Overall, 43 reproductive-aged women (M = 31.9±6.1 years) without children, living in or near Florence, Italy, completed in-depth interviews. Most participants indicated they were in a non-marital relationship (67.4%, n = 29), with some indicating they were married (11.6%, n = 5) or single (19.6%, n = 9). Most participants self-identified as heterosexual (83.7%, n = 36), while others self-identified as bisexual (14.0%, n = 6) or homosexual (2.3%, n = 1). Most participants had some college or completed a college degree (86.0%, n = 37), while 6 participants (14.0%) completed a high school education or less.
Participants’ interview responses often highlighted the presence of a spectrum of opinion around a given belief. Preconception perspectives around pregnancy and birth in this population can thus be modeled as three intersecting continuums over which beliefs are held and decisions are made: supported vs. controlled, medical vs. natural, and safe vs. risky (see Fig. 1).
Supported vs. Controlled
Participants described pregnancy as a period of support and excitement, particularly tied to social networks. One participant said, “it seems pretty positive in how [pregnancy is] perceived and how people live through their pregnancy. I think it’s a very assisted process. Not just from the health system, but also from a family support system perspective [P46].” In addition to available group prenatal classes, women considered the role of their social circle as vital to information-seeking and problem management: “So, when you have an issue, a concern, you talk with your friends, with your family...It’s the same in case of pregnancy so people talk [P01].” Support was also described as practical, in the form of “friends that can help you do everything as soon as you’re pregnant; everyone starts to help you [P16].” Though this suggests social support, others perceived constant assistance and attention as challenging or frustrating. One participant suggested,
When you’re pregnant everyone is treating you as if you are sick, like you cannot do anything. Although this is just the culture of course, women that are pregnant end up working and…still being themselves… [P31].
Pregnancy-associated social treatment in this sense was a barrier to women’s daily lives. Prenatal care was similarly perceived as a form of support that is helpful and positive, but at times can feel regimented or excessive. One participant explained,
I was surprised because they give you this small notebook, inside you have all the analysis, all the ultrasound you have to do. You have your plan and you have to follow it. It...is mandatory to go and organize your pregnancy period with a doctor [P25].
Many saw this as a benefit, “because [women] are really followed […] you don’t have to worry about anything and you have all your appointments with the public system [P32].” Others felt it was too much, describing the burden of constant “analysis to check if everything is ok, if the baby is ok; many, many checkups [P06],” Reflecting how some women were bothered by overly attentive social support, excess medical attention may contribute to pregnant women being “view[ed] like [they are] sick” [P02].
Natural vs. Medical
Cultural attitudes suggested a desire to incorporate natural lifestyle choices into pregnancy experience. One participant emphasized this, suggesting:
The vibe among [Italian] mothers is to be as natural as possible…so most women prefer the natural option. There is…a movement of women who prefer the less intrusive, they prefer to have the most natural as possible experience—before, during, and after—so less drugs, less surgery, less intervention, less medical action [P26].
Participants valued cultural norms related to holistic health and well-being in pregnancy. This was in contrast to how some women felt like pregnancy was viewed, either by society at large or by the healthcare system. One participant described prenatal care as “a whole protocol,” elaborating with:
I’ve heard that lately in the last maybe 20 years or so in Italy, pregnancy is too medicalized, that there are too many exams, too many parameters to reach, too many doctor’s appointments, too many ultrasounds...while it should be a natural thing [P30].
Despite cultural preferences towards natural lifestyle choices, health care patterns still suggested strong influence of the biomedical model on birth.
In that same vein, participants described varied views of vaginal birth and C-section. Many participants recognized vaginal birth as the preferred method barring medical complications. One woman explained, “in Italy, there is a tendency to deliver vaginally and only to do ‘the cutting’ [C-section] if there is an issue that required it medically [P24].” However, others noted perceptions of high C-section rates: “in Italy, at the moment, it’s very trendy to [deliver] by C-section because it’s now very easy… [P43].” This participant continued on to say, “because [doctors] just give you a date…and that’s it. And many woman, they use it now, even if they don’t need it for health….” According to this participant, rates rose because of convenience for both provider and patient to treat birth as a medical rather than natural process.
Safe vs. Risky
Throughout discussion of various aspects of pregnancy and birth decision-making, participants expressed concerns, often constructing the process as “risky.” Risk mitigation was a predominant theme; because of “complications, you want to be in a structured [situation] [P15].” This started from the beginning with prenatal care: “People take prenatal care very seriously [P46].” Safety and risk also affected decisions regarding C-section:
Usually it depends on the health and the safety for the women and the baby, if they have a pregnancy that is already a risk they prefer to prearrange a birth…other cases, a lot of people prefer normal birth just because they think it’s more natural and very often…they try to let you have a normal birth but if they realize you don’t have enough strength or you are having problems, they just choose the other option because it’s safer [P08].
Complications were consistently of concern, with the desire for safety being placed ahead of personal birth goals:
In my dream, I want to give birth in water. But when you are pregnant, you forget about all these things and you just want the best things for you and your child. So, you just choose the best hospital you can… and you try to make the best choice for you, your health, and your child…because in that situation, everything can happen so you have to be prepared [P25].
Preparation and responsibility were considered motherly ideals, and necessitated careful consideration of risk. Most participants expressed similar viewpoints in preferring the structure and safety of hospitals over other options such as birth centers or home births, “because [at the hospital] they feel more protected [P18].” One participant said, “I think people could find it dangerous because…if something doesn’t go well you need to have all the resources at the hospital, which you wouldn’t be able to have [P42].” Birth was framed as dependent on preparation and resources to evade adverse outcomes.