In Brazil, the midwife profession, including its educational requirements, is regulated by federal law, while regulation of the activities of doulas is currently under consideration in Congress. In the meantime, states and municipalities have issued their own laws regulating doula activities in their jurisdictions. In 2005, coverage of assistance to women during labor was introduced in the country’s health care system, which is funded by the government.
I. Regulation of Midwives
A. Law No. 7,498 of June 25, 1986
Law No. 7,498 of June 25, 1986, regulates the exercise of nursing in Brazil. According to article 2, nursing and its auxiliary activities may only be performed by persons legally qualified and enrolled in the Regional Nursing Council with jurisdiction over the area in which the person intends to practice.
Nursing is practiced exclusively by a nurse (enfermeiro), nurse technician (técnico de enfermagem), assistant nurse (auxiliary de enfermagem), or midwife, according to their respective qualifications.
B. Decree No. 94,406 of June 8, 1987
Law No. 7,498 is regulated by Decree No. 94,406 of June 8, 1987. Article 12 of the Decree determines that midwives are responsible for
I - providing care for pregnant women and women in childbirth;
II - attending normal birth, including at home; and
III - providing postpartum and newborn care.
These activities must be carried out under the supervision of an obstetric nurse when performed in health institutions, and, whenever possible, under the control and supervision of a health unit when performed at home or other necessary location.
II. Professional and Educational Requirements for Midwives
Article 9 of Law No. 7,498 defines a midwife as
I - the holder of a certificate provided for in article 1 of Decree-Law no. 8.778 of January 22, 1946, observing the provisions of Law No. 3,640 of October 10, 1959;
II - a holder of a diploma or certificate of midwife, or equivalent, conferred by a foreign school or course, according to the laws of the country, registered by virtue of cultural exchange or revalidated in Brazil.
Decree-Law No. 8,778 of January 22, 1946, regulates the qualification exams for nurse assistants and practical midwives. Article 1 establishes that nurses (enfermeiros práticos) and midwives who have more than two years of effective nursing practice in a hospital may undergo the qualification exams that give them the certificate of practical nurse (prático de enfermagem) and practical midwife (parteira prática). Decree-Law No. 8,778 further specifies, among other things, the dates and place for the exams, necessary documentation, and the types of exam and exam subjects.
A practical midwife or practical nurse certificate grants the holder the right to serve as a patient attendant in hospitals, maternity hospitals (maternidades), nursing homes, and outpatient clinics in the state in which it was issued.
III. Regulation of Doulas
Brazil has yet to regulate doula activities in the country. Several bills of law regulating such activities are currently under consideration in Congress. In the absence of a federal regulation, many states and municipalities have enacted laws regulating doula activities.
A. Rio de Janeiro State Law No. 7,314 of June 16, 2016
On June 16, 2016, the State of Rio de Janeiro enacted Law No. 7,314, which obligates maternity hospitals, birth centers (casas de parto), and public and private hospitals in Rio de Janeiro to allow the presence of doulas during labor, delivery, and the immediate postpartum period, if requested by the mother.
1. Definition of Doulas
For the purposes of Law No. 7,314, and in accordance with Code 3221-35 of the Brazilian Classification of Occupations (Classificação Brasileira de Ocupações, CBO), doulas are birth attendants chosen freely by pregnant women or women who have just given birth, who “aim to provide continuous support to pregnant women in the puerperal pregnancy cycle, favoring the evolution of the delivery and well-being of the pregnant woman,” with proper occupational certification for this purpose.
Article 1(§ 2) of Law No. 7,314 determines that the presence of doulas should not be confused with the presence of an accompanying person as established by Law No. 11,108 of April 7, 2005.
2. Professional/Educational Requirements
For the regular exercise of the profession, doulas are authorized to enter public and private maternity wards, maternity halls, and similar hospital establishments in Rio de Janeiro with their respective work materials, consistent with safety standards and the hospital environment.
Doulas are forbidden to perform medical or clinical procedures, such as gauging pressure, assessing the progression of labor, monitoring the fetal heart rate, or administering medication, among others, even if they are legally able to do so.
Public and private maternity hospitals, birth centers, and similar hospital establishments in Rio de Janeiro must establish their own methods for admitting doulas, respecting ethical precepts, the individual’s level of competence, and their internal rules of operation, upon presentation of the following documents:
I - letter of presentation, containing full name, address, CPF number, ID, telephone contact and electronic mail;
II - copy of official document with photo;
III - statement of procedures and techniques that will be used at the time of labor, delivery and immediate postpartum, as well as a description of the planning of the actions that will be developed during the assistance period;
IV - authorization term signed by the pregnant woman for the performance of the doula at the time of labor, delivery and immediate postpartum;
V - copy of the certificate of professional training, according to the Brazilian Occupational Certificate – CBO.
3. Certification of Professional Training
Other than several websites offering courses designed to allow a person to become a doula and obtain a certificate, no professional training and certification requirements were identified.
B. São Paulo Municipal Law No. 16,602 of September 23, 2016
The Municipality of São Paulo enacted Law No. 16,602 of September 23, 2016, which authorizes the presence of doulas, when requested by the mother, during the entire period of labor, delivery, and immediate postpartum, as well as in prenatal consultations and exams, in maternity wards, hospitals, and other facilities of the municipal health network.
IV. Alternative Care Before, During, and After Childbirth
A. Subsystem of Assistance
On April 7, 2005, Law No. 11,108 included in the Unified Health System (Sistema Unico de Saúde, SUS) a subsystem of assistance to women during labor, delivery, and the immediate postpartum period. According to the Law, the SUS is obliged to allow the presence of one accompanying person during the labor, delivery, and immediate postpartum periods. Law No. 11, 108 states that such person must be indicated by the mother.
In addition, Law No. 11,108 further determines that the actions intended to enable the full exercise of these rights must appear in a regulation of the law, to be prepared by the competent body of the executive branch of government.
B. Stork Network
The Ministry of Health created the Stork Network to provide women with health, quality of life, and well-being during pregnancy, childbirth, and the postpartum period, and to support child development through the first two years of life. The Network aims to reduce maternal and infant mortality and ensure the sexual and reproductive rights of women, men, young people, and adolescents.
The Stork Network was created on June 24, 2011, by Administrative Act (Portaria) No. 1,459 issued by the Ministry of Health. According to article 1, the Stork Network was created under the SUS and consists of a network of care aimed at assuring women the right to reproductive planning and humanized attention to pregnancy, childbirth, and the postpartum period, as well as to the child’s right to a safe birth and healthy growth and development.
A. Social Security
Article 195 of the Brazilian Constitution determines that social security must be financed by the whole society, directly and indirectly, in accordance with the law, through funds from the budgets of the federal government, states, the Federal District and municipalities, and the other social security contributors listed in article 195. Article 198 establishes that the SUS must be financed, pursuant to article 195 of the Constitution, with resources from the social security budget, the Union, states, the Federal District and municipalities, and other sources.
B. Unified Health System
Article 31 of Law No. 8,080 of September 19, 1990, states that the social security budget must allocate to the SUS, according to the estimated revenue, the resources necessary for the fulfillment of its purposes. According to Law No. 11,108 of April 7, 2005, a subsystem of assistance to women during labor, delivery, and the immediate postpartum period was included in the SUS. Therefore, such assistance is funded by the government.
Senior Foreign Law Specialist
 Lei No. 7.498, de 25 de Junho de 1986, art. 2, http://www.planalto.gov.br/ccivil_03/LEIS/L7498.htm, archived at https://perma.cc/7NYG-CB3E.
 Id. art. 2(sole para.).
 Decreto No. 94.406, de 8 de Junho de 1987, art. 12, http://www.planalto.gov.br/ccivil_03/decreto/1980-1989/D94406.htm, archived at https://perma.cc/F49U-X9GV.
 Id. art. 12(sole para.).
 Lei No. 7,498 supra note 2, art. 9.
 Decreto –Lei No. 8,778, de 22 de Janeiro de 1946, reinstated by Law No. 3.640, de 10 de Outubro de 1959, art. 1, http://www.planalto.gov.br/ccivil_03/Decreto-Lei/1937-1946/Del8778.htm, archived at https://perma.cc/89CW-VSRE.
 Id. arts. 2, 3.
 Id. art. 4.
 Id. arts. 5–7.
 Id. art. 13.
 Doula, Busca, Câmara dos Deputados, https://www.camara.leg.br/busca-portal?contextoBusca=Busca Proposicoes&pagina=1&order=relevancia&abaEspecifica=true&q=doula&tipos=PL.
 Estado do Rio de Janeiro, Lei No. 7.314, de 15 de Junho de 2016, art. 1, http://alerjln1.alerj.rj.gov.br/ contlei.nsf/c8aa0900025feef6032564ec0060dfff/f6a4bdfe5bb46c4383257fd4005a506c?OpenDocument&Highlight=0,7314, archived at https://perma.cc/46WL-3ZT6.
 CBO Code 3221-35 states, among other things, that doulas aim to provide continuous support to the pregnant woman in the puerperal pregnancy cycle, favoring the evolution of the delivery and well-being of the pregnant woman. They evaluate the physiological, systemic, energetic, vibrational, and unaesthetic dysfunctions of patients/clients. Classificação Brasileira de Ocupações, Ministério do Trabalho, http://www.mtecbo.gov.br/cbosite/pages/pesquisas/ResultadoOcupacaoMovimentacao.jsf.
 Lei No. 7.314, art. 1(§ 1).
 Id. art. 1(§ 2).
 Id. art. 2.
 Id. art. 3.
 Id. art. 4.
 Município de São Paulo, Lei No. 16.602, de 23 de Dezembro de 2016, http://legislacao.prefeitura. sp.gov.br/leis/lei-16602-de-23-de-dezembro-de-2016, archived at https://perma.cc/EM9U-YBAU.
 Lei No. 11.108, de 7 de Abril de 2005, art. 1, http://www.planalto.gov.br/ccivil_03/_Ato2004-2006/2005/Lei/L11108.htm, archived at https://perma.cc/8WZV-F3B6. Law No. 11,108 amended Law No. 8,080 of September 19, 1990, which provides for the conditions for the promotion, protection, and recovery of health, and the organization and operation of the corresponding services. Article 4 of Law No. 8,080 defines SUS as a set of actions and health services provided by federal, state, and municipal public bodies and institutions of the direct and indirect administration and foundations maintained by the government. Article 4(§ 2) determines that the private sector may participate in the SUS in a supplementary manner. Lei No. 8.080, de 19 de Setembro de 1990, http://www.planalto.gov.br/ccivil_03/LEIS/L8080.htm, archived at https://perma.cc/5RW5-YH58.
 Lei No. 11,108, art. 1.
 Rede Cegonha, Ministério da Saúde, http://portalms.saude.gov.br/saude-para-voce/saude-da-mulher/rede-cegonha (last visited May 2, 2019), archived at https://perma.cc/YPY8-XVHX.
 Id. The Youth Statute, which was enacted by Law No. 12,852 of August 5, 2013, defines “youths” as persons between fifteen and twenty-nine years of age. Estatuto da Juventude, Lei No. 12.852, de 5 de Agosto de 2013, art. 1(§ 1), https://www.planalto.gov.br/ccivil_03/_ato2011-2014/2013/lei/l12852.htm, archived at https://perma.cc/4D86-JVHP. However, the dispositions of the Child and Adolescent Statute are applicable to “adolescents,” meaning those between the ages of fifteen and eighteen, and, exceptionally, the Youth Statute, when it does not conflict with the norms of full protection of adolescents set forth by the Child and Adolescent Statute. Estatuto da Criança e do Adolescente [E.C.A.], Lei No. 8.069, de 13 de Julho de 1990, art. 1(§ 2), http://www.planalto.gov.br/CCIVIL_03/LEIS/L8069.htm, archived at https://perma.cc/J4WC-JTZT.
 Portaria No. 1.459, de 24 de Junho de 2011, Ministério da Saúde, http://bvsms.saude.gov.br/bvs/saude legis/gm/2011/prt1459_24_06_2011.html, archived at https://perma.cc/NZT2-AL93.
 Id. art. 1.
 Constituição Federal, art. 195, http://www.planalto.gov.br/ccivil_03/constituicao/constituicao.htm, archived at https://perma.cc/2E3X-JJYX.
 Id. art. 198.
 Lei No. 8.080, supra note 12, art. 31.
Last Updated: 11/01/2019