Births happen outside the walls
Vatican City is a sovereign state, but it is not a self-contained city with the full range of services found in a larger country. It has no hospital or maternity ward. When someone who lives or works there is about to give birth, the practical destination is a hospital in nearby Rome, just beyond the Vatican’s borders.
That arrangement reflects the city’s scale and setting: Rome surrounds the tiny enclave, so specialized medical care is close at hand without needing to be provided inside the state. The absence of births is therefore a matter of where delivery takes place, not an inability to care for pregnant people.
Citizenship does not pass automatically by birthplace
Vatican citizenship is generally connected to a person’s role or residence in the state, rather than simply being born on its territory. That makes the usual assumption—that a country’s population grows through children born there—less applicable here. Many residents are clergy, while others serve the Vatican in particular jobs; the population is not organized like that of an ordinary city with generations of families.
So the striking detail is partly geographic and partly administrative: a Vatican resident can have a child in Rome, while the child’s birthplace alone does not make the child a Vatican citizen.
