A Pregnancy in Spain – An Expat’s Experience

On August 10, 2010, I gave birth to our fourth child in La Coruña, Spain. Having had three previous c-sections in the United States, we knew that this fourth child would also come via c-section. These two posts (this one, “A Pregnancy in Spain,” and the next one, “A C-Section in Spain”) are a resource for expat moms giving birth through the public health system. I’m sure they do things differently in different parts of Spain, but the way they did things here in Galicia was different than what I was used to from living in the US, and I highlight some of those differences so you can loosely know what to expect.

CONSULTATIONS:
On January 1, we discovered we were pregnant. The first step, then, was to make an appointment with the matrona at the local health center (Centro de Salud). The matrona gave me a schedule of future appointments and tests that would happen during the rest of the pregnancy – some of the appointments would be with her, some with the obstetrician, and some at the hospital. Through it all she would be the one supervising the pregnancy.

I saw the matrona about every 8 weeks. She always took my blood pressure and weight, listened to the baby’s heartbeat, and sometimes measured my tummy.

During alternate months I saw an OB/GYN at the Centro de Especialidades. They always took my blood pressure and weight, and looked at the results of blood tests. They never touched my belly, though, which I thought was funny; they left that for the matrona.

ANESTHESIOLOGIST CONSULTATION:
At Week 34, I had an appointment with the anesthesiologist at the hospital. This appointment felt very Spanish to me. My appointment was for 12noon, and I arrived and sat down in the waiting area. More women trickled in to the waiting area. The nurse took our referrals and told us to wait. At around 12:30, she came out and called us in to the office, and a group of 8 of us went in and listened as an anesthesiologist explained epidurals and the standard procedure. We asked questions at the end.

We all left the room and then were called in one by one to speak with another anesthesiologist. She was very sweet and very young. We talked about how my previous c-sections had gone, and when she learned that after my 3rd c-section I’d had a spinal headache, she made a note that for this upcoming c-section I should get a spinal block put in with the thinnest needle they had.

Something that cracked me up – but didn’t bother me too much, although maybe it should have – was that the nurse gave me a sample release form while I was waiting to go in to see the anesthesiologist. This release form was actually someone else’s – it had someone else’s name, ID number, and signature on it. The privacy laws here are different, so it didn’t really surprise me that they were having me read a release form that someone else had signed as an example of what I would soon sign.

ULTRASOUNDS (Ecografías):
I had my first ultrasound (ecografía) at the centro de salud at my 8th week. It took about 5 minutes.

At Week 12, I had another ultrasound, this time at the centro de especialidades. Again, the ultrasound only took about 5 minutes.

At Week 20, I went to the public hospital to have another ultrasound. I waited forever to finally go in, and the ultrasound took about 30 minutes. The tech (probably actually a doctor) instructed me to be very quiet and that he would answer any questions afterward. It was at this ultrasound that I found out we would be having another boy.

I had two more ultrasounds, at Week 28 and Week 35, at the centro de especialidades. If you’re counting at home, this makes a grand total of 5 ultrasounds – all for free!

BLOOD TESTS:
I had two blood tests during the pregnancy, one during the first trimester and one during the second trimester. At both blood tests they did the glucose challenge; here it’s called the “Test O’Sullivan.”

SCHEDULING A DATE:
In all, I had five appointments with an OB/GYN. At the first appointment, he wrote down that my expected date of admittance to the hospital would be August 2. The 20-week ultrasound showed that the baby’s gestational age was one week younger than expected, so at the second OB/GYN appointment, he pushed back the date to August 9. At the third appointment, everything still looked on track for an August 9 admittance to the hospital. When I asked if we could schedule it in concrete, though, he told me to wait.

At Week 35, I had my first major breakdown and was utterly frustrated with the Spanish way of doing things. I hadn’t been frustrated before, but when I thought about it, between the blood tests, ultrasounds, matrona visits, and OB/GYN visits, I’d already had about 15 appointments with 8 different people for this pregnancy. In the US, by Week 35, I may have had, what, 9 appointments with three different people? Things already seemed more complicated than they needed to be and not at all streamlined.

I showed up for my fourth OB/GYN appointment, and it was a different OB from the one I’d seen the three previous times. The first thing he said to me was, “Habla español?” I thought that was kind of rude, but told him that yes, I understood it fine. And then he proceeded to tell me to schedule a fetal monitoring session for Week 39, which would have been the week of August 29.

When the nurse tried to ask a question, he brusquely told her to wait until he had finished. Then, when he told me to schedule my next OB/GYN appointment for Week 40, I started to say that my intake date at the hospital was for August 9, Week 37. He told me to be quiet until he was done talking. And then he rattled off a few more instructions, writing me prescriptions for iron and for a vitamin. Finally, I tried telling him again that this would be my 4th c-section and that my intake date was August 9. He said, “Well, then, we’ll schedule the c-section for the 38th week. At the next appointment we’ll see how you’re doing and then we’ll see when the c-section will be.” And then we were done, he wouldn’t let me say anything more. I started to panic, more for personal reasons. If we pushed back the c-section a week, there would be a solid chance that Nate’s parents – who would be flying in from the US to help us out – wouldn’t be around for the c-section, couldn’t help out with the other 3 kids while I was in the hospital, and wouldn’t meet the new baby.

I went to wait in line to make my appointment. (Every time I was at the specialty center I had to take a number and wait in line just to make an appointment.) I showed the receptionist that the doctor wanted me to request a fetal monitoring session for Week 39. She made the appointment for August 29, and I took that paper and went back to the OB/GYN’s office. I waited until the nurse came out to call the next patient and said, “Look, this is when the fetal monitoring session is going to be, but it’s too late. I’m supposed to go into the hospital for my c-section August 9.” So she told me to first make an appointment with the OB/GYN even though my next appointment, according to the OB, shouldn’t have been until Week 40.

So I took a number yet again and requested an appointment with the OB for the next week because my date of intake was supposed to be August 9, two weeks away. She said there were no appointments at all, and that they would call me once someone gave birth so I could have another appointment. I asked her to repeat that because I couldn’t believe what she was saying. Basically, she said she would put me on the waiting list for an appointment, and when someone gave birth I would be moved up the list and be able to schedule my next appointment. What?!

I was so angry. I went home and cried and cried. I think if Nate’s parents hadn’t already scheduled their trip here I would’ve been fine with the ambiguity of it all. But since they were only going to be here until August 17, I had a very short window to have my c-section. After the actual delivery I’d still have to be in the hospital for 5 nights and Nate would need their help back at home with the kids while I was away. But now I was looking at the possibility of not even having an appointment any time soon in order to discuss an intake date AND the possibility of the c-section being the week of August 16, not August 9. This was when being a pregnant expat in a foreign country, depending on the help of family flying in, felt a bit helpless!

But this story has a happy ending, I’m glad to say. The receptionist called back the next day to schedule an appointment. I was able to schedule something for Thursday, August 5.

At this appointment, it was yet another OB/GYN presiding in the office. I mentioned that my estimated date of admittance was August 9. He immediately had the nurse fill out a volante – a referral – for admittance to the hospital on August 9, gave it to me, and cheerfully sent me on my way. So in the end it was much ado about nothing. Praise the Lord I had this doctor on this day and not the previous one – this doctor actually left space to talk and he listened as well.

After giving me the referral, he told me I could check myself in on Monday (August 9), Tuesday, or Wednesday – really, whenever I wanted to. That seemed strange! I would have to go to the Urgent Care area of the hospital, and they would take it from there. I totally forgot to ask him at what time I should show up and whether I should fast, and he didn’t offer any instructions either. Oh well. It was off to the next part of this adventure – the hospital stay. I cover it in the next post, “A C-Section in Spain.

 

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