Family Planning and Maternal Health Consultation

The Family Planning and Maternal Health Consultation is a fundamental component in the provision of reproductive health care.

It also provides other health promotion activities, such as: sexual information and counselling; prevention and early diagnosis of sexually transmitted diseases; cervical and breast cancer screening, as well as pre-conception and puerperium care.

Who is it aimed at?

It is aimed at women of reproductive age and their partners, who can and should be present.

Ideally, the first Family Planning Consultation should be held before sexual activity begins, so that the most suitable method of contraception can be chosen for each patient in good time.

What are the purposes of this consultation?

Its main objectives are:

• Promote healthy and safe sexuality.
• To regulate fertility according to the couple's wishes, through specific guidance on contraceptive methods.
• Prepare for responsible motherhood and fatherhood.
• Reduce maternal, perinatal and infant mortality and morbidity.
• Reduce the incidence of sexually transmitted diseases and their consequences.
• Improve the health and well-being of the family.

In this consultation, in addition to general guidance on the different contraceptive methods, prescribing them, counselling and monitoring, it is also possible to:

• Insertion and removal of a subcutaneous implant.
• Insertion and removal of an intrauterine device.

Menopause

This consultation also promotes women's health during the menopause, a phase marked by specific physiological changes.

This is a natural biological process in a woman's life and corresponds to the date of the last menstrual period as a result of definitive ovarian failure.

The clinical diagnosis is only made retrospectively, i.e. after 12 consecutive months of amenorrhoea that is not explained by another pathological or physiological cause.

Therefore, the doctor looks after the well-being of premenopausal and postmenopausal women, assessing and recognising their symptoms, such as vasomotor symptoms, weight gain, dysfunctional vaginal bleeding, urogenital changes, vulvovaginal atrophy, mood and memory changes, among others.

After the clinical assessment, the patient is recommended the most appropriate Hormone Replacement Therapy (HRT) to minimise the general symptoms related to the menopause.

Maternal Health

The Maternal Health Consultation provides comprehensive support for women's health before, during and after pregnancy. It is designed to assess women during the pre-conception consultation, the surveillance of low-risk pregnancies and the puerperium consultation.

During the consultation, a set of recommendations and appropriate interventions is defined for preconception, pregnancy and the puerperium:

• To integrate antenatal care into a more comprehensive perspective that includes pregnancy preparation (preconception care), pregnancy monitoring and the Puerperium Consultation, ensuring continuity of care;
• Identify and provide early guidance on complications and risk factors that may affect the progress of the pregnancy and the well-being of the foetus;
• Promoting health and health education throughout pregnancy.

It is recommended that when a woman and/or couple express their desire to become pregnant, a specific appointment should be made: the Pre-Conception Appointment.

This appointment should be scheduled before stopping contraception and a subsequent appointment should be scheduled to assess the results of the tests carried out and the proposed interventions.

It is part of the surveillance of low-risk pregnancies:

• Assessing maternal and foetal well-being, through clinical history and data from complementary diagnostic tests;
• Identifying risk factors that may interfere with the normal course of pregnancy, maternal and foetal health and well-being;
• Promoting health education, including counselling and psychosocial support throughout the periodic monitoring of pregnancy;
• Preparing for childbirth and parenthood.

In low-risk pregnancies it is advisable to:

- Carry out the first consultation as early as possible and no later than 12 weeks into the pregnancy (1st trimester of pregnancy);

- Carry out antenatal care appointments after the first appointment:

• Every 4-6 weeks until 30 weeks;
• Every 2-3 weeks between 30 and 36 weeks;
• Every 1-2 weeks after 36 weeks until labour.

All pregnant women between 36 and 40 weeks should have an appointment at the hospital where the birth is expected to take place.

What interventions are carried out in this consultation?

• Assessment of adaptation to pregnancy, mental health and psychosocial factors;
• Assessment of nutritional status;
• Assessment of weight progression: evaluate weight and height and advise on appropriate weight gain during pregnancy;
• Analytical screening throughout pregnancy;
• Requesting ultrasound scans throughout pregnancy;
• Assessment of the consumption of harmful substances such as tobacco, alcohol and other psychoactive substances;
• Questioning about the intake of drugs and over-the-counter medicines;
• Supplementation during pregnancy;
• Assessment of immunisation status;
• Screening for cervical cancer, if applicable.

Puerperium consultation

The puerperium is the period of the mother's physical and psychological recovery, which begins immediately after the birth of the newborn(s) and lasts for 6 weeks (42 days) postpartum.

A puerperium appointment is the appointment or appointments made during this period. At this stage, it is important to assess the state of health and adaptation of the woman and the newborn.

Objectives of the consultation:

• To assess the physical, emotional and social well-being of the woman, child and family;
• To correct and treat situations of difficulty or deviation from normality during the puerperium;
• To identify situations of perinatal bereavement (death of the child or someone significant to the puerperal woman) or hospitalisation of the newborn, so that they receive specific intervention.