Midwife and Lactation Consultant – Interview with Gabriella Pacini

Gabriella has been working as a midwife in both private and public institutions throughout Rome for the past 20 years. She has attended births in the largest public hospitals, smaller private clinics, in birth centres as well as in homes. Gabriella is passionate about supporting women during breastfeeding and is one of the rare IBCLC (International Board Certified Lactation Consultant) certified midwives in Rome.

“Giving fact-based information and support
is the best way to help a woman make choices”

What services do you offer for pregnant women?

I help pregnant women understand how the system works in the clinics and hospitals, or with homebirth here in Italy. I prescribe the necessary exams and tests to be done throughout pregnancy, I assist during labour and birth as well as help mothers with breastfeeding. I also have been teaching the only ongoing English language birth course in Rome for the past 5 years.

What is the “normal” procedure in terms of checkups and scans for pregnant women in Italy?

“Normal procedure” calls for 3 sonograms and blood tests done about every 6 weeks. To have a complete list you can consult the website of the “istituto superiore di sanità“.  You can see a full list of the tests prescribed by the Italian State Health System here.

When do women need to choose their hospital?

There isn’t a precise date, it should be when they feel prepared to choose.

Are pregnant women guaranteed a hospital of their choice or are they given a hospital assigned by their gynaecologist?

This is not a simple answer, a woman can choose any hospital she likes but is not guaranteed to have “her” gynaecologist present unless she chooses to pay for private care where her gynaecologist will be present but her choice of where will then be limited to the structures where her gynaecologist is permitted to practice.

Do you think midwifery services are underdeveloped in Italy?

The services are not underdeveloped but the understanding of their role is. Ostetriche, which is actually a bit different than the English term of a midwife, are the most important professional figures during pregnancy and birth. Women are just beginning to understand this and that with medical doctors things do not always go smoothly and for this the percentage of Cesarian sections is high.

From your experience how accommodating are the Italian public and private hospitals to natural births?

We have one of the highest rates in the world for Cesarian sections but women are beginning to understand the advantages of a natural birth and therefore the system is slowly changing to be more accommodating to those who choose natural childbirth.

What advice would you give a woman looking for a natural birth in Italy?

They should inform themselves and choose the birth centre wisely and if is possible choose also their ostetrica. Questions to ask are: What is the Cesarian rate?, What is the episiotomy rate?, Is it possible to have rooming-in? (where the baby’s crib is placed by the side of the mother’s bed).

From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in Italy?

Finding someone who understands their desires for their birth experience as well as someone who can be an advocate for them within the Italian structures.

Do you work with any specific hospitals in Rome and if so can you recommend any in particular?

Last year in Lazio the law changed and now Midwife run birth centres are able to host birthing mothers. We now have three in Rome, including the one I helped found called GEA, which has been a wonderful addition for many mothers here. For hospitals I think that Cristo Re is a good choice for delivery because it is the only hospital that really permits a woman to choose her positions for labour and delivery, the rate of Cesarian sections is less than 30% (it is high, I know, but many hospitals in Rome have a 50% Cesarian rate), but unfortunately rooming-in is not available. For rooming-in, Fate Bene Fratelli, Isola Tiberina, Santa Famiglia or Città di Roma are better. There is also a unique place in Ostia called Casa del Parto which has very low levels of medical intervention and is staffed solely by ostetriche.

Do you also offer post-natal care to mothers, if so what does this encompass?

I perform follow up medical checks on the mother and child, help mothers understand how breastfeeding works by giving them information and support, as well as teaching them how to clean the umbilical cord, bathe the newborn, and help understand sleep rhythms.

photo: Fanny Renaud @Unsplash

Do you feel there is adequate support for mothers in Rome post-birth in terms of caring for the baby and breastfeeding?

No, professional Lactation Consultants are too few, and often paediatricians, midwives, and nurses don’t have adequate information (from the World Health Organization for example) about breastfeeding. There is a lot of misinformation that gets passed around which often confuses mothers and leads them down bumpy paths. When a mother leaves the hospital, she is on her own, there is no follow up care. It is up to her to find and call in any professionals she may need.

What are the main problems women suffer in the first few days after birth?

Women often feel tired and overwhelmed by their new role as mother, it is important that they ask for help and guidance. La Leche League offers great support for breastfeeding and Bellies Abroad has many different contacts who speak English who offer different forms of support and care from medical, to mental, to legal.

You are an International Board Certificated Lactation Consultant (IBCLC). What does this mean exactly?

The IBCLC credential identifies a knowledgeable and experienced member of the maternal-child health team who has specialized skills in breastfeeding management and care. IBCLCs have passed a rigorous exam that demonstrates the ability to provide knowledgeable, comprehensive lactation and breastfeeding care.

What are the benefits of breastfeeding your baby?

We need a whole other page for this! The antibodies passed from the mother to the baby make for a much healthier baby, which means calmer and happier parents. Breastfed babies have decreased likelihood for allergies and dental issues. Moms risk of ovarian and breast cancer are reduced as well as burning 500 calories a day just by breastfeeding! It is also the best way to bond with, get to know and understand your baby. And you never find yourself at 2 am with nothing in the house to feed him or her. Also, new research that has been emerging about the human microbiome has been fascinating and is showing the importance of breastfeeding on a level we never understood before.

What advice would you give a pregnant woman on how to prepare for breastfeeding her newborn? Is there any literature they can read or advice they can seek?

I would suggest they attend La Leche League meetings while they are pregnant, read the La Leche League book “The Womanly Art of Breastfeeding” or contact a IBCLC lactation consultant for informative sessions prior to birth.

How important is it that a mother attempts to breastfeed her child straight after the birth?

The World Health Organization recommends that a mother put the child to her breast before leaving the delivery room immediately after birth. The more immediate the start the smoother the road ahead. This is not to say all is lost if the first days do not go as planned.

For mothers who have low milk production, what would you advise? Is this eventually self-regulating? Are there any herbal remedies? Or should a mother introduce a milk supplement?

The first thing is to check the baby’s latch on the breast and to understand how often she breastfeeds. The more often the mother puts the baby to the breast the more milk her body will make. There have been no conclusive studies that have shown that herbal remedies can be useful in breastfeeding. Before introducing supplements the mother should consult with a breastfeeding-friendly paediatrician, which can be hard to come by here in Rome.

Until what age ideally would you recommend a baby be breastfed?

The World Health Organization recommends exclusive breastfeeding for up to six months and then for as long as the mother and child want. The ideal age changes from family to family and from child to child within each family. It is important to do what works best for your family.

There is a huge amount of pressure on mothers to breastfeed for up to 6 months, and many feel very guilty if they do not manage to do so, what advice would you give to mums in this situation?

Here in Italy, there is much less pressure, as unfortunately, we do not have systems in place to support and promote breastfeeding in the same way many other countries do. I think a mother just needs to try to do what is best for her baby and herself, sometimes women can breastfeed and sometimes they can’t, or feel that for her it is better to feed her child formula. I believe any choice she makes deserves respect and it is nobody’s place to judge.

Is it acceptable in Italy to breastfeed in public and are there any breastfeeding areas set aside for mothers in public places?

I think there is more “acceptance” than in Anglo countries. More than meeting with disapproval, women who breastfeed in public here are met with incredulity as we have many issues with successful breastfeeding here, especially the further south one goes. There are a few places certified by the La Leche League as “Baby Pit Stops” which offer a safe place for a mother to breastfeed her baby, relax and change a diaper.

What is the primary reason for women discontinuing breastfeeding?

Most women discontinue breastfeeding because they are unaware of the benefits for both her and her baby, as well as not understanding how breastfeeding works.

At what age would you recommend a mother introducing solids?

The World Health Organization recommends introducing solids at 6 months old as introducing them sooner can lead to issues such as food allergies or rejection which can create stress and make eating a battle later in life. Six months is a general guideline, as babies can survive healthily exclusively on their mothers breast milk for the full first year of life.

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