Birth Process SERVICES CARD

www.aopoma.gov.it www.aslmn.it Index Birth Process

Pregnancy, the birth of the child and the after-birth period, are the most relevant physiological events from a social, af- Being born in Mantova () 4 fective and biological viewpoint within a woman’s vital cycle. The manifold aspects which spring out of the experience contribute to build and consolidate the state of psychological-physical well-being, thereby involving the woman, the The Support Services network 6 man and the entire family nucleus. Before the Pregnancy 9 The Local Health Care Unit (ASL) and the Hospital offer a Birth process that ensures to the woman assistance during pregnancy and after child- The Pregnancy 10 birth, as well as company and assistance in her living environment, via Pregnancy and Birth 14 the support provided by the aptest health care facility. This organizational He is Born – She is Born 21 model envisages taking charge of the task, the integration of all the servi- ces involved, the transparency of the assistance offer, and the quality of Home at Last 26 the communication between operators inter se and between operators The Paediatrician’s Check-ups 28 and family nucleus, thereby ensuring a strong focus on security throu- ghout the pregnancy period and after the birth. Addresses and Contacts 30 Reference Volunteer Associations 32 Local Health Care Unit (ASL) addresses for the 34 Paediatric Immunizations 35 Family Clinics 36 Internet Websites 38

2 3 Being born in Mantova (Mantua) The Carlo Poma Hospital is equipped with three birth centres capable of covering the needs of mother and child across the provincial territory: Mantova, Asola and Pieve di Coriano. The integrated network made up of the three Keywords: integration and continuity of support units of Obstetrics, Gynaecology and Paediatrics guarantees safety through two systems of protected transport of the The birth process is a program of continuous support between the territory and the birth centres within Mantova’s pro- expectant mother with a pathology and the mother at risk of losing the problematic infant, carried out by a dedicated vince, in close collaboration with the family Clinics, the hospital facilities of Obstetrics, Neonatology and Paediatrics, the team attached to Obstetrics and the Intensive Neonatal Care Unit pursuant to procedures certified by the company General Practitioners and the family Paediatricians. quality service. Admission and assistance are understood to be a sharing process between family and operators, so as for them to agree on the decisions to be taken in respect of situations that unfold themselves during the pregnancy and after birth. A few demographic data on Mantova’s province The objectives pursued are: uniformity of assistance; sharing the processes; a multi-discipline approach ensuring physi- Mantova’s province boasts 411.335 residents , 52.894 of whom of foreign citizenship. The number of born residents was cal, psychological and social well-being; continuity of support as regards pregnancy, childbirth and postpartum; centra- 3.671, 1.059 of whom foreigners. The number of children per woman is in line with the one for the Region lity of the woman, the couple and the child; facilitated access to the services. and is found to be significantly lower among Italian women, 1.16 as opposed to 2.53 among foreigners. Generally, the latter gives birth for their first time around 28.7 years , while their Italian counterparts do so at the age of 31,8. In the three birth centres of the province 2013 witnessed 3.046 childbirths, 1.090 of which with caesarean operations. A significant number of women, 543, came from neighbouring provinces, especially from , , , and Rovigo, due both to logistical reasons and to the good attraction capacity on the part of Mantova’s facilities. Nearly half of caesarean sections, that is, 483, took place under urgent circumstances, while the remaining 607 have been planned. 394 admissions were made on account of problems associated with the pregnancy. Entries in clinics due to the pregnancy amounted to 7.215. It is possible, for pregnant women, to access the Obstetric departments either through Casualty (Emergency Care Unit) or directly. Maternal mortality is an exceptional occurrence in the provincial territory, as is generally the case in the Lom- bardy Region and in , and it does not prove possible to measure such a phenomenon over one year. Neonatal mortality (from birth to the 28th day of life) evinces a rate of 1.01 per thousand children born alive, a figure in line both with regional and with national comparable rates.

1 ISTAT 2013 • 2 regional certificates of assistance to childbirth

4 5 The support services network The Family Clinic For a good part, pregnant women followed by the family Clinics come from foreign countries. When the woman does Fifteen family Clinics, administered by the six Social and Health Districts of the Local Health Care Unit (ASL), operate not speak Italian, in order to facilitate communication and a correct understanding of her health and family situation, it within the provincial territory. They carry out an activity directed in particular to the promotion of health in relation to is possible to resort to an interpreter system over the phone which, in real time, places at the disposal interpreters and affectivity and sexuality, to the prevention of sexually transmitted diseases, and to responsible procreation as well. translators in 70 languages and dialects. It is possible, in respect of the most complex situations, to also activate the lin- The family Clinics contribute to the screening of the neck and womb cancer through the execution of the pap-test; and guistic-cultural mediator who, pursuant to prior booking, will come to the family Clinic in order to assist the woman they lend citizens an attentive ear, company and orientation. Inside the clinics, there is an active multi-professional and and the midwife during the consultation, for the sake of ensuring the clarity and intelligibility of the communication multi-discipline team consisting of gynaecologists, caregivers, psychologists and social workers ensuring support to the between them. Every year, at the family Clinics of the province, approximately 1.500 women are assisted throughout pregnancy through controls, visits, exams, sonograms and courses to accompany the birth. After the childbirth, mee- their pregnancies. tings are secured so as to promote and support breastfeeding and other interventions aimed at facilitating the establish- ment of a positive relationship between the parents and their child. The Hospital In the three Hospital’s Birth Centres, the admission facilities of Obstetrics-Gynaecology and Paediatrics, capable of en- The psychological assistance offered during the pregnancy -mi suring 24 hour assistance, are operative. They boast the ongoing presence of gynaecologists, paediatrics, midwives, nur- ght help face the several changes a woman goes through, in the ses, support staff and other professional roles suited to the support needs relating to the physiological pregnancy and interaction within the couple and in social relationships, the- childbirth as well as to the pregnancy and childbirth complicated by pathologies. The said facilities are placed inside the reby preventing, in particular, the rise of feelings of inadequacy, Mother and Child Department, and are constantly interlinked and linked with the territorial and clinic-based services. discomfort, states of anxiety and depression. The investigations and the medical or surgical therapies, both gynaecological and obstetrical, might be carried out in The support model for low level pregnancies is the one traced accordance with the type of service involved, either day hospital for outpatients or hospital admission. in the 2011 Guidelines by the Ministry of Health and the Natio- Mantova’s Obstetrics Department, thanks to the presence of the Neonatal Intensive Care Unit, admits and deals with nal Institute of Health. It envisages the midwife as the reference the pregnancy-related pathologies, by organizing, wherever necessary, the transfers from the peripheral aid centres. Ac- person, in collaboration with the entire clinic team, the family cess to the departments, with regard to the obstetrics patients, might take place both as a matter of urgency, after a con- Doctors and the Hospital’s outpatient clinic facilities wherever sultation at the Casualty Department, and pursuant to a planned admission. necessary. The reference midwife looks after the woman throu- ghout the pregnancy and, in the presence of possible complica- tions, defines, jointly with the Gynaecologist and the Clinic, a specialist consultancy path. All the performances envisaged by the national guidelines are free of charge. 6 7 Before the pregnancy Emergency transfer of mother and infant Responsible procreation The birth centres of Asola and Pieve di Coriano activate the transfer of the pregnant patient and the infant jointly with What is meant by contraception is the totality of methods and means which might be resorted to so as to plan a pre- the Casualty Department and with the admitting facility in the following instances: before the 35th week under the gnancy. Every couple is entitled to comprehensive information, provided by experts, on contraceptives, their undesired threat of a premature birth; in the presence of a relevant maternal pathology In the doctor’s view; in the presence of a effects and their efficacy. One might approach the General Practitioner, one’s own gynaecologist, or, directly, the family pathology affecting the foetus which necessitates a childbirth in a birth centre equipped with a Neonatal Intensive Care Clinic. The gynaecological consultations and any possible prescribed tests are subject to payment of medical fees. Unit. In the event that the delivery of a premature or critical infant nonetheless takes place in the birth places of Asola and Pieve di Coriano, the Neonatal Emergency Transport Service (STEN in Italian) is activated with the help of the me- The preconception period dical-nursing team of the Neonatal Intensive Care, so as to facilitate transfer to the Mantova Hospital, a 2nd level centre. The long process leading to a child’s birth begins prior to conception, with the monitoring of the mother’s sta- te of health and that of her partner. Today it is possible to prevent many situations which negatively impact on Independent professional activity both female and male fertility. Therefore, even before seeking a pregnancy, it is very useful to plan a meeting with At the Hospital facilities, it is possible to book specialist intramural consultations of a gynaecological and obstetrical the Clinic professionals so as to get a reproductive risk assessment concerning the couple, receive preconcep- nature by calling the toll-free number 800 724 505. tion advices, and request tests and the prescription of folic acid. The entire preconception process is free of charge. Infertility Medically Assisted Procreation is the totality of diagnostic and therapeutic procedures aimed at restoring fertility when the search for a spontaneous pregnancy has met with failure. The Hospital’s Medically Assisted Procreation Centre is a highly qualified 3rd level facility. The goal is to safeguard the reproductive function of the single and of the couple. Outpatient clinic activities are envisaged to take place in day surgery and at the lab. Visits, consultations, clinical and instrumental exams are aimed at the diagnostic search for the possible causes of infertility, and the most state-of-the-art techniques and therapies in this field are adopted. As regards the cases that are not strictly linked to fertility problems, an adequate structure is envisaged for the freezing of sperm, oocytes and embryos which patients affected by serious pathologies might have recourse to. Lastly, a seminal liquid test is offered to whoever might request it, regardless of the existence or otherwise of infertility problems. Access takes place by central booking pursuant to a referral from the patient’s doctor.

8 9 The pregnancy Exams and check-ups Prenatal diagnosis The woman’s health reflects on the state of the pregnancy, hence, in order for it to be lived in serenity, it is advisable to What is meant by prenatal diagnosis is a cluster of instrumental and lab exams which help a precocious identification carry out the envisaged check-ups and investigations. Obstetric consultancies at the family Clinics are provided by a qua- of alterations in the foetus’ chromosomes, infectious diseases contracted in the womb, malformations and anomalies lified team who, in the event of problems, offers the necessary assistance along with the specialists attached to the three associated with foetal development. That way, it is possible to follow their evolution during the pregnancy, plan the chil- birth centres within the territory. Assistance during pregnancy includes: diagnostic investigations, periodical check-ups dbirth and organize specific neonatal check-ups. Prenatal diagnosis further aims to inform about the unborn child’s state and the prescription of tests in order to monitor and promote the well-being of the mother and that of her child, in ad- of health. It mainly includes: dition to interventions of health care education and specific consultations. The • Screening tests for the Down syndrome, also termed nuchal translucency with bitest, the aim of which is to calcula- woman will receive detailed information in the course of individual meetings. te the likelihood of the foetus being a carrier of the pathology. The midwife will guarantee assistance throughout the pregnancy, until admission • CVS (Chorionic villus sampling) and Amniocentesis which are carried out through a sample taking of the cho- for labour and even after the discharge. At least five meetings and three sonograms rionic villi or the amniotic fluid. They are invasive exams which ensure a definitive diagnosis, though they entail an are envisaged, at the 1st, 2nd and 3rd trimester. The 2nd trimester sonograms, and abortion risk of 1 out of 100. in some instances those of the 3rd trimester as well, are conducted in one of the • Sonograms: during pregnancy, three standard sonograms are envisaged, in the 1st, 2nd (foetal morphological ultra- three hospitals by accredited specialists. The documentation on assistance during sound) and 3rd trimester. The 2nd level ultrasound is carried out instead upon a specific medical request in women at pregnancy is summed up in the regional obstetric file, which becomes a personal special risk or in the event of foetal anomalies. document accompanying the mother throughout her pregnancy: at hospital du- The 1st and, in some instances, the 3rd trimester sonograms are carried out at a clinic, whereas all the other investigations ring childbirth, and at the Clinic during the postpartum. Access to the Clinics is are conducted at hospital. The standard sonograms and the follow-up sonograms, as well as the invasive investigations in envisaged to be by prior booking, and the performances are exempted from pay- those instances envisaged by the ministerial protocol, are exempted from payment of medical fees, whereas the ones not ment of medical fees. indicated in the ministerial protocol and the screening test for the Down syndrome are subject to a fee. The pregnancy at risk Pregnancy is a natural event, but in some instances, due to pre-existing health problems or problems arisen during pre- gnancy, the well-being of the mother or the unborn child might be jeopardized; in such cases, the need arises for diffe- rent check-ups than the usual type and for specific assistance. The pregnancy, childbirth and post-partum represent a physiological event, which is why the family Clinic ensures an adequate assistance before and after birth; in special risk cases, the woman or the child is ensured additional assistance, provided by the Pregnancy Pathology Outpatient Clinic, 10 11 which is present in the three hospitals of the province, and by other specialized hospital outpatient clinics. In that event, ths after the childbirth (flexibility). Maternity leave is the right of all female employees with a work relationship in force though the Clinic retains the role of the assistance reference for the woman, visits and check-ups are planned at the Pre- as at the date of the commencement of the leave. gnancy Pathology Outpatient Clinics of the birth centres. The Clinic’s gynaecologist and the hospital specialist, who Compulsory leave from work might be followed by parental leave, to be utilized within the 8th year of the child’s life. The constantly liaise with one another, will ensure the necessary and adequate continuity of assistance. leave might be consecutive or fractionated and apportioned between mother and father.

Management of maternal-foetal pathologies Anticipated leave Foetal pathology In most instances, pregnancy is not an impediment to the continuation of work, but when it comes to dangerous, tiresome In the event of a diagnosed congenital foetal pathology and in those instances associated with a growth failure, at the and unhealthy activities, the pregnant woman’s health must be safeguarded. In the event, in fact, that the occupation entails Hospital’s outpatient clinics performance is made of the multi-discipline diagnostic completion, which involves a num- a working risk and transfer to other functions is not possible, allowance is made for an anticipated leave, even in cases of serious ber of specialists with regard to the highlighted foetal pathology (neuroradiologist, paediatric surgeon, cardiovascular complications or pre-existing diseases which might be exacerbated during the pregnancy (pregnancy at risk). Within this surgeon, geneticist, etc), together with a consultation on the prognosis and the pre-postnatal therapy. In particular, all the scenario, the female employee will submit the risky pregnancy certificate, drawn up by a specialist gynaecologist, to the Local consultations about congenital pathology are carried out along with the medical geneticist, so as to assess the genetic risk Health Care Unit, which will issue a directive allowing immediate leave until the completion of the child’s 3rd month of life. associated with the specific malformation. Moreover, within a team the place, method and time frame of the childbirth is determined. Courses to accompany the birth In the Local Health Care Unit’s family Clinics and in the three Hospital’s birth centres, cycles of meetings are periodi- Maternal pathology cally organized to accompany the birth and to support the postpartum/breastfeeding. The said group activities, aimed In the event of a maternal pathology having surfaced or predating the pregnancy, check-ups are conducted on a regular at prospective parents, represent an important health promotion opportunity, in that they set about to enhance the pa- basis pursuant to the application of multi-discipline management protocols recommended by the national and interna- rents’ knowledge and skills, as well as to reduce social isolation and loneliness during this period of life. In principle, the tional guidelines. meetings begin with the seventh month of pregnancy and are partly exempted from payment of medical fees. Registra- tions are collected at the family Clinics and at the three Hospital’s birth centres. Participation in the courses necessitates Protection of the working mother a doctor’s referral and payment of medical fees. Compulsory leave and optional leave Maternity leave is the compulsory leave period during pregnancy and childbirth, and lasts five months: two months prior to the expected date of delivery and the next three months. However, in the absence of counter-indications, request might be made to keep working until one month prior to the childbirth, and to extend the leave period up to four mon-

12 13 Child delivery and birth When to go to hospital What to take to hospital The day of the childbirth is one of the most important days in one’s life: to carefully and attentively prepare that moment It is advisable to prepare what is necessary for the hospital stay close to the deadline for delivery: is a gesture of love towards the child. It is important to get ready in time and to know what to do. It would be fit to arrive • All the tests carried out during the pregnancy and the obstetric file at hospital when the labour pains begin, or when the water breaks, if blood losses emerge, or at whichever moment is de- • Identity document and Health insurance card emed necessary. Once she has arrived at Casualty, the mother will be entrusted to the midwives, who will welcome her • Personal effects for both mother and child and ask her for the necessary documents: health insurance card, tax code, exam and sonogram results of the pregnancy • Full tank in the car – basket or child seat with approved belts for the discharge from hospital and the obstetric file summing up the check-ups conducted, the exams and the sonograms. For the mother: At that point, in the presence of the gynaecologist on duty, an obstetric consultation will be conducted, together with a • Comfortable lingerie for the labour and for the breastfeeding monitoring of the baby’s heart rate and, simultaneously, of the contractions, and possible additional exams at the specia- • Socks list’s discretion. Depending on the stage reached by the labour pains (prodromal, initial or advanced), the woman will • Bra suitable to the breastfeeding and comfortable slips enabling the use of pads be sent back home or admitted at Obstetrics, or sent directly to the Delivery Room. In all those instances, the presence • Pads for the post partum of a trusted person is always allowed. • Personal hygiene products • Possible drugs taken at home • Slippers, preferably with non-slip rubber sole • Towels of various sizes and uses • Favourite musical CD’s

For the infant: • Four-six sets of clothes suitable to the current season • Small-sized cotton towels • Bibs, cap and socks It is advisable to prepare an envelope setting out the mother’s name and surname and including a complete set of clothes to be handed to the operators at the time of the delivery.

14 15 Labour and child delivery Control of pain during labour The pain during labour and the childbirth might be an obstacle to surmount, a passage absorbing many energies, the- Epidural analgesia is currently the most efficacious pharmacological technique to keep pain in check during labour. It reby limiting the possibility of a more active and serene participation in the birth of the child. In order to keep it in check, is carried out by an experienced anaesthetist by following a sufficiently quick and painless procedure. At the level of the one might resort to a number of approaches, natural or pharmacological. The same objective is sought by the staff’s lumbar region, by means of a needle, a thin plastic catheter, into which the analgesic solution is administered, is inserted. precautions offering: a welcoming environment and ongoing emotional support; respectful obstetric management, The small catheter is fastened onto a sticking plaster behind the back, in such a manner as to allow the woman to move protective of individual times and rhythms with the support of either the partner or a family member; free motion and freely. The solution thus injected only blocks the nerve fibres susceptible to pain while sparing the motor fibres: it is thus postures during labour and childbirth. possible to lift oneself up and move around, to push during the expulsion, and, if one so wishes, to give birth in alterna- tive postures. The childbirth accordingly takes places with full participation and collaboration, in a thoroughly natural Natural analgesia methods fashion. Free postures A natural birth is always encouraged. During labour, therefore, recourse can be made to the most liked The possibility of giving birth painlessly is offered free of charge to all the women requesting that, pursuant to a prior and spontaneous postures, within a protected, calm and intimate environment. Two types of stools, besides a bed and a anaesthetic consultation and signature of the informed consent form after the 36th week of pregnancy. At the Mantova couch, will enable the woman to freely position her body in the best manner. Hospital, as part of the pre-birth courses, a meeting is held with the anaesthetist who will explain the technique, the Hydrotherapy During labour and childbirth, it might be useful to immerse oneself in hot water, as it has a good an- indications and the possible complications of epidural analgesia. After the 36th week of pregnancy, it will be possible to ti-pain effect and relaxes all the muscles, even those of the perineum, thereby facilitating the shortening of labour times, book the anaesthetic consultation through central booking without the need for a doctor’s referral. On the morning of with positive spin-offs for the newborn. This type of birth is only possible when countenanced by the conditions of the consultation, the blood chemistry tests and the ECG necessary to the procedure will be duly conducted. They will mother and child, and when the doctor and midwife deem it feasible. There is no counter-indication in the event of be followed by the anaesthetic consultation which does not entail payment of any medical fee and does not bind the positive swabs, and it does not need any prior booking. woman to undergo any analgesia during labour. At the time of labour itself, the decision will be made whether to make Music Therapy If it is to one’s liking, it is possible to equip oneself with musical CD’s so as to spend time serenely: the use or otherwise of such a technique. music one feels connected to, to be listened to during labour, will help create a more familiar and reassuring environ- ment. Operative delivery and caesarean section Aromatherapy It is practised at the Asola hospital. It is a holistic discipline making use of essential oils for the attain- In the event that a quicker execution of the delivery (operative delivery with suction cup, i.e. vacuum-assisted vaginal de- ment of well-being, and it should be personalized. It might be applied directly through a massage (direct contact with livery) or recourse to a caesarean section proves necessary, the woman will first be adequately informed. The caesarean the patient) or through a nebulizer. There are different types of oils, and their utilization varies according to the phase of section is generally executed under spinal anaesthesia, save in the event of medical counter-indications or emergency the labour. situations.

16 17 In the event of allergy to latex, the Hospital, throughout its aid centres, offers the chance of either giving birth spontane- is always preferable, since a repeated caesarean section entails a higher chance of complications for mother and baby ously or of being subjected to a safe caesarean section according to preset latex-safe processes. alike. The chances of uterine rupture during labour pains for a woman previously subjected to caesarean section, being Nel caso in cui si renda necessario un più rapido espletamento del parto (parto operativo con ventosa) o il ricorso al ta- an event which might ultimately occur even in the last months of the pregnancy, are extremely rare. In order to reduce glio cesareo, la donna sarà prima adeguatamente informata. Il taglio cesareo si esegue generalmente in anestesia spinale, this possibility to a minimum, throughout the pregnancy important information is collected both about any prior de- salvo controindicazioni mediche o situazioni di emergenza. livery carried out with a caesarean section, and about elements of the current pregnancy. This technical information is In caso di allergia al lattice l’Azienda Ospedaliera, in tutti i suoi presidi, offre la possibilità di partorire spontaneamente o assessed, interpreted and discussed with the woman. An additional final assessment is then done at the hospital, where di essere sottoposta a taglio cesareo in sicurezza con percorsi latex-safe preimpostati. a woman previously subjected to caesarean section is nevertheless made to undergo, as a precautionary measure, some Donating the cord blood pre-operation tests. Upon completion of the delivery, after the child’s umbilical cord has been severed, a little bit of blood, generally deemed Breech presentation of the foetus and spontaneous birth a waste product, lingers in the blood vessels. This blood is instead rich in stem cells that might be utilized for transplan- In the breech presentation, the foetus is positioned inside the womb with the head up. The spontaneous birth with a breech ts into patients affected with leukaemia or other serious blood disorders. If collected, the cord blood bank stores it for foetus is more complex, so preference is accorded to the caesarean section, which entails however specific risks for the mother years, keeping it at the disposal for people needing a transplant. One can ask to voluntarily and gratuitously donate the and for the baby compared to the vaginal birth. In order to avoid recourse to the caesarean, two methodologies are offered, cord blood. It is a free, personal and voluntary choice, which entails no risks either for the woman or for the baby. namely, moxibustion and turning the foetus around, which in at least two instances succeed in positioning him in a normal presentation, that is, with the head down. Assuming such manoeuvres yielded no result, a caesarean section would be planned. Mothers from foreign Countries The sick population from foreign countries in need of a transplant does not currently find a compatible donation; the Request for a caesarean section without genetic characteristics for compatibility, in fact, vary from one population to another, and in nearly all countries of origin any medical indication to that effect there are no conservation banks. That is why donation by foreign mothers is important. Fear of childbirth, the worry not to receive quality assistance, an alleged greater safety for the infant, are the motivations In order to donate cord blood, it is necessary to undergo free of charge blood tests before childbirth and after six months, most frequently adduced by the woman who asks to give birth through a caesarean section. A spontaneous birth is in- for the sake of excluding the presence of diseases that might be transmitted to the receiving patient. stead always to be preferred, as it entails lesser problems for both mother and child. When the woman asks to give birth via a caesarean section without any prior medical indication to that effect, the mo- tivations underpinning such request are discussed and shared with the operators during the pregnancy. In the event of Spontaneous birth in the event of prior caesarean section persistent disagreement between the woman, the doctor and the midwife, a psychological support and a second medi- 80% of women with a previous caesarean section can tackle a spontaneous birth. It is known that a spontaneous birth cal opinion are solicited.

18 19 He is born – She is born Childbirth under anonymity The newborn close to the mother When, in the course of the pregnancy, the woman is of the view that she is not in a condition to perform the role of Throughout the Hospital’s birth centres, it is possible to bring one’s own baby into the delivery hall, provided he is well mother for the unborn child, she can decide to complete the pregnancy without recognizing the child who will thus be and is born on time. The chance will be given to keep him in one’s arms, warm him up and feed him since the first mo- adopted, within a short time, by a couple capable of receiving the child, pursuant to an order by the Juvenile Court. The ments in life, thereby facilitating the mother-child relationship and the start of breastfeeding. Thereafter, the baby will be woman’s right not to recognize her child is established by Article 30 of Law No. 396 of 2000. After the birth, a woman admitted into the unit beside the mother, who will keep on looking after him pursuant to the aptest times and methods, has ten days within which to decide whether or not to recognize the child. A mother who does not recognize her child with the staff’s help. This practice of living together, called rooming-in, enables reciprocal understanding and helps the has the same rights as the other women, throughout the stages of pregnancy up to childbirth; she will additionally be mother realize her own child’s needs. During the first hours of life, the maternal nourishment consists in colostrum, the duly assisted and informed so that hers will be an informed choice. If she wants to remain anonymous, the declaration best possible one for the newborn given that it is highly energetic, at a time when he is unable to receive the more ma- of birth will be made by the doctor or midwife who has helped with the delivery, while her name will always be secreted. ture milk, production of which will start after the first week of life. Room is found for the infant born on time in a good The unrecognized child is vested with the essential rights: the right to a name, to the Italian citizenship and to education. clinical condition who needs diagnostic classification, but who does not require any close health care.

20 21 Lotus birth The newborn’s tests The termlotus birth comes from Clair Lotus Day, a Californian nurse who first held the view that cutting the umbilical Every infant’s history begins with the pregnancy. The neonatologist’s task is to assess how that child was in the womb, cord was “a violence on the child’s body”, whereas preservation of the contact with the placenta entailed several benefits through the tests conducted on the mother’s blood and the sonograms to exclude infections, malformations and foetal for his well-being. This natural practice envisages that the newborn remains attached to the placenta through the umbi- growth anomalies. By analyzing such tests, it will be possible to identify a personalized assistance for all the infants, who lical cord until he spontaneously detaches himself once the mummification process has been completed. will in any event be subjected during pregnancy to metabolic screening, monitoring of bilirubin and otoacoustic emis- The crèche at the Asola hospital has already accepted the practice for a number of years and has specialized in this acti- sions so as to exclude the chance of congenital deafness, or red reflex in respect of retinal pathologies. vity, by drawing up an ad hoc protocol. Metabolic screening, which is compulsory in Italy at pursuant to ministerial recommendation, is carried out at the 49th hour of life through the collection of blood in a cardboard, to be subsequently sent to the regional reference centre so Breastfeeding as to exclude hypothyroidism, phenylchetonuria, cystic fibrosis and mucoviscidosi and congenital adrenogenital syn- The mother’s milk is the best food, as it favours a special rapport between mother and child that is, at the same time, drome. The monitoring of bilirubin takes place through a simple device resting on the newborn’s skin. This substance nourishment, care giving and transmission of affection. The mother’s milk includes all the necessary substances for the increases in all the infants during their first days of life, in order for it to subsequently drop after the first week. Whenever child’s growth during the first 6 months of life. It is moreover practical: always ready and clean, well digested and cost- the values are too high, phototherapy lamps will be resorted to. free. It is a live liquid, as it changes over time by adapting to the child’s characteristics: its composition varies in fact du- ring the feeding, in the course of the day and as the child grows. It protects him from infections, especially during the first The declaration of birth year of life. Suckling is good for the woman, by for instance facilitating the contraction of the womb and by reducing the The issue of the birth declaration certificate is governed by Presidential Decree No. 396 of 3/11/2000 “New Civil Regi- blood losses after the childbirth. Many other health benefits for the child, even after many years, have been highlighted stry System “. The law envisages two routes: by scientific research. As for the newborn who is not well and especially the premature child, the tendency is to promote • The declaration of birth might be made in the Municipality of the territory where the birth has taken place (Mantova, maternal breastfeeding, thereby enabling moms and dads to always be close to their child, touch him, and take him in Asola, Pieve di Coriano), within ten days from date of the child’s birth or in the Municipality of the mother’s residence their arms as soon as the health conditions permit it. This practice, called pouch therapy, , helps the infant’s growth within the same time limit. until he becomes able to suck directly from the breast. • The declaration might be made directly in the Hospitals of Mantova, Asola and Pieve di Coriano within three days In the event that, temporarily, the newborn cannot be attached to the breast, the milk will be collected and kept at Man- from date of birth. As regards the Asola and Mantova Hospitals, one has to approach the secretary of the Aid Centre’s tova’s Neonatology Unit, alternatively, sent home. The Hospital, however, is not equipped with a milk bank. Medical Direction, carrying the same type of documentation. As for the Pieve di Coriano Hospital, it is necessary to approach the Aid Centre’s Medical Direction in the presence of the responsible staff, again by bringing the certificate of actual birth signed by the doctor or by the midwife who has attended to the delivery, together with both parents’ identity

22 23 documents. ference centre issues the certificates of rare pathology diagnosis, produced by the specialist in charge of the baby, which The procedure differs according to whether the couple is legally married or otherwise: in the former instance, the decla- serves to obtain the unlimited duration exemption certificate issued by the Local Health Care Unit in one’s city of resi- ration of birth is signed by the father only, while in the latter instance both parents’ signatures are needed. dence. The pathologies of paediatric interest which are monitored are: some rare disorders of the metabolism and the The following are valid identification documents: transport of carbohydrates (glycogen storage disease), Turner Syndrome (Mantova Hospital’s Paediatrics Unit), some • With regard to Italian citizens: identity card, driver’s license, and passport. types of hereditary anaemia and hereditary coagulation disorders (Immuno-transfusion Service and Mantova Hospi- • With regard to foreign citizens: Passport, residence permit or Italian ID card if resident in Italy. tal’s Paediatrics Unit) and progressive myoclonic epilepsy, hereditary essential myoclonus, West Syndrome (Infantile Spasm) and Lennox-Gastaut Syndrome (LGS) (Child Neuropsychiatry). Born prior to term or with health problems On the website of the Regional Network’s Coordination Centre (www.malattierare.marionegri.it), managed by Ranica The premature child (BG)’s Mario Negri Institute, it is possible to find, fully detailed and updated, all the monitored pathologies, the relevant Premature birth is a pregnancy complication. Premature is every child born between the 22nd and the 37th week from offices, the reference specialists, the contact details, and the processes activated at a regional level, in addition to the pro- conception. Within this time span, one then distinguishes between slightly premature children, born between 34 and tocol of taking up the case and the reference documentation. 37 weeks from conception, on the one hand, and the seriously premature ones, born between 29 and 34 weeks, or the seriously premature infants born under 28 weeks and weighing less than 1.000 grams, on the other hand. Instances of slight premaurity or minor pathologies might be admitted to rooming-in at the Hospital’s three birth cen- tres, since it is important, so long as the clinical conditions allow it, that each newborn, even if premature, might stay with the mother and receive her milk. The more serious instances of prematurity are admitted into Mantova’s Neonatal Intensive Care Unit, if possible by giving preference to the transfer of the mother before childbirth or, alternatively, the transport of the newborn on an ambulance along with dedicated staff. At the Mantova Hospital there is also an Intermediate Care Unit where newborn who have reached greater stability are assisted. Within this area, greater heed is paid to the educational aspects, so as to ensure for the family a safer and more serene discharge. Rare diseases The Carlo Poma Hospital is the reference centre for fourteen rare diseases. Being a reference centre for a rare disease means to be experienced in diagnostic and therapeutic activities, besides being equipped with support facilities. The re-

24 25 Home at last The post-delivery assistance gional Health Service, with a resultant chance to access health care pursuant to prior self-certification by the parent. The first weeks after the childbirth are characterized by profound changes for the woman, not only physical and physio- As at the time of registration with the Regional Health Service, choice is as of rule made of a paediatrician among the logical, but also in terms of the relationship within the couple. In order to live out this delicate period, called postpartum, doctors attached to the territory of one’s belonging. The list of available doctors can be consulted at the Local Health better, it is possible to approach the family Clinic, where a multi-discipline team will supply all the useful information, Care Centre of one’s residential District or on the website of the Local Health Care Centre. Upon registration with the especially on the first assistance to the newborn (for instance, dressing of the navel, breastfeeding) and will plan check- Regional Health Service, a provisional health insurance card is issued. Thereafter, generally within one month, the Re- ups for the mother and the infant at an outpatient clinic or at home, depending on requirements. The service is exemp- gional Service Card is forwarded to the child’s residential address. Education is free of charge. ted from payment of medical fees. The choice of the Health Care Unit (ASL) paediatrician Health care is ensured to all the citizens (Italians and duly entitled foreigners) through a network of services (medical and paediatric, pharmaceutical services, specialist services on an outpatient, hospital, residential or consultancy basis) via registration with the Regional Health Service, which is obligatory in respect of the infant and entails the choice of a family paediatrician. What to do In order to register the child with the Regional Health Service, the parent or his proxy will have to approach the offices of the Social and Health District within his own area of residence, carrying on him the following documents: • As regards an Italian infant: tax code of the child, identity document of the parent and self-certification of birth. If the registration with the Social and Health District is not done by a parent but by his proxy, the latter shall have to produce his own identity document. • As regards a foreign infant from the EC: tax code of the child, identity document of the parent, self-certification of birth, parent’s contract of work or certificate of permanent residence. • As regards a foreign infant from other than the EC: tax code of the child, identity document of the parent, self-cer- tification of birth, both parents’ original certificate of residence, last paycheck. • As regards an illegally resident foreign infant: the new illegally resident foreign babies are registered with the Re-

26 27 The paediatrician’s check-ups The paediatrician receives the newborn and his family and is heedful of such issues as prevention, care giving and the have time to obtain a valid immune protection lasting throughout his lifetime. child’s psychological and physical development. The filter visits, which are booked beforehand, are provided for healthy The Local Health Care Centre’s Hygiene Service sends home an invitation letter together with an appointment to subject babies, so as to check and monitor his psychological and physical development and the development of his interperso- one’s child to the mandatory and optional vaccinations, by attaching thereto the relevant health care information. nal relationships. These visits have fixed deadlines, based on the evolutionary phases of growth: As regards the first vaccination (children from the 2nd month of life), it would be appropriate to carry the record book • From 0 to 45 days: first filter visit, with a special focus on the promotion of maternal breastfeeding filled out by the family paediatrician, and for the later vaccinations, the accompanying cards of the previous ones. The • From 2 to 3 months: second filter visit, first vaccination vaccinations are free of charge. • From 4 to 6 months: third filter visit, weaning • From 7 to 9 months: fourth filter visit, including a hearing test Quality and protection • From 10 to 12 months: fifth filter visit, beginning of deambulation The Public Relation Offices of the Hospital and Local Health Care Unit have as their main functions to listen attentively, • From 15 to 18 months: sixth filter visit, the first accidents to facilitate access to the facilities and the performances, and the divulgation of information to the citizens. Through • From 24 to 36 months: seventh filter visit, including a visual test the customer satisfaction processes, they further analyse the degree of users’ satisfaction with the services, from the The paediatrician, in the event of the child’s illness, issues the medical certificate, which serves to the parents to make use viewpoint of an ongoing improvement of the quality standards. Reports and grievances are gathered, in the event of of the leaves and authorizations contemplated by the legislation in force. disservice, or, conversely, praises when patients intend commending the professionals’ conduct. In short, until completion by the child of the third year of age, it is possible to take leave without any time limitations. From 3 to 8 years, leave from work is allowed only up to 5 days a year per child. Vaccinations Vaccinations represent one of the most effective prevention interventions against some infectious diseases. The purpose of vaccines is to stimulate the production, on the part of the organism, of substances, called antibodies, which afford specific protection from bacteria, viruses and toxics, the agents responsible for diseases of an infectious nature. There are some vaccinations which, albeit not compulsory according to the legislation in force, are nevertheless strongly re- commended. Among them are the vaccinations against whooping cough, measles, rubella, parotitis and haemophilus diseases, pneumococcal and meningococcus. The cycle of immunizations begins by rule in the third month of life (two completed months), since this is the period in which the child begins to produce his own antibodies, so by regularly following the calendar of immunizations he will

28 29 Addresses and Contacts For cord blood donations Immuno-haematology and Transfusion Medicine Service at the Mantova Hospital, telephone 0376.201234; The Hospital Pieve di Coriano, 0386.717233 • Asola, 0376.721286 • Alternatively, contact obstetrics at the Local Health Care Unit Surgery MANTOVA PIEVE DI CORIANO Strada Lago Paiolo 10 •Switchboard: 0376.2011 via Bugatte 1 • Switchboard: 0386.717111 Medical records booking Complex Obstetrics and Gynaecology Unit Mantova: appointment at the 41st week by booking with 0376.201485 Complex Obstetrics and Gynaecology Unit Tel. 0386.717233 • [email protected] Pieve di Coriano, telephone 0386.717280 • Asola, telephone 0376.721286 Tel. 0376 201582 • [email protected] Where we are: ground floor Where we are: Obstetrics – Gynaecology Surgeries 1st floor Medically Assisted Procreation Centre Childbirth block – 1st floor, block B (surgeries 3, 4 and 20) For information and appointments, call the number 0376.201693 or write to the e-mail address [email protected]. Obstetrics – 2nd floor, block B Gynaecology – 1st floor, block B Complex Paediatrics Unit PUBLIC RELATIONS OFFICE Obstetrics – Gynaecology Surgeries – 1st floor, block B Tel. 0376.201452 • [email protected] MANTOVA Public Relations Office | Strada Lago Paiolo 10 | Office: Directorate of Health Services. Where we are: ground floor The Office is open to the public Monday to Friday | from 9 to 13 and from 14 to 15 Complex Paediatrics Unit CONTACTS: 0376.201443 - fax 0376.201667 | [email protected] Tel. 0376.201454 ASOLA [email protected] Piazza 80° Fanteria 1 • Switchboard: 0376.7211 ASOLA Public Relations Office | Piazza 80° Fanteria | Office: Directorate of Health Services. Where we are: Block A Complex Obstetrics and Gynaecology Unit The Office is open to the public Monday to Friday | from 9 to 13 and from 14 to 15 Tel. 0376.721286 • [email protected] Other options by appointment. Complex Neonatology and Where we are: 1st floor CONTACTS: 0376.721552 - fax 0376.720189 | [email protected] Neonatal Intensive Care Unit Tel. 0376 201451 • [email protected] Complex Paediatrics Unit PIEVE DI CORIANO Public Relations Office | Via Bugatte, 1| Office: Directorate of Health Services. Where we are: second floor - block B. Tel. 0376.721259 • [email protected] The Office is open to the public Monday to Friday from 9 to 12 Where we are: Paediatrics and paediatric Surgeries ground Other options by appointment. floor, Crèche 1st floor CONTACTS: 0386.717268 - fax 0386.717409 | [email protected] 30 31 Reference volunteer associations

Association Office Telephone Mail

Abeo Strada largo Paiolo 10 0376.288754 [email protected] Associazione Via Chopin 12 347.6288385 [email protected] (Association of Children Ospedale Mantova Genitorinsieme 347.8186980 with Hemopathic and (Parents Together Oncological Problems) Association) Abio Strada Lago Paiolo 10 328.4452880 [email protected] Associazione Alessandro Strada Zara Chiaviche 9 348.6633187 [email protected] (Child in Ospedale Mantova Dotti Insieme Per La Vita Hospital association) (Alessandro Dot- ti “Together for Admo Via Pirandello 21 0376.392139 [email protected] Life” Association) (Bone Marrow Avulss Piazza S.Leonardo 1 bis 338.1077673 [email protected] Donation Association) Mantova Agad Via Susani 17/B 328.8694931 [email protected] (Association of Young and Mantova Cav via Vittorino da Feltre 46 0376.325737 presidenza@centroa- Adults with Diabetes) Mantova 0376.2259597 iutovitamantova.it Archè Via L.B. Alberti 15 0376.781899 [email protected] 3421250058 Il Coraggio di vivere Strada Lago Paiolo 10 320.1163478 [email protected] (The Courage of living) Ospedale Mantova

32 33 The Local Health CareUnit Family Clinics Choice of Paeditrician

Asola’s social-health care district Suzzara’s social-health care district Asola’s social-health care district Assisted Management Office • Via Mas- Asola • Via Schiantarelli, 3 Suzzara • Via Cadorna, 2 Asola Assisted Management Office • Via Schiantarelli, 3 sarani, 29 dal Martedì al Venerdì 8.30 - 13.00 dal Lunedì a Venerdì 8.30 - 12.30; Lunedì 14 - 17; Lunedì e Martedì 9.00 - 13.00 e 14.00 - 16.00; Tel. 0386.331381 Tel. 0376.331032 • [email protected] Martedì 8.30 - 13.00 Mercoledì 9.00 - 13.00 Tel. 0376.331414 • [email protected] Tel. 0376.331058 Suzzara’s social-health care district ’s social-health care district Suzzara Assisted Management Office • Via Cadorna, 2 Castiglione delle Stiviere • Via Garibaldi, 65 46043 Viadana’s social-health care district Guidizzolo’s social-health care district Lunedì 8.30 - 12.30 e 14.00 - 17.00; dal Lunedì al Venerdì 9 - 12; Lunedì 14 - 17 Viadana • Largo De Gasperi, 7 Castiglione delle Stiviere Assisted Management Office da Martedì a Venerdì 8.30 - 12.30 Tel. 0376.861732 • [email protected] dal Lunedì a Venerdì 8.30 - 12.30; mer. 8.30 - 13.00 Via Garibaldi, 65 Tel. 0376.331425 Tel. 0375.789731 - 2 • [email protected] da Lunedì a Venerdì 9.00 - 12.00; • Strada Statale Goitese, 313 • 46044 Lunedì e Mercoledì 14.00 - 16.00 Viadana’s social-health care district dal Lunedì al Venerdì 8.30 - 12.30; Mercoledì 14 - 17 Campitello di • Via G. Rossini 10 , , Ponti s/M e Viadana Assisted Management Office Tel. 0376.689922 • [email protected] Mercoledì e Venerdì 8.30 - 12.30 : Tel. 0376.331225 Largo De Gasperi, 7 Tel. 0376.926034 • [email protected] Castiglione d/S, Goito, Guidizzolo, e Martedì, Mercoledì e Giovedì 9.00 - 12.30 Mantova’s social-health care district : Tel. 0376.331226 Tel. 0375.789786 – 5 Mantova • Via Trento, 6-8 • 46100 • Via XXV Aprile, 71 da Lunedì al Venerdì 8.30 - 12.30; Lunedì 8.30 - 12.30 Mantova’s social-health care district Giovedì 8.30 - 16 orario continuato Tel. 0376.331577 • [email protected] Mantova Assisted Management Office • Via Trento, 6-8 Tel. 0376.334728 - 334149 •[email protected] dal Lunedì al Venerdì 8.30 - 12.30 Tel. 0376.334606 ’s social-health care district Ostiglia Ufficio Gestione Assistiti • Via Belfanti, 1 Ostiglia’s social-health care district Lunedì Mercoledì Giovedì e Venerdì 8.00- 12.30; Ostiglia Assisted Management Office • Via Belfanti, 1 Martedì 8.00 - 13.00 Tel. 0386.302061 Tel. 0386.302008 • [email protected] 34 35 Family Clinics Asola’s social-health care district Lunetta• Via Valle d’Aosta Suzzara’s social-health care district PUBLIC RELATIONS OFFICE Asola Family Clinic • Via Schiantarelli, 3 Monday to Friday 8 - 12 San Benedetto • Via Bertazzoni, 1 Mantova’s LOCAL HEALTH CARE UNIT Monday and Friday 9-12 by appointment Tel. 0376.334811 Wednesday and Thursday 9 - 12 Via dei Toscani, 1 Tel. 0376.331016 - 331023 Tel. 0376.331492 Curtatone • P.zza Corte Spagnola, 1 Suzzara • Via Cadorna, 2 Office: General Direction Castel Goffredo Family Clinic • Via San Pio X, 19 Monday and Thursday 9 - 12 Monday to Thursday 9 - 12 Monday to Friday from 9 to 12.30 Tuesday, Thursday and Friday 9-12 • Tel. 0376.779573 Tuesday 15 - 17 Tel. 0376.331450 - 458 Tel. 0376/334350 – 334356 CONTACTS Guidizzolo’s social-health care district Viadana’s social-health care district Tel. 0376 334570 • Toll-free number 800 384384 Castiglione delle Stiviere Family Clinic • Largo Nuvolari, 1 Bozzolo • Via Bini, 2 [email protected] • [email protected] • [email protected] Via Garibaldi, 65 46043 Monday to Friday 8 - 12 Monday to Friday 9 - 12 Monday to Friday 9-12 • Tel. 0376.861732 Tel. 0376.334822 Tel. 0376.331571

Goito Family Clinic • Via Artigianato, 23 Viadana • Largo De Gasperi, 7 Strada Statale Goitese, 313 • 46044 Monday to Friday 8 - 12 Monday to Friday 9 - 12.30 Monday to Thursday 9-12 • Tel. 0376.689914 - 689915 Tel. 0376/334860 - 861 Tel. 0375.789745

Mantova’s ’s social-health care district Ostiglia’s social-health care district Mantova Family Clinic Ostiglia • Via Belfanti, 1 Strada statale Goitese, 313 • 46100 Monday, Tuesday and Friday 9-12 Monday to Thursday 9-12 Tel. 0386.302028 Tel. 0376.334728 - 334149 [email protected] Poggio Rusco • Via Massarani, 29 Wednesday and Friday 9 - 12 Tel. 0376.331386

36 37 Internet websites Additional information might be discovered by visiting the Internet websites of Carlo Poma Hospital (www.aopoma.gov.it), of Mantova’s Local Health Care Unit (www.aslmn.it), and of the Lombardy Region (www. regione.lombardia.it) and the following theme-based websites: Maternal – Child Health Breastfeeding www.ondaosservatorio.it www.unicef.it www.saperidoc.it www.epicentro.iss.it www.sigo.it www.lllitalia.org

Rare Diseases Working mother www.iss.it www.inps.it www.orpha.it

Folic Acid www.iss.it

Pregnancy www.aopoma.gov.it www.aslmn.it www.salute.gov.it www.pensiamociprima.net www.epicentro.iss.it Illustrazioni di Giacomo Arvati • Liceo Artistico Giulio Romano www.snlg-iss.it Progettazione grafica: Studio Ramen web.grafica.creatività • www.studioramen.it Donation www.lamiavitainte.it Potrebbero intervenire, nel corso del tempo, variazioni rispetto a quanto riportato; Asl e Azienda Ospedaliera cureranno comunque il costante aggiornamento delle informazioni.

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