If you’re having a baby in Spain, here’s a guide to Spanish prenatal care, delivery, aftercare, and maternity and paternity leave in Spain.
Life brims with quirks and contradictions in the land of flamencos and familias, something you’ll discover also holds true if you’re having a baby in Spain.
You’ll be happy to know to know that Spanish healthcare including children’s healthcare is of a high standard and free for residents who work and live in Spain and contribute to social security. If you’re a legal resident working in Spain, you will likely already be paying health insurance through social security contributions towards state healthcare cover. Spanish public healthcare covers a number of maternity services, although only private healthcare insurance will cover giving birth in Spain’s private or specialized facilities.
Not so great is that you’ll almost always always need a native Spanish speaker by your side when navigating that healthcare system – especially in the delivery room!
Tired mums who just want to sleep may curse Spain’s fundamental sociability, which means a steady stream of visitors – friends, colleagues, extended family, neighbors – dropping in at all hours in the weeks after the baby’s born. In the weeks and months afterwards, it’ll also take some getting used to when strangers walk up to you and comment about your baby, her lack of shoes, what they think of his or her name, as well as when you’re offered unsolicited advice of all kind. But then again, nobody bats an eyelid when you breastfeed in public, or enjoy a caña on a terrace with your baby at 9pm.
This Expatica guide explains what you need to know about having a baby in Spain and what services are provided by the public Spanish healthcare system. It covers the following areas:
- Having a baby in Spain: an overview
- Finding a gynecologist
- Maternity insurance in Spain
- Pregnancy testing
- Prenatal care
- Giving birth
- Postnatal care
- Registering your baby
- Procedures for tourists giving birth in Spain
- Spanish maternity and paternity leave
- Tips for new moms
- Useful terms in Spanish
- Handy websites
Cigna Global provides comprehensive health insurance to over 86 million customers in over 200 countries. They have a wide access to trusted hospitals, clinics and doctors and provide expats with help on tailoring a plan to suit your individual healthcare needs.
In line with most developed countries, fertility indicators have fallen over the past few decades in Spain, from 14.1 live births in 1981 to 9.1 in 2013. The average number of children per women has gone from 2.03 in 1981 to 1.27 in 2013. However, Spain’s magnetic appeal and its popularity with expats have influenced birth statistics. Some 22.5% of all births in 2013 were to couples where at least one parent is a foreigner, although there are regional variations. Some 40% of births also now happen outside marriage in this strongly Catholic country.
When it comes to health care, the degree of medical contact with pregnant women is reasonably high in Spain, with more antenatal tests, scans and intervention during childbirth than in some other countries, such as the UK. The standard of care in Spain is highly regarded, both public and private, although women are generally required to have held a private insurance policy for a certain amount of time to cover maternity costs (e.g. 6–12 months), while state healthcare does not have any time restrictions.
In the larger cities, such as Barcelona and Madrid, maternity facilities are very comprehensive, ranging from large hospitals to smaller clinics. Larger facilities are usually run under the social security system, while smaller providers are via private health insurance. With the public system, you’re most likely be in the hands of a midwife for the duration of the birth, and you may not always have the same midwife throughout your pregnancy. The doctor is only likely to come in if there are complications or for special procedures.
In both cases, anecdotal evidence testifies to a variable standard between different facilities, so expectant parents are advised to seek recommendations and visit the hospitals in advance before making up their minds.
Even if you’re not covered by insurance, Spain is one of the more inexpensive places to give birth. You’re only likely to be billed around $1,950, with any complications adding minimal costs.
The Spanish aren’t big believers in home births and the practice isn’t regulated, so Dutch or other expats keen on keeping things as natural as do as much due diligence as possible, and ensure that backup is available in case of an emergency. Read more on home births in Spain.
Maternity health services are available through your local health centre (centro de salud or centro de asistencia primaria, shortened to CAP), or by an individual practice as a general doctor (médico de cabecera) – but you should ask friends and colleagues for recommendations if you want to consult an English-speaking professional. Remember that you can – and should – shop around to find a doctor you’re happy with.
Expats living and working in Spain are likely already paying health insurance through social security contributions towards state healthcare cover. If you’ve just moved to the sunny climes of Europe’s fourth-largest country, you can find out more about registering with a doctor in Expatica’s guide. In general, it’s worth remembering that Spanish health authorities are decentralized, so systems can differ between regions. A directory to all regional health bodies in the autonomous communities can be found on the Spanish health ministry’s website.
Spanish public healthcare covers a number of maternity services, although only private healthcare insurance will cover giving birth in private or specialized facilities.
Maternity care when having a baby is Spain is not included under the European Health Insurance Card (EHIC) scheme that covers public healthcare for EU nationals, so all foreigners should make sure their Spanish health insurance and social security has been sorted out. Being registered for social security is also necessary to receive the standard maternity leave of 16 weeks.
Mothers thinking about giving birth at a private clinic are usually required to held their policy for between six to 12 months before becoming pregnant, and it may be difficult to find an insurer after this period.
Worth noting are Ministry of Health statistics that put the rate of cesarean operations in Spain’s public hospitals at around 25.2% of live births, whereas in the private sector 28% to 38% of women have their babies via C-section. This is partly because more women take advantage of being able to fix their delivery date with private healthcare, but do enquire about procedures and in what circumstances the hospital feels a C-section may be necessary.
Some of the largest private health insurance companies which provide maternity coverage in Spain include:
Home pregnancy tests (pruebas de embarazo) are available over the counter at pharmacies (farmacias) for €10 and online at €7.
Alternatively, you can ring your local clinic (centro de asistencia primaria) directly and book in a consultation with a doctor. You’ll typically be seen by a midwife, who will ask about your own medical history, family history and so on, and it’s best to be accompanied by someone who speaks Spanish.
Expatica’s guide to finding doctors explains how to register with a doctor.
Once you think you may be pregnant, contact a doctor or primary care centre (Centro de Asistencia Primaria) as soon as possible to confirm the pregnancy and be examined. Read more about doctors and specialists in Spain. Routine blood tests and ultrasound scans will be arranged. Many clinics have a community midwife who will arrange monthly antenatal appointments with progress recorded in the consultation document, or ‘mothers’ passport’.
After your first meeting with a doctor, you’ll usually be seen by a midwife once every four weeks for the first 32 weeks and then every two weeks. Should there be complications, you may be asked to come in weekly.
Many clinics have a community midwife (comadrona/llevadora) who will arrange monthly antenatal appointments with progress recorded in the consultation document, also called a pregnancy booklet (cartilla de embarazo) or mother’s passport (not to be confused with a real passport). This document will be issued at your first appointment.
Clinics may or may not provide assistance with doulas. Spanish nurses spoke out against the emotional support assistants in 2015 and questioned their role, after which some doulas stopped working. The Asociación Española Red Circular de Doulas, established in 2011, has around 40 members across the country.
Scans, tests and checks
Spanish professionals monitor a pregnancy’s progress pretty thoroughly. Soon after the first appointment, you’ll head to the local hospital for a scan. Read more about main hospitals in Spain.
A number of tests will be conducted including for diabetes, toxoplasmosis and HIV. You will also have regular blood and urine tests. Three ultrasound scans – one each trimester – are the standard requirement to monitor the health of both mother and fetus, and to check for any deviations from the norm.
As the birth draws nearer there will also be a test for streptococcus B, which is compulsory in state hospitals. Should you be receiving treatment from a private hospital, then the test will only be carried out upon request (but be aware that Strep B is an infection you can pass on to the baby during delivery, so getting the test is recommended by most physicians).
The Spanish Association of Pediatrics recommends that pregnant women are vaccinated with a dose of TDAP – the inoculation against tetanus, diphtheria and pertussis (whooping cough) – between weeks 27 and 36 of gestation.
Prenatal classes are available for mothers and often their partners, and typically start in the 25th week of pregnancy, although it can be difficult to find them in languages other than Spanish.
In big cities and areas with large expat populations, such as the Costa del Sol, you’ll easily find courses in other languages, typically English, French and German. Some courses are listed below:
- Liana Doula, Barcelona
- Birth Barcelona, Barcelona
- The Irish Midwife, Costa Del Sol
- Bump2Baby, Jávea
- International Women’s Health Center, Madrid
- Pregnancy Pilates at Maxifisio, Madrid
- Antenatal Classes & Midwifery, Marbella
When you go to the hospital to give birth you should go to the emergency ward (urgencias) of the local hospital, and take your passport, foreign identification card (NIE) and necessary paperwork. English is not always widely spoken so it is sensible to have someone with you who can speak Spanish to ask questions and communicate your preferences concerning medical treatment. Spanish hospitals will have standard operating procedures that they don’t necessarily run past patients, so it is important to have someone to explain what is happening and to speak up for you.
Michelle Amato, an American expat who runs a website Spanishized: Insights from an American in Spain and who gave birth to her first child in Spain, emphasizes the importance of having a native speaker present even if you speak some Spanish: “I consider myself bilingual but would definitely not recommend going through this experience without someone native by your side. I realized this right after getting an epidural, when the doctor was asking questions to see if it was taking effect. He asked me if I was feeling numbness but for some reason I thought the word meant ‘cement’.”
Similar to Germany, hospitals in Spain do not allow gas or air, although epidurals and pethidine are available. Birth in Spain is seen as a fairly straightforward medical process and alternative birth methods, such as water births and birthing plans, are not as common in Spain as in other countries. However, you can still write your birthing plan in Spanish and take it with you.
Many expats having a baby in Spain choose to give birth in a private rather than a state hospital. This can be done if you have private health insurance cover. Standards of treatment are known to be high but you may need to provide more yourself. As Michelle explains: “If you give birth in a public hospital you don’t have to bring much as they provide you with diapers, etc. However, if you have your baby in a private clinic you need to bring almost everything with you – diapers, baby pyjamas and onesies, baby bath towel, toiletries both for the baby and you, etc.”
Home births in Spain
Home births in Spain are rare and not covered by the state health system. Costs of home births can range from €1,500 to €3,000. In 2015, less than 1% of Spanish midwives were registered to legally oversee a home birth in Spain. Midwives will only agree to perform a delivery at home when the pregnancy is low risk.
Anyone looking to have a home birth in Spain needs to ensure they have medical assistance. In 2018 a couple were sentenced to 15 years in prison after their newborn daughter died following a home birth because they didn’t seek medical assistance quickly enough.
Nevertheless, there are specialists in home births and the Spanish association for home births (in Spanish) claims to represent 90% of professionals in this field.
Immediately following the birth, the baby’s health will be thoroughly assessed based on the Apgar score, which rates the baby’s condition with particular focus on heart rate, breathing and reflexes. An overall score of between zero and 10 will be given, with 10 being the highest. Any concerns about the score will be addressed by the doctor or midwife. A score of seven or higher usually indicates that the baby is in good health, but a lower score doesn’t necessarily mean there will be any long-term health problems for the newborn.
Some common duties performed by nurses in other countries, such as supporting new mothers with personal care, are not generally done by nurses in Spain. Partners, family or friends are generally required to help. You can have one visitor with you throughout your time in hospital, including at night.
Most mothers leave the maternity hospital within five days, in which time at least two checks on the newborn will have been completed. A final examination will include a scan and you will be given an infant record book to track the child’s condition and health appointments until the age of 18. The baby will also have a blood test at one week to determine if there are any genetic defects.
A range of postnatal classes exist all over the Kingdom. The majority are in Spanish, but a large number are available in English, French and German in expat-heavy areas. Some institutes to consider are listed below:
- Piscina Climatizada Nucía, Alicante
- Bel & Mums, Madrid
- International Women’s Health Center, Madrid
- Family Medical Centre, Albir, Costa Blanca
- Angels Nursing Agency, Mallorca, Menorca and Valencia
- Laura Independent Midwife
Vaccinations for children
Spain follows a vaccination schedule pretty much in line with the rest of the EU. Children up to the age of 14 are assigned a paediatrician at the local health center (Centro de Salud), and the record book given to new mothers delineates the recommended vaccines.
The Spanish Association of Pediatrics has published an official schedule for each region, and each year, an updated schedule is released. Vaccines are not mandatory in Spain, nevertheless pediatric pressure remains high. In some cases, it can be difficult to get your child into school and summer clubs here if there is no immunisation record. All vaccinations in Spain are free under the national health service and are usually required up to the age of 14 years.
Nurseries and childcare
Schooling is not compulsory for the first six years of a child’s life in Spain, although it is recommended for a child’s development. The OECD reports that as of 2017 Spain has nearly full enrollment in early childhood education and care, at 95% for 3-year-olds and 97% for 4-year-olds.
It can be difficult to find information about good quality, inexpensive childcare no matter where you are, and even more difficult if you’re new to the country. Whatever your nationality, expect a few cultural clashes regarding attitudes towards child-rearing and childcare. Read Expatica’s guide to help you make the right decision for your family when choosing childcare in Spain.
Breastfeeding in Spain
Public breastfeeding is widely accepted in Spain’s family-focused society. Overall, however, only 77% of babies are breastfed in Spain.
Under Spanish law, mothers are entitled to take an hour off during each workday in order to feed an unweaned child for the first nine months of a child’s life. In 2010, the European Union Court of Justice ruled that working fathers in Spain have the same rights to breastfeeding leave as mothers do.
When you are being discharged following having a baby in Spain, the hospital will give you a yellow form to register the birth called a Cuestionario para la Declaración de Nacimiento en el Registro Civil. Check that the information is correct (especially your baby’s name) and that it is signed by the midwife or doctor who delivered your baby. A copy of the form is available on the Ministry of External Affairs website (PDF in Spanish).
You must register your baby at the local Civil Registry Office (Registro Civil) within eight days of the birth. If there is a valid reason, a delay of up to 30 days is allowed. If you intend to apply for a non-Spanish passport for your baby, remember to ask for a full birth certificate (certificación literal). In addition to the documentation provided by the hospital, you must also bring any national insurance documents belonging to the parents and a marriage certificate, which must be officially translated into Spanish. If the baby is born outside of marriage, then both parents must attend the registry office. It is generally advisable to bring your passports and identity cards (and copies), in case they are required to verify your identity.
The registration process for an adopted child in the civil register is relatively similarpaternit as for a biological child.
You can also sign your child up to social security so that you can access free vaccinations.
EU citizens who find they need to give birth while on holiday in Spain will be covered by reciprocal rules and their European Health Insurance Card is usually enough.
In line with the rest of the Schengen travel area, other visitors to Spain must have taken out a travel insurance policy. Typically, this will cover emergency delivery, but it’s best to check with your insurer if you think you’re likely to give birth on holiday. You may need to pay privately, and costs begin at around €2,000, but depending on the facility chosen, could range upwards dramatically.
Should you find you need to give birth earlier than planned in an emergency, ring the emergency helpline at 112. This number is free of charge and valid in all Spanish territories. The Spanish word for A&E department is urgencias.
If you ask a hotel or travel representative to call a doctor, they may book you into a private hospital, so be aware that you must call 112 for an ambulance and treatment under the state system.
Be aware that if you ask a hotel or travel representative to call a doctor, you may be treated privately. If you wish to be treated under the state system you must call 112 and ask for an ambulance to take you to the nearest state hospital.
Will my child have Spanish nationality?
Spain discourages birth tourism. At least one parent must have Spanish nationality to be eligible for citizenship.
Children of non-residents only acquire Spanish citizenship at birth if at least one parent was also born in Spain (except the children of diplomats accredited before the Spanish Government); if both parents lack any nationality or if their country’s law does not assign any nationality to their children; or the children’s filiation has not been determined.
Non-resident parents of minors that are Spanish nationals may be authorized to stay in the country as residents, under the so-called arraigo familiar (family reunification) policy, if the parents live with the minor, are in charge of the child, and meet all the obligations and responsibilities required of parents. The resident status under these circumstances is granted for one year and may be extended while the qualifying conditions are still met. The parents do not automatically gain citizenship through the birth of a child.
Read Expatica’s guide to obtaining permanent residence in Spain and Spanish citizenship.
Statutory maternity leave in Spain is 16 weeks, rising to 18 weeks for twins and 20 weeks for triplets, although at least six weeks must be take after the birth. Maternity leave is also extended to 18 weeks in certain special circumstances. Since July 2018, paternity leave has been set at 5 weeks, extended by 2 days for each additional child. Maternity benefits are also available to self-employed women, provided they are registered in the Spanish social security system.
In order to qualify for maternity benefits after having a baby in Spain, you must have been paying contributions for a set period of time (zero for mothers under 21; 90-180 days for mothers aged between 21 and 26; or 180-360 days for mothers over 26). These processes can take time to complete, so it’s important to plan these things in advance.
The amount of maternity benefit you receive will depend on things like your salary, your contributions and which part of Spain you live in. Explains Michelle: “It depends on your company whether you’ll receive 100% of your salary or not. Also, in Madrid, you’re entitled to an economic stipend of €100 a month if you’re a working mother.”
Extended maternity leave is also available for women who cannot perform their job because it puts their pregnancy at risk. Extended benefits are also offered to breastfeeding mothers if their job prevents them to nurse. After the birth, breastfeeding mothers are eligible for two paid, half-hour daily breaks to either feed or express milk. Both are also accessed through the social security.
Support for mothers after the birth or adoption is slightly limited in Spain, principally because women have relied on strong family networks and there has been less of a need than in other countries. You can, however, always visit the midwife at your local health center for help or questions, or visit a pediatrician. In some popular expat areas, you can also find English-speaking mothers groups and midwives for support. However, most women go back to work immediately after the 16 weeks, which means mother and baby groups are less common. Thus, the standard option for daycare is the nursery (guarderia), which often takes children from a few months old and upward.
Child benefits in Spain
If your family experiences financial difficulties because of your children’s birth or adoption, various benefits are available, provided you are resident in Spain.
If your yearly income does not exceed €11,605.77 (or €17,467.40 if you have a large family of at least three dependent children), you can apply for benefits currently set at €291 a year per child until the children turn 18. If you have children with disabilities, benefits are awarded of between €1,000 to €6,658.80 per year, depending on the severity of the disability.
You may also be eligible for benefits for multiple birth or adoption if you give birth to or adopt two or more children at the same time, from €2,943.60 upwards.
More information, including the documents required, is available at the European Commission website.
- Spaniards adore babies – don’t be alarmed if passers by ask questions, peek into your stroller, play with or kiss your baby or openly offer opinions on your child-raising choices, even your baby’s name.
- Public breastfeeding is acceptable – in general, you do not need to worry about covering up. Says Michelle: “There’s a strong culture and acceptance of breastfeeding which makes it easier to get out of the house and do things.”
- The Spanish population are generally respectful to pregnant women and new mothers, and will give up their seat on public transport or risk the disapproval of a bystander.
- Strangers are open to sharing their mothering advice; a common comment will be on whether your baby is dressed appropriately for the weather or if your baby isn’t wearing shoes or something to keep their feet warm.
- It is not uncommon for baby girls to get their ears pierced, which helps avoid gender confusion, so don’t be offended if people mix up your baby’s gender if you opt not to do it.
- Children are accepted into all parts of society. It is acceptable to take a stroller into restaurants and bars, and children are allowed to stay up late with adults. You are unlikely to get disapproving looks for having a screaming baby in public.
- Not all facilities cater for babies, and you may find restaurants and bars lack changing areas. In such cases, people are generally not bothered if you change your baby in public.
- Midwife: matrona/comadrona
- Epidural: epidural (stress on ‘al’)
- Scan: ecografía
- Maternity scan ward: tocología
- To give birth: dar a luz (literally ‘to give light’)
- To express how many months pregnant you are: Estoy embarazada de x méses
- To breastfeed: dar el pecho.
For easy reference, we’ve pulled together the websites you need to consult when having a baby in Spain. You’re welcome.