In one of many maternity deserts across the US, a midwife offers prenatal care
In one of many maternity deserts across the US, a midwife offers prenatal care
Between her two young toddlers, her work as a seaweed farmer on coast, and a third baby on the way, Leslie Booher doesnât have a lot of spare time.
But her prenatal appointments with her , give Booher the opportunity to really focus on the pregnancy.
âFor me, feeling more informed and curious makes you feel much more empowered in your body,â she told and the .
Unlike the 10- to 15-minute OB check-up, Booher and Doyle spent a full hour together in early March, chatting on a comfortable sofa at in Eureka, California. The cozy room where they met has kidsâ toys in one corner, calm pastel-colored paintings on the wall, and feels more like a friendâs living room than a clinic.
Doyle listened to the babyâs heartbeat, took Booherâs blood pressure, and reviewed her blood test results. The midwife also asked about Booherâs stress levels, whether sheâs exercising, and if sheâs getting enough time to herself.
âIn prenatal care, what I am learning the most is who this person is,â Doyle said. âYes, I look at blood work. Yes, Iâm feeling babies and their growth. More importantly, Iâm like: âWho are you? What are the relationships like in your life? Are you supported? Are you fearful?ââ
She continued: âEvery little story I get out of somebody is like telling me so much about how they are, and often, how their birth will be.â
Across California, and across the U.S., there are now fewer places in which to give birth. Hospitals â facing rising costs, staff shortages, and falling birth rates â are maternity wards.
Rural parts of the state are especially impacted: Many women in these regions must travel for hours in labor to give birth, which can cause for moms and babies, including a of preterm births, C-sections, and infant deaths. In California, the is higher in rural communities than in urban areas.
In Humboldt and other northwestern parts of the state, two hospitals have closed their labor and delivery units in the past five years, leaving the entire county with just one hospital in which to give birth, Providence St. Joseph in Eureka.
âPeople are coming from a couple hours [away] to have their babies,â Doyle said. âWe only have one hospital that is doing deliveries for hours in every direction. Itâs super stressful.â
Abundant research has shown that midwifery care is associated with in many cases. As medically trained healthcare professionals, midwives offer a different kind of care that can help fill some of these gaps in care. They can place IVs, do sutures, and give antibiotics â but they donât administer epidurals or perform C-sections.
âDoing unmedicated birth means weâre relying on preventative care, so good nutrition, really good sleep, low stress, and getting these babies in an optimal position,â Doyle said. âUnfortunately, standard medical practice doesnât have time for that.â
And they offer women longer prenatal appointments, birth care outside a hospital setting for appropriate patients, and regular postpartum check-ups â a crucial time, because occur in the postpartum period.
But the vast majority of people may not be able to afford midwifery care. Midwives are not covered by most insurers, and incredibly low reimbursement rates mean that most midwives also canât accept low-income clients on Medi-Cal. Holly Smith, a midwife and colead of , estimated that Medi-Cal reimburses around $3,000 per birth.
âMidwives across the state have told us that the minimum they need is $7,000-$8,000 per birth, in order to sustain their practice,â said Smith, adding that the actual cost is around $14,000-$15,000.
Doyle has found a way to serve low-income families in Humboldt, where the median household income is about 60% of the state median.
âI always say, weâre all working hard to be poor,â Doyle said. âThe stress is real for most people in this community.â
After a year of meetings, Doyle was able to negotiate a better deal with the local Medi-Cal payer in Humboldt, Partnership HealthPlan. This makes her birth center one of the very few in California able to accept low-income families. Around 75% of current Moonstone clients are on Medi-Cal.
âItâs so frustrating to know that you can only have this if you can afford it,â said Doyle. âThat is just wrong. Everybody should have access to good midwifery care. Itâs really been the motivator of my career: people should be empowered in their birth experience, no matter who they are.â
Moonstone is located opposite Humboldtâs last remaining labor and delivery ward, at Providence St. Joseph, so that if a birthing person wants an epidural, needs surgery, or the baby has to go to the NICU, the transfer is quick and easy.
âWeâve always been able to reach out to doctors and consult with them,â Doyle said of the hospital staff. âWeâve built that rapport; they trust us, and we trust them.â
Community midwives, meaning those who donât work in a hospital, attend around in California â but that more birthing people are interested in this kind of care.
Some women seek midwifery care because theyâve had a difficult experience in the hospital. Claire Henderson gave birth at Mad River Community Hospital nearby in Arcata, before it closed its maternity ward in 2024.
âThey had three birthing rooms, and at that time I think nine babies were being born, or were just born, so there was no room for me,â Henderson said. âBut I was in full labor, so they stuck me in this little exam room we called a âcloset,â and thatâs where I had my baby.â
Henderson said she felt unheard by the hospital staff, who kept offering her medicine she didnât want. Even though her baby was born healthy, she felt overwhelmed â so when she got pregnant a second time, she knew she wanted a midwife instead.
âI believe in hospital births, but I knew I wanted a natural, physiological birth,â she said, âuninterrupted as much as possible, and to have everything calm down.â
At Moonstone, Henderson gave birth in a birth suite with the lights dimmed low. âI was very present in my body and brain. The midwives checked the baby here and there, but I wasnât on continuous monitoring â they left us alone a lot of the time. I was laughing in between contractions. It felt so natural.â
Even so, Henderson said, âBirth is really hard. It was still one of the most intense pains of my life. But I didnât need anything for [it]. I just needed to feel secure and safe â and that was my team and the environment.â
Doyle said she gave birth to her first baby at home in a very remote area, supported by midwives.
âThe most impactful thing was their patience, and [the way they] really listened to me,â she said.
Doyle trained as a midwife herself, and after many years of attending home births, she opened Moonstone with co-owner Calista Young in 2014. Itâs still the countyâs only birth center.
âI think we have a really unique culture in Humboldt,â she said. âI always call it the â707 culture.â Itâs like a different way of being, and a lot of it was driven by the outlaw culture of marijuana growing.â
Doyle believes that mindset has influenced birthing peopleâs approach to their healthcare.
âA lot of these women are like, âNo, Iâm not doing that. Iâm declining this, Iâm declining that,â she said. ââI want to do it this way.ââ
On a typical day at the birth center, pregnant women will come in for their check-ups or group prenatal classes, while new moms can join postpartum support groups. Moonstone has two birth suites which resemble hotel rooms: comfy queen beds and large tubs for water birth.
Occasionally, a mom will drop by with her newborn and a box of cookies or muffins for the midwives, as a little token of thanks. Doyle has lost count of how many babies sheâs delivered, but estimated sheâs passed the 1,000 mark.
âYou can tell thatâs whatâs happened when Iâm going through the grocery store,â she said, laughing, âbecause I see everybody and itâs hard to get anywhere, which is the sweet thing about being in a small town.â
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