Health authority guidance on childbirth dives headlong into controversy

Doctors official body calls for "immediate revocation"

No sooner had the health new guidance on childbirth been announced, than doctors’ official body (Ordem dos Médicos) went on the attack.

The bottom line of the orientation is that in low risk pregnancies, not requiring any kind of instruments, specialist nurses can deliver newborns without the presence of an obstetrician.

The background to this new guidance is a desperate lack of obstetric cover throughout the country. Maternity units have been deeply compromised for months, due to the fact that there simply are not enough State obstetricians to go round.

The DGS’ (health authority) plan, on paper, ‘makes sense’ in that an increasing number of babies in Portugal are being born ‘at home’: their parents opting for the expertise of professional ‘doulas’ and registered midwives, and avoiding the utter confusion that reigns over hospital births.

But for the Ordem, the concept is simply unacceptable.

The situation is doubly frustrating for the DGS which insists the orientation was ‘okayed’ by five representatives of the Ordem who accompanied the decision-making behind it.

A subsequent statement from the Ordem suggests this isn't exactly the case. The entity explains that although it accepted to "actively participate in the Commission for the Monitoring of the Response in Gynaecology/Obstetrics Emergency and Delivery Blocks with the presentation of proposals" for the "improvement of health responses for mothers and children", the technical opinions of its medical representatives were not considered and are not included in the published document".

The Ordem adds that its five representatives were "not aware of the final version of the report", and "the name of the representative of the Gynecology and Obstetrics College of the Order of Physicians was excluded from the document", which it classifies as "an institutional disrespect".

"The non-sending of the final report (…) to the National Council of the Portuguese Medical Association – which originated the guidance on health care during labour issued by the DGS – shows institutional disrespect and reveals a non-cooperative action in a matter of great relevance to the population and to healthcare in Portugal," the Ordem went on.

Thus it's a great big confusion – as so many issues in Portugal are these days.

Specialist nurses meantime have said they are fully prepared to take on their new responsibilities. They have trained specifically to deliver healthy babies to healthy mothers, so it would be a surprise if they weren't.

Guadalupe Simões, president of the syndicate of Portuguese nurses, actually believes this orientation "comes late": nurses have been ready for this for a long time, she told SIC Notícias.

But the Ordem is so against the new guidance, "the way the process was carried out, and the result" that the five ‘representatives’ on the commission have now resigned "and under these circumstances, their replacement is not being considered".

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