Guide to Natural Birth Options in Spain

The majority of Spain’s maternity care is hospital-based. However, a growing number are looking at alternatives, such as water births and home births. Some women also use private midwives or a doula. Although these practices are legally permitted, they may not be widely available via the public healthcare system. Therefore, it is essential to know your rights, as well the practical aspects. This guide provides a comprehensive overview for expectant parents considering natural birth options across Spain, including Andalucia, Cataluña, Madrid, and the Balearic Islands.

Legality and rights

In Spain, home births and natural childbirths are both legal. In Spain, the law does allow women to choose whether or not they give birth in a hospital. However, in most cases, Sanidad (the public health system) does not provide services for home births. Those mothers who opt for this option must arrange their own care. The presence of a midwife is essential. The Spanish Supreme Court warned parents that they could be charged with negligence if any harm occurred if an unattended childbirth was attempted.

Spanish law gives women certain rights in hospitals. The rights of women in hospitals include the right for informed consent, to refuse unnecessarily interventions, to demand skin-to flesh contact immediately following birth, and have a companion present. Spain also has regional “humanized birth” initiatives, which are designed to reduce interventions while increasing maternal autonomy. The implementation varies from hospital to hospital.

One mother from Cádiz commented: “I spent months calling hospitals and searching for the right one. You are initially registered for birth at the nearest hospital. You must inform your GP if you wish to give birth at a different hospital. All your medical data will be sent to that hospital. Then they contacted me to arrange my final checkups and birthing plan.

Home births

Home births are only possible for women with low-risk pregnancy, usually when the baby is head-down in a cephalic position (head-down) and labour takes place between 37-42 weeks. Women with multiple births or complications, as well as high-risk pregnancy, are advised to give birth in hospital.

Home births are attended by independent midwives in private arrangements. In Catalonia, some midwifery teams also provide care for eligible families. Costs for home birth services usually range from €1,300 to €3,000, depending on the number of prenatal visits, postnatal care, and whether additional support such as a doula is included.

In Spain, home births are rare. They represent less than 0.2%. The rates of home births are slightly higher than the national average in Catalonia (as well as Navarra and the Balearic Islands), where they have traditionally been better organised. Mallorcan research shows that home births with professional midwives can have positive outcomes, even though around 10% of women require hospitalization for intervention. Home births have many advantages, including the continuity of care, the ability for the mother to customize the environment and minimal medical intervention. Families should consider issues like emergency transfer protocols, the availability of qualified midwives and legal implications for unattended or unsupported deliveries.

Natalia, from Granada, shared her experience of giving birth at home: “As my first time as a mother, I wanted as little interference as possible, but still the calm comfort at home. My baby was born breech, so I had to get an emergency C section at the hospital nearest me. I would suggest that any mother considering this option have a good midwife nearby, and not only a doula. As a first time mum, I now think it would have been safer for me to give birth in a hospital.

Water Births

In Spain, water immersion is more common during labor and delivery. However, availability varies greatly. Public hospitals and private clinics offer water births. However, not all of them have pools, and some facilities do not allow for the delivery to take place in water. Some hospitals use pools for pain relief only during the dilation period, but then delivery is done on land.

Hospitals in Spain known to offer full water births include La Plana Hospital in Castellón, Vall d’Hebron Hospital in Barcelona, and Hospital de Torrejon in Madrid. In Andalucía, mothers can access water birth pools for full delivery at PTS Granada, El Ejido Poniente Hospital in Almería, and Hospital del Mar in Cadiz. Even at these hospitals, women should be aware that the pools are not always available for full delivery, depending on staffing levels, equipment, and schedules.

Mary comments on her experience six years ago: I chose the PTS University Hospital in Granada, which offered water births. This is because university hospitals are usually up-to-date with the latest medical information and techniques. I initially wanted to give birth in water, but complications prevented me from doing so. I was thankful to have a team of amazing people supporting me. “I would suggest asking other mothers their experiences in hospitals before hand and not expecting everything to go as planned because you never can tell.”

Private clinics in Madrid, Alicante, and other regions also offer water births, with prices ranging from €1,000 to €5,000, depending on services, follow-up care, and the number of visits included. Water birth is still classified as experimental by the Spanish Societies of Obstetrics and Neonatology, which warns that more evidence on neonatal health and safety is required. Immersion in water during labour is generally accepted to be safe for mothers, and it can reduce pain and the need for interventions like episiotomy and epidurals.

Water births have several advantages: they increase maternal mobility, reduce stress and pain and can even shorten labour. They also create a more calm environment for your baby. The warm water could also help to reduce tearing, and improve satisfaction for the mother.

Midwives

The midwives or “matronas” are highly qualified health professionals in Spain who play an important role in maternal care. Midwives are responsible for the majority of vaginal births in hospitals. Obstetricians only intervene when there is a high risk or surgical case. Midwives provide prenatal care and breastfeeding advice, as well as postnatal follow up.

Home births are only covered by independent midwives, since the public health system doesn’t cover them. Independent midwives in many urban areas, such as Barcelona and Madrid, are often bilingual and experienced working with families from abroad. Midwives at home births have emergency equipment and medications as well as protocols for hospital transfers. This ensures safety in the event of complications. The midwives work closely with the families to create a birth plan that details preferences regarding pain relief, birthing postures, immediate skin-toskin contact and other personal preferences.

Doulas

Doulas are non-medical professionals who provide support during pregnancy, childbirth, and after the birth. They provide emotional support, comfort measures and practical assistance. Doulas, unlike midwives, cannot carry out medical examinations nor deliver babies. They complement midwifery services, especially when it comes to home births. Some hospitals allow doulas, with partners’ consent, to be present during labour in Spain. However policies can vary. In home births, a doula can be present to help with breathing, positioning and emotional support, while the midwife concentrates on clinical safety.

Regional Considerations

There are many variations in the availability of home births and waterbirths.

• Andalucía: Several hospitals provide water birth pools for full delivery, including PTS Granada, El Ejido Poniente Hospital in Almeria, and Hospital del Mar in Cadiz. Independent midwives are available to provide home births. However, the service is completely private. Public hospitals may promote “humanised births” and low-intervention protocols. However, access to birthing pool or midwife-led unit is limited.
• Catalonia offers some public hospital support to home births via midwife teams in addition to private options. Some hospitals, like Vall d’Hebron, have birthing pools that are suitable for full deliveries.
• Madrid: The Hospital de Torrejon, as well as private clinics, offer water births. Home births require independent midwives.
• Balearic Islands – Certain hospitals offer midwife-led treatment and limited water immersion. Private midwife networks are also available.
• Valencia and other areas: Hospitals such as La Plana Hospital, Castellon, offer full-water births while others only allow immersion for pain relief.

Safety and Practical Tips

• Make sure your pregnancy is low risk.
• Hire a midwife qualified with emergency training. She should also be familiar with hospital transfer protocols.
• If water birth is available, ask your hospital or midwife if it includes a full delivery or just dilation.
• If you want emotional and practical support, hire a doula.
• Prepare a birthing plan describing your preferences, and share it with your care team.
• Birthing pools are not always available when labour begins. Flexibility and flexibility are essential.

Spain offers many options for birthing naturally, but the availability of these options varies depending on region and private or public settings. Home births, while rare, are legal and require private midwives. Water births are increasingly available, particularly in Andalucian hospitals such as PTS Granada, El Ejido Poniente, and Hospital del Mar in Cadiz, as well as in Cataluña, Madrid, and Castellon. Doulas offer valuable support outside of medical care. Planning, knowledge of local options and professional guidance can help families to customize their birthing experience. This ensures safety and personal preference.