Choosing where to give birth in Spain

Terms used

• Padrón — The padrón is the town hall's register of residents, used as proof of address and the first step to a health card.
• Tarjeta sanitaria — The tarjeta sanitaria is the health card issued by your regional health service, giving access to public care.
• Centro de salud — The centro de salud is your local public health centre, where your GP and midwife work.
• Matrona — The matrona is the midwife at your health centre who follows your pregnancy.

Key rules

• Default hospital: In the public system you are assigned the hospital for your health area, based on where you are registered.
• Free choice: Whether you can pick another public hospital depends on your region, and the hospital can refuse.
• Timing: Ask for a change early in pregnancy, well before the third trimester.
• Home and private birth: Home birth is legal but usually privately paid; private clinics are widespread in big cities.
• Newcomers: A pregnant woman is entitled to birth care whatever her administrative status.

Your public birth hospital is assigned by area

In the public system you give birth at the reference hospital for your health area (área de salud). The area follows the health centre (centro de salud) where you are registered by address. You do not pick the hospital by default.

The midwife (matrona) and GP at your health centre follow your pregnancy. They refer you to the area hospital's obstetrics unit for scans and the delivery. This referral usually happens at the first pregnancy visits, in the first trimester.

Area maps are set by each region, so the hospital for your street can differ from what a friend in another region got.

Can you choose a different hospital?

It depends on your region. Some regions allow free choice of hospital for specialist care, which in practice covers birth. Madrid is one of them. Other regions, such as Valencia, Galicia, Andalucía, Aragón, Navarra, Castilla y León, Catalonia and the Basque Country, have schemes of varying scope, often a choice within the region. Many regions allow no choice at all for some cases.

Even where choice exists, it has limits. The hospital you ask for needs spare capacity. It also needs the right level of care if your pregnancy is high-risk, and it can refuse you if it lacks either.

How to ask for a change

Where choice is allowed, do this:

1. Ask your midwife or GP early in pregnancy whether your region allows it.
2. Get the choice request form from your health centre, your regional health service or the hospital's patient service (atención al paciente).
3. Hand it in with your ID, your health card (tarjeta sanitaria) and proof of address.
4. Ask the chosen hospital to confirm it can take you. Keep your assigned hospital as a fallback until it does.

Ask early, ideally before your first hospital visits and well before the third trimester, so your file can be transferred.

Private clinics and other settings

Almost all births in Spain happen in hospitals, public or private. Private clinics are widely available, especially in Madrid, Barcelona and other large cities. You pay yourself or through private insurance.

Home birth is legal. In most of Spain it is not publicly funded, so you would hire an independent midwife privately. Catalonia has run limited publicly supported pilot schemes. Stand-alone birth centres are very rare. Some public hospitals have low-intervention or natural-birth rooms, so ask your assigned hospital.

If you are new and have no papers yet

A pregnant woman is entitled to pregnancy, birth and postpartum care whatever her administrative status. In practice you should not be turned away from birth care. The first step is registering on the padrón at your town hall, then getting your health card at your health centre. Undocumented people are often asked for 3 months of residence, but the pregnancy exception applies. Offices apply the paperwork differently, so ask yours what they need.

Plan in time

Register and get your health card as soon as you arrive. Raise the place of birth at your first midwife visit. Use the decision, documents, checklist and warnings below to work out your route.

Choosing between options

Do you stay with your assigned hospital or ask for a different one?

• Stay with your assigned public hospital: Your region does not allow choice, you are happy with the area hospital, or your pregnancy is high-risk and needs that hospital's level of care.

• Ask for a different public hospital: Your region permits choice and you prefer another hospital. Ask early in pregnancy, as the new hospital needs capacity to take you.

• Give birth in a private clinic: You want a private setting and can pay yourself or have private insurance.

• Plan a home birth with an independent midwife: You want a home birth and accept paying privately, as it is not publicly funded in most of Spain.

Start from your assigned hospital. Ask for a change only if your region allows it, and choose a private or home setting only if you can pay for it.

Check with your regional health service whether hospital choice is available where you live.

Documents you need

• Photo ID, such as your passport or foreign ID card, to submit a hospital choice request.

• Your health card (tarjeta sanitaria), issued by your regional health service at your health centre.

• Proof of address. Your padrón registration from the town hall is the usual proof, and it is also the first step to getting a health card if you are undocumented.

• The hospital choice request form, available from your health centre, the regional health service or the hospital's patient service (atención al paciente).

Checklist

• Ask which hospital your health area assigns you to, so you know the default.

• Ask your health centre or the chosen hospital's patient service for the choice request form and fill it in.

• Hand in the form with your ID, health card and proof of address, before your first hospital visits and well before the third trimester.

• Ask the chosen hospital whether it can take your pregnancy, and keep your assigned hospital as a fallback until you have a reply.

What to watch out for

• The hospital you choose can refuse you: A hospital can turn down your request if it lacks capacity or if your pregnancy is high-risk. Ask early and keep your assigned hospital as a fallback until you have a written or clear reply.

• Asking too late can block the transfer: If you leave the request until late in pregnancy, your file may not be transferred in time. Raise it with your midwife or GP in the first trimester, and well before the third trimester.

• Free choice is not available everywhere: Where choice exists, its scope differs by region, and in many places it only covers the specialist centre within your region. Ask your health centre what your region allows before you plan around a specific hospital.

Frequently asked questions

Can I give birth at home or in a birth centre in Spain?

Yes, home birth is legal in Spain, but it is not publicly funded in most of the country. You pay an independent midwife privately. Stand-alone birth centres are very few, though some public hospitals have low-intervention birth rooms. Catalonia has run limited publicly supported home-birth pilots.

Can a pregnant newcomer without papers get public birth care?

Yes, pregnant women are entitled to pregnancy, birth and postpartum care whatever their administrative status. In practice you are not turned away from birth care. Start by registering on the padrón at your town hall, then ask for the health card at your health centre.

Can the hospital I ask for refuse my request?

Yes, the receiving hospital can refuse if it lacks capacity or if the pregnancy is high-risk. Ask your midwife which hospitals can take your case, and ask early so you have time for another option.