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

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 care system has carried out a home birth service for more than 13 years. 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. In Emilia-Romagna, in-depth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Questionnaires, focus groups, a field diary and participant observation were also used for data collection. Data were analysed using ethnographic method. The findings suggest that compared to a non public model of birth, home birth care provided by the National Health Service (NHS) leads to: a) the increase of the social legitimacy of homebirth, b) the transfer of best practices from homebirth to hospital birth, d) the increase in continuity of care even if the woman is referred to hospital, d) the added advantage of a free service, e) the increase in the autonomy and skills of hospital-based midwives