Pandemic Pregnancies: Social Transformations of Perinatal Care Services in the Shadow of COVID in Italy (Vanessa Grotti, Alice Larotonda and Chiara Quagliariello)
Pandemic Pregnancies: Social Transformations of Perinatal Care Services in the Shadow of COVID in Italy (Vanessa Grotti, Alice Larotonda and Chiara Quagliariello)

Pandemic Pregnancies: Social Transformations of Perinatal Care Services in the Shadow of COVID in Italy (Vanessa Grotti, Alice Larotonda and Chiara Quagliariello)

One year and a half into the COVID-19 pandemic, Italy has gone through three pandemic waves, with related closures, restrictions, and reopenings. With around 75% of the population vaccinated, the media talks about reaching herd immunity, while the government recently enforced the use of a vaccine “Green pass” to prevent a new surge of cases. Alternating tensions and relaxations in social distancing and access to public spaces, however, have not always trickled onto the world of birth and birthing, in which a certain policy rigidity lingers.

The three of us have spent a significant part of our research time conducting ethnographic fieldwork on the effects of the Covid-19 pandemic on maternity care services in Italy from March 2020 to June 2021, as part of the ERC-funded project EU Border Care

Our body of data allows us to draw some considerations on the evolution of experiences and clinical practices over this time and to identify longer-term, structural processes at play (Grotti & Quagliariello 2020). Overall, the spread COVID-19 pandemic has led to the imposition of strict safety measures in pregnancy and birth health services. While some of these measures were welcome to our research interlocutors, others have had a strong impact on people’s perinatal and birthing experiences.

Our data indicates that some safety restrictions – like a strict use of protective gear and empty waiting rooms thanks to rigorously timed appointments – made patients feel protected when accessing the clinical space. This was a cause of satisfaction among patients, although new obstacles to service access sometimes emerged, such as long calling times to schedule appointments, or linguistic challenges for those who did not speak Italian fluently.

Meanwhile, other measures created intense disruption for expecting and birthing people. Among these, most evident is partners’ exclusion from prenatal visits and labor, which has cast disproportionate anxieties and responsibilities on women. Partners were allowed back into the birthing rooms a couple of months into the crisis. However, they could only be present during active labor and up to two hours after the baby’s birth. This has meant that many women had to face the greatest and most challenging portion of their labor alone, with little support from understaffed and overworked healthcare personnel. This has taken a toll on many women’s birthing experiences, possibly affecting outcomes of the birthing process by compromising women’s opportunities to give birth without medical interventions.

Most postpartum hospital visits were prohibited even for partners, with exceptions depending on individual healthcare facilities. While some research interlocutors appreciated the opportunity to have a quieter time with their baby, others faced considerable difficulties in caring for a newborn throughout the day without help. This was particularly true for those who were bedridden, for instance, after a Caesarian birth. Fear of contagion made many participants reluctant to ask hospital roommates for help monitoring their baby while showering or using the restroom. According to both patients and health professionals we interviewed, this may have triggered an increased reliance on the nursery, a service where babies are left under professionals’ care, which some women appreciated for the opportunity to rest, but others argued compromised bonding and breastfeeding initiation. A common thread appears in many narratives: that of a gradual but steady transformation of intimate relationships and affective ways of occupying spaces of care around birth, performed by both patients and those around them, directly impacting how newborns are socialized and nurtured from the moment they are born. 

Starting in spring 2021, health services have received directives to relax some safety restrictions due to the improved epidemiological situation and increased vaccination rates. This has included allowing partners or other accompanists to access prenatal screenings and ultrasounds. Despite this, we have noticed a clear tension between a public healthcare infrastructure that remains stranded within an emergency mode, and patients who have taken it upon themselves to find alternative solutions. Most notably, our data suggests that expecting families who could afford it have resorted to private care to circumvent healthcare restrictions. Private providers have more autonomy in administering safety restrictions: for instance, many interlocutors purposefully scheduled ultrasounds so that their partners, who were usually allowed to be present at private prenatal visits, could “meet” the baby. Parents’ creative efforts to create bonding, therefore, have often had to rely on new forms of elective, privately-run medicalization to obtain basic services that were not available in state infrastructures. Health policy appears to be slow to adapt to changes brought by increasing vaccination rates among the general population, which could justify a relaxation of social distancing measures in state clinics.

In conclusion, we have found that the fluidity of COVID-19 waves and related restrictions and relaxations has not directly reflected on perinatal care which, in contrast, has remained somewhat rigid. In Italy today, health policy appears to have failed to keep pace with an ever-evolving epidemiological landscape. Meanwhile, healthcare practitioners are caught between the need to follow directives and to care for their patients. Indeed, a tension exists between the wish to protect patients’ health and patients’ right to achieve their desired birthing experience. While the initial emergency response was rapid, changes have been small and careful ever since, as if somewhat restrained by an underlying culture of institutional containment reminiscent of Alison Bashford and Carolyn Strange’s historical analysis of practices of exclusion and isolation developed in late 19th C Euro-American societies (2003). COVID-19 seems to have reinforced preexisting limitations to the agency of expecting and birthing people in national perinatal care services, rather than creating opportunities for change.

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