Having a Baby in Costa Rica

Well I am pregnant with baby #2 so I figured it was finally time to write about having baby #1. Turns out you don’t have as much time on your hands for blogging when you have a toddler!

One day you’re 38 weeks pregnant standing in the middle of a hardware store in Costa Rica looking for a water hose for your last minute home birth and it hits you…”Is this actually happening? What the heck are we doing here?” More on that in a bit but let me tell you how it started…

Conceiving in Puerto Viejo

After visiting Costa Rica for the first time on our honeymoon in 2016 and then again twice in 2018 while backpacking Central America, we finally settled here in 2019 when I got a job as the school counselor at an international school. I negotiated a sweet part-time schedule with Fridays off so being the travelers we are, we would go on weekend getaways around Costa Rica. We love vacationing in the Caribbean so we knew we wanted to check out Costa Rica’s Caribbean coast.

On the long cross country drive from Tamarindo to Puerto Viejo we started discussing life plans, as one does on a road trip, and we had been married three and a half years and were thinking of starting a family. Being quite the planner, I decided I wanted to get pregnant when I was 30 and that I wanted to have the baby in Costa Rica so they would be a dual citizen but we were planning on spending 6 months in San Diego the following fall, etc. My mind, internal clock, and calculator started racing and I told Grant we needed to get pregnant on our first try that weekend in Puerto Viejo. Well we are super lucky because it worked!

Planning my Pregnancy in Costa Rica

I took an at home pregnancy test as soon as possible and it there it was! I was still in disbelief so I decided to get a blood test from Laboratorio Clínico in Liberia. To my surprise the results came back negative! Then I noticed the name was wrong. They had sent me someone else’s results! (You can’t make this stuff up!) I quickly received my positive results. Our Costa Rica pregnancy journey had begun!

I starting googling and reading blogs about having a baby in Costa Rica and I decided I wanted to deliver at CIMA, a nice private hospital in San Jose. We did a tour there early on and I was very impressed with the birthing suite.

I would do my prenatal visits at the public health system because we lived in Tamarindo and go periodically to San Jose for an ultrasound and ultimately to deliver. I selected Dr. Adam Paer after reading great reviews online. I decided I wanted to have a natural water birth and Dr. Paer is the only doctor in the country with a tub at the hospital! My decision to have a natural unmedicated birth was partly because I’m a little natural/hippy-dippy and partly because the c-section rate in Costa Rica is alarmingly high compared to other countries.

Prenatal Care in Costa Rica

We have private international insurance through Vumi but because I worked at the school and had a work visa I was already in the public health system, called the CAJA (EBAIS Seguro Social). I simply presented my CAJA number at the clinic in Villareal and started receiving free prenatal care. It is my understanding that all women who are pregnant in Costa Rica (even if on a tourist visa) can receive free prenatal healthcare as the country recognizes the baby as a citizen while still in the womb. (Imagine if the US did such a generous thing, ha!)

My prenatal care at the CAJA was definitely interesting but overall a great experience. I would go every 6 weeks for a check-up and they wanted urine and blood samples more often than that! I would come wait in line on Wednesday mornings with all of the other pregnant and old people. The appointments were exclusively in Spanish so bring a translator if you aren’t semi-fluent. We have good conversational Spanish but medical jargon was tricky (especially after COVID started and everything was muffled by a mask! Who knew how much I read lips?!)

I think I would have been less at ease if the CAJA was my only prenatal care option (remember I was going to San Jose periodically for check-ups with Dr. Paer and his fancy ultrasound machine, whereas the CAJA only has an old-school auditory sonogram machine that functions 50% of the time as you lay on your back in a run-down room staring up at a sign that says “just smile.”)

To be fair, the CAJA does write you a prescription for a free ultrasound in Santa Cruz. I skipped it because I was already going to Dr. Paer. I would show him my CAJA paperwork and vice versa. Since I was taking the all-natural route I didn’t do hardly any of the things the CAJA recommended. For example they told me I had a UTI and prescribed me an antibiotic. I had no symptoms so I skipped it. I also had a borderline high reading on my glucose test but the follow up test was at the hospital in Santa Cruz. This was in March 2020 so I was staying as far away from hospitals as I could because of the new and unknown coronavirus. I knew my diet was healthy and I had no other risk factors so I skipped it. During my first appointment they also gave me some natural bug spray and a mosquito net to prevent Zika, the bug spray was great!

Hiring a Doula in Costa Rica

Once I decided to take the natural birth path I knew I needed a doula. My friend and yoga instructor, Virginia, shared her midwife’s contact. (Read about Virginia’s Costa Rica birth experience here.) Her midwife, Rebecca Turecky, has been doing it for years! Being my first baby and my American/ western medicine mindset, I wanted an OBGYN (Dr. Paer) to deliver the baby so since I didn’t need her as a midwife I hired her as a doula instead.

Rebecca is an incredibly talented midwife and she provided me with some helpful information early in my pregnancy, but I wasn’t getting the doula vibes and support I craved. My friend in California was pregnant at the same time and told me all about her doula experience, which I wanted to mimic. To Rebecca’s credit, she had a lot of babies to deliver and didn’t have the time and energy to give me what I was looking for, thus in February 2020 when I was 24 weeks pregnant, my hunt for a new doula began.

I searched online, in Facebook groups, and asked other pregnant mamas in town. Turns out in Costa Rica, word of mouth yields more than a Google search. I asked Dr. Paer if he worked with any doulas and he recommended Ansu who seemed like she would be awesome to work with… but she wasn’t available during the month I was due. I asked her if she had another doula she recommended and she said Silvia Ulate. I instantly connected with Silvia and knew she would be a great fit! She provided me with virtual calls before I moved to San Jose and in person sessions once there. She sent me guided meditation exercises and I could text her at any time with any of my first-baby jitters and paranoia questions. I literally can’t say enough good things about her. (She is an incredible doula to work with. We are using her again with baby #2!)

Funny Pregnancy Happenings

Because I had been consulting Virginia so much on her birth experience (which was breech) I was convinced my baby was breech. I felt a hard lump high on my stomach and assumed it was the head which would indicate he was positioned feet first (not ideal). After lots of visualizing (I even set my phone background to a non-breech photo) and too many headstands (See: Spinning Babies) I decided to consult an expert. My doula and doctor were 4 hours away in San Jose and the CAJA wasn’t much help in the matter so Silvia recommended a midwife in Playas del Coco to check it out. I also decided to get adjusted by a nearby chiropractor (my first ever appointment). So off to Coco we went! (I feel like we were really bored during this quarantined time and enjoyed these little adventures.) The Coco midwife was a bit cooky for my taste and couldn’t make heads or tails of it (literally!). The chiropractor adjustment was fine (except for the fact that it was outside on her driveway thanks to COVID!) So we left Coco with no answers but some good Mexican food!

Moving to San Jose to Have a Baby

We live in Playa Langosta outside of Tamarindo so the nearest private hospital is Liberia (where they are notorious for c-sections) and the nearest public hospital is Nicoya (which is free but all in Spanish and apparently you can’t have your spouse in the room with you).

So while a home birth in my actual home would have been nice, at this time we were still planning on using the hospital and it was a better fit for us to move closer to CIMA, where we planned to deliver with Dr. Paer. Fortunately we work online so we booked an Airbnb for a month in the Escazu neighborhood of San Jose. I chose a spot that was literally 5 minutes from the hospital and big enough for our families to visit. This is the Airbnb we rented. The host Roxy is amazing. My due date was June 20th so we booked for the entire month of June.

Life in San Jose was pretty fun. We missed the beach but we hung out and worked at trendy coffee shops in Barrio Escalante, walked around the mall in Escazu, and ate the best Indian food in Costa Rica at the Taj Mahal.

Switching Doctors at 35 Weeks Pregnant

Right before we moved to San Jose I was starting to hear some mixed reviews about Dr. Paer. Nothing too bad, but mostly stories of where the water birth didn’t happen or some seemingly unnecessary interventions were used. With an intervention free birth being my top priority I decided to throw a hail mary and switch doctors last minute! Virginia had a great experience with Dr. Freddy Perez so that’s who I was leaning towards. Silvia has worked with him many times and gave me his contact.

The minute I met Freddy I knew he was the one! His demeanor was so pleasant and he was so kind and positive. His office was full of good vibes and essential oils! Dr. Freddy confirmed my baby was in fact not breech, and we were good to go! The only problem was Freddy doesn’t deliver at CIMA. He works at Clinica Biblica and he doesn’t have a tub. I wanted a water birth because the water is supposed to alleviate the pain since I wasn’t going to take meds. Dr. Freddy recommended Casa Kuna Verde, which is a birthing suite above his office. It is not located at the hospital. he said we could do it there as long as we have a midwife present too, and he exclusively works with Monica Miranda.

I thought this was the perfect solution. It’s like a home birth which I found appealing after reading Ina May’s Guide to Childbirth, yet it had the safety feel of a hospital or doctor’s office should there be an emergency. We thought it was going to be a comfortable birthing suite but with a hospital bed, medical equipment, and IV machines. Nope! It’s just a plain ol’ apartment. We were a little disappointed and not sure what to do next.

Having a Home Birth in Costa Rica

Soon after our Casa Kuna Verde visit our midwife, Monica, was over at the Airbnb house for a check-up and suggested doing it there! She thought it would be perfect and although we didn’t have a tub, she had a blow up one she would bring. Meanwhile I was hearing rumors that you couldn’t take more than one person into the hospital room to deliver because of COVID meaning I would have to choose between Silvia and Grant. An impossible decision! Obviously Grant has to be there as my husband and the dad, but Silvia knows all the tricks to support the natural birth. I also had just found out that our parents (who were supposed to visit from the states) couldn’t come because the borders were closed due to COVID! It was a tough week.

I was almost 38 weeks pregnant at this point and a decision had to be made. We decided to have a home birth…in the Airbnb we were renting. Obviously I had to run it by the host (awkward!). She knew we were staying there to be close to the hospital (this is a common thing to do) but she didn’t expect me to give birth at her house! Turns out she was super cool about it. She thought it would bring great energy to the house! The neighboring house she also owns and women deliver there all of the time. We even heard a baby being born while we were staying there!

So Monica gave us a list of things to buy to equip the house for a successful home birth. And that’s how we ended up at the aforementioned hardware store shopping for a hose for the birthing tub. It was surreal but we felt confident in our decision and our team. Although Monica is totally qualified to deliver a baby solo (she does it all of the time) I wanted Dr. Freddy there too in case there was an emergency and we needed to be transferred to the hospital. And of course we had Silvia! We called them our dream team!

So how much does the dream team cost? We spent about $5000 all in all and our insurance covered some of that. Much cheaper than similar VIP treatment in the US!

Welcome to the World Baby Marin!

On June 8, 2020, two weeks before my due date, Baby Marin decided to make his arrival! He came early and fast! Dr. Freddy barley made it in time and we didn’t even have time to fill up the tub! Fortunately I had a smooth delivery and squatted him out on a yoga mat in the bedroom! Read all the details of my birth story here.

Postpartum Struggles

Turns out breastfeeding isn’t as easy as you think! I struggled with mastitis (but fortunately powered through with the support of Silvia and her lactation specialist friend, Ines.) They were amazing and like our family the first couple weeks after Marin was born. (Our actual family was stuck in the US, remember?) They connected me with Dr. Marilyn who finally helped him get a good latch.

Marin also had a tongue tie (thus explains the poor latch) that we had to go to the hospital and have lasered off! Dr. Andrea and Dr. Andreina at Clinica Biblica did the consult and procedure and were great to work with.

Getting a Birth Certificate and Passport for a New Baby in Costa Rica

Amidst my postpartum struggles there were still logistics to be figured out. We needed a Costa Rica birth certificate (Marin was born at home and not the hospital so we didn’t automatically have one.), as well as a US birth certificate. We also wanted to go ahead and get his passport because we planned to travel back to the states in August so everyone could meet the new baby and we could spend a few months in San Diego. (Our original plan was to live half the year in San Diego, half the year in Costa Rica. Now we are full-time in Costa Rica.)

Below are the notes we have from what we gathered online. We did this process in June 2020, and have updated our notes in June 2022 to prepare for the new baby.

Getting a US Birth Certificate (Report of Birth Abroad) and a new baby’s passport in Costa Rica

Forms that must be completed

• DS-2029 (Report birth abroad application) 
• DS-11 (passport application)
• SS-5 (social security number application) 

Required documents 

• Costa Rica birth certificate issued by civil registry (we visited the registro office in San Jose)
• Written statement from physician who attended the birth stating mothers name and pertinent facts about birth.
• Certified copy of marriage certificate
• US passports of parents
• Prenatal care / ultrasound (to prove biological relationship) 
• One (1) recent photograph, in color, size 2” x 2”, with a white background and full front view. (Can be done at consult)
• College transcripts or paystubs (proving you lived in US)

Use this link (https://evisaforms.state.gov/acs/default.asp?postcode=SNJ&appcode=1) to schedule the appointment (can be done a month out). Once the appointment is done it takes about two weeks for everything to be processed. I am being told that the only way to get an appointment now is to get all of the required documents together and then email them to ACSSanJose@state.gov 

Passport Application: $115.00

Consular Report of Birth Abroad Application: $100.00

Total: $215.00

Getting a Costa Rica Birth Certificate

Documents Needed

• Birth Certificates (can be purchased online) (https://www.consulta.tse.go.cr/appcdi#/) 
• Permiso de Salida
  • In person at La Uruca Migration office (lots to choose from) Monday to Friday from 7 am to 12
  • Request an appointment by calling the 1311 Migration Call Center
• Passport (5 to 10 days) if you do the passport they do the Permiso de Salida at the same time. 
  • Just need birth certificate and passports along with copy of the first page of each passport and the payment receipt from Banco Central de Costa Rica ($56.00)

Back to the beach!

After 5 weeks that felt like 5 years (newborn life is brutal!) we eagerly returned to our beachside condo in Playa Langosta. Baby Marin hopped on a surfboard and the rest is history!