Prenatal & Postpartum Care
If you're having a baby in Costa Rica, and use the country's public health care system, known as the Caja, prenatal care is begun when you are four to six weeks pregnant. A wonderful bonus is that pregnant women are considered preferential patients with the Caja. This means that you will be exempt from waiting in line, and all your prenatal visits, blood tests, and other appointment will be scheduled in advance. Prenatal care with the Caja is unlike what you might experience in the United States; here are some notable differences:
- Free care: Your baby is entitled to free medical care with the Caja from the moment of conception. All testing, visits, exams and other medical expenses related to pregnancy are completely free.
- General Doctor, not OBGYN: Your local Ebais clinic has one or two general practitioners on staff. Scheduled prenatal visits will be with this doctor, not an OBGYN. You will only visit an OBGYN for ultrasounds or for consultations outside your normal prenatal care.
- Monthly visits: The Caja schedules prenatal checkups every four weeks up until week 36, when they switch to every two weeks. By contrast, most prenatal consults in the U.S. occur every four weeks until 28 weeks, then every two weeks until 36 weeks, and finally every week until the baby is born.
- Weight gain: The American Pregnancy Association suggests a 25-35 pound weight gain for healthy women. The Caja adamantly recommends that you only gain 2.2 pounds per month, or less than 20 pounds during your entire pregnancy.
- Frequent tests: The Caja will schedule you for a urinalysis every month, and a blood test at least every other month.
- Glucose screening: In the U.S., most women take a gestational diabetes test between 24 and 28 weeks of pregnancy. With the Caja, you'll have your first screening around 20 weeks, and a second one around 28 weeks. If you are positive for G.D., you will undergo further testing.
- Dental exam: The Caja strongly recommends that all women have at least one dental exam during their pregnancy to check for cavities, infections, or anything that could affect the pregnancy. If all looks good, you will have a general cleaning and fluoride treatment.
- Vaccinations: The Caja all but requires that a mother be up-to-date on all vaccines that are safe to give during pregnancy. The most common is a tetanus booster after the 24th week.
- Ultrasounds: These are supposed to be scheduled by the Caja after a mother's 20th week. In practice, you may never get an ultrasound with the Caja due to long waiting lists. If you do get an ultrasound, you will not get a photo printout of your results. Visit a private doctor for the ultrasound, and for about $80, you can receive a 3D or 4D printout.
- Big babies: If your ultrasound shows that you're on track for a big baby – any child predicted to weigh more than 8 pounds, 13 ounces at birth – the Caja labels yours a "macrosomic" pregnancy. The OBGYN will discuss your options, and may recommend an induction or even cesarean.
After giving birth, the Caja will schedule your child for a "tamizaje," or blood test for congenital diseases. This is usually scheduled four to seven days after your child is born, and the appointment also serves as your first postpartum exam.
After the blood test, you will be scheduled for a one-month postpartum checkup. Before this appointment, you will have to take another blood test and urinalysis to determine that all vitamins, minerals and other nutrients have returned to appropriate levels. The doctor will conduct an internal exam, or review your cesarean scar at your one-month consultation. At this time, he or she will also screen for post-partum depression, review birth control options, and recommend appropriate levels of exercise.