Pregnancy and birth in Spain: the public and private systems, how to find a gynaecologist and what to expect along the way

Public system

Unlike in many other countries, the main care provider for pregnancy is the Obstetrician or Gynaecologist as opposed to a midwife. However, in recent years, Spain has seen increasing number of Spanish midwives who want to provide home birth and other natural birth options.

Antenatal care is provided in local health centres (Centro de Salud) and you will then be referred to a local hospital for the birth or sooner if you are having a detailed scan or problematic pregnancy. Antenatal Screening can vary slightly from one region to another region. When the pregnancy is confirmed your gynaecologist 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, which 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 or you can return at 15 weeks to have an amniocentesis. This test takes a sample of the baby’s amniotic fluid, through a needle placed carefully into your abdomen and analyses 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 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 (glucose tolerance) tests for diabetes. Starting at 37 weeks of pregnancy your baby will be 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.

Private system

Private Healthcare is a preferred choice for many foreigners. Be sure you take any policy out before you get pregnant otherwise your pregnancy will not be covered. It is also worth noting that caesarean section rates at these clinics are fairly high. A Gynaecologist/Obstetrician will conduct all of your care within the private sector, which follows a similar pattern to the process in the public sector but with routine scans at almost every appointment. Your Gynaecologist will often work from a local clinic but may take you to a private hospital for the actual birth. If there are language issues be sure you understand any cultural differences that the labour process will entail.

For more information on pregnancy and birth as well as women’ s experiences of having a baby in Spain please visit the pregnancy and birth section of the MumAbroad Spain website