Private healthcare

PRIVATE HEALTHCARE
21% of births are carried out in private clinics. Although it may seem that by paying to go private there will be more choice, this is really not the case where childbirth is concerned. Intervention levels in the private sector are far higher than in the public sector (36% caesareans as opposed to 22% in the public sector). The main advantage of going private is that you can choose your gynecologist. Also, since you will be in a clinic rather than a teaching hospital, you are likely to have more privacy. If you do plan to use private healthcare and you have specific concerns about the birth, it’s essential that you find a gynecologist that is sympathetic to your wishes. For a list of private gynecologists who are pro-natural birth (and who may also deliver breech vaginally) see  Birth Professionals.

PRENATAL
I have private insurance. Will this cover all my prenatal and birth costs?
Pregnancy and birth is covered by most insurance companies. However, you must have had the insurance policy for a stipulated amount of time before you get pregnant. The amount of time can be up to 12 months – this will be clearly stated in your contract. When looking for a good insurance policy also check if your newborn baby is covered at all, and if so, for how many days. Many insurance policies do not cover birth defects or hereditary illnesses.

I’m not happy with the options that my insurance offers. Can I change to another insurance company?
Most insurance companies will allow you to transfer to them whilst pregnant if you had your previous insurance for the stipulated time before getting pregnant.

Who will I see for my antenatal visits?
Your antenatal visits will be with the gynecologist that you have chosen.

How often will I see my gynecologist?
Generally, for the first months of your pregnancy you will see your gynecologist once a month. This will probably increase in the last couple of months to once every two weeks or weekly, depending on how the pregnancy is going.

Will this gynecologist attend my birth?
Yes, unless an emergency comes up. Occasionally, the woman is expected to pay extra to have her gynecologist at the birth. Clarify this with your gynecologist beforehand.

What if I don’t like my gynecologist?
You can choose a different one covered by your insurance company.

How many ultrasound scans will I have?
This will depend on your gynecologist. Often, a scan is performed at each visit, generally carried out by the gynecologist in his/her practice. The second trimester scan may be carried out by a specialist. At some centres this may not be covered by your insurance policy, in which case you can either pay extra or go to a specific centre just for that scan where your insurance policy does cover it.

Will I be offered a nuchal translucency scan? (see Glossary)
Yes, this is standard practice in Spain.

Will I be offered an amniocentesis? (see Glossary)
Your gynecologist will review the results of the triple blood test  (see Glossary) and the nuchal translucency test with you to help you determine whether an amniocentesis is advisable in your case.

What antenatal classes are available? Can my partner attend too?
Your health insurance will offer antenatal classes, although you may have to pay extra for them. Some do not allow partners, except for some particular classes.

Will I be able to discuss my birth plan?
Birth plans are not common in Spain and you will probably have to shop around to find a gynecologist who is happy to discuss your birth plan with you.

Will I be able to choose where I give birth?
You will be expected to give birth where your gynecologist attends births. If you have a preference for a particular clinic then you should choose a gynecologist who works at that clinic.

Will I be shown around the labour ward before the birth?
This is not standard practice. Ask your gynecologist if she/he can arrange a visit for you.

Will I be able to see the clinic’s protocol beforehand?
No, although you can ask your gynecologist to tell you about the clinic’s standard procedures.

Will I be able to know the sex of my baby?
It is standard practice in Spain to find out the baby’s sex. If you don’t want to know, make sure you tell the person doing your scan.

BIRTH
I would like to have a natural birth. Will this be possible?
At present no private clinic in Barcelona offers natural birth as an option. Some gynecologists are more pro-natural birth than others. If you want your birth to be as natural as possible, you should invest time in finding a gynecologist who respects your wishes.

Who will attend my birth?
You will be attended by a gynecologist and midwives.

Do any private clinics in Barcelona offer birthing pools?
No

What birthing aids will be available to me? (birthing ball, chair etc)
Generally, there are no birthing aids available.

Will I be able to move around freely during labour?
Generally, women are not encouraged to move around, partly because they are attached to a drip and a fetal monitor, which make movement difficult. If you do not have continuous monitoring you may be allowed to move around, depending on the staff attending you. Most clinics have special birthing beds that can be moved into a semi-seated position.

Can I choose my own position for the delivery?
This is very unlikely unless your gynecologist has previously agreed to it in your case. When birth is imminent, you will be moved from the labour ward into a delivery room (sala de partos), where the majority of Spanish hospitals still employ the lithomy position – woman on her back, feet in stirrups.

Will my partner be able to cut the cord?
This will depend on the gynecologist attending your birth.

Will the cord be cut immediately or left for a few minutes?
The cord is usually cut immediately.

What routine procedures may affect me? What if I do not want the procedure?
Each hospital will have a standard protocol. Whether you are able to negotiate your way out of some of them will depend very much on the individual hospital and the staff attending you at the time. Standard procedures may include:
Shaving of the pubic area and enema. Standard practice a few years ago, both are now increasingly uncommon in Catalunya.
Continual fetal monitoring. Originally designed for high-risk births, continual fetal monitoring (see Glossary) has become standard practice in the majority of births.
Induction Oxytocin (see Glossary) is frequently used to speed up labour (in an estimated 80% of births, Spain-wide). It is generally applied intravenously through a drip.

What pain relief options will be available to me?
Generally, the only pain relief option is an epidural. (see Glossary)

Will I be supported if I do not want pain relief?
Your request may be met with surprise and some incomprehension as the epidural has become routine in Catalunya and used in 95% of births. The support you receive will depend very much on who is attending your birth

Will I be able to eat and drink during labour?
No

How long will I have to dilate naturally before they decide to speed up my labour.
This will depend on the staff attending you. It is very common for a slow labour to be speeded up with oxytocin even when there is no cause for worry. If you are against this, you should make your feelings known.

Under what circumstances will I be given an episiotomy?
Episiotomies (see Glossary) are very common in Spain and are applied in approximately 85% of births. An episiotomy is more likely if you have an epidural as you will have less control over when you push and you are more likely to need a forceps delivery.

POSTNATAL CARE

Will I be given my baby to breastfeed immediately after the birth?
Yes, as long as he/she is breathing well.

What procedures will be carried out on my baby as soon as it is born?
Your baby will be given an Apgar test, weighed and measured and will receive eyedrops and a vitamin K injection.

Will my baby be taken away for tests?
The above procedures can be carried out in your presence. However, many mothers still report that their babies were taken away for a period of time for no apparent reason particularly in private clinics. You are within your rights to insist that the baby stays with you unless there is a medical reason for doing otherwise.

Will my baby be allowed to stay in my room with me for the duration of my stay?
Yes.

How long will I stay in the clinic?
After a normal birth you will stay in the clinic for three days. After a caesarean, you will stay for five days.

Will I be helped with the breastfeeding?
Normally you can expect to receive help with breastfeeding. How much help you get will depend on the individual clinic and the staff attending you.

Will there be restricted visiting hours for my partner?
No. Guests will be allowed at any time. You will have your own room which will probably have a sofa which your parner can sleep on.