Mum Abroad 2: The Butcher, The Baker, The Candlestick Maker

(Bringing in the Professionals)

We're officially halfway through. It feels like I can start counting down earnestly now. The baby and I are both doing well, although I've been prescribed three days of R&R to hopefully clear up a bad cold and laryngitis. Thankfully, I do not have a bacterial throat infection (wanna know how I know? I do like the Spanish medical system, I tell you - I went to after-hours care after work yesterday, and an ear, nose and throat specialist saw me straight away - no referral necessary - and looked into my throat via a camera that went down my nose! Craziness! Although frankly, I was more shocked about the nonexistent waiting time than the camera...).

Today Tall Guy and I went to the hospital for my 20 week scan (good timing, since as I'm feeling quite under the weather, here they would have done a scan to check on the baby "just to be sure", had we not had this one scheduled), and Baby looks perfect.

the baby is the length of a banana! (source)

An important part of pregnancy, especially when living abroad, is learning about the professional procedures and care typically given. For example, ultrasounds are way more frequent in Spain than Canada (one at every visit, verses three to four during the entire pregnancy). At first, so many appointments freaked me out, since back home that would mean something was wrong. So, I did my research and am convinced Baby and I are in good hands.

Doctors

Some doctors in Spain will follow a birth but do not deliver. Check on this before you get attached. Also, it is uncommon, especially in cities and larger centers, for family practitioners to follow the birth. Home births are not covered by any insurance, and doctors will only come for home births in emergency situations (you go into labor at home and the baby is coming too fast for you to get to the hospital - even in this case, doctors may not come and paramedics will be the ones catching the baby). There are a few birthing centers, and some midwives who support home births, but most Spanish babies are born in hospitals.

Depending on where your doctor trained and practices, your birth experience will vary. The birthing ward in my local hospital looks like a scene from Mad Men - moms are strapped down and often not even awake for the actual birthing moment, and my questions about natural birth were answered with,"That IS natural..." Don't even get me started on the looks after I asked about water birthing. (What kind of careless hippy IS this foreign girl???) I was also alarmed at the high cesarean section birth rate in Spain, so much so that I thought about going back home for the birth, but this is the national average, and it is essential to talk to each doctor to find out his or her personal rate. After hunting around, I have found a doctor with a very low intervention rate, working at a hospital with a dedicated natural birthing wing (individual birthing rooms with all kinds of birthing options, including water birthing).

It was important to me to find a doctor who shared my birth philosophy (staring is caring* - intervention only when necessary, please!) and a facility where I could try to have as natural a birth as possible, but be able to receive top-notch care should the need arise. I feel I have found both at Nuevo Belen (Madrid Moms, send me a private message if you'd like doctor details). My doctor also speaks English! Hooray! And she's a woman, totally a personal preference, but I feel more comfortable and at ease with her. My doctor also guarantees she will be at the baby's birth - not a common thing these days.

If you have any ongoing health issues, make sure you keep them in the loop and follow their checkup schedule, although it may not be what you're used to in your home country, as well as letting the dentist or any doctors you may see at after-hours care know how far along in your pregnancy you are.

This is Spain. Things are different. Knowing what to expect, taking time to find a doctor you're comfortable with, and keeping in mind Spain's very low infant fatality rate, can take the edge off birthing in a foreign country.

*I do really mean staring here - obstetrics, from Latin obstare, to observe. In the words of Dr Ernst Bumm, German obstetrician, The hands of a good obstetrician belong in the pockets of his white coat!  (Obviously, emergencies aside, but I am glad to have a doctor who believes birth is indeed a natural, not a medical, process.)
. Midwives and Doulas

In my case, the midwife comes with the doctor. She also speaks English, as do most midwives on my doctor's "team". She conducts the antenatal parenting course (also in English, hooray!), and is also on hand for post natal home visits to help with feeding and adjusting.

Hospitals in Spain provide the midwives, and in the public system, midwives most often carry out the antenatal visits. You'll be seen by a doctor only for certain visits. Talk to the midwives at your hospital to find out their birthing philosophies, and try to request that one who matches your thinking be present at the birth.

If you want to chose your advocate, call a doula. I haven't seen many adds for midwives for hire, but there do seem to be a number of doulas, both foreign and Spanish, for hire. You may wish to hire a doula should your doctor not guarantee his or her presence at the birth, so you'll have someone there who knows you, your partner, your pregnancy history and your birthing plan really well. A doula might also be essential if you don't speak the language. 

Alternative Health Care

Physiotherapists, chiropractors, and massage therapists should all be informed about your pregnancy. Spain's massage therapist regulations are very different from Canada's, and some massage therapists will not perform pregnancy massages. Even though it's less beautiful, I prefer going to physiotherapy centers for massage, pregnant or not. I just like the peace of mind that the therapist has had formal training. If you go to a spa, be sure to ask if the therapist has training in prenatal massage.

Back in May, I was in a car accident. I continued to go to physiotherapy during the first months of pregnancy, and my treatment was mainly manual. No heating pads, my own massage oil (a smell-thing, not a medical-thing) and no lying down for a long time, so I don't get overheated or dizzy. Again, just talk with your health care provider, and if you're not sure, your doctor.

A lot of Spanish chiropractors have trained abroad. Mine trained in the USA, at the same school my Canadian chiropractor trained at. She is experienced with a special technique for adjusting during pregnancy. Often left as a last resort for "spinning" breech babies, chiropractors can provide effective care during the entire nine months. 

Nutritionists

Especially if you have ongoing health issues, you may wish to see a nutritionist to help figure out a meal plan during your pregnancy. There are nutritionists in Spain, again, regulation differs from Canada, and for language convenience, you may opt for e-consultations. I was already eating a healthful diet, and the doctor is satisfied with the nutrients I'm getting, so food is not on my worry-list.

Psychologists and Therapists

Having a baby is a major life change. If you want to talk to someone, you should! There are many English and English speaking professionals in the Madrid area found through a quick Internet search. Again, although not the same as an in-person chat, this may be a case for an e-consultation if there's someone you know and trust back home.

To sum it up, do lots of research and ask lots of questions! Research standard practices in your area and don't be afraid to ditch doctors. My regular gynecologist is absolutely lovely, but she's always extremely busy and I end up spending a disproportionate time in the waiting room compared to the actual appointment. I didn't feel good about this, and so found my current doc, with whom I feel 100% confident and comfortable. She books appointments in one hour time slots (yes, Canadians, ONE HOUR - 60 minutes of doctor time JUST FOR ME!), and I have never had to wait. She takes time to answer all of my questions (I take a list to each appointment), and waits for me to write down notes about what she's saying if I want to. If she doesn't know something, she emails me. I also get near-instant text and email replies when I have questions on the go.

In the end, you want to feel comfortable and well-cared for. Babies bring with them their own set of parenting worries, and worrying about their well-being and arrival into the world is just not necessary.