El Parto – Having a baby in Costa Rica part 1

I am a  30 year old Canadian woman living in Costa Rica and 27 weeks pregnant so obviously I haven’t had my baby yet, but with the due date quickly approaching I have done a lot of research and spoken to a lot of people about their experiences here. There is not enough online about having a baby in Costa Rica as an expat in English, so hopefully others who are thinking about it or are in the same boat as me can use the info I’ve gathered to their advantage.

In Costa Rica, there is free healthcare for any child from conception through to 1 year old. This means that any mother, of any citizenship, regardless of residential status can get free medical care while they are pregnant through the CCSS (Caja Costarricaense de Seguridad Social)  at their local EBAIS clinic, and can deliver their baby for free at any public hospital. Costa Rica has a good health-care record, very low infant and maternal mortality rates (the 2nd lowest in Latin America) and high levels of breastfeeding success.

First off, let me say that as a Canadian citizen I have always taken good quality, free healthcare as a given. If I was in Canada, I would go to my regular family doctor, and if there were any complications or if he/she deemed me to be “high-risk”, then I would be sent to an OBGYN or specialist and all of my appointments, medications, treatments, ultrasounds and finally the delivery of my baby either naturally or by c-section would be covered by OHIP (Ontario Health Insurance Plan) which is paid for through provincial taxes.

When I found out I was pregnant here in Costa Rica, I started going to my local EBAIS clinic. At first, this experience was a little overwhelming. I speak some Spanish, but didn’t have the vocabulary necessary for a medical setting, and the system is very different than it is in Canada. Basically it’s like a walk in clinic, emergency clinic and doctor’s office all in one. So there are different secretaries who are in charge of the various areas. The first time I had an appointment for a prenatal check-up I went to the emergency/walk-in secretary, and she spoke to me very harshly and shoo’d me over to another secretary down the hall . It took me awhile to figure out where I was supposed to go and what I was supposed to do, and I felt a little worried that I’d be able to navigate the system alone.

Once I found the proper secretary’s window (fyi they call it “control“) she created a file in my name and asked me some questions about my citizenship, birthday, marital status, employment, address etc… She then sent me with my file in hand to the enfermeria, the nurses’ station. Here they asked me about my age, how long it had been since my last period, my family history of illness (this took a little game of charades) and my allergies and medications. They weighed me and took my blood pressure. Then they sent me out of the room and down another hallway to see the doctor. There must have been 20 pregnant ladies or new moms waiting in the hallway. I waited about 1.5 hours in the busy clinic before finally I met with the doctor. He did not speak any English, but we got along fine. He prescribed me iron and folic acid pills, and requested blood tests and a urine test to determine for sure that I was pregnant and to check for STDs, Hepatitus and other problems. I made my way back to the secretary with all of the papers and prescriptions from the doctor. She scheduled my next prenatal check up in a month’s time and she forwarded me on to the testing area to get my blood and urine test date (8 days prior to my next prenatal appointment so the results would be ready) and to the dispensary for my pills. I paid nothing.

I walked out of the clinic feeling like I’d gotten somewhere in this foreign system and it felt good. The level of care the doctors and nurses gave me felt like what I’d expect in Canada. Everyone was kind and professional. The place was kept very clean, even if it was a little over-crowded. I felt that if this was the quality of care I’d received locally, than I was sure I would be fine to give birth in the public hospital. Let me also say, that as a student of cultural anthropology I felt a little like I should be open to this new experience in a different country and be aware of my own bias towards the North American system, trying hard to allow myself to acclimate to this culture knowing full well that women give birth to babies here with success every day and that just because things may work a little differently doesn’t mean that it’s not the proper way to do things here.

I went online and tried to find information in English about women giving birth in Costa Rica and their experiences. I found this article provided a good overview but didn’t give me enough details. Most of the stories and testimonials I’d found on message boards, websites and blogs were written by American expats who had given birth in one of the private hospitals in San Jose. I couldn’t find anything much about the public system, and figured this was probably due to the fact that Americans were used to paying for their health care, and to most of them the Costa Rican private care costs seemed cheap at about $2000 USD for an average delivery (about $1000 in hospital fees and $1000 in doctor’s fees). I figured I’d need to talk to some people to get the real scoop on the public hospital.

My first line of questions were directed at my Nica housekeeper, who had given birth two years previously at the hospital in Puntarenas. She told me her experience there was good, but they didn’t give you any pain medications and you were quite on your own for most of the process. She did not know whether they allowed men in the delivery room as she was a single mom and had only brought her mother with her to the hospital. Overall she was happy with the level of care she was given. I inferred that she was impressed  with the Costa Rican system because it was of much higher quality than what she would have gotten in Nicaragua (one of the poorest countries not only in Latin America but the world).

So I vowed to find someone who had used the public system but had a similar background to me, and therefore would have similar expectations. This proved quite difficult. I asked friends of my mother’s if they knew anyone who had used the public system and got nowhere – it seemed to be that all expats went to hospital CIMA or Clinica Biblica or Cathólica in San Jose, or had their babies at home with a midwife. I started to contemplate this option – I knew I wanted as natural and intervention-free birth as possible, but I wasn’t sure I’d be comfortable giving birth here at the hotel (not private enough). We are also more than an hour away from any hospital and I feared that in the case of complications I would not be able to reach one in time. I looked online for any info on midwives in Costa Rica and found out the practice of midwifery is actually illegal here, which really surprised me! I found a link to Mamasol Partos Costa Rica, an NGO/Grassrooots association of midwives whose mission it was to make midwifery and more natural births acceptable and available in Costa Rica.

This website was some of the best information I could find online; I read a couple of their scholarly articles which were available as .pdf’s, but the article about Childbirth in Costa Rica‘s Public Hospitals made me change my mind completely about where I wanted to give birth, for a variety of reasons (read the 1 page article and you’ll probably see where I’m coming from).

I also spoke to a Canadian friend of my mother’s who has had two children here. When I told her I was thinking about using the public hospital in Puntarenas she almost choked on her coffee – she was totally in shock. She claimed that the public system was fine if I was okay with “laboring in a room with up to 20 other women, on a blood-stained thin mattress, with no company,” as visiting hours are only 2 hours long. She said I would be stuck in bed as they use an internal electronic fetal monitor, forced to labor on my back without any pain medication.  She said that I would for sure be induced to speed up my delivery, which if it didn’t happen within a short-enough time-frame would lead to a mandatory c-section.  And I would have no say in any of these matters. I was horrified. She assured me that some of the other public hospitals, especially those in San Jose such as Hospital Mexico would be a little better, but that the one in Puntarenas was one of the worst of them all, and I would be crazy to go there. She also assured me that it would be better if I had a doctor who spoke some English, as one tends to lose all traces of Spanish when in labor. I asked her for the name of her doctor and the phone number for his office and she gladly referred me.

Fast-forward to September 5th, 2012 where I experienced the biggest earthquake that Costa Rica has had in over 50 years. A 7.6 on the Richter scale meant that our hilltop hotel was swaying, things fell off of walls and tables, a huge wave of water was sent out of our swimming pool and we all feared for our lives for about 40 seconds. Luckily we didn’t have any structural damage, and there was no tsunami to follow. However, I did find out that the public hospital in Puntarenas suffered major damage from the 5th floor upwards and was to be closed indefinitely:

As this hospital was the only public one within a 1 hour drive of my town, and also because I was now suspect of the structural integrity of the publicly-owned buildings (I mean, can you imagine?! What if I had been in there giving birth that day?!  A hospital is supposed to be one of the most solid structures…there wasn’t this much damage to people’s homes in the area!) I decided that the best option for me was to travel  30 minutes further to the privately owned CIMA hospital in Escazu (San Jose suburb).

CIMA hospital is by far the fanciest hospital I’ve ever been in. There are several other private hospitals that specialize in maternity care – Clinica Santa Rita and Clinica Biblica are both supposed to be cheaper options than CIMA. But the reason I went with CIMA is that it is located directly off of the highway, and I can get there quickly no matter the time of day. For anyone who has ever driven in downtown San Jose where those other hospitals are located, you know it can be a nightmare – traffic jams, one-way streets, no street signs (but that’s going to change soon apparently). But under the stress of being in labor there is nothing I’d like my partner to avoid more than trying to find his way in San Jose. That was for sure.

I had called CIMA to set up an appointment for a tour of their maternity unit. I was told on the phone that they didn’t do this by appointment, but that you could just show up and speak to a security guard at the front desk, and that he would radio to a nurse to give you the tour. So of course, when I drove 1.5 hours from Jacó and asked for my tour I was told that I needed an appointment.  I pleaded with the nice man at security and he eventually found someone to give us the tour (in Spanish). The maternity suites are all on one floor, private rooms with laminate wood floors and adjustable beds, a day-bed/sofa for 1 guest to stay overnight, a flat screen tv, wifi, private bathroom with shower…it was like a hotel room! Apparently the suites are sound-proof so you can make as much noise in labor as you want without fear of scaring other people. I asked the nurses about electronic fetal monitoring as I’ve read it’s good to walk around in the early part of labor, and they said they use external monitors, and walking around was fine. They told me I was allowed 1 person in the delivery room (my husband) and up to 3 people with me in my suite before that. I asked about what was covered by hospital fees and was told one night accommodation in the suite, all the medical supplies for the birth, the vaccinations for the baby, use of the incubator for 1 hour, a crib and blankets for the baby in suite, free international calls, WiFi, parking for 24 hours and a fancy dinner for the mother and father. These last two things made me giggle a little. I had read that in some San Jose clinics they have a stylist who comes in to do the mother’s hair and make-up right after birth so she looks good in the first photos with baby. No WAY I’m paying for that one!

Overall I was quite happy with the nurses at CIMA and the tour. Although the nurses didn’t speak English I left feeling like I could definitely communicate with them and they were very patient with my bad command of Spanish medical terms. I knew that my doctor at least would understand me if I needed to get something across in English, and it put my mind to rest a little to see where this big scary event was going to take place.

I continued my monthly prenatal appointments at the Ebais clinic in my town. I was lucky to have my husband with me on the day we got our first doppler reading and heard our baby’s heartbeat aloud for the first time. I laid there in the office with the cold gel on my belly while he moved the doppler around looking for the little beat. It took awhile. I looked at my husband and he looked worried. After about 5 minutes of fuzz we finally heard a steady beat and the doctor smiled. Then it went away. He moved the wand over to the other side of my belly and found it again. He joked that maybe it was twins. NOT FUNNY. He said it was good the baby was moving so much and that made me happy. I asked about when I would get an ultrasound and he said that he would order one for the 5 month mark, but that the system was so bogged down I might not get one at all unless I had priority, “high-risk” status. I was disappointed as I really wanted to know that everything was progressing normally and maybe even find out the gender of my little one. So I waited….

When I was 5 months and 2 weeks along I had a 2 week vacation in Canada. The 2nd trimester is the best time to travel because you feel almost normal again – the queasiness of “morning” sickness had subsided, the tiredness was gone and I felt good. We decided that since we wouldn’t necessarily be getting an ultrasound in Costa Rica, that I should get one done for free while I was home in Canada. I set up an appointment with my GP and he checked me out and then sent me on to a clinic for the ultrasound. Although the ultrasound technician is not supposed to interpret the results, she knew I was leaving the country to go back to CR in a week and that I wouldn’t have them quickly from my doctor, so she told me everything she was doing. I was so thankful. Having the ultrasound made me so much calmer about the baby – everything was normal, healthy, good. We were going to be having a boy!

The next big step was making an appointment with my friend’s recommended doctor in Costa Rica. We drove to his office which was right in CIMA hospital and had a consultation. I asked him a lot of questions to find out what his positions were on certain topics – if I was going to hire a specialist I wanted to be sure he had the same ideals as me and would support me in trying to have a drug-free, intervention-free hospital birth. He was very straight-forward and didn’t try to sell me at all, which I appreciated. I let him know that I would prefer to continue my prenatal check-ups at the Ebais clinic in my town as it was inconvenient to drive to San Jose every month. He didn’t mind this and said that as long as everything was normal, I could just see him once more a couple of weeks before the main event.

In order to determine that everything was normal, he gave me a 4D ultrasound. Now this was really amazing!!! I got to see my baby’s face for the first time. It was so much more detailed and so much faster than my last ultrasound and at the end of it I walked out with both photos and a DVD. He said that everything looked normal and I could schedule my appointment now or take some time to decide and call his secretary. I decided that I wanted to have him as my doctor and we scheduled the appointment after paying $80 for the ultrasound (the consultation was free). I was very impressed, as I expected a 4D ultrasound to cost about $200.

So that brings us to present day. I have my next prenatal check-up in a week at the Ebais clinic. I’m happy with the decision to go to CIMA over the public hospital even though I could be having my baby for free in Canada. I feel that it is worth the peace of mind as having a baby is already a scary prospect – but having a baby in a foreign country is even more terrifying as there are so many unknowns.  I hope that some of you who read this can use any of the information to help you make your own informed choices.
Part two to follow in a few months after the big day!!!!