Born HPM

The Positive Childbirth Experience

HPA Magazine 20

The Maternity Ward of the Hospital Privado da Madeira (HPM) had its official inauguration on September 29, 2019, with the first cesarean section, resulting in the birth of a princess weighing 2,696 grams. This strategic four-month wait after the HPM's inauguration was based on the selection of an experienced team with innovative purpose, but one that followed a practice based on scientific evidence, combined with safety and humanization of healthcare. It was necessary to build a support structure for our couples, establishing a network of communication and contact, implementing a prevention scheme, and utilizing the highest technology to support the birth of a new human being.

SUPPORT STRUCTURE FOR OUR COUPLES
The development of a strategy centered on the needs of the couple was the focus of the structural development of the HPM maternity ward. Couples who choose to experience the birth of their child in the maternity ward have at their disposal a team with extensive experience in promoting, monitoring, and executing positive childbirth. The facilities, technology, and expertise of the professionals ensure the safety and quality of care, with an emphasis on humanization and, above all, the empowerment of the couples.
At 36 weeks of gestation, the couples undergo a consultation for "Clinical Process Elaboration," conducted by the Maternal and Obstetric Health Nurse (ESMO). Maternal-fetal monitoring is analyzed, and the clinical process is filled out based on the information acquired through the medical history. 
The couple's birth plan is developed, and cardiotocography (CTG) is performed. With this consultation, the couple gains access to the maternity prevention team's phone contact, which provides guidance and evaluation in cases of pain complaints, contractions, suspected rupture of membranes, decreased fetal movements, or even vaginal bleeding.
From 37 weeks onwards, maternal-fetal well-being is evaluated on a weekly basis using CTG and ultrasound (ECO). 
The ESMO, trained in relaxation techniques and pelvic strengthening exercises, enables training for the expulsion stage in the delivery room.
During the breastfeeding period, postpartum women have access to guidance and empowerment regarding breastfeeding, a task carried out by the ESMO. This support enables a healthy adaptation to the lactation process, avoiding the progression to pathological situations and subsequent discontinuation of breastfeeding.

POSITIVE CHILDBIRTH EXPERIENCE
The positive childbirth experience is multifactorial, as it is characterized by several variables, such as the support of healthcare professionals, the duration of labor, the couple's own expectations, pain management, the involvement and participation of the couple in the labor process, the techniques adopted, and the type of delivery.
The academy emphasizes that a positive childbirth experience generally results in a more positive postpartum period. Parents who have control during their childbirth process develop more effective parenting skills. This positive birth experience is also beneficial for the mother, increasing her self-esteem and personal fulfillment, and favoring future pregnancies.
Promoting a safe and comfortable environment, with a focus on dignity, privacy, and confidentiality of care, based on active listening and informed and shared decision-making, triggers a sense of power and control for the couple, thereby increasing confidence in their childbirth process.

SERVICES PROMOTING HEALTHY MATERNITY
Preconception Consultation
This consultation aims to provide preconception counseling. It is conducted by a specialist in Maternal-Fetal Medicine, who, together with the woman/couple, advises on aspects necessary for a healthy pregnancy, optimizing strategies, especially important in cases of existing pathologies such as hypertension, diabetes, psychiatric illness, nephro-urological, respiratory, hematological conditions, and a history of adverse obstetric outcomes (repeated abortions, preterm birth, cervical incompetence), among others.
In addition to risk stratification, screening for gynecological pathology, therapeutic adjustments or switches, guidance on dietary behaviors, physical exercise, vitamin supplementation, smoking cessation, and vaccination are provided. If necessary, screening for cervical cancer and breast cancer is also updated.
General Obstetrics Consultation
Performed by a group of specialists in Gynecology/Obstetrics from the medical staff of HPM, this consultation is intended for the monitoring and surveillance of low-risk pregnancies without previous pathology. After the initial consultation and proper risk assessment, the follow-up adheres to the low-risk pregnancy surveillance protocol according to the guidelines of the Direcção Geral de Saúde - Directorate-General of Health (DGS). However, as pregnancy is a dynamic condition, this risk assessment, performed at every consultation, may change throughout gestation, requiring a different approach to surveillance and therapy.
Maternal-Fetal Medicine Consultation
In this more specialized consultation, the conditions are met for the surveillance of high-risk pregnancies, whether due to chronic or acute maternal pathology, as well as specific pregnancy-related conditions. To meet the demands of this consultation, multidisciplinarity is essential. When necessary, it is carried out in conjunction with other specialties, including endocrinology, internal medicine, vascular surgery, and nutrition, all within the same physical space, on specific days, and with the support of maternal and fetal health nursing. Our objective is to provide the best assistance for each pathology by offering the necessary resources, centralized for the couple's greater efficiency and comfort. Examples include gestational diabetes, chronic hypertension, obesity, and thyroid pathology.

Prenatal Diagnosis Consultation
This consultation, conducted by an obstetric specialist with expertise in prenatal diagnosis and competence in level 1 and/or level 2 obstetric ultrasound, aims to study, guide, and advise in cases of suspected fetal pathology, as early detection is of utmost importance.
Prioritizing technological and scientific advancements and improving diagnostic accuracy, obstetric ultrasound, in general terms, allows for confirmation and localization of the pregnancy, diagnosis of congenital anomalies, screening for aneuploidies, pre-eclampsia, preterm birth, fetal growth restriction, and evaluation of fetal well-being.
This consultation is available to any pregnant woman followed at HPM or other centers in the Autonomous Region of Madeira. Ultrasounds are performed throughout pregnancy according to the guidelines of the Directorate-General of Health for low-risk pregnancies or with greater frequency depending on associated maternal-fetal pathology. Between 11-13 weeks and 6 days, the first-trimester morphological ultrasound includes combined screening for trisomies, early pre-eclampsia screening, and fetal DNA analysis. This is followed by the second-trimester morphological ultrasound, ideally between 20-22 weeks of gestation, which is crucial for the detection of congenital anomalies and screening for preterm birth. When indicated, it is usually during this time frame that a fetal echocardiogram is performed for a more detailed study of the heart, conducted by a pediatric cardiologist. The third-trimester ultrasound, typically performed between 30-32 weeks (adjusted according to different risk situations), allows for reassessment of fetal morphology to detect late-evolving changes and evaluate parameters of growth and fetal well-being.
Due to its particularities, this consultation involves other specialists, including pediatricians, pediatric cardiologists, and geneticists. There is close coordination, when necessary, with the Hospital Dr. Nélio Mendonça for invasive tests (chorionic villus sampling, amniocentesis).
Nursing Consultation in Maternal 
and Obstetric Health
The purpose of this consultation is to promote the health of pregnant women and ensure a healthy transition in women's reproductive health. HPM offers autonomous nursing consultations as well as support to medical consultations.
In autonomous consultations, the evaluation of pregnancy progression and adaptation to parenthood is conducted. The clinical process is carried out with a focus on jointly developing a birth plan, promoting the couple's proactivity in order to achieve the best possible childbirth experience.
The consultations are personalized to meet the needs of each pregnant woman/couple and assist them in realizing their pregnancy, childbirth, and postpartum plans. We also provide complementary consultations to medical consultations where cardiotocography (CTG), sample collection for analysis, vital signs assessment, pre-eclampsia screening, biochemical screening, and fetal DNA blood sampling, among others, are performed. During these moments, topics such as pregnancy discomforts and normal changes, fetal development, warning signs, education on labor and delivery, newborn care, breastfeeding, and postpartum support can be addressed. A visit to the maternity ward and delivery room is also conducted, and the functioning of our unit is explained.
Postpartum Consultation
This consultation, typically conducted by the obstetrician who followed the pregnancy, takes place approximately 4 to 6 weeks after childbirth. Prior to this, one or more specialized nursing consultations for postpartum assessment and breastfeeding support are provided, as well as urgent medical consultations if necessary.
The main objectives of this consultation are to screen for postpartum pathologies, make therapeutic adjustments, clarify doubts, and plan contraception.
Pelvic Floor Consultation
Integrated into the specialized gynecology consultations at HPM, this consultation is also coordinated with the postpartum consultation, allowing for continuity of care regarding the pelvic floor, with a particular focus on situations such as pelvic muscle hypotonia, pelvic organ prolapse, and/or urinary incontinence. Conducted by gynecologists specialized in this field, it enables detailed assessment and implementation of individualized approaches, both pharmacological and non-pharmacological, including pelvic physiotherapy.

PHYSICAL ENVIRONMENT
The maternity ward has ten individualized rooms with private bathrooms and two suites, all rooms allowing for overnight stays by partners. Each room is associated with an essence, enabling the use of aromatherapy and music as relaxation strategies. The rooms facilitate the progression of labor until full dilation, utilizing non-pharmacological measures such as showering, birthing balls, rebozo, among others, as well as pharmacological measures like "walking epidurals" and nitrous oxide, and the entire postpartum stay.
The birthing unit is designed to promote freedom of movement and encourage upright birthing positions. We have a relaxation pool available where the pregnant woman and her partner can benefit from the advantages of water during the active phase of labor. This birthing unit also allows for emergency cesarean sections as it is equipped with all the necessary equipment, always prioritizing the safety and well-being of the mother and fetus.
We have a Special Care Unit for Newborns, which optimizes the transition of newborns to extrauterine life and is activated only based on indications from the neonatologist and parents. It is equipped with the necessary technology and equipment to provide specialized care to newborns with a gestational age of ≥36 weeks who require special attention. In more severe cases, coordination and transfer of the newborn to the Neonatal and Pediatric Intensive Care Unit of Hospital Dr. Nélio Mendonça are carried out, with decisions made and guided by the neonatologist and parents.

TRAINING, EDUCATION, AND RESEARCH
HPM has developed "NASCER HPM," a childbirth preparation service aimed at helping expectant parents experience their pregnancy and parenthood fully, safely, and with informed knowledge. 
It has dedicated facilities for theoretical training and practical exercises, promoting knowledge acquisition and practical skills development for childbirth, breastfeeding, newborn care, and postpartum physical recovery.
The maternity ward also serves as a training ground for undergraduate nursing students, allowing them to develop skills in providing care to postpartum women and newborns, as well as in complementary consultations to medical appointments.