After a long hiatus, I'm thrilled to bring back my Florence birth story series, for which I interview other foreign mums about their experiences giving birth in Florence, Italy.

See stories 1-5 (plus my own) here:

Peanut's Birth Story, Part One: Au Naturel, Italian Style
Peanut's Birth Story, Part Two: From Heaven to Hell
One: Kim and Ariel at the Centro Margherita
Two: Lisa and Matteo at Torre Galli
Three: Miriam and Esme at Home
Four: Jonnel, Niccolo' and Gabriel at Villa Donatello
Five: Kate and Livia at Ponte a Niccheri

This story comes from a Canadian friend who gave birth a couple years ago at the private clinic of Villa Donatello, which unfortunately has since closed its maternity ward. However, I think we should be aware of what was once possible. Her story is also really valuable for the insight she provides on the Italian approach to things like pain management and following women through pregnancy. She asked me to use her and her daughter's middle names for privacy reasons.

Hi Kate, please tell us how you ended up living in Florence.

I moved to Florence over 4 years ago with my Florentine husband and our two young sons. My husband had the opportunity to work in Italy, I had always wanted to live abroad, and we wanted to give our children a sense of their roots here.

Let’s start with your pregnancy. Did you prepare for the birth in any way? Read books? Take classes? Did you come across any particularly helpful resources to this regard in Florence?

This was my third pregnancy in 5 years, so I remembered a lot from my earlier experiences and only occasionally looked over my old pregnancy books. Aside from talking to my Italian friends and family about their experiences, I did not look for specifically Italian resources—maybe I should have, because I found the inter-cultural aspect of giving birth here a much bigger challenge than I had expected!

Can you tell us more about that?

I’m sure an anthropologist could get into this issue much better than I could, but I discovered firsthand some of the many differences between Canada and Italy! To broadly generalize, I think there is more deference here to “experts” and traditional ways of doing things (so you aren’t supposed to ask as many questions), and people tend to worry about different things. I felt like there was this expectation that I would think exactly like an Italian just because I'm an educated western woman who speaks Italian, and that therefore I didn't need any cultural mediation.

Did a doctor follow your pregnancy? If so, did she or he attend the delivery?

Yes and yes. I had a planned c-section—I had an unplanned c-section after a failed induction with my first born, then a planned section with my second son since he was born only 18 months later. I was not interested in trying for a VBAC [vaginal birth after caesarian] after 2 sections (and I understood that even if I had wanted to, I might have had a hard time convincing a hospital here to allow it). So I knew I needed a doctor for the birth and I wanted the same person to follow me throughout my pregnancy.

How did you decide where to give birth?

One of my first calls after finding out I was pregnant was to one of my husband's cousins—a neonatologist who has both worked and given birth at both Torregalli and at Villa Donatello. I found it really helpful to talk to her both to gather information and also to calibrate my expectations of giving birth in Florence after my experiences in Canada. I knew that I was going to be in the hospital for a few days after the birth, and it was very important for me to be able to sleep in the hospital. I had had a hard time getting any sleep in a semi-private room (with babies and partners rooming in) after my first son was born, and I was pretty desperate for some sleep. So I really wanted a private room! I also knew that I wanted my husband to be with me during the birth, I wanted to breastfeed as soon as medically possible, and continue to breastfeed on demand. I also wanted nursing/midwife/doula like support after the birth. I knew that it is no fun changing diapers 30 hours after major abdominal surgery, and while I wanted to exclusively breastfeed and bond with my baby, I also wanted to recover as fast as possible from the birth.

I was told that there was no guarantee of having a private room at Careggi, even in the private payment maternity ward, nor in the other public hospitals. Villa Donatello had only 6 rooms in the maternity wing, but they were all private. Villa Donatello also provided a lot of support postpartum—there was a good ratio of nurses and midwives to patients, the option of either rooming in with your baby, or the baby spending time in the nursery, and the only change table was at the nurses' station—just ring and the baby would be changed! There was also the option of staying longer in hospital—5 days postpartum after a c-section—than in the public hospitals. I heard that all hospitals were supportive of breastfeeding, at least in theory, but that at least with a c-section, the medical side of things takes precedence and it might take a while to meet the baby. I was also told that unlike my experiences in Canada, regardless of the hospital, unless my husband was medically trained himself (which he is not), he would not be allowed into the operating room for the birth.

I know I am very fortunate because I have health insurance through my husband's work so I could consider having private medical care here without worrying about the costs. As a Canadian, I am used to having only public health care without user fees, so it took a bit of getting used to having to pay anything for health care, even "tickets" in the public system. The Canadian system is very different from the Italian public system. I got my libretto della gravidanza here, and (again, compared to my experience in Canada) was not impressed that I had to go to an inconvenient place at an inconvenient time merely to chat with a midwife and book appointments 6 months into the future. After the midwife wanted to schedule me for CVS, an invasive prenatal test, since I was "entitled" to have it, without even considering whether it was necessary or telling me about the doctor(s) who might perform it, I told her I would consider doing it, if necessary, privately. My private doctor wisely suggested doing the non-invasive tests first, and as the results were normal, I was spared an unpleasant, unnecessary, and moderately risky procedure. I ended up doing everything privately here—from my lab tests, doctor's appointments, to birth at Villa Donatello.

However, had I had pregnancy complications or anything other than a scheduled section, I probably would have gone to Careggi. Villa Donatello does not have a newborn intensive care unit. Many of my Italian friends preferred to deliver at a level 3 hospital like Careggi just in case there were serious complications for them or for their babies.

It's too bad Villa Donatello has closed its maternity ward. Do you happen to know what private options remain in Florence?

I don't think there are any left. I understand the nearest clinics where you can deliver privately are Pisa or Bologna.

Can you tell us more about some cultural differences you observed during pregnancy?

There are some differences in food taboos—here there is more concern about toxoplasmosis, so more of an emphasis on cooked/peeled vegetables and well cooked meat. Listeriosis doesn’t seem to be a concern here, so you can eat (certain, well seasoned) deli meats. My Italian doctor was very relaxed about wine or beer consumption, but was horrified at the thought of a sip of cognac or other “superalcolici”! No one here seemed to care much about caffeine consumption—while in Canada I remember a tactful Starbucks barista asking whether I wanted my coffee decaf when I was clearly pregnant.

In Florence I also heard more comments about how many children we were having/how closely our children were spaced, and I don’t think that would have raised any eyebrows in North America. On the plus side, no one thought I was old for being pregnant at 36 and I escaped the “geriatric pregnancy” discussions my Canadian friends had with their doctors at the same age!

Yes, you definitely don't feel out of place here being pregnant in your late 30s! Please describe your experience of birth: who was there with you; the kind of care and support you had; how long it all took; how you were feeling throughout; any particular thoughts you had, or funny/dramatic moments that stand out.

I was lucky—I scheduled a c-section, and gave birth when, where, and how I expected to. At Villa Donatello, they typically schedule sections either early in the morning, and request that you admit yourself into hospital the night before, or in the early afternoon, when you come to the hospital mid-morning. I opted for an early afternoon section because I wanted to see my older children that morning and I did not want to spend the last night of my pregnancy in the hospital.

My husband and I arrived a bit after 9 am, did some admittance paperwork, had some time to settle into our room (which was nice—I kept on referring to the hospital as a "hotel" when I was there!) and the most urgent thing for the nurses seemed to be getting my husband's lunch order in because if we ordered too late in the morning, not everything on the menu would be available! Unfortunately, I was fasting (I was told to have a light breakfast with clear fluids) but the menu looked good!

I then had a few meetings with the midwives and doctors, and about an hour or two before I was scheduled to go in, I was asked to wash my belly with antiseptic soap, change into a gown, and had an IV put in. It was a very calm environment—we were excited and nervous as we waited, but it was a pleasant, sunny, quiet time together.

My husband's cousin was coming for the birth to support me in the operating room, and for weeks I had been campaigning hard to have my husband present in the operating room. He had been with me for our sons' births and I really wanted his support during the birth. Everyone, both at Villa Donatello and others I had talked to about this, had told me that it would not be possible for logistical, insurance, health, etc. reasons, but I was persistent and about an hour before we started, we were told that he could come in. One thing I did not like about having a section here is that the surgery really trumped the fact that this was also a birth—the head of the maternity department (who had agreed to advocate for me) did not have the power to admit people into the operating room—that was at the discretion of the head of surgery and probably required some additional permissions from a health agency. I was very happy to hold my husband's hand while Emma was being born, and I am so glad that I persisted in insisting that he be present. The team—the head midwife, my obstetrician, a second obstetrician, the anaesthetist, the neonatologist, and a few others I was not introduced to, had trooped into our room to check in on us before things really got started.

Everyone save me and one of the nurses left to scrub in, and I was rolled into the operating theatre. The anaesthetist was really fantastic—I felt very comfortable with him, he was very skilled (I had no problems with nausea, trembling, or side effects from the spinal), funny, and responsive. There were a lot of nurses, doctors, and midwives bustling around the operating room, and my husband and his cousin soon joined us. The atmosphere was great -- lots of positive energy, and '70s rock playing (the lead doctors were all in their 60s)! I remember hearing "Ruby Tuesday" and Battisti's "La canzone del sole" when I was being sewn up. Once I was draped and the actual surgery started, there was very little conversation across the screen, but the anaesthetist kept me updated.

I felt the movement when Emma was born, and felt so happy and relieved when I heard her first cry. After I had a very brief look at her, the doctors examined her. I knew from talking to my husband's cousin that, unlike my experience in Canada, hospital protocol had newborn babies examined in another, slightly warmer, room rather than the operating room where I was. I requested, and received, frequent updates as to how Emma was, and felt reassured to have two family members, including an expert, keeping an eye on her.

Unfortunately she had aspirated some amniotic fluid, so the doctors had to suction her and, in the end, I did not nurse her until about 18 hours after she was born. Intellectually, I knew that her glucose levels were fine, and that it made sense to have her in an incubator until her oxygen levels were stable, but I found it really hard emotionally to be separated from her and not to breastfeed her right away.

I did get to cuddle her for a few minutes while I was still in the operating room, her incubator was moved next to my bed a few times, and I did do some skin to skin cuddling with her in those first hours. However, I was anxious about her health and in pain from the surgery, and it was not the happy first hours I had enjoyed with my sons.

The hospital staff were sensitive to updating me frequently and explaining why they thought it best to have her in the incubator. I appreciated that.

You are so so lucky you got to have your husband in the room with you, and it sounds like it was a great experience overall. How was the postnatal care?

I stayed in the hospital for almost five days after Emma was born to recover as much as possible before coming home. It was a really tranquil environment—I appreciated the quiet and being able to focus just on Emma and myself. My husband spent a few nights with us in hospital while my parents stayed with our older children.

My doctors visited regularly, more than my experience in Canada, and the hospitality side of the hospital (if I can say that) was well done.

There was a big cultural difference in attitudes towards pain management. In Canada, the focus was on a pain free recovery. In the first 24 hours after birth, I was given morphine by IV with a button to increase the amount if I felt pain. Nurses constantly asked me to rate my level of pain on a scale of 1-10, and if I said anything as high as a 3 or 4, they told me to take a painkiller. I was also urged to medicate to try and stay ahead of the pain—in hospital I was given a box of Tylenol (paracetamol), a box of ibuprofen, and a chart with instructions to take both drugs regularly as long as I was feeling any pain, and not to hesitate to call if I still felt pain after taking both drugs (the nurses would then bring me OxyContin). When I was discharged from hospital, I had a prescription for a painkiller, and again, was told to use it to feel comfortable.

My experience was very different here. I felt like a drug addict for asking for paracetamol 30 hours post-surgery! Like my experience in Canada, I was also given morphine postpartum, but what felt like a miserly trickle of it, with no button to push if I was feeling pain (which I did—my hours after surgical birth here were among the most painful in my life—including induced but pre-epidural labour with my firstborn). In addition, I was given several doses of oxytocin to contract my uterus faster, which was also painful (but I did fit into my pre-pregnancy jeans a bit faster than I did with my other kids!). The whole idea of taking paracetamol regularly was foreign to the nursing staff—they only wanted to give me medicine when I asked for it. One of the midwives told me that I really shouldn't be taking so much Tylenol, and another seemed to think I really was a drug addict -- she brought me a strong prescription painkiller instead of the paracetamol I had asked for!

I probably should have expected that pain management attitudes would differ, but I was surprised at how big the differences were. However, partly because of the different attitudes, and I think partly because I was in a more restful place to recover for longer than I had been in Canada, I did take fewer drugs after this birth than with my sons.

Right, there are advantages I guess to both approaches. Can you tell us how breastfeeding went in the hospital?

I had had a lot of experience breastfeeding my first two, and fortunately Emma and I didn’t have any problems—once we finally got started! I do remember the midwives asking whether I agreed with giving her a pacifier in the hospital if they were quite sure she just needed to suck. So while I never used a pacifier with my first two (but often did use a finger), she started early!

What part of your experience reminded you the most that you were in Italy?

The many ringing cell phones in the delivery/surgery room! It seemed as if there was a nurse constantly asking the doctors and nurses whose phone was ringing, whether she should answer it, and if so, what she should say!

I also felt, very literally, the "bella figura" body expectations for pregnant women here. It felt like everyone, strangers included, was constantly telling me how good/tired/large/small I was looking and speculating on whether I was carrying a girl or a boy. I knew I was looking good that day if random strangers guessed I was having a boy and was less farther along than I really was. However, that did not always happen! I was thoroughly sick of hearing the "un kilo per ogni mese" expectation—the idea is that women should only gain 9 kg (20 lbs) during pregnancy, maybe slightly more, but nothing like the 25-35 lbs expectation I had been told in North America. Some of my Italian friends are tiny, and had small babies, so maybe 9 kg is plenty if you are only 50 kg and 150 cm to start with, and have a baby under 3 kg, but I am bigger, and so are my babies! As with my second pregnancy, this time I started at a healthy weight, gained a total of 11 kg, and gave birth to a 3.5 kg baby, so I thought I was fine. However, I gained very little in the first few months, and then a few kilos at once during my second trimester, and my doctor told me that I "could have gained less" that month and put me on a diet for several weeks. I was really unhappy about that, especially since I felt I could hardly eat anything between my North American pregnancy food restrictions and the Italian ones my doctor insisted on!

I think there is a different cost/benefit analysis in prenatal, and perhaps all, medical care here that I had not appreciated before. Take toxoplasmosis as an example. In both Canada and Italy, about 1 or 2 in 1000 women are diagnosed with a new toxoplasmosis infection in pregnancy. Doctors in both countries agree that a new toxoplasmosis infection in pregnancy is a bad thing, and routinely test newly pregnant women for their immunity to toxoplasmosis. Since toxoplasmosis can be found in food (which I understand to be the principal transmission vector, at least in Italy), in both countries we are encouraged to wash fresh fruit and vegetables well and eat fully cooked meat. However, in Italy my doctor told me also to avoid all fresh herbs, berries, leafy greens, etc. and to peel just about anything I did eat fresh to avoid exposure to toxoplasmosis. I was also asked to do a blood test almost every month I was pregnant just to make sure that despite these precautions I was not infected with it and asymptomatic. Perhaps the Italian protocol results in fewer infections and better health outcomes if infections are caught earlier, but I really don't think this has been proven. The Italian protocol definitely imposes higher costs, obviously on the laboratories analyzing all of those blood tests, but more importantly on all the women who must restrict their diets for months, go for regular blood tests, and stress over the fact that they might have eaten some freshly picked unwashed strawberries before they knew they were pregnant. I did not feel that my time, discomfort, or psychological well-being was a factor in the medical advice I received here.

Wow, that is really interesting. And you had private care! If you could do it over again, is there anything you would do differently?

I probably would have found a second gynecologist to follow me during the pregnancy. My doctor was excellent at prenatal testing and surgery, and I would go to him again for those things, but I really underestimated my need to receive medical advice from someone I could relate to on a personal level (and who was more conveniently located, not to mention consistently on time with appointments). I also wouldn't have bothered with getting the libretto. And I would have taken more photos.

More photos! Me too. What was the best part about being pregnant and/or giving birth in Florence?

The gelato! And the kindness and good wishes of strangers.