Interview with Costa del Sol Midwife Anne Halpenny

Anne Halpenny originally from Dublin and has lived on the Costa del Sol since 1996. Anne qualified as a midwife in 1985 and has worked in Australia, Iraq, Saudia Arabia, the UK and Ireland thereby exposing her to different cultures and ways of practicing midwifery. She settled in Marbella in 1996 and whilst awaiting Spanish registration, she also worked in St. Bernard’s Hospital Gibraltar. She was the first foreigner to work in the Maternity Unit in the Hospital Costa del Sol, Marbella in 1999.

English-speaking Midwife on the Costa del Sol

What are your services?

I am available to advise couples from when women find out they are pregnant, to when they need help with newborn babies.  Many do not know where to turn being away from their own country and health systems. I have organised courses of antenatal classes for women and their partners since 2005. These classes are in English but all nationalities attend, including Spanish. The emphasis is on knowing what to expect here in Spain. I am available for postnatal care and advice most often in relation to breastfeeding support. I am a CPR/First Aid Instructor and offer this training to an array of clients including schools, gyms, groups and of course, parents.

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 gynaecologist?

In the Public Health system women, (if entitled to care ie working, being a ‘dependent’, paying directly for Social Security healthcare or they have a S1 form 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 are then are seen by a Doctor throughout the pregnancy. Midwives have minimal input in antenatal care in the public system. Independent midwives can fill this gap. The minimum number of Ultrasound scans are four – at 11, 20, 32 & 40 weeks. Women usually 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.  Many women mix their Antenatal care with private Obstetrician’s visits and can, of course, give birth in private hospitals also.

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 and their partners have needed. I did not like meeting so many fearful women in labour in the hospital where I worked, which was often caused by misinformation. This has changed somewhat by access to information online, but social media is never objective and often not up-to-date. Since leaving the hospital setting – I had twins in 2009 – I chose to work independently to ensure no bias as I believe couples have the right to know the facts in order to make informed decisions for themselves.

Why do you feel there is a need to offer alternative midwifery services in Spain?

Additional services are needed because there is such a big international or expat community, which often come with different expectations than Spanish couples have. They rarely have the family back-up Spanish couples have. The postnatal home care I offer is for some, a huge reassurance. Through a postnatal support group I facilitate, I continue to be there for these new parents.

Post-natal meet up with babies

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 similar in Holland and New Zealand but unfortunately not everywhere. But change is afoot as many Spanish nurses who went abroad to train as midwives have returned with different work practices and expectations. There are insufficient numbers as yet.

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 Hospital Costa del Sol, Marbella, the rate is somewhere between 20-25%, month-month. More of the public hospitals are offering women choices in how they give birth 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 open. But competition helps!

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 not to facilitate them. As in any country, women wanting natural childbirth have to prepare themselves in a number of ways – physically, emotionally and psychologically. I have been really impressed by the number of women, having their first babies, who have had completely natural births following my courses. Home births are still rare, in Andalucia.

From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in Spain?

A language barrier, the misinformation about facilities or choices available and lack of support in the postnatal period. They all value the opportunity to talk about their choices,

Many expectant mothers believe gynaecologists 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 discussing this with them they argue about minimizing the risk of gestational diabetes, with brings its own long-term risks. They believe if excess weight is gained it also predisposes women to high blood pressure, bigger babies and ultimately, is harder to lose postnatally. I believe sometimes it is not justified – Doctors can 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 worked in the Hospital Costa del Sol from 1999 -2009 but my aim is 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 decided to stay working in the public health system as I believe, in the hospital in Marbella, the midwives offer women real choices and very good care. It was good to be part of positive change and to be involved in training Spanish student midwives that attended Malaga University. Seeking the perfect hospital is unrealistic and I always ask the couples to decide what is important to them – then to follow their instincts. They should not be afraid to change their mind, as here in Spain, it is an option to do so. A positive!

Do you also offer postnatal care to foreign mothers, if so what does this encompass?

Yes, I will visit couples at home according to their needs. Whilst both Mum and baby are checked physically most of the support is centred on feeding the new baby and helping the couple adjust to being a family.

Postnatal care is a service that many foreign mums complain is almost non-existent in Spain, why do you think this is?

It is due to a lack of midwives and the family traditionally being very involved and providing that care.

Are there baby groups/ meeting places for new mums in your area? Can you recommend any?

Bouncers is the longest-running Mother and Toddler group on the Costa del Sol which is on Wednesday mornings in Nueva Andalucia. This is where I facilitate a postnatal meeting monthly – on a different day so we have no toddlers annoying very young babies! Parents know there will be a midwife (and baby weighing scales) in a friendly environment where they can support each other and just chat. There are many other options available on the coast once babies and toddlers are sitting or on the move. I always recommend a parent and baby swimming course given our lifestyle here. One of the longest standing is Little Fishes. These swimming and safety courses are excellent.

Can you recommend any shops for maternity clothes and newborn 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. With high VAT (IVA in Spanish) children’s products are expensive in Spain and therefore shopping online can prove a better option.