Home birth · Episode 5

Home birth in Portugal: what a midwife wants you to know

Midwife Raquel Cajão on home birth in Portugal: who attends it, what a safe birth really means, when to go to hospital and how to protect your labour.

Born to be Wild · 2026-09-28

Listen to the episode

Raquel Cajão has been attending home births in the Lisbon area for more than 11 years. On episode 5 of the Born to be Wild podcast, she sat down with Aviva Markowicz and Irene Jaspers (whose own home birth Raquel attended) to talk about physiological birth, safety, and why "doing nothing" is one of the hardest skills a midwife can learn.

Here is what she wants every expecting parent in Portugal to know, whether you are planning a home birth or a hospital birth.

Who attends home births in Portugal?

In Portugal, midwives first qualify as nurses and then specialise in maternal and obstetric health (enfermeira especialista em saúde materna e obstétrica, or EESMO). It is a long training path, and it produces highly skilled professionals, whose competencies are defined in law (Regulamento n.º 391/2019).

Raquel took that path and then went further: she trained alongside midwives in Brazil, including traditional midwives whose knowledge is passed down through generations. What struck her most was that many practices now "confirmed by evidence", like free movement and free positioning during labour, were things these midwives had always known.

Only a small number of midwives in Portugal work independently on home births. Raquel is one of them, and you can find her profile in our directory.

"Doing nothing" is a skill, not an absence of care

When people imagine a home birth midwife, they sometimes picture someone passive. Raquel describes the opposite: sitting quietly in a corner for hours, listening and observing, is active work.

"We have to know when is really the moment to intervene, so we can do nothing, even if the nothing is a lot."

She points to what research suggests: one intervention can lead to another, sometimes called a cascade of interventions. For example, continuous electronic monitoring (CTG) in labour is linked to more caesareans and instrumental births (Cochrane, 2017), and epidurals to more instrumental births (Cochrane, 2018). Restraint, when birth is unfolding normally, is a form of care in itself.

Interventions aren't only medical: words matter too

For Raquel, an intervention isn't just an epidural, synthetic oxytocin, forceps or a cesarean. A word can be an intervention.

Her example: during an ultrasound, a professional remarks casually, "What a big head!" Nothing is wrong, but the parent walks out wondering whether the baby will fit through. That single comment can shape how they live the rest of their pregnancy, their labour and even the postpartum period.

What does "safe birth" really mean?

Many people assume that more monitoring and more intervention automatically make birth safer. Raquel challenges this: safety is often confused with control, and constant disruption can interfere with physiological labour.

True safety, in her view, also includes:

emotional safety: feeling calm, respected and unobserved,
autonomy: making your own informed choices,
continuity of care: being supported by someone you know and trust, from pregnancy to birth. Midwife-led continuity of care is associated with fewer interventions, such as epidurals, episiotomies and instrumental births (Cochrane, 2016).

How a midwife knows when to step in

Raquel watches three things: rhythm, focus and inwardness. In physiological labour, women often become less verbal and more instinctive, and their breathing, sounds and movements organise themselves. When something disrupts that "dance", it calls for her attention.

She also listens to pain. A sudden, very different kind of pain in the pushing phase can tell her something about the baby's position or the cervix. The same goes for a change in the baby's heartbeat at an unexpected moment. Then she makes a suggestion, like changing position, to guide things back towards health.

She is clear about the limits: physiology is one thing, pathology is another. If a condition like pre-eclampsia develops, that is the moment to act, and not to wait.

What can slow labour down, at home or in hospital

Labour is hormonal and deeply sensitive to its environment. According to Raquel, the most common disruptors are:

noise,
bright lights,
people coming in and out, especially strangers,
anything that puts the mind on alert.

According to Raquel, fear makes the body tense, which can make labour longer and more painful, and stops the endorphins from doing their job.

Her practical tip for hospital births: pack a pair of noise-cancelling headphones. You can listen to your own music or simply block out the noise around you. Many hospitals also accept a birth plan where you can ask for dim lights, music and privacy.

When should you go to the hospital?

Raquel sees many first-time mothers admitted to hospital very early in labour, sometimes at 2 or 3 cm of dilation. That early admission can, in itself, steer labour towards more interventions.

The World Health Organization defines the active phase of labour as starting at around 5 cm (WHO, 2018), and the UK's NICE guideline uses 4 cm (NICE, 2023). Either way, that's well beyond the 2 or 3 cm at which Raquel sees many women admitted. Every woman and every labour is different, so talk to your midwife or doctor about when to leave home. But know that staying in a calm, familiar place for the early phase is often a good idea.

Real autonomy: yes, no, or "not now"

For Raquel, autonomy means real choice, informed consent, and the freedom to say yes, no or "not now" without pressure. It also means respecting choices a professional wouldn't make herself.

Irene shared a moment from her own birth: exhausted, she started pushing before her body was ready. Raquel gently suggested waiting for the pushing reflex, while making clear it was still Irene's choice. Birth works best as a collaboration, not as surrender to a professional.

And her answer to what makes a truly respectful birth? "Listening, acceptance and respect."

Home birth or hospital birth?

Raquel refuses the "home good, hospital bad" framing. She has heard wonderful hospital birth stories, and she knows home births can bring difficult moments too. What matters is that women give birth where they feel safe, and that professionals have the conditions to respect the physiology of a normal birth, wherever it happens.

Frequently asked questions

Is home birth legal in Portugal? Yes. No law prohibits it, and attending a normal birth is part of the legally defined competencies of specialist midwives (EESMO) (Regulamento n.º 391/2019), who attend home births as independent midwives.

Who can attend a home birth in Portugal? A specialist midwife. Many families also choose to be accompanied by a doula for emotional and practical support. Doulas don't provide medical care.

Is home birth safe? It depends on your situation. In a large English study of healthy women with low-risk pregnancies, planned home births led to fewer interventions. For women who had already given birth, outcomes for babies were similar to a hospital birth. For first-time mothers, there was a small increase in risk for the baby, and around 45% were transferred to hospital during labour (Birthplace in England, 2011; NICE, 2023). Discuss your personal situation with a health professional.

Can I have a physiological birth in a hospital? Often, yes. A birth plan, a calm environment, staying at home during early labour and continuous support can all help.

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 5 of Born to be Wild, the podcast: The art of doing nothing at birth, with Raquel Cajão. Listen on Spotify.

Looking for a midwife? Browse the midwives in our directory, with reviews shared by other parents.