Mental well-being is no less important than the physical health of the expectant mother. Between 10% and 15% of women who give birth experience more or less severe depressive disorders in the months that follow, which negatively affect both their health and their relationship with the newborn, and therefore can compromise the emotional and cognitive development of the child (33). This is postpartum depression, which should not be confused with the so-called baby blues, a physiological and temporary condition of fatigue and emotional instability that occurs immediately after birth and usually resolves spontaneously within 10–15 days.

True postpartum depression may appear even months after birth, typically lasts for 3–6 months, and in 25–30% of cases lasts a year or more.
Typical symptoms include anxiety, sadness, despair, fear of harming the baby, unjustified concern for the baby’s health, sleep disorders, loss of appetite, and feelings of guilt and inadequacy.

It is a multifactorial condition, meaning it arises from the convergence of different factors: a predisposition to depressive disorders, health problems in the mother or baby, hormonal changes during the postpartum period, lack of social support, financial difficulties, poor relationships with the partner or family members.
To fight postpartum depression, it is necessary to act quickly on all these fronts. First of all, the partner and the people close to the new mother in difficulty must help her take care of the baby and relieve her workload, so that she has time to rest. Home visits by midwives and childcare professionals in the weeks following birth, and participation in support groups, can provide reassurance and reduce stress. In more serious cases, it is necessary to consult a specialist, and drug therapy may also be helpful.

But postpartum depression, like many physical illnesses, can largely be prevented.
Often, women who show depressive symptoms after childbirth were already suffering from them during pregnancy, even if in a milder form.
Anxiety, social isolation, family conflict, and health issues in the mother or unborn child are other early warning signs of postpartum depression that should alert the woman herself, those around her, and the healthcare professionals assisting her.
In the presence of these warning signs, it is essential to talk to people nearby, the midwife, the gynecologist, the family doctor, and if necessary, contact the dedicated service at the local counseling center or hospital.

As soon as they come into the world, the newborn, placed on the mother’s body, moves their little hands around to explore a somewhat unknown yet familiar territory. They grab onto whatever they can, push forward, slowly shift, press their open mouth here and there until they find the nipple — their target. They latch on, at first clumsily. Then, after a few adjustments, more securely. And finally, they suck with satisfaction and relax.
It’s an incredible scene in its tenderness and natural perfection — the so-called “breast crawl” (30), the climb toward the breast that every newborn instinctively attempts if placed on the mother’s body and left undisturbed, guided by touch, smell, and taste. This is how the first feeding begins spontaneously, right after birth.

As we’ve seen, the sucking reflex is innate, and already in the fetal state, the baby is capable of feeding.

The first half-hour after birth is the best moment to promote the start of breastfeeding because it coincides with a phase of wakefulness and activity in the baby, known as Quiet Alert and Active Alert states. Once that phase ends — usually about 30 to 60 minutes later — the newborn generally falls asleep.

The World Health Organization (WHO) acknowledges and supports the experience of skin-to-skin contact at birth and the early initiation of breastfeeding, which has many positive effects on the baby’s development (31). Colostrum, the first milk produced by the new mother, is a concentrate of antibodies and proteins that stimulate the immune system, protecting the baby from the risk of respiratory and intestinal infections. It also has a laxative effect that helps the intestines eliminate meconium, the waste substance produced by the baby’s digestive system during pregnancy, and promotes the maturation of the intestinal lining.

Skin-to-skin contact stabilizes the baby’s body temperature and promotes the transfer of the mother’s bacterial flora to the baby’s body before other, non-beneficial and potentially harmful microbes colonize the baby’s mucous membranes. An initial bacterial transfer already occurs during birth, through the birth canal. If the baby is born via cesarean section and misses that passage, early skin-to-skin contact becomes even more important. That’s why WHO recommends this practice even when the baby is born by surgery. It’s an even more valuable resource in the case of premature birth. Thanks to Kangaroo Mother Care, the baby maintains proper body temperature even without an incubator, heart rate stabilizes, oxygenation improves, and the risk of hypoglycemia is reduced.
This is confirmed by the results of a meta-analysis published in the journal Pediatrics (32). A team of researchers from Boston reviewed over 1,000 studies on mother–baby skin-to-skin contact, selecting 124: the results showed that Kangaroo Mother Care reduces mortality risk by 36%, protects the baby from serious infections such as sepsis, and supports successful breastfeeding.
According to the meta-analysis, it increases the likelihood of exclusive breastfeeding at hospital discharge by 50%, with positive effects on feeding duration: when mothers and babies can stay close after birth, breastfeeding lasts longer.

Early latching to the breast is also helpful for the mother, as nipple sucking stimulates oxytocin production, which in turn promotes uterine contractions, placenta expulsion, and quick reduction of blood loss.

Lastly, but no less importantly, skin-to-skin contact in the first moments after birth is the most magical way for mother and baby to reunite.
It helps the mother and her baby establish a first bond of mutual knowledge and love — the foundation of secure attachment that will support calm and balanced development of the child in the coming months and years.
Mutual understanding deepens even further in the following days if the new mother has the opportunity to remain in continuous contact with the baby, day and night, getting used to the baby’s rhythms and needs and learning to recognize the signals and respond promptly.
Today, almost all birth centers offer rooming-in, meaning that mother and newborn share the same room 24 hours a day during hospitalization, without being separated, so that newly initiated breastfeeding can be strengthened.

Although some scholars such as Frédérick Leboyer — who has repeatedly described fathers as “intruders,” accusing them of “distracting” the mother’s attention from the newborn — or Michel Odent — who, speaking of women’s generative power, has pointed out how the presence of the father can block the automatic, instinctive mechanisms that facilitate expulsion — it is now widely recognized that the presence and closeness of the partner have positive effects on the smooth outcome of childbirth.

According to the latest CeDAP Report (Certificate of Assistance at Birth) on childbirth in Italy, related to 2017 and published by the Statistics Office of the Ministry of Health in September 2020 (29), “in 91.85% of vaginal deliveries, the woman had the child’s father next to her at the time of birth, in 6.7% a family member, and in 1.4% another trusted person”.

Being present at the birth of one’s child is a great opportunity for personal growth, a beautiful chapter to write in the couple’s story, a journey through emotional bonding, an extraordinary emotion.

To be helpful, however, the father must convey calm and instill confidence in the laboring woman. He must not impose his presence unnecessarily and must adapt to the constant and sudden mood swings, outbursts of anger and frustration from his partner, helping her overcome them with the supportive help of the healthcare staff.

It is therefore advisable for the father to take part in childbirth preparation courses, especially the sessions focused on labor and birth, so that he will be prepared for the most overwhelming moment of his life!

The birth of a child marks the culmination of a nine-month journey. If the pregnancy has followed a physiological course, the expectant mother and the baby are in good health, the baby is full-term, well-developed, and in a cephalic position. In the absence of high-risk factors, the birth is also expected to be physiological. These are conditions present in the majority of births.

That’s why it’s important to tailor childbirth assistance based on obstetric risk, to ensure it is always appropriate. Just as it’s done during pregnancy — where care varies according to the risk of complications and the health of the woman and fetus — assistance during labor must not be excessive nor insufficient. However, risk is a dynamic parameter, which can change over time and must be continuously monitored by healthcare professionals. When birth is expected to be physiological, it can be attended solely by a midwife, with maternal and neonatal outcomes equivalent to those of a physician-led delivery, but with fewer invasive interventions (such as cesareans and episiotomies) and greater satisfaction from the mother, who — with the midwife’s support — feels more in control and gains confidence in her maternal abilities.

Giving birth with midwifery-led care is still not possible everywhere in Italy, but only in a few dozen maternity units that have established specific protocols. In these units, a specialist physician is always available but is only called upon by the midwife in case of complications that require medical intervention.

There are also midwife-led birth centers located within hospitals, but independent from the maternity ward — such as those at S. Martino Hospital in Genoa, S. Anna Hospital in Turin, Careggi Hospital in Florence, and Spedali Civili in Brescia. These are still rare in Italy.

There are out-of-hospital, privately managed birth centers, also known as maternity homes, from which the laboring woman can be quickly transferred to a hospital if needed.
Lastly, there is the option of home birth, assisted by experienced midwives, possible only if there is quick access to a nearby hospital. Except for a few rare cases where hospitals provide home birth services, home births in Italy today are exclusively handled by freelance midwives, many of whom are affiliated with the National Cultural Association of Midwives for Home Birth and Maternity Homes.
Provided the women are carefully selected, motivated, and assisted by qualified professionals, those who plan a home birth or choose a maternity home have the same health outcomes as those who give birth in hospitals (28).

So far, we’ve discussed physiological birth. In the presence of risk factors that may shift labor and delivery toward a pathological course — such as advanced maternal age, obesity, or a multiple pregnancy — the assistance of a gynecologist is necessary, and the most appropriate place for birth is a hospital maternity unit that manages at least 500 births per year, preferably 1,000 or more, to ensure staff have sufficient experience to manage uncommon complications.

If the pregnancy is pathological — for example, in cases of gestational diabetes or intrauterine growth restriction — the woman should go to a large hospital where multidisciplinary specialists are available, and be cared for by a gynecologist specialized in maternal-fetal medicine.

According to the latest data from the Ministry of Health, 89.2% of births take place in public or accredited hospitals, 10.5% in private clinics, 0.1% elsewhere. 63.9% of mothers chose a facility that handles more than 1,000 births per year, while 5.8% chose one that manages fewer than 500.

As with all other aspects of reproductive health and pregnancy, the choice of location and type of birth assistance should be made by the woman — informed and consciously, based on her needs and preferences. For this reason, during pregnancy, it’s important that the mother-to-be learn about the available options and facilities in her area, visiting them in person or calling to inquire about their protocols and health outcomes.
Questions to consider include: Is continuous one-to-one midwife support offered? Can the partner or a trusted person be present during labor and birth? What is the cesarean rate? How often are vacuum extractions or episiotomies used? Is skin-to-skin contact between mother and baby allowed immediately after birth?

Another important aspect to consider, especially in the case of fetal complications or preterm birth, is whether the hospital has a Neonatal Intensive Care Unit (NICU) — vital for the survival and quality of life of babies born extremely or very preterm, between 22 and 31 weeks of gestation. Nationwide, as of 2016, there were 173 NICUs, 104 of which are located in hospitals that handle over 1,000 births per year, the others in hospitals managing 500 to 800 births per year.

Finally, it’s important to know that midwife-led birth centers typically do not offer pharmacological pain relief during labor and birth. Women who wish to receive epidural anesthesia should ask in advance.
Although labor analgesia has been officially included in the Essential Levels of Care (LEA) and should be guaranteed to all women who request it, in practice not all Italian maternity units offer it. This is because round-the-clock anesthesiology coverage is required.
According to the 2017 National Outcomes Evaluation Program by the Ministry of Health, only 176 out of 500 facilities (public and private) provided 24/7 epidural anesthesia during labor.

“Health promotion must produce skills and awareness.” This sentence, taken from a report by the Istituto Superiore di Sanità on the birth pathway, clearly conveys the usefulness of childbirth preparation courses: they serve to inform the expectant mother, actively involve her in decision-making processes about pregnancy and childbirth, strengthen her confidence in her own abilities, and allow her to share experiences, doubts, and emotions with other women going through the same journey. It is a useful and valuable moment also for the couple, to face changes together and prepare for their new roles.

Since 2017, childbirth preparation courses have been included among the health services that must be provided free of charge throughout Italy under the Essential Levels of Care (LEA), but at present not all Regions are equipped to offer them in a systematic way. Many family counseling centers and maternity units organize free series of meetings throughout the year for expectant mothers approaching the end of pregnancy.

Topics covered in the courses include lifestyle during pregnancy, childbirth methods, assistance protocols adopted in the specific facility organizing the course, breastfeeding, and newborn care. Rarely addressed topics, which instead would require greater in-depth discussion, include vaccinations in early childhood and the choice of the most effective contraceptive method compatible with breastfeeding for the resumption of sexual activity, with the aim of spacing out or avoiding a subsequent pregnancy if the couple has reached the desired size of their family.

There are also associations of freelance midwives, private medical practices, and other organizations that offer paid meetings, sometimes dedicated to specific topics, such as natural methods to ease labor and childbirth pain, or changes in family dynamics after the birth of a baby.

According to the results of two surveys recently conducted by the ISS, 53.6% of Italian expectant mothers have attended a childbirth preparation course during at least one of their pregnancies, usually the first. In 70% of cases, women attended the course from the seventh month onward, although experts recommend starting earlier, as the information acquired during the meetings does not only concern childbirth but is also useful in the early months of pregnancy.

Attending a childbirth preparation course reduces the likelihood of resorting to cesarean delivery and increases the likelihood of initiating breastfeeding early and continuing it beyond the first 5 months of the baby’s life (27).

In the first trimester of pregnancy, nausea and vomiting are very common and are considered “psycho-biological adaptations” of the pregnant woman. Among the typical symptoms, nausea is one of the first to appear and is very often associated with altered taste perception and increased sensitivity to smells.

It is commonly referred to as “morning sickness”, but its symptoms can appear throughout the day and even at night (24). The symptoms generally appear between the 4th and 9th week, peak between the 7th and 12th, and tend to disappear between the 12th and 16th.

Vomiting during pregnancy is a symptom that occurs especially in the first trimester and is caused by increased hormonal activity in the woman’s body. This leads to a disruption in the normal functioning of the digestive system, which implements this mechanism in order to protect the fetus’s growth from food contamination.

We speak of “hyperemesis gravidarum” only when these symptoms persist beyond the first trimester or increase in intensity, with continuous vomiting, electrolyte imbalances, weight loss, ketosis, and acetonuria.

Typical cases of nausea during pregnancy usually do not pose any risk to the mother or the fetus. However, it can be harmful when it is so intense that it causes an excessive loss of fluids and nutrients through vomiting, resulting in a decrease in the mother’s weight, creating a state of stress that may also be potentially harmful to the fetus (25).

To alleviate the sensation of nausea, experts have developed a series of recommendations, listed below:

• sleep as many hours as possible: fatigue from pregnancy worsens nausea. Upon waking, it is recommended to get up slowly to avoid sudden drops in blood pressure;
• avoid hot places, because rising temperatures increase the sensation of nausea;
• take a daily walk;
• do not lie down after eating;
• avoid brushing your teeth immediately after meals;
• avoid long car trips.

As for nutrition, here are some very useful tips (26):

• eat small meals and snacks frequently, preferring cold foods over hot ones;
• prefer foods rich in protein and low in fat: for main meals, a classic second course in rotation (meat, fish, eggs, legumes, cheese); for snacks, small quantities of shelled dried fruit (walnuts, hazelnuts, almonds) and seeds (pumpkin, sunflower, sesame) are recommended. In some cases, foods containing ginger may be helpful;
• increase fiber intake (including blended vegetables, fruit, legumes, wholegrain toast, wholegrain pasta and bread) to avoid constipation, which may increase discomfort;
• drink at least 8–10 glasses of water a day;
• avoid foods and smells that seem to worsen nausea;
• chew slowly to aid digestion;

Pregnancy is not an illness, so it is not incompatible with work activity, provided that the work is not dangerous to the health of the woman and the unborn child and that the pregnancy progresses without complications or pathologies that require rest. In the last months before childbirth, physical fatigue throughout the day tends to increase and the expectant mother begins to feel the need to prepare for and focus on the upcoming birth and the changes it will bring.

For this reason, today in Italy, the law (23) provides for a mandatory maternity leave of 5 months and the possibility for the worker to choose how to use it: either to rest two months before birth and three months after, or one month before and four after, in order to have more time dedicated exclusively to the newborn. Recently, further options have been introduced, for example, it is possible to work until the birth and preserve the full 5 months of leave for after the baby is born.

It is a completely personal choice that each expectant mother must freely make, by listening to her own emotions and needs —without fear of being judged or of changing her mind. Even if there is a desire to save as much time as possible for the postpartum period, for example, it is possible that changes or needs arise requiring a different plan. And for the wellbeing of both mother and baby, these needs absolutely must be respected.

Whatever the choice, the pregnancy and the maternity leave request must be communicated by the seventh month of pregnancy to the employer and to the INPS (Italian National Institute of Social Security) or to the relevant social security institution. The pregnancy must be certified by a doctor from the national health service who, in the case where the expectant mother chooses to work until the end of the eighth or ninth month, must certify that there are no risks to the health of the woman or the unborn child.

If the work activity of the expectant mother is incompatible with pregnancy, the employer is required to transfer her to a different position; if this is not possible, either the employer or the worker may submit a request to the Territorial Labor Inspectorate, which is responsible for issuing the order for early leave from work. If, instead, it is the health condition of the woman that prevents her from working due to complications or risks related to the pregnancy, it is up to her to request early leave from work through the local health authority (ASL), by presenting medical documentation attesting to the situation.

When talking about check-ups and examinations during pregnancy, one cannot help but think of another important topic, which is usually close to the heart of would-be parents, namely prenatal diagnosis.

Once, the public health service offered chorionic villus sampling or amniocentesis to all pregnant women aged 35 or older – and to all those with recognized risk factors. Two invasive tests that consist of withdrawing, with a syringe through the abdominal wall, a sample of placental tissue or amniotic fluid in order to analyze the genetic makeup of the fetus and accurately diagnose possible chromosomal abnormalities, such as Down syndrome, or genetic diseases such as cystic fibrosis.

Chorionic villus sampling can be performed between the 10th and 14th week, while amniocentesis is preferably done between the 16th and 18th week. Since 2017, with the approval of the new LEA (Essential Levels of Care), the free offer of CVS or amniocentesis remains available to women with specific risk factors. For all others, regardless of age, between the 11th and 14th week a screening test is recommended that includes an ultrasound measurement of fetal nuchal translucency combined with the so-called “bitest”, a blood test measuring the concentration of two proteins. From the combined result of these two tests, an estimate is obtained of the risk that the fetus may be affected by trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), or trisomy 13 (Patau syndrome).

The bitest combined with the nuchal translucency measurement does not provide a certain diagnosis, but a risk percentage. If the risk appears high, the woman is offered a free amniocentesis to confirm or rule out the suspicion.

In recent years, the offer of screening and diagnostic tests has further expanded thanks to advancements in DNA sequencing, which now allow for a review of the entire fetal genome from a sample of amniotic fluid or placental tissue, scanning for the genetic mutations responsible for hundreds of diseases. Thus, the most advanced laboratories offer expecting mothers “super-amniocentesis” or “super-CVS”, promoting their ability to diagnose or rule out most genetic diseases that the fetus may carry.

Future parents can request testing for the most common genetic diseases, such as cystic fibrosis and congenital deafness, or request analysis of a greater number of genes. The cost of the test varies accordingly, from 600–700 euros to over 1,000, and is not reimbursed by the national health service.

These highly “comprehensive” tests are not offered by the SSN (National Health Service), nor are they recommended by the Italian Society of Human Genetics (SIGU) (22), because they are essentially of limited utility.

In the absence of family history or consanguinity between partners, the probability that a couple will have a child affected by a genetic disorder is extremely low, less than 1%. Excluding a few hundred diseases does not significantly lower the overall risk, especially because the number of conditions for which the responsible genes are unknown — and thus cannot be diagnosed by these tests — is far greater than the number of known diseases.
Finally, there are cases where the test result does not make it clear whether the fetus is a healthy carrier or affected by the disease, and even if it is affected, the severity of the clinical condition cannot be predicted, since the same genetic variant can be expressed differently from one individual to another, with symptoms that may be so mild that it’s difficult to speak of an actual illness.
Prospective parents therefore learn from the report that there is an anomaly — but they cannot know what it means: this is a situation that generates anxiety with no resolution.

Another recently developed tool is the NIPT (Non-Invasive Prenatal Test), which allows for the analysis of fetal DNA without needing to extract amniotic fluid or chorionic villi cells — and thus without invasive procedures. It is based on the fact that small amounts of fetal genetic material cross the placental barrier during pregnancy and circulate in the mother’s blood. With current techniques, it is possible to isolate this DNA from a blood sample taken from the woman and analyze it to detect any chromosomal abnormalities, such as Down syndrome, and to screen for some specific genetic diseases, such as cystic fibrosis.

Although it is extremely reliable, much more so than the combination of bitest and nuchal translucency measurement, the NIPT is not yet considered a diagnostic test capable of providing a definitive result, but only a risk estimate. If the result shows an anomaly, it is still necessary to undergo the traditional invasive test to confirm the diagnosis.It can be done starting from the 10th week of pregnancy and its cost ranges from 600 to over 1,000 euros, depending on the information being sought.
It is not reimbursed by the National Health Service because it is much more expensive than the bitest and nuchal translucency measurement.

In most cases, expecting a baby is a physiological event that expresses a condition of health, not of illness. And it is important that all future mothers can begin the waiting period with this awareness and, therefore, with peace of mind. The data collected by the Istituto Superiore di Sanità is clear: 67.3% of mothers report no complications during pregnancy and childbirth, 18.5% have minor issues, discomforts that often do not require medical intervention, and only 14.2% report serious problems that require forced bed rest or hospitalization.

The purpose of the tests and periodic check-ups recommended during the nine months is precisely to verify that everything is going well, reassuring the mother, and to highlight possible risk factors to act on early. And at the same time, to reduce maternal stress. Doing more tests than those provided by the Ministry of Health, if not justified by specific indications, does not guarantee better results or greater protection of the pregnancy. And it can generate insecurity and fear in the expectant mother, which is exactly the opposite of what is meant when talking about health promotion.

So, what are the appropriate care interventions to assess the progress of pregnancy, the health conditions of the future mother, the growth, and the wellness of the unborn child? They are those described in the ISS Guidelines and offered free of charge by the public health system of all Regions as part of the LEA, the Essential Levels of Care (21). At the beginning of pregnancy, preferably by the 13th week, the health service offers the expectant mother some blood tests that aim to determine whether she is immune or susceptible to certain infections potentially harmful to her baby. In case of susceptibility, she can take useful measures to reduce the risk of infections. Here is what they are, what they are for, and when they should be done.

The rubella test detects susceptibility to rubella, which during pregnancy can cause miscarriage or congenital damage. Ideally, this test should be done before trying to conceive so that the aspiring mother has time to be vaccinated if she is not immune. After conception, the rubella vaccination is contraindicated, and in case of susceptibility, all that can be done is to avoid contact with infected people. If the expectant woman is not immune, the rubella test is offered a second time between the 15th and 17th week to diagnose any infection contracted during pregnancy in asymptomatic or mild form. After the 17th week, it makes no sense to repeat the test further because, even if the woman contracts rubella and transmits it to the fetus, the risk of damage to the baby would be very low.

The toxoplasmosis test is used to determine immunity or susceptibility to toxoplasmosis, an infection that can be contracted from raw or undercooked meat or by coming into contact with cat feces. In pregnancy, it can cause fetal malformations. There is no vaccine against toxoplasmosis and in case of confirmed susceptibility, the most effective remedy to reduce the risk of infection is to avoid eating raw or undercooked meat, to thoroughly wash fruit and vegetables before consuming them, and to avoid contact with the cat litter box and garden soil where the cat usually roams. For the non-immune woman, the test is offered again every 4–6 weeks to diagnose any infection contracted during pregnancy. If the infection is present, prompt drug therapy will be administered.

The HIV test is used to diagnose an ongoing infection and is offered before conception, at the beginning of pregnancy, and again after 33 weeks, in preparation for childbirth, to implement, in case of positivity, all precautions useful to avoid infecting the baby.

The test for Treponema pallidum, or syphilis, is also offered at the beginning of pregnancy and after the 33rd week. The infection, sexually transmitted, can pass to the unborn child through the placenta or during childbirth. In case of a positive diagnosis, it can be treated effectively and quickly with an antibiotic that is not contraindicated during pregnancy.

The test for hepatitis C is offered by the 13th week because the infection can be transmitted through the placenta, although the event is unlikely. The one for hepatitis B, however, is offered after the 33rd week because the contagion can occur when the baby passes through the birth canal. If the result is positive, the baby must be given a dose of the hepatitis B vaccine and a dose of specific immunoglobulins against the virus within 24 hours of birth.

There are also three tests for the diagnosis of potentially dangerous infections in pregnancy that are carried out using a vaginal swab and not a blood test. By the 13th week, those for Chlamydia trachomatis and Neisseria gonorrhoeae. Both are treated with antibiotic therapy and, if not diagnosed promptly, can cause miscarriage or preterm birth. After the 33rd week, the swab for the search for group B beta-hemolytic Streptococcus, is instead offered, which can infect the baby during passage through the birth canal. This too is treated with antibiotics.

A blood test recommended to assess the health condition of the expectant mother is the complete blood count, which is performed at the beginning of pregnancy and again at 28 and 33 weeks and measures the concentration of red blood cells, white blood cells, and platelets in the blood. Its main function is to diagnose any anemia to be corrected with iron supplementation.

The blood glucose test, which measures the concentration of sugar in the blood, is provided at the beginning of pregnancy to detect any diabetes already present before conception and not diagnosed.

To diagnose possible diabetes that has arisen during pregnancy, the glucose curve test is used, offered to expectant women in the presence of some risk factors: obesity or severe overweight and diabetes during previous pregnancies. It consists of measuring fasting blood glucose followed by the administration of a solution of water and 75g of sugar. Then the glucose is measured again one hour and two hours later, to assess the body’s ability to metabolize sugar. The test is proposed twice: between the 14th and 17th week and again between the 24th and 27th. At the beginning of pregnancy, at the 24th and after the 33rd week, the urine test is proposed, to assess various health parameters of the expectant mother and diagnose any urinary tract infections.

The indirect Coombs test provided at the beginning of pregnancy and a second time at 28 weeks, detects in the mother’s blood the possible presence of antibodies that can attack and damage the unborn child’s red blood cells, causing a hemolytic disease called erythroblastosis fetalis. People who have Rh-positive blood have on the surface of red blood cells a molecule, antigen D. Their immune system recognizes that molecule as part of their own body and does not attack it. Those with Rh-negative blood do not have antigen D and their immune system does not recognize the molecule as their own. The first time the immune system of an Rh-negative person comes into contact with Rh-positive blood, it becomes sensitized against antigen D, meaning it identifies it as an enemy and organizes to attack it. At the second contact, it attacks and destroys the red blood cells that carry it. If an Rh-negative woman is expecting an Rh-positive baby, her immune system can become sensitized to the baby’s antigen D if it comes into contact with their blood. Normally, the placenta prevents the exchange of blood between mother and fetus, but during childbirth, in the case of an invasive test such as chorionic villus sampling or amniocentesis, or in case of threatened miscarriage with bleeding, sensitization can occur. The mother’s body can then begin to produce antibodies directed against antigen D that pass through the placenta and attack the fetal red blood cells. The test is also offered to women with Rh-positive blood, because there are other antigens, in addition to D, with which the mother may have come into contact during pregnancy or following a transfusion and which can trigger an immune reaction. Even if they are antigens that cause clinically mild forms of hemolytic disease, they must still be investigated and not overlooked.

In addition to laboratory tests, at least eight meetings are recommended during pregnancy with the healthcare provider in charge of the expectant mother, whether midwife or gynecologist. These are important appointments, and if possible, it is better to attend them as a couple because they are opportunities to discuss, raise concerns, ask for advice, measure the mother’s weight and blood pressure, and, if necessary, perform an obstetric examination. The provider may have an ultrasound machine in the office, which can be used for a quick check-up to assess the general health conditions of the unborn child.

The two most accurate — and eagerly awaited by mom and dad — ultrasounds are those recommended and offered as part of the Essential Levels of Care (LEA): the first, to be done within the first trimester, is used to accurately date the pregnancy, count the number of embryos, and verify their correct implantation in the uterus. The second, the so-called morphological ultrasound of the second trimester, is used to check the growth of each anatomical structure of the baby and the development of the individual organs. A third ultrasound, once offered between the 30th and 32nd week, is now provided free of charge only in the presence of a maternal or fetal pathology risk. If everything is progressing well, therefore, it is preferred not to subject the expectant mother to one more test, which would be unnecessary and, therefore, inappropriate.

Access to accurate knowledge and to counseling that respects personal choices has concrete and measurable effects on the health of the expectant woman and her unborn child. Evidence shows that future mothers who receive proper information from healthcare professionals and are involved in decisions about pregnancy management are less likely to undergo cesarean delivery, more likely to start breastfeeding early — within 2 hours of birth — to continue it for longer — over 5 months — and are less likely to need to bring their babies to the hospital for any reason during the first year of life (17).

In an era where pregnant women are overwhelmed by alarming messages of all kinds, fake news, and unsolicited interference, evidence-based information becomes a valuable health promotion tool — a tool that, according to the Guidelines for Physiological Pregnancy Care published by the Istituto Superiore di Sanità, helps future mothers “make informed choices based on their needs and preferences, after discussing them with the professionals assisting them.”
It is in this way that the woman becomes an active protagonist of pregnancy and childbirth: healthcare professionals inform, accompany, and advise her, but the decisions are hers.

Who are the professionals who support future mothers during pregnancy? In Italy, 66% of women rely on private gynecologists, 17.5% on public hospital staff, and 16.4% on staff from local family counseling centers (18). All of them value continuity — the chance to be followed during pregnancy, childbirth, and postpartum by the same person, with whom a relationship of trust is established. And in fact, continuity is also beneficial to health, according to the World Health Organization (19). It is associated with a lower incidence of hospitalizations during pregnancy, less frequent use of vacuum extraction during birth, higher breastfeeding rates, and greater maternal satisfaction (20).

In addition to being continuous, care must be essere differentiated based on risk, that is, it must include a path of tests and medical interventions that differs depending on whether the pregnancy is physiological or complicated by conditions or risks. Managing all pregnancies as though they were high-risk, in the name of the precautionary principle, leads to unjustified expenses — often borne by the woman — and a higher likelihood of inappropriate, unnecessary, or even harmful interventions.

The qualified professional to care for healthy women during low-risk pregnancies is the midwife, who has the role of supporting and encouraging physiology, while remaining attentive to signs of pathology or risk and, if necessary, involving the gynecologist or other specialists.
Both the Istituto Superiore di Sanità and the World Health Organization agree on the value of this care model: a woman who is followed continuously during pregnancy, childbirth, and postpartum by a single midwife or a small group of midwives with whom she has established a trusting relationship — and with the possible involvement of a gynecologist or other specialists in the event of complications — has a lower probability of hospitalization during pregnancy, less need for medical interventions such as vacuum extraction, cesarean section, and episiotomy, and a higher level of satisfaction and sense of control.
In our country, midwifery care during pregnancy is offered free of charge by family counseling centers and hospitals, and privately by independent midwives.

Non-communicable diseases, especially cardiovascular diseases, diabetes, and some forms of cancer, are currently the leading cause of death worldwide, and are largely preventable by adopting a healthy lifestyle: eating a balanced diet, engaging in physical activity, and avoiding harmful habits such as smoking and excessive alcohol consumption.

These are good habits that should be taught to children as early as possible to guide them toward a future of wellness. But what does “as early as possible” really mean? Recent research tells us: even before birth. This refers to the first 1,000 days, the period from conception to roughly the child’s second year of life. It is proven that the lifestyle of the expectant mother during pregnancy, and even better in the preconception period, influences the activation of the genes directing the development of the unborn child, effectively programming their metabolism. This is supported by nutrigenomics, the science that studies the link between nutrition and DNA: genetic heritage is sensitive to lifestyle — especially diet. A child born to a mother with poor nutrition, a sedentary lifestyle, who smokes and consumes alcohol, is predisposed to obesity, diabetes, high cholesterol, and chronic inflammatory diseases (14).
That’s why an expectant mother who wants to give her baby the best possible opportunities and begin caring for them from the very start must commit to correcting harmful habits and lifestyle choices during pregnancy, and ideally even before conception: a healthy diet, physical activity, an optimal body mass index, and reduced exposure to harmful substances. This applies to both the future mother and the future father.
It’s a gesture of love and responsibility for their child — and at the same time, a way to improve their own health.

The recommendations for healthy eating and avoidable risk factors in pregnancy are listed in the guidelines of the Istituto Superiore di Sanità (ISS) (15), along with information on how harmful habits impact the health of both the mother and the unborn baby.

According to the document, a proper diet should be varied and include: Plenty of fruits and vegetables, Whole grains, Protein from meat, fish, and legumes, Dairy products such as milk, yogurt, and cheese. In a balanced diet, fortified foods and supplements may be added if needed. Among these, the daily intake of 0.4 mg of folic acid is always recommended — essential during the preconception phase and the first months of pregnancy to prevent neural tube defects like spina bifida and cleft lip/palate. It is therefore recommended to all women of childbearing age who may become pregnant. Tobacco and alcohol are potentially harmful even in small amounts and should be completely avoided during pregnancy. Finally, unless there are specific contraindications, moderate physical activity is advised throughout all nine months of pregnancy.

Learning the rules of a healthy lifestyle during pregnancy is the first step toward applying them and practicing prevention.
Knowing why these rules matter, where they come from, and what evidence supports them is even more motivating for a future mother. This is confirmed by findings from the Istituto Superiore di Sanità (ISS) (16): the most effective approach to promoting healthy behavior is personal communication between the woman and the healthcare provider supporting her during pregnancy — a type of communication that is never alarmist, but clear and targeted.

During pregnancy, it’s not only the foundations of the future relationship between parents and child that are being laid. The foundations of the child’s future well-being are also being established. It is now proven (13): physical and neurological development, metabolism, and susceptibility or resistance to various diseases are determined or strongly influenced by what happens during the nine months of pregnancy.

It’s an intense and valuable period, during which not only the baby is formed, but also the mother, who during these months has the opportunity to gradually become aware of the transformation and of her new role. A role that, from the very beginning, requires her to consider the well-being, health, and safety of her child, through the choices she makes. A mother, in fact, can begin to take care of her child as early as when she starts thinking about motherhood — by changing habits and lifestyle in light of this new path.

It is a great responsibility, of course, but mothers naturally possess all the resources they need to care for their children in the best possible way. An innate gift, which can only grow stronger with self-confidence and support — both emotional and practical — from those around her. Today, every expectant mother can be the protagonist of her pregnancy and birth, thanks to access to respectful care and evidence-based information, which allows her to make the right choices for her own health and her baby’s, gaining confidence and trust in her own abilities.

If in the past life before birth was shrouded in complete mystery, today we know that the baby, from the very first weeks of pregnancy, is a sensitive, intelligent, and social being, psychologically and emotionally capable of perceiving and processing sensations. This is why it is possible to connect with them.

In prenatal bonding, mother and baby communicate on different levels to get to know each other: while the mother discovers the baby, the baby discovers her and the world in which she lives. The first level is physiological: what the expectant mother eats, drinks, inhales, or absorbs passes through the blood to the placenta and is transmitted to the baby. More generally, the health of the expectant mother influences that of the unborn child.

However, health is not just the absence of disease or the result of a healthy lifestyle, but more broadly, it is the physical and psychological well-being of a person. Even without physical illnesses, prolonged stress, work or family tensions, financial difficulties, and social isolation are risk factors for the developing child.

Maternal stress can affect fetal health: it can trigger the production of cortisol, and prolonged exposure to high concentrations of this hormone during prenatal life can limit physical and cognitive development and predispose the child to metabolic diseases such as diabetes and hypertension (7). Through small RNA fragments released by the placenta over the 9 months, the mother’s body regulates and guides the expression of the baby’s genes, adapting it to the environmental conditions it will encounter after birth. Stress also interferes with this mechanism, predisposing the child to diseases characterized by chronic inflammation (8).

To offer her baby the best starting conditions, the expectant woman should live a calm life, free from trauma and stress, engaging in fulfilling activities — including work, if it is satisfying and not too tiring or unhealthy — while also finding enough time to relax, unwind, and familiarize herself with the baby growing inside her, to listen, and to begin connecting. Pleasant experiences promote relaxation and increase body awareness, stimulating the release of higher levels of oxytocin, the hormone naturally produced during pregnancy to help the mother feel calmer. This state is undoubtedly beneficial for both the mother and the baby, who in turn experiences a sense of well-being.

Despite busy schedules, family obligations, and work, every expectant mother can still carve out time and space for enjoyable activities that benefit her wellbeing and that of her baby. For example, the refreshing and restorative effect of healthy rest, even during the day, should not be overlooked. Some time spent on the couch, reading a book or listening to music, can be very relaxing and rejuvenating. So can a walk in the park, surrounded by greenery, without rushing, just for the pleasure of walking and enjoying the moment. Weekends out of town are also encouraged, to fully enjoy the benefits of outdoor life as well as positive stimuli like discovering new places, landscapes, art, and good food.

It’s also a great opportunity to strengthen and deepen the couple’s bond. A good connection helps prepare for the arrival of the baby and for gradually taking on the role of parents — even through sexual activity. It’s rare that sex needs to be avoided during pregnancy (9). In all other cases, if the midwife or doctor does not explicitly advise against it, making love during pregnancy carries no risk. The light uterine contractions induced by intercourse and the prostaglandins in semen are not strong enough to trigger labor prematurely, and if the partner is healthy and basic hygiene is observed, there is no danger of transmitting infections to the baby, who is well protected by the membranes and the sealed cervix. In fact, intimacy benefits the mother’s physical and emotional state and strengthens her connection with her partner.

A second level of bonding is behavioral: the actions of the mother and father are perceived by the baby, and vice versa. Parents can feel the baby’s movements and tiny kicks or nudges as they caress the belly, talk, or sing to the baby.

Today we know that the fetus changes behavior in response to different stimuli (auditory, olfactory, gustatory) and can even remember and recognize some of them after birth.

Around the fifth month of pregnancy, the baby begins to process both internal and external stimuli from the mother’s body — especially her heartbeat (10), which soothes the baby both in the womb and after birth, when they are placed on the mother’s chest or hear a recording of it. At the same time, the baby’s taste buds are activated, and by swallowing small amounts of amniotic fluid, they can taste what the mother eats. Between the sixth and seventh month, the unborn child can open their eyes and respond to light stimuli. Most importantly, they can recognize the voices of the mother and father, distinguishing their tone, intensity, and sound duration from other voices.

Talking to the baby, reading stories and rhymes, even during pregnancy, is a great way to communicate and lay the foundation for a future relationship. So is music, or using the voice to sing or make rhythmic and repetitive sounds: in this playful-creative dimension, the mother strengthens the attachment and emotional bond with her baby, tuning in, speaking to, and singing for them, supporting the natural regressive state that occurs during pregnancy (11).

Visualization, which involves using mental imagery in a state of deep relaxation, also allows the mother to connect with her baby by imagining them in positive scenarios. The first visualizations are usually guided by a professional who helps the woman relax and suggests which images to focus on. Later, the exercises can be done independently, using a recorded voice. Visualizations can be helpful during the early stages of pregnancy — up to the fourth or fifth month — when fetal movements are not yet felt. Later, it becomes much easier to sense the baby’s presence and establish a connection. In fact, the baby starts moving at the end of the third month, but is still too small for the mother to feel. As the weeks go by, and as muscles and the nervous system mature, movements become increasingly active and coordinated.

From week 11 to 14, the baby begins to frown, move their lips and head — movements that are very useful for developing the sucking reflex.

Around week 18, their face already shows different expressions; they suck their fingers and grasp the umbilical cord.

By week 19, they push with their feet against the uterine wall, begin to rotate their head, and arch their back.

If it’s a first pregnancy, the mother might start to notice something between weeks 16 and 18. But it depends a lot on her lifestyle, daily rhythm, and ability to listen to and interpret her body’s signals. Initially, movements are felt sporadically and unexpectedly. After week 20, they begin to occur more regularly — a sign of vitality and well-being.

This sign is so important that until a few years ago, during the final weeks of pregnancy, women were advised to count fetal movements over a two-hour period and ensure they felt at least ten a day (12). Otherwise, a checkup was recommended. Although a common-sense precaution, this approach often led to anxiety. Today, the advice is simply to pay attention to fetal activity and report any sudden changes in movement frequency or pattern to the midwife or gynecologist.

Movement is also a form of communication, allowing mother and baby to connect, understand the baby’s temperament — whether calm or more active — and “play” by gently tapping the belly and waiting for a response.

Not only the mother’s caresses, but also those of the father help the baby feel more secure and confident. When the father places his hand on the belly, the baby’s heartbeat slows and becomes more regular. This happens because the fetus can distinguish paternal touch. When the father comes home, the baby moves more — as if happy. They perceive his arrival by the tone of his voice, which by around the sixth or seventh month, they can differentiate from that of the mother.

You become parents long before the birth of a child. It happens when you discover you’re expecting a baby — and sometimes even earlier, when the desire, even just the thought, of having a child first arises. And it’s right there, in the mind and heart of a mother and a father, that the idea of the little one takes shape — among imagination, dreams, and plans. Pregnancy is a period of deep reflection, allowing parents to lay the foundation of the attachment bond with their baby.

For some, it’s a slow, almost imperceptible process; for others, an overwhelming emotion. Fantasies and emotions are an integral part of the journey. Taking time to listen to the baby’s movements in the womb, imagining what they’re doing, whether and how they’re moving, even what their emotions or mood might be — this isn’t just daydreaming: it’s already a way of connecting, using the waiting period to begin getting to know them, so that birth is not a meeting, but a reunion. This process of listening, imagining, and communicating — through touch and body posture — is known as prenatal bonding.

The English word “bonding” means “connection, attachment” and refers to a process — partly conscious, partly unconscious — through which the baby and parents form an intimate relationship. It’s been shown that building a strong bond with the unborn baby supports attachment between the baby and their parents after birth, and reduces the risk of postpartum depression for the new mother (1).

In 1958, English psychoanalyst Donald Winnicott was one of the first to highlight how the parent-child relationship begins before birth. According to Winnicott, the mother, already in the early months of pregnancy, enters a psychological state he called primary maternal preoccupation — a condition of heightened sensitivity, which he described as a temporary withdrawal that leads the woman to prioritize her baby and tune in to their needs even before birth.

Psychoanalyst John Bowlby, in 1969, recognized the connection between the quality of the mother-child relationship during pregnancy and the healthy development of the individual (2).

Among the most well-known studies, that of M.S. Cranley (3) showed how during the nine months of gestation, both the psychophysical development of the fetus and the transformation of the woman into a mother occur. For the woman, this means becoming aware of a new identity linked to her new role; for the fetus, forming their own; and for both, building a relationship — the first relationship — which Cranley called prenatal attachment, directly linked to postnatal attachment. According to her, the quality of prenatal emotional investment influences the course of pregnancy and birth, the parent-child attachment relationship, and the child’s psychological development (4). But what does prenatal attachment actually involve? It refers to the mother’s emotional and cognitive representations of her baby in the womb — something some researchers have tried to measure and classify.

Cranley proposed a measurement model, the Maternal-Fetal Attachment Scale (MFAS), which includes five dimensions:

• Role-taking (e.g., “I imagine myself taking care of my baby”),
• Differentiation of self from the fetus (e.g., “I like watching my belly move when my baby kicks”),
• Interaction with the fetus (e.g., “I talk to my baby while I stroke my belly”),
• Attributing characteristics to the fetus (e.g., “I imagine what my baby will be like”),
• Giving of self (e.g., “I adopt virtuous behaviors I didn’t have before pregnancy, thinking of the baby’s well-being”).

Other researchers (Müller and Condon) proposed variations of this scale, including factors such as the influence of the woman’s relationship with her own mother, and the thoughts and feelings she has toward her baby. According to Müller, prenatal attachment is “the unique and affectionate relationship that develops between a woman and her fetus,” which she attempted to measure through the Prenatal Attachment Inventory (PAI) — a tool that assesses various aspects of the mother-fetus relationship: interaction, communication, expressions of love, caregiving readiness, projections for the future, and sharing pregnancy milestones with others, starting with the baby’s father (5).

In recent decades, with the rise of increasingly sophisticated ultrasound technology that allows the mother to see a real-time image of her baby, research on the mother-fetus relationship has accelerated. These studies now also take into account social, geographic, and cultural variables, yet they all underscore the same point: the importance of investing in a quality relationship with the baby during pregnancy.

It is now well established that nurturing and supporting prenatal attachment means building a solid foundation for the mother-child relationship, which will be strengthened at birth and in the early years of the child’s life (6).