Having a Baby: Birth Options
Pregnancy is an exciting time, but when you're living in a foreign country, the news may also bring questions and concerns. Luckily, Costa Rica has excellent health care and prenatal services, both private and public.
Pregnant women receive comprehensive prenatal care through the public health system, known as the Caja. This includes monthly prenatal check-ups, dental appointments and blood tests, among other visits. The main advantage of the Caja is that all services, including childbirth classes, are included in your monthly Caja payment. Non-residents and those not affiliated with the Caja will be asked to sign up for public health insurance. By law, all children from conception to one year of age are considered insured, so pregnant women receive all medical services directly related to their child free of charge.
Through the private health care system, you'll have added advantages like choosing your own doctor, 4-D ultrasounds, and flexible scheduling. Additionally, the private system leaves more decisions up to the patient. For example, the Caja all but requires you to update your vaccinations, but the private system merely makes recommendations – the final decision is yours. Private obstetricians charge 25,000-40,000 CRC ($50-$80) per visit, including an ultrasound. As your due date approaches, you'll need to make a decision regarding where and how to give birth. There are three main options:
Pregnant residents are entitled to free birth and postpartum health services through the Caja. If you are not affiliated with the Caja, you may still receive prenatal care at your local Ebais or clinic, and give birth at a Caja public hospital. Caja personnel may request that you affiliate with the public health system, but your child is considered insured and therefore you are entitled to receive related services without cost.
By law, according to Article 3 of File (Expediente) #14888-21-03, "All persons, from the moment of their conception to one year of age will be considered insured and will receive all health services offered by the Caja. Notwithstanding her affiliation status, any pregnant woman or mother of a minor up to one year in age may request the prenatal care and health services that her child requires."
A Caja delivery will occur at your closest public hospital and involves some unknown factors, which may be difficult for women accustomed to personalized medical care. In most cases, you will not meet your delivery doctor in advance; when you go into labor, whoever is on-call at the time will attend the birth. Additionally, the Caja does not give epidurals or schedule voluntary cesarean sections.
In the past few years, local law has changed in favor of patient rights, and the Caja strives to emphasize a woman's birth experience. Your husband or partner is allowed in the birthing room, provided he has attended childbirth classes, and you are encouraged to assume the most comfortable birthing position, take warm showers to relieve pain, and write up a birth plan to communicate your wishes to your doctor. After delivery, you will stay in the hospital for at least one night and talk with a lactation specialist, while your baby is given his or her first round of vaccines. Keep in mind that a working level of Spanish is helpful, as many nurses and doctors at public hospitals do not speak conversational English. Download the Caja's Prenatal Guide for more information on prenatal care and birth.
Giving birth at one of Costa Rica's private hospitals is very similar to giving birth in the United States. You can schedule any type of birth, from a scheduled C-section to a drug-free water birth. You'll meet with your delivery doctor in advance for scheduled visits and ultrasounds, and make detailed decisions, such as whether you'd like a private room and your length of stay in hospital. In general, expect to pay $1,000-$1,500 in hospital fees, $1,000-$1,500 in doctor fees, and $150-$200 per night of stay. If there are any complications, or your doctor uses more supplies than covered by the basic hospital fee, you will be required to pay extra.
Midwives & Homebirth
There are several options for natural childbirth and homebirth in Costa Rica. These include a meds-free delivery at a public or private hospital, a waterbirth with Dr. Adam Paer at Clinica Catolica (the only private hospital with a birthing pool), and assisted or unassisted childbirth at home. If you choose to give birth at home, you must complete extensive paperwork to get your child's birth certificate. A homebirth costs about $2,000 for your prenatal, delivery and post-partum care with a midwife. And if you choose to deliver in the hospital, you'll be subject to the same fees listed above, plus an additional payment to your midwife.
One important consideration is that in Costa Rica, midwifery does not exist as a profession; there is no certification process, and certified nurse midwives do not exist. However, several midwives practice under the radar, having obtained training and certification abroad. Many of them are from the United States, Canada and other countries where midwifery is more openly practiced. Additionally, there is at least one midwife who is registered with the Costa Rican National Nurse's Board as an Obstetric Nurse, meaning she is legally permitted to attend a hospital birth. For mothers who choose homebirth, in the event of complications, this midwife would be permitted to transfer with you to a private hospital.