Background and Objective: The National Outcomes Evaluation Programme (Programma Nazionale Esiti, PNE) monitors several aspects of perinatal health care, with particular attention to the quality and appropriateness of health care in Italian maternities. Methods: Perinatal health care was assessed by calculating seven indicators: two volume indicators (total number of deliveries; number of deliveries by caesarean section, CS); three process indicators (proportion of deliveries with primary CS; proportion of vaginal births after caesarean, VBAC; proportion of episiotomies in vaginal deliveries); and two outcome indicators (hospital readmissions within 42 days from hospitalization in case of vaginal delivery and CS). The information source was the National Hospital Discharge Records. Risk adjustment models were implemented to compare hospital performance and the impact of women’s area of residence, eliminating confounding due to women’s age, and comorbidities both before and at the time of hospitalization for delivery, as well as for potential clinical determinants of the mode of delivery. Results: In Italy, the number of hospitalizations for birth has progressively decreased over time, from 484743 in 2015 to 398,506 in 2021. At the same time, the primary CS rate decreased from 25.1% in 2015 to 22.4% in 2021, and the proportion of episiotomies dropped from 24.4% to 12.3%. Both procedures demonstrated significant regional and hospital variability and a strong North-South gradient. Within the same period, the proportion of VBAC increased slightly from 8.4% to 10.7%. Conclusions: The analysis based on perinatal indicators of the PNE shows high proportion of CS and episiotomy compared to the WHO recommended rates. In addition, the low proportion of VBAC and the persistence of a wide inter- and intra-regional variability suggest ample room for improvement in perinatal care in Italy.