Doula Bowie

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Birthing in Costa Rica

Sloth mom with sloth baby in a mossy tree

In Costa Rica, giving birth at home with the assistance of traditional midwives, or comadronas, have always been the norm up until the 1970s. Many people born in the 40s or 50s have fond memories of the village woman who helped bring them and their siblings into the world within the comfort of their homes. She was also highly sought after for her skills as a “sobadora,” herbalist, kinesiologist, or physiotherapist. In different indigenous communities, such as the Huetar, Cabecar, and Bribri, certain women still have traditional midwifery knowledge and are known as the go-to person for the village for delivering births.

Nowadays, most births in Costa Rica are delivered in public or private hospitals. Even in indigenous communities, many women opt to give birth in hospitals, given the dwindling number of comadronas in their communities. Research by Marín and Vega (2013) highlights that during the years 1960 to 1980, regulations governing midwifery became increasingly stringent, leading to the universal practice of hospital deliveries. In 1997, the last guidelines were published, emphasizing the midwife's role in advising women to seek hospital care, with home births only recommended in emergencies. By 2000, fewer than 3% of births occurred at home, and new statistics from 2018 indicate that this option has almost completely disappeared, with home births dropping to less than 1%.

Public Hospital Births

In any part of the country, public hospitals, managed by the Caja Costarricense de Seguro Social (CCSS), are accessible for childbirth. It is a universal right guaranteed to all pregnant women in Costa Rica. Although they have updated their official care protocols, change has been slow and sporadic. They still perform obsolete routines that are discouraged by the WHO and considered as traumatic and unnecessary, such as routine vaginal tactos, intravenous serum usually with Pitocin, fasting, lying position for delivery, piquete, Kristellar maneuver, early cord cutting, and postpartum uterine scraping. In 2017, they implemented the new rule that every woman has the right to be accompanied at all times during labor, delivery and postpartum, but the reality is that many times they ask the companion to wait outside when the maternity ward is full, due to lack of space.

Advantages

  • Free

  • Accessible

  • For emergencies, high risk mothers

  • Mother-baby co-sleeping

  • Allow support person (in some cases)

Disadvantages

  • Unknown personnel and limited staff

  • Shared wards, limited equipment, no pain medication provided

  • Separate birthing room

  • Unnecessary interventions

  • 60% induced with Pitocin

  • 30-50% c-section rates

  • C-sections: partner cannot accompany c-section, no immediate skin-to-skin

Private Hospital Births

The option of giving birth in a private clinic is very expensive for the vast majority of Costa Rican women. Very likely, private OB/GYN specialists will convince you to have a c-section. Some clinics only offer the option of scheduled cesarean section and do not receive women in spontaneous labor.

There are some, but few, obstetrician-gynecologists in private clinics who respect your birth plan, and support natural and family deliveries. If the process ends in a cesarean birth, it is also done in the most humane way possible. Make sure to do your research before choosing a private hospital, clinic, and care team.

Advantages

  • Choice of delivery team (obstetrician-gynecologist, pediatrician, doula)

  • Private rooms for birth and postpartum (same room), private bathrooms with hot shower

  • 24-7 support person

  • Epidural, upgraded equipment

  • Allow support person in c-section

Disadvantages

  • Only in San Jose and other large cities

  • Expensive (US$4,000-$7,000)

  • 80-90% c-section

 

Home Births

CCSS and popular culture consider home births dangerous and even forbidden, although there is no law against it. Very few women opt for home births due to lack of exposure and knowledge about how they go. Also, very few professionals are willing to attend a woman at home, and the vast majority would be afraid and have never seen a natural birth at home. In the health system, there is no formal support for women who choose to give birth at home.

There is growing evidence of benefits of giving birth at home. Even the WHO promotes it and in countries such as England, Canada and Holland, planned home birth is recommended and incorporated into national health systems. Home birth benefits include: safe, safer than hospital for healthy, low-risk women, fewer infections, fewer unnecessary interventions (traumatic), greater satisfaction, less postpartum emotional and obstetric trauma, successful breastfeeding and attachment.

In Costa Rica, more and more women are looking into home births. Only obstetricians or registered obstetric nurses may legally perform home births but there are also experienced midwives and comadronas who can attend home births. Since there is no public support for home births, they are done out-of-pocket of the family, so it can be more expensive than the public system.

Advantages

  • Continuous care with chosen birthing team (midwife, doctor, doula) on call 24-7

  • Comfortable and familiar environment

  • Privacy, security, intimacy, warmth, control of environment, respect and autonomy

  • Can be as safe or safer than hospital delivery

  • Appropriate and personalized medical interventions

  • No separation of mother and baby

Disadvantages

  • Only for low risk women, i.e. no complications and very healthy habits.,

  • Not accessible in many areas of the country, lack of midwives

  • Home has to be a maximum of 30 minutes from a hospital

  • About 10% are transferred to the hospital
More on Home Births

Mother and Baby Legal Rights in Costa Rica

In October 2021, a law was passed to secure the rights of mother and baby to have safe and respectful births, free of trauma and full of peace. It was a hard fought battle by different parties, including the Humanized and Respected Childbirth Movement of Costa Rica and Mamasol.

If you are giving birth in Costa Rica in a hospital setting, it is helpful to familiarize yourself with the law and have it in hand when advocating for your rights during your birth and pregnancy, and after.

The purpose of the new law is to protect and guarantee the human right of women and members of pregnant families to achieve a pregnancy, childbirth, postpartum and puerperium with qualified care and humanized management, ensuring the exercise of these rights, as well as the rights of newborns; with the purpose of contributing to the reduction of maternal and neonatal morbidity and mortality; promoting the experience of a dignified, healthy, safe maternity with the lowest possible risk, through the timely, efficient, quality and warmth provision of prenatal, childbirth, postpartum and newborn health services, contributing to the human development of the family.

Read the law here (Spanish).