In SNS, half of births are natural. In private companies, less than 20% | Health

How did you give birth in Portugal? Mainly in hospitals that, according to the latest detailed data available from the National Statistical Institute (INE), performed 82,800 births in 2022 – and almost 80% were performed in the National Health Service (SNS). Here, half (50.2%) were performed without instrumental or surgical intervention, namely caesarean section (so-called natural births or natural deliveries). Private hospitals performed “14.7 thousand births”, just over a sixth of the total and almost 82% of them (around 12 thousand) involved caesarean sections or the use of support devices such as forceps or suction cups (dystocia during childbirth).

PÚBLICO has requested the Directorate General of Health (DGS) and the Health Regulatory Authority (ERS) — Bodies to which all hospitals are obliged to report by a decree dated 2016 and authored by Fernando Araujo, then Deputy Secretary of State for Health. — 2023 figures for public and private births. The General Directorate of Public Security referred to data from SNS hospitals available on the transparency portal (it only has the number of births and caesarean sections), while for private hospitals, it requested statistics from the National Institute of Statistics as of 2022.

ERS has this detailed data, but it is from 2021 and is the result of last year’s monitoring. This data is from 61 health institutions that performed 75,468 births in 2021 in mainland Portugal. — Between the public, private and social sectors — It allowed us to understand that in that year, three private companies performed 100% of births by caesarean section, and other companies used this method with the help of almost all pregnant women.

As for recent data on births in private hospitals, without a transparency portal for this sector, we remain dependent on the figures that health groups decide to make available. PÚBLICO requested the 2023 figures for births and obstetricians working in the three large private hospitals in Lisbon, where the problems of gynecological and obstetric emergencies are concentrated.

Luz Saúde said that last year she performed 3,891 deliveries in Lisbon, while Lusiadas performed 3,205 in the capital, and that Cuf Descobertas had a total of 3,140 doctors. Regarding the number of gynecologists and obstetricians, Lusiadas only answered, adding that in the Greater Lisbon area there are “more than 130 doctors” in this specialty “working together under different contractual conditions, both full-time and part-time.”

Compared to the figures for 2021, the three large private hospitals will have performed about 900 more births than two years ago, when births in Portugal were, for the first time, below 80,000. But Nuno Claude, president of the Portuguese Society of Obstetrics and Maternal-Fetal Medicine and coordinator of the Gynecology and Obstetrics Service at the CUF Hospital in Torres Vedras, once again defends that “private companies do not have the capacity to be an alternative to the SNS system.”, especially since they are “at the limit”, because they are “sized for a certain number of births“.

This was announced by former Health Minister Manuel Pizarro on several occasions.Intention to close Maternity hospitals in the private and social sectors are unable to remain open. But for this to go forward, it was necessary to define the licensing rules. A source told PÚBLICO that the decree that would allow this intention to be realized – requires maternity hospitals with fewer than 700 births per year and caesarean section rates above 50% to close their doors, with the exception of those in the interior, such as Bragança, Guarda, Castelo Branco, Portalegre, Beja — He remained in the transitional government portfolio. When asked about this, the health minister’s office did not respond.

The current legislation stipulates that in obstetric and neonatal units that do not have open emergency care (as in special units) it is necessary to have an obstetrician responsible for the pregnant woman, a pediatrician specializing in neonatology, and an anesthesiologist on a preventive basis. In perinatal support units with an open emergency in the SNS, according to the rules of the Medical Association, the number of obstetricians must range from at least two in actual presence, in the smallest hospitals, but can reach five or six in the largest differentiation (when they perform more than 2,500 or more than 3,500 births per year, respectively).