Pregnancy and childbirth in Spain: free public care, the matrona and what to do
Pregnancy and birth care in Spain's public health system is free and high quality — and pregnant women are covered even without legal residence. This guide explains the matrona, prenatal follow-up, choosing a hospital, the birth and the steps right after (registering the baby).
How maternity care works
Maternity care runs through your centro de salud and a public hospital: your GP refers you to the matrona (midwife) who leads the prenatal follow-up.
You get tests, ecografías (scans) and check-ups, then give birth at a public hospital — covered public maternity care is free at the point of use.
After the birth, there are several practical steps: register the birth and arrange a pediatra and a health card for the baby.
Who is covered (even without papers)
- Having the health card (tarjeta sanitaria) confirms access to the public system; how it is issued depends on the basis of your right to care — usually the padrón, but other proof of residence works too.
- Pregnant women and minors are always attended, including people without legal residence — pregnancy, birth and post-partum care are guaranteed.
- EU citizens via registration or the EHIC for temporary stays.
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Your rights
- Free prenatal follow-up, birth and post-partum care.
- A matrona and, for the baby, a pediatra.
- Care cannot be refused on immigration grounds for pregnancy or childbirth.
- Maternity/paternity leave (permiso por nacimiento) is a separate, paid benefit — check it with NAVI.
What you need
- Your tarjeta sanitaria (or the document proving your right while it is issued).
- ID (NIE/TIE/passport) and, for the health card, proof of address — usually municipal registration (padrón), but other proof of residence works too; pregnancy care is guaranteed either way.
- The pregnancy card / cartilla de embarazo the matrona gives you.
- After the birth, you will need the hospital report and the parents' documents required for the birth registration.
From the first cita to after the birth
- Get (or confirm) your tarjeta sanitaria and book a cita with your médico de cabecera.
- You are assigned a matrona who starts the prenatal follow-up.
- Attend the scans, blood tests and check-ups during the pregnancy.
- Choose your reference public hospital and prepare the birth.
- Give birth at the hospital; you receive the medical birth report.
- After: register the baby (Registro Civil), get the baby a pediatra and a health card.
A real case: a birth plan, an emergency caesarean and the consent record
A woman at 42+3 weeks planned a home birth. After a compulsory hospital admission, the case reached the Constitutional Court, which found no breach of her autonomy or informed consent in the hospital care. The exact timeline mattered. Although the court order mentioned induction, labour began spontaneously and no oxytocin was given. The hospital continuously monitored the fetus and explained tests to the woman, her partner and the private midwife accompanying them. When labour stopped progressing, the fetal position was abnormal and the heart rate deteriorated, an urgent caesarean was performed. The record showed verbal acceptance by the woman and her partner and a signed consent form.
The non-obvious detail. The court did not compare labels — “birth plan versus doctors” — but the plan with the timed clinical record: what was proposed, what was not actually done, who was present and what was consented to. Keep your plan, reports and discharge record; when circumstances change, ask for the reason and your decision to be recorded.
Outcome: the Constitutional Court dismissed the amparo appeal and awarded no compensation. The judgment includes dissenting opinions disagreeing with the majority.
Limits of the case. It does not give hospitals a general licence to disregard a birth plan or replace informed consent. The majority’s conclusion depended on exceptional facts: a post-term pregnancy, a recorded risk, spontaneous labour, continuing information and separate consent to interventions.
Tribunal Constitucional, Pleno · 23.02.2023 · № STC 11/2023 · ECLI:ES:TC:2023:11
Take your birth plan and previous clinical reports to hospital. Ask staff to explain any change and record the information given, your consent or your refusal.
Check your childbirth rightsCommon mistakes
- Thinking no papers means no care — pregnancy and birth are always covered.
- Not sorting out the tarjeta sanitaria or padrón early in the pregnancy.
- Missing the deadline to register the baby after birth.
- Not asking about maternity leave (permiso por nacimiento) in time.
Refused care
- If you are refused maternity care, ask for it in writing and escalate — pregnancy and childbirth care is guaranteed for everyone.
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Related guides
Key terms in this guide
Maternity care FAQ
Is pregnancy care free?
Yes — prenatal follow-up, birth and post-partum care are free in the public system.
Can I be attended without legal residence?
Yes. Pregnant women (and minors) are always attended, regardless of immigration status.
What is the matrona?
The midwife at your centro de salud who leads the pregnancy follow-up.
Do I need the tarjeta sanitaria?
It is the practical key; if it is still being issued, bring the document proving your right. Pregnancy care is guaranteed regardless.
Where do I give birth?
At your reference public hospital. The matrona/GP helps you arrange it.
What about maternity leave?
Permiso por nacimiento is a separate paid benefit — ask NAVI to check your case.
What do I do right after the birth?
Register the baby at the Registro Civil and get the baby a pediatra and a health card.
Does the baby get healthcare?
Yes. A minor’s right to public healthcare depends neither on municipal registration (padrón) nor on the parents’ immigration status (RD 180/2026 art. 4.a). In practice, once the birth is registered, the centro de salud assigns a paediatrician (pediatra) and issues the baby’s health card.
Official sources
- Ley 16/2003 del SNS (arts. 3 y 3 ter)
- RD 1030/2006 (embarazo y puerperio)
- Ley 20/2011 del Registro Civil (arts. 44-47)
- Seguridad Social (permiso por nacimiento)
Informational guide; healthcare is managed by each autonomous community, so steps vary. Check your case with NAVI.
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