As a resident in Spain, whether you're working for a company or are self-employed, you have access to the public healthcare system throughout your pregnancy. Public healthcare in Spain is organized regionally, by autonomous community, which means it can vary somewhat in the different regions of Spain. For this article, I use the information provided by the Andalusian Health Service ¨Servicio Andaluz de Salud (SAS)¨, which offers the medical care for all pregnant women residing in the region, so this includes Malaga and Costa del Sol, where I am based. If you've elsewhere in Spain it might differ slightly, but in general it will look more or less the same.
How maternity care is arranged in Spain in short
As soon as you find out you are pregnant you will be assumed to go to your family doctor in your own local healthcare centre so you can be identified as being pregnant. From that moment on the regular visits start;
- more or less every 4 weeks until week until week 32
- from week 32 on every 2 weeks when you and your baby are in good health.
Most appointments will be conducted by either your family doctor, midwife or nurse at the healthcare centre in your town or village. Further on in this article I give an overview of what is scheduled for which week of pregnancy in the first trimester.
Can I refuse standard maternity care offered in the public system?
In this article, I discuss the standard care that is offered in the public healthcare system. You can also choose to do the doctors visits or tests at a private clinic and not go to the public hospital or you can choose to do some visits in the public system and some in a private clinic. Check for the private clinic if your insurance covers you. For most insurances you have to be insured for 9 or 10 months already before they cover the maternity care. You can also often choose to pay out of your own pocket or not to have an of the maternity care that is provided. None of the appointments, tests or scans are mandatory.
Maternity care in the social healthcare system in Spain - 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. Learn more about the prenatal diagnosis of congenital anomalies in this article.
A test for Gestational Diabetes Mellitus (GDM) will be offered when you are identified as being part of the at risk population. Read more about this here.
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 Spain
In this article, I've delved into the maternity system in Spain, based on the information on how its is arranged in Andalusia, 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.
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