First Trimester Facts from a Midwife in Spain

Congratulations if you have just found out you are pregnant! Now is the time to start planning ahead. This information is to help you make the early choices, which include personal decisions and some changes to your lifestyle which benefit both you and your developing baby.

You can address the following issues immediately you have a positive test. Start taking Folic Acid 400mcg daily, if not already doing so. This is to reduce the risk of Spina Bifida and related problems (neural tube defects) in your new baby.
It can be bought over the counter in any Farmacia. The most recent research also recommends:- stopping smoking, cutting out alcohol and reducing your caffeine intake – found in chocolate, coca cola & tea, as well as, coffee! Soft cheeses, unpasteurised dairy products, pates and uncooked smoked fish or meat products are not to be eaten by pregnant women. They may carry the risk of an infection, LISTERIA, which can be harmful to your developing baby. If you are a cat lover or avid gardener you need to take precautions against the organism causing TOXOPLASMOSIS. Cat litter and garden soil are the most common sources of infection so leave the litter tray to someone else, wear gloves in the garden and thoroughly wash hands afterwards. This infection also effects the developing baby.

Tiredness is common in the first 12 weeks. You may consider moderating your exercise regimen if you regularly keep fit. You will have more energy after 12-14 weeks but high impact sport eg; aerobics, skiing, horse riding are usually avoided throughout pregnancy. If you are a frequent airline traveller you may think about flying less just now, particularly if you have had problems early on, in a previous pregnancy. It is also advisable to avoid hot baths including thermal pools & jacuzzis found in Spas. This may all sound like quite a change, but in fact these measures will all have a positive impact on your pregnancy.

The next issue to consider is who is going to care for you over the next 8 months or so? You are not sick in the conventional way, but it is advisable to be seen and monitored throughout your pregnancy.Your choices include:-
1. the care in the public social security system (SSS)
2. an independent midwife
3. an Obstetrician covered by a private healthcare plan
4. an Obstetrician whom you pay directly
5. You can also consider a mix of these - being seen both by a midwife and/or private and public Doctors simultaneously.

Many women are unsure of where they will give birth until quite late in pregnancy in Spain. You do not ‘book’ into a public hospital ahead of time, as in other countries. This is accepted practice – as you now have the right to choose which public hospital you will have your baby in.

The role of the midwife in ante-natal care in Spain varies between centro de saluds, (local health centre) but principally it involves the 1st ‘booking’ visit, visits at the later stages in pregnancy and running ante-natal classes. This is quite different to practice in other countries. They then see you when baby is about 5 days old, but in the health centre rather than in your home. They either work in the centro de saluds or in the hospitals but do not inter-change as the ‘systems’ are separate, again, unlike elsewhere There are a few UK & other EU registered Midwives living on the Costa del Sol & throughout Spain. For the most part they work independently although some are employed in the Spanish state system.

You need to be registered with a GP in your centro de salud once paying into the SSS in Spain. This entitles you to avail of services in that centre and this is where you make the first appointment with the midwife or ‘matrona’. If you are not paying into the SSS but have been contributing in the UK, or any other EU country, you may be eligible for full care for up to 1-2years by applying for it through the National Insurance HQ in the UK, or the equivalent office in your EU country. The EU Healthcard (formally the E111) is for emergency care in any EU country and is not the correct way to access the Spanish healthcare system for long term care, such as is required or advisable in pregnancy.

Most private healthcare companies require previous membership to cover care and the birth of your baby. Many foreign or expat women here in Spain will choose a private Obstetrician by hearing about them from a friend or reading about them on-line. You need to be happy and feel confident in your choice. Perhaps write your important issues or questions down before your first appointment to help remember to ask them. Never feel you are unable to get another opinion or meet another Doctor.

Ideally make your 1st appointment for when you are approx 8-10 weeks in order to be in time to have the choice of having 1st trimester screening between 11-13 weeks. Your first visit will include taking a medical/surgical & gynaecological history and usually having blood taken for group, rhesus, haemaglobin, Hepatitis B, Rubella, Toxoplasmosis and HIV – as a general guide. Your weight/height ratio (BMI) will be checked along with your Blood Pressure. Your EDD (expecteded date of delivery or fecha de parto de probabilidad, in Spanish) will be confirmed by doing a ‘dating’ ultrasound scan. It is recommended that your Tetanus cover is updated if required.

Antenatal screening is then offered to women in order to give them the possible risk of their babies having certain abnormalities eg; Downs Syndrome or Spina Bifida. Remember 95% of babies are born healthy and normal. The results are only a possible risk - written down or expressed as 1:1000 or 1:300 for example - and if found to be high you will be offered more accurate and definitive Antenatal diagnostic tests.

NOTE This is a general guide and individual women may have specific needs that require different care or screening. Personalised information can be obtained from your Midwife or Obstetrician.

Anne Halpenny has lived in Spain since 1993 and has worked in St Bernard’s Gibraltar & continues in the Hospital Costa del Sol, Marbella. She organises Antenatal classes in English & provides support for new parents, before & after the birth of their baby.

Contact her www.irishmidwife.com or 630 231 037 or read more about her classes on www.mumsinspain.com/forum

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Moving to Spain with children

Embarking on a new life in a foreign country is a major step for anyone. It takes a good deal of nerve, boundless enthusiasm and an unswerving determination to overcome the inevitable obstacles. If you're making the "big move" with children, you're going to need all these qualities by the bucket load!

Over the last two decades an increasing number of families from northern European countries have set up home in Spain. And for many, the move has turned out to be the best decision they ever made. They left behind an inclement climate, high stress levels, long working hours and streets too unsafe for their kids to play in. .
In their new promised land they found year-round sunshine, a laid back lifestyle and friendly towns untainted by the weekend violence of binge drinking teenagers. But not all families find their Utopia in the Mediterranean sunshine. For many the upheaval of leaving their native land and adjusting to a completely different way of life proves too much to cope with and they return home wiser for the experience (and usually considerably poorer!) If you're considering moving to Spain with children, make sure you're aware of all the common problems and pitfalls which face foreign families trying to start afresh in a new country.

As a rule of thumb, the younger your children are the more likely they are to settle abroad and adjust to all the sudden changes in their lives. Young kids can adapt quickly and easily to almost any change of circumstances as long as they're at the centre of a loving, secure family. Pre-school children pick up a new language in no time, they make new friends quickly and are likely to adapt easily to the new climate and different routine.

The older your children are when you move, the more likely they are to suffer with problems such as homesickness, isolation and feelings of inadequacy at school. No matter how loving and supportive you are as parents, teenagers are likely to find it extremely difficult to settle into a Spanish school especially if they're not fluent in the language from day one. So you'll need to consider whether you can afford private education within an international school. And if you can, you'll obviously need to do some thorough research into where the reputable schools are, what they charge and what they offer.

Getting children a place in a state run Spanish school is normally a straight forward affair for EU citizens - you can get your child in school almost immediately, it's free and you don't need to wait for a resident's permit ("residencia"). Some of the more popular schools have a waiting list but the local authorities have a responsibility to find an alternative school if necessary. In areas with large ex-pat communities, many Spanish schools provide special language coaching for newly arrived foreign children for the first few weeks.

If you plan to send your children to a Spanish school, it's important that you master the language yourself so that you can be fully involved in their education, progress and any problems that may arise. And don't forget that some areas of Spain, such as the Valencian region and Catalonia, have their own local language which is predominant in many state schools.

Brace yourself for minor hiccups and probably a few serious setbacks in the first few months. When anything goes wrong in your child's life during that initial period, he or she is likely to wail: "I want to go home!"

Be patient. It may take a year or two before your child starts thinking of Spain as home.
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10 steps to potty training!

My little boy is going to be 2 in a couple of weeks and is constantly ripping off his nappy and randomly weeing all over the place! I have bought him a potty and have gently been encouraging him to use it.......he's getting there! Here are perhaps some good tips for anyone else in the same boat!.

Although there are no hard and fast rules, these tips should help make the journey from nappy to potty more smooth. Remember, however, that accidents are inevitable at first – so don’t be angry or make a fuss. If, however, your toddler shows any signs of distress about potty training, or has lots of accidents, stop for a week or more before trying again.

TOP 10 WAYS TO POTTY TRAIN

1 Make your purchase
From around 18 months onwards, buy a comfortable, broad-based potty. Let him sit on it for fun now and again – before bath time is a good time to try. Tell him what it’s for, and if he does anything in it, praise him. If he’s not happy, wait a few days and try again.

2 Choose a pot spot
Decide on a place to keep the potty so that he gets used to where it’s kept, and when you think he’s ready, increase his number of daily visits. Every time he sits on it, remind him what you hope he’ll do on it from time to time, and always praise him if he does something.

3 Time it right
Continue with these occasional sessions. If your child does a poo at more or less the same time every day, get him to sit on the potty at that time, explaining and reminding him what it’s for. If his habits aren’t regular, watch out for the signs that he is about to ‘go’ (reddening face, concentrated look, standing still) and quickly put him on the potty.

4 Bear his bottom
Leave his nappy off from time to time. Try this one morning or afternoon when you’re at home, and tell him it’s because he is learning how to use the potty. Sit him on the potty now and then. He may wet or dirty lots of pairs of pants without using the potty - if so, go back to steps 2 and 3, and wait a few days before trying again.

5 Ask him nicely
Start asking him if he needs the potty - but don’t nag! He may sometimes refuse and then
promptly wet his pants. If this is the case, don’t criticise. Help to increase his sense of independence by reducing the number of times you decide to put him on the potty - your aim is to help him recognise the signals for himself.

6 Skip to the loo
Once he’s comfortable with the potty and you think he understands what it’s for, you can start to encourage him to use the toilet. To make sure he feels comfortable and safe on the loo, buy him a special trainer seat and explain to him that using the loo is what grown-ups do (he’s probably seen you on it enough times!).

7 Be prepared
Put him on the potty or toilet before you go out. It'll take time for him to learn to urinate at will without having first felt the urge to go, so be patient with him.

8 Make allowances
Gradually leave your child nappy-free for longer, more frequent periods. You might want to use disposable trainer pants instead, especially when you’re away from home or when you don’t know if there’ll be a toilet you can get to quickly. These absorb accidents but can also be pulled up and down like ordinary pants. Accidents are unavoidable: try to be sympathetic rather than irritated!

9 Relinquish the power
Let your child use the loo more often in preference to the potty, and allow him to decide for himself more and more often when he wants to use it. Try to keep your reminders to an absolute minimum.

10 Bye-bye nappies!
When he is clean and dry most days, use nappies only at night. He'll probably still have a few accidents, but keep on persevering. Remember, he'll still need help from you with the more advanced skills of bottom-wiping and dealing with zips and buttons.

Good Luck!
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Postnatal Depression Support Network

Postnatal Depression or PND as it is known, is a very common condition that can occur after childbirth. It affects up to 15% of all new mothers. It is more likely you may suffer from PND if you have a past history of depression, have undergone big life changes during pregnancy, are lacking support at home, if the baby was unplanned or unwanted, the baby has health problems but, sometimes, PND arrives unexpectedly and none of these factors seem to have a bearing.

Ultimately, the stress and responsibility of motherhood may be enough for some women to feel this way. The important thing is to talk to somebody about how you are feeling.

Symptoms of postnatal depression
The symptoms are very similar to other types of depression, i.e apathy or feeling constantly tired and unable to enjoy anything, sleeping too much, lack of interest in anything, overwhelming feelings of sadness or despair, anxiety, compulsions (like constantly cleaning or washing your hands repeatedly), being unable to concentrate, feeling irritable, and excessive crying.

In addition to these feelings, new mothers suffering with PND may experience feelings of worthlessness, hopelessness and feeling completely unable to cope with the demanding task of being a mother to a new baby. The reality of life with a newborn is often a shock to first-time mothers and can create very negative feelings in a woman. Sleep and appetite are often affected in a detrimental fashion, as is learning to take care of another person who is completely reliant upon you; this can be a daunting and overwhelming period of time.

Anxiety is another very common symptom; the fear of something harmful happening to your baby can make the mother feel tense and tearful. Frightening panic attacks, that leave the mother short of breath and feeling as if something terrible is about to happen, are also common.
If you are experiencing any of these symptoms or feel you are unable to cope you must seek medical advice. This does NOT mean you are a bad mother.

Don't feel like you're alone. Post a comment on our forums and talk to other mums who may have been through a similar experience. We have a support network for Mums who think they may be suffering from some form of depression with a resident counsellor, Roxanne Claude, on hand to answer any questions.
www.mumsinspain.com/forum
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My Top 10 Tips for giving birth in Spain

1) Not many hospitals offer antenatal classes but they really are worth seeking out privately if this is the case for you. There are a number of independent midwives offering classes throughout Spain. You can either join a group class or in some cases have private sessions. I didn’t have any and I do regret this, not just for me but also for my partner who didn’t have a clue on the day! www.mumsinspain.com


2) If you are planning to breastfeed try to find as much support as possible. Hospital staff do encourage you to breastfeed but most do not offer anything in terms of help or advice. It is possible that you have a La Leche League group in your area who could give good advice, or if you have used a midwife for antenatal classes they could offer some support. Failing that talk to some experienced breastfeeding mums. www.mumsinspain.com

3) There is a high caesarian rate in Spain, particularly private hospitals. It is best to be prepared for this just incase by reading up a little about them and what expect. Your hospital stay will be longer than a natural delivery which is normally one over night stay, with caesarian it is up to 5 days and you should expect to find it difficult to move around for approx 2 weeks afterwards. This is worse case scenario but it is better to be prepared. Even if you do have a natural delivery it would pay to plan to have help when you come home.
There is little in way of support in the hospital after delivery and nothing when you come home, no health visitor system like in the UK, so someone to help with the house or younger siblings would be a great help, and possibly a home visit from a local independent midwife to check you and baby are well and coping. www.mumsinspain.com

4) It will save a lot of stress if you could make sure you know how to go about registering your baby before their arrival so that neither you or your partner are panicking after the baby has arrived wondering how to go about it. Locate your local civil registry office and find out a little bit about the process and what papers you will need to take. There is a time limit on registering your baby.

5) Don’t be afraid to ask questions from your Obstetrician or primary care giver. If a tour of the delivery suite is available request one. It might seem scary when you see it for the first time but it really doesn’t look the same way to you when you are in labour! My hospital didn’t offer me a tour but I did ask for one and they were glad to accommodate. I was horrified afterwards but it all looked a lot more welcoming on the day!

6) Do take anything that could make your labour more comfortable, i.e. a pillow, comfy T-shirt, birthing ball. Most hospitals will not offer much in the way of “comforts” so better to be prepared. I did pack CDs with me but I didn’t listen to any of them, but at least I had them incase. A big pillow or cushion would have been great to kneel on or lean against though with those hard marble floors! A birthing ball even better! I would include a good supportive birthing partner in my list of comforts too!
If you are planning to breastfeed perhaps take a breastfeeding pillow with you as the hospital beds can be uncomfortable and awkward to get a good position in, especially post-caesarian.

7) Pack a coming home outfit for your baby, but hospitals tend to provide everything for the baby including blankets, baby-gros, nappies, hats, etc. Do check with your hospital first if you are not sure. You will need some stuff for yourself though like breastpads, nursing bra, disposable pants and a nightdress that you can feed from easily as hospital robes are not practical for this, as well as maternity pads, although the hospital can provide you with these during your stay. Better to pack a couple of days worth of everything just incase your stay in hospital is a little longer than expected.

8) Never be afraid to ask for help or feel intimidated by any language barrier. If you aren’t sure of something get your partner to find someone who can understand you, there is sure to be at least one person who can speak a little English.

9) Speak to other mums about their own experiences and learn about what you can expect of your hospital care, etc. Do remember though that everyone’s birth experience is different, even within the same hospitals. Horror stories do the rounds wherever you live. Talk to as many different mums as possible and get a balanced view. www.mumsinspain.com

10) Keep an open mind! Giving birth may well be a different experience in Spain compared to the UK for example, but different doesn’t necessarily mean worse.

Good luck! You’ll be fine

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New Spanish School Year

The new school year is one week away and lots of little ones will be taking a very grown up step forward with their first day at big school. You can send your little one from the age of three over here, although legally it is not compulsory until they are six. It seems such a tiny age to send them off, but the hours are 9 til 2 which is the same as lots of children are spending at nursery anyway and the structure of the day is very much preschool, so plenty of learning through play. Here is a really comprehensive article about the school system in Spain which you might find useful:

Spain's state-funded school system (escuela pública) is supported by a comprehensive network
of private schools (escuelas privadas), including many foreign and international schools. Around one third of Spain's schoolchildren attend private schools, most of which are co -educational day schools.
State education is the responsibility of the Ministry of Education and Science (Ministerio de Educación y Ciencia), although authority can be delegated to regional governments. Of the 17
autonomous regions, seven (Andalusia, the Basque Lands, the Canary Islands, Catalonia, Galicia, Navarre and Valencia) have responsibility for their own education system (including higher education). State education is free but parents must usually pay for school books (which are expensive, although they are provided free in certain cases), school supplies, and extra curricular activities such as sports and arts and crafts. Pupils usually go to local village (pueblo) nursery and primary schools, although attending secondary school may entail travelling long distances (buses are provided). Compulsory education (escolaridad obligatoria), termed the basic general education (Educación General Básica/EGB), begins at six years of age in a primary school (escuela primaria) and lasts for eight years. At the age of 14 (equivalent to eighth grade) pupils receive a school -leaving certificate, which determines the course of their future education. Those with high marks are awarded a título de graduado escolar certificate and attend a higher secondary school to study for their baccalaureate (bachillerato). Less academically gifted pupils are awarded a school certificate (certificado de escolaridad) and attend a vocational school (formación profesional) providing specialized training for a specific career.

Enrolment
The normal registration period is in May for the following September, and is usually done at the
local town hall (or sometimes by applying directly to a school). Enrolment in a Spanish school requires an interview and in rare cases an examination. New arrivals in Spain must have their children's education record officially verified through a process known as homologation (homologación) or validation. This is an expensive and lengthy process involving the confirmation of credits and marks for each year of schooling. It can be very expensive, e.g. 300 € to 1200 €, depending on the number of years to be validated. Without the necessary paperwork a child won't be accepted at a state school, irrespective of his qualifications (foreign qualifications such as the British GCSE aren't recognized in Spain). If possible, this process should be completed before arriving in Spain, as a child may not be accepted at a school until the official papers (confirming validation) have been received and stamped by the Spanish Department of Education. In Spain, children must attend a state school within a certain distance of their home, so if you have a preference for a particular school, it's important to buy or rent a home within that school catchment's area. Town halls and provincial Ministry of Education offices can provide a list of local schools at all levels. To enrol a child in a Spanish school you must provide your town hall with the following documents:
your child's birth certificate or passport, with an official Spanish translation (if necessary); The academic year in Spain runs from the first week in September to the end of June, with the main holidays at Christmas, Easter and the long summer break. School hours vary depending on the particular school and are usually from 0900 until 1600 with a one hour break for lunch, although an increasing number of schools don't have a lunch break and finish classes for the day at 1400. Lessons are usually divided into teaching periods of 45 minutes. State schools and communities usually provide an after school nursery (guardería) for working mothers.

Spanish school children have long school holidays (vacaciones escolares) compared with many other countries. School terms are fixed and are generally the same throughout the country, although they may be modified in autonomous regions to take account of local circumstances and special events (such as local fiestas). The school year is made up of three terms, each averaging around 11 weeks.

School holiday dates are published by schools and local communities well in advance, thus allowing parents plenty of time to schedule family holidays during the school holidays.

Pre-school education (Educaciòn Infantil)
Spain has a long tradition of state-funded pre-school (preescuelar), with over 90 per cent of children aged four or five attending for at least one year before starting compulsory schooling.
The term pre-school embraces play school, nursery school (guardería), kindergarten (jardín de la infancia) and infant school (escuela infantil).

Under the LOGSE reforms, pre-school education is divided into two cycles; cycle one (ciclo 1º) for ages one to three and cycle two (ciclo 2º) for ages four to six. Attendance is voluntary and ree in public centers in many areas until the age of 5. The obligatory age for starting school is 5 years old.In addition to state-funded schools, there are also many private fee-paying nursery schools,
usually taking children aged from two to six, some of which are an integral part of a larger primary school. Arrangements are generally flexible and parents can choose attendance during
mornings or afternoons, all day, or on selected days only. Many schools provide transport to and from homes. Fees are generally low and schools are popular, well-organized and good value for money.

Children learn about social, personal and environmental values, as well as developing their
physical and mental skills. During the final years of nursery school, the rudiments of reading,
writing, English and arithmetic are taught in preparation for primary school.
Nursery school is highly recommended, particularly if your children are going to continue with a
state education. After one or two years of nursery school they will be integrated into the local
community and will have learnt Spanish in preparation for primary school.

Primary schools (Educaciòn Primaria)
At six, children move to primary school. It last for 6 years and is divided into 3 cylces. Pupils will
study Spanish language, Maths, Conocimiento del Medio (include biology, history, geography...), a second language, art and physical education. In addition most of them will study religion.
Although State education is free, parents will still have to buy books, material and pay for extra
activities.

Secondary Education schools (El Instituto)
At age 12, children progress to Secondary school. The first 4 years are called ESO (Educaciòn Secondaria Obligatoria) and children can leave the education system at the end of this section (or at the age of 16). The EsO is divided into 2 cycles of 2 years each (with the possibility of repeating the first year)
At the end of the 4 years, students will obtain a certificate. For most of the students who choose
to stay at school, they will then follow a 2 years Bachillerato academic course. There are 4 types of Bachillerato: Arts, Humanities, Natural and Health Sciences and Technology. At the end of the 2 years students will stand examinations during the monthj of May and the final result will be based both on results and continuous assessment.

University
In June, students who wish to go to University take a general University entrance examination
(PAU) and the courses they will be able to follow depends on that examination and the result of the Bachillerato. Students may take as long as necessary to complete their degree, repeating courses and spreading out examinations over years.

InformationAEEA - Andalusian Association of Spanish Schools for Foreigners - Marbella, Spain Nathalie
Boone Ctra Nacional 340, km 189, 6 Marbela, Malaga 29600 - Spain
http://www.aeea.es/

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