Finding and OB as an expat living in Nicaragua
When those unexpected two lines showed up on the pregnancy test showed up a couple months before our planned move to Nicaragua, you can imagine the gammit of emotions and thoughts that ran through my head.
At first I thought I will travel back to have the baby, but very quickly a realized that was a. not realistic and b. that could not be my answer to every unexpected medical need that arose. God was calling us here and knew having a baby here was going to be one of the first things on our list.
My first pregnancy that ended in miscarriage at 9 weeks I was in the care of a family doctor in Canada. Her bedside manner as I faced the loss of my first baby led me to the care of midwives when I got pregnant with Lilia. I absoloutely loved being with midwives throughout pregnancy, delivery and post partum. So of course I did it again with Marissa and knew that was the way I would have any babies in the future!
Well sadly this is not an option in Nicaragua. Midwives are actually illegal here. The midwives here are trained by passing down information through the generations and there is no formal midwifery training here. Sadly my only option was to find an OB.
I hit the expat facebook groups asking for recommendations and one name came up several times so I decided to book an appointment with him within the first few weeks of arriving here. Personally I am not a fan of male doctors for my lady parts but there are many more male doctors than female doctors in Nicaragua and only one lady’s name was recommended and she wasn’t fluent in English.
I understand as a foreigner it is my responsibility to learn the language and adapt to here, but I knew I wanted the doctor who was going to be delivering my baby to be fluent in English as I knew I wouldn’t be fluent in Spanish by my due date and birth is just one of those things where you don’t want to have a lost in translation moment.
So at just before 20 weeks I fumbled my way through the hospital and found his office. A very nice office that was playing lounge type music in English on the speakers. I thought ohh maybe the receptionist and the nurse speak English too!
This was not the case and I didn’t know exactly what to do or say as my heart rate rose while trying to figure out what the nurse wanted from me. I fumbled through and got my height, weight and blood pressure checked and then she sent me back to the waiting room.
Later she called me back in and it was a relief when I met the doctor who spoke perfectly clear English. He asked me pretty typical medical health questions in regards to pregnancy and then had me go into an exam room and performed a pap, a cervical ultrasound, measured my cervix, a stomach ultrasound. This was all a little overwhelming for me for my first time meeting this doctor. I was not expecting to have to “undress from the waist down” at all in fact. But it is what it is. I was uncomfortable for a few reasons, first who is ever comfortable getting a pap, second it was my first experience with a male doctor doing that, he did have his nurse present which I guess made me feel a bit better. I do not think at 20 weeks pregnant that a measurement of my cervix is required… but then reminded myself he is fetal medical specialist and is equipped to handle all sorts of high risk situation so this must just be a normal part of his process. I assumed the pap was because I am a brand new patient to him and hope I don’t have to have another for a long time!
One thing I really enjoyed about the appointment, was how thorough the ultrasound was. In Canada the ultrasound techs are not allowed to tell you anything so those appointments are usually awkwardly quiet which always left me uneasy due to my miscarriage history. The ultrasound was done right there by the doctor and he showed me so many details even the 4 chambers of our little guys heart! He confirmed it was a boy and then had me go to the bathroom give a urine sample and dress and meet him back in his office.
There he talked to me about my weight since I am overweight for my height and talked about the risks that can be avoided during pregnancy and delivery simply by being a healthy weight. He recommended I meet with a nutritionist and in a kind way told me it’s not a comfortable thing to talk about but necessary for the baby’s health.
I left the appointment with another appointment booked for 3 weeks later for a complete blood work panel as well as the gestational diabetes test and the “anatomy ultrasound” for 23 weeks. He also gave me his personal phone number and told me to text him with anything I needed.
Total cost was $120 US dollars
Overall the appointment went well and I felt cared for even though I felt it was a little over the top for my stage of pregnancy – aka I hate having things inserted in my lady bits.
Next appointment I felt more confident because I knew where the office was, knew more Spanish due to the lessons I had been taking the 3 weeks innbetween and knew the just of what the nurse was going to ask of me before I met with the doctor.
First I had to go to the lab for all my blood work. It was quite an interesting experience because due to covid they have. the option of a drive thru lab! It was great! The lady wheeled her cart out to me and took my blood while I sat in the backseat of the van. She also collected my urien sample that the doctor had given me the sample cup for at the last appointment. Then she came back out and gave me the glucose drink and told me to wait for an hour. An hour later she came again took more blood, and then finally one more hour a different tech came out for my final blood draw. I finished all this up right in time for my appointment and headed upstairs to my doctors office.
So the nurse called me in, weighed me, took my blood pressure and had my undress AGAIN for the ultrasound. I asked her why and she told me the ultrasound is on my stomach and an internal. So I guess that is just normal here and I am going to have to be dropping my pants for every appointment.
The doctor came in, did the ultrasound, everything looked great although this baby loves to snuggle up with his head straight into the placenta so he again could not get a good profile pic for me but got a very clear gender shot and printed that off lol. It is definitely a boy! He then asked me to empty my bladder and come back in and then did a super quick internal ultrasound which was much shorter than the first time! I dressed, met him back in his office where he discussed that he was happy I had not gained any weight (in fact I had lost a lb due to my new routine of walking on the beach for an hour every morning and ensuring I am eating balanced, nutritional meals and cutting back on sugar. I don’t need to pay a nutritionist to tell me what to eat I just need to do it. And told me to screenshot and send in my lab results when the lab emails them to me.
I am still unclear if he also gets a copy or he only gets the info from me. Or maybe they just send it to me first. Anyways I left and on the way back home I received all my blood work results. After some translating and decipering everything looks good, passed the gestational diabetes test, but am still slightly anemic, which has been a common problem in all my pregnancies. So I am trying to get more iron in me and eat more foods that help the absorption of iron.
Total cost $140 for doc appointment/ultrasound and $190 for bloodwork (I pay half price for lab work with my health coverage I pay for in advance for our family directly to the hospital) So actual cost for bloodwork was just under $400 – yikes coming from Canada with universal healthcare all these medical expense are seeming to add up quickly (also my doctor is not part of the healthcare coverage I pay for in advance but because he is fluent in English I don’t mind paying full price for his care)
My next appointment is in one months time at 26 weeks and not sure what to expect – Hopefully. a basic weight and health check, measurements and no internal ultrasound!