1st Trimester Facts from Midwife in Spain
Congratulations if you have just found out you are pregnant! Now is the time to start planning ahead. This information is to help you make the early choices, which include personal decisions and some changes to your lifestyle which benefit both you and your developing baby.
You can address the following issues immediately you have a positive test. Start taking Folic daily, if not already doing so. This is to reduce the risk of Spina Bifida and related problems (neural tube defects) in your new baby. It can be bought over the counter in any Farmacia. The most recent research also recommends:- stopping smoking, cutting out alcohol and reducing your caffeine intake – found in chocolate, coca cola & tea, as well as, coffee! Soft cheeses, unpasteurised dairy products, pates and uncooked smoked fish or meat products are not to be eaten by pregnant women. They may carry the risk of an infection, LISTERIA, which can be harmful to your developing baby. If you are a cat lover or avid gardener you need to take precautions against the organism causing
TOXOPLASMOSIS. Cat litter and garden soil are the most common sources of infection so leave the litter tray to someone else, wear gloves in the garden and thoroughly wash hands afterwards. This infection also effects the developing baby.
Tiredness is common in the first 12 weeks. You may consider moderating your excercise regimen if you regularly keep fit. You will have more energy after 12-14 weeks but high impact sport eg; aerobics, skiing, horse riding are usually avoided throughout pregnancy. If you are a frequent airline traveller you may think about flying less just now, particularly if you have had problems early on, in a previous pregnancy. It is also advisable to avoid hot baths including thermal pools & jacuzzis found in Spas. This may all sound like quite a change, but in fact these measures will all have a positive impact on your pregnancy.
The next issue to consider is who is going to care for you over the next 8 months or so? You are not sick in the conventional way, but it is advisable to be seen and monitored throughout your pregnancy.Your choices include:-
1. the care in the public social security system (SSS)
2. an independent midwife
3. an Obstetrician covered by a private healthcare plan
4. an Obstetrician whom you pay directly
5. You can also consider a mix of these - being seen both by a midwife and/or private and public Doctors simultaneously.
Many women are unsure of where they will give birth until quite late in pregnancy in Spain. You do not ‘book’ into a public hospital ahead of time, as in other countries. This is accepted practice – as you now have the right to choose which public hospital you will have your baby in.
The role of the midwife in ante-natal care in Spain varies between centro de saluds, (local health centre) but principally it involves the 1st ‘booking’ visit, visits at the later stages in pregnancy and running ante-natal classes. This is quite different to practice in other countries. They then see you when baby is about 5 days old, but in the health centre rather than in your home. They either work in the centro de saluds or in the hospitals but do not inter-change as the ‘systems’ are separate, again, unlike elsewhere There are a few UK & other EU registered Midwives living on the Costa del Sol & throughout Spain. For the most part they work independently although some are employed in the Spanish state system.
You need to be registered with a GP in your centro de salud once paying into the SSS in Spain. This entitles you to avail of services in that centre and this is where you make the first appointment with the midwife or ‘matrona’. If you are not paying into the SSS but have been contributing in the UK, or any other EU country, you may be eligible for full care for up to 1-2years by applying for it through the National Insurance HQ in the UK, or the equivelent office in your EU country. The EU Healthcard (formally the E111) is for emergency care in any EU country and is not the correct way to access the Spanish healthcare system for long term care, such as is required or advisable in pregnancy.
Most private healthcare companies require previous membership to cover care and the birth of your baby. Many foreign or expat women here in Spain will choose a private Obstetrician by hearing about them from a friend or reading about them on-line. You need to be happy and feel confident in your choice. Perhaps write your important issues or questions down before your first appointment to help remember to ask them. Never feel you are unable to get another opinion or meet another Doctor.
Ideally make your 1st appointment for when you are approx 8-10 weeks in order to be in time to have the choice of having 1st trimester screening between 11-13 weeks. Your first visit will include taking a medical/surgical & gynaecological history and usually having blood taken for group, rhesus, haemaglobin, Hepatitis B, Rubella, Toxoplasmosis and HIV – as a general guide. Your weight/height ratio (BMI) will be checked along with your Blood Pressure. Your EDD (expecteded date of delivery or fecha de parto de probabilidad, in Spanish) will be confirmed by doing a ‘dating’ ultrasound scan. It is recommended that your Tetanus cover is updated if required.
Antenatal screening is then offered to women in order to give them the possible risk of their babies having certain abnormalities eg; Downs Syndrome or Spina Bifida. Remember 95% of babies are born healthy and normal. The results are only a possible risk - written down or expresed as 1:1000 or 1:300 for example - and if found to be high you will be offered more accurate and definitive Antenatal diagnostic tests.
NOTE This is a general guide and individual women may have specific needs that require different care or screening. Personalised information can be obtained from your Midwife or Obstetrician.
Anne Halpenny has lived in Spain since 1993 and has worked in St Bernard’s Gibraltar & continues in the Hospital Costa del Sol, Marbella. She organises Antenatal classes in English & provides support for new parents, before & after the birth of their baby.
Contact her on 630 231 037 or visit her website www.irishmidwife.com