Supporting physiological birth in Italian Hospital maternity care: Findings from a descriptive observational study.

BACKGROUND: Physiological birth, characterised by minimal medical intervention, is associated with improved maternal and neonatal outcomes. Despite evidence-based recommendations supporting physiological approaches, their implementation is often constrained by cultural norms and organisational structures. In Italy, where childbirth remains highly medicalised and caesarean rates are persistently high, midwives face significant challenges in promoting physiological processes. Understanding how midwives support such practices within this context is essential for informing maternity care policy and practice. AIM: This study aimed to describe midwifery practices and support strategies for physiological birth within the Italian hospital-based maternity care system. METHODS: A quantitative, descriptive observational design was employed. Fifty-one midwife-woman interactions were recorded using the Physiological Practice Observation Tool, comprising 30 items across seven domains rated on a four-point Likert scale. Each observation lasted at least one hour, resulting in a total of approximately 100-150 h of data collection. The analysis examined adherence to evidence-based recommendations across domains and explored differences according to women's clinical status and midwives' years of experience. FINDINGS: Overall adherence to recommended physiological practices was high. The strongest alignment was observed in domains related to approach to care, environmental support, and early postnatal hours. No significant differences emerged according to women's physiological or risk status at the onset of labour. Midwives with more than ten years of experience showed higher adherence in providing emotional support, labour care, and facilitating decision-making. CONCLUSION: Midwives generally demonstrate high adherence supporting physiological labour and birth even within a highly medicalised system. However, lower adherence in decision-making practices indicates persistent barriers to achieving fully woman-centred care.