Saturday, May 23, 2009

natural birth in Costa Rica

21 April 2009
I was recently asked if I knew anything about natural birth in Costa Rica and here's what I answered:

A little about my experience:

Our amazing baby Gabriel was born at home in San Juan de Santa Barbara de Heredia in Costa Rica on 10 January, 2009 at 3:50am. My DP Julio and my midwife Rebecca were there helping me bring Gabriel into the world. I feel blessed to have been able to have a wonderful natural labor (9 hours) utilizing a lot of walking in the full moon light outside our house and a birth pool.

My midwife Rebecca is awesome and things worked out very well - although we were all tired since I labored through the night. However, because of this she was able to arrive much much faster than expected. Which was good because my baby was born less than 3 hours later!

I had a not-so-beautiful afterbirth - a partially detached placenta - and lost a lot of blood. I was on IVs during the day and then took iron supplements, ate iron-rich food, and drank lots of water. Because Rebecca lives farther away from my house they tag-teamed and Marie checked in on me several times on Gabriel's birth day and especially that first week. I felt so supported and cared for by both Rebecca and Marie!

In short I was very pleased with my prenatal, labor & delivery and post-partum attention from Rebecca and Marie. Their business is called Mamasol I clicked really well with Rebecca from long before we'd even conceived our baby - we had talked at length on the phone and I already knew that I wanted her to be my midwife. Therefore Rebecca was my primary midwife - she lives in Turrialba, Cartago. Marie was my secondary midwife; she lives in Belen, Heredia. Marie was not able to attend the actual birth, but as I mentioned she helped a lot with my post-partum visits.

Here's an article from last July that came out in the national newspaper in Costa Rica about homebirth:

I believe that overall the health system in Costa Rica is excellent - both public and private. However, for labor and delivery, my opinion is that the protocols call for measures that are antiquated and over-medicated.

This is what I've learned about standard labor and delivery in Costa Rica:

The public health system was created in the 40s and modernized throughout the 40s, 50s, and 60s. With those changes the government did put a lot of scare tactics out there and effectively killed off the profession of traditional midwifery. The general public in Costa Rica now believes it is much safer to birth in a hospital than at home. There is no certification for midwives here, just certification for Obstetric Nurses. Therefore, the only midwives practicing are foreigners who have been certified in other countries. They are not technically allowed to practice here, which is why I said that they operate "under the radar" and often with the back-up of Dr. Adam Paer (more on him below).

On a positive note, Midwifery Today had their 2007 conference in Costa Rica and did the first doula training with 30+ women participating. It should be fairly easy to contract a doula - any of the practitioner links I'm providing will be able to help connect you with one. I took my doula training in 2004 in Portland, Oregon, but haven't yet practiced; I would be happy to help anyone who lives in the Central Valley who is interested.

If you had national insurance with the Caja (the national health service) everything would be free but you would need to have your baby in a hospital and be subject to those protocols. You can get national health insurance as a tourist/visitor and I know it's very cheap - I heard it was less than $50 a month a few years ago. As a pregnant woman in Costa Rica you are entitled to public health care without paying anything at all, same goes for babies. This widespread availability of healthcare is one reason that the entire population is so healthy as opposed to other Latin American countries. At the public hospitals the norm is to give pitocin to speed up labor, but of course it just makes the contractions faster and more intense and more painful - they don't offer pain relief meds, birth pools, or allow you to walk around. You labor in a large room with about 20 other women until transition, then you are transferred to a more private room where you'll get a table with stirrups. Julio's sister had a hellish experience with what sounds like an overdose of Pitocin at the Hospital de Alajuela - over 100 45 second contractions with 15 seconds to recover between contractions... but a friend just said she had a positive experience birthing in the Hospital Mexico and DP's sister-in-law just had a positive experience birthing at the Hospital de la Mujer (Carid). I wouldn't judge those public hospitals on one experience each, but that's something to start with.

If you opted for private medical attention there are at least half a dozen private hospitals in the Central Valley (and others in cities around the country) - the doctors there will all do what they can to follow a woman's birth plan... though there are varying levels of belief in natural birth, just like in the US. Sadly, most of the time a woman goes in for a natural birth she ends up with a c-section in the private hospitals, simply because it's more convenient and they make more money.

Doctor Adam Paer is about as natural as you can get for a doctor and a hospital birth - he believes strongly in the midwifery model and waterbirth. He did our 4-D ultrasounds (2 of them) and if I had needed to transfer to a hospital would have been the lead of my birth team. Here's his profile: My friend Mary did have a scheduled C-section with him and was very pleased with her whole private hospital experience at La Cima.

So as you can see for private homebirths attended by a midwife it's a bit harder to get in touch with the right people, but a great place to start is with Rebecca or Marie at MamaSol. I've also heard great things about Nati and Ansu of Mamas Al Nacimiento

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