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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

‘Behind the times’: Why women in Italy struggle to get menopause treatment

For many women living in Italy, accessing HRT means paying for private treatment and, in some cases, travelling abroad in order to find a doctor willing to prescribe the medication they need.

'Behind the times': Why women in Italy struggle to get menopause treatment

Sitting in her garden in rural Tuscany, Tara Gould, a 55-year-old British national, reminisces about her old job back in the United Kingdom. 

“It was such a support group for people like me, so to be able to work for it and help other women was such a bonus,” Tara says.

The support group Tara worked for was the Latte Lounge, an online community for UK women over the age of 40 going through menopause. The site had resources such as articles, help finding a nearby specialist and in-person events. Tara managed the emails sent in by women who were either asking questions or struggling.

READ ALSO: Public vs private: What are your healthcare options in Italy?

“I had a few women reach out to me who were feeling suicidal and had nowhere to go or no one to ask about what they were going through. Talking to them about their options and helping them out, helped me out too.

But in Italy, she says, “I cannot find any support network like that here.”

In the two years she’s been living here full-time, Tara has had to go back to the UK for her hormone replacement therapy (HRT) which is crucial in managing symptoms such as hot flashes, sleep problems, and low moods. 

“In Italy, it is like what it was like in the UK 30 years ago, and coming from there two years ago was a massive shock to the system,” she adds.

“Women just have to grin and bear it.”

She believes the situation in Italy boils down to a lack of knowledge and possible embarrassment about discussing menopause. While the UK is far from perfect on the issue, she says, there is help available for women needing it, while Italy is “behind the times”.

READ ALSO: Why are medicines so expensive in Italy?

Tara is not alone in feeling this way. A post on the topic in one expat Facebook group this month sparked a lively discussion, attracting hundreds of comments from women in Italy sharing their personal stories, advice, and observations on the differences in menopause treatment between Italy and other countries.

But, she says, continuing to travel back to the UK for this routine treatment is “becoming too expensive for me especially as I’m paying into the SSN here too.

“I shouldn’t have to go back to the UK for this.”

Tara returns to the UK once her medication finishes and forks out around €600 each time she goes: €100 for flights and €500 for the HRT medication via private healthcare. 

“It should be a standard medical procedure, but it isn’t here. I can’t keep on going back to the UK and paying out every time I need something, because it is a need not a want.”

Tara started going back to the UK after her family doctor in Italy told her they didn’t prescribe HRT and advised her to buy it online, go abroad or go to a gynaecologist. 

“I thought it was outrageous that a female doctor was telling me these things, especially someone trained in the medical field advising a patient to buy medication online.

“I don’t feel hopeful,” Tara says.

Without her oestrogen, Tara says her anxiety goes through the roof making everyday life a struggle. She’s too worried she’d be dismissed in the same way her doctor dismissed her if she went to a private gynaecologist here. 

“It’s worrying. I don’t know what I’ll do. There must be someone here, but I don’t know how I feel. They tend to be more city-focused, and if I’m going to Rome I might as well go to the UK,” she adds.

In a recent study named Menopause: Knowledge, attitude and practice among Italian women co-written by Italian biologist Paola Mosconi along with six other researchers, more than half of their study sample (women with menopause) had not received any information about the condition and possible therapies.

Another survey conducted in 2021 found only 7.6 percent of the 1028 Italian women surveyed were on HRT. The majority of them were on herbal remedies.

Whilst a global shortage of HRT was widely reported last year, both the studies found medical expertise in the field of menopause to be only “satisfactory”.

READ ALSO: OPINION: Why Italy’s private healthcare isn’t always worth the cost

This is in spite of the Italian health ministry’s webpage outlining the numerous benefits of hormone therapy for menopausal women, such as improved heart health and a reduced risk of strokes.

Tara says she feels as though the lack of information on this topic trickles down into society, as she has tried talking to her Italian friends about it with little success.

For Liguria-based Noah, from the United States, the experience of obtaining HRT from her doctor was not an easy task.

Like Tara, she finds there is a huge lack of education for practitioners and the general public not just on HRT but around menopause in general, which differs from her experience back home. She also thinks views on it are outdated.

She moved over to Italy four years ago whilst she was going through the change. 

“Our family doctor would not prescribe it and lacked any knowledge around it so she sent us to private clinics instead,” Noah says. “I can laugh about it now, because I finally have it, but it was very frustrating in the beginning.”

Noah and her husband, who is Italian, found out about a doctor in another region who specialised in menopause and whose work on the condition was published in medical journals. She got her HRT from him. Whilst Noah felt very comfortable in his care, she had to stop visiting him because of the distance.

“We went back to our family doctor with literature on the use of HRT and the effects of stopping it abruptly. She then did her own research and now has started prescribing it to me,” Noah says.

Noah largely considers herself lucky. Nevertheless, she has to drive 45 minutes to another town in the region to pick up her prescription.

READ ALSO: ‘Very professional but underequipped’: What readers think of Italy’s hospitals

Tuscany resident Kelly Hodgson, like Noah, has also had to do extensive research into the benefits of HRT before she was prescribed it. She found the process of obtaining her medication extremely time-consuming and disheartening. 

“I had to do all the research myself until finally I found a gynaecologist who is open to HRT,” Kelly explains.

Kelly feels like she should have been able to get HRT from her doctor rather than pay privately. She argues that Italy is advanced in most areas of medical care – but not for menopause.

She thinks a huge reason why doctors are hesitant about giving it out is because they associate it with a high cancer risk.

“There is so much scaremongering,” she continues. “My doctor is female and she point blank said to me no, because I could get cancer, even though I’ve been on the contraceptive pill for years which comes with its own cancer risks.

“I come from a family with osteoporosis so HRT is beneficial to me. If I were in the United Kingdom now, I’d have access to it without having a full gynaecological visit before it’s prescribed.”

Kelly says friends from Turin who are also going through the menopause have had to go privately too, rather than get treatment from their doctor. 

“There has to be more education on menopause here,” Kelly concludes.

For Noah and Kelly at least, their journey to get their medication is within the country. For Tara, unless things change culturally and medically, going abroad is the only option she feels comfortable with.

“The way Italians think about menopause is the old-fashioned way everyone used to think. They view us as grumpy old women rather than looking at the reasons,” Tara says.

“It’s just something you have to deal with. It’s frustrating to say the least.”

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