We’ve done a series of posts in the past about having a baby in Costa Rica. These covered prenatal care, delivering at a small private hospital in San Isidro de El General, and the paperwork after a baby is born. Last year, we welcomed our second son into the world. We did things a little differently this time around. Below we share our experience with our new doctor in San Jose. We also tell you about what it was like to have the baby at Hospital CIMA.
Prenatal Care
Background
The birth of our first son was magical, of course, but looking back, we feel that the experience could have been better. Because of this, we wanted a different experience for our second birth.
With the first birth, I had some complications (retained placenta) and was bedridden for a while after. There were a lot of extenuating circumstances, but fundamentally, based on what I know now about the condition I had, I feel that my doctor should have done more sooner. Also, the hospital in San Isidro de El General where we delivered was a bit small and understaffed to deal with the situation. This was several years ago and the hospital has changed a lot since then, so it may be different now. But at that time, we felt that the staffing was inadequate. We knew that this time we wanted reassurance that there would be a way to manage the placenta not delivering on its own, since we now know that this can be a very serious condition.
So for this birth, we reached out to a doctor in San Jose who we had heard great things about. Some of my friends here had delivered with him and just about everyone had wonderful things to say.
Since we live farther from San Jose, we wanted to avoid the monthly trips to the big city for routine checkups as much as possible. So we went to the same local doctor we saw for our first birth. Then a few months before my due date, we started seeing the doctor in San Jose who practices at CIMA.
Meeting the Doctor in San Jose
We had several checkups with the doctor at his office near Escazu where we were able to get more comfortable with him and feel out his birthing ideology. Like with the first birth, we wanted a natural delivery if possible. He was totally for this, but also gave information on pain management options like epidurals.
I connected with him almost right away because he was really laid back. He was also very intelligent, and I found it reassuring that he kept up with medical studies. He clearly brought this information into his practice too. We have found that some doctors in Costa Rica are sort of “old school” and maybe don’t stay on top of all the new developments in their field. Our doctor was the exact opposite and answered many of our questions by referencing current medical studies.
The most important thing was how he handled the retained placenta issue. He told me that this was a stage of labor that we would manage 100% just like any other and we would be proactive to make sure it didn’t happen again.
Check Ups
Like my first doctor, he spent the beginning of each visit talking about how things were going. Then he did the exam in a separate room adjacent to his office. The ultrasound equipment was state-of-the art. It could do 4D and even blood-flow imaging. We went home with a handful of adorable ultrasound photos for the fridge every time. We also got a 4-page printout with different measurements and data.
Getting Ready for Delivery
Moving
Since we lived around two hours from San Jose, we decided we should move closer to the city before the birth. We weren’t sure when exactly we would do this. We had thought a couple of weeks early, but since I was almost two weeks late the first time, we waited. I had no signs of labor so we ended up waiting to move until my exact due date. We rented an Airbnb in Santa Ana. My doctor told me that if I felt any signs of labor to let him know. Otherwise, we decided that we would induce one week after the due date.
A week passed, and of course, there was no baby yet. It was one of the longest weeks in memory, with the three of us stuck inside a small apartment. But we are still glad we did it, just in case I did go into labor quickly.
Induction
We talked with the doctor a lot over WhatsApp during that week we were in Santa Ana because I had some different symptoms happening and we wanted to make sure everything was okay. Finally, over text, we decided to induce on a Sunday. He wanted to use a gel insert, but it ended up not being available. Normally the CIMA pharmacy had them, but the management had recently changed, and it was no longer available. He couldn’t find it in any of the other pharmacies around San Jose, which really surprised us, but everything is not always available in Costa Rica.
We discussed alternatives. I asked about Pitocin because that was what I was familiar with. He explained that because I was not having any contractions and my body was not showing any signs of preparing for birth, that we needed to use something else first. If we went straight to Pitocin, the induction may not work and we’d have to do a C-section. So he proposed using cervical dilators. This was a totally new concept to us, but basically they are tiny rods that mechanically open the cervix by osmosis. It didn’t involve using any medication so didn’t have any real side effects, which we liked. We don’t think they are used too often for inducing labor and thought it was a really cool option.
He put in the cervical dilators in his office (pain free) and sent us home to our Airbnb. He said the dilators don’t usually produce contractions so expected that we’d go to CIMA the next morning to start the Pitocin.
Delivery
About five hours after the dilators were put in, I started having minor contractions. They progressed, and by 1:00 a.m., were strong. Since I was in labor for days with our first son, we waited, probably a little too long, to call the doctor. We were using one of those apps and it still seemed like the contractions were not close enough. Well, when we finally got out of the Airbnb around 4:00 a.m., I could barely walk and was keeling over in excruciating pain. Matt drove as fast as possible. We dropped off our son with some close friends who were standing by at the Holiday Inn, right next to CIMA, to take care of him while we had the baby.
We finally got to CIMA and couldn’t find a way to get in! The main entrance we had always used was closed since it was so early, so we spent a few agonizing minutes finding the emergency entrance on the side. Figure this out in advance so that you’re ready in case this happens to you.
They admitted us right away since we had done our preadmission paperwork a while back (see below) and wheeled me to the maternity ward. The nurse checked, and sure enough, I was fully dilated. The nurse spoke perfect English and was very calm, which was just what we needed at the time. She and another nurse took some basic information from me for my chart and brought me right into the delivery room.
My doctor and the pediatrician we had picked to attend the birth arrived within ten minutes or so. We wanted to use the same pediatrician in San Jose who we use for Sam’s regular checkups. It was super reassuring to have him there as well and I felt like I had an excellent team.
Our son, Evan, entered the world in light speed, just as the sun was starting to rise over the mountains out the window. I wish we had taken a picture because I will never forget how beautiful the landscape looked at that moment. The pediatrician took the baby to make sure everything was all right, then placed him on my chest. It was a truly magical moment meeting that little baby for the first time.
Meanwhile, my doctor was managing the third stage of labor. For most people, this is no big deal, but as mentioned, this was difficult during the first birth. My doctor saw that the uterus was trying to contract around the placenta, so he just took charge and manually removed it. I honestly don’t remember any of it so it couldn’t have been too painful, especially after giving birth. I was ecstatic that it had turned out this way as I had been very worried about having a retained placenta again.
After the baby was cleaned up, we all went to our room together and they placed him in a crib beside my bed. He stayed with us the whole time, but there were nurses to help whenever needed. The birth experience was great, and I attribute a lot of it to the doctors we used.
Hospital CIMA
As for the hospital itself, overall, we had a great experience delivering at CIMA. CIMA is one of the largest private hospitals in Costa Rica. It’s well run, well staffed, and has modern equipment.
A great thing about it is that you can get just about any medical procedure done there since there are so many affiliated doctors. This can be essential if you have any complications. For my first birth, they told me I would have to go to the public hospital down the street if I wanted a blood transfusion, which seemed crazy. If I would have needed one this time, CIMA would have been able to handle it onsite.
Maternity Ward
CIMA has its own maternity ward. It’s small and from what we’ve heard, usually isn’t very busy. When Evan was born, there were actually a lot of other babies being born via C-section. Semana Santa (Easter Week) was the following week and apparently everyone wanted to have their baby before then!
CIMA’s maternity ward is spread out along one floor. It has separate delivery and surgery rooms. There is even a special section for premature babies with high-tech incubators and monitors. All recuperation rooms are private and have a couch that pulls out to a bed, cable TV, Wifi, and A/C. Here are some photos to give you an idea.
Staff
The staff at CIMA was awesome in general. Most of them spoke English and were very pleasant and professional. The only problem we had was in the middle of the night when I was having problems urinating, it seemed like it took forever for the two nurses who were on duty to come do the catheter. It had been way too long (about 18 hours since I had last urinated) and they kept telling me to try, which obviously I was but it wasn’t working. You’re supposed to go after giving birth within six to eight hours max so they should have been much faster in helping me. These two nurses who were working the overnight shift didn’t speak English, so while we were able to communicate with them, it wasn’t perfect.
Otherwise, we have no complaints and the nursing team was pleasant and helpful.
Birth Packages and Pricing
CIMA has packages for natural births and C-sections. They are very transparent with pricing. They will give you literature on the packages when you do a tour, which we highly recommend. You also can request a quote from their website. We were communicating with some of their administrative staff by email about pricing in the days before the birth.
As of April 2019, the price for a C-section was $2,020 and a natural birth was $1,319 or $1,391 with an epidural. This is the hospital fee. The doctor’s fee is an additional, separate charge that you pay to them directly. We paid our doctor $1,500 for attending the birth, and the pediatrician was $500, which included the baby’s first visit on his fourth day of life.
What’s Included in CIMA’s Hospital Fee?
The hospital fee includes a lot. Here’s a breakdown:
• One night of hospitalization
• Basic medications for mom and baby
• Blood tests for baby
• Hearing test for baby
• Four sessions of fetal monitoring
• Newborn metabolic heel screening test
• Vaccines (Hepitatis B and tuberculosis)
• All meals – The food was really good actually, for hospital food. I never would have expected this in Costa Rica, but the salmon was awesome!
• Photo session for the baby
• Beauty session for mom – Yes, you are reading this right! A lady comes to do your hair and makeup to get you photo ready.
• Baby blanket and outfit for right after birth
• Nightgown for mom to wear after birth – It was actually quite comfortable
• Goody bag with diapers, wipes, and lots of baby products
• Free parking
• Free mini bottle of wine!
Other Things to Know – Preadmission
If you decide to give birth at CIMA, you should do preadmission. This is the paperwork you have to do before they will admit you to the hospital. If you have a fast birth, like we did, it’s absolutely essential to have done it ahead of time because it takes around an hour. You also have to make an advance payment then. They had us put down $1,000, which was taken off our balance at the end. This is a refundable deposit so if you end up not giving birth at CIMA for whatever reason, they will refund you. You can pay with a credit card or by bank transfer.
To start the preadmission process, your doctor will give you a piece of paper with information on the birth you are likely to have (natural vs. C-section). You take this to the Preadmission desk right in the main lobby of CIMA. Someone will take your personal information and have you sign a bunch of forms, then you’ll be in the CIMA system.
Takeaways
Looking back at our two births, they were very different and we definitely think the second time around went a lot better than the first. We knew more going into it, which helped, and had an amazing team of doctors. We thought CIMA was a great hospital and would highly recommend it to others.
Have a question about giving birth at Hospital CIMA? Ask us below.
Looking for more information about having a baby and living in Costa Rica? Check out these posts:
Having a Baby in Costa Rica: Prenatal Care – This was our first article on having a baby in Costa Rica. It covers some of the more basic questions.
Having a Baby in Costa Rica: The Paperwork – Explains what to do to get baby’s first passport, paperwork to be able to leave the country, and more.
Applying for Residency in Costa Rica – If you’re planning to apply for residency through the birth of your child, you’ll want to check out this article. We go through the process step by step.
