How to choose where to give birth in Italy

Irene · August 7, 2026 · 8 min

In Italy, choosing where to give birth isn't just a matter of distance from home: there's precise regulation behind which hospitals can have a delivery room, and a clinical classification that determines how prepared that facility is to handle complications, if they arise. Knowing both helps you choose on concrete criteria, not just a gut feeling.

The 500-births-a-year rule: why it exists and what it means for you

Italy's Accordo Stato-Regioni of 16 December 2010 (the State-Regions Agreement) set a size threshold for maternity unit safety: facilities that handle fewer than 500 births a year should be progressively closed, barring proven geographic hardship (geographically isolated areas, where closure would leave a territory without nearby care). The document also cites 1,000 births a year as an aspirational “optimal” standard over three years, a separate goal from the hard closure threshold, with which it's often confused.

Even though the regulation dates back more than fifteen years, the fragmentation hasn't fully disappeared: a share of Italian births still happens in facilities below the 500-births-a-year threshold, a sign that enforcement has been gradual and uneven across the country.

Level I, II, III: the classification that actually matters (and is often confused with the first one)

The number of births a year says nothing about a facility's clinical capacity to handle a newborn born with difficulties. That's why there's a second, separate classification, based on the level of neonatal care:

Level I, handles healthy newborns and mild conditions, typically serving a catchment of 500-1,000 births a year, without a neonatal intensive care unit (NICU).
Level II, includes neonatal intensive care, with a much wider catchment area (typically at least 5,000 births a year).
Level III (A and B), full care for newborns under 28 weeks or under 1 kg in weight, advanced mechanical ventilation, complete NICU.

The point not to confuse: a maternity unit can have volumes high enough to stay open (above 500 births) and still be Level I, meaning without a NICU. The two classifications need to be assessed together, not treated as synonyms, especially if the pregnancy has even a single risk factor.

One more concrete criterion: the facility's c-section rate

The gap between public hospitals and private clinics on c-section rates is wide and documented: roughly 28% in public hospitals against nearly 45% in accredited private clinics, according to the latest CeDAP data. Many Italian regions publish the specific figure for individual facilities through regional CeDAP reports: it's one more concrete piece of information, to be used alongside (not instead of) distance from home and the risk level of your pregnancy.

Distance from home: how much it really matters

For an uncomplicated pregnancy with no known risk factors, proximity to home is often the most practical criterion: getting to the hospital in labour without travel-related stress matters, especially for a second or third birth, where things tend to move faster. For a pregnancy already classified as high-risk, it's instead better to prioritise the level of care (II or III) even if it means a longer journey, to have neonatal intensive care available on site if needed.

What changes if the pregnancy becomes high-risk along the way

It's not unusual for an initially uncomplicated pregnancy to develop a risk factor later on (gestational hypertension, poorly controlled gestational diabetes, abnormal fetal growth). In these cases your OB-GYN arranges a transfer to a facility with the appropriate level, with enough time before delivery, whenever possible, one more reason to find out in advance which Level II or III maternity units are reachable from your area, even if they're not your first choice.

How to inform yourself before choosing, in practice

Ask directly at your local family clinic (consultorio) or at the unit what level of neonatal care it offers (I, II, or III) and whether it has a NICU.
Check the specific facility's c-section rate through the regional CeDAP report, if published by your region.
Weigh these together, not separately: distance from home, your pregnancy's risk level, and the facility's clinical capacity, none of the three criteria is enough on its own.

In summary

Choosing where to give birth means assessing two distinct things: whether the facility has enough volume to stay open (the 500-births-a-year threshold) and whether it has the clinical capacity suited to your risk level (the Level I/II/III classification, based on whether it has neonatal intensive care). Neither criterion replaces the other, and distance from home carries different weight depending on whether the pregnancy is uncomplicated or already classified as high-risk.

Frequently asked questions

How many births a year does a maternity unit need to stay open in Italy?

Italy's 2010 Accordo Stato-Regioni (State-Regions Agreement) sets 500 births a year as the threshold below which a maternity unit should be progressively closed, barring proven geographic hardship (isolated areas). The document also cites 1,000 births a year as an aspirational “optimal” standard, but that's a separate goal from the hard closure threshold.

What does it mean for a maternity unit to be Level I, II, or III?

It's a classification of neonatal clinical capacity, not of facility size: Level I handles healthy newborns and mild conditions without a neonatal intensive care unit (NICU); Level II includes intensive care with a wider catchment area; Level III has full NICU capability for newborns under 28 weeks or under 1 kg.

Can I find out a hospital's c-section rate before choosing it?

Yes, it's often public through the Ministry of Health's regional CeDAP reports. It's one more concrete factor to weigh alongside (not instead of) distance from home and the risk level of your pregnancy.

Is it always best to choose the hospital closest to home?

For an uncomplicated pregnancy with no risk factors, proximity is often the most practical criterion. For a pregnancy already classified as high-risk, it is instead better to prioritise a Level II or III maternity unit even if it means travelling further, to have neonatal intensive care available if needed.

What happens if my pregnancy becomes high-risk after I've chosen a Level I maternity unit?

Your OB-GYN will arrange a transfer to a facility with the appropriate level (II or III) with enough time before delivery, whenever possible. It's one reason why the level classification, not just birth volume, should always be considered alongside how the pregnancy is progressing.

How can I find out if a maternity unit has neonatal intensive care (NICU)?

You can ask directly at the unit or at your local family clinic (consultorio), or check the website of your local health authority (ASL) or region, which usually publishes the level classification of maternity units in the area.