title: The care of pregnant women and their babies: empirical data from Umbria region.
abstract: BACKGROUND
  The promotion of the concept of evidence-based health care in the field of maternity care began in the 1980s; the indicators in this field were devised to enable us to know key components of care for mothers and babies and to relate them to health outcomes.
  
  
  METHODS
  The study is based on data from the Standard Certificate of Live Birth (SCLB) forms of the Umbria region (Italy) during 2012, which merges data from each mother and her baby for a total of 7964 records. We followed the healthcare indicators recommended by World Health Organization for monitoring and evaluating maternal and child health services. We considered number of prenatal medical visits and timing of first antenatal visit such as indicators of Antenal care, and mode of delivery and place of birth by volume of deliveries such as indicators of Intrapartum care in healthcare maternal and child services. Odds ratios were calculated to indicate the likelihood of some individual and social variables across appropriate access to prenatal care.
  
  
  RESULTS
  It is present an association between social disadvantage (mothers' educational level and mothers' country of birth) and inappropriate access to prenatal care, low number of prenatal medical visits (below 4) and late timing of first visit (after more than 12 gestational weeks). In Umbria there are 11 place of birth, 9 of I level and 2 of II level. Overall, 29.3% births occurred in 6 maternity units with fewer than 500 births in 2012 (in Italy is 7.3%). The average rate of cesarean section observed in the NTSV sample (Nulliparous, Terminal, Single, Vertex), was 28.2%. This value was higher than expected, especially in this class with an indication for the physiological birth. The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. Moreover there is a wide variability between birth centers (7.2% -41.4%).
  
  
  CONCLUSIONS
  The use of mother and child prenatal care services was associated with individual characteristics of the mothers from less advantage social classes (i.e., unemployed or poorly educated); cesarean section was higher than expected, especially in the NTSV sample; we foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time.
authors.affiliation: Department of Experimental Medicine, Unit of Public Health, University of Perugia, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Minelli
authors.affiliation: Department of Experimental Medicine, Unit of Public Health, University of Perugia, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Pasquini
authors.affiliation: Department of Experimental Medicine, Unit of Public Health, University of Perugia, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Chiavarini
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Antenatal care; Birth centre; Indicators; Mode of delivery