Spain Dad, a baby blog

For those who are curious about what it’s like to give birth in Spain, I got to sit down with April this afternoon and interview her about her second pregnancy and how she’s gone about choosing a birthing center in Madrid.

This interview is also available to listen to as a podcast.

Kelly (Spain Dad): In terms of having a natural childbirth in Madrid, what are you looking for in a birthing center? What are your priorities in order of importance?

April: What’s most important to me is a birthing center’s approach to childbirth and pregnancy. I’m looking for an approach that assumes giving birth is something women can do naturally, instead of a sickness that needs to be cured. The task of the staff at the birthing center then is to do whatever they can to make it possible for the woman who is giving birth to have a say over what is happening. For me what that looks like is being able to move around while I’m having contractions if that’s what I need to do. I don’t want to be tied down to a bed because I’m being monitored. I want the least amount of unnecessary procedures, like not having to be hooked up to an IV or a monitor if things are going well or lots of other procedures that I don’t want to go into right now, but that are fairly invasive and are not necessary in the process of having a child because it’s not an illness, it’s a natural process. If I want to lay in the bed, I’ll lay in the bed. If I need to pace up and down, I’ll pace up and down. If I need to lean over, I’ll lean over. I want to be able to do what my body is telling me to do. For me, that’s a first priority.

Another priority for me is having options for dealing with pain. Often the options are either an epidural or nothing. I would like more options since I know they’re out there.

I’m also looking for a medical staff that’s supportive and encouraging instead of demanding or authoritarian.

Kelly: Based on this list of priorities you mentioned, what natural childbirth options have you found in Madrid?

April: So far I’ve found three options. One is doing a home birth with a midwife. Another option is a group called Nacentia with a doctor called Regina Cardenas. It’s like a birth center, but their births actually happen at a small clinic nearby called Clínica Milagrosa. The third option is Hospital Quirón with Dr. José Ángel Espinosa.

Kelly: The home birth is obviously different than the other two options, so can you give me just a quick summary of the last two, Nacentia and Hospital Quirón, and what makes them different from each other?

April: Both of them were started, I think, within the last two or three years by doctors who decided that they wanted to give women more freedom in the way they approach birth. From what I’ve read, the biggest difference between the two is that Nacentia really prioritizes natural birth, while Quirón really prioritizes women having choices. So, women might choose natural birth, but they might choose not to have a natural birth as well. My guess is the support structures at these two places are different if they’re coming from different approaches. But, it seems like at Quirón as well as at Nacentia there is quite a bit of flexibility.

Kelly: I’m curious where you looked for these natural birthing centers in Madrid, and if for example there’s someone else that’s researching childbirth options in Madrid with a different set of priorities in mind, what’s a good way of finding out which options are out there?

April: The main place, or I should say the only place I found information was on the Internet. So, keep that in mind. There is a website and forum called Crianza Natural where I’ve found a lot of information on natural parenting in general like using cloth diapers and breastfeeding and stuff like that. They have information on their website about natural childbirth in Spain. There’s another website called El Parto Es Nuestro, which is an advocacy group for women being in charge of birth instead of doctors. And then there’s Nacer en Casa, which is a website specifically focused on home births. So, between these three sites, I was able to find the information I was looking for.

Kelly: Okay, so interfacing your priorities with these three natural childbirth options in Madrid, how did you go about deciding which one to pursue?

April: Actually, I decided which one to pursue not so much because of the priorities I mentioned but because of other factors, like which one took our insurance, how close it was to our house, and that sort of thing. From what I understand about how the birth will go, all three options matched my priorities equally well, so my final decision was based on other criteria.

Kelly: Can you talk a little more about how the distance from your home and health insurance helped you decide which birthing center to choose?

April: For a home birth, as far as I know, there’s not any private insurance company or public health care program that would cover the cost for a home birth. One of my friends who had a home birth in Seville told me the cost for them was around 2000€ for everything, including all the appointments through the pregnancy, the birth, and follow-up.

Nacentia is a private clinic, so they work with most of the private insurance companies. Our private insurance is Sanitas. It covers most of the appointments, but it doesn’t cover the actual birth. There are two options for paying with Sanitas depending on which insurance plan you have. There’s a reimbursement option called Sanitas Mundi or there’s the option where you have to get permission from Sanitas ahead of time, which they call Sanitas Multi. If you have the reimbursement option, it covers up to 80 percent of the cost of the birth. If you don’t have the reimbursement option, the birth costs about 2,500€ beyond what Sanitas will cover. I do know that a lot of the insurance companies pay for the whole thing at Nacentia.

At Quirón they also work with most of the major insurance companies. The pregnancy and birth are covered, so there wouldn’t be additional costs.

As far as distance from home, I think that depends on how you give birth. I’ve given birth before, and it went really fast. Being 45 min. away from a hospital is not really an option for me. We’d have to deliver the baby in the car on the way to the hospital. So, having our birth center close by is going to be important to us, which is why a home birth or Nacentia, which is about a 20 minute walk from our house, rose to the top because they were closer.

It’s also worth keeping in mind that when you have to go for appointments towards the end of your pregnancy, possibly every week depending on what’s happening, it sounds very time consuming to have to travel 45 min. both ways for all those doctor’s appointments.

Between Nacentia and a home birth, we haven’t decided for sure what we’re going to do because we haven’t had the chance to actually talk to a midwife and find out more details about what kind of follow-up care there is after a home birth, so that meant that for right now, Nacentia made the most sense.

Kelly: At this point, what would it take for you to choose a home birth over going to Nacentia?

April: The main question is finding out what happens if something goes wrong. Because home births are not very common in Spain, how does the transition go from having problems at home to checking in at the hospital?

My second question is what happens after the birth? What kind of follow-up care does the midwife provide? If you’re at the hospital, someone checks up on you and brings you food. Obviously, I don’t expect a midwife to cook for me for three days, but I’d like to know what kind of follow-up care to expect from her.

Kelly: We’re going to take some time to zero in on the childbirth option that we’ve decided to pursue, which is the Nacentia birth center in Madrid. You’ve had your first checkup at 14 weeks into your pregnancy, and you also had an ultrasound at that checkup. How was your experience at Nacentia. Any first impressions?

April: Overall, the checkup went very well. The receptionist and the doctor were both extremely friendly. The receptionist was helpful and welcoming and made us feel like we had a right to all the information we wanted. Sometimes in medical settings in Spain it feels like people have the information you want, but aren’t comfortable with or used to giving that information to you. They’re not used to being asked questions.

Something else that surprised me about our first pregnancy in Spain, and something that I’ve even experienced in other medical situations in Spain is that doctors tend to be pretty hands-off. Rather that using physical touch to determine health, they use machines or tests. I’m not exactly sure if my first appointment at Nacentia was a normal since I was so late in making the appointment. They kind of squeezed me in before lunch. The reason it didn’t seem normal to me was because they didn’t check my blood pressure, weigh me, or measure my stomach. So, even though Nacentia is a clinic that advocates for and approaches pregnancy from more of a natural perspective, there were still things about the appointment that were more medicalized than I think you would even find in general practices in other places. Nacentia is still a part of the general medical environment here where they’ll do an ultrasound or another test instead of using physical touch to determine the health of the baby. Those were my first impressions. I’m looking forward to going back, so that’s a good thing.

Kelly: I have one last question. You’re not from Spain, and I’m wondering how being a foreigner plays into your experience of having a baby in Spain. Does the language or a fear of another medical system or anything else stand out to you as you think about giving birth here?

April: The hardest thing is finding the right information. The fact that there are these natural childbirth websites that I mentioned and the friendships you can make through these websites is what’s probably going to help you find information much more quickly than other ways you might go about doing it.

It is hard when you have information from your home country, and you know how things work there. The realization that you’re going to have to give birth differently than you imagined is a hard adjustment. I had to make this adjustment in my first pregnancy. Finding someone who is sympathetic and willing to listen and help you process through this is important. The key is trying to look for the positive things. For example, the first time I was pregnant in Spain when it looked like we were probably going to have a really medicalized birth, the positive thing that I tried to keep in mind was that Spain’s infant mortality rate is one of the lowest in the world. So, as traumatic as a birth might be, the end, we were probably going to have a healthy baby, whereas there are other countries in the world where that’s not necessarily going to be true. The challenge is trying to maintain a positive perspective in the midst of it all, and I don’t know, believing that the options you want might be out there if you’re willing to look for them. Almost anywhere you are you’ll find a small alternative community that can help you.