Public healthcare

PUBLIC SYSTEM
78% of births are carried out in public hospitals. Statistics regarding level of interventions tend to be considerably better in the public hospitals than in the private clinics (22% caesareans, as opposed to 36% in the private sector). The changing attitude to childbirth is also more apparent in the public sector, where many midwives are pushing for a more respectful and less standardised approach.
PRENATAL CARE
I just found out that I’m pregnant. What should I do?
You should call your CAP (Centro de Asistencia Primaria) to arrange an appointment with a midwife (comadrona/llevadora). If you don’t yet have a health card (targeta sanitaria), get in touch with your local CAP for information about how to go about getting it. At your first appointment you will be given a pregnancy booklet (cartilla de embarazo). This booklet will be used by your midwife to record all information about your bloodtests, scans and anything else related to your pregnancy. You are expected to bring the booklet to all your prenatal checkups and to the hospital for the birth. As well as the midwife you will also be assigned a gynecologist who you will see for scans.


How often will I see my midwife and gynecologist?

If you have a normal pregnancy with no problems you will probably have a monthly checkup with your midwife and a visit each trimester to the gynecologist. This may vary according to the CAP. Towards the end of your pregnancy, checkups will be more frequent depending on how the pregnancy is going.

Will these people also attend my birth?
It is very unlikely that the same midwife or gynecologist will attend at your birth.

Will all my appointments be at the CAP?
This will depend on the facilities your local CAP has. You may have appointments at your CAP or at your local hospital.

What if I don’t like one of the people attending me? Can I change?
Yes, you have the right to change until you find someone you are happy with. You also have the right to ask to be attended by a female gynecologist if you prefer.

How many ultrasound scans will I have?
During the course of a normal low-risk pregnancy there are usually three scans, one per trimester. These are carried out by the gynecologist.

Will I be offered a nuchal translucency scan? (see Glossary)
Yes, this is standard practice and generally carried out during your first scan.

Will I be offered an amniocentesis? (see Glossary)
All women over the age of 35 are offered an amniocentesis and will be offered a meeting with a specialist to determine whether one would be beneficial or not, depending on the results of the triple test (see Glossary) and the nuchal translucency scan.

What antenatal classes are available? Can my partner attend too?
From about week 25, you will be able to attend antenatal classes at the hospital where you will be giving birth. These classes are usually conducted by a midwife. Most centres now allow partners also to attend, but check beforehand as there are some places that do not encourage it.

Will I be able to discuss my birth plan? If so, who should I discuss it with?
Birth plans are not yet the norm in Spain, although they are becoming more common. Submitting a birth plan however, is no guarantee that your wishes will be followed. According to the association El Parto es Nuestro, who campaign for more rights for women giving birth, you should send three copies of your birth plan to the hospital where you will be giving birth. One should go to Atencion al Usuario, one to Servicio de Ginecologia y Obstetricia and the other to Servicio de Neonatologia. You should ask that it be included with your notes. For an example birth plan in Spanish, click here.

Will I be able to choose in which hospital I give birth?

You will be assigned the hospital that corresponds to your CAP. If you have a particular wish to go to a different hospital you can ask your midwife to make the change.

Will I be shown around the labour ward before the birth?
Mothers-to-be are not shown around the labour ward before the actual birth. If this is important to you, talk to your midwife and see if she can arrange a visit for you.

Will I be able to see the hospital’s birth protocol beforehand?
Although every hospital has a protocol for birth, which will detail which procedures are routine and what course of action the staff should follow in each given situation, it is near impossible to actually get to see the protocol. It is probably more effective to get as much information as you can from your midwife, who will be familiar with the hospital’s protocol. The only protocol that is openly available is the natural birth protocol at the Maternitat hospital (see protocol).

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, the only hospital in Barcelona that has a protocol for natural birth (where the birth proceeds at the woman’s pace with freedom of movement, choice of position etc) is the Hospital de la Maternitat. However, they only have one natural birth room and a limited number of midwives trained in natural birth, so can only attend one natural birth at a time. Hospital Sant Pau does not have a natural birth room yet (but plans to within the next two years) but does have a very good reputation for trying to respect the woman’s wishes as far as possible.

Who can I have with me during the labour?
You can have one person with you (usually, but not necessarily the partner) for the whole of the labour and birth. If you want another person present you will have to request it.

Who will attend my birth?
A gynecologist, anesthetist, midwife and auxiliary nurse. In the public hospitals there may well also be students present at the birth. You may or may not be asked/informed about this beforehand, so make your feelings known if you would prefer not to have students present.

Do any hospitals offer birthing pools?
At present, no hospital in Barcelona has a birthing pool.

What birthing aids will be available to me? (birthing ball, chair etc.)
Generally, there are no birthing aids as such 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 hospitals have special birthing beds that can be moved into a semi-seated position.

Can I choose my own position for the delivery?
Unless you have an extremely sympathetic midwife with you, this is very unlikely. When birth is imminent, you will moved from the labour ward into a birthing 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.

Continutal 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?
Generally not.

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. 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 hospital/clinic?
After a normal birth you will stay in hospital 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 hospital and the staff attending you.

Will there be restricted visiting hours for my partner?
No, hours are normally not restricted.