Premature birth · Episode 9

Three premature births, three different stories: from trauma to empowerment

Midwife Sara Arruda had three premature babies in the Azores. How she went from a traumatic first birth to the birth she visualised, and why self-care matters.

Born to be Wild · 2026-09-28

Listen to the episode

Sara Arruda is a nurse, a midwife and a health coach in the Azores. She is also the mother of three boys, aged 17, 6 and 4, all three born prematurely, in three completely different ways.

On episode 9 of the Born to be Wild podcast, she told Aviva Markowicz and Irene Jaspers how she went from a birth she wasn't "present" for to the birth she had visualised every day, and why she now sees self-care as a radical act.

First birth: a helicopter and a baby in neonatal care

Sara was 23, just out of nursing school, when she became pregnant. The pregnancy was normal until, at around 26 weeks, contractions started during a weekend on Santa Maria, an island with no maternity unit and no neonatal care. She was evacuated by helicopter to the hospital on São Miguel.

Her son was born by caesarean under general anaesthesia. The last thing she heard before surgery was a neonatologist saying he didn't know if the baby would survive. Afterwards, she kept her eyes closed for four hours, too afraid to ask.

"I didn't want to open my eyes, because I didn't want to know if he was alive or not."

Then came three to four months in neonatal care: expressing milk, going home each evening praying "keep him safe until tomorrow", while her husband worked on another island. When they finally took their son home, she dressed him in doll's clothes, because there were no premature baby clothes then.

No cause was ever found. That uncertainty is what made her wait 12 years before trying again.

Second birth: a vaginal birth, but not on her terms

During those years, Sara trained as a midwife and built her own tools: meditation, breathing, mindfulness, hypnobirthing. The fear was still there throughout the pregnancy. She took it one day at a time.

At 36 weeks and 5 days, she saw heavy bleeding and rushed to the hospital where she worked. The baby was fine. Overjoyed not to have a very premature baby, she "just did what everyone told her": an epidural at 6 cm, then a forceps birth with an episiotomy, without explanation beyond "you were bleeding".

It was a vaginal birth, which she had wanted. But she wished for less intervention and more dialogue, even with a doctor she knew and trusted. That became her lesson for the third birth.

Her postpartum, on the other hand, was the one she'd missed the first time: little sleep, constant breastfeeding, and deep happiness. She went on to breastfeed for four years in a row, two with her second son and two with her third.

Third birth: exactly as she visualised it

Feeling empowered, Sara sat down with pen and paper and wrote what she wanted for this birth. She visualised it in meditation every day.

She would have liked a home birth, with two midwives she trusted and the hospital ten minutes away. Her husband, marked by two premature births, didn't feel safe with it. They compromised: labouring at home, then going to hospital for the birth itself.

Contractions woke her at 3 a.m. She laboured at home until 5:30, arrived at the hospital around 5:45, and her son was born at 6, at 36 weeks and 6 days, healthy.

"Everything was as I planned, as I imagined, as I visualised."

Is home birth legal in Portugal? Yes. As Irene explains in the episode, no law prohibits it, although no specific law regulates it either. Attending a normal birth is part of the legal competencies of specialist midwives (Regulamento n.º 391/2019).

The hardest postpartum

The third postpartum was the hardest: a newborn, a toddler, and a second son diagnosed with autism. Sara learned that love multiplies with each child, but attention has to be divided, and that's hard.

The "postpartum of the postpartum"

Textbooks say postpartum ends at six weeks. Sara knows it doesn't. Around three months, when the baby is doing well and everyone expects you to get back to normal, many women realise the woman they were no longer exists.

"In Portugal we say that when a baby is born, a mother is born. I think a new woman is born."

That's why Sara includes a postpartum module in her birth preparation classes, and why she follows women long after birth as a health coach.

Self-care isn't a spa day

After being diagnosed with ulcerative colitis at 22, Sara learned to take care of her health. She wrote a book about it, Cuida-te ("Take care of yourself").

For her, self-care isn't a massage or two hours of free time. It's one small thing for your health, every day: two litres of water, a walk, a breathing exercise, a long bath.

"Taking care of yourself is not a luxury. The luxury is your health."

Her message to new mothers

"This will pass, and it will pass very fast. It's hard, try to enjoy some of it. It's normal not to feel like the same person. I got you, and you got this."

Looking for a midwife to prepare your birth and postpartum? Browse the midwives in our directory.

Frequently asked questions

Can I have a vaginal birth after a premature caesarean? Often, yes. Sara had two vaginal births after her first caesarean. Whether it's an option depends on the type of incision and your medical history (RCOG, 2015), so discuss it with your care team.

What happens when a baby is born very premature in the Azores? Pregnant women on islands without a maternity unit are transferred, sometimes by air, to a hospital with neonatal care, such as the one on São Miguel.

How can I prepare for postpartum? Talk about it during pregnancy, plan practical support, and identify people who will be there without you having to ask.

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 9 of Born to be Wild, the podcast: Three premature births. One radical transformation, with Sara Arruda. Listen on Spotify.

Read also: Giving birth in the Azores: Irene's home birth story.