Doulas & midwives · Episode 6

The role of a midwife in Portugal: from birth trauma to home birth

Midwife Filipa Piedade turned a traumatic birth into a mission. What midwives can do in Portugal, why birth plans help, and the reality of hospital work.

Born to be Wild · 2026-09-28

Listen to the episode

Filipa Piedade is a nurse midwife who attends home births as an independent midwife. Ten years ago, she was a nurse with a master's in palliative care, working in a Lisbon intensive care unit, when the birth of her daughter Luz ("light") changed everything.

On episode 6 of the Born to be Wild podcast, she told Aviva Markowicz and Irene Jaspers how that difficult birth led her to midwifery, why she left the hospital delivery room, and what every woman in Portugal should know about what a midwife can do.

See Filipa Piedade's profile in our directory.

From palliative care to birth

Filipa draws a direct line between the end of life and the beginning of life. People used to die at home, surrounded by loved ones, and people used to be born at home. Both death and birth became medicalised. Palliative care taught her to look beyond the medical: at people's wishes, their needs, and the space and silence they deserve.

A traumatic first birth, even as a nurse

Despite being a nurse, Filipa had no idea she could ask for a midwife during pregnancy. She followed "the traditional Portuguese path", with an obstetrician.

She laboured well at home in her bath until her husband, worried about the noise in their apartment, suggested going to hospital. She was 4 cm dilated.
She was immediately offered an epidural, and after that labour stalled.
Synthetic oxytocin was started and stopped several times because her baby didn't tolerate it well. She was scolded every time she got out of bed.
It ended in an emergency caesarean. Her husband wasn't allowed in, and her daughter was dressed before being shown to her for a few seconds, then taken to her father. No skin-to-skin.

"The birth was not something I was doing. It was something that happened to me."

Afterwards came isolation, no family nearby, and difficulty bonding, along with the guilt many mothers feel and rarely say out loud.

Birth is loud

One lesson Filipa now shares with every partner: birth is loud, and that's normal. She now knows she could have stayed home longer. What she needed was someone to be with her, not a push to leave.

Why a birth plan is a midwife's ally

When Filipa later worked as a midwife at Cascais hospital, birth plans were her best tool. Hospital protocols push "active management of labour", including augmentation with synthetic oxytocin, which she disagrees with when labour is progressing normally.

"If your birth plan says you don't want augmentation of labour, great, we're on the same path! You are my priority, not the protocols."

According to Filipa, in public hospitals low-risk births are largely attended by midwives, and many of them share her vision. Your written birth plan gives them room to follow it.

What midwives can legally do in Portugal

In Portugal, midwives are nurses first, then specialise in maternal and obstetric health. Their competencies are defined by the Ordem dos Enfermeiros (Regulamento n.º 391/2019), in line with the European directive on midwives (Directive 2005/36/EC, art. 42). As Filipa explains, they are broad:

Following a low-risk pregnancy from start to finish, without needing to see a doctor.
Attending a physiological birth, at home or in hospital.
Postpartum care, with several visits.

What's missing, according to Filipa, is the ability to prescribe in practice: even though the regulation includes prescribing some exams, the system still requires a doctor to sign off on scans and blood tests. And independent midwifery care isn't covered by the SNS, and usually not by insurance, which only covers "medical acts". Filipa sends invoices anyway, so insurers keep receiving them.

Another Portuguese specificity, according to Filipa: there are no birth centres. As Filipa puts it, Portugal went straight from traditional village birth attendants to hospital births for everyone, without a middle ground.

The hidden burnout of hospital midwives

Filipa describes a reality rarely discussed:

Guidelines recommend one-to-one midwifery care in established labour (NICE, 2023). In her experience, it was often one midwife for four women.
Hourly paperwork for every woman, no time to eat or go to the toilet, coming home after midnight too overstimulated to sleep.
Constant interruptions breaking the "oxytocin bubble" she was trying to protect.

After a final incident of disrespect between colleagues, she left the delivery room. She now works as a home birth midwife with a former hospital colleague, Sandra Pedro, and supports women through pregnancy and postpartum.

"The more physiological births I attended, the more I believed what we were doing in the hospital was wrong."

Her message to every woman

"The place to give birth is the place where the woman feels safe."

That can be home or hospital. With a low-risk pregnancy, you can choose midwifery-led care throughout, an obstetrician and a midwife together, or an obstetrician only. Ask yourself, and ask your providers: what makes me feel safe and respected?

Looking for a midwife? Browse the midwives in our directory.

Frequently asked questions

Can a midwife follow my whole pregnancy in Portugal? Yes, for a low-risk pregnancy: it's part of specialist midwives' legal competencies (Regulamento n.º 391/2019). In practice, Filipa explains, scans and blood tests still need a doctor's prescription.

Can my partner be with me during a caesarean in Portugal? Yes. The law gives you the right to be accompanied during all stages of labour, including forceps, vacuum and caesarean births (Lei n.º 15/2014, art. 16). Hospitals sometimes invoke clinical reasons to refuse, as happened to Filipa, so discuss it in advance and write it in your birth plan.

Is independent midwife care covered by the SNS or insurance? Generally not. It is private care, and most insurers only reimburse care given by a doctor.

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 6 of Born to be Wild, the podcast: "I didn't want you to feel alone anymore", with Filipa Piedade. Listen on Spotify.