Shortly after Shona moved to Portugal, she found out that she was pregnant. While obviously excited, she was also unsure how to navigate being pregnant in a country where she didn’t really know the language or culture. Her experience later inspired her to create Positively Pregnant in Portugal, a resource for expectant mothers also living in Portugal.
James: Can you tell us a bit about yourself and what inspired you to create this website?
Shona: Hi James! I’m Shona, a British mum living in Aveiro with my Portuguese husband and two children who are 3 years and 1 year old. We moved to Portugal at the end of 2019, and shortly after, I found out I was pregnant.
I was excited, but also anxious about navigating pregnancy in a new country, especially with limited Portuguese language skills plus a global pandemic. I felt lost and overwhelmed, and many other mums I spoke to felt the same. This inspired me to create a resource for others, so they wouldn’t feel as alone and unprepared as I did.
James: The healthcare system in Portugal has public and private options. Can you elaborate on the pros and cons of each for expecting mothers?
Shona: Absolutely. Public healthcare is subsidised, with small fees for appointments and medication. However, prenatal care and childbirth services are completely free for women registered in the public system. The quality can vary depending on location, and waiting times can be long, but I personally had a positive experience with the public system.
Private care offers shorter waiting times and more personalised attention, but at a significant cost. Ultimately, the choice depends on personal preferences and financial considerations.
When it comes to giving birth, private hospitals tend to offer more privacy during labour and postpartum, and your birth partner can often stay with you throughout your stay there. However, the C-section rate is higher in private hospitals.
Additionally, in certain emergency situations, they may not be as well equipped as public hospitals. Public hospitals, on the other hand, tend to have lower intervention rates but you may be in a shared room during early labour and/or postpartum, and birth partners may be limited to hospital visiting hours.
But despite these generalisations, every individual hospital is different so it is really worth looking into the options in your specific area.
James: You chose to use the public system, whereas I notice a lot of people in your Facebook group choose to go private. Did you make the same choice for your second child?
Shona: Yes, I did. I have a couple of reasons for this: firstly, my husband is Portuguese and grew up using the public healthcare system. We are registered with the family doctor he’s always been to, and he’s always had a positive experience of the public system.
Secondly, I come from the UK, where I am used to how a government-funded national health service works. So let’s say, my standards were perhaps lower than people from other countries where privatised healthcare is the norm.
I find that very often, the women I speak to who jump straight to accessing private healthcare in Portugal may associate public healthcare with poorer quality. But I have come to understand that the difference between public and private healthcare in Portugal is more nuanced: it is not a simple case of saying one is “better” or “worse”, but there are pros and cons to each, depending on the situation.
James: You’ve recently had your second child in Portugal. What did you do differently this time around?
Shona: I asked more questions! But I had the advantage of being more fluent in Portuguese, and of course being much more familiar with the process. So I made sure I asked things like when exactly certain blood tests were expected to be done, or what appointments I had coming up and why. Due to all my research in the meantime, I was also much more aware of my rights and choices, so I felt much more confident in taking control of my care.
I researched my options for giving birth once again, and actually ended up going to a different public hospital this time. The birth went smoothly and I also had a much more positive and comfortable experience on the postpartum ward this time. This was because the hospital offered private rooms, my husband could stay with me as many nights as necessary, and any neonatal care was done in our room rather than on a separate neonatal ward.
This time I also felt confident pushing back against any mention of formula from the professionals, as I was more educated about the breastfeeding process and more sure of my ability to breastfeed.
James: You mentioned that you didn’t speak Portuguese when you gave birth to your first child. What advice would you give to women in a similar position?
Shona: Well I personally had the big advantage of having a Portuguese husband, so that helped in many situations! But due to the pandemic, he was also not allowed to attend many of my appointments with me.
During prenatal appointments, if I lacked vocabulary I often managed by using gestures or quickly using Google Translate if needed. But learning some key phrases will help, such as being able to express if something hurts or other common physical symptoms. If you have questions – which we often do! – I would advise translating them before your appointments, as it’s often hard to translate in the moment and you might need specific vocabulary.
If you’re not able to understand the responses, you can always ask to record them so that you can listen later with a native speaker. Definitely get your birth plan translated as well, and bring a copy each for yourself, your birth partner and the medical team.
If you don’t have any Portuguese connections, you may also wish to hire an English-speaking doula to support you through the process.
James: You mentioned that Portugal has a history of high intervention rates in childbirth. What are some common interventions expecting mothers might encounter and what advice would you give them?
Shona: Unfortunately, Portugal has one of the highest intervention rates in Europe. Common interventions include episiotomies, inductions, and C-sections.
It’s crucial for mothers to be informed about these procedures, their risks and benefits, and to have a birth plan outlining their preferences which is discussed with the medical team beforehand. All women and their birth partners should also be aware of their right to informed consent and refusal.
James: What about non-hospital births, such as home births and water births. Is that an option in Portugal?
Shona: In Portugal, anything that goes against the medical norm, like water births, is often seen as risky or even dangerous. While water births are becoming more common in other Western countries and are associated with a more relaxed birth experience, they’re still not allowed here.
You can labour in water (though to my knowledge, there is only one hospital with a birthing pool), but you have to get out to actually give birth. To have the full experience of a water birth, you would have to plan a home birth and cover all the costs yourself.
Home births are generally frowned upon and not covered by the state, probably because they’re associated with a time when healthcare was scarce and the infant and maternal mortality rate was higher. It is legal to give birth at home, but it’s still very rare and you may encounter some hurdles due to the cultural views around it.
James: How common are birth plans in Portugal?
Shona: Birth plans are a relatively new concept here, but they are incredibly important and are becoming more and more common. They help ensure your wishes are known and, hopefully, respected by the medical team.
Even if things don’t go exactly as planned – as they often don’t – having a birth plan helps advocate for your preferences and increases the chances of your voice being heard.
My hope is that as more women write birth plans, more professionals will become familiar with the idea.
James: Can you talk about the role of midwives and doulas in Portugal, and how they can support expectant mothers?
Shona: Midwives are typically involved in the actual delivery but not always in prenatal care within the public system. There are also midwives who work independently, who you can choose to hire for a more personal approach during pregnancy and postpartum.
Doulas provide continuous physical, emotional, and informational support before, during, and after childbirth. Having a doula can be particularly helpful for foreigners who may not be fluent in Portuguese and need someone to advocate for their needs and preferences.
James: Let’s talk about the postpartum period. How is the support system for new mothers in Portugal?
Shona: Honestly, postpartum support in the public system can be lacking. There’s a focus on the baby’s health, but not much attention is given to the mother’s physical and mental well-being. I was also offered no support with breastfeeding and I felt very lost about it the first time around.
In my opinion it’s important for new mums to actively seek support, whether it’s from lactation consultants, women’s health physiotherapists, or mental health professionals.
James: You mentioned the importance of understanding your rights during pregnancy and childbirth in Portugal. Can you highlight some key rights that expectant mothers should be aware of?
Shona: Absolutely. Every woman has the right to:
- Information: Receive clear and understandable information about all aspects of their pregnancy, childbirth, and postpartum period.
- Informed consent and refusal: Consent to or refuse any medical interventions, and be fully informed of the risks and benefits involved.
- Respectful care: Be treated with dignity and respect by healthcare professionals, regardless of their background or choices.
- Birth partners: Have companionship during labour and delivery, as well as during a C-section.
- Birth plan: Create a birth plan outlining their preferences and have it respected by the medical team.
James: Are there any cultural differences or expectations regarding pregnancy and childbirth that foreign mothers should be aware of?
Shona: Yes, there are a few. Portugal has a strong family culture, and children are generally adored. I have certainly noticed being treated very generously in public when pregnant or with a baby.
For example, people who are pregnant or have a baby under 2 years old are allowed to skip queues, whether that’s in the supermarket, at the post office or at the airport. I have also felt completely at ease breastfeeding in public, which I know can be an issue in some other countries.
However, it’s important to know that there can be a more medicalised approach to childbirth, with higher intervention rates than in some other countries. Being aware of these differences can help you to advocate for your own preferences.
James: What advice would you give to expecting mothers who are feeling anxious or overwhelmed about navigating pregnancy and childbirth in Portugal?
Shona: My main advice is to do your research, ask questions, and don’t be afraid to advocate for yourself. Connect with other mothers who have been through the experience, and seek out supportive resources. Remember, you are not alone and there is help available.
James: You also mentioned prenatal classes. Can you tell us more about their availability and the type of information they provide?
Shona: Unfortunately, the availability of prenatal classes is inconsistent, and they are often not offered in English. Some hospitals and health centres provide them, but others don’t. As a foreigner, I personally recommend seeking out additional resources, especially those that promote a positive and empowering birth experience. There are plenty of online courses these days and also some prenatal centres and doulas in Portugal who can offer prenatal education in English.
James: Let’s talk about shopping for maternity and baby items. Are there any particular stores or websites you would recommend in Portugal?
Shona: There are many options available, both online and in physical stores. Popular choices include H&M, Kiabi, Zippy, and Chicco. Many of the big supermarkets also sell baby clothes and items. For eco-friendly options, consider second-hand stores or brands like Eco-Tiny and Meekbum.
James: Your website also provides a wealth of resources and links for further information. Are there any particular favourites you would like to highlight?
Shona: Definitely! The Positive Birth Company and Evidence Based Birth offer fantastic online resources and podcasts. For books, I recommend “The Positive Birth Book” by Milli Hill and “Mindful Hypnobirthing” by Sophie Fletcher.
James: You have a thriving Facebook group. What are some of the things you’ve learned from other mums and expectant mums?
Shona: Thank you! I have been really humbled by all the kindness and support shared by other mums in the community.
An interesting pattern I’ve noticed is that when it comes to administrative tasks such as registering at a health centre or getting your baby’s citizen card, how easy or hard this is for you often depends on the individual in front of you – and sometimes, what mood they are in!
Often I have seen one person saying that they were unable to complete a certain task, and someone else commenting that they were able to do the same easily but in a slightly different location or with a more willing employee.
So what that has taught me is that persistence is key here: if you are met with a hurdle or two, don’t give up straight away. And taking someone Portuguese with you – just a neighbour or a friend, it doesn’t have to be an official translator – can really help to get these administrative tasks completed more smoothly.
James: Is there anything else you would like to share with our audience about having a positive pregnancy and birth experience in Portugal?
Shona: Yes, I just want to say that it is possible to have a positive experience! Of course there are many external factors to consider, so it’s important to figure out what you are in control of, and accept what you are not.
Being a foreigner means that everything takes a bit more effort, but there’s no need to despair. There are so many of us that have already lived through it and we are all here to support each other and share what we have learned. So please do reach out for help. We were never designed to go through all this alone.
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