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HEALTH

‘What it was like being pregnant during the pandemic in Italy’

New mother Shirin Georgiani gave birth during the pandemic in Italy. Here she gives us the lowdown on the Italian healthcare system and the support networks available.

'What it was like being pregnant during the pandemic in Italy'
Going through pregnancy during a global pandemic, alone or in a new country, can only add to the anxiety - especially if there are language barriers too. Photo by freestocks/Unsplash

On Sunday 23rd February 2020, the news had just broken that Italy was the first country in Europe to be hit by coronavirus, after China.

At that point most of us still didn’t think we would be in any serious trouble. After all, we lived in Italy, in Europe. But then, as I was enjoying what would be my last Aperol Spritz for the next nine months, I overheard someone say that schools were being closed down as of tomorrow.

READ ALSO: ‘We’re exhausted’: What it’s like planning a wedding in Italy during the pandemic

I checked my emails –  there was a message from the international school my husband and I teach at saying that the school would be closed for the rest of the week, pending further notice.

This is when I started to feel nervous. If they’re closing the schools, this must be serious.

I was especially concerned because, earlier that morning, I had just found out I was pregnant. 

Over the next few weeks I went through a rollercoaster of emotions – from being excited that we were going to have a baby, to downright panic about catching the virus and getting sick or worse. Not to mention the lack of information at the time about the effects of Covid-19 on pregnant women and unborn babies. 

As the nation went into lockdown, we too hunkered down and hibernated in between online teaching.

Thankfully, antenatal appointments continued. The only difference being that everyone was now required to wear masks and partners were not allowed to join you for appointments. 

This meant you had no partner to support you, to hold your hand, listen to the heartbeat for the first time or see the first scan of your baby.

At the time, this was really difficult to deal with. Dads were being cut out from being involved in the medical oversight of the pregnancy and all my husband had to go on, like all other dads at the time, were a few fuzzy black and white photos.

It also meant that I didn’t have a second pair of ears in my antenatal appointments. My level of Italian is not bad, a rough B1 speaker, but suddenly being pregnant and having so many other things to think about, coupled with everyone now speaking behind masks, made it almost impossible for me to rationally take in what anyone was saying.

Cue Maria. After my first appointment – which took almost three hours – I was allocated a translator at the clinic. Maria was in every single one of my antenatal appointments and helped me understand all that was required of me and how my baby was doing, as well as translate my numerous questions.

Most of the time I understood the doctors, but having Maria in the room gave me reassurance, not just linguistically but also emotionally. It really makes a difference when someone speaks to you in your native tongue when you’re in an emotive situation.

On the whole, my appointments were regular and thorough. I was told I would see the same doctor each time, but unfortunately,  this turned out not to be the case. Still, I didn’t mind, I had after all come from England and was used to the NHS where you rarely ever see your ‘own’ GP.

Shirin during her pregnancy in Italy. Photo courtesy of Shirin Georgiani

Very early on, I decided to sign up for the ‘corso accompagnato di nascita’ (antenatal course) which was being run by the clinic. Because of the pandemic, it had been moved online and I thought why not? It’s free, no hassle and I can do it from the comfort of my own home. I then received an email in August confirming my place on the in-person course in September.

I immediately decided I wouldn’t attend, not only because I thought it wasn’t safe, but also because I had no means of getting there every Monday at 9am when seven months pregnant. Also, mostly, because it would be in Italian in front of other Italians.

Had it not been for my husband’s encouragement and my newfound free time (I was officially on maternity leave having chosen the ‘two months before and three months after due date’ option of compulsory maternity leave) I would’ve cancelled my place.

So I went, begrudgingly, to my first meeting where I was overwhelmed by the language and the antenatal vocabulary, the mascherine interactions and the cultural-health differences between advice given in the UK and Italy.

After much deliberation, I convinced myself to see it through. Week after week, I understood more and communicated with more confidence whilst furiously using the translate app and comparing things with the NHS website.

In the end, I was actually glad I attended because it taught me about giving birth at my local hospital (especially useful when visits were prohibited) as well as being told by the midwife doing the course what to expect when going into hospital here during the pandemic.

We were also sent copious antenatal and postnatal material written by the regional health authority and the Ministry of Health and I was able to ask an experienced professional any questions every week whenever I wanted. Perhaps more than anything, the WhatsApp group we set up continues to be a source of support for the seven of us who did the course – about what’s going on with our babies, who were all born within less than a month of each other. 

READ ALSO: Italy’s ‘baby bonuses’: What payments are available and how do you claim?

As the birth drew closer, I was referred to the high risk clinic in the hospital. Suddenly, I no longer had my translator and I panicked.

Luckily for us by this point, my husband was allowed to come in with me. The first appointment was an awful experience that I wasn’t prepared for. I had to recite and explain everything that had happened the past seven months, as electronic notes don’t exist to allow sharing between health centres. And none of the midwives or doctors I saw spoke any English. I felt so overwhelmed and left the hospital dismayed.

Before my next appointment I decided to be proactive and emailed the head of the maternity ward to explain my situation, who replied courteously telling me not to worry. When we arrived at the hospital for our next appointment, there was an army of midwives and a translator to explain everything to us about what will happen when we come in for labour.

From then on I also only had appointments with doctors who spoke English. It was reassuring to have someone who could fill in the gaps I couldn’t understand or when I didn’t know the medical word in Italian.

My biggest concern throughout my pregnancy, aside from getting Covid, was being able to clearly communicate and understand what would happen in the labour ward. 

Thankfully, my fears were unfounded as the all-female medical teams spoke to me in English when I needed it and I had the support of my husband to help filter messages when things got really tough. 

The worst part of my pandemic pregnancy experience in Italy – which I was totally unprepared for – was staying in hospital for a week by myself.

I had been told during the course that if all goes well with labour we were expected to stay in the maternity ward for two nights if it had been a natural birth and five nights if a caesarian one. What I wasn’t told was that when your water breaks and you go to hospital, you will be kept in hospital and your partner cannot stay with you, not even in maternity A&E. This came as a huge blow.

I was in hospital for four days before our baby arrived (and two days after), during which time I wasn’t allowed to leave the maternity ward once my negative Covid test arrived and I only got to see my husband for one hour a day – in a mask.

This effective quarantine really took its toll on me, not only because I wasn’t prepared for it (physically or emotionally) but also because I kept worrying about the baby and why things weren’t going as they should.

Outside of a global pandemic, most maternity wards would allow the mother’s chosen trusted person (or two) to be with her before, during and after labour, with perhaps relatives being able to visit for a couple of hours.

Unfortunately, due to Covid, it became a strict no-visitor zone, except for partners for one hour a day. When you’re waiting for your baby to come and they’re not coming, this loneliness can be destructive.

On the other side, when your baby does finally arrive, the loneliness and lack of help, can result in new mothers feeling drained, exhausted and unconfident. The desire to come back home is real.

I was incredibly thankful for the all-female medical staff that were involved in all aspects of mine and baby’s care whilst in hospital. 

Shirin and her son. Photo courtesy of Shirin Georgiani

Unfortunately for me, the moment I walked out of the hospital doors, the support appeared to stop. Unlike in the UK, there is no universal postnatal care provided by Italian health authorities (though each region may have different rules).

During my antenatal course I was informed that there were groups in the city run by the comune (local authority) where mums could go to for support. But these groups were suspended during the Covid restrictions which started mid-November. During the course we were told to call the clinic when we arrived home to book our forty day postpartum health check, which ended up being booked in seventy-five days after baby was born. Far too long to wait to talk to a professional. 

I really struggled with settling into life as a new mum and feeling like I was able to care for my baby. By week three of baby being home, my husband was back at work after only having seven days of paid paternal leave (now the law has extended it to 10 days). 

READ ALSO: How Italy’s new ‘Family Act’ aims to increase the plunging birth rate

I had no family here, the region was in lockdown and the baby-blues (it’s the same term in Italian by the way) came and hit me hard.

I really struggled with breastfeeding and in the frequent visits to the paediatricians that followed in the first four weeks of our son’s life, I was constantly asked how feeding was going and told that I shouldn’t feel guilty to give my baby some formula if I was struggling.

As any new mother trying to breastfeed will tell you, this is one of the most unhelpful things you can hear. Instead of, “here’s where you can get some support”, I was constantly being told that, “if I can’t breastfeed, a bottle of aggiunta (additional milk) is fine”. This wasn’t helped by the fact that almost all the ladies in my antenatal group had almost given up breastfeeding by week four.

Luckily, a lady from the female choir I am a member of works for the local children and family centre (centro di bambini e famiglie). She reached out to me and told me about the service and that I could ask for help if I ever needed it. 

Unfortunately as any new mum soon learns, it’s almost impossible in the first few weeks of having a newborn to pick up the phone and have a long conversation (especially in another language) about postnatal problems.

I did however end up asking for help from the service and a midwife came just before the Christmas lockdown to look at our breastfeeding practice and give me some tips. Since January we’ve also had regular online 1-1 support from another consultant at the centre with regards to feeding, eating and sleeping. 

Thankfully, early on, I found La Leche League Italia and got in touch with one of the consultants in my region that speaks English. Anna became my new best WhatsApp friend. She helped me a lot with evidence-based advice, tips and articles that allayed my concerns and taught me things I didn’t know. She also introduced me to the online biweekly breastfeeding support meeting for English speaking mums across Italy. I quickly signed up and attended every single one of those early classes. 

I also signed up for classes run by organisations such as Blossom (based in the UK) and a few other organisations that proliferated in the post-Covid online antenatal class boom. Fortunately for English speakers living abroad such as myself, these classes have proven to be of invaluable support.

As lovely as it is to be growing your own mini-human, pregnancy is an anxious time in a new mum’s life. Going through it during a global pandemic, in a lockdown, by yourself or in a new foreign country, can only add to these anxieties – especially if there are language barriers too.

Networks are however being founded everyday online to help support parents in this situation. 

Information is your weapon for the unknown, so don’t be afraid to ask and seek support, during and after pregnancy. Above all,  keep perspective: this too shall pass.

Useful resources:

Shirin is a former civil servant turned English language teacher-food blogger from London. She currently lives in Ferrara with her husband and their baby boy. She can be contacted via her instagram page at @myimmigrantkitchen

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HEALTH

Key points: What you should know if you need to see a doctor in Italy

Sooner or later, every foreign national in Italy will have to make an appointment to see a doctor. Here are the key things to know.

Key points: What you should know if you need to see a doctor in Italy

Making a doctor’s appointment is usually thought of as a fairly uncomplicated task but doing so in Italy can turn out to be very tricky, especially if you’ve just relocated to the country and are not quite familiar with how the Italian healthcare system (Servizio Sanitario Nazionale, or SSN) works.

On top of that, Italian doctors and other healthcare staff are rarely fluent in English and only very few sections of the SSN’s website provide information in languages other than Italian. 

So, should you ever be faced with the dreaded task, here’s what you need to know about making a doctor’s appointment in Italy.  

Who has access to GPs?

Only people that hold a valid Italian health card (tessera sanitaria) or an equivalent, i.e. a European Health Insurance Card (EHIC) or a UK Global Health Insurance Card (GHIC), can access public GPs’ services.

READ ALSO: Who can register for national healthcare in Italy? 

That said, it’s worth noting that the SSN provides emergency care to anyone in need, regardless of their nationality or immigration status and without asking for upfront payment.

A GP making a prescription

Only people that hold a valid Italian health card or a EU equivalent can access public GP’s services. Photo by Thomas SAMSON / AFP

Those experiencing a medical emergency can call 118 for an ambulance or head to the emergency ward (pronto soccorso) of the nearest public hospital.

How to register with a GP

In order to make an appointment (visita) with a general practitioner (medico di base) within the SSN, you must first be registered with the doctor in question. 

However, registering with an Italian GP isn’t nearly as straightforward as it should be. 

Firstly, patients are expected to view the list of doctors operating within the territory of their local health authority (Azienda Sanitaria Locale, ASL). 

Though in some cases these lists can be found online, in others residents will have to directly ask their ASL to be sent a copy.

Then, taking the location and office hours of the listed professionals into account, patients are asked to pick the doctor that’s best suited to their needs and communicate their choice to the ASL.

While in some areas this can be done online, most ASLs ask that patients turn up in person at their Scelta e Revoca (Choosing and Cancelling) offices and provide operators with an ID card, a valid Italian health card or equivalent (EHIC or GHIC) and a certificate of residence

READ ALSO: Who to call and what to say in an emergency in Italy

Registrations are generally processed immediately and the doctor’s contact info and booking details are emailed to the patient right after.

How to book an appointment

Once you’re registered with a GP, you can go ahead and book your first appointment. 

A booking can generally be made via phone, email or, in some cases, online. However, as previously mentioned, healthcare staff, including booking office staff, are rarely fluent in English, so email or online bookings might be the better options if you’re not really proficient in Italian.

Doctor speaking on the phone

Patients can book an appointment with their GP via phone, email or, in some cases, a designated online booking platform. Photo by Nicolas TUCAT / AFP

It’s also worth noting that, though they provide patients with a set appointment time, Italian GP clinics tend to run a little late, so, depending on the circumstances, you might have to wait up to thirty minutes for your turn.

During the first appointment, patients are usually handed a form to fill out with general information about themselves and their overall health. 

Due to the above formalities, the first appointment might last a little bit more than normal appointments, which are usually around 15 to 20 minutes.

All consultations with an Italian GP, including the first appointment, are free of charge.

Referral to specialists

GPs can refer patients to a specialist doctor (specialista) for further diagnostic exams or medical procedures.

However, unlike in other European countries, people choosing to see a specialist through the SSN cannot select the doctor they will be referred to as they will be given the earliest available appointment within the relevant medical field.

READ ALSO: Five essential facts about Italy’s public healthcare system  

The referral comes in the form of a red prescription (ricetta rossa) with letters P, D, B and U indicating the different levels of urgency associated with the consultation – P marks the lowest priority level, whereas D is for consultations that must take place within 72 hours from the time of prescription.

The ricetta rossa allows patients to book their appointments online, in person or over the phone by calling the relevant Regional Central Booking Office (Centro Unico di Prenotazione Regionale, CUP).

Nurse looking at X rays

Patients choosing to see a specialist through the public healthcare system cannot select the doctor they will be referred to. Photo by Alberto PIZZOLI / AFP

Again, foreign nationals with a poor command of Italian may find that online bookings are the best available option given that most operators are not fluent in English.

Private doctors 

As in other European countries, Italian residents can choose to see private GPs or specialists.

Private healthcare is provided at a fee – typically anything from €40 to €160, depending on the type of service required – and, in most cases, fees must be paid upfront. 

Unlike public health authorities, private providers do not require patients to have a tessera sanitaria or a valid equivalent.  

Aside from the above distinctions however, booking an appointment in the private sector is no different than booking one within the SSN, with patients being allowed to book via phone, email or a designated online platform. 

If you’re looking for an English-speaking doctor, the US Embassy in Rome and the Consulates General in Milan, Florence and Naples provide lists of English-speaking professionals available for private consultation. These can be downloaded here.

The UK government provides a similar list

Essential vocabulary and useful sentences

  • SSN (Servizio Sanitario Nazionale) – National health system
  • ASL (Azienda Sanitaria Locale) – Regional health unit
  • Medico di base – General practitioner 
  • Ricetta – Prescription
  • Visita – Appointment 
  • Specialista – Specialist doctor
  • Farmaco – Medicine
  • When booking by email or phone, a useful phrase is: Vorrei fissare una visita alle ore X di X (I would like to schedule an appointment for [day] at [time]).
  • Should you need to cancel the appointment, you could say: Putroppo, devo cancellare la visita.
  • To ask to reschedule it, you could say: Sarebbe possibile spostare la visita?

To describe your sickness, you can check out our terminology guide for the most common ailments.

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