Interview with Alex Weatherhead - British Midwife in Spain
What is the "normal" procedure in terms of check up and scans for pregnant women in Spain ? When do women need to choose their hospitals? Are they guaranteed a hospital of their choice or are they given a hospital as assigned by their gynecologist?
The normal procedures vary from hospital to hospital, but generally a woman should present to her local doctor as soon as she know's that she is pregnant, who will then refer her to a local medical centre where she will be seen by a midwife. The midwife will arrange appointments as soon as possible to take blood and urine tests, blood pressure, weight etc. Between ten and fourteen weeks she will refer for an Ultrasound scan to a local hospital. In my area hospitals tend to be allocated to spread the workload evenly between the hospitals, but I have heard that mum's to be can choose a hospital of their choice in other areas. Generally a woman will see the midwife every six weeks, up to thirty six weeks at which point she will be seen weekly. Further to the initial Ultrasound scan mentioned above, scans will take place at twenty weeks (dating scan) and thirty weeks (general observation scan).
How do your midwifery services differ from the Spanish system?
Rather than offer a clinical service I provide information, explanations, answers and reassurance, this is in the form of early pregnancy home visits and parentcraft classes and also postnatal home visits, This prepares couples both physically and mentally for the birth and enpowers couples to make informed choices. I also hire out ELLE TENS machines which can be used in early stages of labour as a form of pain relief.. All my TENS machines are recommended by the National Childrens Trust (based in the UK). I also offer early pregnancy information packs and documentation to support Parentcraft classes.
Why do you feel there is a need to offer alternative midwifery services in Spain ?
It is not so much an alternative midwifery service, as much as additional service for women. A great deal of women (especially with their first child in a foreign country and the language barrier) feel apprenhensive and possibly isolated from their friends and family at a time when they may feel vulnerable. Many women will have questions regarding their pregnancy (the do's and don'ts) and may have nobody to turn to for support and to answer any questions that may arise.
Do you think midwifery services are underdeveloped in Spain ?
I do not think clinically Spain is underdeveloped i.e. the monitoring throughout pregnancy is generally good, but the pregnancy and labour tend to be treated as a medical condition. Pregnancy should not be seen as an illness, more of an experience to be enjoyed, and for couples to have informed choices as to how and where they should have their baby.
How accommodating are the Spanish public and private hospitals to natural births?
Spanish hospitals do not appear to be very accomodating to natural childbirth! There is a natural birth centre approximately ninety kilometres outside Alicante, but I know very little about this facility (apart from the information that is readily available on your website).
What advice would you give a woman looking for a natural birth in Spain ?
Some women choose to go back to their home country, others may pay to obtain private care IE the natural birthing centre hospital near Alicante. Depending on the Doctors and Midwives you have on the day of your delivery this could determine how much choice you have. I don't think a natural birth can be guarenteed, but if you aware of your choices and depending on how assertive you are willing to be this may increase your options, and the ability to choose a natural birth. You should always try to discuss your options but sometimes intervention is required. It is best to have an open mind as labour and delivery can be unpredictable and the best outcome is a healthy Mum and baby
From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in Spain ?
The main concerns for foreign mum's giving birth in Spain is the fear of the unknown entity of pregnancy and labour (eg no entonox ,can dads be present in labour and at delivery?) and the care they will recieve. Plus the added difficulties surrounding communication with the language barrier.
Many expectant mothers believe gynecologists in Spain are overly concerned with their weight during pregnancy, do you think that is justified?
Many factors in pregnancy can influence weight gain and may vary between individuals. In the UK the weight is monitored at the beginning of pregnancy to obtain a baseline and calculate a BMI (body mass index), then it is not monitored throughout the rest of the term. On average most women gain between ten to twelve point five kilograms (twenty two - twenty eight pounds) Factors influencing weight gain may be maternal weight, increased size of the baby or the amount of water around the fetus. A good healthy diet and gentle excercise (such as swimming) is recommended.
What do you offer in your parentcraft classes?
Parentcraft classes are typically held between 28 and 36 weeks. The aim of the course is to give you the assurity and support that many individuals and couples seek at this time. Often the group classes form friendships that stretch way beyond the birth of your child. Group classes consist of either 6 individual Mum's or up to 4 couples. The list below covers the main areas that will be covered in the group courses.
Each course is unique however, and will be adapted to cover topics or concerns that are requested by individuals.
Labour and Birth
Wellbeing health & Safety
Preparing a birth plan
Late Pregnancy
Packing your bag
Signs of labour.
Processes of normal labour
Role of a birth partner
Birth environment and hormones
Positions in labour
Self-help measures in labour
Pain relief in labour
When labour or birth needs a helping hand (induction, forceps, caesarian section etc)
Care of Newborn
Newborn appearances
Feeding options. (breast & bottle)
Practical babycare. (dressing, bathing, nappy changes etc)
Baby Safety
.You also offer post-natal care to foreign mothers, what does this encompass?
Postnatal care provides a support program to evaluate the progress of mum and baby both emotionally and physically. As you would expect, all aspects of post natal care will be covered, monitoring signs of infection (post natally) in the breast, uterine, caesarian section / or episiotomy site. To make sure Mum's well being is returning to normal, including bodily functions, dietary requirements, excercise and most importantly rest. Mum's may feel tearful and anxious, don't worry this is common and the symptom's should not persist (this is commonly known as the baby blues). It is however important to evaluate this less serious post natal feeling with Post Natal Depression which will be more intense and lasts longer, but can be treated successfully babies are observed. Breast feeding is encouraged but bottle feeding is also be fully supported. Babies are encouraged to breast feed as long and as often as the baby demands, and this will help to stimulate enough milk. The baby will stop when he or she is satisfied. Skin to skin is something that Midwives encourage, to promote a close bond between baby and mother / partner. The baby will feel mum's skin against it's own skin, baby will feel mum's heartbeat, her breathing pattern and this will regulate baby's breathing and temperature, therefore having a calming affect. A six week final post natal check can be carried out on mum and baby and a discussion takes place regarding contraception, as it is now possible to get pregnant again. I can visit you in your home following the birth of your baby. I can help, advise and reassure you in the care of your baby and offer you help with breast / bottle feeding issues, whilst monitoring the well being of yourself and your partner. You may ring me for advice, when you have those niggling questions or concerns. As a mum and a midwife I hope to make this a unique experience, as pleasant and as memorable as possible for all the family.
Post-natal care is a service which many foreign mums complain is almost non-existent in Spain , why do you think this is?
Post-natal care is just as important as labour and delivery for the womans well being and to support and advise in the care of the newborn baby. EG feeding, sleeping, emotions etc. I think possibly the Spanish culture relies on the Family to fullfil this role therefore no postnatal care is provided.
Do you believe there are an unnecessary number of C-sections performed here?
It is hard to answer this question without looking into individual performances within each hospital. It is often down to working practices at an individual hospital, this includes decisions made by the doctor, gynaecologist.
In what areas of pregnancy and birth do you believe Spain excels in?
Whether "excels" is the correct word is debatable, but clinical care appears to be good, and I have read that the rate of infant mortality in Spain is low. Choices in labour and postnatal care appear to be limited.
How do people find out about your services?
Alex Weatherhead Tel 689102134 www.midwifeinspain.es (website available from December 1st 2008) email: a.weatherhead@yahoo.co.uk
Early Antenatal visits.
Visits as requested throughout pregnancy.
Parentcraft classes.
Postnatal visits.
Tens machine hire Bebe as recommended by NCT.
Information packs to support early pregnancy and Parentcraft classes.
Friendly advice, no problem or question is too trivial.
Jan 09
