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Aviano out of the baby business, sending military women ‘downtown’ to deliver

The Pordenone public hospital is one of the local Italian medical facilities that will be providing maternity care to Americans as the Air Force hospital at Aviano Air Base discontinues its obstetrical program as part of a downsizing.

COURTESY OF U.S. AIR FORCE

By NANCY MONTGOMERY | STARS AND STRIPES Published: December 15, 2017

VICENZA, Italy — The U.S. military is set to end maternal care for women assigned to Aviano and Vicenza this spring, leaving obstetrical and other medical services to local Italian hospitals that officials say are better-equipped to handle American patients than in the past.

Aviano Air Base’s 31st Medical Group hospital — the last bastion of American military maternal medicine in northern Italy — has set May 1 as the last delivery due date. After that, local hospitals will handle almost all obstetrical cases for women at Aviano and Vicenza. The unit has delivered about 250 babies a year for the past decade.

The end of Aviano’s maternity services is part of a Defense Department-mandated downsizing of the hospital into a clinic that will also terminate in-patient surgery and reduce services for civilians and retirees.

It’s a back-to-the-future change.

“Before (2006), our babies were all born downtown,” said Col. Dawn Eggert, 31st Medical Group deputy commander. Air Force babies were in fact delivered in an Italian hospital from 1997 to 2006 — but on a ward leased and staffed by Air Force personnel.

On a recent tour of one of two local hospitals that will be providing obstetrical care, she said, the Italians had put up a banner that read “Welcome Back!”

“That told us volumes” about how the Italians were enthusiastic to care for expectant American women and make their deliveries as pleasant as possible, Eggert said.

That wasn’t always the case. The U.S. military opened obstetrical units in Aviano, and later, in Vicenza, partly in response to bad experiences U.S. women had repeatedly reported: crowded labor wards, no pain relief and unsympathetic nurses who spoke only enough English to shout “Shut up!” at women screaming in agony.

“That was a tremendous dissatisfier,” Brig. Gen. David Rubenstein, then-commander of the European Regional Medical Command, recalled in 2007.

Military officials insist that Italian hospitals have come a long way since then. “They want our business,” said Capt. Megan Howell, flight commander of Aviano’s TRICARE Operations and Patient Administration.

“They’re happy to have our cases and to accommodate whenever they can,” she said.

Hospital visiting hours may be negotiable, she said, flowers may be allowed despite what the policies supposedly forbidding them.

Hospitals near Aviano and Vicenza, which have always handled Americans’ high-risk pregnancies, deliver far more babies than military facilities. Last year, for instance, more than 1,000 babies were delivered at the Pordenone hospital near Aviano; 700 more were delivered at the private clinic there. Research shows that facilities that perform more procedures have better outcomes than those that do fewer.

But there are some significant differences in how Italian and U.S. health care providers approach childbirth. Italian hospitals still have visiting hours and limit the number of people who may be in the delivery room. Fathers are not allowed in the operating room, where some 38 percent of Italian deliveries take place by caesarian section.

An especially large cultural gap exists in how labor pain is addressed. More than 60 percent of American women get an “epidural,” a nerve block considered highly effective in easing pain, with few side effects. At Aviano last year, 64 percent of laboring women got one.

But just 11 percent of women at the Pordenone hospital near Aviano did, Eggert said, and only 7 percent did at the nearby private clinic.

Aviano officials said agreements had been reached with both local hospitals to guarantee epidurals to U.S. women who want them. They said the low rate of epidural use by Italian women was due to cultural and personal preferences.

But a 2008 study in Lombardy found that it had more to do with cost and availability, and a poll suggests that many Italian women agree. Until Italy passed a law last year requiring hospitals to provide free epidurals to women who wanted them, they were either unavailable or provided for a fee of up to 1,000 euros.

The law was changed after an Italian nonprofit group called Human Rights in Childbirth began a campaign to change what the group said was routinely punitive treatment of women giving birth, reflecting patriarchal beliefs of required maternal suffering.

More than a third of mothers in an online poll conducted by the group said hospital staff had verbally abused them and nearly a quarter said they’d been denied requests for pain medication.

But many American women who gave birth at Vicenza-area hospitals in recent years have reported excellent childbirth experiences, including kindly nurses, speedy pain relief, delicious food and the comfort of knowing that the hospital was equipped to deal with any complications.

“Of course I got an epidural. We all get them. You just fall asleep,” said Michela Blosfield, who delivered in Vicenza’s San Bortolo hospital two years ago. “They gave me the best room.”

If you’re an expectant mother associated with the U.S. military, “You’re delivering like a VIP,” she said.

Since the Vicenza garrison’s birthing center closed in 2014, most U.S. women have delivered their babies at San Bortolo. Last year, 155 did so. But 57 others chose instead to “stork nest” for a couple of weeks and deliver at Aviano.

The same Defense Department directive that ended maternity care at Aviano also meant that Navy hospitals in Naples and Sigonella, like at Aviano, would do away with in-patient surgery and other services

But those two facilities will continue to deliver babies into the foreseeable future.

Tami Begasse, a Navy spokeswoman, said the decision to continue providing maternity care was made to keep the two facilities’ services consistent with other Navy medical facilities. The intent will be to discharge new mothers within 24 hours after delivery.

“If a longer length of stay is clinically warranted, appropriate care will be rendered to best meet the medical needs of the mother and newborn,” she said. The two facilities each deliver on average eight to 11 babies a month.

Health care in Italy is considered widely variable between the country’s north and south. Hospitals in the Naples and Sigonella regions have, respectively, the highest and third-highest rates of caesarian deliveries in the country – over 60 percent in Campania and almost 50 percent in Sicily. At certain hospitals in Campania, the rate is as high as 95 percent, according to some studies.

Caesarian surgeries, though sometimes lifesaving and generally safe, carry more risks than vaginal births, cost more and require longer maternal recovery times. Northern Italian hospitals, by contrast, have about a 20 percent rate.

montgomery.nancy@stripes.com
Twitter: @montgomerynance

 

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