Portugal lets specialist nurses monitor low-risk pregnancies in primary care

Portugal's government published Despacho Normativo n.º 11/2026 in the Diário da República on Wednesday, 28 October 2026, approving rules for a pilot in which specialist nurses in maternal and obstetric health (EEESMO) follow low-risk pregnancies in primary care. The decree takes effect on Thursday, 29 October. The pilot will run in 12 local health units (ULS), integrated into their primary care services and linked to hospital gynaecology and obstetrics departments, with an evaluation of the model planned after 12 months.

What the pilot allows

Under the decree, specialist nurses may follow low-risk pregnancies, apply the agreed clinical protocols and request complementary diagnostic exams and screening tests. They can also carry out preventive measures such as supplementation and vaccination, in line with the norms in force. Surveillance should start as early as possible, with the first assessment ideally made by a specialist nurse by 9 weeks and 6 days of gestation. If a doctor's appointment cannot be secured within that window, the nurse carries out the assessment instead. Risk is reassessed throughout the pregnancy, and a pregnancy that needs more specialised care leaves the model and is referred under ULS protocols.

Government rationale

The government says the measure responds to a growing shortage of specialist doctors in general and family medicine and to the need for timely access to prenatal surveillance. It frames the goal as making better use of available resources without compromising quality or clinical safety. The Sindicato dos Enfermeiros argues that collaborative models, working in permanent articulation with primary care doctors and hospital services, are safe and effective, citing international scientific information and their use in other European countries. Its president, Luís Silva, called the measure a "natural step" and a matter of the most elementary professional justice, following earlier union requests to the government.

Reactions from the nursing bodies

The Ordem dos Enfermeiros also welcomed the decree. Its bastonário, Luís Filipe Barreira, told the Lusa news agency that the rules match a position the Ordem has long defended, and he praised the political courage of the health minister, Ana Paula Martins. He said the aim is for pregnant women to get a timely appointment, regular follow-up and a clear contact for questions. He added:

“We are particularly pleased, because this decision will provide a concrete answer to women who today spend weeks or months of pregnancy without any follow-up.”

Background to the pilot

Diário de Notícias reports that the Ministry of Health presented the project in September 2025 as one of its most important measures for improving access to care for pregnant women. Despacho n.º 1572/2026 created it in February 2026 and set its guiding principles. A working group followed, but in May the nurses' representative left it, saying what was being built did not match what had been promised to the profession or the February despacho. In July, sources told DN the project was at risk, while the Direção Executiva said the group was still working.

Next steps

The decree was published nearly nine months after the draft of the project, according to PÚBLICO. According to DN, the Direção Executiva and the SPMS have 90 days to put the project into practice. The pilot is to be tested in 12 ULS, and the model will be evaluated after 12 months.