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Path birth: ten points approved by the State-Regions Confererza

Sato Regions The conference approved the guidelines for the program that aims at promoting and improving the quality and safety of care interventions in the birth path and reduction of caesarean .
The program 'divided into 10 lines of action that are complementary and mutually reinforcing''and''needs to be started in conjunction with national, regional and local levels.
The Italian Society of Gynecology issued a favorable opinion.

It was concluded in December 2010, the passage of the measure and start the path should lead to the final closing of maternity wards where fewer than 500 shares per year and the rationalization / reduction of those who make less than 1,000. Another priority, the killing of the use of cesarean section.

The Conditions of the Plan :

- The excessive use of caesarean section has brought Italy to occupy first place among European countries, surpassing the European values \u200b\u200breported in the euro-Peristat on maternal and child health in December 2008. Italy holds the largest share of 38%, followed by Portugal with 33% while all other countries have rates below 30% to 15% reduction in the Netherlands and 14% in Slovenia. In Italy it has gone from 11, 2% in 1980 to 29.8% in 1996 and to 38.4% in 2008 varied considerably by region (23.1% in Friuli Venezia Giulia and 61.9% in Campania ) and presence of lower values \u200b\u200bin northern and highest in central, southern
-The available data confirm, for Caesarean section, and general assistance during pregnancy and childbirth, the 'increase in Italy of the use of a set of procedures whose usefulness is not based on scientific evidence and is not supported by any real increase risk conditions. Their use is often completely independent of socio-demographic characteristics of women and their medical conditions and is instead primarily associated with the availability of the structures involved and their organization;
-In Italy, in 2008, about 220,000 operations were performed cesarean section, with a significant human and economic cost: the risk of maternal death is in fact 3-5 times greater than the vaginal delivery and puerperal morbidity is 10-15 times higher;
points-birth with a number of shares of less than 500, without a cover on-call doctor-midwife, anesthetist active pediatric and medical-h24, still represent a market share of approximately 30% of the total, are present, especially in Central and South America. In these structures, the number of parts is small (the average is less than 300 shares per year) and represents less than 10% of total shares. In these units, delegated care delivery in terms of physiology, where it would be reasonable to expect a lower prevalence of diseases, performing more cesarean deliveries (50%), while in larger units and higher level where c ' is high concentration of disease, the rate of cesarean is many times lower, although the variability is large;
-Besides standard clinical indications, absolute and / or relative, maternal and / or fetal coexist, with increasing frequency and with an important role, no clinical signs or rather non-medical, some of which are attributable to structural defects , technological and organizational-functional, such as organization of the delivery room, staff training, availability of the team midwives complete, the anesthesiologist and neonatologist 24 hours a day, along with the convenience of the doctor, defensive medicine, financial incentives.

The 10 points in the document :

1. measures of health policy and accreditation. rationalize / reduce points over 3 years with birth number of shares less than 1000/anno, providing for the combination of complexity of the activities of obstetrician-gynecological UUOO those with neonatal / pediatric, based on two previous three levels of care, making arrangements, at the same time, the system of transportation assisted breast (STAM) and neonatal emergency (STEN). The structures must be approved and accredited based on standards that are identified. The network of local services, particularly the Family Clinics in number and adequately supported in the organic, is the focal point for the care of normal pregnancy. Finally, strategies are suggested incentive / disincentives on economic thresholds of appropriateness of interventions and implementation of the measures identified is indicated as a specific target for the evaluation of general managers, directors of departments and UOC;
2. Service Charter. Companies active in health care is a birth should develop a Charter of services specific to the birth path, in which, in accordance with the principles of quality, safety and appropriateness are given information about general information on the operation of services containing major indicatori di esito, sulle modalità assistenziali dell’intero percorso nascita, sulle modalità per favorire l’umanizzazione del percorso nascita, sulla rete sanitaria ospedaliera-territoriale e sociale per il rientro a domicilio della madre e del neonato atta a favorire le dimissioni protette, il sostegno dell’allattamento al seno ed il supporto psicologico;
3. Integrazione territorio-ospedale . Garantire la presa in carico, la continuità assistenziale, l'umanizzazione della nascita attraverso l'integrazione dei servizi tra territorio ed ospedale e la realizzazione di reti dedicate al tema materno-infantile sulla base della programmazione regionale. Sono previsti percorsi assistenziali differentiated to encourage the management of pregnancies at physiological counseling and the resignation of protected mothers and infants;
4. Development of guidelines (LG) on normal pregnancy and cesarean section by the ISS-SNLG . Will shortly be available on the LG set amongst both health professionals, in technical summary, women;
5. program implementation of the LG . Through analysis of the assistance to regional and local level we identify critical issues and barriers to change. It will support continuity of care and integration with the assistance territorial. Later he was promoted to the role of professionals within the birth path, including through the identification of different routes to assist with pregnancy and risk of physiological saline. To encourage the appropriateness of care interventions in the birth path and to reduce the caesarean section will be developed clinical pathways-care business, according to the guidelines;
6. Development, dissemination and implementation of recommendations and tools for safety birth path. Will be promoted instruments such as recommendations for the prevention of maternal mortality, the prevention of neonatal mortality and adherence to monitoring of sentinel events, adverse events.
7. Procedures for pain control during labor and delivery . Foster care procedures, pharmacological and not for pain control during labor and childbirth-defined protocols for shared diagnostic therapeutic partoanalgesia, giving assurance of that performance with deliverability availability / presence of an anesthesiologist on the basis of volume of activity of the point birth;
8. Training of . As part of the training courses and updating of all professionals involved in the birth path, a way integrated, is given particular weight training program concerning the implementation of the guidelines and clinical audit as a tool for evaluating the quality of services and care provided; With MIUR you want to activate systems for testing and adaptation of the theoretical training and practical schools of specialization in gynecology and obstetrics, and paediatrics / neonatology and the degree course in midwifery, in line and consistent with standards of care, not a secondary role in the training of operators assume the effective integration of the university function teaching hospitals with teaching and the promotion of the involvement of scientific societies in the formation continuous health care professionals, in promoting the dissemination of procedures for pain control during labor and delivery is expected in terms of educational activity and pharmacological methods of pain control, with a multidisciplinary character, is finally promoted to a structured the integration of new hires professional, tailor-made for the guaranteed levels of care;
9. monitoring and verification activities . For all the planned activities is promoted the use of monitoring and evaluation of activities that define the clinical relapses and charitable activities through the same measurable indicators;
10. Establishment of a coordinating role for the path to permanent birth. for proper coordination and monitoring of the activity is the establishment of a Committee for the birth path (CPN), inter-institutional, with a coordinating role, with the involvement of the General Directorates of the Ministry of Health (Planning, Prevention, Communication, Research Information System), the regions and autonomous provinces and other national health institutions (ISS, Agenas). A similar function will be activated at the level of each Region and Autonomous Province.