past decades. The Italian caesarean birth rate (38%) is among the highest in the world. Could be birth at home as a public model of care a superior alternative to current practices? This paper focuses on the experience of the Emilia-Romagna region, where the National Health Service (NHS) has carried out a home birth service for more than 13 years. The aim is to discuss the strengths and weaknesses of homebirth as a public health model compared to homebirth within the private practice system.
Methods: Qualitative data were collected between 2010 and 2013, as part of a wider anthropological research project on out-of-hospital birth in Italy and Spain. Seventy participants were interviewed in total. In Emilia-Romagna, indepth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Focus groups, a field diary and participant observation were also used for data collection. Data were analyzed using ethnographic method and content analysis.
Results: Main findings suggest that the added value provided by the NHS home birth service in the Emilia-Romagna region (home births attended by communitybased or hospital-based midwives) compared to the private care model encompass increasing of the social legitimacy of homebirth, the transfer of best practices from homebirth to hospital birth, increasing the continuity of care when the woman is referred to the hospital, increasing the continuity of training and the autonomy of midwives in caring for normal births in the hospital and providing free services. Homebirth managed by the NHS contributes to the promotion of a physiological model of care also in the hospital.

KEYWORDS
home childbirth, natural childbirth, midwifery, public policy, pregnancy