Three hospitals refused pregnant women who lost their babies

Three hospitals in Lisbon and the Setúbal Peninsula refused to admit the pregnant woman—who lost her baby in the early hours of Tuesday—because they had no vacancies in their neonatal services, which forced the National Institute of Medical Emergencies (INEM) to transport the woman, who lives in Barreiro, to Cascais Hospital, an hour away, INEM itself confirmed to Observador.

During the journey, and with the pregnant woman already hemorrhaging, the fetus ended up dying, confirmed the Cascais Hospital.

With the obstetric emergencies at the Hospital do Barreiro and Garcia de Orta closed, the INEM Urgent Patient Guidance Center (CODU) contacted the Hospital de Setúbal, the Hospital de Santa Maria and Maternidade Alfredo da Costa (MAC), in Lisbon, “who reported not receiving [the pregnant woman] because they did not have neonatology vacancies available ”.

“The patient was then referred to Cascais Hospital, which did not present any constraints,” adds INEM. The distance between the city of Barreiro and Cascais Hospital is 60 kilometres, a journey of around one hour.

When the woman, aged 38 (and 31 weeks pregnant) arrived at Cascais Hospital, the fetus was already dead, an official source from that hospital confirmed to Observador.

The INEM CODU reported that it received a call from the fire department at 1:30 a.m. for assistance to a 38-year-old patient. According to RTP, the woman had already tried to contact the SNS24 line at around 11 p.m., but the call was not answered. As an alternative, the pregnant woman decided to call 112, which alerted the Barreiro fire department.

They then contacted INEM, which forwarded the call to the SNS24 line. “The result of the triage determined that the call was forwarded to SNS24”, explains INEM. At 1:47 am, CODU received another call from the site, “reporting a reduction in the time between contractions, without the water breaking”.

At that moment, INEM called an ambulance from the Barreiro Volunteer Firefighters “which, after assessing the patient, transmitted clinical data to the CODU at 02:28”. It was at that moment that, realizing that the pregnant woman would need to be treated in a hospital unit, the CODU tried to locate, for the next 20 minutes, an obstetric emergency room with capacity to receive the pregnant woman. With the hospitals of Setúbal and Santa Maria and also the MAC unavailable due to lack of beds, the woman was sent to Cascais.

“At 2:51 a.m., the Fire Department team called CODU again” reporting that the pregnant woman had suffered a hemorrhage. It was at this point that INEM decided to call a special emergency service. “Recognizing the potential seriousness of the situation, CODU immediately called the Emergency Medical and Resuscitation Vehicle (VMER) from Barreiro Hospital, which provided assistance to the patient and accompanied the transport to Cascais Hospital.”

Reconstruction. Normal tests and a difficult birth: the story of the pregnant woman who lost her baby after going to five hospitals

Observador asked the Ministry of Health's Shared Services (SPMS) to find out whether the call allegedly made by the pregnant woman to the SNS24 line was answered or not, and if not, why this happened. In its response, the SPMS stated that “there is no record of any constraints on the SNS 24 line on 2 and 3 July” and that “the maximum waiting time for pregnant users to be seen between 11 pm on 2 July and 2 am on 3 July was 73 seconds ”.

Regarding the initial call that was allegedly made by the pregnant woman herself at around 11pm, the organization says that “two calls were recorded from the telephone number indicated by the user, with the first call, to the 'SNS Pregnant Line' option, at 1:20am , being disconnected after 41 seconds of waiting. The second call, in which the 'Respiratory Problems' option was activated, was made at 1:23am and disconnected at 1:28am”.

In other words, the SPMS reports the existence of two calls to the SNS24 line, but only reports a first call at 1:20 am — around two hours after the moment when the woman herself said she had made the first contact.

In a note sent to Observador, the Ministry of Health states that, “given that the pregnancy was 31 weeks old and preterm, it was necessary to refer the patient to a hospital with specialized perinatal support (neonatology)”, but denies that the pregnant woman was refused care “due to the closure of the obstetric emergency services in the Setúbal Peninsula”. In fact, the hospitals that refused care were those that, although open, had no available beds (Hospital de Setúbal, Hospital de Santa Maria and MAC).

According to the Ministry of Health, assistance to the pregnant woman complied with the referral and access protocols. “Access to healthcare was guaranteed at all times, concluding that the response provided to the user by both the SNS pregnancy line and INEM was consistent with the referral and access protocols in force”, highlights the Ministry of Health, which “regrets the outcome of the situation and extends its condolences to the family”.

This case follows that of a 37-year-old woman , resident in Amora, who lost her baby after being treated in five hospitals. The pregnant woman, 40 weeks pregnant, ended up giving birth at the Hospital de Santa Maria, in Lisbon, but the baby ended up dying due to lack of oxygen, after an emergency caesarean section.