Natural Childbirth Choices in Costa Rica

In July of 2004, I gave birth to a beautiful, healthy boy at my home in Costa Rica.

It was a truly natural experience - no medication, no hospitals, not even electricity (though that last one was not actually by choice!). I was attended by a midwife and doula, as well as my husband, who was able to "catch" our son as he was born and later cut his cord.

After the baby was delivered, he stayed in my arms while the midwife checked him, and my husband, son and I soon slept soundly together - at least for a few hours!

Costa Rica Health - Natural Childbirth - New Mom & Son

Truth be told, when we first found out we'd be having a baby, we had no idea that a homebirth was even a possibility. With no laws sanctioning midwives, and the difficulty involved in registering a baby delivered at home, hospital birth is firmly established in Costa Rica, and information about homebirth is not always readily available.

Having a homebirth was a wonderful experience for me, though I would not recommend it for everyone. I highly suggest that the parents-to-be engage in some serious soul-searching prior to making a decision. Decide what constitutes a natural birth for you.

For some women, this simply means a birth without unnecessary medical interventions, such as pain-relieving drugs or monitoring. For other women, such as myself, this means giving birth at home in as natural a state as possible.

Natural Childbirth - First Checkup

If you decide homebirth is not for you, but you would still like to consider natural childbirth, there are other choices available within the medical system, such natural childbirth in a hospital setting.

When we first learned I was pregnant, we did the usual hospital birth center tours. We actually found our obstetrician through one of the top hospitals - CIMA - in the country. During the tour, the hospital administrators and nurses told us about their extremely high cesarean rate (an astonishing 80+% - a rate over 25% in developed countries is considered high), which was enough to scare me out of a hospital birth right then and there!

They also informed us of the hospital's policies, including separate labor and delivery rooms, only one family member in attendance at the birth, etc. Additionally, we heard about their "programmed birth" option: set up your labor date in advance, come in during the morning, have your caesarian, and be on your way the next day! Though this would be fine for some women, birth by convenience didn't sound like the experience we were interested in at all.

When we voiced our concerns, the name of one obstetrician who would be more receptive to our "crazy" ideas about natural childbirth frequently emerged: Dr. Adam Paer. Dr. Paer, who practices at MediPlaza in Escaz+¦ and is affiliated with both CIMA and Cl+¡nica Cat+¦lica, acknowledged that some hospitals are more open to natural childbirth than others. He suggested that if we decided to have our son in a hospital, Clinica Catolica was the best choice.

The hospital offers a combination birthing and labor room suite, and parents may choose as many family members as they wish to attend the birth. Doulas and midwives are welcome there, though Dr. Paer himself works only with doula Ansu Coto and not midwives. (Parents wishing a midwife-attended birth may have an obstetrician as a backup.)

Additionally, Dr. Paer is the only obstetrician in the country with his own labor/birth pool, which can be used in Clinica Catolica's labor/delivery suite. Similar to a Jacuzzi, the pool can often help women have an easier, more relaxed birth.

Another option - the one we ultimately chose - was a natural homebirth. We were first led to doula Ansu Coto through Dr. Paer, who understood our desires for our son's birth. ("Doula" is a Greek word literally meaning "one who ministers.") A doula supports the mother during labor, and often during the pregnancy and post-partum periods as well.

For my part, Ansu was absolutely indispensable. We took hypnobirthing classes with her before our son was born, and the relaxation techniques learned during that time were incredibly helpful during labor. Through the most difficult parts of my labor, Ansu helped me focus on my goal - a healthy, happy baby born in a natural setting - and I don't know what I would have done without her.

Costa Rica Health - Weighing

Through Ansu, we met Nathalie Steverlynck, a midwife from Argentina. With years of experience and hundreds of births behind her, I felt confident she would be the right person to attend our son's birth. Though we continued to see Dr. Paer for regular monthly checkups, we also saw Nathalie on a monthly basis as well. Like other midwives, she also performed checkups, albeit with a more low-tech, hands-on approach.

Both Dr. Paer and Nathalie encouraged us to create a birth plan, an essential part of any planned natural birth, whether at home or in a hospital setting. This lets your birth attendants know exactly what you want - as well as what you would like to avoid - during your birth. To create a birth plan, you can either obtain a form from your doctor or midwife, find a fill-in birth plan on the internet, or write your own. One option can be found at www.PregnancyAndBaby.com; this form can be printed out and given to your birth attendants. I also suggest translating it into Spanish, and be sure to review it with your attendants before the actual birth.

Perhaps the most difficult part of having a baby at home was not the birth itself, but the lengthy and red-tape ridden process involved in obtaining a Costa Rican birth certificate. A number of signed and notarized letters must be presented before the Civil Registry (Registro Civil) - these include letters from your obstetrician, birth attendants and pediatrician, as well as at least one other person who can testify that he or she saw you pregnant.

Note that since midwifery is not legally recognized in Costa Rica, your midwife may be unwilling to provide such a letter. This is not usually a problem, however. In our case, my husband provided one of the two required letters from birth attendants (the other was provided by doula Ansu Coto). It is highly recommended that you call the Civil Registry (287-5472 or 287-5555) to get a list of the currently required documents for a homebirth, as these seem to change on a whim.

In addition, you will probably want to check with the embassy of your country of citizenship regarding requirements for a birth certificate and passport. In my case, this was the United States, which, in addition to requirements similar to those for Costa Rica, requests verification that you spent at least five consecutive years actually living in the United States.

School or military records can fulfill this requirement; since these can take some time to acquire, it is suggested you make the request for such records before the baby is actually born. (Check U.S. Embassy for a current list of birth certificate requirements.)

Deciding to have a natural childbirth, whether at home or in a hospital, can be a daunting prospect. I encourage you to read as much as you can on the subject, and speak with others who have had natural birth experiences, as well as prospective midwives, doulas, and obstetricians. To this end, I have included some resources below that may be helpful to you.

Whatever your final decision may be, having a baby is an amazing experience, and the birth itself is only the beginning. I wish you and your family the very best!
Written by Wendi Patrick who is the editor of Costa Rica Outdoors magazine. Wendi lives in Ciudad Colon with her husband and son, and an ever-growing menagerie of rescued animals.

Resources:
Ansu Coto (224-5806); Besides her role as a doula, Ansu is a certified hypnobirthing instructor, and also teaches yoga for pregnancy and massage for babies (among other classes) at the Gaia Center for Integral Balance in San Pedro.

Nathalie Steverlynck (837-5444) of MamasalNacimiento.com is an Argentine midwife (also speaks English).

o Marie Tyndall of MamaLuvBabies.com Registered Midwife from Canada; Marie also sells baby slings and cloth diapers.

Dr. Adam Paer (288-7576 ext. 111 at Mediplaza, 208-1406 at CIMA Hospital; 4-D ultrasound, birthing tub, natural childbirth practitioner available as primary obstetrician and/or backup to midwife-delivered homebirth.

o La Leche League of Costa Rica (group leaders: Greta McAlpin, 592-0726; Maria Melia, 271-1686; Maria Weinrich, 761-1858; Waleska Porras, 441-0148; and Nancy Sabean, 228-0941); For help with breastfeeding; meetings take place monthly.

o Ina May's Guide to Childbirth, by Ina May Gaskin and The Birth Book, by Dr. William Sears and Martha Sears, R.N. Both are invaluable guides if planning a homebirth or natural childbirth. And for after baby's birth, The Baby Book, by Dr. William Sears and Martha Sears, R.N. is an all-around guide to attachment parenting and baby care.

Mothering.com; Online forums dedicated to "natural family living," a great place to connect with moms- (and dads!) to-be.

Dr. Carlos Orozco (256-0856); Pediatrician, practices both traditional and homeopathic pediatric medicine.