As we conclude our exploration of maternity care in Andalusia, this article covers the prenatal visits and healthcare procedures during the final trimester of pregnancy. For the first and second trimester check the links.
Consistent with my previous articles, remember that these are guidelines, and you always have the freedom to make informed choices about your healthcare.
Important preliminary consideration: Each medical procedure and recommendation during this trimester is voluntary. Healthcare recommendations are not immutable laws, but suggestions to be carefully considered. Always take time to research, ask questions, and make decisions that align with your personal health philosophy and individual circumstances. If you need help to gather information don't hesitate to contact me. I will be more than willing to get you to some good sources of information.
Maternity care in the social healthcare system in Spain - first trimester
These are the prenatal visits that will be offered to you and what each visit will include:
Eighth Prenatal Visit - Preparation for Birth and Parenting conducted by midwive or nurse
This series of at least three sessions focuses on preparing you for childbirth and early parenthood. Starting from the 28th week, these visits will cover:
- Metabolic screening information
- Immunization-preventable diseases
- Vaccine administration
Hospital-Provided Childbirth Preparation: A Critical Perspective
When attending the childbirth preparation of the hospital it is good to keep in mind that the hospital midwife will inform you according to hospital policy and guidelines. Their preparation is fundamentally rooted in institutional protocols, not in what's truly best for you as an individual. These standard preparations systematically exclude numerous available options and often present a narrow, institutionalized view of childbirth.
In contrast, choosing independent childbirth education offers a transformative alternative:
- Specialists who are experts in their field
- Education not constrained by hospital policies
- Engaging video content and empowering stories
- Focus on natural pain relief techniques beyond medication
- Comprehensive exploration of all childbirth options
- Freedom to choose your own childbirth educator
- Active involvement of your birth partner
- Development of informed birth preferences that transcend hospital limitations
If you prefer independent childbirth education check out my courses!
Ninth prenatal visit Week 28 (28-30) conducted by Family doctor, midwife or auxiliary nurse
A comprehensive physical examination will be conducted, including:
- Weight and blood pressure measurement
- Uterine height assessment
- Baby's heartbeat monitoring
Special Considerations:
- Potential Oral Glucose Tolerance Test (OGTT)
- Possible Anti-D gamma globulin administration for Rh-negative women
- Optional and voluntary donation of umbilical cord blood to the Umbilical Cord Blood Bank of Andalusia discussion*
*A critical perspective on umbilical cord blood donation
Consider carefully the implications of cord blood donation. This blood is the very precious blood of your baby! It is not merely excess – it contains valuable stem cells and nutrients crucial for your baby's initial development. ¨Cord blood¨is not just blood left in the cord and the placenta, it is blood that otherwise would go to you baby. This very valuable blood with special cells called hematopoietic stem cells that can be used to treat some types of diseases, but also a good amount of iron and nutrition is carried in this blood.
Do you really want to give away this valuable blood or keep it for a possible moment in the future in which it could be used or do you want to give your baby the best possible start with its own valuable blood? Cord blood cannot be collected when you do optimal cord clamping, sometimes it is said it can be collected with delayed cord clamping, but then your baby still doesn’t get all its blood from the placenta and cord.
Extra appointments before your 30th week of gestation seperate from this schedule.
Workshops are given on preparation for childbirth and postpartum psycho-physical recovery, in which physical exercises are performed before and after childbirth, as well as dynamic relaxation techniques, advice on newborn care and promotion of breastfeeding.
Also the possibility of developing a Birth Plan* will be mentioned, and the birth plan that is offered by the Junta de Andalusia can be provided.
*Critical note on the birth plan provided by the Junta de Andalucía
The birth plan that is offered by the Junta de Andalucía is a nice gesture, but when reading it I found that not all your options are described and also at times it is written in a way that you could think you have no other choice as to what is written in this birth plan. In my opinion this birth plan is biased and does not leave room for discussion or extra consideration of all option there are in birth. It is written in accordance with hospital policies and not for the birthing woman. Therefor I think it is an incomplete and somewhat misleading document. If you want to have a full overview of your choices you can book a birth plan meeting with me or book the hypnobirthing course in which all your choices are discussed and you receive a very complete document with all the choices you have in pregnancy, birth and postpartum.
Tenth prenatal visit - Week 34 (33-35) conducted by obstetrician or nursing assistant
In this appointment an ultrasound examination of the third trimester is offered.
Eleventh to twelfth prenatal visit - Weeks 35 to 40 conducted by the midwife, family doctor or primary care nurse
Visits will include:
- Physical assessments
- Potential Group B Streptococcus testing
- Discussion of labor options
- Fetal well-being monitoring
Important Decision Points:
- Epidural analgesia options
- Potential labor induction discussions
- Gestational diabetes management considerations
For those with gestational diabetes, delivery timing recommendations will be discussed. However, these are guidance, not mandates. Overall, these recommendations are intended to optimize the timing of delivery for pregnant women with GDM, balancing the risks associated with GDM and the benefits of allowing the pregnancy to progress to full term. However, you may choose a different path based on your specific circumstances. Discussions with your healthcare providers and doing your own research to fully understanding your situation and benefits & risks involved are essential to determine the most appropriate course of action for you.
Thirteenth prenatal visit – Week 41 conducted by obstetrician, midwife or nursing assistant
Physical examination will be offered as well as ultrasound examination for assessment of amniotic fluid, and echocardiography for fetal well-being monitoring.
Besides that you will be offered to the Hamilton manoeuvres also known as a membrane sweep. This is a way of inducing your labour. Something to consider carefully, since it is a method of induction and has its own set of risks and side effects although it might sounds like a gentle and/or natural way of getting your labour started it can be quite the opposite. Do your research before agreeing!
Fourteenth visit this is after birth conducted by midwife or primary care nurse
A final visit is scheduled postpartum, typically on the third or fourth day after birth, which will include:
- Newborn health assessment
- Contraceptive counseling
Conclusion
Your pregnancy experience is uniquely yours. While healthcare systems provide guidelines, you are the ultimate decision-maker for your body and your baby. Approach each recommendation with curiosity, critical thinking, and a commitment to understanding the full context of any medical suggestion.
Informed choice is your most powerful tool in navigating this transformative experience and will contribute to making your pregnancy and birth experience a positive one!
These pregnancy, birth and postpartum blog stories you might also like:
Add comment
Comments