Specialist Nurse Midwives Will Run Low-Risk Pregnancy Care and Order Scans in SNS Health Centres That Opt In
A normative order published on 28 October lets specialist nurse midwives run low-risk antenatal care and request tests and scans in health centres whose local health unit adopts the model, with a named doctor still in the loop.
Specialist nurse midwives will be able to follow a low-risk pregnancy from the first appointment and order the tests and scans it needs, in SNS health centres that sign up to a new model of care. The rules are in Despacho Normativo n.º 11/2026 (Normative Order 11/2026), published in the Diário da República on Wednesday 28 October and in force from Thursday.
The order, signed by the health minister, Ana Paula Martins, sets the rules for the pilot project created in February by Despacho n.º 1572/2026. Its preamble cites the growing shortage of family doctors.
What the nurses can do
The professionals involved are enfermeiros especialistas em saúde materna e obstétrica (specialist nurses in maternal and obstetric health), effectively midwives. Under the regulation they:
- run the scheduled check-ups from the first pregnancy consultation, ideally by 9 weeks and 6 days of gestation;
- request laboratory tests, prenatal screening and imaging, as well as supplements, vaccines, immunoprophylaxis and pregnancy certificates, within national clinical rules;
- reassess the woman's risk at every contact and ask a doctor for advice when in doubt.
Doctors stay involved. Every woman must have a named reference medical team, acts reserved by law to doctors remain theirs, and a hospital obstetrician backs up the model. A pregnancy that stops being low risk is referred on; anything urgent goes straight to the obstetric emergency department.
Only a single, viable pregnancy with no maternal illness, obstetric complication or suspected foetal problem qualifies. The woman must agree after being told how the model works, and she can leave it at any time.
Where and when
The regulation applies only to the Unidades Locais de Saúde (Local Health Units, ULS) that adopt it, and each must first approve a local protocol and train its staff. The ministry's shared services agency, SPMS, and the Direção Executiva do SNS (SNS Executive Board) have 90 days to add the supporting tools to health centre software. Results will be evaluated after 12 months.
In February the SNS said the project would run in ULS with low family doctor coverage. In March the Executive Board named 12, mostly around Lisbon and the Setúbal peninsula plus Oeste, Alto Alentejo and the Algarve, Observador reported. The new order lists none, and DN reported that it is not yet known which will test it.
The bastonário (president) of the Ordem dos Enfermeiros (Order of Nurses), Luís Filipe Barreira, told Lusa it was "a historic step for Portuguese nursing" that would help women "who today go weeks or months of pregnancy without any follow-up", RTP reported. The Ordem dos Médicos (Order of Physicians) accepted the idea in November 2025 as a transitional solution for under-served areas, Público reported.
It follows revised HIV prevention rules that gave nurses PrEP check-ups this month, and comes as Lisbon and the Tagus valley gained 49,000 people without a family doctor in a year.
If you are pregnant
- Book early. A Direção-Geral da Saúde (Directorate-General of Health) standard says every pregnant woman should have a first consultation by 9 weeks and 6 days, with low-risk pregnancies followed in primary care.
- If you are registered at a health centre, you can request the first maternal health consultation through the SNS 24 portal, app or line (808 24 24 24) where your centre offers slots; later ones are booked in person.
- The SNS 24 pregnancy guide says a normal pregnancy has at least six consultations and usually one scan per trimester.
- If your ULS adopts the model, you may be offered nurse-led care; you can decline it or leave later.
