Public or private pregnancy care in Spain

Terms used

• Matrona — The matrona is a midwife who leads routine pregnancy follow-up in the public system.
• Centro de salud — The centro de salud is your local public health centre, where primary care is given.
• Carencia — The carencia is the waiting period before an insurance policy covers maternity.
• Reembolso — A reembolso plan lets you see any doctor and claim part of the cost back, and often excludes childbirth.
• Copago — A copago plan makes you pay a small fee per visit or service, and basic versions often exclude childbirth.

Key rules

• Public scans: The three routine scans and any medically necessary extra scan are free in the public system.
• Waiting period: Private maternity cover usually starts only after a waiting period of typically 8 to 10 months.
• Existing pregnancy: A pregnancy already under way when a policy starts is generally excluded from maternity cover.
• Choice of doctor: In the public system you usually cannot choose your doctor or hospital.
• Combining: You can add private scans to public care and still give birth in a public hospital.

The short answer

Public care is free at the point of use and led by a midwife. Private care gives you one doctor and more scans, and you pay for it, either through insurance or yourself. Combining the two is common: many people follow the public route and add a few private scans.

How public follow-up works

If your pregnancy is low-risk, your main contact is the matrona at your centro de salud. Sometimes the family doctor is involved too. The obstetrician at the hospital sees you at the key scan visits. These are usually around week 12, around week 20, and around weeks 32 to 36. There is also a late-pregnancy visit to plan the birth. Higher-risk pregnancies are referred to hospital obstetric clinics with more frequent visits.

You usually cannot choose your doctor. You give birth at your assigned public hospital, with whichever staff are on duty. Public hospitals tend to favour physiological birth. They also have the neonatal units that high-risk cases need.

How private follow-up works

One obstetrician-gynaecologist usually follows you throughout. Visits are roughly monthly, and there is often a scan at each one. You give birth at the private clinic where your doctor works. Often your chosen doctor attends, and you get a private room. Private clinics tend to have higher caesarean rates.

Scans

The three routine scans are free in the public system: first trimester, around week 20, and third trimester. So is any extra scan the obstetrician thinks is medically necessary. Scans for reassurance, 3D/4D scans, souvenir scans and recordings are not covered. You can only get them privately, for a fee.

What private care costs

With insurance, check what your plan covers. Most plans cover follow-up and birth, but usually only after a waiting period, the carencia. This is typically 8 to 10 months from the start of the policy, so conception has to happen after the policy begins. A pregnancy already under way is generally excluded from maternity cover. Cheaper plans, such as reembolso or basic copago plans, often exclude childbirth or sell maternity as an add-on. Newborn cover is often included only once the mother's waiting period is complete.

Without insurance, you pay per service or buy a package. Many private hospitals sell an all-inclusive birth package covering follow-up and delivery. It costs several thousand euros, and caesareans and complications cost more. Madrid and Barcelona are generally the most expensive. Ask the clinic for a written quote.

Combining public and private

Adding private scans to public care is common. People often add an early scan, a 3D/4D scan, a second opinion or private prenatal screening. Bring the reports to your matrona or obstetrician. They generally accept them but do not have to rely on them, and they will still do their own protocol scans and tests. You can give birth in a public hospital after private follow-up.

Which to choose

Choose public if you want free, midwife-led care and are happy with the staff on duty. Choose private if you want one doctor, more scans and a chosen place to give birth, and you have insurance or can pay. The decision, timeline and checklist below help you work through it.

Choosing between options

Should you use public care, private care, or combine both?

• Public care: You have low risk and are happy with a midwife-led approach, three hospital scans and the assigned hospital for birth.

• Private care: You want one obstetrician throughout, monthly visits, more scans and a chosen clinic for the birth, and you have insurance with maternity cover or will pay a quote of several thousand euros.

• Public care with private extras: You want public follow-up and birth but also an early scan, a 3D/4D scan or a second opinion, paid for privately.

Choose private if having one chosen doctor and a chosen clinic is worth the cost to you; otherwise start public and add private scans if you want them.

Timeline and deadlines

• Take out private insurance with maternity cover: before you conceive

• Conceive after the waiting period, so maternity and newborn cover apply: after the waiting period ends

Checklist

• Ask your insurer how long the maternity waiting period (carencia) is.

• Check whether your plan includes childbirth or sells maternity as a separate add-on.

• Confirm whether your newborn is covered and when that cover starts.

• Ask a private clinic for a written quote for follow-up and birth, if you will pay yourself.

• Ask the quote to state whether it covers a caesarean, complications and the length of the hospital stay.

• Bring any private scan reports to your matrona or obstetrician if you combine public and private care.

What to watch out for

• Insurance may exclude a pregnancy that has already started: If you buy a policy while pregnant, the insurer may refuse or exclude maternity cover. Take out a policy before you conceive and read the maternity conditions before you pay.

• Cheaper plans may not cover birth: Many reembolso or basic copago plans exclude childbirth or sell maternity separately, and newborn cover may depend on the waiting period. Ask the insurer in writing what is covered for pregnancy, birth and the newborn.

• You usually cannot choose your public doctor or hospital: In the public system you give birth at your assigned hospital with the staff on duty, and low-risk follow-up is mostly with the matrona. If choosing your doctor matters to you, look at private care or add private visits to public follow-up.

Frequently asked questions

Can I buy private insurance once I am already pregnant?

You can buy it, but a pregnancy already under way is generally excluded from maternity cover. Maternity cover usually has a waiting period (carencia) of 8 to 10 months from the start of the policy. Some policies still cover complications of the mother afterwards.

Will my public midwife accept the results of my private scans?

Usually yes, if you bring the reports to your matrona or obstetrician, but they do not have to rely on them. They will still do their own routine scans and tests. Giving birth in the public hospital after private follow-up is allowed.

Do I pay for extra scans in the public system?

Yes, you pay for extras such as 3D/4D scans, souvenir scans or recordings, and they are only available privately. Routine scans are free, and so are any extra scans your obstetrician considers medically necessary.

Does private insurance cover my newborn?

Often only if the mother's policy has completed its maternity waiting period. Cheaper reembolso or basic copago plans may exclude childbirth or sell maternity as a separate add-on, so check this before you sign.