Pros and Cons of Spain's Free Healthcare System for Maternity

The Spain free healthcare system is one of the best in the world. As an American, I’m always astounded when I can walk into my health center or attend an appointment without them asking for my insurance or requiring any payments or deductibles. While “public healthcare” is wrongly seen as sub-par or of lesser quality in the United States, in Spain, I received high-quality care and attention through the Spanish public health system. Still, as an expat here from the States, you will likely find the differences of giving birth in Spain eye-opening to say the least. There are certain pros and cons you may want to take into account before you decide to go through your pregnancy in the public vs. private health systems in Spain.

Pro: Expert doctors and services

During my pregnancy journey, I visited a number of different doctors and specialists within the Spain free public healthcare system:  

• Before getting pregnant, I told the doctor at my assigned health center (centro de salud) that we were thinking about starting a family. She prescribed me the prenatal vitamins I would need. 
• After getting pregnant, I called the health center to tell them I was pregnant, and they set me up with an appointment with a gynecologist at another center near me. 
• During my first appointment with the gynecologist, they did an initial scan to confirm my pregnancy, explained details of how the process would work over the following months, and scheduled appointments for the obstetrician, matrona (midwife/nurse specialized in maternity and birth), vaccines, and blood tests. 
• I did a series of 3 standard ultrasounds and consultations over the course of my pregnancy with the obstetrician at the hospital. 
• As they discovered a blood mutation during some initial blood tests, I also had several consultations with the hematologist. I would highly recommend knowing the entire medical history of your parents and any family illnesses in order to report these to your doctor. 
• I had an appointment with my matrona every few months to monitor my status before and after birth, get vaccines, ask questions, sign up for classes, etc. I found my visits to the matrona to be the most rewarding part of the experience. 

Con: Different doctors each visit

In my case, every time I went for a scan, ultrasound, or consultation, I saw a different doctor. There was no one single doctor assigned to me. They were all extremely nice and competent, and they all had my records and history in the system for them to consult. However, it would have been a better experience to have a doctor that knew and recognized me immediately, and was familiar with the in-depth details of my situation. 

As a note, I did see the same matrona throughout the course of my pregnancy. 

Pro: Most prescriptions are covered or discounted

The medications I took during my pregnancy were prescribed directly by my doctor and gynecologist, and were for the most part covered or highly discounted under the Spanish health system. For example, I had to take injections of a blood thinner called Clexane that would normally cost over 130 euros per month, and I only paid 3-4 euros. Famotidina, an antacid to absorb stomach acid and prevent acid reflux was around 1 euro, and Yodocefol, prenatal vitamins were under 1 euro. 

The only thing that wasn’t covered under the Spain free healthcare system was my anti-nausea medication, Cariban, which cost around 20 euros per month. Luckily I only had to take that for 3 months while my morning sickness symptoms persisted. 

Con: Language barrier 

None of the doctors, nurses, specialists, or assistants I had through Spain's free healthcare system were proficient in any language besides Spanish. Obviously, this makes sense and I didn’t expect any of them to provide services in my language. I speak Spanish well enough and my Spanish husband was always there beside me; however, if I had to do it again, I would have liked to see doctors that spoke English, so I could understand everything with 100% clarity and certainty, and be able to ask questions without expressing myself incorrectly.  

If you go through the public system, brush up on this Spanish maternity vocabulary to prepare. 

Pro: You can go to any hospital to give birth

You are allowed to go to any public hospital throughout your pregnancy and to give birth. You are not limited to the one closest to you, the one you’ve been having appointments at, or one recommended to you. 

For example, halfway through my pregnancy we moved to a new apartment in a different health zone. Normally, this would mean switching health centers and hospitals, but we were able to maintain our visits and appointments at the same hospital, with the doctors and matrona that we were already familiar with. 

Furthermore, you can typically request a hospital tour where they will show you the birthing areas, rooms, etc. Keep in mind, that when admitted to the hospital on the day giving birth, you may be transferred to another hospital if they do not have enough beds or staff. 

Con: Delays and a lack of flexibility

Granted, I began my pregnancy journey during the Covid-19 pandemic, so my first appointments with my local health center were via phone. If I wanted to ask for an in-person visit, the wait times for an appointment were quite long due to an over-saturation of patients. If I had questions that weren’t urgent, but I wanted to speak with or see a doctor, it was very difficult to get in contact with the right person. In addition, they were not very flexible in scheduling appointments and I frequently had to rearrange my work schedule to attend appointments within my working hours. 

That being said, I had no problem scheduling my scans and checkups with the obstetrician, but friends who have gone through the private system have told me they had the ability to schedule more or more frequent appointments. 

Pro: Maternity classes are available through health centers

I had several friends recommend us to do to prenatal classes in order to prepare for labor (breathing and birthing techniques), feeding, taking care of a newborn baby, etc. I wasn't really offered any information about these classes until the 6th month of my pregnancy. When it came that time, I brought it up with several of my doctors and they all said the matrona would arrange it through my health center, as the classes were performed in the area nearest you, so you could be part of your local community of mothers. 

While typically done in-person and in groups, during the Covid-19 pandemic, these classes were done virtually via Zoom. I was pleased to learn that there were classes being offered as my husband and I knew little to nothing about labor and birth preparation. 

Con: Lack of maternity info up front or before conception

To be honest, I didn’t do much research about pregnancy, babies, or birth before getting pregnant. The only thing I was proactive in was asking my doctor about any prenatal vitamins or the typical time it might take me to get pregnant, which I did just a few months before trying to conceive. She prescribed me vitamins and little more. Even when asking different doctors the same questions, we got a variety of responses that didn’t always coincide. 

In all honestly, I felt that there was a lack of information on the part of my doctors to inform me about need-to-know information, and my husband and I mostly relied on the advice of our friends and family with babies to learn essential information, find resources, and understand what to buy for the preparation and birth of our baby. As I got pregnant much faster than expected, I would highly recommend planning for the possibility of having a child 6 months to 1 year in advance of conceiving. 

Discover the maternity coverage and family planning options with Caser Expat Insurance.