Table 2

Results of the political engagement and commitment of parliamentarians and recommendations from the local round tables

Political commitment achievementsRecommendations from local round tables
  • Political support to promote the agreement between the national government and the regions to implement an action plan for the promotion and improvement of quality, safety and appropriateness of care interventions in the birthing process and for the reduction of caesarean section.

  • Participation on the parliamentary hearings on ‘Safe birth’ (Nascere sicuri) that were held from September 2010 to November 2012. The hearings addressed key issues regarding the quality of the birthing process in Italy and the situation of the birthing/childbirth centres and led to the investigation of the lack of self-determination of women in the choice for mode of birth.15

  • Adoption of the ministerial CS guidelines at subnational level which promotes discussion between women and providers about mode of delivery, and risks and benefits when women request a CS which is not medically indicated as well as documentation of the entire decision-making path in the medical record. In the absence of an appropriate clinical indication, the doctor has the right to refuse a request for a planned caesarean section.21

  • Developing and implementing national guidelines on CS.

  • Facilitating and promoting doctor–patient discussions on the mode of delivery.

  • Providing training and clinical updates for physicians, midwives and nurses to handle emergency situations during labour and delivery.

  • Implementation of best practice approaches to manage women with previous CS.

  • Improving access to epidural analgesia in all hospitals.

  • Providing efficient audit instruments to monitor CS rates, such as nationwide use of the Robson classification as a standard system.

  • Providing more information to women on mode of delivery.

  • CS, caesarean section.