How exciting! You see those two little lines on your test and your heart is pounding, as you comprehend what it means. You’re PREGNANT! A cluster of emotions has probably overcome you: happiness, fear, excitement, and nervousness. It’s all normal and part of accepting a very big change about to happen in your life. However, at least for me, being American in Italy – my emotions mostly centered around uncertainty. I literally had NO IDEA how to be pregnant here.
So, before getting ahead of myself, I went online, to my trusty Misericordia to find a doctor and get these results confirmed. I had no idea how to use the ASL or public health system for something like this, so my first idea was going private. The Misericordia of Florence is the oldest in Italy and was started in 1244. They were originally founded to transport the sick and deceased but nowadays it’s a confraternity with many members and they offer medical services to citizens and foreigners alike. I have been utilizing their services since I first came to Florence, because I like the convenience. You can make appointments online, find every type of specialist you might need, and the prices are very reasonable.
Looking online the day of my (7) positive pregnancy tests, I saw one Dr. available same day. I clicked his name, and made my appointment for later that evening.
I won’t bore you with all the details but he checked me out, scheduled my next exams and indeed confirmed my pregnancy. He, and a pregnant Italian friend, also informed me I needed to go get something called a “libretto” from ASL right away. I left with more questions than when I walked in. What is a “libretto?” How do I get this little book? What happens after I get it? How much are these exams and this libretto going to set me back?
And it is precisely because of these questions, why I decided to write this guide. I hope the following information is helpful as you embark on this exciting (tiring, challenging, and a million more adjectives) time of your life!
Part 1: First Trimester
As I mentioned, one of the first things to do is get your libretto. To do this, you must have national health care and an assigned doctor. Your assigned doctor can issue you a certificate confirming your pregnancy – so make an appointment with them (or go private like I did). You will likely need to do some blood work or submit an official urine test in a clinic in order for them to issue this certificate.
Once that is done and signed by a doctor you can get your libretto. My recommendation to you is, make the appointment for the libretto AS SOON AS you see a positive pregnancy test. The reason is because I waited until I had all my certificates signed and I couldn’t get in to the public system in time to do the first trimester exams. It was a NIGHTMARE and involved multiple trips to various health care providers to get it sorted out.
So, how do you get the libretto? It’s actually easy. In Florence you call the ASL CUP number and tell them you need to make an appointment for your libretto. The will schedule the appointment with an ASL that provides this service.
Once your appointment is secure, MAKE SURE you’ve obtained your official document attesting to the pregnancy and you’re all set. As soon as you go to the libretto appointment they will explain how everything works (well, sort of – in a vague you should already know this kind of way) and also assign you a doctor if you don’t already have one. I HIGHLY recommend taking one of their doctors even if you have your own private one. I didn’t do this, and it was a mistake. (Note: if you’re not high risk you will be assigned a midwife not a doctor). The reason being you are entitled to monthly appointments with this person and can email them, ask questions, have someone to share your results with etc. I had only my private doctor and it got very expensive to constantly go back to him with questions or results to review.
*Also, just a side note on how this whole process works here, this doctor or midwife you’ve been assigned will likely not be present during the birth. In Italy, the doctors and midwives working on the day you show up are the staff you will have. The only way to know for sure who your attending physician/midwife will be is if you go private and pay out of pocket.
During your libretto appointment they will also schedule your three important ultrasounds (if they don’t, ask them to!):
1st trimester translucenza nucale exam– it’s also called a “test combinato” and it includes blood work that will be analyzed with an ultrasound to assess your risk of having a baby with birth defects such as Downs Syndrome.
2nd trimester morfologica – they check for birth defects, organ function, growth etc (often called an anatomy scan in the U.S.)
3rd trimester growth exam – they make sure everything is progressing as normal and check fluid levels and general development.
Opening your libretto that they gave you, you will see it’s basically a prescription book for various exams for the next 9 months. It is broken down based on weeks pregnant and has additional tests your doctor can order underneath the standard ones.
One would assume that these “prescriptions” are ready to go, but unfortunately this is not the case. This was a step I did not understand and it took me a bit to figure out. You need to take the libretto to your medico di base and have them sign and stamp every page. I recommend getting them to fill out the whole booklet in one go, otherwise you will have to return to them, to have them sign each page one by one before every exam. My doctor signed and stamped the whole book, handed it back and I was good to go for the next 9 months. At the bottom of some pages there are also additional tests offered, so if you’re taking the booklet to your general doctor, make sure you know which of those you might need (your assigned midwife or gynecologist can tell you).
Next, and this is just a personal tip, I went home and based on how far along I was, entered each exam into my calendar so I would remember when I needed to get them done.
The exams in the libretto are all free, but you must present your libretto at ASL when you go for each exam or blood work, and be prepared to show your Tessera Sanitaria and your ID.
As for the exams in the libretto, besides the three ultrasounds that should be booked at that first ASL appointment (almost) all the rest are exams that require blood work or urine sample and you can just show up at any ASL location to do them. If you have a favorite ASL office that’s probably going to be your best bet. The two other exams that require a call to CUP to schedule are the glucose / prenatal diabetes screening or “la curva” (if your doc wants you to have it) and the tampone at the end of pregnancy (more on that later).
So to summarize this first trimester’s must do’s:
1. Get all your appointments scheduled for your ultrasounds (three of them – one in each trimester) at your libretto appointment
2. Take the assigned doctor or midwife from ASL, even if you have a private doctor. Costs nothing to get one and is a huge help if you find that you need it later.
3. Get your libretto signed and stamped on every page for every exam in one appointment with your medico di base (ASL assigned)
4. Find a convenient place for your blood/urine work – there are A LOT of appointments and you might have to go back and forth for results. Some places let you check results online, but this is rare.
Part 2: Second Trimester:
Around 20 weeks you will have your morfologica exam. This is the same as the “anatomy scan” in the US. If you go through ASL you will have a relatively short appointment where they check the measurements and look closely at the organs and blood flow.
Around this time also you will begin to be assessed for preeclampsia more frequently. I decided to order a cheap (20 euro) blood pressure monitor from Amazon instead of constantly going to the pharmacy for readings.
During this trimester you will also have your “curva” or diabetes screening. The Italian version of this test has you consume 75mg of glucose in about 10 minutes and then checks your blood sugar after 1 hour and after 2 hours. It’s not fun, and the drink is sickly sweet, but most doctors recommend it now, even if you’re low risk. You will need to schedule this test with ASL and your doctor will have to check off on it the libretto, it’s not part of the standard set of exams but it’s still free if signed off by your doctor.
Don’t forget you can also schedule appointments with your assigned doctor or midwife if you have questions or feel the need or to review your results.
Part 3: Third Trimester:
At 32 weeks or so you will have your last routine ultrasound. It’s called the growth ultrasound and they will give you an idea of baby’s weight, length and overall size. If everything is fine, you’ll be sent on your way and you won’t have another ultrasound unless baby is late and they need to assess fluids etc.
Also in the third trimester you’ll have the regular blood/urine work ups but also a delightfully named “tampone vaginale-retale” that is basically a swab around your sensitive bits to check for a certain type of bacteria that could make baby sick if they pick it up from you in labor. Unlike the blood work/urine tests that don’t require an appointment, this test does require that you call CUP to schedule. You can technically call to schedule this anytime in pregnancy, it just must be completed around 35-36 weeks of gestation (don’t worry, your libretto tells you at what weeks you need what!).
Additionally, in the third trimester you will need to decide on a hospital and book your 40 week “tracciata” or heart rate monitoring exam. This is of course only if the baby isn’t already here by then, but you can always cancel it if you don’t need it. I booked it 8 weeks before needing it so I could be sure to get it done right at 40 weeks. If you wait to long to book you might not find an appointment that quickly. This will be done at your hospital of choice, which brings me to another important step in trimester 3: choosing your hospital.
In Florence there are three main options:
Careggi (including Margherita)
Santa Maria Annunziata in Bagno a Ripoli (also sometimes just referred to as “Ponte a Niccheri”)
Torregalli aka Ospedale di San Giovanni di Dio
(If you’re not from Florence a quick Google search for Ospedale should show you, or check your regions ASL site).
Careggi is the largest and most well known hospital and is also a university hospital. It also has a birthing center called Margherita that is ENTIRELY run by midwives and they offer completely epidural free, natural births. If you have any complications you will not be accepted to Margherita and if your birth doesn’t progress smoothly you will be transferred to Careggi proper (they are connected by a hallway so its not a big transfer). Careggi is the hospital of choice for complicated births, or other issues as it has the most advance medical tools available.
Ponte a Niccheri – This is the smallest of the three and located outside of Florence proper. It is known for their dedication to mothers and their infants and has received awards for this. It is however rather far from Florence center, and time getting there in case of traffic etc should be a consideration depending where you live.
Torregalli – I found Torregalli to be a bit of the middle ground between the two other options. It has much of the resources that Careggi has (but not all) but it’s smaller. It’s on the border of Scandicci and Florence so again depending on traffic and what side of Florence you are coming from it could be more or less convenient.
Each of these hospitals (and Margherita) offers a set visiting time, where you can go, meet the staff and decide if it’s right for you. The hours you can find by calling their main non-emergency line or looking online. The visit lasts about 2 hours and perhaps most importantly, they have you sign the mandatory paperwork for an epidermal if you want one.
OK I know what you’re thinking…Say what? Paperwork for an epidural? YES. And, if you don’t sign the paperwork BEFORE you’re in labor they can deny you one on the big day. The reason is because they want you to know and assess the risks when you are of sane mind and body (i.e. not in pain). I highly recommend doing the visits at the hospital(s) that interest you – it will give you a chance to ask questions, and feel more comfortable (you already know where to go for example) when it’s time and get this paperwork signed. Even if you want to go without an epidural, it’s not a bad idea to sign the paperwork just in case you change your mind or need it.
You can request to attend free prenatal classes (corsi di preparazione alla nascita or corsi preparto) by looking online at ASL. Here is a link to the numbers to call based on your neighborhood (if you don’t know what is closer, just map them all three). These courses start after (and you shouldn’t call before) your 16th week of pregnancy. They are usually two hours a day, once every other week then once a week as you get closer to the end of the course. It’s a great way to meet other moms, feel more “involved” and also ask any questions.
Additionally, Careggi offers a swimming course for moms to be. You’ll need to reserve your spot (call around 20 weeks to reserve a spot, they don’t enroll you until you’re 30 weeks though) and is has a minimal fee (was 40 euro in 2018) for 4 weeks of classes in small groups of 6 people max. This is an exercise class, but really it’s relaxation. The pool is warm, the water alleviates pressure on your joints and will help you feel refreshed.
You can find more info here. You’ll see a number to call and an email address so you can get in touch. I found them super nice and helpful!
What if I want my own doctor or midwife or doula?
You can absolutely hire your own doctor, midwife or doula. Especially if you don’t speak Italian, this can be very helpful as you navigate uncertain waters. I personally met and really liked Ester Tatini who is a midwife and owns a store, PioPio where you can rent baby necessities (breast pumps, scales etc). She also offers a prenatal class and assistance on the day of birth plus lactation help later.
I do not know if she speaks English but she is amazing and at the very least her shop could be useful if you don’t want to buy every single object needed in the first few weeks. Her site and contact information can be found here.
Additionally, I have not met but I have heard the following doctors/midwives speak English and are amazing. Keep in mind you will have to pay them since they will be assisting you privately.
Marianna Rimbaldi : 055 794 2000 (office line at Careggi)
Francesca Rizzello: Here is a link to her site (prices and appointments)
Barbara Brodbeck: You can book an appointment with her at 055.470521 or 055.485524
Polina Zlotnik: Email: firstname.lastname@example.org, telefono: 338 237 27 72
Check out this site: https://www.mondo-doula.it/
Note on Doula’s in Italy: The hospitals have strict rules about how many people can attend your labor, and normally, outside medical professionals, it’s just one person. Since a doula is not a registered medical professional, they would count as your one person, meaning husband or mom can’t assist you during the birth. If that works for you, great, but don’t expect to have your hubby and your doula in the same room otherwise!
So, there you have it. All the things I had no idea about and learned along the way. I hope it’s helpful as you get ready for the greatest adventure of your life!