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 to give birth in Spain, you’ll be happy to know that Spanish 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 income tax 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 specialised facilities. This guide provided by leading international health insurance provider BUPA Global explains what you need to know to have 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 (eg. 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.
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, although 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 physician centre (Centro de Asistencia Primaria) as soon as possible to confirm the pregnancy and be examined. Read about doctors and specialists in Spain. Routine blood tests and ultrasound scans will be arranged. Many clinics have a community midwife who will arrange antenatal appointments, generally once a month with progress recorded in the consultation document, or ‘mothers’ passport’.
Your next port of call will be the local hospital for a scan. Read 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, possibly monthly. In most cases the midwife will schedule you for a scan once 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.
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Maternity care 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. In order to qualify you must have been paying contributions for a set period of time (zero for mothers under 21; 90 days for mothers aged between 21 and 26; or 180 days for mothers over 26 or 360 days in their entire working life in Spain). These processes can take time to complete, so it’s important plan these things in advance.
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, for example, in Costa del Sol there is a course run in English.
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.
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; an example (in Spanish) can be found here.
Home births in Spain, meanwhile, are rare and not covered by the state health system. In 2015, less than 1 percent 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, and 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 the hospital will give you a yellow form to register the birth, Cuestionario para la Declaración de Nacimiento en el Registro Civil. Check the information is correct (especially your baby’s name) and that it is signed by the midwife or doctor who delivered your baby.
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, which can provide access to free vaccinations.
Spanish maternity and paternity leave
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 take children from a few months old and upward.
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 if the child has special needs, was born to a single-parent who is the sole provider, or was born into a large family.
Maternity benefits are paid by Seguridad Social, the Spanish social security system, and thus also available to foreigners holding a Spanish residence permit and paying social security or covered by a family member’s social security. To qualify, you must have paid contributions for at least 180 days in the last seven years if you are 26 or older with certain exceptions, for example, those aged 21–25 qualify in fewer days and women under 21 have no contribution period.
Maternity benefits are also available to self-employed women, provided they are registered in the Spanish social security system for the self-employed, the régimen especial trabajadores autónomos. Women also qualify following an adoption. You apply through your local social security office. The application form, the Solicitud de prestación de maternidad por nacimiento, adopción o acogimiento del Régimen Especial del Mar, can be found online in Spanish only. You can read more about social security for the self-employed.
Fathers receive 15 days of paid paternity leave but are entitled to take three years of unpaid leave (or longer if there are complications with the mother). The government plan to increase paternity leave to one month in 2015 was put on hold for economic reasons. Similar to mothers, the minimum contribution period is 180 days within the last seven years or at least 365 days during the entire working life in Spain.
Maternity and paternity leave can be taken part-time if an arrangement has been made with the employer ahead of the birth. In the case of patenity leave, a part-time day must be no less than 50 percent of the full-time workday. In the case of a birth (versus an adoption), the mother cannot avail of part-time maternity leave until after the mandatory six-week, full-time maternity leave period after the delivery.
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.
To apply for leave, you must fill out a form with the Spanish social security office. Read more in our guide to sign up for Spanish social security and claim your benefits.
Tips for mothers in Spain
- Spaniards adore babies – don’t be alarmed if passerbys 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.
- 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. Nor will you get disapproving looks for having a screaming baby in public.
- Not all facilities cater to babies, and you may find restaurants and bars lack change tables. In such cases, people are generally not bothered if you change your baby in public.
Helpful pregnancy-related Spanish terms
- 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.