Being born at the HPA
A positive childbirth experience

HPA Magazine 17

In our Unit, we try to make positive and constructive changes in order to improve the experience of giving birth, while at the same time guaranteeing maximum safety for the baby and the mother.
In medicine and healthcare, as in life, everything happens in cycles. In our times a pregnant woman is always accompanied when giving birth, regardless of the type of birth.  Various methods of pain relief are used and during the course of the birth, the pregnant woman can discuss and choose from the available choices for the birth of her baby.

Dra. Ivone A. Lobo

Obstetrician Gynaecologist
Sub specialist in Maternal Foetal Medicine
Director of the Gynaecology/Obstetrics Unit

Enf.ª Patrícia Sancho

Specialist in Maternal 
and Obstetric Health
Head of Nursing Services Gynaecology/Obstetrics Unit
Doctorate in Educational Sciences

Enfº Tito Manuel Félix

Specialist Nurse
in Obstetrics and Maternal Health

All births are wonderful experiences, but an in-hospital natural birth is a rewarding experience for everyone involved. Many pregnant women who have a hospital birth like to minimize interference with the normal physiology of labour and delivery.
Many couples want to have a natural birth, with the security of the technology that the Hospital can offer.
Nature sometimes presents us with unexpected challenges and these need to be anticipated and identified. When the unexpected happens, a hospital birth reduces risks and increases access to resources.  Childbirth is a natural process that with little or no intervention usually goes well. But nature does not ensure a good and perfect outcome and unfortunately in many parts of the world women die in childbirth.
In our Service we follow the recommendations of the World Health Organization for a positive birth experience.
We have the essential physical means, competent and motivated staff that permits us to have a well-established birth plan beforehand. We provide mobility during the dilating period and the choice position for delivery; the pregnant woman can be accompanied throughout the birth by a person of her choice; we have several pain relief strategies available; we allow oral ingestion of fluids and food and encourage effective communication between the various stakeholders.

The Gynaecology and Obstetrics Units of the HPA in Gambelas, in its different sectors, from the Obstetrics Consultation, through to the Childbirth Unit and the Postpartum In-Patient Unit, is intended to provide a positive childbirth experience.
We provide individual monitoring of each pregnant couple so that childbirth becomes a unique, rewarding experience teeming with positive feelings, guaranteed to meet the couple’s expectations. The Birth Plan is therefore, a very important determining tool so that the work of our professionals is aligned with the experience of childbirth designed by the couple. After all, it is their baby that will be born. 

The individual support provided in the pre-partum, delivery and post-partum period by our teams aims to help the couple throughout the entire process, empowering them to face all the challenges that parenting and birth present, so that in the end we have healthy and happy mothers and babies.
The experiences that follow are a recognition of our work which reflects the miracle of life we witness in our daily chores, while at the same time honouring not only our Unit but above all our Hospital and the HPA Health Group. The names of the professionals have been removed. The texts have been fully transcribed.

ANA'S TESTIMONY

My name is Ana, I'm 29 years old and I was a mother for the first time. I want to leave my testimony about my personal experience when I went into labour at 39 weeks and 4 days pregnant, which took place at the Gambelas unit. Before talking about the experience of childbirth, I want to very briefly say that during my pregnancy I had a big scare. At 22 weeks gestation, hyperechogenic bowel and dilated colon was detected in the foetus at 22 weeks gestation. After numerous exams and consultations, at 28 weeks the bowel returned to normal and from then on, all follow-up was carried out exclusively at the HPA-Gambelas, which gave us what we needed until the last moment, confidence and at the same time tranquillity. This is because during those 6 weeks, we literally had to forget about motherhood and focus exclusively on exam results and the possibilities on the table. In the midst of this worrying situation, there was also the issue of COVID, where the father, was never able to be present at consultations or ultrasounds.
When the big day arrived, the day of delivery, I felt that I had surpassed myself, for several reasons: because I had an eutocic delivery,  without any hitches, because I didn't feel worried or pressured at any time and luckily, the father could be present throughout the process. During the day I was given special care, everyone always explained at each stage what was going to be done next. It was my decision to have a planned, induced delivery, where induction techniques are carried out accelerating contractions, to artificially provoke labour and consequently, cervix dilation.
During labour, the cervix “expands” to allow the baby to descend from the uterus. During the period when the contractions became intense, the nurses who conducted my labour explained and encouraged me to perform conventional relaxation techniques (squats, breathing, among others) to alleviate and help as labour progressed. These techniques were always carried out under their supervision and assistance. An epidural catheter was placed in the morning when I arrived, but analgesia was only administered as a patient-controlled epidural, during the advanced and more intense phase of the contractions so that I could have mobility, that is, the pain was relieved to bearable and as I felt the need, I would ask for an analgesic increase.
This technique called “walking epidural” which I think makes perfect sense due to the increased benefits it brings to the mother and foetus. As I still felt some pain, I have to confess that there was a time when I thought about asking for a caesarean section, as at one stage I was getting restless due to the discomfort caused by the pain.
The position of the baby in the birth canal made it necessary to carry out more exercises instructed by nurses to help its descent. It is for this reason that I say the work of the professionals was spectacular, they were both tireless with me and I have to say that I'm glad they supported and encouraged me to continue. Above everything else I felt that I was giving labour in a safe environment. And believe me, the first thing we forget is after all, the pain.

At 5:14 pm the baby was born!!!

Soon after, the nurse placed my baby on a skin-to-skin position. This was an extraordinary mother/baby bonding process and also initiated breastfeeding. Up to now, breastfeeding has been a success. It's an emotion, impossible to describe. It's a feeling of total ecstasy. I felt and feel totally fulfilled. I have made a point of mentioning very briefly about the mishap which occurred during my pregnancy because in my opinion if in this negative period, little importance had been given to make me feel safe, comfortable and positive during childbirth, it would have affected in a negative way my experience of pregnancy,  which we hope to always be positive and transformative in our lives. I felt cherished, respected. Thank you to all the professionals in the delivery room and in-patient unit: they were exceptional.

ANDREIA'S TESTIMONY

My name is Andreia, I'm 33 years old and being a mother of more than one child has always been part of my plans.
Today I have two children, two super easy pregnancies, but two completely different births! For the birth of my first child I chose another hospital. I wouldn't have done it today. My first birth (induction and labour) lasted a long time, about 14 hours. During this entire process there was no communication or support whatsoever from those who assisted me, I do not know what went wrong or why, as no explanation was given. I felt that I was just one among so many other women and that I was simply there waiting for the baby to be born. I didn't feel the human side, just the professional. The term obstetric violence could be mentioned…
A week later, I had complications which led a hospital admission, together with my new-born baby. All these aspects contributed negatively to a postpartum emotional health.
Luckily for my baby everything went well.
My first experience was so negative that the idea of having another child and going through the whole process again terrified me.
When I became pregnant for the second time, I decided immediately to have my baby at the Maternity Hospital of the Hospital Particular do Algarve in Gambelas. I had a very traumatic previous birth in another hospital and for this reason I wanted the opportunity to have another experience. From the very beginning I asked my obstetrician about the birth and whether it could be handled by her and her team. I felt quite calm knowing that, regardless of the day or time, I could be assisted by the professionals I had consulted and got to know throughout my pregnancy. The fact that I could have someone with me throughout my hospital stay was also very important. These factors combined were all very important in the peaceful way I experienced my pregnancy.
During the nursing consultations, all the nurses I met during the pregnancy surveillance were always very attentive to me, always trying to find out what my doubts were so that I was always aware of both my health and that of my baby, living habits , feeding, alarm signals, breastfeeding plan and delivery plan were all discussed. 
During the appointments with my obstetrician, detailed attention was always given to all ultrasounds, as well as total availability to answer my doubts and concerns about my well-being while pregnant.
In the last few consultations, I addressed issues related to my intended delivery how I wished it to take place (birth plan). We talked about my personal perspective regarding the epidural, skin-to-skin contact, breastfeeding, cutting the cord, which for me was very important as I had the opportunity to decide about the whole process before going through with it. In this way, my birth plan was being made during the last few consultations. I decided that I wanted to have a normal birth, but that if this was not possible, we would have a caesarean section. I just wanted the birth to be a positive experience for both me and my baby.
As I reached the end of my pregnancy and did not spontaneously go into labour, induction was scheduled. It all went quite naturally and painlessly. I was super calm, waited in the room, while listening to music or watching television. From induction to delivery I was always accompanied by the same team. A small group of people who are aware of the whole process and not several different people where we have to answer the same questions over and over again.
When the time came to decide which form of pain relief I preferred, my nurse explained to me what each one consisted of. What for me was also a determining factor for the birth itself, was that it was possible that I could continue walking, and also able to control the intensity of a contraction even with an epidural.
My induction went so smoothly, painlessly and quickly that, although I was allowed to, I didn't feel any need to use a pilates ball or to resort to other methods to alleviate pain, such as for example a shower.
When I entered the delivery room, I had the same team waiting for me, which gave me a feeling of familiarity and comfort. The support of my nurse, as well as my doctor, was very important, I was taught the exact type of breathing and effort I had to perform and when to do it. This made all the difference!
My doctor gave me a lot of security and tranquillity. Also, very important was the fact that, from induction to delivery, everything that was happening was explained to me. Elements that for me were crucial. All expectations I had were fully met!
As soon as my baby was born, she was placed skin-to-skin straight away. No rushing or set timings. This contact was as reassuring for me as it was for my baby, allowing her to start breastfeeding when she wanted, without interference or any obligation imposed by anyone.
 

The postpartum in-patient period went very well. At a time when there is some vulnerability, having the constant assistance of nurses and assistants, always friendly and helpful, in the room, for both me and my baby, was extremely important. 
If I were asked for a word to describe my second birth, it would be “wonderful”.
I wanted to share my experience at the HPA, because for me the way a birth takes place is decisive in the postpartum period as is the reception of a new baby. When talking about baby blues or postpartum depression, first you have to talk about how a woman's delivery is performed and, consequently, a woman's postpartum period.
For me, this “wonderful” experience made the whole “post” easier.
I would like to express my public thanks to the entire HPA Obstetrics Team that assisted me, from the induction, delivery and postpartum in-patient periods. 
I am very grateful to the entire Obstetrics Team at HPA Gambelas for accompanying me throughout my pregnancy, childbirth and a great postpartum period.
A big thank you to all/all, they were and will always be very important to me, as a mother and as a woman.

A message for dad.

Very important was the fact that I was allowed to have a companion during induction, delivery and the postpartum hospitalization.
As my baby was born during a pandemic, not all maternity hospitals allowed a companion.
It was important for me and my husband to be together all times during this process, as it was not only the birth of a baby, but also of a mother and father.