This on-going interview series shares the experiences of expat moms who have given birth in Florence. The aim is not only to tell their stories but also to provide pregnant foreign moms with an informational resource on the different birthing options in Florence and what to expect, from natural home birth to fully medicalized hospital birth and everything in between.

Originally from Philadelphia, Kate Hash first came to Florence in 2005 to study at AIFS on Via Maggio. Her now-husband Rob came to visit her and they fell in love with the city. They decided then that they wanted one day to live together in Italy or somewhere else abroad. A few years later they were living in Louisville, Kentucky. Kate was working for herself, getting really busy and asking Rob to come work with her, and they realized there was no better time to move abroad. What made it so easy was that Kate qualified for Italian dual citizenship through her great-grandfather. This has also made everything with their daughter Livia a cinch because she was born Italian. Kate and Rob run their own internet consulting firm and write the popular La Vita e Bella blog.

M: When you got pregnant, what kinds of things did you do to prepare for the birth?

K: I’m a type A and I knew that if I read too much I would really overwhelm myself. So I decided I was going to read a few books in the first three months and then I was just going to be comfortable with it. So I read Ina May’s book…

M: Oh, so you read that early on? I didn’t read it till the end of my pregnancy.

K: I read it really, really early on. I read another one called Preparing for Your Childbirth. I stayed away from What to Expect When You’re Expecting. I really wanted the facts, and all the gory details. I wanted to just process it all. I loved the stories in Ina May’s book of women actually sharing their birth stories because they were all so different, and I felt like it prepared me for what I might expect in the process and challenges I might face, disappointments I might have. I just read those books and I actually made Rob read one…

R: I read the Ina May book. It was really good.

K: (Laughing) He would be like, Oh my god! Oh my god!

M: I read passages to Andrea while I was reading it. That’s great. It’s really key, so helpful.

R: She was in the state of mind to articulate what I wouldn’t have known had I not read this book.

K: So I read those books and a friend actually gave me hypno birthing CDs. I didn’t use them in labor. But for the month and a half before Livia was born, anytime I found myself thinking about pain, or if I was uncomfortable, I would listen to the CDs just for relaxation purposes, leading up to labor. So I found them very relaxing during that month or two before, when the pregnancy really takes over your whole being.

M: How about physically, did you do anything to prepare yourself?

K: I actually thought I would do more yoga. I was so excited to do yoga, but it was so dreadfully hot, and we don’t have air conditioning…We took walks. I also took really good care of my body with what I ate and I think that helped because I didn’t gain all that much weight and most of it came off really fast.

M: Did you go to any classes?

K: No. We thought about going to the classes offered by the comune [the city government], but it was summer and they didn’t offer them for a certain period when we probably would have gone. And I actually felt so confident…it was probably totally naïve confidence. I almost didn’t want to ruin it by going to a class! And I’m kind of glad we didn’t now because...I don’t know, I didn’t want to be scared. I was just in such a good spot that I didn’t want to ruin it.

R: Tell me if this incorrect but Kate’s personality is very much like, Let me figure it out for myself the first time.

K: Yeah.

R: And I think that was true with the pregnancy. (Turning to Kate) you probably didn’t want someone telling you how to give birth.

K: (Laughing) Maybe. I think it was also just a hot summer, the thought of going places…It sounds so simple, but it was also just a logistical thing for me.

M: Sure. And how about the care? What kind of care did you receive, and how did you go about finding it?

K: I immediately went to my primary-care doctor and she was really excited. She was like OK, now you have to go to the ASL and get the official pregnancy test. But the lab was closed at the time, for two weeks. So we were like, OK, let’s find an English speaking OB-GYN and just get the pregnancy confirmed that way. It ended up being a really great choice because he is an awesome doctor—actually one of your previous birth story subjects went to him: Dr. Scuderi.

M: Oh yeah!

K: He is fantastic. So we went to him, and he confirmed the pregnancy. We actually got to hear the heartbeat at like seven weeks. It was really neat. We kept seeing him about every six to eight weeks. It made us feel comfortable because we did everything in the public health system, which is all in Italian. And our Italian is beginner-to-intermediate, at best. So it was nice to know we were doing everything properly and to have him explain things that maybe we didn’t 100% understand. We got that amazing libretto, which as a first-time parent I found to be the most amazing thing in the whole wide world. One thing that really stresses women out in the U.S. is you talk to a friend and, well, she’s had four ultrasounds, [and you wonder] why has she had these tests and you haven’t...You start thinking My doctor’s not doing a good job…The libretto just standardizes everything so there’s no fear that you’re not taking care of your baby. Of course, if there are any additional tests that you need, you can get them. But I had pretty much a textbook pregnancy. To know when to do the next test, when to get the next ultrasound…We call it the idiot’s guide to pregnancy.

M: (Laughs) I know, it’s really helpful!

K: And for us, not being fluent in Italian, we could see what was coming next, read about it in both English and Italian, and prepare, maybe learn vocabulary if we needed it…It allowed us to be the type of people we are, which is to research everything before we do it. I think it helped our interactions in Italian with the doctors and nurses to be prepared.

M: Sure. Alright, tell me about the big day.

K: Well, labor started over a weekend. I was six days overdue. That’s also a really interesting difference between the U.S. and Italian systems. They will induce at forty weeks exactly in the U.S.; induction is really common. In fact, I’ve had lots of friends who were induced on their due date. You can almost schedule it. Here they made it very clear that unless you have problems they are not inducing you unless you get to be two weeks overdue.

M: Was that hard, to go over your due date?

K: No. I had a very good pregnancy, Livia was very good to me. I more just wanted to meet her. I would say to Rob, I just want to see our baby! I had really intense Braxton-Hicks--you know, those early contractions--for weeks. But there was a Saturday when it started getting clear these were real contractions. They were coming really frequently but they weren’t hurting, so we just went into the hospital and they were like, OK, you’re a centimeter dilated…

M: Oh, I forgot, we should probably back up a minute to talk about how you chose the hospital.

K: Well, one thing that was really helpful was your Florence birth stories. I read them over and over because…I mean, you should never choose based on one story, but it definitely gave me some perspective because I think that…each of the hospitals [in Florence] have almost like a personality, and you really have to figure out what you actually want and then find one that matches. So I just did a lot of research, I talked to a lot of people, and I kept coming back to Ponte a Niccheri. I thought about the natural birth center at Careggi [the Margherita]. But I was hearing so many mixed things about the actual Careggi that…I think it was you that said, If you go to Ponte a Niccheri and you like it, don’t even go visit the one at Careggi because it will look so perfect that you’ll want to go there. But I never actually had the urge to go check it out because we went to Ponte a Niccheri and we loved it. It’s actually where Dr. Scuderi does his normal job.

M: Oh cool, I didn’t know that!

K: Yeah. So we visited and everyone was so nice. I went there and I just felt comfortable.

R: Scuderi even said, When you go, tell them you’re a patient of mine, and they’ll at least know if something crazy happens they can contact him.

M: That's great. Did they have an information session?

K: They do, but of course it was, again, in that summer session when they didn’t offer it! We showed up and it was literally the first Tuesday when they didn’t offer it. We got a little tour though. We went up to the obstetrics department and they showed us around, which is really all you need. You just want to make sure there’s not something crazy that turns you off. I liked that they were really into natural birth. I never had a birth plan; I never wanted to get attached to anything, but my hope was to have a totally natural birth, and I like that this is something they really support in trying to make happen. That was really, really important.

M: Cool. OK, so back to you feeling that your contractions are the real thing. It’s Saturday. Did you call the hospital?

K: We decided to just go to the hospital because, again, not being totally fluent in Italian makes talking on the phone extremely difficult for us.

M: Oh, of course.

K: So we were like, Let’s just go in. And they checked and I was one centimeter dilated. They were so nice about it. I think it was probably late afternoon at that point, and they were like, Look, you can stay here, see how you progress. And we did. But then it was three or four a.m. and it was clear that it wasn’t going to happen anytime soon. They said, You can still stay here or you can go home, and I was like, Well, I’m going to go home. I’d much rather do this at home…So we come home at like four a.m. Sunday morning and we just spent most of the day here. Then around two o’clock in the afternoon it became clear that OK, this is what actual contractions feel like! So we called our pet sitter, she came and got Winston, and then I just sat in the tub for (turning to Rob) what, like two or three hours?

R: Yeah, you sat there for a long time.

M: Sorry, we’re talking here [at their home]?

K: Yes, just having the contractions…the tub was one of the most comfortable places for me.

M: Wait, so that’s interesting. You had the scary bad contractions and you decided to still wait it out here?

R: Well, what happened was—oh, you start (to Kate).

K: (laughing) Well, you probably have a better memory of some things than I do! They weren’t super bad, but I could tell they were the real deal. I just knew. I had a sense that I was going to progress very slowly, so we just stayed here until they got closer together. I assumed I would have back labor because that’s where I always have my menstrual cramps, and I prepared myself for a certain type of pain. What I did not prepare myself for was to feel the majority of my pain in my thighs. It was so bizarre. It felt like…I was a runner in high school, and after you would run certain races, the cramping in your legs would be terrible, and that’s what it felt like. Every three to five minutes. And you could actually see my muscles tensing up.

M: Wow!

R: We stayed here and put her in the tub because the first time we went in they told her, Get so that it’s so terrible you can’t stand it, then get in the tub and it will relax you, and when you can’t stand it in the tub, come. So that’s when we left. And we waited here as long as we did because she was having so much trouble standing.

K: So we got to the hospital and they checked and I was still only two centimeters dilated. But this pain in my thighs was just terrible. They have these shower rooms at the hospital in the maternity ward. So I just sat under a shower with a hand held thing and Rob was just spraying it on my thighs and my back. But it was funny, the pain in the back. Comparatively…In my head I wonder what the pain would have been like without the pain in my thighs. Because it was so bad, I can’t even express how terrible it was.

M: Oh gosh. That is just wild. I’ve never heard of anything like that.

K: Yeah, it’s funny, I came home and googled it, and there were enough women saying, Oh my god, this happened to me…My thighs were sore for a couple days afterward. So I was laboring and laboring till about two or three a.m. when they checked me again and said, OK, you’re about three centimeters dilated, so we can send you over to the actual delivery side.

R: Well, you’re moving really fast here. (Kate laughs). When we first got to the hospital it was only like ten p.m. First of all—

K: Oh, this is the best part…

R: The nurse that we met there—

K: Yeah! The intake nurse who was checking us in, she says to me in this beautiful Canadian accent, Do you want to speak in English? And I was like, Yes please! (Michelle laughing) And it turned out she is half-Canadian and half-Italian, her mom’s Canadian.

M: Wow!

K: I just felt like it was meant to be, because it could have been anyone else. And she was fantastic.

M: I’ve got to look her up!

K: She was amazing. She was there on that night shift so she was the one who eventually sent me over to the delivery wing and then she came and checked on us the next day with Livia. Yeah, that was fantastic.

R: She was the one who suggested the shower, she gave us hot water bottles to put on your thighs. They gave you a bed…

K: Yeah. Most of the rooms there have three beds. So they gave us a bed so we could lie down. And then in every room there’s kind of this second area that’s closed off behind glass. It’s got changing facilities, a scale, chairs for women to sit in. So I went in there because there was another girl in my room and I did not want to keep her up all night with her baby with my early labor.

M: I know, that’s so tricky.

K: We were in there for most of the time, or I was in the shower with Rob spraying my thighs. But then once I hit three centimeters they sent me over to the delivery area and it was fantastic. There was a king-size bed—

R: Or bigger.

K: Yeah, it was huge. So he was able to just lie down in the bed with me.

M: That’s so cool. You just picture in the delivery room this thin bed…

K: Yeah. That was really nice to be able to lie down and relax. And they were like, Look, you can get up and go into any position you want. But I was so tired that it just felt good to lie down, and I think that’s an important thing to point out of something I wish I had done differently. The early labor started on Saturday and at this point it’s already late Sunday into early Monday morning and I had barely eaten or slept. I really wish on Saturday I had just stuffed my face either with saltine crackers or something really basic. It’s funny what you prepare yourself for. I prepared myself for labor pain, but what caught me off-guard was the exhaustion, the absolute exhaustion of once you’re sixteen hours into it. Because it became that I was almost too tired to manage the pain. And my thighs were just killing me. One thing that I loved—we were on three different shifts of midwives and they were all so amazing. I kept waiting to get a new shift with someone that I didn’t like. And it never happened. I walked away from pregnancy and labor with so much respect for midwives. That job is just intense and amazing. But they were all so wonderful and so attentive to me. And making suggestions for things that might make it better. I was progressing, just very slowly. And I was so terribly exhausted by everything. One midwife came over and she basically said, You’re very, very tired. Are you having trouble managing pain?Have you thought about an epidural?

M: Wow, that’s so interesting.

K: Yeah, because the rumor on the street is that you can’t get an epidural at Ponte a Niccheri! And I was really upset. I cried and said I really wanted to try for a natural birth but I also knew that I was having a really tough time with my exhaustion. So I was like, Yeah, I would consider it. The way it works is that you can’t just ask for it and get it, they have to have a doctor come over and look at you and essentially prescribe it. It was probably at nine o’clock that they suggested it and I said yes.

M: Nine o’clock Monday morning?

K: Yeah. And then of course I got it into my head that I was going to get one! So an hour goes by, an hour and a half goes by, and no one’s come up to me. It turns out they just want to see if you’re actually going to need it. I don’t know if it’s partly psychological, that it helps you to relax a bit or something…

R: That was the one point in the whole process when I was like, Come on! You can’t just walk away and not come back!

K: So at eleven the doctor came by and said, Yes, she needs one. But then it was still 45 minutes until the anesthesiologist came up and I got one. But it also made me feel better because I was thinking, OK, it’s been two and a half hours since they asked me, and it’s still clear that it would help me. Because at that point it started to get really slow with the progression. The contractions were still coming normally, I just wasn’t dilating anymore. So they came and said to Rob, Go down to the cafeteria, get a coffee, get something to eat. And he was like, No, no, no, I want to stay. But the nurses were insistent, they were like, No. You need to get some nourishment. Because he also hadn’t eaten or slept much in the same time period.

R: The real work was on me.

K: (Laughing). He loves to make that joke and I always want to just [pretends to hit him]. Once they took me out of the room to give me the epidural, he did go down. I think it actually made a big difference in how he was able to help me, just to get a little nourishment. But I’ll never forget, they were giving the epidural and they were like, OK you have to sit really still. But of course I’m having contractions, so I’m trying to not move during a contraction!

M: Oh my god.

K: And then the epidural was like magic. As someone who so in my head wanted the natural birth, I can’t even express the elation of two hours without pain. Because they were very clear that they weren’t going to make it so it stayed for the pushing as well. They were like, We’re going to make sure we time it so that you can feel your pushing. Which again is different from the U.S. for sure.

R: They basically just treated it as a rest period for her. They encouraged her to sleep through as much of the contractions as possible.

M: Aw, yeah, it’s a great idea.

K: And they timed it really well, so I think it was maybe two and a half hours later that they were like, OK. And Dr. Scuderi actually came on at that point and he checked me. And the midwife was like, OK, we can start pushing!We can do this! In the beginning, as the epidural was wearing off, it was definitely just me trying to figure out when to push, but then as it completely wore off I could really feel when to push.

R: They started you pushing in that large bed and then they moved her—it was like a large suite with a bathroom in the middle—to another room. That was the delivery room.

K: The actual delivery room. I pushed for about 45 minutes in the big bed and then I thought they were joking when they said, OK get up, you have to move to the delivery room. I was like, No. I’m not moving. I’m in the middle of having a baby and you want me to walk to a different room?! But they did.

R: Well, two midwives took her arms—

K: They helped, it’s not like they just kicked me into the other room or anything--

M: Sorry to interrupt but were they telling you to push?

K: They were being very supportive. They were like, Look, where the baby is, you’re probably going to start getting the urge to push. And I said, Should I push? And the midwife was like, You need to listen to your body and really push when you feel it. In the beginning as the epidural was wearing off it was just me feeling ever-so-slightly the urge to push. But then as it started to really wear off I was like, Oh, this is kind of exciting. Honestly, I was smiling during some of it because it was so exciting. Because you labor for so freaking long, that to actually start pushing felt amazing, it felt productive.

R: In the beginning you said you were trying to pay attention to the pressure, not the pain.

K: Yeah, when you have an epidural, it’s more like feeling pressure not pain. But then it started to get painful and I went over to the actual delivery suite and that’s where of course there’s the old-fashioned bed with the stirrups…And that’s when it felt real, it was like, Holy shit, I’m going to have a baby. (Turning to Rob) And I think that’s when it started to hit you too.

R: Yeah, I mean, it’s pretty real! (Michelle and Kate laughing)

K: For your first baby, you’ve never held your own baby in your arms, so you just can’t wrap your head around it.

M: I know.

K: But it was when I got in that room I thought, Oh my god, in an hour I’m actually going to be the mother to a human being. It was this crazy feeling. But that’s also the point where any Italian was out the window for me.

R: Oh yeah.

K: It was funny because he would say, The nurses want you to do this and that, and I’m like, How do you know this? Are you making this up? (Michelle laughing). And he was like, No, they’re saying this in Italian and I’m telling you in English! I was just not there. Of course, most medical people here do speak a bit of English, so he would translate for me and I would be like Listen…And they’d be like, Sì sì! He’s telling you the right thing to do!

M: (Laughing) Oh my gosh, that’s cute.

K: Yeah, it was cute even in the moment because then I was like, OK... But one thing that is funny about this delivery room is that they have these bars for your arms so you can really bear down and push. I was using them and it was awesome. But for days—not even days—weeks [afterwards I was in pain]. I used muscles that I’ve never used. And I couldn’t even…I could pick Livia up for the first couple weeks but I couldn’t put her down!

M: Wow.

K: I did something terrible to my arms. I joke that if we get pregnant again I’m going to do bicep curls to prepare. But it was awesome in labor to be able to really bear down. Again: unexpected. You don’t think, Maybe I should do some bicep or tricep curls in preparation for labor.

It was funny because initially Rob said he didn't want to see the baby being born. It kind of weirded him out a little. But he had four Italian midwives saying, Robert! Vieni qui, vieni qui, you have to look! He was like, I couldn’t say no, these Italian women were yelling at me! So he actually did watch it. He said it was amazing. And I could see it in his face that I was actually progressing.

M: Right, that must have been helpful.

R: Well, she kept asking, Rob, am I really making progress? And I was like, Yeah! She didn’t believe it. But I could tell her.

M: Wow, that’s so cool. So you were talking about how you were really happy about the pushing. Does that mean that the pain of pushing was not as bad as the contractions for you?

K: Yes, absolutely. I mean, it sounds crazy but pushing was easier to me just because of how the pain was manifesting itself in my body. I’ll never forget those contractions. But one thing was, there were probably a few more people in my delivery room than usual because there had been meconium in my waters when they broke—

M: Wait, we didn’t talk about water breaking! When did your water break?

R: It broke in the hospital before we actually went to the sala parto [delivery room].

K: I didn’t even know! I mean, I was pretty sure when it happened, but I didn’t have the gush that a lot of women have.

M: And there was some meconium in there?

K: There was, so they wanted to make sure—they had one of the neonatologists come down just to make sure [Livia] hadn’t aspirated any of it. I was so prepared to have her on me immediately when she was born, but because they had to check this, they had to take her right over. It was funny though, the last few pushes happened really fast. And it was crazy because like, There’s a baby!

R: Yeah. But she came out face down, so we just kept seeing little bits of head…We knew once she got past the big head that it would go quickly, and that’s exactly what happened.

K: So they whisked Livia about four feet away to check everything. Then of course I delivered the placenta. Then they stitched me up just a little bit, and then they took me back to that big bed to relax. At this point I still hadn’t even seen Livia! So Rob was in there hanging out with her and he comes in to the room where I am—it’s just literally separated by a very small walkway—and I was like, Tell me about her! And he was like, She has really big feet. (Everyone laughs). (To Rob) This is the first thing you’re telling me about our daughter! So I said, Let me see a picture. And he runs back in to go and take a picture. It was really sweet because I think--in this day and age when 15 seconds after a baby is born there’s a photo on Facebook--that he was so busy just taking her in, he didn’t even think to take a picture till I said it.

R: There’s a little funny story though. Right after she was born, the doctors were checking her out and they said, What’s her name? And we said, Livia and they said, What a great name. Wait, who was Livia again? But they were saying this in Italian. And the doctors were having a little conversation trying to figure out who she is, and the woman who didn’t understand a word of Italian all through the delivery, responds! Literally three doctors turn around saying, She speaks Italian!

M: That’s hilarious.

K: It was this really funny moment where I was like, Oh wow, I understand Italian again! Like this split second where I was back in my right mind. So he hung out with her for a little bit, and then he brought her in to me and the three of us just lay in this bed for like an hour and a half, which was really nice. We were just sitting there mesmerized by this little person. They were also running a bunch of tests to make sure everything was OK. So I think we may have stayed there for a little longer than someone with a totally normal birth does. But everything was fine and they put me in the wheelchair with her in my lap and we went back over to the actual maternity ward. I had at that point two roommates, both of whom also had girls.

R: One of them was from the night before.

K: Yeah, I apologized to her for making so much noise. And she was like, Oh no, that was me two nights ago. But it was really fun, they were both really sweet, they both had really nice husbands. When I tell people in the U.S. that I didn’t have a private room, they’re like, Oh my god! You had to share your space? But I can’t imagine having had a private room, because it would have felt really lonely and isolating. I actually really enjoyed having other women around me who knew exactly what I was going through. None of us could sit down in chairs; we were all waddling around the room. It makes you feel like you’re not alone. Particularly at night when the husbands go home.

M: Well, sure.

R: Plus you had someone there that was two days ahead, and one day ahead of you. So she could literally see the progression.

K: Yeah, that helps out a lot.

M: Sure. How about the breastfeeding?

K: (Sighs) It was a challenge. She breastfed well in the hospital, but then I had a lot of trouble when we got home, just a ton of trouble, a lot of pain…So I started pumping a little bit because that helped, and then we just supplemented with formula and for the first three months we did a mix of the two, but I could never—breastfeeding just never worked for us. And it was so sad and I was really upset about it.

M: Oh, I’m sorry.

K: Then finally I made the decision. I can be really upset and be not a full mom to her because I’m so upset or I can just accept it and move on. And once I did that, it got a lot better.

M: Good for you.

K: Yeah. But it’s hard when you want it to work so badly and it just doesn’t. And of course, as soon as I stopped she got bronchitis, and I thought, Oh it’s because she doesn’t have my antibodies anymore! I just had a lot of nipple pain. Honestly, it was terrible. It got to the point where I was dreading the contact because it hurt so terribly. That’s when I knew I was going to do just the pumping.

M: Because the pumping didn’t hurt?

K: The pumping didn’t hurt as much. But it still hurt.

R: You had supply issues…

K: Yeah. And I tried everything! We actually started out with one pediatrician and then we switched. But the first pediatrician was like, If you drink three liters of water, your milk will come in. And I was thinking, If I drink any more water, I’m going to explode.

R: She literally had a glass of water with her all the time.

K: I was constantly drinking water. I literally tried everything.

R: There was one day I’ll never forget. It was just clear she wasn’t getting enough and you went down and bought a breast-pump…and literally cleared off the shelf. She bought everything…came back with all these bags…

K: I had no idea what I’d need…

R: Then we started researching formulas and went and bought Neolatte. Then they started supplementing.

M: Yeah, I supplemented from the start, for different issues. But I’m all about that, I think it’s ridiculous when people say you shouldn’t.

K: One thing that’s really hard for me, and I think that’s one of the fatal flaws of women, is that we like to pick on each other. There are some people who only formula-feed that think people who breastfeed are disgusting, and then there are breastfeeders who think that formula will kill your baby. And it just makes me sad because if women could just support each other, whatever happens, there wouldn’t be this…there would be the guilt that you feel as a mom that you couldn’t do it, but there wouldn’t be this idea that other women are going to judge me or hate me.

M: It all comes out of this defensive feeling, of I’m not good enough, so you know…it all comes from our own insecurities. Yeah, it’s tough.

K: I love our families and friends back in the U.S. but I actually felt really fortunate to be pregnant and to give birth so far away from all of it because I felt like I was in this very safe cocoon. From the moment you’re pregnant to the time you give birth, and even when you’re raising your child in the U.S., it seems like someone is constantly judging you, second guessing something. I mean, strangers will stop you and say you’re doing things wrong…And I’ve never felt that here. I just felt good. And maybe that’s why I had that blind confidence going into labor, because I just felt like we had done everything and made choices that made sense for us from the very beginning and that felt very empowering. I went out for lunch with girlfriends when I was a day or two overdue and my friend was like, Give it to me straight:Are you really scared of all the pain? And I actually said, No, I’m just really not. I feel like when you find out you’re pregnant, you can either be consumed by the thought of pain or you can come to terms with it. Yes, it’s going to hurt like hell, and then focus on other things. And that’s kind of what I did.

R: Yeah, you never let it distract you. You were never the type to plan a c-section or schedule any kind of designer delivery.

K: I don’t think you could even get that here if you wanted to.

M: Actually, I’m not so sure. Italy has one of the highest c-section rates in the world. It’s quite popular here.

R: Huh.

M: I think you had a rather exceptional experience because Ponte a Niccheri is one of only about 20 hospitals in Italy that conform to UNICEF standards.

K: I honestly cannot speak highly enough of that hospital. I’ll never forget Dr. Scuderi walking into the delivery room as I’m pushing. Livia’s like five or ten minutes away from being born, and he was like, The two Americans! You’re here! Are you excited? This is going to sound terrible, but in the U.S. I’ve encountered many doctors whom I’ve walked away asking myself, Do you even like your job? Do you like what you do? And here…

R: Like we said, we kept waiting for the bad one to come on, and it never happened.

K: Dr. Scuderi I think is still entranced by the magic of birth, and I think that’s amazing. He’s pretty late in his career. When we heard the heartbeat at seven weeks, he was like, This is amazing!

M: Wow. And you imagine this is what he does, how many times?

K: I know! The passion and the dedication…Even the midwives’ job blows my mind.

R: One thing we didn’t mention that I was impressed with was that when a shift change came, each midwife introduced the next one coming on to [Kate], and they wouldn’t leave until they were both in the same room at the same time. It made it really comfortable. It wasn’t like someone just left and someone new came on. We had one midwife who I know stayed 15 minutes after her shift changed because, I don’t know, she seemed to like us, like you.

K: Well, we were a bit of a novelty too because even though I have the dual citizenship, we are still very much two Americans.

M: Yeah, it’s usually an American woman with an Italian husband.

K: Exactly: we were a novelty. So I think that was part of our allure. But I was just so, so impressed with the hospital and the care. And then of course this idea of walking out with no bill. And, yes, I pay taxes here, so I know that it’s not free in every sense of the word.

R: It was nice to worry about what she needed rather than…

K: My sister gave birth two weeks after I did, and she stayed in the hospital for only one night because she would have had to pay so much to stay a second night. And she has insurance! I think her hospital stay cost her $600 or $800...

M: On top of the insurance?

R: Yeah.

K: And this is normal. It’s fascinating to us. And to have all those tests done, the libretto, and to never have to really worry…

R: You also liked the rooming-in…

K: Oh yeah, Ponte a Niccheri does the rooming-in, and to have her with me the whole time, even when I was in tons of pain and it was hard... I couldn’t imagine not having had her right there. I really liked that. I read a lot of nightmare birth stories too of expats in Italy, and I think…sometimes I think it’s—particularly American women—not recognizing the really important differences and deciding if that’s too much for you. If I had looked at all the hospitals and none of them were right for me, I probably would have gone to Villa Donatello, the private one. Because I think sometimes when you see Americans commenting on the Italian system, it’s all these things that... it’s just how it is here; things you can’t change. A lot of people are shocked—I hear American women say this all the time: They told me to bring my own sanitary napkins! (laughs) And I’m thinking, I’d much rather spend 20 euro on supplies, and not have a bill when I walk out of the hospital than go to a hospital in America and have everything provided but then have a huge monstrous bill when I walk out.

M: Seriously.

K: It’s funny, everything they told me I would need to bring to Ponte a Niccheri they actually provided anyway. The one thing we routinely forgot and I had no idea to bring was silverware. So we had to keep sneaking into the staff break room and ask [in a sheepish voice], Can we please have some cutlery?

R: I totally forgot to bring it every day. But actually we thought the food was great.

M: It really reminds you you’re in Italy, right?

K: And of course they know exactly what to serve women who’ve just had babies. You know, stuff that actually sat well in your stomach.

R: Just very bland, but in a good way.

K: But also, I had trouble with my bladder right afterwards, and I had a fabulous midwife who overnight found what the problem was and fixed it. And then the next morning, the next midwife came in and said, I read your file, I saw you had trouble last night and kept an eye on it all day. It just felt like you didn’t have to explain anything to them, they just communicated to each other. That could just be specific to a hospital where the staff like each other and try to make the next person’s job easier.

R: She was in a lot of pain and we had no idea what was going on...We were just thinking, you know, Is this a big issue or a small issue? And it was so nice to come back the next morning and they had figured it out. She was tired, but I could see this relief on her face.

K: Yeah, we almost had to stay an extra day and it wasn’t because of Livia, it was because of me. They wanted to make sure my system was OK. They wouldn’t let me leave till they did an ultrasound to make sure I was OK.

M: Is there anything else you'd like to add?

K: I think one thing that Americans do in particular is we assign quality of healthcare visually. So if I walk into an office and it has a flat-screen television, nice waiting-room chairs, beautiful art on the wall, maybe some plush carpeting, I’m thinking, This is a really good doctor’s office, I’m going to get excellent care here. And that’s not really true at all. Particularly in Louisville, I had serious stomach problems and I saw four great gastroenterologists with beautiful offices who provided terrible care. Until I finally found one who actually had an office that reminds me a lot of doctors’ offices here. You know, 1970s building…and I think that’s what a lot of American expat women have trouble getting past: the buildings aren’t glamorous, and when you walk into your doctor’s office, it’s probably not going to be fancy. Even my primary care doctor, her office is very, very simple. I was having stomach problems, and she was the first doctor who actually gave me a physical exam in years, who actually put their hands on me. For me, that was the moment I changed my opinion. You just have to get past the fact it’s not fancy, but it’s good quality care.

M: I think any American women that are fairly new here are going to appreciate that information.

R: Yeah, that and what you said earlier, that you just have to embrace what’s never going to change about the Italian system.

K: And decide what’s most important to you. Because, especially in Florence, we’re lucky that we have a lot of hospitals to choose from, and they have such different personalities, for lack of a better word. I just knew what was most important to me and I was willing, not to sacrifice the other things, but I was willing…

R: To prioritize.

K: Yeah. And we were lucky that we had a really good experience.

R: It was great.

M: That’s great. I’m so happy for you.