In this opinion, the Order also highlights the need for “screening and early diagnosis of possible situations of increased risk, must be carried out and pregnant women referred to hospitals, within the deadlines considered appropriate, regardless of whether or not they have a family health team”. Situations that, in recent times, have been difficult to ensure in areas where the shortage of family doctors is high, namely in Lisbon and the Tagus Valley and in the Algarve.
However, in this regard, “the Order is sensitive”, noting that there are “serious circumstances in areas currently in need where it has not been possible to comply as required with the obligation of obstetric surveillance, in view of which, always in collaboration with a family doctor, it is necessary to recognize the importance of the care role of nurses”.
And for this reason alone, he assumes that he is available to continue “to dialogue and collaborate with the Ministry of Health and other representative orders of health professionals”, also admitting that he is available to “adhere, in this case, as long as it is recognized as a transitional, circumscribed and absolute contingency solution, the monitoring of pregnant women by EESMO of primary health care, through the collaboration of a reference Family Doctor, within the scope of teamwork and complying with technical guidance standards validated by: Order of Doctors and Order of Nurses”.
For doctors, “the future of maternal health cannot be based on replacement solutions, but rather on models of true complementarity and integration, always centered on the woman, the baby, the family and the community”, arguing that it is essential to reinforce the role of Primary Health Care (CSP) as a “pillar of pregnancy surveillance, without moving skills to hospital contexts or creating models of substitution between professions. And, for this very reason, it reinforces that the resolution of the problem of monitoring pregnant women cannot fail to involve measures that return professionals to NHS services”.
In the letter sent to the minister, the Order demands that measures be taken to “strengthen human resources in PHC, with the hiring and implementation of measures to retain Family Doctors and Nurses and guarantee equity in safety and access to consultations and Complementary Diagnostic Exams (a problem that has become more acute and without a timely response in many cases), in the care provided to all pregnant women and their families”.
Among other measures, the Order recalls that we must “invest in digital innovation and telemedicine/teleconsultation to bring care closer together, reduce geographic inequalities and ensure specialized support in real time”, as well as “make the most of human and material resources that bring efficiency and innovation with an impact on access, quality of care, health outcomes and satisfaction of the population we serve”.
In the end, the Order proposes the “Creation of a Commission coordinated by the Ministry of Health with specialist doctors and nurses, appointed by the respective Orders”, to study possible solutions for monitoring pregnant women in health centers, because “We need complementarity and we should never choose to replace each other. The roles of the doctor and nurse are defined and do not replace each other. Their work must focus on the pregnant woman, her surveillance, her well-being and always as a team.”