Second trimester guide to maternity care in Spain

What prenatal appointments can you expect during the second trimester?

The schedule includes three main appointments during this period.

The schedule is based on the Andalusian Health Service (SAS). Timing and appointments may vary between autonomous communities and according to your individual circumstances.

Informed Choice and Medical Procedures

It is crucial to understand that all medical procedures during pregnancy – including ultrasounds, blood tests, screenings, vaccinations, and examinations – are entirely voluntary. While healthcare providers may recommend these tests, you have the absolute right to decline. 

Are ultrasounds completely harmless?

In my first pregnancy, I was so excited to see my baby! I had read that it was not recommended to have too many ultrasounds and that I could decline them, so I decided to reduce the number of scans as much as possible. I combined the appointments at weeks 8 and 12, and that was it.

I was looking forward to finding out my baby's sex and preparing for the birth, so I didn't give it much more thought. Looking back, I wish I had known more about ultrasound examinations. I would have made different decisions for sure.

We do not have high-quality studies comparing the long-term development of children exposed to modern, high-output ultrasound with that of children who were not exposed. This topic deserves a much more detailed explanation, which I will explore in a future deep-dive article. For now, we simply do not know whether modern ultrasound exposure is safe or not.

If you would like another perspective from an experienced midwife, you can read Sarah Buckley's article on ultrasound scans in pregnancy.

Choosing to do or not to do the ultrasound is absolutely up to you and your partner. Your body, your baby, your choice.

What does this mean for your second-trimester scan?

The quadruple test: what does it tell you?

If you have not previously had prenatal screening for congenital conditions, the Andalusian pathway provides for a blood test called the quadruple test, offered up to 17 weeks of pregnancy.

The test measures four biochemical markers in your blood and estimates the chance of certain conditions, particularly:

• Down syndrome (trisomy 21)

• Edwards syndrome (trisomy 18)

• Open neural tube defects, such as spina bifida

The test cannot tell you with certainty whether your baby has a condition. It estimates the likelihood, and the accuracy varies depending on the condition being screened for. A result indicating a higher chance does not mean that your baby definitely has the condition.

A higher-chance result may lead to further testing, such as another screening test or a diagnostic test. Some diagnostic tests, including amniocentesis, carry a risk of miscarriage.

Before starting screening, consider what you would want to do with the result. Would you want further testing if the result indicated a higher chance? If you would not pursue further testing, consider whether you want to begin the screening process at all.

These are personal decisions. It is worth understanding the possible next steps before deciding whether to have the initial test.

For more information, read my guide to prenatal tests, scans and screening in Spain.

Gestational diabetes screening

Gestational diabetes is diabetes that develops during pregnancy. In Spain, generally screening is offered between weeks 24 and 28, although it may be carried out earlier if you have particular risk factors.

The initial screening commonly involves the O'Sullivan test: you drink a glucose solution and have your blood glucose measured afterwards. If the result is above the screening threshold, you may be offered a longer oral glucose tolerance test to establish whether you have gestational diabetes.

Ask what each test involves, how its result will be interpreted, and what would happen if the result were outside the expected range. A screening result is not necessarily a diagnosis.

If you are offered a test, make sure you understand whether it is screening for a possibility or diagnosing a condition. The distinction matters because it affects what the result can tell you and what may happen next.

Gestational Diabetes Screening

• If previously diagnosed or at risk, you'll be offered an Oral Glucose Tolerance Test (OGTT)
• Otherwise, screening will be conducted between weeks 24-28

Vaccination Recommendations: two vaccines may be discussed:

1. Tdpa (Tetanus, Diphtheria, Pertussis): Recommended during pregnancy
2. Flu shot: May be offered simultaneously

Important when you are not getting tested on Hepatitis B

A special consideration concerning vaccines is that if you decide not to get tested for Hepatitis B during your pregnancy, your status when giving birth is unknown. In this case your baby will be treated as if you would be positive for Hepatitis B. This means:

• As a standard of care within 12-24 hours of birth, your baby may receive:
  • Hepatitis B vaccine
  • Anti-HB immunoglobulin

As with other medical procedures also this you can decline, but you have to be very clear about it. Check here the vacination schedule of Andalusia, by the Junta de Andalucía.

Important Vaccination considerations

While these vaccines are routinely recommended, it is crucial to approach them with a critical and informed mindset. Vaccination is not a one-size-fits-all medical decision. Consider carefully:

• What is the actual risk of the disease you're vaccinating against?
• Are you capable of naturally fighting off the illness?
• What are the potential short-term and long-term effects of introducing these vaccines into your body?
• Are you comfortable with the additives and foreign substances being introduced directly into your bloodstream?

Vaccines contain more than just the targeted pathogen – they include adjuvants, preservatives, and other substances that may raise questions. Take time to conduct thorough, independent research from multiple sources, including scientific studies, medical journals, and alternative health perspectives.

For those seeking additional information and resources about vaccination, I'm happy to provide guidance on books, documentaries, and research materials that can support your decision-making process. Feel free to reach out if you would like to explore this topic further and gather comprehensive information to make an informed choice.

Conclusion

Conclusion As with any medical recommendation, these procedures are guidelines. Your health and comfort are paramount. Always feel empowered to ask questions, seek clarification, and make decisions that you believe are best for you and your baby.

In this article I've shedded a light on the standard care offered to pregnant women in Spain and more specifically in Andalusia. 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. 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 or check the document for yourself.

Next Steps: Stay tuned for my final article covering the third trimester of pregnancy in Andalusia!

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Want to delve into the material yourself? Good idea! Here are my sources