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.
If you’re planning on having a baby in Spain, you’ll be happy 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 private or specialized facilities. This guide provided by BUPA Global explains what you need to know about having a baby in Spain and what services are provided by the public Spanish healthcare system.
Spanish maternity 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.
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The traditional option of birth in a hospital is by far the most common in Spain, although in some areas home births are becoming available. This is at a far slower rate than in other European countries.
Prenatal care in Spain
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’.
Your next port of call will be 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. In most cases the midwife will schedule you for a scan once per month up until the 32nd week of pregnancy, at which point the frequency of appointments will increase to once every two weeks. 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).
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.
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 some areas courses can be found in other languages, typically areas with larger expat populations such as Costa del Sol.
Giving birth: Delivery in Spain
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, emphasises 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 realised 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 are rare and not covered by the state health system. In 2015, less than 1% of Spanish midwives were registered to legally oversee a home birth in Spain.
Maternity aftercare in Spain
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.
Registering your baby’s birth in Spain
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 (in Spanish) is available here.
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 similar as for a biological child.
You can also sign your child up to social security so that you can access free vaccinations.
Spanish maternity and paternity leave
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 centre 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.
Tips for mothers in Spain
- 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.
Helpful terms when having a baby in Spain
- 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.