Mary Zwart offers a brief overview of maternity services available to Portuguese women
This is a first impression of maternity care in Portugal so not all the data is collected yet. Portugal has 10 million inhabitants and city life very much differs from life in the countryside.
The infrastructure provides a Centre da Saude, a health centre, within easy reach of most of the population but these only offer services during the day time. This service has doctors and nurses but no midwives. In all other cases you have to go to a hospital which can be more than two hours away.
Although there are 1850 midwives registered, only 10 in the whole of the country offer care outside hospital. There is no reimbursement for midwifery care in the public health care system, services are paid for privately. Maternity homes are closed down and the care is very centralised.
As a pregnant woman you go to the Centre da Saude until 37 weeks and then you have to be seen in the hospital: this can take you as much as six hours to have a 10 minute check up. There is a great over use of medicine and ultrasound; care is not by informed choice and informed consent.
Episiotomy and induction of labour are standard, the caesarean section rate is on the rise and women who want to have a home bir th are said to be irresponsible. There is a consumer organisation Hum Par but at the moment it is not very active. Doctors 'rule the waves'and the 'midwives' are 'medwives'.
Antenatal classes hardly exist: this year there will be a course for doulas to give more information to women. At the moment there are around 20 doulas in Portugal. Post-partum care consists of a stay in hospital until three days post-partum and if you need help afterwards you have to go to the Centre da Saude, for check-ups and screening such as the Guthrie test.
Doctors are now creating new birth environments, with, for example, a birth pool in the hospital, but the staff do not have a clue how to work with it. It is window dressing to get more women into this specific hospital for economic reasons.
Last year we made a repor t which was shown on national television about the recent situation and we intend to organise a Film Festival in May about women and birth which will be held in the university city of Coimbra.
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