Interview with Costa del Sol midwife Anne Halpenny
What are your services and how can people contact you?
I am available for advice, from when women find out they are pregnant as often they do not know where to turn being in a foreign country. I run courses of antenatal classes for women and their partners with an emphesis on what to expect having a baby here in Spain. These classes are in English but all nationalities attend, including some Spanish. I have always been available for postnatal care & advice most often in relation to breastfeeding support. anne@irishmidwife.com, googling BE BIRTH WISE or 630 231 037 are ways of contacting me.
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?
In the Public Health system women, (once entitled to care - paying social security or their husbands are OR they have a form 121 from the NHS entitling them to care in another EU country for one year in relation to their pregnancy) present themselves to their Centro de Salud and request an appointment with the matrona as soon as they have a +pregnancy test. They then are seen by a mix of Drs depending on their risk factors throughout the pregnancy. Midwives have minimal input in antenatal care in the public system. Independent midwives can fill this gap. The minimal number of scans are four - at 11, 20, 32 & 40 weeks. Usually women go to their local hospital to give birth, but the law changed some years ago and women can now choose where they wish to go. They do not need to 'book' as in the UK, but can in effect just turn up at the door. They can also request this via their Dr in the centro de salud towards the end of pregnancy.
How do your midwifery services differ from the Spanish system?
I would like to think I compliment the system. I am filling a gap that women were requesting. I was also very sad meeting so many women in labour in the Hospital where I worked who were petrified by misinformaton 'on the street'. This has changed somewhat by access to informaton online, but tales still abound. In the hospital setting, I chose to continue working as I always had - eg; I stayed with women as much as possible in labour and explained why I worked as I worked to colleagues who were interested (& there were many who were).
Why do you feel there is a need to offer alternative midwifery services in Spain?
Additional sevices are needed because there is such a big 'international' or expat community which often come with different expectations than Spanish women have. They very often do not have the family back-up Spanish couples have. The Spanish women themselve are now also looking for improvments in services.
Do you think midwifery services are underdeveloped in Spain?
Yes - as they are in many 'developed' countries. The UK has a wonderful strong tradition valuing midwives and their work. It is similiar in Holland and New Zealand but unfortunetely not everywhere. But change is afoot as many Spanish nurses who went abroad to train as midwives are now returning with different work practices and expectations.
Do you believe there are an unnecessary number of C-sections performed here and from your experience how accommodating are the Spanish public and private hospitals to natural births?
It is a figure that is constantly changing but certainly in the past Spain was chastised for the high c-section rate. It is still true today that the rates vary greatly between hospitals and also, between public and private hospitals. In the HCS, Marbella, the rate is somewhere between
20-25%, month-month. More of the public hospitals are offering women choices as the law now insists they do. In Marbella women can labour in water and use a swiss gym ball, floor mattress or give birth using a birthing stool or in any position they choose. Private hospitals may not be as accommadating - often from lack of experienced staff, or, because private Obstetricians may not facilitate choice.
What advice would you give a woman looking for a natural birth in Spain ?
Do your homework well in advance. I am surprised by women who contact me late in pregnancy requesting a homebirth or looking for some information but have chosen a hospital or doctor that perhaps will do little to facilitate them. As in any country, women wanting natural childbirth have to prepare themselves in a number of ways - physically, emotionally and pyschologically. We have been really impressed by the number of women, having their first babies, who have had completely natural births following our courses.
From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in Spain?
A language barrier, misinformation about facilities or choices and lack of support in the postnatal period.
Many expectant mothers believe gynecologists in Spain are overly concerned with their weight during pregnancy, do you think that is justified?
I believe it is true - they do keep a close eye on weight gain. When questioned about this they argue about minimsing the risk of gestational diabetes, with its own longerterm risks. They believe if excess weight is gained it also predisposes women to high blood pressure, bigger babies and ultimetely, is harder to loose postnatally.
I beieve sometimes it is not justified - Drs forget to take into account the height/build of the couples from Northern Europe in relation to this. They are inclined to have bigger babies than their Spanish counterparts.
Do you work with any specific hospitals on the Costa del Sol and if so can you recommend any in particular?
I have worked in the Hospital Costa del Sol since 1999 and I try not to influence women's decisions. Some have 'private medical insurance' (not comparable to the UK) and feel they have to use it by going to a private hospital! I chose to deliver my son & daughter, twins, there last year, in spite of having a choice! It has changed beyond recognition in the 10yrs I have worked there. I decided to stay in the pubic health system as I believe in the hospital in Marbella the midwives offer women choices & very good care. It is good to be part of positive change and to be invovled in training spanish student midwives that attend Malaga University. Seeking the perfect hospital is unrealistic and I always suggest decide what is important to you then, follow your instinct. Do not be afraid to change your mind, as here in Spain, it is an option to do so.
Do you also offer post-natal care to foreign mothers, if so what does this encompass?
Yes, I will visit couples at home as their needs dictate. Whilst both Mum & baby are checked physically most of the support is centred around feeding the new baby and helping the couple adjust to being a 'family'.
Post-natal care is a service which many foreign mums complain is almost non-existent in Spain, why do you think this is?
A lack of midwives and the family traditionally being very involved and providing that care.
Are there any baby groups / meeting places for new mums in your area? Can you recommend any?
Bouncers in Nueva Andalucia is a M&T group which is available 3 mornings/week with one reserved for the under 1yo, and Little Fishes mum/babe Swimming courses are excellent. They also run Aquanatal courses for pregnant women.
Can you recommend any shops for maternity clothes and new born clothes / equipment?
I try not to endorse one producer or supplier over another. When women give me positive (or negative) feedback I will pass this information on to the couples at our antenatal classes. I have a constantly changing list of online suppliers that I can recommend. Two local success stories are Ecobebes.eu and Indybel.com run by Mums for Mums supplying good quality 'real nappies', clothes other equipment.
(April 2010)
