Introduction
If you are new to the area, and you are expecting a baby it might be helpful to know about the alternatives from which you can choose. This page describes procedures commonly carried out in local hospitals and private clinics in the Varese area, based on the experience of parents who have had babies over the last 10 years. None of the procedures are compulsory, all require the agreement of the pregnant woman or prospective parents. Depending on your caregiver and yourself you may not have all of these tests, but you will probably have some.
Choosing your caregiver
You should choose a caregiver, who can be a midwife/ostetrica, or a obstetrician (OB/GYN = medico ostetrico-ginecologo, commonly simply called ginecologo) .
An OB/GYN visit can be done privately, at a ASSL poliambulatorio, at a Consultorio or in a hospital. In the pre-conception phase ) and during pregnancy visits are free of charge.
Public
You can either go to a hospital useful addresses or to a consultorio.
Throughout the Province of Varese, Consultori Familiari provide free direct acess to psychologists, social and health workers, obstetricians, gynecologists, and pediatricians. The Consultorio provides psychological, medical, and social assistance related to issues of sexuality, birth control, abortion, sexually transmitted diseases, and women's and children's health.
In a hospital you will use your health card/tessera sanitaria to get care. You will not need a referral from your family doctor/ medico di base in order to see a hospital specialist during your pregnancy. You will have routine periodical OB/GYN examinations with whichever specialist is on duty in hospital. Even if you are privately insured (e.g. JRC Cassa Malattia) you can choose to do your tests and see specialists in the public hospital system. In this case you are considered a "paziente solvente" and you will have to pay for each appointment.
In a consultorio consultations are free of charge for everyone (including non-EU citizens), and you do not have to have a tessera sanitaria. It's unclear if an OB/GYN or midwife can work both in the hospital and in the consultori. Does anyone know more about this?
Private
Whether you are privately insured or not, if you opt for private healthcare your caregiver can be a obstetrician or a private midwife. While doctors can have both private and hospital practices it seems that midwives cannot. Does someone know more? Private obstetricians may range from very traditional to very alternative. You will see your chosen caregiver throughout your pregnancy, with variable frequency, and can request their presence when you give birth. Private midwives and obstetricians can accompany you to the hospital when give birth but cannot assist you during the birth unless they have working privileges in the hospital or clinic.
If you choose private care from a obstetrician working in the hospital s/he is not guaranteed to be present at your delivery. Some doctors will assist their private clients even when not on duty, others will not. Private midwives can attend your labour at home and accompany you to hospital/accompagnamento all'ospedale for the delivery.
home birth
There are private midwives able to assist in home births. These midwives practice across the whole Province of Varese. There are also two birth centres, in Varese and Milan, staffed by private midwives.
If you wish to have a home-birth you should find a private caregiver who accepts to assist you.
In the Province of Varese home birth is neither provided nor paid for by the public health system. For those who are covered by JRC health insurance, the JRC Cassa Malattia completely reimburses home-birth expenses. [hyperlink]
obstetric appointments
During the 1st obstetric appointment your caregiver will usually evaluate your health, history and possible risk factors. You will usually be prescribed a series of blood and urine tests and given advice on diet and lifestyle.
You will be asked standard questions: medicines you take, smoking, allergies, infections, family health history.
Usually during one of your first visits the caregiver will prepare a "cartella ostetrica" with your medical history, that of your husband, examinations and visits results, other important information… In all following visits and at birth you will always have to bring your "cartella" with you.
Your caregiver will take your blood pressure and check your weight, to use as a baseline for subsequent visits. if your caregiver is an OBGYN you will usually be asked to have a “visita”. The Italian “visita” is an internal examination, carried out with a gloved hand; very often an internal ecography is be performed with an ultrasound wand. As everywhere, it establishes size, position, texture of the uterus with regard to gestational stage of pregnancy.
You will usually be asked to see your caregiver at regular intervals so your blood pressure and weight can be monitored. If you want, you can also monitor both weight and blood pressure at a pharmacy.
Your caregiver will be looking out for complications like pre-eclampsia/ preclampsia or high blood pressure/ipertensione gravidica. You may be asked if you have had contractions or bleeding and whether the baby’s movements are normal.
tests
There are standard tests foreseen in the public health system/Sistema Sanitario Nazionale, which are internationally recognized as sufficient to monitor a normal pregnancy; they are free on prescription by your family doctor, consultorio specialist or hospital specialist.
You will need to do these tests in a public hospital or in a private, fee-paying clinic useful-addresses depending on whether you use the public health insurance scheme, are privately insured or are paying out of your own pocket. In the public hospital you will usually need to arrive early on the day of your test, and queue up. At Angera Hospital, the procedure is to take a paper ticket to establish your position in the queue and wait for your number to appear on the board or for it to be called out. You may choose to use a hospital even if you are privately insured; you will need to make this clear at the beginning so you can be billed for the test. There may be a separate window/“sportello” or office dealing with private patients, shortening your wait. In Angera Hospital this is on the 1st floor of Padiglione B. You may be able to make an appointment by telephone. In Arona you can arrange an appointment for your baby's hip ultrasound/controllo dell'anca over the telephone.
There are also private labs which have a special agreement with the public health insurance scheme, so that you can do your tests using your tessera sanitaria.
Calendar for Standard Tests
- By week 13: blood type; complete blood count (blood values, platelets count, hemoglobin (Hb), red blood cells (GR) and white (GB), platelet (PLT), hematocrit -Part solid blood HCT; leucocyte formula –LC; index of saturation of red blood cells) Rhesus factors; toxoplasmosis (repeated monthly if non-immune); ultrasound examination to confirm gestational dates; measles antibody test; HIV (if not done before conception; repeated in week 33-37 for at risk pregnancies); Coombs indirect (for couples where the mother is Rh negative and the father Rh positive), urine, liver function tests: aspartato aminotransferasi (AST/GOT); alanina amniotransferasi (ALT/GPT); virus rosolia anticorpi /rubella or German measles (at start of pregnancy and then if non-immune, repeated at week 17); sifilide anticorpi (treponema palladium anticorpi -TPHA)/ syphilis antibody tests (Treponema pallidum antibody, or TPHA, if not done before conception); glicemia/blood sugar;
- Weeks 14 and week 18: urine tests
- Weeks 19-23: morphological ultrasound examination to detect major abnormalities of vital organs, urine tests
- Weeks 24-27: blood sugar tests, urine tests
- Weeks 28-32: complete blood count/emocromo, ferritina/iron, urine tests, ultrasound to monitor growth and heart function
- Weeks 33-37: urine tests, Hepatitis B, and Hepatitis C;HIV test for at risk pregnancies
- Weeks 38-40: urine tests
- Week 40 onwards if prescribed by the specialist: ultrasound examination to establish the amount of amniotic fluid/ liquido amniotico (amniotic fluid index ) and cardiotocografia/cardiotocography (cardiac activity test or CTG) which may also monitor uterine contractions.
Your caregiver may prescribe other tests than those recommended and paid for by the public health system, to be paid for out of pocket.
A vaginal swab/tampone vaginale for B-group streptoccocus is prescribed towards the end of pregnancy. If the test is positive antibiotics are used during labour to prevent the baby from being infected.
A glucose tolerance test (blood tests before and after taking glucose)/ la minicurva da carico may also be done between weeks 24 and 28 to diagnose gestational diabetes.
ultrasound examinations
In the Protocol three ultrasound examinations are foreseen. It is recommended to book in advance.
In Italy pregnant women do a significantly higher number of ultrasound examinations as compared to other European women. here is a link to a Ministero della Salute article (in Italian) about this.
Special Tests [hyperlink]
For at risk preganancies i.e: where screening tests are positive, where there are fetal abnormalities, where the mother is over 35, or where there are chromosomal abnormalities in the family, prenatal tests can be done for free within the public health system. These tests are: the bi test, the tri test, the ultra screen. They evaluate the statistical probability of chromosomal abnormalities in the baby.
The bi test is a blood test done between 11 and 14 weeks; risk is computed taking into account maternal age. The tri test is a blood test done between weeks 16 and 18. Risk is estimated by combining maternal age with the levels of l'alfa feto proteina, l'estriolo non coniugato e il free Beta HCG. The ultra test combines the bi test with an ultrasound examination to calculate the thickness of the nuchal translucency/traslucenza nucale.
From the 40th week these tests may be done: ultrasound to establish the amount of amniotic fluid/ liquido amniotico (amniotic fluid index ) and the cardiac activity test (CTG)/monitoraggio cardiotocografico, which may also monitor uterine contractions.
corsi pre-parto
Vocabulary
doctor/il medico
surgeon/il chirurgo
nurse/l'infermiera
doctor's consulting room/ l'ambulatorio del medico
hospital/ l'ospedale
private hospital/la casa di cura privata
patient/il paziente
utero/ uterus
la posizione del bambino/ baby’s position
il collo dell'utero/ neck of the uterus
il battito del cuore/ heartbeat
contrazioni/ contractions
perdite anomale/ abnormal blood loss
gli esami del sangue/ blood tests
gli esami del urine/ urine tests
Il piano di assistenza prenatale
esami di routine convenzionati con la Sistema Sanitario Nazionale/ standard tests foreseen in the public health system
emocromo/complete blood count
gruppo sanguigno e Rh/ blood type and Rhesus factors
aspartato aminotransferasi (GOT/SGOT)/ Serum Glutamic Oxaloacetic Transaminase)
alanina aminotransferasi (ALT/GPT)/Alanine aminotransferase
virus rosolia anticorpi/ rubella or German measles
Toxoplasma anticorpi; if not immune, repeated monthly
sifilide anticorpi/syphilis
virus HIV/HIV
glicemia
glucose tolerance test/la minicurva da carico
Group B Streptococcus
test di Coombs indiretto/ indirect Coombs or indirect antiglobulin test, usually repeated monthly
esame urine/urinalysis
ecografia ostetrica/ultrasound
Amniocentesi/amniocentesis
Villocentesi/chorionic villi test
Funicolocentesi
monitoraggio cardiotocografico
l'alfa feto proteina,
l'estriolo non coniugato
il free Beta HCG
ostetrica/midwife
medico ostetrico-ginecologo, commonly simply called ginecologo= OB/GYN
