Between her two young toddlers, her work as a seaweed farmer on Humboldt County’s coast, and a third baby on the way, Leslie Booher doesn’t have a lot of spare time.
But her prenatal appointments with her midwife, Laura Doyle, give Booher the opportunity to really focus on the pregnancy.
“For me, feeling more informed and curious makes you feel much more empowered in your body,” she said.
Unlike the typical 10- to 15-minute OB check-up, Booher and Doyle spent a full hour together in early March, chatting on a comfortable sofa at Moonstone Midwives Birth Center in Eureka, California. The cozy room where they met has kids’ toys in one corner, calm pastel-colored paintings on the wall, and feels more like a friend’s living room than a clinic.
Doyle listened to the baby’s heartbeat, took Booher’s blood pressure, and reviewed her blood test results. The midwife also asked about Booher’s stress levels, whether she’s exercising, and if she’s getting enough time to herself.
“In prenatal care, what I am learning the most is who this person is,” Doyle said. “Yes, I look at blood work. Yes, I’m feeling babies and their growth. More importantly, I’m like: ‘Who are you? What are the relationships like in your life? Are you supported? Are you fearful?’”
She continued: “Every little story I get out of somebody is like telling me so much about how they are, and often, how their birth will be.”
Across California, and across the U.S., there are now fewer places in which to give birth. Hospitals — facing rising costs, staff shortages and falling birth rates — are closing 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 serious complications for moms and babies, including a higher risk of pre-term births, c-sections and infant deaths. In California, the maternal mortality rate 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.
“People are coming from a couple hours [away] to have their babies,” Doyle said. “We only have one hospital that is doing deliveries for hours in every direction. It’s super stressful.”
Abundant research has shown that midwifery care leads to better outcomes for many of these challenges. As medically-trained healthcare professionals, midwives offer a different kind of care that can help meet this need. They can place IVs, do sutures, and give antibiotics — but they don’t administer epidurals or perform c-sections.
“Doing unmedicated birth means we’re relying on preventative care, so good nutrition, really good sleep, low stress and getting these babies in an optimal position,” Doyle said. “Unfortunately, standard medical practice doesn’t have time for that.”
And they offer women longer prenatal appointments, safe birth outside a hospital setting, and regular postpartum check-ups —a crucial time, because most pregnancy-related deaths occur in the postpartum period.
But the vast majority of people can’t afford midwifery care. Midwives are not covered by most insurers, and incredibly low reimbursement rates mean that most midwives also can’t accept low-income clients on Medi-Cal. Holly Smith, a midwife and co-lead of Midwifery Access California, estimated that Medi-Cal reimburses around $3,000 per birth.
“Midwives across the state have told us that the minimum they need is $7,000-$8,000 per birth, in order to sustain their practice,” 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.
“I always say, we’re all working hard to be poor,” Doyle said. “The stress is real for most people in this community.”
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.
“It’s so frustrating to know that you can only have this if you can afford it,” said Doyle. “That is just wrong. Everybody should have access to good midwifery care. It’s really been the motivator of my career: people should be empowered in their birth experience no matter who they are.”
Moonstone is located opposite Humboldt’s 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.
“We’ve always been able to reach out to doctors and consult with them,” Doyle said, of the hospital staff. “We’ve built that rapport; they trust us and we trust them.”
Community midwives, meaning those who don’t work in a hospital, attend around 1% of births in California — but research has shown that more birthing people would like to have this kind of care.
Some women seek midwifery care because they’ve 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.
“They 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,” Henderson said. “But I was in full labor, so they stuck me in this little exam room we called a ‘closet,’ and that’s where I had my baby.”
Henderson said she felt unheard by the hospital staff, who kept offering her medicine she didn’t want. Even though her baby was born healthy, she felt overwhelmed — so when she got pregnant a second time, she knew she wanted a midwife instead.
“I believe in hospital births, but I knew I wanted a natural, physiological birth,” she said, “uninterrupted as much as possible, and to have everything calm down.”
At Moonstone, Henderson gave birth in a birth suite with the lights dimmed low. “I was very present in my body and brain. The midwives checked the baby here and there, but I wasn’t on continuous monitoring — they left us alone a lot of the time. I was laughing in between contractions. It felt so natural.”
Even so, Henderson said: “Birth is really hard. It was still one of the most intense pains of my life. But I didn’t need anything for [it]. I just needed to feel secure and safe – and that was my team and the environment.”
Doyle said she gave birth to her first baby at home in a very remote area, supported by midwives.
“The most impactful thing was their patience, and [the way they] really listened to me,” she said.
Doyle trained as a midwife herself and after many years of attending home births, she opened Moonstone with four other midwives in 2014. It’s still the county’s only birth center.
“I think we have a really unique culture in Humboldt,” she said. “I always call it the ‘707 culture.’ It’s like a different way of being, and a lot of it was driven by the outlaw culture of marijuana growing.”
Doyle believes that mindset has influenced birthing people’s approach to their healthcare.
“A lot of these women are like, ‘No, I’m not doing that. I’m declining this, I’m declining that,” she said. “‘I want to do it this way.’”
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 she’s delivered, but estimated she’s passed the 1,000 mark.
“You can tell that’s what’s happened when I’m going through the grocery store,” she said, laughing, “because I see everybody and it’s hard to get anywhere, which is the sweet thing about being in a small town.”
Clare Wiley is a Los Angeles based reporter covering women’s health.
This story was co-published and supported by the journalism nonprofit the Economic Hardship Reporting Project.
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