Birth in Portugal · Episode 2

Giving birth in Portugal: what they don't tell you

Doula and activist Sara do Vale explains how maternity care works in Portugal, public vs private, your rights, and what to do when things go wrong.

Born to be Wild · 2026-09-28

Listen to the episode

Sara do Vale has three children, born in the Portuguese system over 14 years. She trained as a doula in 2014, and a few months later co-founded the Portuguese Birthrights Association (Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto) with two other mothers, after hearing again and again that "this is Portugal, nothing ever changes".

On episode 2 of the Born to be Wild podcast, she told Aviva Markowicz (whose doula she was) and Irene Jaspers what every expecting parent should know about giving birth in Portugal.

See Sara do Vale's profile in our directory.

How maternity care works in Portugal

Sara describes the system as conservative and hierarchical, still largely built on the idea that "the doctor knows best". A few key points:

Midwives have less autonomy than they should in the public health service (SNS), even though more midwifery care would ease the chronic staff shortages.
Continuity of care is rare in the public system. Being followed by the same midwife or small team is associated with fewer interventions and fewer preterm births (Cochrane, 2016). To get it, families usually go private, either to a private hospital with their own obstetrician or to an independent midwife for a home birth.
According to Sara, the north offers more options, with more midwifery-led projects and practice closer to the evidence. The further south you go, the fewer options there are.

Calling before you go: the Lisbon reality

In Greater Lisbon, labouring women are asked to call the SNS 24 line (SNS 24) before going to hospital, to be told which maternity unit is open. Emergency departments close when there aren't enough obstetricians on duty. It started in summer, then Christmas, then became routine.

"Can you imagine having contractions, opening an app and finding out tonight which hospital is open? It's against physiology and all we know about what women need."

Her advice: know this in advance, keep a plan B, and don't let it add fear to your pregnancy.

Public or private hospital?

Many families who can afford it choose private care. Sara understands why: your own obstetrician, and a private room where your partner can stay after the birth. In public hospitals you labour and give birth in an individual room, but postpartum rooms are usually shared.

But she warns that private maternity care is also a business: obstetricians are paid per birth, so booking an induction or a C-section is easier for everyone's schedule. According to the figures she cites, Portugal's C-section rate is around 30% in public hospitals and 67% in private ones. For comparison, a rate of 10–15% has long been considered the reference, and the World Health Organization notes that above about 10%, higher caesarean rates are not linked to lower maternal and newborn mortality at population level (WHO, 2015).

You can also mix and match: a private obstetrician during pregnancy and a public hospital birth, or an independent midwife alongside a hospital birth.

Your rights: the law is on your side

This may surprise you: Portugal has very progressive laws. Since 2019, the law states that health services must follow the World Health Organization's recommendations for a positive childbirth experience. It guarantees the right to a birth plan, to informed consent and to informed refusal, and says the birth plan should be discussed, preferably by 32 weeks of pregnancy (Lei n.º 110/2019; Lei n.º 15/2014, consolidated).

What's missing, according to Sara, is application and training. In her experience, many professionals fear birth plans because they believe they carry more legal responsibility than they do. In reality, a written birth plan documents your informed choices.

"The law is above hospital procedure."

Induction and the 40-week pressure

In both public and private care, the pressure to induce often starts right after 40 weeks. Sara, who had her second baby at 42 and a half weeks, reminds us that waiting is possible, especially in the SNS:

After 40 weeks, appointments often stop being scheduled. Many women then go to the hospital's emergency service simply to check that all is well (CTG, amniotic fluid).
Ask for the full picture, on both sides. Waiting beyond 41 weeks is associated with a small increase in risk for the baby, and research doesn't show that inducing at term increases caesareans: a Cochrane review even found slightly fewer (Cochrane, 2020; NICE, 2021). On the other hand, an induction can mean more intense contractions, more monitoring, and time in hospital before labour starts. You should be given this information to decide.
Some women will choose to be induced, and that's valid too. What matters is an informed choice.

Finding good information

The internet doesn't sort information for you. Sara recommends reliable sources such as Cochrane reviews, and a support team that helps you find answers without deciding for you, for example a doula. And listen to your intuition: if you leave every appointment feeling uneasy, it's never too late to change obstetrician.

Looking for a doula? Browse the doulas in our directory, recommended by other parents.

After a bad experience: what you can do

If you felt pressured, lied to, or treated without your consent, you have options:

According to Sara, a formal complaint within six months carries the most legal weight. After that, other routes remain possible.
You can complain to the hospital, to the professional orders (doctors, nurses and midwives) if you know the person's name, and to the Health Regulatory Authority (ERS).
The Portuguese Birthrights Association can help you with these steps.

Sara insists on care: telling your story again can be retraumatising. Do it only if and when it helps you.

Debriefing your birth story

At the end of her support, Sara always holds a debrief session with the couple: putting the pieces of the story together, celebrating what went well, grieving what didn't.

"Whatever she feels it is, it is. Believe women."

Research on birth trauma points the same way: many women link their trauma to how care providers acted and communicated with them (Reed et al., 2017).

A difficult birth isn't necessarily one that went off-plan. It's one where the woman lost control and things were done to her without her understanding or consent. Many women say: "Nothing went as planned, but I was part of every decision."

Frequently asked questions

Do I need to call before going to hospital in labour in Portugal? In Greater Lisbon, you are generally asked to call the SNS 24 line to find out which maternity unit is open. Check the current rules for your region before your due date.

Can I refuse an induction at 41 weeks in Portugal? Yes. Consent is required for any intervention, and the law guarantees informed refusal (Lei n.º 15/2014). Guidelines recommend discussing induction from 41 weeks and offering extra monitoring if you choose to wait (NICE, 2021). Ask for the full information on both options, and decide what feels right for you.

Where can I complain about my birth experience in Portugal? To the hospital, the professional orders, and the Health Regulatory Authority (ERS). According to Sara, complaints are most effective within six months.

Sources

What our guests share comes from their own experience and practice. The medical and legal information in this article is based on the sources below. It doesn't replace advice from your care team.

Listen to the full episode

This article is based on episode 2 of Born to be Wild, the podcast: What they (don't) tell you about birth in Portugal, with Sara do Vale. Listen on Spotify.