Un modello di riprogettazione del percorso nascita: strumenti di empowerment delle donne e di supporto decisionale clinico e manageriale

Pregnancy and childbirth symbolize a period of decisions during which the woman feels the need to express her needs and to receive correct information leading to conscious choices. Over the years the theme of the birth path has become relevant due to the increase in the number of parts carried out by caesarean section, a surgical practice capable of compromising the health of women and children if performed without real medical needs and with a strong impact on the health system from an organizational, social, clinical and economic point of view. In many territorial contexts the choice of opting for surgery rather than favouring natural childbirth is conditioned not so much by the presence of real differences in the health status of the population, as many factors of different nature that lead to decisions increasingly inappropriate from the clinical and organizational point of view. Focusing the interest on the birth path is the most appropriate way to study a phenomenon on which it is necessary to intervene with an integrated approach that connects the different moments of the path, the actors who are part of it, the modalities with which the services are delivered, the criticalities that are found and the hypotheses of participation. The following study aims to support the formulation of clinical and managerial decisions appropriate to the mode of childbirth, promote a conscious and rational use of the practice of Caesarean section and realize an effective process of patient empowerment. On the basis of data and information obtained from the main sources of information relating to the birth event, a dataset has been built in which clinical and extra-clinical variables have been reported clinics that correlate with the modalities of childbirth in order to carry out a descriptive study on the multidimensional nature of the phenomenon. The project activity included a cognitive investigation of the organizational and procedural aspects applied at the two units under investigation, the Departments of Gynecology and Obstetrics of the Clinica Mediterranea S.p.A. of Naples and the Hospital Company- University of San Giovanni di Dio and Ruggi d'Aragona of Salerno. The study has interesting practical and policy implications. First, it identifies the aspects of the organizational process useful for the construction of an integrated care path that promotes the synergy between hospital and territory, aimed at an effective management of patients both in terms of appropriateness of care and clinical governance. Secondly, it defines methodological tools useful for clinical and governance decision support to enhance patient education, increase women’s empowerment in decision-making and provide an economically sustainable health service. Finally, it contributes to the literature on the theme of the birth path in public and private health facilities, identifying factors useful for the creation of an innovative model of redesign of the care path. [edited by Author]