No, I am well aware that the story you are about to read goes in the category of "stupid and annoying." Still, it is worth describing in all its stupid and annoying, gory details.
First, there are two things you need to know ahead of time.
Number 1), the punchline: despite everything, I will not get an epidural. Like everyone else, I will arrive at the hospital, ask for one, and a nurse will make up some absolutely bogus medical mumbo jumbo reason why I can't have one, and they will refuse to give it to me (see that? see how your foot twitched like that? that's a sign of potential nerve-labor, and an epidural is absolutely out of the question for women with nerve-labor...). So there's that.
Number 2): this is not the story of me being unlucky. Nothing out of the ordinary has happened at all. Everything you are about to read is pretty much exactly how the Italian State has ordained that things should be. That is, stupid. And annoying.
Ok, here we go.
If you want to have an epidural during a labor and delivery in Italy, you need to be pre-approved for one at least two weeks ahead of time (baby premature? guess you're SOL. LOL). The scientific and medical reason for this is to save money on all the people who for whatever reason, fail to get pre-approved.
Pre-approval depends on you having two blood tests and then taking the results to have them looked over by a qualified doctor. Who is qualified to read a blood test that says "yes your blood coagulates" or "no your blood does not coagulate?" (because this is clearly not something you would know ahead of time...). ONLY an anaesthesiologist, of course.
So here's whatcha gotta do. Actually let's not be theoretical about it. Here's what I did. Note that for every visit I had to pay a babysitter, take a half-day off of work, and pay for cabs, buses, and trains (should I mention being almost nine months pregnant) to go back and forth... Also note that this is ONLY what I had to do for the epidural approval. Every other blood test, ultrasound, swab, pee sample, and so on involved a separate and equally long and convoluted tragicomic tale. In the last four weeks of pregnancy (when I have two major work deadlines), I have to make SEVEN trips to various doctors and labs to do what an American doctor does in your last two pre-delivery check-ups in the US.
Back to my story:
I called a friend who is a doctor (the only successful healthcare stories in Italy start this way). She happened to mention this two-weeks-ahead-of-time rule that my doctor apparently had no intention of mentioning. I go to see my doctor (VISIT 1) and ask about it. He writes a prescription for a blood test and a separate prescription to make an appointment with the anaesthesiologist to read the results. I go home. I call the number to make the appointment. And then I keep calling it for two weeks, without getting through to anyone. The August vacation answering service is on for the first week (this is mid-September). During the second week I get two promises to call me back and one time I am put on hold for an hour during which no one seems to remember me, but someone DOES remember to hang up on me precisely at 4pm, when the service closes.
The problem is, I can't get the blood test done until I know when the appointment is, because I have to make sure I have the results in hand before the appointment, and if the state-run blood test people can't get me the results in time I will have to go pay a private place so I can get them in 24 hours...
So I go in person to the hospital to schedule the effing appointment (SECOND VISIT). I get there at 3:08 and they are open until 3:30. But since apparently they have interpreted "open until 3:30" to mean "at 3:30 I, employee, should be halfway to Fiji," they will not let me in. I call the number again from the car, and this is where I sit on hold for an hour until they hang up on me at 4pm. I guess the phone people get to go to Fiji, too. Jerks...
The next day I go back to the hospital again (THIRD VISIT). I take a risk and get the blood test first because you can only get blood tests until 10am because THAT makes sense (if they can't get me the results on time, I will have to go BACK to my doctor for another prescription for the same test, then go BACK to a faster, private lab and pay to have the same test run again...). Then I go to a different part of the hospital and wait in line to make a reservation for an appointment. The lady behind the counter ACTUALLY asks me why I am wasting her time when I could have just made the appointment over the phone...
Whatever, she gives me the appointment, so...SUCCESS! Buuuuut, it's before the results of the test will be available. Luckily, it's only one day later, and the totally un-reassuring lady behind the counter reassures me that the test results will probably be available.
On the day of the appointment with the anaesthesiologist, I go back to the hospital (VISIT FOUR). First I have to go wait in line at the lab to see if my results are proooooobably there. They are! Yes! Then I have to wait in line for the anaesthesiologist to tell me whether my blood coagulates or not (eye roll).
I get called in to see the anaesthesiologist, who can't be bothered to look up and who looks at his phone while holding out his hand, apparently for me to insert the test results into them. I do so. After a while he gets around to leafing through them. "Where's such-and-such test?" he asks. Such-and-such test is not there. Why? Because the only doctor authorised to write the prescription for the tests did not know that I needed it, since he neither runs the tests nor reads the results of said tests. Because he's only a doctor, so what does he know, right?
"What do I have to do?" I ask.
"When you come in to deliver the baby, you can ask them to first run this blood test, and then, after you get the results of the test, if they check out, you can ask for an epidural..."
"How will I get them to run the test? On what authority?"
"I made a note of it, so the attending doctor can run it then if he or she wants to..."
This guy could not give two F's less...
"Wait a minute," I say, "this is kid number 3. How much time do you think I'm going to have after I come in to deliver the baby to sit around and wait for a blood test result. It'll be over before the results are in. This isn't a test I can just do right now?"
"Sure, you can do it now. You just have to schedule a visit with your gynaecologist [VISIT 5], ask him to write a prescription for the test, go to the lab for a blood draw [VISIT 6], collect the results [VISIT 7], and bring them with you to the delivery."
"But aren't you a doctor? Can't you just write the prescription for me?"
"...Does it matter that I've already had an epidural and anyway I had all these tests done and got approved for a second epidural just a year ago?"
NOT APPROVED. The saga continues.
So, to make a long and Faustian story short, I will have to make SEVEN TRIPS to different locations to get scientifically unsound pre-approval for an epidural they will never give me. I am living in a wretched game of telephone, where I have to be the go-between for multiple doctors each of whom is only allowed to do one tenth of the things a doctor should be able to do, but also won't talk to the other ten doctors I need to put together one single doctor-task.
My sister lives in Bolivia, and when I told her this story she said, "Yeah! Bolivia is just the same!" I think I will just send that one sentence to whoever is in charge of the healthcare system: "Bolivia is just the same!" Good job, Rome.