HPA Gambelas Maternity

From preconception to puerperium 24 hours taking care of maternal foetal health

HPA Magazine 19

A few days after the inauguration of the HPA Gambelas, on the 8th of January 2010 the first baby was born. 
A boy weighing 3.540kg, whose mother of Scandinavian origin, had not yet decided on a name. However, the team baptized him Balder, meaning in Scandinavian “lord” or “prince”, and this is how he was referred to when taken care of by the team, during the period we had him with us.  
A team that remains, to this day, passionate about the care they provide and motivated to achieve excellent results on a daily basis.
While it is a source of pride to work at the only private maternity hospital in the south of Lisbon, available 24 hours a day, 365 days a year, it is also a great responsibility to offer quality care on a permanent basis, in an area as sensitive as that of maternal foetal health. 
Over these years, the entire team and the entire physical space have been adapting, modernizing and innovating, to make sure that the expectations and desires of couples are fully met. 

SAFETY AND QUALITY. FROM NATURAL BIRTH TO THE MOST SOPHISTICATED BIRTH
The unit has an experienced team with all the technology necessary, capable of providing safe quality care for all types of delivery; from natural birth to the most sophisticated cases, knowing that the couple always has the obstetrician, midwife, paediatrician and anaesthesiologist present.
One of the methods of childbirth, much requested by future parents is the natural caesarean section, where our team is one of its national pioneers.  
The natural caesarean section maintains the technical and aseptic procedures of a classic caesarean section, but offers some environmental modifications, which allow women and couples a more positive experience, with greater participation and involvement in the birth process of their children.
Procedures that promote early bonding between mothers and babies are encouraged, respecting the WHO guidelines regarding the 1st postpartum hour. Early skin-to-skin contact during the Golden Hour brings unquestionable advantages for both, favours early breastfeeding and its success over time.
It is important to note that the natural caesarean section is not intended to replace natural childbirth, much less promote an increase in the practice of caesarean sections births. It arose as an alternative capable of providing a more reassuring environment, despite being technical, as well as providing more pleasurable, humanized and beneficial moments for parents and babies.
The Gambelas Maternity is accredited by Joint Commission International (JCI) since 2018.  This organization is one of the most demanding in terms of clinical certification, meaning that the service complies with the most demanding international safety and quality standards.
With the safety of families in mind, the Maternity is equipped with several security systems, including an electronic bracelet for the baby, conditioned access and a video surveillance system.
On discharge from the Maternity Hospital all our babies, are covered by the Alta Segura Project, where the restraint system (baby car seat) is checked to make sure it is correctly placed inside the vehicle to guarantee maximum safety when transporting a new-born infant.
Complementing the safety and quality requirements whenever necessary, the Maternity Unit has the support of the Neonatal Intensive Care Unit at any time.

HUMANIZATION AND CARE PROVIDED 
The humanization of childbirth in a hospital context means articulating the couple's expectations for “their childbirth”, with the conditions available at the hospital.
There are many couples, who draw up their birth plan in advance and discuss it with the team during their pregnancy monitoring appointments. The basic and primordial principle that conditions the acceptance of certain demands or wishes,  is always the safety of the mother and the baby.
We therefore respect and pay special attention to privacy, the possibility of walking around during labour, position during childbirth (we have the latest generation childbirth table  that allows for the most diverse positions in comfort during childbirth, respecting the future mother’s preference), the permanent presence of the father, whether during a normal delivery or caesarean section, the possibility of the father cutting the umbilical cord, early binding (providing immediate skin-to-skin contact with the new-born infant) and, of course,  pain control measures.
The pain control measures used may be drugs (epidural analgesia, gas mask, intravenous medication), or other (walking, showering, massage, Swiss ball, peanut ball and comfort measures).
Still within the scope of providing Quality care centred on continuous improvement, the service monitors future mothers’ satisfaction, with regards to the aspects that are most valued by them, so that the team has to adjusts to fulfilling these expectations.

COMPREHENSIVE AND SPECIALIZED MONITORING 
The mission of the HPA Gambelas Maternity Unit is based on valuing the lives of mothers and babies, through comprehensive care.
Humanism, experience and specialization of its professionals, specialists in mother and foetal care is fundamental. 
Experience in prenatal diagnosis and postpartum care, which includes, for example, breastfeeding or complications that may occur, such as high blood pressure is of utmost importance.
With this in mind, several specialized services/consultations are available.

Infertility Consultation
This consultation is aimed at couples looking for solutions to their infertility problem.
During the first consultation, the doctor begins by reviewing the entire medical history, the reproductive history and the treatments already carried out or in progress.
After the first consultation, planning is carried out, and the couple is provided information concerning the following steps to be taken. 
Throughout the process, the team is committed to clarifying and informing the couple and, above all, proving tranquillity and serenity.

Pre-Conception Consultation
Before pregnancy, and whenever necessary, the doctor specializing in Maternal Foetal Medicine may recommend this consultation, especially for women with a chronic illness who want to become pregnant, or who have had a poor outcome in previous pregnancies.
In the pre-conception consultation, the specialist reviews medical and obstetric history in order to plan an optimal strategy for a future pregnancy.

Prenatal Diagnostic Center
The importance of multidisciplinary teams in a Prenatal Diagnosis Unit is widely known. Thus, our obstetric unit has paediatrics, genetics, paediatric cardiology and other specialties. Prenatal diagnosis cannot be carried out when there is only one type of medical specialty available.  However, the availability of Specialists with differentiation in maternal-foetal medicine the individual capacity of each element of in our Unit makes it unique, such as Specialists with ultrasound competence level 1 and ultrasound competence level 2.
The experience of each one and the sharing of knowledge are essential for providing the best possible clinical care. 
Paediatric support makes it possible to integrate prenatal findings into postnatal care, providing the best care possible for the new-born infant.
This Unit also possesses an extremely useful added value: the integration of Paediatric Cardiology with a team specialized in foetal pathology.
When faced with the suspicion of foetal pathology, a quick response is essential. 
The Unit also has the latest technology in genetic evaluation available. The possibility of discussing each case individually permits an efficient approach to a genetic study.
Pregnant women who opt for follow-up at this Unit are guaranteed peace of mind knowing that this multidisciplinary support will always be present.

Prenatal Diagnosis Consultation
This consultation was created for an early detection of foetal malformations, where, depending on the evolution and length of pregnancy, different obstetric ultrasounds are performed.
The first ultrasound that the pregnant woman wishes to undergo is the Dating/Viability Ultrasound Scan (before 11 weeks). After a positive pregnancy test, every woman wants to know “how far pregnant she is”.
Then follows the 1st Trimester Morphological Ultrasound, performed between 11 weeks and 13 weeks and 6 days.
The 2nd Trimester Morphological Ultrasound should take place around 21-22 weeks, when it is usually possible to detect the sex of the baby. 
The 3rd Trimester Morphological Ultrasound takes place at 32 weeks (in some situations between 28 and 36 weeks).  The development of the main organs such as the brain, heart and kidneys, the location of the placenta and the volume of amniotic fluid are evaluated.
Although any pregnant woman can be monitored in a Prenatal Diagnosis Consultation, this is fundamentally indicated in the following risk situations:

• Increased risk for Trisomy;
• Anomalies diagnosed by ultrasound;
• Risk of malformations due to the use of medication and/or radiation;
• Serious maternal illnesses;
• Personal or family history of genetic, metabolic or chromosomal disease;
• Previous obstetric complications such as dead or malformed foetus;
• Significant changes in foetal growth;
• Complicated twin pregnancy;
• Maternal age over 38 years;

Depending on each situation, it may be necessary to request specific screening tests such as amniocentesis or chorionic villus sampling, foetal MRI, foetal echocardiogram, among others.
General Obstetrics Consultation
This consultation is dedicated to pregnant women who have not had previous complication, and is also called a low-risk consultation.
After the first consultation, the assistant obstetrician will program the chronological dates of the pregnancy.
Subsequent consultations, obstetrical ultrasounds and other necessary tests during the pregnancy are prescribed according to the pre-delivery surveillance protocol.

Maternal-Foetal Specialist Consultation
Maternal-Foetal Medicine is a more specialized area of Obstetrics that deals with diseases related to the pregnant woman and the foetus.
Unlike the General Obstetrics Consultation, this consultation is dedicated to women with previous health problems, such as diabetes or hypertension, which is why it is also called a risk consultation. 
The Maternal-Foetal Specialist consultation is also indicated for all women with multiple pregnancies.
This consultation is also dedicated to families who have had an abnormal pregnancy experience in the past (abortions, preterm births), mothers with chronic illnesses, as already mentioned, and women who develop unexpected problems during pregnancy. 
These consultations are carried out by obstetricians with sub-specialization.

Gestational Diabetes Consultation
Gestational diabetes is defined as an intolerance to carbohydrates, diagnosed or detected for the first-time during pregnancy. It can occur during any month of gestation. It is however more frequent in the second half of pregnancy, namely from the 24th week.
It is associated with a wide and important set of complications for both the mother and the baby and requires a specialized and multidisciplinary approach.
Nursing Consultation 
in Maternal Health and Obstetrics
This consultation is carried out for all pregnant women, before the consultation with the Obstetrician. It is a free service and complementary to the follow-up by the doctor.
One of the objectives of the consultation is to provide practical advice, namely, on the most appropriate practice of physical exercise, taking into account the particular needs and objectives of each woman and the specificities of the pregnancy.
Other fundamental aspects are also addressed for a positive experience and outcome of pregnancy, childbirth and postpartum:
> Pregnancy and its various steps; Development of the foetus, health and well-being of the pregnant couple, discomfort caused by pregnancy, expected alterations during pregnancy, warning signs, examinations and their purpose.
> Breastfeeding support and postpartum warning signals (up to 28 days after the birth of the baby)
> Referring pregnant couples; If the couple/pregnant woman needs to undergo an exam or be seen by another medical specialty, priority access is provided, according to the specific situation.
This consultation also enables the pregnant woman familiarization with the maternity and its professionals, as well as getting to know the Unit. 
Postpartum Consultation
It is also known as Puerperium Consultation and should be held between the 4th and 6th week after childbirth. It aims to evaluate how the woman – now a mother – is recovering from pregnancy and childbirth.
Among other aspects, the Postpartum Consultation aims to monitor blood pressure, discuss the contraceptive method that the couple plans to use, talk about breastfeeding, monitor the breasts, uterus and vagina.

24H HELPLINE
It permits a specialized response to any discomfort or warning sign, and subsequently referring to the appropriate service when necessary, or providing information on simple measures that can be taken outside the hospital environment.
This allows the pregnant couple to always feel supported by specialized maternal health care, to minimize risks and possible discomfort during pregnancy, always maintaining safety and safeguarding maternal and foetal well-being. This line can also be used in the postpartum period.

PHYSICAL ENVIRONMENT 
The In-Patient Admission Unit is divided into two independent areas: Admission for pregnant women and the puerperium. Both Units are equipped with suites and rooms all with private bathrooms, ensuring privacy and excellent safety conditions, to guarantee a quiet atmosphere for the pregnant woman, the couple and the baby.
The Delivery Room is also situated in the In-Patient Admission Unit equipped with all the necessary facilities for both mother and new-born infant.

 

TRAINING, TEACHING AND RESEARCH
A vast set of training courses are provided by this department annually, some are strictly for internal staff only, such as those related to childbirth, lactation, rooming-in, emergency and urgency; others courses permit the participation of trainees and outside instructors. 
These training courses include Training in Obstetric Emergencies, which we have been holding annually since 2015. The purpose is to promote good practice, permitting one to identify and correct individual and system flaws in order to optimize clinical outcome. All our Professional staff participate in these training courses which are divided into three pillars: identifying the most important obstetric emergencies, discussion of selected cases for training purposes, and finally analysing the performance of the team.
Over the years, this Unit has also carried out various activities for pregnant couples, within the scope of literacy in health related subjects – parenting, childbirth, breastfeeding, among others. 
Examples are the Symposiums for Pregnant Women, where the 2nd edition brought together approximately 200 participants or the Breastfeeding Symposiums. 
As far as teaching is concerned, the participation of professionals has been growing in a structured way, with the Unit being recognized by several institutions, teachers and students, with capacity for both pre- and post-graduate teaching. 
This Unit welcomes dozens of students annually.
Participating in research programs, is related to our collaboration in the collection of data for academic work, used in presentations at scientific meetings, or even publications.
Now almost reaching fourteen years of existence, the HPA Gambelas Maternity is definitely a reference in maternal and foetal health in the Algarve and Alentejo, owing this status to the humanism and skills not only to its professionals, but also to its technological availability and to the quality and comfort of its facilities.
Its mission has grown in sustainability and scope, with two aspects in which its professionals have been particularly dedicated to: a Baby-Friendly Hospital and a Childbirth-Friendly Hospital. 
The first mission aims to protect, promote and support breastfeeding, a program launched by the World Health Organization and UNICEF, while the second intends to enable and encourage, always within safety parameters, natural childbirth, with as little intervention as possible. 
Will all this, it makes sense that this should be your baby's first home.