Giving Birth in Spain: Applying for US Citzenship

Two important items in the process

This may come as a surprise to some, but because Sammy was born on Spanish soil, that doesn't automatically mean he is a Spanish citizen. And it also may interest you to know that just because he was born abroad to parents with US citizenship, the US government doesn't just miraculously give him his birth certificate and passport. And yes, he does need a passport. Many people are shocked that a baby would need a passport but anytime a US citizen leaves the country, they need a valid passport. Therefore to get back IN to our country we'll need passports for all 4 members of our family. I'd really hate to leave Sammy at the airport . . .

So here is what we had to do in Spain to get all the necessary documents for Sammy to become a bona fide American.

1st, we had to head to the Registro Civil. Here is where we registered Sammy as being born in Madrid. We needed to bring with us a document filled out at the hospital containing all of Sammy's info (birth date, weight, etc), his parents info, (names, our parents names, marriage date) and information from the hospital (doctor info etc). We also filled out some other forms there. By the time we left, we had a simple version of a Spanish birth certificate, and his Libro de Familia. The Libro de Familia is something all Spanish families have here. It contains information on each member of the family and it's needed for the next step in the process.

Where one can speak with an American . . . ahhh

2nd, we secured an appointment at the US embassy. For our appointment there, we had to bring our passports, the Libro de Familia, a translation of the Spanish birth certificate, our marriage certificate, proof that we've lived in the US recently (old tax forms), Sammy's passport application, social security number application, and form for obtaining a US birth certificate.



5 weeks old . . .

We also had to bring passport size photos of Sammy. All I have to say is taking a picture of a 5 week old with eyes open in one of those photo booth thingies is no easy thing . . . This was the best one we could get. Luckily, the guy we had was really friendly, easy to work with and had children, therefore he said the picture we submitted was just fine. Whew!



Sammy's first passport . . . it's good until he turns 5!

A few weeks later we received Sammy's passport in the mail. Along with that came his birth certificate which looks completely different than Renae's and even ours! His is actually called a Consular Report of Birth Abroad. Both the certificate and the passport state that Sammy was indeed born in Spain. I love that his American passport will always say Spain in the Place of Birth slot!

Sammy the luchador . . .

So no, Sammy is not a Spanish citizen, but is now officially an American citizen! And most importantly, he can come back with us when we return to the states . . .

Giving Birth in Spain: Labor and Delivery!

Sammy is 2 weeks old today so I figured it was time to write about my birthing experience here in Spain. When I was looking for information about what it's like to have a baby in Spain, I couldn't find much via my multiple Google searches. I'm happy to report that when you Google "Giving Birth in Spain" this blog shows up on the 2nd page of search results. So hopefully this recap of my experience will help out a fellow American expat in the future. If you are just a friend or family reading this blog, I guess you can enjoy (or die of boredom) learning about Sammy's birth. Warning-it's a little long.


One happy birther . . .

**I had an GREAT birthing experience here in Spain. But as I've mentioned before, the labor process here is highly medicalized. Therefore, if you are more comfortable with a more natural approach to labor, having a baby in Spain could be frustrating for you. So keep this in mind as I write because many of the reasons I loved it are reasons that could have driven you crazy! **

*If you'd like to know about a non-medicalized birth in Spain, this blog features 2 Americans who are having baby number 2 here! Scroll down to the bottom and look through their topics for info about pregnancy and birth.*

First off, I went into labor on my own which contributed to a better delivery. I woke up around 5:15 am Wednesday the 14th with a very strong contraction. Over the next 45 minutes I started having a few contractions but wasn't sure if this was real labor or not. At 6:00 I started timing them and another 45 minutes later, I realized they were 7 minutes a part. I told Jesse I was going to get up and see if the change in position slowed them down. A half hour later I was back telling him that I was most likely in real labor because the contractions were getting stronger and were continuing to come every 6-7 minutes.

Jesse got up and took a shower and I tried to get last minute things ready. I kept my priorities straight-updated Facebook, sent some emails-Oh, and woke my Mom up to tell her I was finally in labor. By the time Jesse was finished with his shower I was so glad because the contractions were getting much stronger. After awhile I realized he hadn't come out of the bathroom. Turns out he was shaving!! I kindly reminded him to HURRY because I needed to get to the hospital-NOW!

We left about 7:45 a.m with contactions coming every 3-5 minutes. As we hit the onramp to M-30 we saw what every pregnant woman in labor wants to see: traffic. It usually takes 10 minutes or less to get to the hospital. On labor day: it took a half hour!! I loved the stop and go lurching of the car during the contractions . . . .

When we first arrived at the hopsital, we were nervous because the initial staff almost seemed oblivious to the fact that I was in labor. One guy did get me a wheelchair to sit in which helped. After Jesse forked over some money for the deposit (we have privado insurance) they let us go up to the maternity floor. The male nurse noted my pillow I'd brought from home and joked that mine must be much better than the hospitals. It was.

On the maternity floor there were two distinct parts. There was the triage, dilation and delivery rooms in one part, and the actual hospital rooms in another part. In the triage room I gave them my epidrual form (Yes I made it to the hopsital without forgetting it!) After the nurse in triage determined I was in fact in labor, (dilated to 3 cm) I was taken to my own dilatacion room. This was just a room with a bed, monitor, IV and a single chair. By now the contractions were unbearable. Wait what am I saying, they were unbearable long before we left the house! Around 10:00 I finally got my blessed epidural. Jesse was asked to leave which made me sad because the anesthesiologist ended up taking awhile so I had to endure quite a few contractions without him there. Not fun. Within 15 minutes of getting the epidural I was another woman. Which was good because we found that most of the things we were being told were not being understood by Jesse so I had to translate what they were saying to him. Speaking in another language during such intense pain is not my idea of fun.

For the next half hour I was able to relax and since Renae's labor took so long we figured we'd be in the dilation room for quite awhile. Jesse was making plans to run home and grab some things when the matrona (midwife) came in to check my progress. I was dilated to a 5 so she said Jesse should not leave. I agreed. By the way, each time the matrona came in with the nurse, I never knew who was who. I didn't know if they were nurses, doctors or what. They were really nice but they didn't tell me their names like they do in the states. I was left alone in the room with Jesse for most of the time that morning after I received the epidural. Around 11:15 the matrona came in to check my progress and told me I was at a 10! So she had me start pushing. Thankfully, I wasn't in a bed in stirrups so the pushing part was pretty similar to the states. Once he was down far enough, the matrona said it was time to head to delivery.

The delivery room looked just like a surgery room. Infact, it was a surgery room. They do that in case something goes wrong and need to switch to surgery mode. This is where the infamous stirrups showed up. They gave Jesse some scrubs and had him wait while I was wheeled down to the delivery room. There, a nurse transfered me from the bed to a chair with stirrips type thingy. I saw the doctor for the first time here, but had no idea what she looked like as she was already in scrubs. I also didn't know her name. Lesson learned-that doctor you see during prenatal appointments? It really doesn't matter because you'll get whoever is on duty and you'll only see her when it's time to push the baby out.

Jesse came in shortly after I arrived and then the fun began. And also the weirdness . . . I'm not sure if this is something they do in the states, but there was a nurse on my left who pushed with her arms on my stomach while I was pushing Sammy out. Talk about weird. And really really uncomfortable. My matrona was on the right and she was very encouraging and helpful. In the delivery room I think I pushed for about 10 minutes and then he was out! They placed him on my chest and Jesse and I enjoyed our first glimpse of Sammy. I think because I was still functioning in Spanish the first thing I said to him was in Spanish, but honestly, I don't remember. Jesse was my English speaking cheerleader from behind as he was directly behind me the whole time. When they took him away to be cleaned, measured etc, I didn't hear him cry. When I asked about it, the typical Spanish nurse said, "This isn't a movie." Yeah. Loved my matrona, wasn't a fan of the nurse. I quickly made sure I didn't tear like I had with Renae and was beyond happy to discover I only needed 2 or 3 stitches and they'd only had to cut a little bit! Hallelujah!

When everything was taken care of, they transfered me back to my hopsital bed on wheels, and wheeled me back to the dilation room with Sammy in my arms. We had to wait there about 2-3 hours while a hospital bed was prepared, and so the matrona could monitor me. I was able to relax and enjoy some quiet time with Jesse and Sammy. Eventually Jesse went home to get my Mom and Renae. When I was finally able to go to a hopsital room, a nurse came and wheeled me to a room in the 2nd part of the maternity floor. We said good-bye to the labor and delivery nurses and staff, and we never saw them again.



During the hospital stay, Sammy had one pediatric nurse who came and weighed him, bathed him and did all the necesary tests. She was wonderful and super friendly. I wasn't assigned any specific nurses, I just had some that would come if I needed something. An OB checked on me once a day to make sure everything was healing properly. Otherwise, we were really left alone. Had this been my 1st child, I think I would have been overwhelmed. But since it was my 2nd and I was in good condition, I really liked it. When I needed something, I could call them. What's kind of weird about this though was that I could have never fed Sammy and they would have never known. No one was coming in to check how often he was eating, and for how long, etc. I did however have to call the nurses station when he did his business in his diaper. Which by the way-we were responsible for changing those diapers. Jesse had me call a nurse to help one time because he was having trouble changing an icky diaper. Love it. My hospital did not have a nursery so Sammy was with me the entire time. Jesse was also able to stay with me because the couch turned into a twin size bed. So nice!

Honestly, overall, it was a much better experience than my birthing experience in the states. I don't really think it has anythinig to do with location, but rather the fact that Renae was my first, she was induced and it was a long hard labor. Sammy was my 2nd, I went into labor on my own, and it was much faster. (7 hours compared to almost 24!) I highly recomend having a baby here in Spain. So if you are ever 9 months pregnant and in the neighborhood, don't be worried! You'll be fine!

Things I missed from the states:

• The kind labor and delivery nurses. They are so helpful, informative and friendly!
• The food of course. I mean, no hospital food is great, but you really want food from your home country after labor.
• Having family come visit us at the hospital. We were blessed to have friends come which made us feel so loved, but we did miss seeing our family!

Things Jesse missed from the states:

• The kind labor and delivery nurses. They are so helpful, informative and friendly!
• Feeling like he was helpful. Jesse felt useless here because he couldn't understand a lot of what was going on, and they usually spoke to me without even acknowledging him. I however just needed his presence and was constantly making sure he could be with me because he kept getting sent out for various things.
• The nurses who changed diapers. Jesse was stuck with diaper duty during our hospital stay.
• Free food. With Renae, I could order food for free, but Jesse couldn't. However, I just always ordered extra and he ate the rest. I mean, who is going to tell a woman who just gave birth she can't eat all that? Here a woman came in each day and read me the 3 choices for each meal. I had to pick ahead of time what I wanted. It wasn't that great.

Giving Birth in Spain: Pain Management

Outside view of the hospital where I'll deliver

This week I had what I consider one of my most important appointments. It was a meeting with an anesthesiologist. Here in Spain, you are considered pretty crazy to not want an epidural. In fact, I've heard it can be somewhat difficult to locate a birthing center that will allow you some of the birthing options common to women in the states. (water births, using doulas or midwives, going without IV's or pain medication, etc.) So for those of you who are really into that stuff: don't have a baby in Spain.

Spain however is the perfect place for me! I like being in the hospital around all that medical stuff. And I sure as heck am a fan of epidurals. I had a GREAT experience with an epidural with Renae. I was able to feel my contractions so I knew when to push, and it didn't slow down my labor. Any of my brothers and especially my mother will tell you that I. Am. A. Wuss. Jesse can really vouch for me as a few months AFTER I'd experienced labor, I was unable to handle the pain of a splinter being pulled from my finger. Jesse ended up using a numbing medicine on my finger so he could pull the sliver out without me fainting and screaming in pain (aka fear.) I do not handle pain well.


A typical recovery room

Back to my very important appointment this week. Each woman giving birth must meet with an anesthesiologist a few weeks before her due date. For me, this entailed going to the hospital and answering a series of questions from the anesthesiologist. What past operations have I had? How did I respond to previous anesthesia? Do I take any medicine? Do I smoke? He also looked at my mouth, and my spine. After that he gave me a form to sign which authorizes the hospital to give me an epidural at the appropriate time once labor has begun. I must bring the signed form, and copies of my 3rd trimester blood results in an envelope to give to the anesthesiologist who will administer my epidural. He also made a point to tell me I cannot have an epidural if that form is unsigned, and or left at home. You can bet I have that envelope clearly marked among my other necessary documents to bring and it's in my hospital bag ready to go. I will NOT be arriving without it!

So I guess if you want to go without pain medication during labor here in Spain, you could accidently forget to bring your signed form. Or . . . you could arrive too far along in labor to receive one. I guess I'd be ok with that . . . As long as the labor goes really, REALLY fast . . .

Giving Birth in Spain: Preparing for Labor

Baby boy Masson . . . almost 35 weeks

Seeing as how I have about 5 weeks left until my due date, I've been trying to learn as much as possible about what I need to know about labor, and hospital procedures here in Spain. Of course, I remember lots of things from Renae's labor, but I still find myself reviewing the chapter on Labor in "What to Expect When You're Expecting." So besides reviewing the labor process in English, I'm now desperately trying to learn a whole new set of vocabulary words!!! I really don't want to depend on flash cards in the middle of a contraction.

Here is a shortened list of basic vocabulary I've had to learn:

• To give birth- dar a luz-literally to give light, or to bring to light
• Pregnancy-el embarazo
• Epidural-epidural (pronounced differently)
• To push-empujar (empuja is what they'll be telling me to do)
• Labor-el parto
• Midwife-la matrona
• To breastfeed-dar al pecho
• Blood/lab work-análisis

On the bus to get my 3rd trimester análisis done

One of the things I've had to do in preparation for labor is have 3 different sets of labwork done. Fortunately, my clinic has a lab in the same building. Unfortunately, I still have to go get lab work done on a separate day. At an appointment, the doctor will give me a prescription to have blood drawn for specific tests. I return to the clinic on a different day with a urine sample and the prescription. In the states, you have to bring a urine sample to each appointment and they provide the cup. Here, you go to a pharmacy and buy a urine sample cup for about 50 cents. All of the results for these different labs can be picked up on a different date and I must take them with me to my appointments. I also am responsible for bringing all ultrasound and lab results with me to the hopsital on the day I give birth. They have record of them too, but I'm supposed to bring my results.



I stole a shot of the waiting room while waiting for blood to be drawn.

Besides my lab results, I also have to bring the following to the hospital:
For the baby: short and long sleeve onsies, footy pajamas, a hat, socks, diapers (they are provided the first day, but the rest of the days I'm in the hospital we provide the diapers), carseat.

For the mother: Shirts that open in the front, socks, breastfeeding "accesories", toiletries, and some other blog unmentionables. (Ladies, just think of all the "stuff" they provide for you in the hospital that you're embarassed to even have to use. THAT is what I need to go buy at a store.)

My new reading material-thanks Beatriz!

My good friend Beatriz has been a Godsend. I met her in the park last month and we've been hanging out ever since. Turns out, she still has a lot of stuff from when she was pregnant with her son and she's loaning me all kinds of magazines, books etc to get ready for labor. One of the books is called "Advice from your Midwife." I've found it a great little book for learning all the vocabulary I'll be hearing (and saying??) during labor. By the way, when you give birth in Spain, you are usually attended by a midwife, a nurse (or two) and then the doctor who will deliver the baby. You are also assigned a nurse for your baby once they are born. I'm gathering that the midwives here are more like labor and delivery nurses in the states. The midwife is with you for most of the time.

I'm going to start making my list of things to buy for the hospital stay as well as typing up a "How to take care of Renae" for whoever ends up watching her. (Hopefully the timing will work out great and my Mom will be here to watch Renae!) There is a lot yet to do in preparation for birthing this baby but I've still got about 5 weeks (maybe less??). Renae's room has been rearranged, and Baby Boy Masson's clothes and other necesities have been moved in. I even have his initials on the wall. (Sorry, I won't be posting a picture of that.) The countdown has begun!

Giving Birth in Spain: Are the Horror Stories True?

32 Weeks

Soon after I found I was pregnant, I began looking online for forums, websites, articles, anything that would give me tips on what it was like to have a baby in Spain. Here are some quotes from an article found at http://www.expatica.com/:

"I had found a birthing position that worked well for me when I had my first son in England. It was a completely ordinary position, but you would have thought that I had asked the doctor if he could come into the woods with me and light joss-sticks from his reaction!"

"I was put on my back with my legs in stirrups."

When she didn't want to forcibly push because she didn't want to tear, the female doctor on duty told her: 'With the volume of deliveries that we have here we haven't got time to wait until you're ready to push."

She (a Spanish midwife) is highly critical of the childbirth system here, describing it as over-'medicalised'.
"It is all defensive medicine with the idea being this is dangerous; let's get this baby out as fast as we can," she says.
"Natural birth is about being patient and waiting. Here almost everyone is induced. Almost everyone is given episiotomies and the drug oxytocin.
"Women can't eat and drink. A drip is stuck into her with glucose. The worst thing is a woman being on her back without being able to move which is the worst position to have a baby in."

But here is one encouraging quote:
According to Eurostat figures, in 2004, infant mortality in Spain was 0.35 percent of births, compared to an EU average of 0.45 and the UK's 0.51. (Read full article here.)

So as you can imagine, I've been somewhat anxious about what my birthing experience will be. My midwife from the states has emailed me a few times and she recommended a birthing position that would help me prevent tearing. So at one appointment, I thought I'd see if any of the stuff I'd read was true. I asked my doctor if it's true that women in Spain can't choose their birthing position. Her response? "Oh no. You'll be on your back with your legs in stirups." Smile.

With Renae I had quite a few complications all relating to my somewhat messed up pelvic bone structure, plus a few other things. Basically, if this baby is big, my midwife in the states said I'm pretty likely to have the exact same problems (which I'm trying to avoid this time around). Even in the states, with what happened last time, many women are often given the choice to do a c-section the 2nd time around.

Here I'm not yet sure what will happen. The upside of a c-section is it's planned, my recovery will be much better than last time because I won't have the other recovery plus the run over by a truck feeling you get from a long labor. The downside of a c-section is your husband cannot be in the room with you. This is a strict rule they follow to a T. Trust me. I've asked. And of course, it would mean future births would be c-sections too.

The upside of delivering naturally (and natural for me includes an epidural for sure!) is that the labor could go much faster than last time (too many hours to count), and our little boy could be much smaller, thus easier to push out. Plus, the way they do episiotomies in all of Europe is different than in the US, and would actually help me out quite a bit.

But for me, it all really comes down to getting a healthy baby. I've come to the conclusion that I can't control what will happen and I just need to be OK with that. Spain has a very low infant mortality rate, and babies are born healthy everyday. So although the process of getting here might not be that great, Baby Boy Masson is pretty likely to arrive safe and sound eventually. I can deal with the aftermath. Plus, honestly, the whole birth experience for me is not some big emotional event (which is weird because I'm usually a big sentimental person and I'm also a huge feeler). It's just something you gotta do if you want a baby. :)

More articles about giving birth in Spain:
http://www.womeninspain.com/birth-in-spain.aspx
http://kellycrull.com/personal/giving-birth-in-spain/
http://www.expatica.com/es/essentials_moving_to/essentials/10-things-to-prepare-before-giving-birth-in-Spain_12980.html

To end on a happy note, here are a few pics of Renae from some potty training we did this week.


She loves eating melons!



See?

Giving Birth in Spain-Appointments

Ever since we began telling people that Renae's little brother was on his way, people were curious to know if we'll be having the baby here in Spain.

The answer is yes.

Which means we're learning a whole new set of formalities when it comes to birthing a baby in a foreign country. Although we live in a civilized western nation, that doesn't mean we necessarily know what to expect. Many things are similar, and many things are vastly different. Over the next 4 months I'll try and fill you in on what it's like to give birth in Spain. Just in case you ever want to give it a try.


Future thumb sucker?

My OB appointments usually work something like this:

• Arrive at doctor's office via public transportation.
• Check into front desk where they ask to see my insurance card. (Sound familiar?)
  
  

Side profile.

• Tell them (again) that we're "privado" which means although we are using their insurance company's clinic and hospital, our insurance is different.
  
• They then ask for my 1st last name. I tell them I only have one last name. (Spaniards have two last names-their mother's first last name, and their father's first last name. Whew!)They print necessary forms and receipts, I pay the big bucks (I mean euros).
  
  

Another side profile and hand.

• I head to a waiting room where I wait with other expectant moms, and middle to late age woman who for some reason forced their husbands to come along to their yearly gyno appointment.
• After a 5-10 minute wait, a nurse comes out and says "You-lee Mah-sohn?"
  
  

Not the clearest but there is an arrow point to IT.

• The nurse takes me to a room that is divided in half by a curtain. On one side is the doctor sitting behind a desk. I shake her hand (no kisses on the cheeks-this is too business formal).
• The nurse has me hop on a scale much like the kind in the US. However my weight is measured in kilos. (It sure is nice to see such a low number on the scale!)
• The nurse will then take me behind the curtain where an "ecografia" machine is located. She tells me what to do to get ready for the ultrasound and I wait for the doctor to come to the other side of the curtain. By the way, this is not just a 20 week appointment kind of thing. Each time I go, the doctor does an ultrasound. It's great.
• The doctor looks at the baby, does her measurements and I try and catch the vocabulary she is using to describe what's going on with our baby boy. (Yes, "niño" means boy. Whew!)
  

Much clearer when zoomed in eh?

• After a quick ultrasound, she heads back to her side of the office while I look around the find kleenex to wipe the goop off from the ultrasound. In the states the nurses make you feel so pampered as they do all of this stuff for you. Not so here.
• On the other side of the curtain, I take my seat again on one side of the desk. The doctor has her computer and my files with her as she asks if I have any questions or concerns to talk about. If I've had blood drawn from the clinic below recently, she'll ask to see the results of that. Almost every time I have a test done, the nurse or technician will give ME the file to either take home for my own use (???) or to give to the doctor (who will sometimes just give the file back to me. (Again . . .???) It's kind of weird to be in charge of keeping track of all these important files on my baby!

I start to breathe a little easier as I can now put my brain on auto pilot for about 1 minute before I get to the check-in desk and am forced to speak in Spanish again regarding my lack of a 2nd last name, how to spell my name, when my next appointment will be, and that I'm still "privado."

Whew. Now that I've got a few appointments under my waistband, I feel better about knowing What to Expect When I'm Expecting a Spanish Doctor's Appointment (1st edition coming soon).
The next thing to master . . . figuring how this whole labor ordeal works in a highly medicalized nation.