POSITIVELY PREGNANT IN PORTUGAL
A friendly guide for foreigners wanting to start or expand their family in Portugal. Written by mums, for mums (and their partners).
1.2 A bit of history for context
2.1 Which professionals are involved
Sonographer/Ultrasound technician
Midwives (aka specialist nurses)
2.2 Standard pregnancy appointments
Prenatal vitamins and supplements
2.4 Maternity leave and benefits
Lists of professionals you can contact:
How can you plan something unpredictable?
3.2 Preparing for a positive experience
What does this have to do with giving birth?
What does this have to do with giving birth?
3.4 What happens when baby is born
In the first few hours after birth
4.2 Your baby’s health booklet and vaccination record
4.3 Register your child’s birth
Pelvic floor health/Women’s physio
My name is Shona and I’m a British mum living in Aveiro, Portugal with my Portuguese husband. We met in the UK and then moved to Portugal in September 2019. I found out I was pregnant with my first child at the beginning of February 2020 (just before the pandemic changed everything!).
Upon discovering this wonderful news, I then began researching what the next steps were. However, after a dozen Google searches I started to feel quite disheartened and anxious about what was to come, as well as generally quite lost. Not only was I new to being pregnant, I was also relatively new to the country so was not yet fluent in the language. Other mums I have spoken to expressed that they also felt lost during their pregnancy.
I was learning a lot about preparing for a positive birth experience, but most of what I read was from the UK or other English-speaking countries. The more I read about birth in Portugal, the more anxious I felt. The rates of obstetric violence and unnecessary interventions are frightening and I was scared of what type of experience awaited me. Not only that, but any information I found was quite bland and not presented from a personal perspective.
So now I’m on the other side of pregnancy with my beautiful baby girl, I wanted to create a resource for others in the hope that they feel informed, empowered, connected and not as overwhelmed as I did. Having a baby is hard enough, without also having to navigate the process alone in a foreign country!
My aim for the website is to create a resource for the key information you may need for your pregnancy and birth here in Portugal, including any external links you may find useful, so you don't have to spend as much time researching as I did! I also want to provide you with my own and others’ personal experiences so you can hear what it’s really like, not just the bare facts.
I have put together information which I would have found useful myself. As such, I’d love to hear from you if you think I’m missing something.
The information presented on this website is based on my own personal experience and reading, as well as the knowledge and advice of fellow non-Portuguese mums who have very kindly shared their experiences with me.
Please bear in mind that I am not an official source or health professional, I’m just a mum trying to help out other future parents.
Any information about childbirth has been paraphrased from my reading or is quoted from another website or book. I have tried to get all the facts right but there are also a lot of opinions and anecdotal information from myself and others. For this reason, please be sure to check out my additional resources pages for more official information and websites.
As you will notice as you read through the website, I was followed at Coimbra Daniel de Matos maternity hospital for my prenatal appointments. As I was determined to have the most natural experience possible and wanted to be fully supported in this decision, I chose to go to Póvoa de Varzim maternity hospital to give birth. Both of these hospitals are public. You will therefore notice that much of what I mention is about these hospitals.
Something we have in common is that we are not from Portugal, however all of us come from different backgrounds and therefore have different expectations when it comes to health care, pregnancy and childbirth.
We will naturally want to compare services here to those from our own country: so one person might think something is fantastic and someone else may think it needs improvement. In addition to this, no matter where we are in the world, every pregnancy and every birth is unique. With that in mind, the experiences shared on this website are here as a guide, but do keep in mind that your own experience will always be unique to you and your baby/ies.
This is a work in progress and I’d love your feedback. If you think something is incorrect or you would like more information about something, please do get in touch here.
Special thanks to my fellow foreign mama, Amélie, who I discussed my ideas with for this site; and big thanks to my husband for all his IT knowledge!
During my pregnancy, I decided to have a few Portuguese lessons while I still had all the time in the world before baby arrived! Part of my homework was to watch the documentary “Portugal, Um Retrato Social” (free to watch here on YouTube: I'd really recommend it if you'd like to learn more about Portuguese history and culture). The first part of the programme speaks about childbirth in Portugal, so this sparked a conversation between me and my teacher about this topic.
My teacher explained to me that during the dictatorship - which only ended in 1975, so is very recent history - Portugal had the highest infant and mother mortality rate in Europe. Women would often give birth at home with little to no medical support, and hospitals were relatively scarce.
When the dictatorship ended and the healthcare system steadily improved to provide more widespread services across the country, the government made it their mission for Portugal to have the lowest infant and mother mortality rate in the world. My teacher even went so far as to say it became “an obsession” to achieve this goal.
Now, while a very low infant and mother death rate is of course an excellent thing, this has come at a price. It has ended up creating a very medicalised system where hospital births have become the norm and obstetricians have complete authority. To my understanding, this in turn has created a childbirth system based on fear, where any risk at all is seen as highly dangerous to the mother and/or baby.
There are risks involved in pregnancy and childbirth, yes. And modern medicine is a fantastic resource when things do go wrong or pregnancies are more complicated. But birth is also the most natural thing in the world, and there is such a thing as too much intervention. In the vast majority of cases in developed countries with good hygiene, birth can be an instinctive, beautiful experience to bring life into the world - not necessarily a life-threatening situation. It is something which takes place 250 times a minute all around the world, and indeed is the reason we are all here, so it can't always be all that bad.
So, although the statistics will say this system is successful in keeping mothers and babies alive, it can bring the disadvantage of a few too many experiences described as traumatic, and even involving what is termed “obstetric violence” (see here). This can happen when women’s voices are not heard and they feel powerless, at literally the most vulnerable time in their lives. The consequence of a very medicalised system is that medical professionals tend to intervene much more than is actually necessary, therefore undermining the woman's natural experience.
However, all is not lost! You can absolutely still have a positive pregnancy and birth experience, and plenty of women do. You may just have to fight your corner a bit, but it very much depends on the services where you live, the professionals you encounter, and your own personal expectations. And of course, that is not to say that this is unique to Portugal: for the reasons stated above, there are positive birth movements going on all over the world.
Every one of us who fights our corner now will be one step towards a more “humanised” rather than “medicalised” system. I have put this website together hoping that those of us who have been through it before can help those who will go through it in the future. It's such a beautiful experience to become a parent, and I believe we can all support each other for it to be less stressful.
Please read on to find out about my own and others’ pregnancy and birth experiences.
If you would like to connect with other like-minded women, come and join our Facebook community.
As a final note here, may I also add that many people immigrate to Portugal because it is considered a lovely place to raise a family. There is a very strong family culture here and Portuguese people generally adore children. The information I relay on this website is to inform you specifically about the pregnancy and birth process, which in my opinion needs an attitude shift.
In Portugal there is public healthcare and private healthcare. Portugal’s healthcare system was ranked as 12th most efficient in the world by the World Health Organisation in 2021.
Public healthcare (provided by the national health service/Serviço Nacional de Saúde) is subsidised so there is a small fee to pay for medical appointments and medication. However, when pregnant, all medical services are provided for free by the national health service. You even also get "dental cheques" to use when you are pregnant and up to two months postpartum.
For private healthcare, you can use medical insurance or pay upfront (see link provided below).
In short, most non-Portuguese mums I spoke to who had experience of both public and private care agreed that the main advantages of private care were what you might expect: shorter waiting times and more personalised care. However, public healthcare can be of good quality in Portugal and it is certainly worth checking out before you make a decision to go private.
Regarding speaking English, there does not seem to be a big difference between public or private. It seems to be coincidental if you have a doctor/nurse who speaks English. However, on the whole, the Portuguese speak English relatively well - particularly in the major cities - so it’s likely that at some point you will come across health care professionals who speak English.
On this website, in the interest of consistency, I will use the terms “health centre” for “centro de saúde”, which you might know in your country as a doctor’s surgery or a GP practice. I will also use the term “family doctor” for “doutor(a) de família”, which you may know as GP (General Practitioner), family physician, family practitioner, or primary care doctor.
Public healthcare, from my experience, can be of very good quality and I personally have not seen the need to turn to private (see my only experience of it below). Do bear in mind that I come from the UK, where I am used to how the free National Health Service works there; if you come from a country where private healthcare is the norm, it may feel different for you.
Public healthcare does seem to be a "postcode lottery", in that you can have an excellent experience at one health centre or hospital, and a terrible experience at another. However, the same could be said for private hospitals. Some women I have spoken to have had quite unpleasant experiences in private hospitals, so unfortunately it’s not just because you are paying that you will be treated more kindly.
In my case, my health centre is in a small town in the Coimbra district. My family doctor is very friendly, very professional, and also happens to speak English fluently. The nurse I have seen has also always been friendly. But this seems to be the luck of the draw.
This seems to vary according to where you live, and your particular health centre/hospital. In my case, I do have a family doctor who I always book appointments with (apart from a few times during the pandemic when she was busy with Covid-related work).
Also at my maternity hospital, I always saw the same obstetrician except from one day when she was unavailable. However, other women have reported to me that they do not always have a set family doctor or the same obstetrician during prenatal appointments.
Be prepared to wait. A lot! This is probably the worst thing about the public system. But knowing what to expect can help. Bring a good book with you or download some Netflix series onto your phone/tablet! I read through a few books whilst I was waiting for my prenatal hospital appointments. However, this is not specific to healthcare… If you like things to be on time or quickly, I wouldn’t advise moving to Portugal!
My first time at Coimbra Daniel de Matos hospital, I did not know just how long I would wait. My appointment time was 9am, so I showed up at 8:45. I still had to be given a ticket (a very common occurrence in Portugal), and was already something like 10th or so to be seen. What I figured out was that lots of women are given the same appointment time, and then it is a first-come-first-served basis. That day, I didn’t leave the hospital until 12 noon. I learned my lesson and arrived much earlier the following times.
At my health centre, although we always have to wait a long time to be seen, we are always given plenty of time once inside. For example, when I went in for my appointment to tell them I was pregnant, the appointment lasted for over an hour! This would never happen where I am from, where you usually have no longer than 15 minutes to get in and get out. Having said this, generally pregnant women and babies are given priority at health centres.
Another advantage at my health centre was that when I was suffering from pelvic pain during pregnancy, I was referred to their local physiotherapist who was in the next building along. She was super friendly and I had 6 weeks of sessions with her, all provided for free. She even gave my husband and me a preparation for birth class and showed my husband some massage techniques to use during labour. But once again, the availability of these services will be dependent on where you live.
I cannot really comment from personal experience here. I went to a private hospital here only once, simply because I was new to the country and it was before I had registered with the public system. But I was then sent on to the local public hospital anyway because the private doctor wasn’t sure of the diagnosis. From what I understand, this is quite common here: private hospitals have their limits and in a real emergency, they may send you to a public hospital. So in this instance, all that happened was that I paid twice rather than once (so about 200€ in the end - approximately 100€ for the private consultation as I didn't have insurance, and then the same at the public hospital as I wasn’t in the system yet).
See below to read about other mothers’ experiences with the public and/or private healthcare system.
For details about health insurance in Portugal, see this website for expats.
Amélie (Canada), gave birth in summer 2020:
“In the public center I felt there was always confusion, rather with the appointment hours, the crew availability... I went one time for an appointment and needed to go back home because the doctor wasn’t there. As for the private, it never happened. Both public and private I felt they are not modern in their approaches of pregnancy and birth.”
Anika (Germany), gave birth in summer 2020:
“A big advantage of private care is the language! You can find english/german/ dutch etc midwives and doctors. You don't feel rushed, they take time to answer your questions. You can get an appointment really quick and the whole process is uncomplicated. The disadvantage is the costs. The advantage from public: it is a good, safe system for a pregnancy without any problems. Disadvantage: difficult to see a doctor if you need to, not a lot of contact. There is a lot of waiting and patience involved. Without a basic level of the portuguese language it's nearly impossible.”
Vaida (Lithuania) gave birth in summer 2020:
“[In the public health care centre] I felt follow ups were rather shallow, I was asking questions rather than was given information needed, and for a first time mom a lot of information was unknown so it felt strange that I had to do so much 'homework' myself. I didn't get a leaflet with allowed foods to eat /avoid which I know pregnant women receive in other countries. And I didnt have one family doctor assigned, just whoever was available that day. But they did give me all prescriptions required for the tests, no complaints on that.”
Juliette (France) gave birth in summer 2020:
“The advantages of the public health system is that everything is free, as long as you have the prescription from the doctor of the health centre or hospital. The disadvantages were the lack of communication as I wrote before, about medication or even vaccination. One example, I am A- and my partner is O-. The doctor at the health centre told me that I have to do the anti-body vaccine during my pregnancy to prevent the fact that if my baby has a positive blood type, I will not have a problem with future pregnancy. I had never heard of doing a vaccine during pregnancy in France, and on internet the public health system in France recommend to do this vaccine right after the baby’s birth. So I asked my private gynecologist, and she said that I mustn't do this vaccine as we have both negative blood type and so the baby will be negative. At the following consultation with the health centre, they insisted on giving me this cause « just in case the lab didn´t have the right blood type »... I mean what ? I simply refused to do it. So, for that type of things I was happy to have my private gynecologist.”
Anonymous (UK) gave birth in spring 2021:
“The doctor who saw me [at the public health centre] wasn't overly attentive, for example she gave me the strip urine test and told me I might or might not have an urinary infection and didn't request further tests, she was going to wait for my regular test to come back which was another two weeks from the exam date. I also have a condition which needs to be checked weekly but she didn't seem to know much about it and gave me the wrong tests. I only saw her twice before I was directed to the hospital where I was going to give birth.
The waiting time was over an hour and during all that time we could hear the two doctors just chitchatting about gossip.
Overall I wouldn't recommend it, the only benefit I got out of it was that she issued the two forms - one for free dentist and one for maternity benefits. Of course if you don't have option for private care you should still go as they are the ones issuing the ultrasounds and blood tests, other than that I wouldn't recommend my experience there.”
[In answer to: What do you wish you’d known before?] “First of all that private could be just as bad as public :) And second that private could be worth it in case you don't know any portugese, I think chances are higher that they speak English.”
Meghan (USA) gave birth in spring 2021:
[When asked for tips for people considering private healthcare] “Email doctors directly if you can get their contact info from someone else - even if your first appointment with a doctor is a ways out - take it... and see if you can see someone else in the meantime. Just because they recommend further scans/testing does not mean that it is necessary. Make sure you are informed about what really raises concern, and try not to let the doctors stress you... trust your body and follow your gut if things need to be pursued further.”
Filipa (Portugal) gave birth in winter 2019:
[When asked for tips for people considering private healthcare] “1) You can choose the doctor (good also to discuss with him/ her about the birth in advance) 2) You can organize your appointments also according to your private calendar 3) Check the maternity ward in advance 4) Check neonatal and other relevant services. 5) Ask the doctor if there is a way to contact him/ her in case of an emergency (in my case, my doctor appointments were very very short but the doctor is reachable by sms or email, this is priceless and not sure you will find that in the public system). ”
Would you like to share your experience? Contact me here.
English |
Portuguese |
Professionals: |
Profissionais: |
Doctor |
Médico |
GP/family doctor |
Doutor(a) de família |
Nurse |
Enfermeiro/a auxiliar |
Midwife |
Enfermeiro/a especialistas em enfermagem de saúde materna e obstétrica [EEESMO] OR Enfermeira-parteira |
Obstetrician |
Obstetrícia |
Doula |
Doula |
Healthcare provider |
Prestador de cuidados de saúde |
Student |
Aluno/Estudante |
|
|
Locations: |
Locais: |
Pharmacy |
Farmácia |
Health centre |
Centro de saúde |
Hospital |
Hospital |
Maternity hospital |
Maternidade |
Clinical testing centre |
Centro de analíses clínicas |
National Health Service |
Serviço Nacional de Saúde |
Council hall |
Junta de Freguesia |
City hall |
Câmara municipal |
The place you go for various public services. |
Loja do Cidadão |
The place you go to register your child’s birth, change your address, amongst other services. |
Registo Civil |
Revenue & Customs |
Finanças |
Immigration office |
SEF |
To take a ticket |
Tirar uma senha (the Portuguese don’t queue, they take tickets! At the supermarket, at the pharmacy, at the city hall, at the hospital...) |
|
|
Human body: |
Corpo humano: |
Urine/pee |
Urina/Xixi |
-- to pee |
-- Fazer xixi (something you will be told to do a lot!) |
Blood pressure |
Tensão |
Weight |
Peso |
-- To weigh |
-- Pesar |
Pain |
Dor(es) |
[...] hurts |
Tenho dor no(s)/na(s) [...] OR Doi-me o(s)/a(s) [...] |
E.g. My back hurts |
Doi-me as costas |
Blood |
Sangue |
Sick/unwell |
Doente |
Nausea |
Náusea/Enjôos |
To vomit |
Vomitar |
Fever |
Febre |
Headache |
Dor de cabeça |
Cough (noun) |
Tosse |
Dizzy spell |
Tontura |
Pill/tablet |
Comprimido |
|
|
Head |
Cabeça |
Shoulder |
Ombro |
Arm |
Braço |
Hand |
Mão |
Chest |
Peito |
Breast |
Seio/mama |
Stomach |
Estômago |
Belly |
Barriga |
Hip |
Anca |
Pelvis |
Pelvis |
Cervix |
Colo do útero |
Vagina |
Vagina |
Leg |
Perna |
Knee |
Joelho |
Ankle |
Tornozelo |
Foot |
Pé |
|
|
Key phrases: |
Frases chave: |
I’m pregnant |
Estou grávida |
I am [...] weeks/months along |
Estou grávida de [...] semanas/meses |
Pregnancy test |
Teste de gravidez |
Pregnancy booklet |
Boletim de saúde da grávida |
Blood test |
Análise de sangue |
Ultrasound scan |
Ecografia |
Birth partner |
Acompanhante |
Epidural |
Epidural |
Pain relief |
Alívio da dor |
Labour |
Trabalho de parto |
Active labour |
Período expulsivo |
Delivery/childbirth |
Parto |
Vaginal delivery |
Parto vaginal |
Caesarean |
Cesariana |
To give birth |
Parir/Dar a luz |
Birth (noun) |
Nascimento |
To be born |
Nascer |
Postpartum |
Pós-parto |
Hospital birth |
Parto hospitalar |
Home birth |
Parto domiciliar |
Water birth |
Parto na água |
Breastfeeding |
Amamentação |
To breastfeed |
Amamentar/Aleitar |
Breast milk |
Leite materno |
The baby is feeding |
O bebe está a mamar |
Skin-to-skin |
Contacto pele-a-pele |
Placenta |
Placenta |
You may also find the birth plan section for some more translated phrases.
For more detailed language regarding pregnancy and birth, you may find it useful to see this document in Portuguese about birth experiences in Portugal from 2012-2015, which is translated into English here (thanks to the Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto).
For the duration of your pregnancy (and at the birth), you will need to bring your pregnancy booklet with you to every appointment. This is where all details relating to your pregnancy will be recorded, such as your weight, your blood pressure, any blood test results, etc. This should be provided to you by either your family doctor or your maternity hospital.
It is even important to bring this with you everywhere because there is a lack of communication between health centres and hospitals here (and clinical testing centres). Unfortunately this is not the most efficient system as every time you see your family doctor or obstetrician, they spend time typing what is written in the book and vice versa.
As you would expect, there are certain stages in pregnancy which require certain tests. They take pregnancy very seriously here and usually health checks are relatively frequent. You are followed at both your health centre and your maternity hospital.
On the whole, for myself and for other women I spoke to, it seems common to see your family doctor (at the health centre) about once a month, and to go to your maternity hospital at least once in each trimester for a low-risk pregnancy. Of course if you are using the private system you can choose to be seen more frequently than this.
Unfortunately there is not one centralized system here, so when you have a blood test or other test done, you have to physically go to your doctor and then to your obstetrician to show them the results.
This outline is based on my own and others’ experiences of low-risk pregnancies.
Weekly appointments at maternity hospital (known as “consultas de termo” = full-term consultations), which will include all the usual checks plus fetal heart rate monitoring and ultrasounds.
Although I can look back now and realise that I was seen relatively frequently, I had no idea at the time what was coming up because it was just a case of booking one appointment at a time. If you are able to, you may wish to ask if you can book your appointments ahead of time (this may be easier to do in the private system but I can’t be sure).
Although I was being followed in a town in the district of Coimbra, I did have to go to Aveiro hospital once at the beginning of my pregnancy when I developed severe morning sickness, a.k.a. hyperemesis gravidarum. I was well taken care of there and I was given medication which is safe to take during pregnancy, which really helped. I was still being sick once or twice a day, but I felt more able to move around and generally function in life!
I would say that overall, I felt in the dark about what was going on. It was like the doctors knew what was happening but didn’t stop to explain it to me, even though it was my body and my baby. And as my language was still pretty basic, I did not know what to ask or how to ask it. I would come out of appointments and think, “damn, I should have asked that”. This was a big motivator for me to create this website for others!
Also just a note about blood testing for abnormalities: I have heard of some women paying privately to do this (paying in the region of a few hundred Euros). In my case, I had an extra blood test done to check for chromosomal abnormalities as there is a case of Down’s Syndrome in my husband’s family. This was done through my maternity hospital and was free of charge.
In our Facebook community we have discussed what supplements or medication are typically suggested here in Portugal. Do remember that it is your body, your baby, and you have the right to make your own informed choices.
I do not wish to express any opinions or recommendations about what medication is appropriate as it is a highly personal choice, but rather I want to present you with the choices you are likely to face in this country. I am relaying anecdotal information only, that is based on mine and other women’s experiences, so that you can be aware of what is available or generally prescribed here.
The general consensus is that what is recommended as a minimum is folic acid and iodine. There was some debate about the need for iodine, as this recommendation seems different to some of our home countries. You may wish to read about this on the World Health Organization website (you can use this page to follow additional links on the topic). There was some discussion regarding the difference between folate and folic acid, as some women suggested that folate is more appropriate; so this is something you may consider reading about.
A common medication suggested here is Nausefe, which is taken for morning sickness. However, once again, there seems to be a lack of consistency, for example one lady reported being told to take iron supplements which did not seem to be based on her blood test results. Another supplement which was prescribed to some women was Gestacare, which is a multivitamin, or another common choice of multivitamin seems to be Natalben.
If you have had a different experience that you would like to share, please contact me here.
Anonymous (UK) gave birth in summer 2018:
“I had a complex pregnancy and the obstetrician listened to me, answered my questions, took me through options and gave me timelines. I understood the extra tests I needed and what the different outcomes would/could mean moving forwards.”
Amélie (Canada) gave birth in summer 2020:
“If you don’t ask, you don’t know. If I wanted to talk about my placenta, my amniotic fluid, the cervix, I needed to ask. I felt that, because everything was ok, and I had a low risk pregnancy, they did not feel the urge to give me details even though it was my first baby. My OB was very relaxed, sometimes too much. He made me do my second round of blood tests quite late.”
Juliette (France) gave birth in summer 2020:
“I had appointments every month: first a nurse consultation (urine test, weight, belly measurement, tension & heartbeat check,...) followed by a doctor consultation (overall evaluation, medication, exams and ultrasound prescription,...). In total 2h-2h30 appointments each time.
The positive thing about the prenatal appointments at the centro de saude and public hospital was that the medical team was always very nice and helpful.
The thing that was not so good at the prenatal appointments at the centro de saude and public hospital was the lack of communication and explanation when they gave me vaccinations, medication, exams to do, results of exams,... Sometimes it's like they are surprised that you are asking questions. It's like sometimes they feel offended if you are asking why you have to take this? Or do that?”
Carla (South Africa) gave birth in summer 2020:
“Sometimes it was difficult to get appointments, luckily my doctor warned me of this and suggested at my first appointment to book all subsequent appointments for the rest of the pregnancy. For the ultrasound scans, I would have liked to stay with the same doctor but again it was difficult to get an appointment with him when I needed them.”
Anonymous (UK) gave birth in spring 2021:
“At best of times I felt like the doctors didn't care too much and at worst I have been shouted at and threatened by the doc that he won't do the exam (because I asked if my husband could join, as we had worries based on the blood tests).”
Meghan (USA) gave birth in spring 2021:
“My doctor was very respectful of my decision about a home birth, she also suggested I skip certain tests etc towards the end of my pregnancy accordingly. I really appreciated that she did not try to push her personal feelings on me, but also was supportive.
My [first] check up - as I was a new patient was very late... 11 weeks. I knew I would already need to get my 1st trimester scan scheduled somewhere, and chose a clinic close to home. I was really in shock when the whole appointment lasted about 10 minutes - he didn't answer any questions, explain what he was measuring - and almost seemed to mock my nervous chatter. I had my following 2 scans at [a private hospital], with a recommended doctor within the private hospital in which my doc worked - which were fine. They were well explained, and calm - although this doctor did seem to pass more judgement on my experience of unmedicated/vaginal births - and wanted to see me for further scans at 32 and 36 weeks which I did not follow up with, as there was nothing to be alarmed about in my 3rd trimester scan.”
Anonymous (UK) gave birth in spring 2021:
“First ultrasound done at [local public hospital] as I was "high risk" due to my age initially, the care was very good, the doctors were very friendly and passionate about their work, the quality of images were good and they spent time making nice images for me to take home.
The care I got at this first appointment was better than I received in the private hospital (I did one scan at [a private hospital] later in my pregnancy)
Blood tests etc all organized in an efficient manner.
Trying to get appointments without a family doctor [was difficult]. Several occasions sent from 1 department to another and back again, very disorganized.
Ended up having to pay privately for my 22 week scan as I had somehow been lost in the system and I was scared of missing it.”
Would you like to share your experience? Contact me here.
Unfortunately prenatal classes are not always offered and there seems to be very little consistency here, regardless of if you are using public or private healthcare. When questioned about this, people’s experiences varied greatly depending on where they lived. Some health centres offer them, some maternity hospitals offer them, but also many do not. Plus unfortunately many classes are not being offered due to the pandemic.
In my case, I believe that I usually would have been offered classes by both my health centre and my maternity hospital, but these were not taking place due to the pandemic.
The hospital where I chose to give birth (Póvoa de Varzim) did offer me online prenatal classes during my third trimester, which covered birth preparation, breastfeeding education, and taking care of a newborn.
However, since I did not think I would be offered any classes - and even if I were, they would be in Portuguese - I decided to pay for an online course in English, and I also read a couple of books. You'll find these on my resources page.
Just something to be aware of - which is not specific to Portugal - I would suggest to also do your own research about preparing for a positive birth experience (you can start with some basic information here), because some prenatal classes may give skewed information focusing particularly on what medical interventions may occur. This can be scaremongering rather than preparing you for a calm, natural birth if this is what you are aiming for.
As a side note, the media doesn’t help! You may wish to watch TV programmes about birth to prepare yourself for the experience, but remember that TV programmes are made to be dramatic to attract viewers and it is likely that they are not an accurate representation of most births.
When you are educating yourself during your pregnancy, don’t forget to read up on breastfeeding and newborn care. So much of your energy can be focused on the birth that you may forget to think about what will happen straight after!
Juliette (France) gave birth in summer 2020:
“The pregnancy started at the beginning of the pandemic so the doctor told me that all the prenatal group classes at the centro de saude were cancelled. Mid of my 6th month of pregnancy, the nurse of the prenatal classes phoned me to join a group of classes through Zoom. I was very happy to attend these classes but you miss the thing if being part of a group, the chat with other pregnant women, with the nurse,... honestly I don't remember all the classes, cause it was kind of boring to have to listen to it through a screen. And also the internet was not always so good, so frustrating…”
Sarah (UK) responded when still pregnant in spring 2021:
“After 2 months of waiting, I got a call from the [local health centre] yesterday offering me remote (by Zoom) prenatal classes to start today (I couldn't attend today unfortunately as didn't have enough notice, but I'll start going next week). I got good vibes from the woman who called me so let's see how they go. There is hope. This is also progress from when I was pregnant with my first son in 2016/2017, as there was never any mention of prenatal classes (I was pregnant in Portugal then until about 34 or 35 weeks).”
Nicole (USA) gave birth in summer 2020:
“The course was cut short because of covid, however the information we learned in the 6 weeks precovid could have been covered in less time. We did enjoy the physical part of the class where partners learned to give massages, we practiced breathing, and prenatal stretches.”
Would you like to share your experience? Contact me here.
I’m afraid I cannot comment from personal experience here. According to other women I spoke to, in order to apply for maternity leave, you need to:
See the following web pages for further information:
Juliette (France) gave birth in summer 2020:
“I was working during my pregnancy, the first 4 months at the office, and the rest of it at home (lockdown and pandemic). I have decided to wait the 3rd month to announce my pregnancy to my manager first, then some of my colleagues. My manager and director are so comprehensive and respectful, so I had no problem of telling it. The 1st thing I had to do was to go to a Social Security office and ask for the declaration of pregnancy. This can only be done if you have a certificate from the doctor at the health centre that testify that you are pregnant from this date to this date. I had to give that declaration to my HR director. At my 30th week, I had to go to the hospital for suspicion of early labour... I had to rest for 7 weeks in bed after that so the doctor at the hospital “put me on high risk pregnancy”. It is a status that apparently can only be obtained from a public health system doctor. Because I was on high risk pregnancy, the Social Security took it from there for my salary payment. I was paid 100% of my salary (without taxes). Everything was linked between the hospital, the social security and my employer, so I only had to send the doctor´s declaration to my HR director. Then, I received my salary from the social security for 9 weeks.”
Carla (South Africa) gave birth in summer 2020:
“I was put on medical leave early on in my pregnancy for the duration of my pregnancy. I had to give an original copy of the doctors letter to Seguranca Social and emailed it to my employer. I had to fill out a form at Seguranca Social, otherwise it was rather straightforward.”
Vaida (Lithuania) gave birth in summer 2020:
“I was working until [one month before due date] online for the US company as a freelancer. So I was not entitled for a proper maternity coverage from them. My application here in Portugal was also declined as I signed as a freelance in Seguranca Social 7.5 months before my baby was born, and apparently for a maternity leave I should have had 1 year payments on SS services. Which felt funny as first year everyone has exemption, so its not me who chose not to pay SS, and Loja do Cidadao couldn't explain me how can I pay voluntary payments for that first year in order to be approved. So after 3 visits at Loja Cidadao and no one giving right answer I did not get maternity pay (only Prenatal pay), buy my partner used all 150 days instead.”
Would you like to share your experience? Contact me here.
This is the most common setting to give birth in Portugal. You will automatically be assigned to a (public) maternity hospital based on your home address.
However, you are free to choose any public hospital to give birth, regardless of where you live.
In my case, I was followed at Coimbra Daniel de Matos hospital for my prenatal appointments, but having researched my options, I decided to have my full-term consultations and give birth at Póvoa de Varzim hospital.
See here for a website which contains reviews of various hospitals. It does not look to be in very frequent use, but some reviews may be helpful to you nonetheless.
By and large, from what I gather, anything against the (medical) norm here tends to be seen as risky or even dangerous. This includes water births. Even though they are becoming more and more common in other Western countries and are generally associated with a more calm and relaxed birth, they are still not allowed in Portugal.
When I enquired about this I was told you may labour in water (although very few hospitals in the country have a birthing pool), but you have to come out to actually give birth.
Water can be used as a natural pain relief method and you may find that your hospital has a bath or shower available for this, so it is certainly worth asking them about it if it would interest you.
For my birth at Póvoa de Varzim I had use of a shower in between being monitored, and I found it really helped, even though I had been told at prenatal appointments at Coimbra "water does nothing" and that I should just get an epidural…
See this link for more information about water birth in Portugal.
Home births are becoming increasingly popular in Western countries. Research from the UK shows that home births are associated with lower rates of intervention during the birthing process. The reasons for this should become clear to you if you read this section.
Home births may be more popular for second/third/subsequent births, as the mother has then already experienced her body in labour and may be feeling more confident. However, as with any birth there are of course risks involved: if you are considering this option, it is worth reading up on the benefits and risks before deciding.
In Portugal, I believe home births are associated with a time when health care services were scarce and medical assistance was unavailable to many, resulting in more mother and infant deaths (see here for more information). Home births are therefore generally frowned upon and not covered by the state.
So you can choose to have a home birth if you hire an independent midwife, but be prepared to be discouraged by your doctor from making this choice. One mother who shared her experience with me actually said that she went ahead and planned a supervised home birth without telling her public hospital because she knew they wouldn’t agree with it. However, I have also heard a handful of reports of doctors accepting this choice, so there are some more open-minded professionals out there! In any case you are completely within your rights to plan this if you would feel more comfortable.
Here is a brief article with links to scientific research about home births: Is home birth safe? by Sarah Wickham.
Home birth professionals shared by the birth rights association
Home birth/water birth professionals shared by the water births association
If you are in and around Porto, the following team has been highly recommended by women I have spoken to: Uterus: Saúde Integrativa da Mulher.
If you would also like a doula as part of your home birth team, you can see the following links:
Rede Portuguesa de Doulas
You may also wish to join the Facebook group “Parto em Casa - Portugal” for more information regarding home births.
Meghan (USA) gave birth in spring 2021:
“It was my first home birth - but after my second birth (which was very fast), I had already decided I would do a homebirth if I was to have a 3rd. Then we moved to Portugal, and I was pregnant soon after - we had no doctors, and had not even begun navigating the health system. Luckily, I met someone else having a homebirth, and was put in touch with a midwife early on. Her team was the best thing about my pregnancy, and I would absolutely recommend them to anyone. I had a number of visits with them during the pregnancy, as well as 3 meetings post-birth. I felt respected, I was given space to speak and process openly with them, and I felt prepared for the birth experience that lay ahead of me. If anyone is wondering about pursuing homebirth in Portugal - just know there are great (legal) options out there. Stand firm in your decision, get a doula to help support you - and try to educate yourself on the human body - and how natural (yet painful) child bearing is. This knowledge can really help to soothe fears, and give you confidence around homebirth. There seems to be a shift, even if it is slow, happening in Portugal - and I am excited to see how this takes shape!”
Would you like to share your experience? Contact me here.
Many may think (like my husband used to!) that you just show up at the hospital and push the baby out. But there is A LOT that can happen to make this a positive or negative - or unfortunately, even traumatic - experience, so it really is worth being informed ahead of time and making sure that you, your birth partner and the hospital staff are aware of your wishes.
Of course you cannot fully plan your birth, because unexpected situations may always occur. So this is a bit of a misnomer and a more accurate term is "birth preferences".
Many women say "My birth didn't go to plan" (unsurprisingly, this is extremely common!), BUT the important thing is that the professionals taking care of you are aware of your preferences and that your human rights are not violated (see here for information about this).
A birth plan is a very new concept in Portugal, so don't be surprised if your family doctor or obstetrician don't even know what it is. It is precisely for this reason that you should definitely have one! And discuss it with your obstetrician during your prenatal appointments.
The more we all do this, the more normal it will become.
At Póvoa de Varzim hospital, they actually organise a specific consultation to talk about your birth preferences and send you a document via email to confirm what you have discussed.
As an example: knowing about the risks and benefits, I was certain I did not want an epidural or only as a very last resort. So during my labour, I was never asked if I wanted one. In my birth plan, I had stated that I knew an epidural was available, so if I really wanted it, I would ask. If, for instance, my plan had not been respected, I may have had doctors asking me frequently or suggesting that I have one, which would have distracted me from my labour.
Below are some questions that I used personally to prepare my birth plan. I was not happy with the responses I received to these questions at Coimbra Daniel de Matos, hence choosing to go to Póvoa de Varzim in the end.
English |
Portuguese |
Notes & comments |
At what point in pregnancy is an induction offered? |
Quando é que o médico sugere a indução do parto? |
It is common for health professionals to start talking about induction when you have passed your due date (or, even before you reach it). |
What pain relief options are available? |
Quais são as opções de alívio da dor? |
See here for my section on common pain relief options. |
Is water available for use during labour? Are there baths or showers? |
É possível a imersão em água (ou o usa desta) durante o trabalho de parto? Existem banheiras ou chuveiros? |
See here for my section on common pain relief options. |
Will I be free to move around during labour? |
Posso mudar de posição facilmente durante o trabalho do parto? |
See here for why this is important to your experience. |
Will I be free to choose which position to give birth in? |
Posso escolher a posição em que vou dar à luz? |
Slightly different to the question above, and you may get a different answer. See here for why this is important to your experience. |
Am I allowed to eat and drink during labour? |
Posso beber e comer a vontade durante o trabalho do parto? |
Often women are prevented from eating during labour, just in case they end up having to go for surgery. But it is worth asking what the hospital’s policy is on this. |
Is electronic fetal monitoring (EFM) standard, or can I choose to have intermittent monitoring? |
É possível escolher entre a monitorização contínua e a monitorização intermitente? |
Research tends to show that in low risk pregnancies, intermittent monitoring is sufficient. If you have continuous monitoring, this may interfere with your freedom of movement. However, as a personal choice, it may also give you peace of mind. As always,it’s worth knowing your options. |
What are my options if my baby is breech? |
Quais são as minhas opções se o meu bebé estiver virado? |
The norm here would be a C-section to prevent complications, however it is worth asking if you are keen to have a natural delivery. |
In what situations would an episiotomy be offered? Is consent always gained? |
Quando é que a episiotomia é sugerida e porque? O médico pede sempre consentimento? |
According to the Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto, |
Who is present in the delivery room? Might there be students? |
Que profissionais estão presentes durante o parto? Pode haver estudantes? |
See here about why this could be important for you. |
When is the umbilical cord cut? Who cuts the cord? |
Quando é cortado o cordão umbilical do seu bebé? Por quem? |
Optimal Cord Clamping = waiting to clamp the umbilical cord until it goes white. I did this personally based on what I had learned about it, but it is worth reading up about if you are considering it. |
When are babies weighed? (e.g. immediately/1-2hrs post birth…) Can this be delayed?
|
Quando é que o bebé é pesado? Pode ser adiado?
O que acontece imediatamente depois do nascimento? É normal ter o bebé colocado no peito da mãe após o parto? |
In a traditional medical model, the baby would be taken immediately to be weighed, measured and dressed. However, research now shows that skin-to-skin immediately after birth - for about an hour - is beneficial to the baby, the mother, and to initiate breastfeeding (see here). |
Can I wait for the natural delivery of the placenta? If not, what are my options? |
Posso aguardar a expulsão espontânea da placenta? Se não, quais as opções? |
Natural delivery of the placenta = a "physiological third stage” of labour. The other option usually being an injection of synthetic oxytocin to aid the expulsion. Otherwise, manual methods may also be used. |
Is Vitamin K injection* given at birth as standard? |
A administração de vitamina K é normal neste hospital? |
Vitamin K is used to prevent haemorrhagic disease of the newborn. |
See also https://associacaogravidezeparto.pt/ for information about women’s rights during pregnancy and childbirth Portugal. Their documents section is particularly helpful and contains documents stating your rights, if you would like to take this to show to your hospital.
Vaida (Lithuania) gave birth in summer 2020:
“I took [my birth plan] to [a public maternity hospital] to discuss with the maternity ward head (lady in her 50s), but she just laughed that I'm spending too much time on FB groups reading all how perfect all settings should be. I felt it was a joke. But still had it printed and asked nurses to read it when coming. Some were supportive, either way the rest were leaving lights on (not dimmed as asked), where chatting loud etc.”
Nicole (USA) gave birth in spring 2020:
“The hospital staff did an incredible job following my requests.”
Filipa (Portugal) gave birth in winter 2019:
“If you can, I personally think it is very important to choose a doctor with whom you have empathy and to discuss the different points/ queries you have during the appointments - in other words "plan the unplanned" :) Always question if you are not sure/ understand what the doctors are saying/ proposing (in Portugal often doctors are seen like "Gods" and no one will dare to challenge/ question them).”
Would you like to share your experience? Contact me here.
According to my reading, having a birth partner can significantly increase your chances of having a positive birth experience, reduce the likelihood of interventions, and is even associated with shorter labouring time and less external pain relief. If you read this section, you will begin to understand why. Unfortunately a lot of hospitals here are not aware of these facts, so they only allow birth partners for a short time, or not at all (even before Covid, there were time restrictions on birth partners).
Although you are allowed a birth partner by law in Portugal (see below), many hospitals may not respect this.
Something to bear in mind is that if you have hired an independent midwife or a doula, in many hospitals you may only be allowed one birth partner with you - so if you want them with you then your partner would not be able to also attend.
To my understanding it is common for fathers/birth partners to not be allowed to attend C-sections, so if you are planning to have one (or even if not), it would be worth asking what your hospital’s policy is. This document from the Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (Association of Women’s Rights in Pregnancy and Childbirth) states your right to have a birth partner when having a C-section.
For my birth at Póvoa de Varzim, my husband was allowed with me from the beginning of my induction until 2 days after the birth. Due to the pandemic, we had to have Covid tests done 2 days before the planned induction.
If it had been a spontaneous labour, my husband still could have been with me throughout labour and up until 2 hours after the birth, i.e. up until the point when I had to share a room.
Had I stayed with Coimbra Daniel de Matos hospital, my husband would have only been allowed in once I was in active labour, and he would have had to leave 2 hours after the birth no matter the Covid test result. According to a friend of mine, this limited time was even the case there about 5 years ago when Covid wasn’t even a factor.
Carla (South Africa) gave birth in summer 2020:
“My husband was present. He checked in with me and was only allowed to leave when I was discharged.”
Anika (Germany), gave birth in summer 2020:
“My partner was not allowed in the hospital at all because of Covid. I gave birth alone. They told him just 2 hours after the birth that his daughter was born! They didn't give him any notice of what was going on for this 2hours. Having been an emergency he was incredibly worried. Language was an issue.”
Vaida (Lithuania) gave birth in summer 2020:
“My partner was allowed at 8cm, and to stay 2 hours after I gave birth. So maybe 4 hours total.”
Anonymous (Canada) gave birth in summer 2018:
“My husband [was with me], throughout the whole process and into the first day of recovery.”
Would you like to share your experience? Contact me here.
As I’ve stated on other pages of this website, the Portuguese have a very medicalised view of childbirth. As such, an epidural is often your only option of pain relief and you may get a funny look if you speak of non-pharmaceutical or natural pain relief methods. (You may also get a funny look if you choose not to have an epidural). Most of the women who shared their experiences with me were offered epidural only, but some were also offered things like showers or baths, for example.
When I had my birth plan consultation at Póvoa de Varzim, as well as my online prenatal classes with them, they spoke much more about the natural pain relief options. The staff fully respected my birth plan and I was never offered an epidural (I had stated that I only would have one as a very last resort - e.g. if I had a very long labour - and I knew it was available so I did not want to be asked directly about it).
In the end I accepted the offer of: heat application, massage, and water (in a shower - baths/birthing pools were not available due to Covid) - all of which I found worked well for me. I tried to focus on my breathing but to be honest, as labour progressed, this got harder and harder. I was very grateful that the midwives knew massage techniques because my husband is a bit useless at massages!
Pharmaceutical options
Non-pharmaceutical/natural options
Portugal has among one of the highest rates of intervention in Europe, which would tend to suggest that many interventions happen unnecessarily. This is why it is worth being informed beforehand, so you (and your birth partner) can know the difference between a truly necessary and unnecessary intervention.
When women are less informed, they are more likely to simply follow the doctor’s orders and only realise the consequences later - particularly when you are in the middle of labouring and you just don’t have the brain power to question things. Speaking of brains...
Something which came up time and again in my reading about birth was the acronym BRAIN. You can use this to help you come to a decision about any intervention which you are offered during pregnancy and birth.
B: What are the benefits?
R: What are the risks?
A: What are the alternatives?
I: What does my intuition tell me?
N: What happens if we do nothing?
From my reading and hearing about others’ experiences, it appears that consent is not always asked for in Portugal. This can commonly happen in a very medicalised system, as it is just assumed that “doctor knows best” and this overrides the woman’s human rights.
I strongly disagree with this and believe that every woman has the right to consent to any intervention performed during her pregnancy, labour and birth. Even in a more urgent situation, there is time to ask for consent.
It is worth bearing in mind that having any intervention without your informed consent may be classed as obstetric violence (see here). Being informed ahead of time is paramount, as you will not be in any state to be taking in new information once you are in labour. This is also why having a birth partner, independent midwife or doula would also be extremely important if you are concerned about your rights being violated.
I myself had a “routine” vaginal examination at 36.5 weeks without my informed consent: I was only expecting my obstetrician to perform the Streptococcus B test, but she then also checked to see if my cervix had started to dilate. Unsurprisingly, it hadn’t. Had I been explicitly asked about this, I would have refused as it seemed very early to me and I personally find vaginal examinations very unpleasant.
However at Póvoa de Varzim where I gave birth, consent was asked at every single stage of my labour and birthing process. I always felt informed about what was happening. Incidentally, during my birth, I only had 2 vaginal examinations: one before the induction started, and one after my waters broke.
I designed this table for myself during my pregnancy just to make sense of all the information I was reading, and to make sure I would be making informed choices.
First stage of labour |
||
Intervention |
Explanation |
Notes |
Sweeping of the membranes/ Cervical sweep |
Doctor puts a finger into the cervix and makes a circular or sweeping movement with their fingers, to separate the sac surrounding the baby from the cervix and trigger natural labour. May happen more than once if the first time is unsuccessful. |
Usually only suggested at 40+ weeks of pregnancy. I have not heard of this intervention being mentioned in Portugal but it is common in the UK. |
INDUCTION OF LABOUR: |
Artificially encouraging labour to start or augmenting the labour process by physical or pharmaceutical means. |
(see below for different stages) |
Induction (1):
Insertion of prostaglandins (in pessary or gel form) |
Doctor inserts a pessary or gel of prostaglandins (hormones) into vagina to encourage the cervix to soften, shorten and open, and the uterus to start to contract regularly. |
|
Induction (2):
Amniotomy (Artificial Rupture of Membranes/ ARM) |
Medical breaking of waters, i.e. the amniotic sac is deliberately ruptured using a thin plastic hook. |
Suggested once the cervix is soft and slightly dilated, and the head has started to enter the pelvis. |
Induction (3):
Pitocin |
Synthetic oxytocin delivered through IV. |
Only used once cervix has already started dilating, because Pitocin only induces contractions rather than changing shape of cervix. May also be suggested after waters have broken if spontaneous contractions have not started within a certain number of hours. |
Enema |
A procedure to clear out your bowel before labour. |
This process should happen naturally as the body prepares to birth the baby. No longer deemed helpful or necessary by WHO (World Health Organisation). |
Shaving of pubic hair |
NOT medically necessary and potential risk of infection if cut. |
|
Electric foetal monitoring (EFM) |
Constant monitoring of heartbeat: belt goes around your belly and is hooked up to a machine. |
May interfere with your freedom of movement. In contrast to intermittent foetal monitoring, where a midwife or trained professional checks the heartbeat either electronically or with a hand-held device at regular stages during labour. |
Vaginal examinations |
Medical professional puts fingers inside vagina to inspect dilation of cervix. |
You have the right to refuse vaginal examinations if you do not feel comfortable with them. There are other ways to check the progress of labour. Consent should always be asked. |
Epidural |
Anaesthesia administered through spinal cord: numbs you from the waist down |
There are different levels of dosage which leave you with more or less feeling of your legs. You can also have an epidural for some of your labour and then choose to have it removed for giving birth. There are risks involved and possible side effects which are worth reading about before making your decision. |
Second stage of labour (active labour) |
||
Intervention |
Explanation |
Notes |
Episiotomy |
A surgical incision of opening of vagina, usually to allow for large head or quicker delivery. |
This one deserves a special mention... See below. |
Vacuum extractor |
Doctor uses soft cup on baby’s head, attached to vacuum pump, to help guide baby’s head out of birth canal (during a contraction). |
For quicker delivery if necessary. Often paired with episiotomy but can be done without. |
Forceps |
A metal instrument is used to guide a baby’s head through the birth canal during a difficult delivery (used during contractions). |
For quicker delivery if necessary. Often paired with episiotomy but can be done without. |
Caesarean section, a.k.a C-Section |
Medical procedure to remove baby from mother by invasive surgery. |
Can be planned or emergency. |
Kristeller manoeuvre |
Pressure is applied to woman’s belly by health professional in order to expel baby. |
Reported as uncomfortable and dangerous by WHO (2010). Currently classified as abusive and falls within the scope of obstetric violence (Human Rights in Childbirth, 2015). |
Third stage of labour (birth of placenta) |
||
Intervention |
Explanation |
Notes |
Active third stage of labour |
Three components: 1) giving a drug (a uterotonic) to help contract the uterus; 2) clamping the cord early (usually before, alongside, or immediately after giving the uterotonic); 3) traction is applied to the cord with counter-pressure on the uterus to deliver the placenta (controlled cord traction). |
In contrast to physiological third stage, where the placenta is birthed without medical intervention. |
When I was first pregnant, my husband said to me “Just so you know, my mum said to warn you that you’ll be cut when you give birth”. “What??” I thought, “No, that can’t be right. I know I may tear naturally but I certainly don’t want to be cut.” And thus my research began.
Episiotomies are unnecessarily common in Portugal, suggesting that it is often performed as “routine” or without a true medical need. This is an outdated practice from times when medical professionals believed that an episiotomy was favourable over natural vaginal/perineal tearing during childbirth. WHO (World Health Organization) does not recommend “routine or liberal use of episiotomy for spontaneous vaginal births”.
As an indicator, I was told during my prenatal classes that the episiotomy rate at Póvoa de Varzim hospital is <1%, whereas in some hospitals in Portugal it can be higher than 90%. The overall rate in Portugal was reported as 73% in 2018 in the “Relatório Primavera 2018 do Observatório Português dos Sistemas de Saúde”, which is the second highest rate in Europe. As you can see, it is really worth asking what your hospital’s policy is on this. If their episiotomy rate is higher than the recommended 10% of WHO, you may want to consider looking into other hospitals because a high rate is suggestive of an overuse of the procedure.
I learned during my prenatal classes at Póvoa de Varzim that their philosophy is that the perineum needs to be relaxed enough to adapt to the baby’s head. They also taught me that evidence shows that episiotomies do not prevent severe (i.e. 3rd or 4th degree) tears. They said that the real advantage of an episiotomy is to allow the baby to be born quicker, in the case of fetal distress. If the baby is doing fine, the perineum should be allowed to stretch naturally.
There are techniques you can use to prepare your perineum for birth if you are concerned about tearing, such as perineal massage (which you can do yourself or you can get your partner to help you). Personally, I purchased a device called Epi-No which helps to stretch the perineal muscles slowly and can be used once you are full-term. Hypnobirthing and visualisation techniques can help you to prepare mentally for this.
In this context, the term “violence” does not only apply to physical violence. According to Lamaze International, obstetric violence is “the physical, sexual, and/or verbal abuse, bullying, coercion, humiliation, and/or assault that occurs to laboring and birthing people by medical staff, including nurses, doctors, and midwives. In short, obstetric violence is anytime a person in labor or birth experiences mistreatment or disrespect of their rights, including being forced into procedures against their will, at the hands of medical personnel.”
I am very sorry to say that obstetric violence is not uncommon in Portugal. For this reason we must fight against it as best we can, to ensure the physical safety and protect the mental health of future mothers. I realise this sounds dramatic but I strongly believe that giving birth should be as positive as possible, despite any emergencies which may occur. According to my reading, some traumatic birth experiences can actually be avoided through prenatal education so women are aware of what their rights and choices are.
There is so much more to childbirth than just surviving.
Remember that not speaking Portuguese fluently does not mean your human rights are any different to other women around the world. Unfortunately language barriers can lead to miscommunication, but I hope that some of the information on this website can help you to prepare for such instances, for example by having a glossary of terms with you or a birth partner or doula who speaks (enough) Portuguese.
The most common example of obstetric violence I have heard from speaking to mothers in Portugal is having an episiotomy without consent (however, plenty more than this unfortunately happens daily). During my prenatal classes with Póvoa de Varzim hospital, I was told that their rate of episiotomy is <1%, whereas in some hospitals in Portugal it can be as high as >90%. See this section for some more information about this.
If you would like advice or help with a situation involving obstetric violence, get in touch with the birth rights association in Portugal: Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (APDMGP): https://associacaogravidezeparto.pt/
You may also like to look at this link from the World Health Organization about their commitment to protecting your rights in childbirth.
Juliette (France) gave birth in summer 2020:
“The induction part I was not really happy with how they presented that to me. The pain of course, and I had to wait more than an hour to get the anesthetist to do the epidural. The gynecologist pushing on my belly to “help” the baby to get out, that was not a good experience at all. Horrible pains... And I learn that this manoeuvre is not allowed anymore in most of the countries and could be treated like an obstetric violence and could harm the baby... But you are so much in pain that you cannot say anything.”
Amélie (Canada) gave birth in summer 2020:
“I had an episiotomy even though I argued with the doctor.”
Anonymous (UK) gave birth in spring 2021:
[When asked if consistently asked for consent during labour] “Yes for vaginal exams but no for medical intervention during the induction and birth. I was expecting someone to ask/explain to me each step what they were giving and why but that was not the case. They just gave me the medication and it was me that asked what it was.”
Would you like to share your experience? Contact me here.
Thank you so much to Mia Negrao for the permission to translate and share our rights according to Portuguese law, available in Portuguese at:
http://www.partocomsentido.com/direitos
Translated by Shona Becker on 10/07/2021
YOUR RIGHTS IN PREGNANCY, BIRTH AND POSTPARTUM
RIGHT TO INFORMATION
The World Health Organization states, in the recommendations for a positive birth experience, that pregnant women have the right to respectful health care, namely by promoting informed choice and dialogue between the pregnant woman and health professionals, through the use of simple and understandable language. In turn, the right to information in pregnancy and childbirth is contained in Article 15 - A, nº 1, al. a) of law No. 15/2014, with the amendments introduced by law 110/2019.
Ask questions. If you don't understand, ask them to explain so that you do understand. You have the right to all information about pregnancy, childbirth, procedures routinely performed in hospitals, procedures or treatments that may be offered to you, birth physiology, etc.
RIGHT TO INFORMED CONSENT
Consent must precede any intervention that is carried out on your body. To be valid, it must be free and clear, which means that the risks and benefits of the intervention or treatment must be explained to you, and it must be clear to you and confirm that you understand the scope of the intervention, the risks and benefits.
If you understood and made a decision based on up-to-date information, then the intervention you will be subjected to is truly consented. This consent does not need to be in writing, with the exception of some cases provided for by law and may be revoked until the intervention is carried out.
If you change your mind seconds before, you can say that in the end you no longer consent to a certain intervention and it can no longer be performed. In your body, you command.
Law No. 15/2014, with the amendments introduced by Law 110/2019, states the right to informed consent in Article 15 - A, No. 1, al. a), but such right was already inscribed in the Portuguese Penal Code and in other international statutes to which the Portuguese State is bound.
RIGHT TO REFUSE PROCEDURES, TREATMENTS AND/OR INTERVENTIONS
Consent must precede any intervention that is carried out on your body. If you refuse a certain intervention or treatment, health professionals have a duty to respect it.
They must inform you about the risks and benefits of your refusal, they must clarify your questions, and in the end, it is up to you to decide.
The Ethics Committee of the ACOG (The American College of Obstetricians and Gynecologists) issued an opinion stating that “pregnancy is no exception to the principle that a patient with decision-making power has the right to refuse treatment, even if the treatment is necessary to maintain life”, promoting respect for pregnant women's decisions by obstetricians. The law also recognizes the right to informed refusal.
An intervention without consent can constitute a crime.
RIGHT TO BE RESPECTED IN YOUR CHOICES AND PREFERENCES FOR BIRTH
You have the right to be respected in your choices and preferences for childbirth. Law No. 15/2014, with the amendments introduced by Law 110/2019, states this.
For this to happen, it is advisable to draw up a birth plan, where you write down your choices and preferences for labour, delivery and the immediate postpartum period.
You must be flexible and understand that not all hospitals offer the same conditions, so take a look at the law to see what demands you can make. Having a birth partner and having a calm and peaceful environment are not extraordinary preferences. These are relevant factors for a positive birth experience.
Health professionals must adjust to provide you with a good birthing experience, in which you are the protagonist.
RIGHT TO HAVE 3 COMPANIONS DURING LABOR AND BIRTH
Having a birth partner is not a luxury. It is essential. The World Health Organization recommends it and a systematic review of the Cochrane Library demonstrates the benefits of having a birth partner during labour, namely a decrease in some interventions. The disadvantages? None, unless you do not want a birth partner.
The right is yours and is provided for in Law No. 15/2014, with the changes introduced by Law 110/2019. You can decide to have companions or not. Currently, due to the pandemic situation we are experiencing, your choice may be limited to just one companion, but the right to have a companion remains valid.
RIGHT TO MAKE A BIRTH PLAN
The birth plan is a document where you express your choices and preferences for labour, delivery and the immediate postpartum period. It is in this document - which should be discussed with the health professionals at the hospital where you choose to give birth - that you express what is important to you at that moment: having a birth partner, having skin-to-skin contact immediately after birth, your preferences regarding pain relief methods, etc.
The birth plan must reflect the information you have and must be in accordance with good clinical practice and the law, remaining flexible. The existence of the birth plan does not prevent health professionals, during labour and delivery, from providing clarifications when requested, or from asking for consent for any procedure, even if previously allowed the plan.
The right to have a birth plan is inscribed in Law No. 15/2014, with the changes introduced by Law 110/2019.
RIGHT TO NON-EXISTENCE OF VIOLENCE DURING LABOUR OR POSTPARTUM
Law No. 15/2014, with the amendments introduced by Law 110/2019, grants you the right to be treated with dignity and respect and to be free from any form of violence, as well as the right to freedom, autonomy, self-determination, including the right not to be coerced. Violence is not always physical and noticeable.
If they don't give you options or alternatives, if they impose interventions on you instead of proposing them, if you feel disrespected and disregarded during childbirth, this is obstetric violence and you should report it.
The environment that promotes a positive birth experience is calm, free from abuse, coercion, threats, screaming or any other type of violence. Obstetric violence is common but it is not normal (#nãoénormal).
RIGHT TO BE TREATED WITH DIGNITY AND RESPECT DURING YOUR STAY AT MATERNITY
Being treated with respect and dignity is a right that you have, not only in motherhood, but always. This includes the right to be treated well, not to be discriminated against and to be free from any form of violence.
Law No. 15/2014, with the changes introduced by Law 110/2019, is clear and also gives special relevance to these rights in situations of particular vulnerability, such as the interruption of pregnancy or in the presence of stillbirth; in the case of victims of domestic violence, sexual abuse, harmful practices or human trafficking; in situations of people at the extremes of the reproductive age range; in case of a disability of the mother or baby; in situations of migrant or refugee people; and in situations of extreme poverty.
RIGHT NOT TO BE DISCRIMINATED DUE TO YOUR COLOUR, RELIGION, SEXUAL ORIENTATION AND/OR GENDER IDENTITY
You have the right to equal treatment during pregnancy and postpartum, and the right not to be discriminated against. Regardless of your skin colour, religion, sexual orientation or gender identity, you are entitled to receive the best, safest and most appropriate health care based on WHO recommendations for a positive birth experience.
It is Law No. 15/2014, with the amendments introduced by Law 110/2019, without prejudice to other national and international statutes that state the right to non-discrimination in any context.
RIGHT NOT TO BE COERCED REGARDING DECISIONS TO BE TAKEN IN THE CONTEXT OF LABOUR
Law No. 15/2014, with the changes introduced by Law 110/2019, states the right to freedom, autonomy and self-determination, including the right not to be coerced. Coercion is a form of obstetric violence.
If it happens to you, report it, because we could be in the context of a crime. To make informed decisions, you must be informed, and pregnancy is a privileged stage for gathering information in order to facilitate decision-making during childbirth. Do not be taken by surprise.
RIGHT TO YOUR FREEDOM AND AUTONOMY. THE DECISIONS ABOUT YOUR BODY, YOUR PREGNANCY AND BIRTH BELONG TO YOU
Any attempt by health professionals to distance you from your reproductive process may be considered obstetric violence. To make use of your autonomy and to make conscious decisions, you need information.
This information should be given by health professionals during pregnancy, stating the preparation for the birth and for all protocol interventions that may be proposed to you. Question them. If you don't know your options, it is as if you do not have them.
RIGHT TO CHOOSE TO GIVE BIRTH IN A HOSPITAL OTHER THAN YOUR HOME AREA
You are not required to give birth at the hospital closest to your home. You can be admitted to another hospital in labour, or you can ask for a transfer to another hospital while you are still pregnant. It is advisable to contact the hospital of your choice in advance, so that you know what to expect.
RIGHTS UNDER VOLUNTARY INTERRUPTION OF PREGNANCY AND MEDICAL INTERRUPTION OF PREGNANCY
This context gives special relevance to the rights that the law recognizes you:
A positive birth experience does not mean it is perfect, nor does it mean all goes "to plan". Emergencies can happen, and the sequence of events on the day can take us by surprise. After all, you are not in control here: your body and your baby are working together, without your conscious thought.
That common phrase "All that matters is a healthy baby" completely undermines the woman's experience and dismisses her feelings about the birth. Of course we want our baby to be healthy. But that should be the bare minimum, it should not be the overall aim. We live in a modern world with access to modern medicine, but we are still human beings and should be treated as such, not like machines which carry and birth a baby mindlessly.
So, in my view, a positive experience is when the woman feels respected, supported, and treated with compassion. You may end up with a C-section when you wanted a completely natural birth, or you may plan on having an epidural but labour progresses too quickly. The important thing is that your personal choices and your human rights are respected, and that you feel safe, seen and heard.
With that in mind, I believe every woman has the right to be informed about the way her body works during labour. The information below is paraphrased from the various reading and learning that I have done about childbirth. In everything I read and watched, these seemed to be the most common points.
If the following information interests you, you can see my resources page for sources containing more detailed information.
Broadly speaking, according to the Triune Brain Concept, your brain can be divided into 3 parts: the primitive brain, the mammalian brain and the human or "higher thinking" brain.
The primitive brain
This part processes information such as whether you are hot/cold or tired, and regulates your heart rate and breathing. It is the most primitive and therefore most basic part of our brain.
The mammalian brain
As the name suggests, this is what we have in common with other mammals. It processes our emotions and our animal instincts such as the fight-or-flight response.
The higher thinking brain
This is what makes us unique as humans. It is where we process language, abstract thought, imagination, and creativity.
Can you imagine a pregnant elephant or a dog sitting and contemplating their upcoming labour/birth and doubting their ability to get through it? No, probably not.
Giving birth is what we have in common with other mammals. As such, we need to get in touch with the animal inside of us: birth is primal, it's animalistic, and it's messy. (A bit like what gets the baby in there in the first place!) So the very last thing we need - and indeed, what can slow the process - is our higher thinking brain worrying about what other people are saying or doing, or even whether we are doing a good job.
Birth is our chance to go inwards, to focus solely on our body and our baby/babies. This is why it's important for the professionals at your birth, and your birth partner, to be aware of your preferences beforehand - because you don't want to be answering a million questions when you're trying to focus on your body and your baby, or your brain may send a message to your body that it is not the right time and place to give birth.
Oxytocin vs adrenaline
Related to the above information about how our brains work, our body is very well designed to release oxytocin to aid the birth process. Oxytocin is secreted with touch (particularly skin-to-skin), so plays an important role in reproduction, birth and breastfeeding. For such reasons, it is nick-named “the love hormone”. Its production in the body causes contractions during labour.
Adrenaline, on the other hand, is secreted when we are in a state of fear. Unsurprisingly, oxytocin and adrenaline cannot be produced at the same time. So if your body goes into a state of anxiety or fear, the flow of oxytocin stops.
Can you imagine an ape lying on its back, with bright lights all around and a bunch of other apes watching and making noises, happily giving birth? No, probably not.
Mammals naturally try and find a quiet, dark and safe space to have their young. If any part of us feels unsafe, our nervous system detects danger and produces adrenaline. This in turn slows down the birth process, as production of oxytocin stops.
Before the days when we lived in houses and gave birth in hospitals, if there was any danger around, it would not be the best time to have a baby. So the body would release adrenaline to allow the woman to get into a safe place. This would slow down contractions so that the mother and baby were kept safe. It’s a very clever process, if you think about it!
Unsurprisingly, many women who are in labour find that their contractions slow down as soon as they arrive at hospital: the mammalian brain detects it as an unsafe environment to give birth.
Women have been giving birth literally since our species began. Your body knows what it's doing. What your body and brain do not like is interference and constraints. So freedom of movement is essential for a positive birth experience. Women should be able to tune into what their bodies want, and follow their instincts. Being told to stay stuck on a bed is therefore very unnatural when you stop to think about it.
The ideal position for giving birth is an upright, forward-facing position: purely thanks to gravity. As you can see in the video below, if we are on our backs, we are actually pushing against gravity to get our baby out (think about the direction of the birth canal: if you are laying down on your back, it points slightly upwards).
The main reason women began giving birth on their backs was so that doctors (often men, totally unaware of the birthing experience) could get a better view. Having said this, of course you may well end up on your back out of choice. Labour is tiring! But the important thing is to have the freedom to choose how to move your body.
So in summary, to increase the likelihood of a positive birth experience, we need:
The information above relates largely to planning for a natural vaginal delivery, however, do remember that you still have rights and choices when it comes to C-sections (whether planned or emergency).
It is worth asking your maternity hospital about their procedures and policies regarding C-sections, for example I believe not all hospitals allow you to have a birth partner despite this being a huge factor in living a positive birth experience. You may still wish to discuss a birth plan with your obstetrician so that you feel more involved in the process.
If you are considering a C-section for medical or personal reasons, you may find this article about a gentle Caesarean interesting to read. According to The Positive Birth Book (pages 209-210), a “gentle” or “woman-centred” Caesarean may involve the following choices:
You will likely be given some information from the hospital about what to pack. Do bear in mind that even if you are planning a home birth, it is advisable to have a hospital bag packed just in case you or baby need to go in for any treatment.
Whether you go into spontaneous labour or have an induction, labour can last for days… or, it can only last a few hours! But particularly if you are a first time mum and you're not sure how your body naturally reacts to labour, it's a good idea to plan for this.
Additionally, although it's not nice to think about, there is a possibility that you may need to spend more than the standard amount of time in hospital (either for yourself or for your baby). The standard in Portugal is 2 days for a natural birth and 4 days for a C-section.
In my case I did end up staying 2 extra nights, so 4 in total, because my little girl had to spend some time in the NICU due to vomiting, and then for jaundice treatment.
Your meals should be provided by the hospital (whether public or private). If there are snacks you particularly like or little tastes that will remind you of home while you’re away, do pack those too. I loved snacking on chocolate biscuits and brownies after giving birth!
In my case at Póvoa de Varzim, meals were also provided for my husband throughout his stay, but the morning and afternoon snacks were for me only.
If you do a quick internet search you’ll find that there are plenty of websites which will give you recommendations about packing your bag. Your hospital will probably also give you a list of ideas. But here are some suggestions based on my own preparation:
Essentials:
Clothes and comforts:
Toiletries, pharmaceuticals, etc.
Electronics
Snacks, etc.
For the baby
In your birth plan, you may like to request immediate skin-to-skin following the birth. It will be important to state this to your healthcare providers, as unfortunately it is not yet standard practice in all hospitals.
According to Unicef:
“There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers in many ways.
Additional benefits for babies in the neonatal unit:
Babies have this wonderful instinct to find the breast immediately after birth. If you are planning on breastfeeding, you might enjoy allowing the baby to do what is known as “breast crawl”. Here are some videos which show this happening:
Something else you might like to consider putting in your birth plan is when to cut the cord, and who will do it. “Immediate cord clamping” refers to the practice of clamping the cord immediately after birth. “Delayed cord clamping” is waiting for at least 1 minute until clamping the cord, and finally “optimal cord clamping” is waiting until the cord stops pulsating and goes white, i.e. when the baby has received all of its blood from the placenta.
In my case, I requested optimal cord clamping and the team at Póvoa de Varzim respected this. However, when my obstetrician at Coimbra Daniel de Matos saw this on my birth plan, she told me it would be up to the obstetrician I happened to be with on the day (but I didn’t like those chances). I also had written on there that I wanted my husband to cut the cord, but I was told at Coimbra that this would not be allowed. At Póvoa de Varzim, my husband cutting the cord was not a problem. They even offered for me to do it at the time, but I said “he can do it, I’ve done enough!”.
For your information, here are some articles you can read on this topic:
WHO guidelines regarding cord clamping
Wait For White - an informative website about optimal cord clamping
And a couple of podcast episodes about it:
Fear Free Childbirth podcast: Why we need to wait for white
The CORD podcast: Delayed and optimal cord clamping: for your newborn’s long term health
When a baby is born, it is covered in a substance called vernix (or vernix caseosa). This coating on the skin creates a barrier between the baby and the amniotic fluid, which is why your baby doesn’t come out with wrinkly skin like we do after a long bath! It is the baby’s natural moisturizer. The longer the pregnancy goes on, the less vernix you will generally see on the baby’s skin after birth, as it has already begun to be absorbed. Here is some more information: “Unravelling the mystery of vernix caseosa”.
With this in mind, something else you can include on your birth plan is whether you would like the baby to be bathed at hospital or not. In a traditional medical model, a baby would be taken away from the mother, washed and covered in a blanket before being handed back to her (you may have seen this on old TV shows or movies). However, the WHO recommends delaying the newborn’s bath for at least 24 hours. For more information, see this document from WHO about Postnatal Care for Mothers and Newborns and this article with reasons to delay a baby’s first bath.
On the other hand, some mothers prefer to bathe the baby with a nurse’s help before leaving hospital to learn how to do it. Whatever you choose, it’s best to make sure your medical team are aware of your preferences.
As you would expect, your baby will receive checks such as being measured, weighed, and that they are generally healthy.
Your placenta will need to be delivered, either naturally or with some help (this is an element to include on your birth plan). The placenta will then also be analyzed to see if it is healthy. You will have the option to have a look at it if you choose.
You will receive stitches if required, your baby will have their first feed, and you will likely then be transferred from the delivery suite to a recovery room depending on your hospital.
The standard hospital stay in Portugal is 2 days for a natural birth, or 4 days for a C-section. You are allowed to leave early if you sign a document stating that you take full responsibility for this action.
In my case at Póvoa de Varzim, I was in a shared room for the initial phase of labour, a private room for giving birth, and then back to the shared room for the next two days. There were two other beds in the room but only one was occupied. All were separated by curtains.
I am unsure if this is standard everywhere, but I was given medication during my time on the maternity ward at every meal time: stool softeners to help prevent hemorrhoids, and ibuprofen for pain relief. I also continued to have meals and snacks provided for me.
My little girl had to stay a few nights in the neonatal ward, firstly due to vomiting and then to receive treatment for jaundice. Unfortunately only mothers were allowed in the neonatal ward so my husband could not visit our baby there. There were no time restrictions on this, day or night. I made sure to practice skin-to-skin contact with my baby whenever I could (see above for the benefits of this).
No phone calls were allowed apart from to the father, so as to keep disturbance to the other mothers and babies to a minimum. After 2 days I was discharged from the maternity ward so I then had to stay in a “mothers’ room” where there were several reclining armchairs for us to sleep. Due to Covid, my husband was not allowed to return to visit us once he left after 2 days, but he could drop off items at the hospital entrance to be given to me if needed.
In the ward they had a nursing pillow for me to use, and an electric breast pump which all mothers could use. They supported me to give my baby her first bath and would take care of her nappies etc. if I was resting.
When you are discharged, you have to sign a document stating that that is indeed your baby. You should be given some advice regarding feedings and taking care of the baby, you will have a chance to ask any questions you may have, and you may also be given a few freebies like nappies and baby wipes.
Anonymous (UK) gave birth in summer 2018:
“My baby didn't pass urine so being in the hospital meant it was easy to access the paediatric team.”
Heather (UK) gave birth in autumn 2020:
“I felt safe in the hospital, I was constantly monitored and the food was good.”
Anonymous (Canada) gave birth in autumn 2017:
“Nurses were very kind and helpful, despite my not speaking Portuguese at the time.”
Jessica (USA) gave birth in summer 2020:
“My delay in going to the hospital because my partner wasn't allowed to be with me meant that I did not start antibiotics soon enough. Shortly after birth, my son ran a fever and his inflammation markers tested too high. The next day we learned that we would be staying in the neonatal unit alone for one week after his birth to finish a 7-day course of antibiotics. My husband missed the first week of his son's life and I was alone healing from birth and struggling to get by with my so-so Portuguese. The doctors spoke English but the nurses did not and my weariness did not help matters. Although I felt the birth had been a largely positive and respectful experience, the week after his birth was the hardest of my life.”
Anonymous (UK) gave birth in spring 2021:
“I was happier with the care I got in the hospital after birth, than before it. Staff very friendly and helpful. The hospital gave lesson and help with first baby bath.
Also a baby safety video/lesson including cars seat safety and helped fit your own car seat.”
Would you like to share your experience? Contact me here.
Based on my own experience and those of the mothers I spoke to, it seems common to be supported with breastfeeding while in hospital but not once you are discharged and back in the community. Home visits do not happen here, like they can do in other places like the UK. A few women reported that they had to ask for help in hospital as it was assumed they knew what they were doing when it came to breastfeeding.
I definitely benefited from reading up on breastfeeding before birth and watching some videos so I knew what to expect - and even then, it is not always as straightforward as you might think!
For instance I figured out on my own, through various Google searches, that I had an over-active let down and over supply. In hindsight I would have really benefited from paying for a lactation consultant and I may well do this for my next baby as I did not feel supported at all by the public system when it came to breastfeeding.
Here are a few useful links to get you started:
from the Positive Birth Company (UK). 1 hour.
from the Built to Birth YouTube channel. 18 minutes.
If you prefer books, I also recommend The Positive Breastfeeding Book by Professor Amy Brown.
If you would like specific personal support you will probably need to pay for a lactation consultant. Be aware that family doctors or nurses can often give outdated or incorrect advice so if you are unsure, always seek out specialist support (and this point is not specific to Portugal!). The same goes for searching for information online: make sure it is from a certified lactation consultant. If you are determined to breastfeed my best advice is to get the right support and information, as many women are actually able to breastfeed when they are well supported and well informed.
Organisations:
As for me, in the maternity ward I was supported to get a good latch for the first feed but then I was left to it. After this, I was in the NICU so if I asked, they would help, but otherwise I was left alone. They provided me with a nursing pillow to use and I could also use their electric pump if needed.
As a side note, I did find it odd that my baby was not weighed from 2 months to 4 months (nor from 4 to 6 months), as from what I understand, feeding difficulties can still occur at that age and I would have thought it a good idea to make sure weight gain was steady.
Carla (South Africa) gave birth summer 2020:
“The nurses were there to help me with that. They helped me latching, positions and even supplied cream and silicone shields.”
Heather (UK) gave birth in autumn 2020:
“It was just assumed that I knew [how to breastfeed]. But when I did struggle one nurse helped me.”
Anika (Germany) gave birth in summer 2020:
“Directly after birth they helped latching the first time and then the nurses cared and checked a lot on us. We didn't need a lot of help.”
Anonymous (UK) gave birth in summer 2018:
“I was visited to confirm baby was feeding, which I confirmed. I recall some advice on latch change but I was confident as I had previously breast-fed.”
Anonymous (Canada) gave birth in autumn 2017:
“I received breastfeeding support after delivery. I was able to have several issues diagnosed and for medical reasons we discontinued breastfeeding.”
Jessica (USA) gave birth in summer 2020:
“The nurses were all helpful but there were not breastfeeding experts.”
Anonymous (UK) gave birth in spring 2021:
“Immediately after birth they helped get a good position and latch. Nurses helped when asked. At 1 week post natal check up for baby they asked if I had any problems or concerns with feeding. I mentioned that he falls asleep a lot during feeding so nurse watched me feed him and wasn't concerned but gave me some tips to help, I felt a lot more confident because he watched carefully, checking latch, explaining what to look for etc.”
Would you like to share your experience? Contact me here.
Whilst in hospital, you will be given a health booklet for your baby where the health professionals will record their measurements and vaccinations. Make sure to take this with you whenever you have a medical appointment.
Upon leaving the hospital, you should be informed of what to do in the following days, such as visiting your family doctor and arranging the heel-prick test (to be done within 6 days of birth).
Your baby’s vaccination plan is detailed in their health booklet. For the national health service’s standard vaccination plan, see here. It is good to be aware of this ahead of time so that you can be prepared for a few potentially difficult days after each vaccination your baby gets.
As for the check-ups, this is where the baby is weighed, measured, and their overall state of health is checked. This is what I had on the public system at my health centre:
You must register your child’s birth within 20 days or there is a small fine. You may do this online or in person.
See this link for information about how to do this.
There are rules restricting which names you can give your child in Portugal. You may have noticed, that’s why everyone has the same names here! I have taken to calling my husband’s friends João 1, João 2, João 3… However, you’ll be pleased to know there are exceptions if you hold a foreign passport. See here for information about this (in Portuguese).
You may have some difficulty with the paperwork if you live in a small city or town. When we went to register my child’s birth in the small town where my husband is from, the lady at the civil registry office became very confused by what was written on the front of my passport (United Kingdom of Great Britain and Northern Ireland).
She kept asking, so you’re Irish? And although we kept saying, “no, I’m from England”, she apparently could not find anything matching this country on the system - not England, not Great Britain, not the United Kingdom…! It also confused her wildly that I was born in a different place to where I said my nationality was from (I was born in Australia).
Then she said, “But where are you from?” - not an easy question when you have more than one nationality. It seems these forms are only made for Portuguese citizens who have only ever lived in Portugal. Luckily I did have both of my passports with me to prove that I had two nationalities (again, this seemed unheard of).
So, in the end, my daughter’s certificate says that her mother is Australian, even though I travelled here on my British passport… but, at least she got registered in the end!
Unfortunately based on my own experience and others I have read, the overall consensus is that you are not very well supported in the postpartum period on the public system. I yearned for experiences I heard from friends in the UK where they had a midwife or health visitor come to check on them and their baby at home, and they were supported with breastfeeding to make sure all was going well. Here, in contrast, your postnatal care seems to end once you are discharged from hospital. I personally felt very much left alone during this period. As with the birth, the focus seems to be all about the baby and not on the mother’s wellbeing. Even though we were going to the doctors’ for checks on my baby, there was nothing specifically for me as a new mum.
From my experience, once again it seemed to be a case of “if you don’t ask, you don’t get”. Particularly being a first time mum - because I imagine you’re feeling a bit more confident by the second or third time - I did not know what was normal and what was not. For example, I had to ask for my family doctor to check my stitches were healing well, at my baby’s 1 month check-up. Otherwise, nothing would have happened.
I also happened to receive a message from my old doctor's surgery in the UK letting me know I was due for a routine cervical smear, around 5 months after my baby was born. So I asked the family doctor at my baby's 6 month check, and as it turns out, it's standard here to do a cervical smear 6 months after giving birth if you have not had one done recently. So, once again, I only knew because I asked.
Even though my family doctor had said everything looked fine and that my stitches had healed well, once again, I wasn’t sure what was normal or what was not. She did tell me to continue my pelvic floor exercises and described this as contracting the anal muscles 15-20 times daily, so I did. But I still felt something was not quite right, so I contacted a women’s physiotherapist.
Going to get an assessment with a women’s physio was one of the best things I’ve done for my own physical health since giving birth. I wanted to write a section about this because it is something women are often embarrassed about, but is so important. So I highly recommend it, if you have any uncertainties about your pelvic floor health. Remember that, just like when it comes to breastfeeding for example, family doctors know about general health enquiries and are not specialists.
I found a clinic near to me where I paid just €25 for an assessment, and the physio I saw was very professional, very thorough, and I came out with a really good understanding of what I could do at home and what she would do in terms of treatment. In my case I did actually have some issues which needed resolving so I regretted waiting so long to make the decision to go. I realised that there is a lot more to pelvic floor health than the typical contraction exercises which you see recommended on most online resources (also known as Kegels). So if you have doubts, follow your gut feeling and do see a specialist who can assess you.
You may find this video informative if you would like to learn about the anatomy and physiology of your pelvic floor muscles.
Sadly this is another area which leaves much to be desired. There was no mention to me at all about taking care of my own mental health, and no one enquired as to how I was doing emotionally. Again, “if you don’t ask, you don’t get”... but how are you supposed to know what to ask, when you haven’t been through it before?
I hope to update this section with time when I learn more about the support available during the perinatal period in Portugal. For now, here are some useful links I found from other countries.
I also found this website which has a helpline based in Portugal:
However if you want someone to talk to in English, it may be more practical to speak to a service in the UK which has no time difference with Portugal.
In any case, make sure you know who you can turn to in times of need. A risk factor for postnatal depression is a lack of support. Whether this is physical or emotional support, we are not made to do this alone so it's important for your well-being to ask for help. I personally find it hard to ask for help so this is why I'm giving you this advice from experience!
Other than asking to get my stitches checked at my baby's 1 month check-up, the conversation went as follows:
"Are you still bleeding?"
"No"
"Any pain?"
"No"
"Do you need birth control?"
"No"
And that was it. That was the only time anyone enquired about my own health, and no one ever asked how I was doing emotionally.
Then at my daughter's 2 month check-up, we got told to wait for her vaccinations and that I was not allowed to feed her in the meantime. However she had just woken from a nap and was ready to feed. So more than half an hour passed, and of course my baby was screaming to be fed and I was there with engorged breasts wanting to feed my baby. So I ended up in tears too.
The doctor rushed in, told the nurse to do the vaccinations already, and then they left me to feed my daughter. When the doctor came back, I must have looked a bit rough as she asked what was wrong. I said I had just been upset that I couldn't feed my baby. She then turned to my baby and said "You have a very sensitive mummy!" Well, suffice to say I did not feel particularly supported there. In fact I then felt shamed for having become emotional, which only made me feel worse.
I suspect that, as with the attitudes towards birth here, the lack of awareness I sense around maternal mental health may also be to do with the country’s history under the dictatorship. Apparently people were not allowed to show emotion publicly and if asked how they were, could only respond with “I’m fine”.
Would you like to share your experience? Contact me here.
Of course the world of the internet is open to you, so I’m not going to list all possible websites you can buy from around the world. But if you do not want to pay much postage or import fees, or you would rather physically go shopping for your clothes/baby’s clothes, then here is a list of websites/shops in Portugal which you may find useful.
If you want to hear tips or recommended products directly from other mums who have been through the pregnancy and birth journey, come and join our Facebook community.
I have found that the sizes of baby clothes vary immensely, particularly from country to country, but sometimes even from shop to shop.
Any clothes that we were gifted from local independent shops here in Portugal, or the local markets which pop up on weekends, have come up incredibly small. For instance my little girl (who has always been 50th percentile according to growth charts) was wearing 6 month clothes at 3 months, and even 12 month clothes at 6 months… you get the idea.
The big supermarket chains also sell baby clothes and items, including nappies of course:
The major supermarkets also deliver groceries, which you may wish to do in those early weeks (or even later on - we still do sometimes!). We made the mistake of going food shopping during our little girl’s colicky phase as we hadn’t thought of online shopping… that was a big, stressful mistake! We have had great service using Auchan and delivery is only about 5€ but I can’t comment personally on the others but they do have this service too.
Amazon
Amazon does not exist in Portugal itself, however you can order from Amazon Spain and get free delivery on many items, or from other European countries such as France or Germany. You could also order from Amazon UK but unfortunately since Brexit, you now have to pay import fees.
Well’s (part of the Continente brand)
For second-hand items, check out www.olx.pt or Facebook marketplace.
There is a wide variety of resources out there, both for prenatal information and for postpartum support.
When it comes to your birth, you can use the information on this website as a basis, and then choose from the following resources for more detailed information.
Many will tell you similar things, so no need to go all-out and buy/look at all of them! I’ve given a variety so you can choose according to your preference: reading websites, reading books, or watching videos.
There are also plenty of really helpful support groups and professional pages on Facebook.
If you answered “yes” to any of these questions, I would love to hear from you!
Get in touch: pregnantinportugal@gmail.com
Would you like to connect with other women who are planning a baby, pregnant, or have given birth in Portugal? Come and join our Facebook community to ask any questions you may have, reach out to others in your area, or just have a rant about your experiences!