The study evaluates the mode of delivery and quality of care given to 1014 pregnant women not belonging to the European Union (EU) during the 10-year period, 1992-2001. The non-EU patients were delivered significantly more often by caesarean section than Italian controls, 35.0% vs. 29.3% (P<0.001, OR 1.30; 95% CI 1.13-1.49) and more often had babies of very low birth weight (VLBW), 7.2% vs. 5.4% (P<0.02; OR 1.35; 95% CI 1.04-1.74). Rates of preterm births (25.4% and 22.9 %, respectively, for non-EU and Italian patients) did not differ significantly (P=0.06). Episiotomy was practiced less frequently in non-EU patients and the difference was significant (P<0.001). Perinatal mortality in this latter group was 23.3/1000. Our observations provide a useful picture of how pregnancy, labour and delivery of immigrant women are managed in an Italian hospital setting. Understanding of different cultural approaches, linguistic communication, technical skills and medical interventions only when really necessary are keys for the appropriate management of childbirth.