She’s having a baby…in Barcelona

Moving to Barcelona with my family and leaving behind my midwifery career in the United States left me feeling a bit homesick. I found myself chatting up any English-speaking pregnant woman I could find in the city. I met some through Spanish classes, my children’s school, friends, and a variety of other ways. I started asking these new friends about their pregnancies. Their stories provide great insight on being pregnant and/or a new mom in this beautiful city.

Homesickness or Morning Sickness?

Moving and adjusting to life in Barcelona has its ups and down for any newcomer, nevermind a pregnant one. In many ways, Barcelona is a wonderful place to be pregnant. As Kate O. pointed out,

Because Barcelona is such a walkable city and the weather is so great, I felt I was able to have a much healthier and active pregnancy than some of my US friends who drove everywhere.

The city offers plenty of parks and other destinations, including local beaches, shady gardens, and walking trails, making it an easy place to have an active pregnancy.

Photo by Camylla Battani

However, when the sun sets, the Mediterranean tradition of late multi-course dinners with wine can be challenging for tired pregnant women who are dreaming of their pillows by 5:00 in the afternoon. Korrin R., who moved to Barcelona from New York, admits she quickly assembled a list of the few Barcelona restaurants that opened before 8:00 pm. Giving up alcohol for nine months is harder for some moms (this author included) than others. With most meals including (at least) one glass of wine, it’s easy to feel excluded from Barcelona’s social drinking culture and many of the women I spoke with expressed as much. Sadly, the Spanish terraza culture may be a casualty of your child-bearing years as you try to avoid second-hand smoke. My interviewees all expressed a universal longing for eating and drinking outside on Barcelona’s sunny terraces.

Beyond the alcohol, Barcelona’s famous food scene can sometimes feel like a minefield for pregnant women: unpasteurized cheeses, uncured meats, ceviche – the foods forbidden to pregnant women goes on and on. For Eva E., who moved from Switzerland to Barcelona for her second pregnancy, the temptation of Spanish jamón “was EVERYWHERE.”  As Eva noted though, her Spanish ginecólogo (gynecologist) reassured her that “as long as it was high-quality jamón, she didn’t need to worry.” Lindsay P., an American mom of two, thinks, “overall Spaniards seem much less risk-averse than Americans when it comes to pregnancy and child safety.” When it comes to food, what appears to be a cultural attitude of “no pasa nada” may feel like a relief to some pregnant women chafing under strict guidelines, but anxiety-provoking to others coming from cultures outside of Spain.

Photo by freestocks

Birth Culture Shock

In addition to food and social differences, the Spanish birth culture also requires some adjustment. I had an opportunity to speak with Dr. Leila Onbargi, a Barcelona gynecologist, and Lynne McIntyre, a local psychotherapist specializing in perinatal mental health, to get some insight about the birth culture here. Both trained in the United States and now practice in Barcelona with an international patient population. They, along with the new moms I spoke with, agreed that birth in Spain is more medicalized than in the U.S. or some other European countries.

For example, Zaida P. experienced birth culture differences between her native UK and Spain because she received prenatal care in both Spain and the UK, but returned to Barcelona to deliver both of her children.  For example, in Spain during week 37 of her pregnancy, she signed a document indicating that her obstetrician was in charge. The document also noted that anesthetics would be administered and all measures to save her or the baby would be made. Essentially, all of the control was shifted to the medical professional. By contrast,

In the UK, I had the green book where I wrote my birth plan, what food I wanted to eat the day of delivery.. what music I wanted to listen to…I also had the choice of a home birth, water birth or aromatherapy.

In Spain, on the other hand, your biggest choice most likely will be whether to give birth in a public or private hospital. This medicalized approach can mean that women more frequently have medication during labor, have more interventions, are more likely to have epidurals and thus may be more likely to have a Caesarean section. When deciding on a hospital (if you don’t want a homebirth, which is legal, but uncommon in Barcelona), you may want to research each hospital’s C-section rate or what percentage of women deliver with an epidural.

As in the US, this can vary significantly between hospitals. According to the Spanish Ministry of Health, in 2018, the C-section rate at public hospitals in Spain was 25.2 percent. At private hospitals there was a much larger variation, ranging between 28-38 percent. As a point of reference, the average C-section rate for the U.S. is 30 percent.

According to Dr. Onbargi, an early advocate for less-medicalized labor in Barcelona, there is still wide variation in what is available from one Barcelona hospital to another. For example, she cautions that natural childbirth can mean many different things to different people. However, she also noted that “completely natural childbirth” is offered by several of Barcelona’s public hospitals with maternity services. This may be because midwives play a much bigger role in the Spanish public maternity system and provide the majority of prenatal care at local Centre d’Atenció Primaria (CAPs) or the primary health care centers. They also care for women throughout labor and deliver babies, as long as the pregnancy is not high-risk and there are not any complications.

International moms also may experience a more hierarchical doctor-patient relationship. That same power dynamic extends to midwives and their patients as well. Rebecca H., an event planner who moved to Barcelona from the UK, found that the idea of informed consent was much different in Spain. In her experience, health professionals did things without much explanation. She advised,

Always ask questions and ask why they are doing what they are doing – make sure you get the answers you want.

Asking questions and understanding the answers can be pretty difficult to do though if you aren’t fluent in Catalan or Spanish.

Photo by Omar Lopez

The Language Issue

Lynne McIntyre and Dr. Onbargi agreed that the language barrier is the most difficult aspect of being pregnant and giving birth abroad. Lindsay found that even if a doctor speaks English, nurses, hospital support staff, or office staff may not. She noted that on the postpartum floor at the hospital where she delivered, none of the medical professionals spoke English.  Scheduling appointments, laboratory or ultrasound screenings, and completing the requisite bureaucratic paperwork was also challenging for the non-Spanish speaking moms. For example, new moms must register the baby with the local Civil Registry Office, a process that requires both parents and the baby to present themselves in person at the office, typically within two weeks of birth, extended to 30 days for extreme circumstances. (The ajuntament recently relaxed the deadline due to the COVID-19 quarantine.)

Many of the women I spoke with recommended having a doula to ensure nothing is lost in translation, even if your partner speaks fluent Catalan or Spanish. Regardless of the type of birth you are envisioning, having a Spanish or Catalan-speaking birth attendant, especially a partner, doula or friend who is familiar with the Spanish birth culture can be a lifesaver. During early labor, Kate was able to remain home for a longer period of time and give her partner a break during her long first labor thanks to her doula, Erika Villanueva’s, support. If you do decide to hire a doula for your delivery, definitely ask whether the hospital where you plan to deliver allows doulas; not all hospitals in Barcelona allow doulas and not all Barcelona ginecólogos appreciate working alongside doulas.

Photo by Jonathan Borba

Running the Business of Baby

Having a baby in a foreign country is a bit like starting a business in that you have to put together the right team. The pregnancy-abroad-business also requires some serious research and comparative shopping. Start-ups don’t do it alone, and neither should you. Start assembling your own “dream team” of people to turn to for help. Some of the support staff to consider hiring include: doula, nanny, night nurse, breastfeeding consultant, childbirth educator, therapist or mental health provider, physical therapist, massage therapist, and cleaning or cooking help (see some of our helpful suggestions below as a place to get started). As psychotherapist Lynne McIntyre points out,

Household help in Spain is generally much more affordable than you may be used to. This might be a great time to call in some extra help.

Josi Van Ogtrop, who works with a lot of new moms and families as the owner of The Nanny Line, added night nurses to the services because of increased demand from international families where one or both spouses may travel for work.

If the plan or the team doesn’t feel right for what you need, make changes. Just because a professional comes recommended, they may not be the right fit for you and your family. It is ideal to hire a professional who understands, respects, or shares your cultural values and language. As Zaida, who is also the founder of International Nanny in Barcelona, noted, “Everyone feels happier, safer, and more relaxed.” Kate J. changed obstetrical providers and her planned birthing hospital three times over the course of her pregnancy until she found a combination she felt good about. Just remember that some private health insurance policies require that you have been covered for at least 6-12 months prior to your pregnancy in order to receive maternity benefits.

Photo by Jonathan Borba

Build your safety net

One of the best ways to get support and information is to connect with other pregnant women. Yoga classes, childbirth education classes, and online parenting groups for Barcelona are all great places to meet other pregnant women. Korrin, who signed up for a birthing class taught in English, says, “…the best thing I got out of it was the group of English-speaking moms I met in my class. Our babies were all born within a month and, to this day, it is invaluable to have a group always going through the same milestones. Our babies still have a playgroup.”

Having a support group in Barcelona of moms experiencing the same pregnancy issues and rollercoaster of emotions as you, may also help you to navigate the difficult postpartum period, a low point for many moms. Lack of social support is one of the biggest risks for postpartum depression. This is especially important for women living away from their cultural home. You may be adjusting to the huge life-changing event of becoming a mother, without your regular network of family and friends.

Repeat after me…”I’ve got this”

While it can be easily overwhelming to be pregnant away from home, think about the amazing opportunity before you. By just going through the process of figuring out how to manage the language, cultural differences, and assemble a healthcare and social support team, you’ll become an empowered, strong mother. You will be able to advocate for yourself and your family, in any country. As Erika, who moved to Barcelona from overseas herself, observes:  “You have to be a very different type of person to be willing to pack up and have your baby in a different country.” Think of your pregnancy as the first chapter in your evolution into a strong mother.

Looking for things to do with your little one? Check out these options around the city.

DISCLAIMER: The information provided in this article does not constitute legal, medical or any other professional advice or personal recommendations. This resource is for informational purposes only. Please exercise due diligence to do your own research and understand your options to choose providers and make the decision that is best for yourself and your family.