As a resident in Spain, whether you're working for a company or self-employed, you have access to the public healthcare system throughout your pregnancy. Healthcare in Spain is organized regionally, by autonomous community, which means it can vary somewhat in the different regions of Spain. In this article, since I give my HypnoBirthing Courses mainly in Malaga and the Costa del Sol, I´ll focus on how healthcare for pregnant women is structured in Andalusia.
Here in Andalusia the healthcare is arranged by The Andalusian Health Service ¨Servicio Andaluz de Salud (SAS)¨, which offers the medical care for all pregnant women residing in the region.
Standard maternity care offered in the public system
In this article, I discuss the standard care that is offered in the public healthcare system. None of this is mandatory, and you are always free to make your own choices regarding whether or not you want a particular appointment, test, or scan. Hospital policy is not equivalent to the law, and as a human being, you have the freedom to make your own choices, even if they don't align with hospital policies.
Of course, when making choices that differ from the recommendations of a doctor, healthcare provider, or hospital policy, it's important to have a clear understanding of why you want to deviate from the recommendations. While some may argue that it's crucial to always have a solid rationale for any decision regarding your own or your baby's health, whether you're following or going against medical advice, ultimately, your health and the health of your baby are your responsibility, always.
Structure of this blog and where I got the main information from
The information in this article is sourced and translated from the Junta de Andalucía. Throughout some paragraphs, I provide simplified explanations of certain topics or tests to make them easier to understand. Originally intended as one blog post, I've divided it into three separate ones according to trimester for the sake of not overwhelming you.
Maternity care in the social health system during your first trimester
These are the prenatal visits that will be offered to you and what each visit will include:
First prenatal visit - Week 8 (6-10) conducted by family doctor
When you find out you are pregnant you can make an appointment with your family doctor in your own local healthcare centre (Centro de Salud). In this visit your pregnancy will be recorded and you will be identified as being pregnant. This identification step can also be done in the ClicSalud+ website and mobile applications.
Second prenatal visit before the 10th week of gestation conducted by family doctor, midwife or nurse
The second appointment is then with your family doctor, midwife or nurse of the healthcare centre (centro de salud). This is done by a prior appointment (cita previa).
The local healthcare centre (centro de salud) will have a protocol that unifies and defines the set of actions and check-ups, distributed between the healthcare centre and the public reference hospital, which agrees on both the visits to be made and health actions* that are required according to the protocols, in the corresponding care setting and the health actions that you require. This will depend on the categorisation of having a low risk or high risk pregnancy.
*health actions: blood and urine analyses, prescriptions supplements, ultrasounds, tests, vaccination and/or monitoring.
What will happen during your second prenatal visit?
During this appointment your medical history will be taken, an assessment of your general health condition will be made, a classification of the risk of your pregnancy made, a review and/or update your gynaecological-obstetric status will be done, your blood pressure will be recorded, your body mass index will be measured, and your vaccination status will be discussed.
They will also communicate health recommendations, speak about nutrition and disease prevention (toxoplasma, listeria, Zika, Chagas disease), review the vaccination schedule for pregnant women and encourage vitamin supplementation.
Bare in mind that all recommendations are exactly that; recommendations. This means you can make your own choice whether or not to undergo the cervical screening, take supplements, take medication, do tests, do scans or a vaccination during any point in time.
During this visit the next visit(s) with your midwife are planned to monitor your pregnancy. Also tests are requested and advice is given on a healthy lifestyle.
In this appointment also the Pregnancy Health Document (Documento de Salud de la Embarazada-DSE) will be provided. This is a booklet with information for pregnant women, which contains forms with all the information that health personnel should know about for the development of your pregnancy. If you want to know what the document looks like check this link.
Third prenatal visit Week 12 (11-13) conducted by an obstetrician and/or auxiliary nurse
At all visits, your medical history will be taken with a review of your Pregnancy Health Document (Documento de Salud de la Embarazada-DSE) and clinical examination. At all appointments your weight and blood pressure will be taken and noted in your Pregnancy Health Document. The need for additional care will be assessed and advice on healthy lifestyle habits will be reinforced.
If you choose to do the combined first trimester screening this will be performed during this appointment.
Prenatal diagnosis of congenital anomalies
In your first trimester you will also be offered prenatal diagnosis of congenital anomalies (birth defects) and laboratory tests can be requested according to the process schedule to be performed between the 9th and 10th week of gestation.
The combined screening test can identify a pregnancy with increased chance of Down syndrome (trisomy 21) and Edward syndrome (trisomy 18). This test involves the pregnant woman having a blood test between 9 and 13 weeks gestation, and an ultrasound between 11 and 13 weeks gestation.
The Andalusian Health Service (SAS) has incorporated prenatal blood testing into the Congenital Anomalies Screening Programme, which will avoid in many cases the need for invasive techniques, which until now were necessary to confirm the diagnosis of foetal chromosomopathies. The chromosomal abnormalities tested for are: trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome).
Specifically, it will apply to women who are found to have a risk of 1/50 to 1/280 in first trimester combined screening and those who have a previous child with a chromosomopathy. Read more about it in this link., this is the source I used. Or you can check this document when you want to look into it even more. It is in Spanish, so you might need to translate since it´s not so easy to read.
If you want to do this diagnosis is up to you. A good question to ask yourselves is what wil you do with this information? Will a positive test mean you end the pregnancy? Would you want to go on and get more tests to make a more accurate diagnosis? Will this bring you stress or will this give comfort?
O'Sullivan test or blood sugar test
A test for Gestational Diabetes Mellitus (GDM) will be offered when you are identified as being part of the at risk population.
The test is called the O'Sullivan test. This test determines the amount of glucose in the blood after ingesting 50 grams of sugar. After one hour, a blood sample is taken and the result is determined. For this test you can go to the health centre to take the sugar drink and remain there until the test is done one hour later. You should not eat or smoke during that hour.
In the case your glycaemia result is high after one hour (≥ 140 mg/dl), the test is considered positive. As this test is not a 100% determinant test, a second test will be used to establish the definitive diagnosis as it is a much more specific test. This second test will be used for the diagnosis of gestational diabetes, this test is called Oral Glucose Tolerance Test (OGTT)(Sobrecarga Oral de Glucosa – SOG).
Tests, scans and high risk pregnancy classification
Throughout this journey, your health and the health of your baby are of the utmost priority. Taking responsibility by considering what best suits your situation and asking yourself why you should undergo a test or scan, as well as contemplating the potential consequences of the outcome, is always wise.
When you're categorized as having a high-risk pregnancy, it's especially important to delve deeper into this classification. What exactly does it mean? Why have you been placed in this category? Do you agree with the assessment? Are there additional details you can gather to better understand your situation?
By seeking further information and understanding, you empower yourself to make informed decisions that prioritize the well-being of both you and your baby.
Conclusion prenatal care in Andalusia, Malaga and Costa de Sol
In this article, I've delved into the maternity system in Andalusia, Spain, shedding light on the standard care offered to pregnant women. While I've strived to provide clarity and accurate translations, it's important to note that there may be variations in care provided by different healthcare providers, and this document is subject to change. The version I've referenced was updated on 03/06/2022. If you have any questions or concerns, I encourage you to reach out to your healthcare provider directly for clarification. You can also check for yourself the Spanish document I´ve used if there are any uncertainties for you.
Stay tuned for the next blog post, where we'll delve into the prenatal visits and procedures during the second trimester. If you have any personal questions or concerns, don't hesitate to reach out to your healthcare provider for guidance.
Add comment
Comments