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Having a Baby in Costa Rica

Emma, 28, is has lived in Costa Rica for five years. She and her Costa Rican husband welcomed a son in September 2011.

Did you choose the Caja or private doctors for your prenatal and hospital care?

My husband and I did almost all of our prenatal and post-partum care through the Caja, which is the public health care system in Costa Rica. As a resident, I already paid monthly dues for the Caja, and I wanted to take advantage of their care. However, I did see a private doctor at the beginning of pregnancy in order to compare public vs. private. In the end, I decided that I felt comfortable enough with my Caja doctor and I was happy with the public system. In fact, because we were planning to give birth at a public hospital, going to the Caja for all my prenatal appointments seemed easier. We visited a private doctor around 20 weeks to get an ultrasound. We wanted to find out whether we were having a boy or a girl, and Caja ultrasounds can take weeks. (We got one around 33 weeks, but only because it was labeled priority/urgent. They still haven't called back to schedule our follow-up ultrasound, and our son is now three months old!)

What's is the Caja's basic schedule for prenatal care?

You'll have scheduled checkups every 3-5 weeks. In between every appointment, you'll also have to go in to drop off samples for urinalysis (every month) and to get blood draws (every other month, usually). At least twice, you'll need to do the test for gestational diabetes. And if you have any issues, they'll schedule you for additional testing. For example, my blood pressure was on the high side of normal and I had to go in three times per week to have my blood pressure taken. Sometimes I felt like I spent my entire life at our local Ebais clinic, but I was thankful for such attentive care.

Did anything surprise you about the Caja's prenatal care?

I did a lot of research into the Caja, so I don't think anything really surprised me. However, what was perhaps different from my expectations – at least, coming from the United States – is that there's no continuity of care in the public system. My prenatal checkups were with my assigned doctor, but I saw another doctor for my ultrasound, and a different doctor interpreted my ultrasound results. And yet another doctor delivered my son; I don't even know his name. The lack of personal care didn't bother me, but I know building a close doctor-patient relationship is important to many women.

Did you visit the hospital prior to delivery?

Unlike in the U.S., you don’t do hospital visits before you deliver. If you're going through the Caja, you don't really have a choice of where you'll deliver, or if you do, it doesn't matter because Caja policy is the same regardless of the hospital. However, I did visit the hospital several times before delivering my son. Specialized services like ultrasounds aren't available at my local Ebais, so we had to go to the hospital for that. My husband went a few times to drop off my ultrasound referral slips, and then we went twice for ultrasounds. We also had to return on separate days to receive and discuss our ultrasound results with an obstetrician.

What was delivery like at a Caja hospital?

I had a good delivery experience with the Caja, but again, it was less personalized than what I would expect in the United States. When I checked into the hospital, I was placed in a room with five other women. This was the pre-labor room, and visitors (including husbands) were only allowed in during visiting hours. The pre-labor room was for women who were not yet in labor (awaiting induction or cesarean), and also for women who were less than 3cm dilated or whose water had not yet broken.

When my water broke, they moved me into the labor suite, which I shared with every other woman who was in active labor. I think there were five total in my room, and another five or six in another. My husband joined me for this part of labor, and an obstetric nurse attended us. There were no doctors in the labor suite with us.

Caja protocol is to put a woman on Pitocin to speed up labor as soon as she enters the labor suite, but you have the right to refuse any meds. A piece of advice: speak up if you want something. There are a lot of patients and few staff members, so you may have to repeat yourself to get what you need. I had to ask several people for an extra pillow, and I did have to be assertive when asking the nurse to turn down my IV (I wanted less Pitocin). The Caja will not give you pain medicine or an epidural during labor.

After a woman reaches 10cm, she is wheeled into the delivery room (they call it the expulsion room!), where doctors await. Unfortunately, I did not have a natural delivery. I had been in labor for about 30 hours, and my body was exhausted from the exertion. A worried OB nurse called a doctor in, and he determined that I needed a cesarean.

They quickly prepped me for surgery, and my husband had to stay in the waiting room. Only underage women are allowed to have someone in the surgical suite with them. They asked if I wanted an epidural or general anesthetic, and I selected the recommended epidural. I was so exhausted that the epidural put me to sleep, but my husband reports that the surgery took less than 10 minutes. If I had been more awake, the nurses would have given my son to me immediately for some skin-to-skin time and nursing. Since I was too drowsy, they wheeled him out to meet his father.

What happened after delivery?

They took me into the recovery suite, and I think I was there for about two hours. When I had sufficiently recovered from the epidural, I went to the post-partum room, which I shared with five other women. They brought my son in, and asked me to nurse him right away. There was a lactation consultant on duty, and she visited our suite several times daily to check up on our progress.

Caja hospitals do not have baby nurseries or even bedside cradles. As soon as they gave me my son, he was mine to take care of until we checked out of the hospital. When I needed to shower or go to the bathroom, I had to leave him in my bed. It was a little overwhelming, but it was an incredible bonding experience to spend so much time with him. I also loved sharing the room with other women who had just given birth. We spent all day chatting about our newborns, and everyone looked after each other (and each other's babies).

Since I had had a c-section, I was required to stay in the hospital for a minimum of 48 hours. They had me on antibiotics and minor painkillers during that time. Two mornings after my son was born, an obstetrician reviewed my file, checked my progress, and signed my exit papers.

Was there anything you didn't like about your Caja delivery?

Some of the nurses were really tough. I was in a good deal of pain the first 24 hours after my c-section, and had trouble getting out of bed. When I asked for help walking to the bathroom, or even changing my son, they refused, telling me I had to get used to taking care of myself and him on my own. Thankfully, other nurses were nicer, so it was just a matter of getting to know who had a friendly face.

I think the hardest part of the Caja birth were the visiting hours. By the time I gave birth, I had already been in the hospital for 48 hours. My body was exhausted from the labor, and I was in pain from the cesarean. As a first-time mom, I was nervous. The whole experience was overwhelming. I wanted my husband there to comfort me, to get to know our son, and to help me take care of our newborn. Unfortunately, men are only allowed into the post-partum suite during visiting hours (two hours per day), so I was basically on my own. By the time 4:30 p.m. rolled around each day, I was desperate to see my husband and have a little help.

Would you give birth again with the Caja?

If we have another baby, I think my ideal combination would be prenatal care with the Caja and a private hospital birth. My prenatal care was great, and since the Caja scheduled all my appointments and exams in advance, everything was convenient and I didn't have to wait in long lines. However, the hospital's short visiting hours and the lack of help made those first 48-60 hours pretty rough. It's hard to say whether an easy first two days is really worth $2,000+ (the out-of-pocket cost of a private hospital birth), but it's certainly something that I would seriously consider.

Having a Baby in Costa Rica in Pictures