GIVING BIRTH IN DR
Updated October 2023
Are you an expat considering getting pregnant or already pregnant and perhaps planning to give birth in the Dominican Republic? Read below!
My name is Leiko, and since 2016 I have been supporting families in the Dominican Republic to prepare for and welcome their babies.
Whether you want a vaginal birth or a scheduled C-Section I am here to offer basic information and some recommendations for you to have a starting point from which to move on in the direction you consider best for your pregnancy and childbirth experience.
First off: I recommend private care over public care. I am not going into the details of the differences between one and the other, I will just say that there is a large difference in the attention you will receive and I am sure you are likely to feel more comfortable with private care. So, from here on, everything you will read will be based on private care.
The Dominican Republic has private hospitals with advanced medicine and modern equipment, a vast network of highly skilled obstetricians (Ob/Gyn), trained doulas, childbirth classes, prenatal yoga, physiotherapists and lactation consultants, among other professionals who can provide you with various services during this period.
Depending on your preferences for prenatal care and childbirth, finding an Ob/Gyn and hospital that meet your preferences may require traveling to Santo Domingo or Santiago. To be more specific: there are a lot more options in the country if you wish for a scheduled C-Section or do not have particular preferences regarding interventions for a vaginal birth than if you wish for a vaginal birth without or with the minimum of interventions.
You can either choose a hospital first and then choose an Ob/Gyn who can attend your birth in that hospital or you can choose an Ob/Gyn first and then choose a hospital where he/she can attend your birth.
Choosing an Ob/Gyn
The most important decision you will make regarding your baby’s birth is the care provider you choose. Because pregnancy care and childbirth protocols will depend on your provider and their own personal protocols. At your first appointment inform the doctor about your preferences for care (and since you may not know all the details and option, start with whether you prefer to have all possible tests done or just the absolutely necessary ones, the type of birth you would like and how far into pregnancy you would like to wait for labor start on its own) and verify you are on the same page. Later on, you can ask about further details. There are many good Ob/Gyn in the DR who know how to do "their thing"... the question is: is the way they do "their thing" coherent with the way you wish for things to be done?
Doctors are not in the obligation to “fit” your preferences, actually they have the right to have their own professional criteria even if it is different from that of their peers here or elsewhere in the world. But if the care provider doesn’t feel like a right fit for you and/or is not willing to genuinely and sincerely discuss the possibility of finding a middle ground between their protocols and your preferences, look for another one (there ALWAYS are options).
In my experience over the last 7 years working with mothers and families in welcoming their babies in Santo Domingo, Santiago, Punta Cana/Bavaro, Las Terrenas and Cabarete, I have only met a handful of Ob/Gyn who truthfully respect the mother’s preferences, who have genuinely shown respect for mothers’ preferences, who don’t do the bait and switch thing, who are willing to discuss options even if the option is not within their own personal preferences and without coercing women into making decisions out of fear, who will not rush into scheduling a C-Section at the first sight of something different than the ideal conditions, and who will go the extra mile within a system that is still far from understanding the mama is the star of this show and that the concept of “well-being” goes beyond a seemingly “healthy mama and healthy baby” and includes a mother/family satisfied with the birth experience.
These Ob/Gyn I personally recommend are in Santo Domingo, Santiago and Nagua. I often get asked for recommendations in the Punta Cana/Bavaro area but, based on experiences from moms who have given birth there, it would seem Ob/Gyn and hospital protocols in that area are less flexible when it comes to childbirth. So, no, at the moment I do not have any particular recommendations for mothers there who wish to have a natural, non-intervened birth, however there are some very good ones if you don’t mind the interventions. What many women who live in that area are choosing is to do their prenatal care and give birth in Santo Domingo. It may sound like a hassle to put together the logistics to do it this way, but for first-time moms it is fairly doable since labor usually takes a good few hours and Santo Domingo is about 2.5 hours away from Punta Cana or Las Terrenas, and about 3.5 hours from Cabarete. And for moms who already have children it can be doable too, just take a little bit more of planning.
Something many expats do is ask other expats about their experiences... and this was usually a good way to go... but in the last couple of years I have met a couple of Ob/Gyn with whom several expats had positive birth experiences in the past, yet who seem to have either changed their ways or others haven't been as lucky... so, my suggestion: go to an interview, meet the Ob/Gyn and go with your gut, don't choose based on somebody else's experience, choose based on how YOU feel.
Are there English-speaking doctors? There are some doctors who say they speak English, and there are a handful who actually speak fluent English.
And I would like to add: thinking that putting up with a care provider with whom you do not feel comfortable is worth it just because you've been told he or she is "the most pro-natural birth doctor", may not pay off... there is no need for you to be miserable during your pregnancy, then going into labor, being admitted in the hospital and putting up with a crappy attitude from your care provider the one day that what you will need the most is positive support... I repeat: there ALWAYS are OPTIONS...
Routine pregnancy and childbirth care protocols in other countries may be different than protocols here. For example, while in other countries birth would be attended by the provider who is on call when your baby’s head is showing, in DR it is usually the same doctor that you choose to do your prenatal checkups with the one who will be assisting you at birth.
Most doctors’ offices use some sort of appointment system but delays are normal. Often there are long waits before seeing a doctor (1h-2h). In part because they may be attending a birth or called into an emergency, or simply because the patients before you had a lot to talk/ask about. When you go see a doctor in the DR, bring a bottle of water and a snack, you may need it (especially if you are pregnant). If you have an appointment time, come on time, even if you know you might have to wait around, because despite your appointed time it usually works on a first come, first served basis.
Keep in mind, routine tests like labs and ultrasounds are usually separate appointments at laboratories or specialized clinics. Results are not always forwarded directly to the Ob/Gyn, you may need to bring the results of these tests to your Ob/Gyn yourself. All patient files stay with the patient.
Also note, if you will pay out of pocket (without insurance coverage of any sort) you do not really need a prescription for most tests and ultrasounds as long as you know what is it that you want to get done. You can literally just walk in a laboratory or make an appointment at an ultrasound clinic, ask for what you want to get done, pay it and have it done. However, if you intend to use your insurance either directly or to ask for reimbursement, you will need a doctor’s prescription.
If you don't have insurance, a medical appointment with an Ob/Gyn could be anywhere between RD$1,000 to RD$6,000 (approx US$18 ~ US$110) and the first appointment is usually more expensive (RD$3,000~RD$8,000 or US$54~US$145), averages being RD$5,000 (US$90) for the first appointment and RD$3,000 (US$54) for follow up appointments. The cost for lab work varies depending on which ones your doctor requests, but the routine bundle in the first trimester (bloodwork, urine, glycemia, virals, STDs, some hormones, immunity to some diseases and blood type) is around RD$5,000 (US$90) without insurance, follow up blood work (once each trimester) is usually around RD$1,200 (US$22). A regular obstetric ultrasound ranges between RD$1,500 (US$27) and RD$4,000 (US$71) in most places, and other more specialized ultrasound studies (usually requested at the end of the third trimester or if at any point in pregnancy something seems off) can go between RD$5,000 (US$90) and RD$10,000 (US$180).
The cost of giving birth varies depending on the doctor, hospital, chosen mode of birth, and a few other things, but in general, adding up hospital expenses with one-night stay and Ob/Gyn and Pediatrician fees, without insurance it can go anywhere from around US$1,200 in a small, modest private hospital to approximately US$7,000 in the very best hospital in the country to give birth vaginally. The above mentioned does not include the use of an epidural and Anesthesiologist’s fees, which would add US$300~US$1,000 to the overall cost. I must clarify something regarding higher end hospitals: they are only worth it if you choose the right care provider for you.
The main difference between less and more expensive private hospitals is basically how flexible their protocols are, they are all equipped for attending a vaginal birth or a C-Section, that part is no concern. So, again, it will depend on your preferences for care which hospital may be best in terms of costs/benefits.
Check with hospital prior to the estimated delivery date on their policy in relation to a deposit in order to have smoother experience when being admitted.
As for emergency care during pregnancy, it tends to work better when you already have a doctor who sees regularly and who you would call if an emergency arises. Depending on the situation and time of the day, your doctor may ask you to go to his/her office or to go to a hospital ER. If you go to the ER, once there you should call your Ob/Gyn who might have specific instructions to give to the attending ER doctor and also be informed later, after you are checked, about the situation. If you do not have an Ob/Gyn you could just walk into any ER and they would do the routine pregnancy check (mother’s blood pressure, heartrate, temperature, baby’s heart rate, maybe an ultrasound if the situation seems to require it), however, keep in mind that usually the ER doctor is not an Ob/Gyn and rarely are there Ob/Gyn’s 24/7 in private hospitals, so it is highly recommended that you have an Ob/Gyn who could respond to your needs in case of emergency.
Unless you see yourself in the middle of a major emergency that requires immediate medical attention and your closest option is a public hospital, it would be best to go to a private hospital.
A few things to know:
Compared to hospitals in the USA or Europe, private hospitals in DR are usually small (20~40 bedrooms).
Depending on the hospital, you will labor in a bedroom or in a labor room, which may be a large room with several beds separated by curtains or it may be a small private room with a bed. In the bedroom you may be accompanied by more than one person but in the labor room they usually only allow one person to be with you.
In most hospitals when you are very close to giving birth you are moved to the “delivery room” (which usually is an Operating Room used for deliveries too). Only a handful of hospitals allow for a companion to be present.
In some hospitals the limit of companions does not affect the doula and she can be present without taking the place of your partner or relative.
There is one hospital in Santo Domingo that has the option to labor and give birth in one same room and then you are moved to a single-patient bedroom for recovery and postpartum. It is more expensive than the other hospitals, and doctors’ fees tend to be higher if they attend your birth there, but if you have the right doctor and you can afford this hospital, it is the best option in the whole country.
If a C-Section is necessary, you will be moved directly to the OR where they will get you ready for the procedure. In some hospitals the partner and/or doula may be allowed, this has to be verified with your Ob/Gyn.
Hospital stay after vaginal birth or C-Section is 1-2 days (usually 1) (depends if the doctor thinks the mother needs more observation due to complications that happened or suspects possible complications, and the mother's desire to stay longer or go home as soon as possible).
All private hospitals rooms are single-occupancy. There are standard rooms and suites, both usually have a small refrigerator. Standard rooms have a sofa-bed or a sofa where an adult could sleep on, and the suite has the same plus an additional small living room.
Take your time to find the right care provider for you, start working on that early, ideally before getting pregnant. It would quite possibly imply going to a few appointments to meet different doctors so you can CHOOSE the proper match for yourself in line with your preferences and your needs.
External professional support may be a good idea (a doula who knows how things works and can provide real and practical information, and even better if she knows her way around the system and is well connected with doctors and hospitals). There are doulas in Santo Domingo, Santiago, Cabarete and Bonao, some are willing to travel to other towns.
Childbirth classes can be very helpful.
Don't forget about the postpartum period, this is where you are likely to need more support
Start saving $$$, it is a fact that more money gives you more options
And finally, if you would like further information or support, contact me at INFO@LEIKOHIDAKA.COM or on WhatsApp at +1 829 660 7080 to schedule a guidance session where we can discuss what is it that you want, the options available in DR (details about specific doctors and hospitals, laboratories, ultrasound clinics, special studies/tests clinics, etc.) plus some extra advice for your specific needs that could come in handy for you to have a smooth and positive experience on the path to your baby's birth!