As you may or may not already know, Spanish residents enjoy a free universal health care system. The WHO ranks it as the 7th best in the world, simultaneously ranking the US as the 37th best, so chew on that for a minute. I knew this going into my pregnancy and was interested to see how the facilities and standards of care would measure up to experiences of friends and family who have given birth in the US. Because although the system may be one of the best, it isn’t usually the most…glam. I’ll go more into detail about the medical process of carrying out my pregnancy in both the public and private systems in a different post, but these are the things that surprised me most about the whole process.

1. The overall efficiency

Yes, the efficiency and timeliness of all of my appointments, blood tests, ultrasounds, and the final process of birth at the hospital did come as somewhat of a surprise. I say this because although universal health care is a beautiful thing, many times you can expect wait times and inefficiency to be the norm, but this was never the case for me. Sometimes, in fact, I felt the appointments were a bit too timely in the sense that most days I felt kind of pushed-out-the-door. But even with coronavirus in full swing, all my tests and check ups went off without a hitch. No doubt universal health care has its pros and cons, but I’ll still take it, thank you very much.

2. The amount of appointments

Full disclosure, I was carrying out my pregnancy in both the public and private systems, so at times my appointments were, in fact, double. Some of you may be wondering why we did this at all and its quite simple. First of all, anyone who pays for private insurance (usually somewhere between 30-50 euros a month, no copays, no deductible), almost always will choose to do the same thing during a pregnancy. This is because using the private system as well gives you more ultrasounds to see and check on your babe, (the public only gives you three during the pregnancy, and I think we have pictures from at least seven or eight different ultrasounds in the private clinic), and because if you’re unsure of whether you want to give birth in the public or private hospital, it gives you the opportunity to get to know both systems and both doctors/midwives up until the moment you go into labor and have to decide. Also, you’re paying for both so you really might as well get your money’s worth.  That being said, the public alone has you doing nine appointments, plus blood tests and an appointment post-birth with the midwife to see how you’re doing. Needless to say, you’re well taken care of.

3. The lack of pain management options

Now this could very well be something I only encountered in my personal situation, but I found it very surprising nonetheless. During my months of pregnancy during lockdown, I had plenty of time to do research, and I found that there are other alternatives to having an epidural, something I was initially going to try and avoid. (This went out the window after multiple hours of contractions, but it was a nice thought). I read about TENS machines, gas and air (nitrous oxide/laughing gas), and walking epidurals which would all allow me to still continue to move and position myself as I needed to, and wouldn’t necessarily lead to the cascade of interventions that epidurals sometimes do. We even learned about them in our Spanish birthing class, which leads me to believe they do exist here, hence my surprise when the very nice private hospital I was at only had your classic epidural available. When push came to shove (no pun intended), it didn’t matter how the relief came, but it would have been nice to have other options to try first.

4. The gender reveal

Word of warning–if you are going to have a baby in Spain, be sure to tell your OB-gyn whether or not you want to know the sex of your baby. In Spain it is pretty much assumed that everyone wants to know, so at our 12 week ultrasound when our doctor said, “Well, I could be wrong but it looks like a girl” (it wasn’t), we were elated, but a bit taken aback–at least I was. When we went to the States for Christmas and announced the pregnancy, the first question people asked was, “Are you going to find out the sex?” and in Spain it was, “Is it a boy or a girl?” We had always planned on knowing, but if I could go back I would definitely have said to the doctor, “please don’t tell us the gender until you’re absolutely sure”. It sounds silly, but we did have to do a mental adjustment a few weeks later when “she” was clearly a “he”.

5. The combination of midwives and obstetricians

This one is interesting and one of the biggest differences between the public and private sectors.  Throughout my pregnancy I was attended to by a midwife at all my public appointments and never met with an OBGYN, and at my private appointments I was always attended to by an OBGYN and never a midwife. Now, on the day I gave birth at the private hospital, I was attended to almost exclusively by a midwife, until the actual moment of truth where my ob came in and delivered Enzo. She also was the one who came to do my check ups after birth, and she is who I saw at my six week check up. Now, if I had given birth in the public hospital, I would have been attended to by a midwife the entire time, including delivery, and post delivery check ups. If you were able to follow along with that, you’ll agree its weird, right?

6. The conflicting advice

You’ll get a lot of, (mostly unsolicited) advice during and after your pregnancy, (much of the “during” advice I got to avoid–one of very few upsides of covid), but I couldn’t help but laugh at each doctor’s take on what I could and couldn’t eat and drink. One told me that the occasional glass of wine was fine, another told me “nada”. The opinions on jamón were extremely divided and ranged from “absolutely nothing”, to “only if its been frozen for 24 hours”, to “if it’s good quality, it’s fine”. I was also told they could be “flexible with smoking, but not with eating ham”. The bottomline for me was, educate yourself, use your best judgement based on that, and do what you want. That being said, Enzo survived a few glasses of wine as well as a couple slices of jamón, and he seems to be alright.

7. The (forced) independence

My mom has never hid the fact that sleep has always been a priority, and that didn’t change when she had me. In fairness to her, things have changed a lot in 30 years, and the American Academy of Pediatrics now recommends room sharing with your newborn for at least the first 6 months of life. But back in 1988 the nurses asked her and my dad if they wanted to send me to the nursery for the night and send me they did. Knowing the recommendations and also wanting to be able to watch over my babe his first nights, I wasn’t going to send Enzo to the nursery anyway, but this is also easy to say because it was never an option. We were taken to our room, (in Spain you are put into three different rooms for labor/delivery, postpartum observation, and your room for the rest of your stay), told three pieces of advice how to keep our child alive and then left on our own to figure it out. I also was given very little support for breastfeeding, and no lactation consultants ever came around, (nor do I know there even were any available), and my ob’s best advice with breastfeeding was to “just relax”, so I probably could have used some more support in that area. I understand we are in the middle of a pandemic, but still, the lack of support, or, put in other words, excessive independence, was surprising.

8. The massive amount of paperwork

After almost eleven years here fighting Spanish bureaucracy and every third photocopy they require, I have no idea why I was still surprised by this. Perhaps because I thought maybe they would have in mind that you’ve just brought home a new human you’re trying to keep alive, so the last thing on your mind is registering your son’s birth, signing him up for social security, putting him on your insurance, sending your employer the paperwork from the hospital, and making sure social security has what they need so you get paid on your leave. Alas, I was wrong, Spanish bureaucracy couldn’t care less, and giving birth is no different. I must admit, though, it was slightly entertaining watching my husband wade through most of this process while I was home with bubs. He finally realized why I come home crying every time I have to deal with it.

9. The lack of lush-ness

Fine, I’ll admit it. I had images of a lush birthing suite where I could bring twinkly fairy lights and spray lavender and put my bluetooth speaker on and make myself right at home during the process of my beautiful birth. Okay, if I was honest with myself maybe I didn’t imagine it being THAT lush, but since I had opted for the private hospital because I knew for SURE I wanted my own room–a luxury not always guaranteed in the public hospital–I was expecting something a bit nicer than what I encountered. Don’t get me wrong, it wasn’t terrible by any means. The delivery room–(remember, three different rooms)–was big and sparse with your standard bed and newborn care unit, an in-room bathroom and a yoga ball. We were able to dim the lights as we waited, (ahem, slept) the seven hours for Enzo to arrive, and I’m sure we could have used a speaker (forgot it at home) and lavender spray (smell made me want to vomit), but it was certainly nothing to write home about. Our room for the next two nights, (standard time to spend at the hospital in Spain after giving birth), was a bit cozier and had a day bed/sofa sleeper for my husband and a TV, but again, pretty middle of the road compared to what I’ve seen in the States. Also, we had to pay for the TV if we wanted to watch.

10. The lack of birthing options

This was my first birth, so I wasn’t necessarily trying to go for a home birth or water birth or anything fancy, but from my research, it seems like these types of birthing options are not readily available to the general public in Spain. There was never any discussion neither with my midwife nor with my obgyn if I would have a hospital birth or what kind of birth I wanted. There is a possibility that that discussion might have been had during the prenatal classes which were cancelled due to covid, but I guess I’ll never know.

You might think after reading this that I didn’t enjoy my birthing experience in Spain, and in that you would be completely wrong. My overall experience throughout pregnancy and birth was fantastic, especially keeping in mind that all of it, every single part of it, could have been totally free if I hadn’t been paying for my private insurance. That incredible luxury is not lost on me. Me and my son were treated with the best care and respect throughout and I would 100% do it again…but I’ll give myself a few years, first.

If you’re interested in hearing more birth stories from expat moms in Spain, head over to Charlie’s Footsteps–a blog and shop from a British mom in Madrid–and read more!