Healthcare Options - Pregnant in Spain

State Healthcare
The system of care is quite different to other nations in Europe like the United Kingdom or the Netherlands where the midwife provides most of the care. Here in Spain the main care provider for pregnancy is the obstetrician or gynaecologist. Although fairly uncommon, there are an increasing number of Spanish midwives who want to provide home birth and other natural birth options.

If your Spanish is good enough you can view their web site at www.commadronas.org

On the whole antenatal care is provided in local health centres, you will then be referred to a local hospital for the birth or sooner if you are having a detailed scan or problematic pregnancy. In some areas many women do not attend the hospital in which they plan to give birth until they are in labour. You are unlikely to be offered an opportunity to view the birthing rooms or 'tour' the hospital but always ask as many women find it useful to know their surroundings.

Antenatal Screening does vary slightly from one region to another region, but in general it starts at a local health centre or Centro de Salud. When the pregnancy is confirmed you will meet a midwife who will take all of your medical history and fill in your pregnancy records called 'cartilla del embarazo'. Then you will have full blood screening tests commonly performed, these check for Rhesus, Rubella and antibody status and look for infections such as Toxoplasmosis, Hepatitis, Syphilis and HIV.
In most regions you will be offered the Triple test which screens for abnormalities, this includes a nuchal fold scan at 12 weeks and a 'combined' blood test to rule out Spina Bifida, Downs Syndrome and Edwards Syndrome. This test highlights your risk factor and is not a confirmation of a problem. If you are high risk then you will be offered further conclusive tests which include Chorionic Villus Sampling (CVS) which is carried out the same day and takes 48 to 72 hours for the results to be available. However, the test can only be carried out if your placenta is easy to access. If this isn't possible or you wish to wait, you can return at 15 weeks and have an amniocentesis. This test takes a sample of the baby's amniotic fluid, through a needle placed carefully into your abdomen and analysis's the baby's chromosomes. However the results are generally not available for a further 2 to 3 weeks which takes you up to 17 or 18 weeks.
Ultrasound scans are offered at 20 weeks which is commonly known as the detailed scan and again at 32 weeks and 40 weeks to ensure growth and development are maintained. You are also expected to have more routine blood tests and usually two O' Sullivan's Test. This is commonly known in the UK as the glucose tolerance test and it checks for diabetes and is carried out in the 2nd and 3rd trimester of your pregnancy in Spain. Starting at 37 weeks of pregnancy your baby will monitored weekly on a CTG machine this is to get a pre labour reading of your baby's heart rate so that your clinician can tell if your baby is coping well with contractions and labour.
Please note that you should carry all of your notes and blood test results so that when you go into labour you have everything with you, if you are having private antenatal care and going to give birth in a state hospital.

Private Healthcare
Private Healthcare is the norm for many nationalities, possibly due to the influx of foreign residents and the increasing number of wealthy Spaniards. However, the caesarean section rate at any of these clinics is excessively high. This may be due to the rising rate of litigation or that their policies tend to allow women only a short time in which to labour, before taking the decision to perform a caesarean.
A Gynaecologist/Obstetrician will conduct all of your care in the private sector it will consist of routine scans at almost every appointment and include the baby heart monitor again from 37 weeks of pregnancy.
He/she will often work from a local clinic but may take you to a private hospital for the actual birth, it is important that you ask questions about their practice and conduct for example, if you become overdue, at what duration of pregnancy does induction of labour take place? Will he be there to care for you during labour or will a Spanish midwife do all of the labour carewith the doctor coming only for the actual birth? And will that midwife speak to you in your own language?
Your Gynae is responsible for meeting your needs and making all decisions so do not be afraid to ask what he thinks about the choices you wish to make for instance; alternative positions for birth or vaginal birth after caesarean VBAC or whether he supports performing routine, elective episiotomy (the cut). But ask questions early on so that you know you will feel supported by him or her on the big day!

Private Midwives
Private Midwives are now growing in number across Spain and the islands and can offer reassurance and guidance through your pregnancy and support you after the birth. They tend to be very reasonable in cost and will often provide home visits, coming into your home to helpyou adjust to family life with a new baby.

Government Payments
From July 2007 all babies born or adopted in Spain are entitled to a one off payment of 2,500 Euros providing the mother can prove she has lived and is contributing to the system for the previous two years. The money is paid to the mother except in the event of a death where the money would be  given to the father. In the case of adoption one parent would be eligible to claim the payment this is usually the mother except of course for same sex couples.
Working Mothers are eligible for 4 months paid maternity leave and are entitled to family allowance payments providing they have a full time contract. There is also a child care allowance of 100 euros a month.