Nurse-Midwives Replace Doctors in Routine Pregnancy Visits at Loures Hospital

Expectant parents who live in and around Lisbon may soon notice a quieter corridor at Hospital Beatriz Ângelo in Loures: routine antenatal check-ups for low-risk pregnancies are now carried out entirely by a team of specialised nurses. The pilot began on 1 October and, if early indicators hold, it could redefine who Portuguese women see most often during the nine months of pregnancy.

A different face at the consulting room door

For decades, the first person to greet a pregnant woman in a hospital setting was almost always a medical doctor. Loures has flipped that script by assigning Nurse-Midwives, officially known as Enfermeiros Especialistas em Saúde Materna e Obstétrica (EESMO), to run every step of the standard check-up—from measuring blood pressure to updating the electronic maternity record. Obstetricians remain on call, but they intervene only if a red flag appears. Hospital managers say this reorganisation has already trimmed waiting times "by several weeks" for first appointments, a crucial gain in a district where maternity services are chronically oversubscribed.

Why the shift happened now

Portugal has wrestled with staff shortages in obstetrics since a wave of retirements and emigration took hold in the early 2020s. In the Lisbon metropolitan area in particular, temporary emergency room shutdowns became routine during peak holiday periods. By allowing nurses to handle the roughly 70 % of pregnancies classified as low risk, the administration hopes to free scarce obstetricians for complicated cases such as gestational diabetes or multiple births. The timing also coincides with the government’s pledge to cut average hospital waitlists across all specialties by 20 % before the next state-budget cycle.

Two professional orders, two readings of the same rulebook

The Order of Nurses (OE) applauds the Loures model as "long-overdue recognition" that Portuguese nurse-midwives already log thousands of hours managing healthy pregnancies. The organisation is lobbying for a nationwide protocol that would let these professionals request blood tests and basic ultrasounds without a doctor’s counter-signature.

Across the aisle, the Order of Doctors (OM) insists that pregnancy, even when uncomplicated, is "never entirely risk-free" and must remain under a physician’s clinical umbrella. Rather than expand nursing autonomy, the OM wants the NHS to invest in family-medicine teams and digital triage so that every expectant mother keeps a single doctor as the "coordinator of care."

How safe is a nurse-led pathway?

International evidence is stacking up. Finland, Sweden and the UK report lower intervention rates and equal—or better—neonatal outcomes under models where nurse-midwives maintain continuity of care. A 17-trial meta-analysis cited by the European Midwives Association found fewer caesareans, shorter hospital stays and higher maternal satisfaction when nurses or midwives ran the show for straightforward pregnancies. Portuguese academic centres, including the University of Porto, are now crunching local data to see if those findings translate to the Iberian context.

The legal backdrop: autonomy, but with caveats

Under Regulation 391/2019, EESMOs can act autonomously in low-risk scenarios, yet a 2024 revision to the DGS obstetric guideline inserted a clause that any hospital admission still requires the "knowledge" of an on-call obstetrician. That small wording tweak delights doctors and frustrates nurses in equal measure. Meanwhile the Portaria 325/2024/1 shifted triage phone duties to nurse-midwives via the SNS 24 help-line, signalling that policymakers do trust these professionals at the front door of the system—even if the back door remains partly guarded by physicians.

Voices from the corridor

Sandra Cota-Pereira, the nursing director who pushed the Loures blueprint forward, calls it "a milestone for obstetric nursing" that delivers both faster access and a more human-centred appointment. On the medical side, senior obstetrician Ana Ramalho concedes the reorganisation "makes operational sense" but warns that "boundary lines must stay crystal clear" to avoid fragmented care when complications do arise. Early patient feedback collected by the hospital’s quality team hints at high satisfaction scores—especially among first-time mothers who value the longer appointment slots nurses typically schedule.

What expectant families should know

For now the initiative applies only to Beatriz Ângelo and only to pregnancies flagged as low risk after an initial screening. Women can still request a doctor-led visit, but that may involve longer waits. Should the trial meet safety benchmarks by mid-2026, the Health Ministry has signalled a willingness to scale the model to other urban hospitals and, eventually, to agrupamentos de centros de saúde where many expectant mothers currently lack a family doctor.

The takeaway for residents is pragmatic: if you are pregnant, live in the Loures-Odivelas catchment area and fall into the low-risk category, your next antenatal appointment will probably be with a specialist nurse. Judging by the early data—and by the experience of northern European neighbours—that may be less a downgrade in medical hierarchy and more an upgrade in personalised care.