Part One

Lately I have been getting a lot of questions from different people about being pregnant and giving birth in Portugal, more specifically in the Cascais area.

I decided a little field guide would be most helpful to answer all of these questions.

So I am writing a two part blog post about it. This first part will focus on the differences between being followed in the public and private system, how each appointment will look like, tests and labs you will be required to get throughout each trimester.

The second part will focus on the birthing experience, what to expect, who can accompany you through the birth all this in the public and private setting so you can make your decisions based on sound information.

A little background from me: I’m a nurse, worked in the Portuguese system, did an internship at Cascais Hospital both in the ward and also labor&delivery while a 4th year nursing student and gave birth to both my boys at the Cascais Hospital. Two completely different experiences being that with my first I was followed privately, only gave birth at the public hospital and my second went all public system. Also basing these posts on my close friends’ experiences with giving birth in the private system so your decision can have both sides in the most impartial way.

So let’s start!

One of the questions I get a lot is:

Should I be followed in the Private or Public System?

If you have insurance private is always a good option because of availability. It’s much easier to schedule an appointment, waiting time on said appointment is usually shorter (even though lately I have heard from different women that this highly depends on the doctor, my sister has waited for over an hour to be seen at CUF Cascais by her doctor). So keep that in mind. In Private Care you usually will see your doctor every 4 weeks and most likely get an ultrasound or hear baby’s heartbeat in EVERY appointment, this also depends on the doctor who follows you. The decision to deliver if you go with private care is still yours, you can choose to be followed through the private system and deliver at a public hospital, a lot of doctors who work in the private system also work in public hospitals.

If you choose to be followed through the public healthcare system you will have to go to the Centro de Saúde (health clinic) of your residence area. If you already have a family doctor and family nurse it will be fairly easy, your family doctor will follow you throughout your pregnancy, request all the necessary tests and ultrasounds (usually 3, one per trimester) and then forward all your information to the hospital so your last appointments will be at the place where you will be giving birth.

If you DON’T have a family practitioner you will be followed by the available doctor so you might see different doctors and nurses throughout your pregnancy, this can cause anxiety to some ladies so I would take this into consideration when making a decision.

The only cons per say I see with the public healthcare system are availability, sometimes it can feel a little rushed (depends again on the doctor) and you are followed by a family practitioner instead of an OBGYN.

The public system always depends on the people who work there and lately there have been many strikes which influence your appointments, also the language barrier: not everyone will speak English, even though Cascais is a very international area it’s still hard to find public places where people will speak understandable English. The good news are that you can take an interpreter in for these appointments to help you navigate your questions and ease anxiety. Overall though, by my experience it is not a terrible one in the public system, I consider I had great healthcare and didn’t have to pay anything from my pocket from appointments, to testing, to giving birth and hospital stay which was great. As a legal resident in this country public healthcare is free. It’s not perfect, waiting times are longer, but the care is impeccable.

What happens in my appointments???

A normal appointment be it in the public system or private will for sure resemble each other. You will get your booklet on your very first appointment which should be at around 8 weeks pregnant, you will also get a request for some lab tests and an ultrasound to check for pregnancy viability ( this ultrasound if you choose private will be done during this appointment, whereas if you choose public you will have to take the request and get the ultrasound somewhere else, Centros de Saúde do not perform ultrasounds in situ)

At every appointment the nurse will check:

• Weight
• Blood Pressure
• Blood sugar if you have gestational diabetes
• Swelling
• Check for baby’s heartbeat after 12 weeks
• Babies movement
• Ask if you’ve had any blood loss
• Check on your concerns and answer your questions

What Tests will I have to get done?

Mainly blood and urine to make sure everything is ok with you.

First trimester  your blood type will be screened especially if you’re not sure on which type you are because if you are Rh- and baby Rh+  it creates and incompatibility and baby could be in danger, this can be treated though, with a shot at around 28 weeks gestation.

You will also get tested to see if you’re immune to certain conditions like toxoplasmosis, cytomegalovirus, rubella and chicken pox and sexually transmitted diseases. This blood work will be repeated every trimester along with an ultrasound and at the very end you will also get the vaginal/anal swab for group B streptococcus. TIP: If you don’t like people all up in your business when you are in your third trimester I sure didn’t, there’s at least one place in Cascais where you get labs done where they will give you the swab and explain the procedure and you can do it yourself. Contact me for place 😉

Between 24-28 weeks you will also get your pregnancy glicose test to rule our gestational diabetes. For this test you must be on a 8hr fast, blood will be drawn first thing, after you will drink between 75g-100g of a sugary drink and an hour later blood will be drawn again, after that you will wait one more hour for your last blood draw. The results will let your doctor know if you’re suffering from gestational diabetes or not.

If you are over 35 or considered high risk or have a history of certain family diseases you will be highly encouraged to get an amniocentesis. This is an optional test and pros and cons will be discussed between patient and physician.

Also in terms of ultrasounds in the public system you will get three:

• 11-14 weeks Down syndrome screening, doctor will measure nuchal translucency and order a blood test to check hCG and/or PAPP-A (pregnancy-associated plasma protein A). The results take between 2-3 weeks and you will get a call from the hospital or clinic to go pick up results to show your doctor on your next appointment.
• 18-24 weeks you will get your morphologic ultrasound doctor will check baby’s growth, correct position of the placenta, gestational age and baby’s gender.This ultrasound is also one where physical birth defects can be seen. The accuracy of this ultrasound depends a lot on the timing you get it done ( better if it gets done between 21-23 weeks), the type o anomaly, maternal conditions such as obesity, low amniotic fluid or the opposite and baby’s position.
• – Some doctors request one last ultrasound in your third trimester anywhere between 32-34 weeks, this last ultrasound serves the purpose of seeing baby’s position and measuring level of amniotic fluid.

At around 25-38 weeks all your paperwork will be forwarded from your family practitioner if in the public system to the hospital so your last appointments will be done at the public Hospital. This way you will get familiar with the hospital, the nursing staff and the different doctors.

If you opt for private care but to give birth in the public hospital two possible outcomes could happen:

• You will continue to be monitored by your doctor at the private clinic/hospital until you go into labor, once you go into labor you go to the hospital and get admitted or,
• If your doctor also works in the public hospital you will be asked to come meet him/her at the hospital do all the paperwork and be monitored the last 2-3 weeks prior to labor at the hospital. Like this you get to meet the nursing staff, the place, get a feel of the environment and lessen anxiety especially if you’re a first time mom, or have recently moved here. ( This is what happened to me with my first son, my doctor worked both hospitals, that was one of the major reasons I chose her to be my doctor).

If you opt for the private system none of this will apply because usually the place you are followed throughout your pregnancy will be near the place you will give birth. Options for private hospitals to give birth are usually in the Lisbon area so keep in mind depending on what time you actually go into labor traffic can be a problem.

On my next post I will be talking about the differences while giving birth in the private system and the public system. Most of the differences will be in this area as protocols and rules are very different between the two systems. Portugal does not have birthing Centres, hospitals all have maternity wards and the great Lisbon area has the Maternity Alfredo the Costa (first maternity in Lisbon, many good doctors, public, with very specific conditions), we will discuss the different public hospitals on my next post.

Hope this was helpful and please if you have any questions feel free to Email me, you can also follow my page on Instagram or on  Facebook