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Cost of Giving Birth at a Private Hospital in Nicaragua

21 Jun

I’ve received enough inquiries about the cost of giving birth at a private hospital in Nicaragua that I thought it was time to share the knowledge.

Lucinda was born at Hospital Metropolitano Vivian Pellas, in Managua.  To the best of my knowledge, it is the highest quality hospital in the country.  In addition to a wonderful OB department, the hospital also has a fantastic pediatrics department.

All told, we spent $2,200 for an all natural labor and delivery and approximately $1,000 on prenatal care.  I had a very healthy and relatively “easy” pregnancy, without complications.  I am 99% certain that I am missing some receipts from a few check-ups, ultrasounds, etc, so it’s probably safe to round the prenatal care up to $1,200.  This amount also includes some thyroid testing that not everyone will need.  In addition, at Lucy’s first check-up, we also ordered the genetic screening test (the heel prick) which tests for up to 60 possible genetic disorders.  I think that ran us about $250.

As we approached my due date, we were given the option to pre-purchase a Labor and Delivery Plan, which you can pay with a credit card.  Pellas offered 3 options.  Prices are from August 2010 and have likely gone up:

Plan de Parto ($610 for a private room; $500 for a semi-private room)

-1 day in a standard room

-The right to an epidural (note that this does not include the actual anesthesiologist)

-Use of the labor and delivery room

-Neonatal Day (nursing services and a pediatric “crib”)

-Determination of blood type and the Rh of the baby

-Basic medication for the mother and the baby for one day following childbirth

-Hearing test for the baby

Plan de Cesarea A ($725 for a private room; $670 for a semi private room)

-1 day in a standard room

-The right to an epidural (note that this does not include the actual anesthesiologist)

-Use of an operating room

-Use of a recuperation room

-Neonatal Day (nursing services and a pediatric “crib”)

-Determination of blood type and the Rh of the baby

-Basic medication for the mother and the baby for two days following childbirth

-Hearing test for the baby

Plan de Cesarea B ($950 for a private room; $800 for a semi private room)

-2 days in a standard room

-The right to an epidural (note that this does not include the actual anesthesiologist)

-Use of an operating room

-Use of a recuperation room

-2 days of Neonatal care(nursing services and a pediatric “crib”)

-Determination of blood type and the Rh of the baby

-Basic medication for the mother and the baby for two days following childbirth

-Hearing test for the baby

Not wanting to borrow trouble and having a natural birth plan in mind, we opted for the Plan de Parto and were reassured by the admin that if I did end up with a cesarean, they would only charge us the difference between the two packages.

It is important to note that this payment does not cover the cost of your doctors during your labor and delivery.  That price is negotiated between you and your doctor prior to your delivery.  At Pellas, in addition to your OB, a pediatrician is present during your delivery.  We paid $1,550 to our OB who then distributed proper amounts between himself, another OB, and the pediatrician.  I think we paid toward the high end because we actually had two OB’s present – one was my primary care OB and the other was the OB who performed all of the ultrasounds throughout my pregnancy.  Doctors usually do not accept credit card payments, so be prepared to pay in cash.  I do not recommend keeping $1,500, in cash, in your hospital room.  Instead, consider talking to your doctor, in advance, about paying him at your first postnatal visit, which will be a few days after your delivery.  We actually ended up paying in two installments, because it’s not easy to have that much cash around.

Below is a spreadsheet that outlines each individual medical expense, beginning with prenatal testing.

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Nebulize This

23 Jun

Do you remember when you were in elementary school and you missed a couple of days due to chicken pox (imagine that chicken pox to our children will be like measles was to us) or the stomach flu? Your mom would call the chain-smoking tenured secretary, who’d been subversively running the school for the last 40 years, and report that you wouldn’t be in attendance that day.  And when you did finally return to school, mom always sent you with a note for your teacher, explaining the reason for your absence.

I think that the same should exist for parents of sick children.  Only the note would not be an excuse from school, but an excuse from responsibility.  “Dear Visa Credit Card/Landlord/Work, Sarah couldn’t pay the bill/rent/come to work today because she has a sick kid and needs a complete break from life.”

While we were visiting family in Boston and Syracuse, in early May, Lucy caught a cold, and then pink eye, then a slight fever, and eventually, came down with an ear infection. Though mildly uncomfortable, Lucy championed through her first illness with aplomb and rebounded quicker than it takes us to get her to sleep some nights. And while concerned, we were surrounded by seasoned grandparents, aunts and uncles, all at the ready with anecdotes and helpful advice.

Two weeks later, we were back in San Juan, I had just returned home from work and noticed that Lucy felt a little on the warm side.  We called her pediatrician who advised us on the proper dose of children’s Tylenol and we waited for her fever to pass.  But, instead of breaking, it spiked.  In 30 minutes, I watched (and felt) it leap from 101 to above 104.  And worse than her temperature was her quickly deteriorating temperament, which went from charming to alarming in minutes.  She became sadly lethargic, insanely hot, and wanted only to be held by me.  My heart crumpled as I watched my usually upbeat, wide-eyed baby melt into a lump of mush on my shoulder.

For two nights, Justin and I alternated between periods of wakeful hyper-vigilance and helpless hazy sleepwalking, monitoring Lucy’s temp(erature and erament) hourly fearful of the spikes and grateful for the breaks.  Her crib, once a source of familiarity and comfort to her, was suddenly plagued by its distance from us (at the foot of our bed).   In an eleventh-hour effort to get Lucy to sleep, we brought her into our own bed and she collapsed into a fever-induced slumber.

Friday morning, we awoke to a smiling, energetic baby.  Her fever had finally broken.  We had survived.  Lucy had survived.  We had our baby back. Sufficiently scarred and appropriately scared, I naively remarked on Facebook that, “after 2 sleepless nights and 3 days of sky-rocketing temps, Lucy’s fever has finally broken! If I didn’t feel like a mom before, I do now!”  And if you remember, I made a similar observation in an old post even before giving birth to Lucy when I declared, “I’ve known for a lifetime that I wanted to be a mom.  I’ve known for 6 months that I was going to be a mom.  But I didn’t truly feel like a mom until last week.”

Lucy’s brief flirtation with sleep ended rapidly as cough replaced fever. We called her doc who suggested that we bring her in to be seen.  Yet, she remained in such high spirits that I encouraged Justin to wait another day or two before dragging Lucy on the 2plus hour drive to Managua.  When the cough persisted the following day, instead of taking Lucy to her pediatrician, we brought her to the local health center.  Within three and a half minutes, he diagnosed her with pneumonia and prescribed a battery of antibiotic injections.  Justin and I exchanged a knowing glance and hightailed it out of there, dialing the pediatrician on the way.

The next morning, we embarked on the familiar journey to Managua, arriving just a few minutes shy of Lucy’s appointment. Not known for his punctuality, we waited on the doc in the germ-infested waiting room, which became quickly populated by other children, all presumably sick [and contagious].  If Lucy hadn’t been ill upon arrival, she certainly would be by the time we left.  We finally got in to see the doc only to be sent down the hallway to radiology.  Feeling intensely frustrated, I questioned our decision to come to Managua in the first place; Lucy appeared to be completely fine.  Eventually, we made it back into the doc’s office, where he reviewed the x-rays, listened to her chest and diagnosed her with bronchiolitis.  As he explained the seriousness of the virus – that many children are hospitalized with it – the possible causes, and reviewed the treatment plan, my frustration snowballed into guilt.  I had delayed the trip.  I had suggested taking her to the local doc.  I was a bad mom.

Instead of making it up to her, in the [10] days to follow, we tortured Lucy with bi-hourly nebulizer treatments, prednisone drops, and chest taps. We shut off the dry a/c air in favor of stifling, humid, sweaty “fresh” air.  We quarantined her in our hilltop home and eventually from her dad, who also came down with a cold.  Combined, Lucy and I averaged 2 hours of broken sleep per night over an 8-night span.  I began to question if the treatment wasn’t worse than the illness.  I furthered question my ability as a mom.  I wondered if my child would ever forgive me.  And yet slowly, the cough subsided and Lucky Lucy emerged from the nebulizer mist with, not only a smile, but also a giant hug for me.

I dare not tempt fate for a third time and so will not say the one thing that I am compelled to say about feeling like a mom.  Because the reality is not that I feel like a mom, but that I am one.

A Slice of Reality: Getting Pregnant and Giving Birth in a Foreign Country

4 Aug

I sliced my finger on the lid of a spaghetti sauce can last night which sent me into a tailspin of panic.  Though painful and bloody, the cut was seemingly benign.  Nothing that a few stitches and a tetanus shot couldn’t take care of.   Yet my reaction was Oscar-worthy, rivaled only by the time I was dumped by my college sweetheart and slipped into a 2-month depression.

Since our move to Nicaragua, I’ve fallen down concrete hills, stepped on stingrays, and boarded down a volcano and survived, all of which resulted in memorable scars of our journey in Nicaragua.  So why was this latest notch on my bedpost of injuries invoking such anxiety?   The answer – I’m 5 months pregnant.

Justin struggled to understand my hysteria.  As he fumbled thru the house in search of Band-aids and Bactine, I sobbed into the blood soaked towel wrapped around my finger and fretted about the possibility of a trip to the local Centro de Salud.  Having only been there once before for an anti-parasite prescription, I conjured up visions of rusty needles and disgruntled nurses.

My already pregnancy-laden hormonal thoughts had spiraled out of control into a place of utter fear that had very little to do with my finger and much more to do with this looming birth.  What if I went into labor early and couldn’t make it to Managua in time?  What if I had to give birth at the Centro de Salud.  What if I went to the Centro de Salud for this cut and they prescribed me something that could ultimately harm this developing baby inside me.  If Justin couldn’t find the Band-aids, how was he going to find the hospital in Managua, two and a half hours away?  What if, what if, what if?

As a self-proclaimed control freak/hypochondriac, pregnancy is bound to cause some level of anxiety in an expecting mom.  DSM-IV diagnoses aside, Pregnancy can cause moments of anxiety in any mom.  Mix it all together with a birth planned in Nicaragua, with Spanish speaking doctors, thousands of miles from family and you have the perfect recipe for an all out freak out, which is exactly what I did last night.  The finger will heal, with or without stitches, but what will happen to me and more importantly, to this baby that I have already been waiting 5 months to meet?

Our original plan was to live in Nicaragua for a year, evaluate our experience, and then perhaps move back to the States, get desk jobs, set up home in an insanely expensive Boston suburb that we couldn’t afford and procreate.  Well, that was my plan.  But, as one year crept into two, both Justin and I began to discuss the possibility of having children abroad.  I wasn’t getting any younger and the economy in the States wasn’t getting any better.   After reviewing numerous birth scenarios (go home now, get jobs, get insurance, get pregnant; get pregnant here, get on a plane back to States for delivery; get over it and just do it), we decided to ignore the one piece of advice that my physician father tried to impart on us during regular visits, “just don’t get pregnant down there.”  Four months later, I was pregnant and we were overjoyed.

By that time, we had met with one of the top OB-GYNs in the country at Vivian Pellas Metropolitano Hospital, discussed a prenatal plan, and witnessed some of our best friends, here in Nicaragua, get pregnant and give birth to happy, healthy babies.  Just as in the States, my OB here recommended the regular battery of pre-natal tests, exams, and vitamins.Moments after we watched the tell-tale pink line develop, we were on the phone to my OB discussing necessary appointments and ultrasounds.  Since that day, we have received top-notch care that rivals the assistance that my sister has received at state of the art Boston-area hospitals.

So, you know the old adage that “women have been giving birth to babies, alone in the middle of fields since the beginning of time”?  Well, it’s more or less true.  And more importantly, women have also been having babies in Nicaragua this whole time.   Giving birth is an incredibly natural life event.  You can prep all you want with doctors and specialists, but ultimately, this little creature is going to enter the world on her own terms at her own pace.  And that, she can do anywhere.

Later that evening, after my finger was carefully washed and bandaged, Justin quietly offered to pack my “hospital bag” so that we are ready to hit the road when labor begins.  With more than 4 months to go until the arrival of Baby Fahey, I’m thinking that maybe Justin really will be able to find the hospital after all.

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