Pregnant during pandemic: COVID-19 fears fuel increased interest in home births

When Tameka Issartel went into labor shortly after midnight on Feb. 3, she found herself drifting into a trance-like state. She didn’t remember when her husband called their midwife or how she arrived with her assistant at her El Sereno home.

“I had an out-of-body experience,” she said.

As her pain intensified, Issartel spent several hours moving around her house, stepping into a shower, sitting in a bathtub and leaning up against the sofa in her living room, while midwife Racha Tahani Lawler massaged her back and encouraged her through labor. But the baby was still not coming out.

The pain grew so intense, Issartel said, she roared like a tiger.

That’s when the midwife told her husband to call 911.

Issartel kept pushing, changing her birthing positions several times with the assistance of midwives and her husband, who was also trying to take care of the couple’s three daughters patiently waiting nearby to meet the baby.

When Issartel’s son finally arrived around 9 a.m., she noticed that he was not breathing. Her daughters surrounded the baby as Lawler kneeled next to him, pulled off her N-95 mask and performed CPR, as Issartel stared in shock.

“Breathe, baby, breathe,” one of the girls said. “Come on, Tenshin.”


Midwife Racha Tahani Lawler describes Tameka Issartel’s difficult labor where she had to perform CPR on the baby all the way to the hospital after he had trouble taking his first breath during a coronavirus surge. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

FOURTH IN A SERIES: Pregnant during the Pandemic

Previous stories:

Programs, midwives step up to support Black mothers

Black midwives in demand; are there enough to handle influx of clients?

Birth centers grow in popularity, but owners say it’s difficult to qualify for state license

Rising interest in home births 

Home births have been on the rise across the Los Angeles region for the last couple of years, in part because of the prolonged COVID-19 pandemic.

More women have been opting for home birth as hospitals postponed or moved most of their health care online due to the pandemic, barring partners, canceling antenatal classes and often leaving women to deliver and recover alone. And many women chose home delivery because they were worried about being exposed to the virus at hospitals.

Another factor contributing to the rise of home birth, experts say, is the growing awareness of health disparities in maternal and infant mortality faced by Black women, who bear a greater risk of childbirth complications than any other demographic group, according to the Centers for Disease Control and Prevention.

It’s estimated that about 700 women die each year in the United States from pregnancy-related complications, including infections, severe bleeding and high blood pressure. Black, American Indian and Alaska Native women have been disproportionately affected by pregnancy- and birth-related complications, with the CDC reporting they are two to three times more likely to die from pregnancy-related causes than other demographic groups.

Interviews with more than two dozen midwives indicate they have attended double or triple the number of home births since the first days of the pandemic, with many of them unable to meet the demand and even turning clients away.

Lawler said she has been receiving dozens of inquiries each day from families inquiring about home birth. On some days, she visits her clients not to provide any prenatal or postpartum care, but just to hold their babies and listen.

“So many Black people are struggling with feeling whole because of everything that is going on,” she said. “They are piecing themselves together, worrying about the pandemic, worrying about their family, worrying about their housing, worrying about their food and struggling to hold it together.”

Nurse midwife Shadman Habibi, who works at UCLA Health Birth Place in Santa Monica, said at least 25 women of 150 patients who were planning their deliveries there changed their birthing plans in the past few months.

“They stopped coming to us and decided to have a home birth,” Habibi said.

The number of home births in Los Angeles County increased by 5.3% to a total of 631 from 2018 to 2020. During the same period, the numbers in San Bernardino County increased by nearly 25% to 186, according to preliminary data from the California Department of Public Health.

In Riverside County, that number rose by 121% to 310 from 2015 to 2020, according to the Riverside University Health System-Public Health.

In Orange County, the numbers have remained about the same from 2018 to 2020, according to the California Department of Public Health.

Licensed midwife Angelica Miller, who is based in Long Beach, said she has seen an uptick of inquiries about home birth since last year.

“A lot of moms choose home birth outside the pandemic because they can be active participants of their care,” she said. “With the pandemic, it’s a fear of COVID.”

Many of her clients, Miller added, choose a home delivery because they want to have control over their birth experience and make sure their needs are met.

One of her recent clients, MyLin Stokes Kennedy, decided to have an out-of-hospital birth after witnessing her wife, Lindsay, being pregnant with their son Lennox about two years ago. She watched in shock as an obstetrician failed to check on her wife while she was in pain.

Stokes Kennedy made up her mind to deliver her baby at home once she became pregnant with the couple’s third child.

  • Midwife Angelica Miller does a prenatal visit with MyLin Stokes Kennedy and her wife Lindsay at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Angelica Miller listens to the heart beat of MyLin Stokes Kennedy’s baby with her wife Lindsay and their child Lennox, 21 months, at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Angelica Miller does a prenatal visit with MyLin Stokes Kennedy and her wife Lindsay who plays with their son Lennox, 21 months, at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Lennox Stokes Kennedy, 21 months, plays with bubbles as his mom Lindsay watches during a midwife visit for his other mom at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

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“I’m just more aware of what’s happening to women like me in the hospital,” said the 34-year old resident of Fountain Valley, who is Black. “I didn’t want to be part of those statistics.”

Stokes Kennedy said she was drawn to home birth and midwifery care because of its focus on avoiding unnecessary interventions. The idea of receiving guidance and support from a midwife made her feel seen and heard. The pandemic was the final straw, she added, convincing her to opt for out-of-hospital delivery.


Lindsay Stokes Kennedy wrote her wife MyLin’s birth affirmations on a mirror where Mylin’s paintings are reflected as seen on Thursday, September 16, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“With the pandemic, I wouldn’t want to be in the hospital,” she said.

It took her more than two months to find Miller, a Black midwife who attended home births in Orange County.

She envisioned delivering her baby in a birthing tub surrounded by candles, lavender scents and family members.

“I wanted a holistic, beautiful, spiritual journey and it has been like that so far,” Stokes Kennedy said. Miller, she added, encouraged her to ask questions during appointments that sometimes stretched to more than an hour — a type of care she believed she wouldn’t get with obstetricians.


MyLin Stokes Kennedy has her wife Lindsay feel their baby move at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

But once she went into labor in the late hours on Sept. 3, all her birthing plans went out of the window.

As her labor progressed quickly, her contractions became longer and more intense. She labored in the bathroom for a while before her water bag dropped. About 30 minutes later, with the midwife still on the way, Stokes Kennedy noticed the baby’s head popping out.

“I said: ‘My baby is coming,’ ” she said.

When Lindsay heard her wife’s voice, she ran over from the dining room, where she was filling the birthing tub with water, and encouraged her wife to breathe and keep pushing. Stokes Kennedy’s doula, mother, and 13-year-old son stood by her side.

She pushed and pushed. Then she rested for a minute and pushed again.

Maddox Levi was born before midnight on Sept. 3. He weighed 9 pounds, 3 ounces and was 23 inches long. Right after he was born, the family FaceTimed the midwife and stayed on the call until she arrived about 15 minutes later.

Stokes Kennedy said although her mother was nervous witnessing home birth without professional help, no one considered calling 911.

“I was safe at home,” she said. “It was never a terrible pain. … Once his head was out, he was fine. There was never any worry.”

Although Stokes Kennedy didn’t have a chance to experience a water birth or light $200 worth of candles, she said she would do a home birth again. “My wife caught the baby,” she said. “It was very calm, intentional and beautiful.”


MyLin Stokes Kennedy rests at home on Thursday, September 16, 2021 with her son Lennox and Maddox, who her wife Lindsay delivered in their Fountain Valley home days ago. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Maddox Stokes Kennedy, 13 days, sleeps in his cradle on Thursday, September 16, 2021 next to his mom MyLin in his Fountain Valley home where he was born. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

As the pandemic continued battering hospitals, midwives say they occasionally received phone calls from women who couldn’t afford to pay for midwifery care but needed advice preparing for an unassisted birth, also known as free birth.

Some expectant mothers turned to Facebook groups, seeking advice on unassisted birth where women shared pictures of themselves laboring in inflatable pools surrounded by candlelight and family members. They also asked questions on how to talk to neighbors about potential screaming during labor, whether free birth is possible with previous C-sections and if there’s a need to call 911 if labor doesn’t progress after a certain period of time.

Although free birth is not illegal in California, there have been instances in other states in which women who delivered stillborn babies at home have been prosecuted.

Doctors maintain that hospitals remain the safest option for pregnant women even amid the pandemic.

Dr. Amos Grunebaum, an obstetrician and gynecologist and a professor at the Zucker School of Medicine in New York, said out-of-hospital birth puts mothers and babies at risk.

“Complications can happen quickly and unexpectedly, even with people who have low-risk pregnancies,” he said. “People who deliver at home put their babies at an increased risk.”

Grunebaum and a team of researchers examined records from 2016-2018 and discovered that nearly 60% of women who planned a home birth had risk factors that could potentially end up in complications and neonatal mortality, according to a study published in the American Journal of Obstetrics & Gynecology and covered by Reuters.

“These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births,” according to the study.

Grunebaum was among a group of researchers who analyzed National Center for Health Statistics data on 88,000 planned home births across the county and discovered that nearly 4% of births followed prior C-section, about 23% of the mothers were 35 or older, and nearly 5% were 40 or older.

He also found that expectant mothers chose home birth despite risk factors like older age, prior cesarean delivery or obesity — factors which whole disqualified them from home birth in other developed countries.

“You have only one or two babies in your life,” he said. “Why would you risk it?


Obstetrics Service Chief Dr. Mya Zapata says the birth center at Ronald Reagan UCLA Medical Center in Westwood supports all births from hypnotic to high-risk births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Dr. Mya Zapata, an obstetrician and gynecologist and the chief of the obstetrics service at Ronald Reagan Medical Center at UCLA, said she would recommend having a baby in the hospital.

“Most patients who get COVID, get it in the community from people they interact with,” she said. “The risk is much higher of getting COVID going to other locations and gatherings. In the hospital, at least the health care workers are vaccinated and everyone is wearing a mask.”ase

No regrets

As the Issartel family was waiting for paramedics to arrive, Lawler continued performing CPR for at least 12 minutes.

During labor, Issartel learned that the baby was large and his shoulder was stuck inside her pelvis, a birth complication known as shoulder dystocia.

When paramedics arrived, they put Lawler on the gurney with the baby as she continued performing CPR.

“I was terrified that I was going break his ribs,” she said.

Issartel, 34, was transported to the hospital in a separate ambulance.

At the hospital, the boy received a cooling treatment, also known as therapeutic hypothermia, used to treat babies who were deprived of oxygen during birth. The treatment lowers the baby’s body temperature to prevent his or her health from deteriorating, by stopping the death of oxygen-deprived cells.

Because of pandemic-related restrictions, Issartel was not allowed to see her son until later in the afternoon. She was allowed to hold him for the first time only after three anxious days.

When doctors returned the boy’s temperature back to normal three days later, Issartel placed him on her chest, watching him latch onto her breast right away, with breathing tubes and oxygen still attached to his body. His MRI images showed no signs of trauma or injury.


Tameka Issartel poses with her husband Yukio Hoshi and their children Kalea, 10, Tenshin, 7 months, Nalani, 5, and Luana, 7, in their El Sereno living room on Thursday, September 9, 2021 where she birthed Tenshin. Midwife Racha Tahani Lawler pulled off her N95 and performed CPR all the way to the hospital after Tenshin struggled to take his first breath. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“I was very blessed that we didn’t have any issues with nursing,” she said.

Before Tenshin was born, Issartel said she was debating whether to have a home birth. She even considered unassisted birth, but eventually decided to hire a midwife.

“I didn’t want to go to the hospital in the middle of the pandemic,” Issartel said.

Home birth allowed her and her son to avoid lengthy and painful recovery, which Issartel said took more than two months after her previous pregnancy.

“I do believe this is really meant to be,” she said. “If I was in the hospital, the healing journey for him and I would be worse. I have no regrets.”


Tameka Issartel and her daughter, Nalani, 5, laugh with Tenshin, 7 months, in their El Sereno living room on Thursday, September 9, 2021 where Issartel birthed Tenshin. Midwife Racha Tahani Lawler pulled off her N95 and performed CPR all the way to the hospital after Tenshin struggled to take his first breath. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Olga Grigoryants’ reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.

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Birth centers grow in popularity, but owners say it’s difficult to qualify for state license

When Racha Tahani Lawler opened the Community Birth Center in South Los Angeles 10 years ago, she wanted her clients to see that she was there to stay.


Midwife Racha Tahani Lawler sits in the space in her garden on Tuesday, July 6, 2021 where she meets with women. She once owned a community birth center but without insurance covering midwifery found it to be difficult to sustain and now does home births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Lawler, then a single mother of three children, transformed an old building she found on Craigslist into a welcoming space with two birth rooms, a kitchen and garden. Her 80-year-old grandmother, who lived a few blocks away, could walk to the center to support women in labor.

Lawler offered generous discounts to families who couldn’t afford to pay thousands of dollars out of pocket for an out-of-hospital birth. Some clients, she said, “were putting all their little pennies together to have a birth” at her center.

Many of Lawler’s clients were eligible for MediCal coverage, but since her center was unlicensed, the state would not reimburse her services. Lawyer tried for months to obtain a license for the center, but eventually gave up because she couldn’t afford the $5,000 cost.


A building on W. Florence Avenue was midwife Racha Tahani Lawler’s first birth center down the street from her grandmother’s home. Her grandmother, a nurse, also assisted women at the center. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“I was using my food stamps to provide snacks in the birth center and growing a garden to make sure my clients were eating,” she said.

Running the center without insurance reimbursements proved to be unsustainable and burdensome. Stressed and burned out, Lawler closed the birth center in 2016.

THIRD IN A SERIES: Pregnant during the Pandemic

Previous stories:

Programs, midwives step up to support Black mothers

Black midwives in demand; are there enough to handle influx of clients?

Licenses difficult to obtain

As a licensed midwife, it is not is not against the law to operate an unlicensed birth center. But to bill MediCal for its services, midwives are required to license their facilities. Experts, however, say stringent state laws are hurting birth center operators and the low-income families they serve.

“There are a lot of regulations and licensing for birth centers, which make it very difficult to become licensed,” said Kathleen Belzer, president of the California Nurse-Midwives Foundation.

The process is so convoluted, Belzer added, that it might take up to three years for some midwives to license their facilities. One example of the bureaucratic nightmare they face involves the Comprehensive Prenatal Service Providers program, or CPSP, designed to increase services available to women and boost reimbursement available to birth centers. To get a license, birth centers are required to be part of the program. But to become a CPSP provider, birth centers have to have a license.

A spokesperson for the California Department of Public Health wrote in an email that “alternative birthing centers must meet a set of requirements in order to receive a license. These requirements are designed per state legislation to ensure every mother and child receive safe, high-quality care while in the facility.”

Why birth centers?

Women opt for giving birth at birth centers because they offer a home-like setting where patients are allowed to move around during labor and bring family members and children. Giving birth at the birth centers typically saves up to $2,000 per family, although the amount depends on insurance coverage.

While operating independently, birth centers that meet the standards of the American Association of Birth Centers, or AABC, are integrated within the health care system so they can transfer clients to a hospital in case of emergency. Midwives who have hospital privileges can continue caring for their clients in such instances.

Nationwide, about 0.3% of births take place in birth centers, according to AABC. Only healthy and low-risk women are eligible for delivery at birth centers.

A 2013 study of about 22,400 women who planned to give birth in a birth center accredited by the Commission for the Accreditation of Birth Centers found that 94% of women who entered labor achieved a vaginal birth and only 6% were transferred to a hospital for a C-section.

In contrast, about 26% of healthy, low-risk pregnancies in hospitals end up with C-sections, according to a 2017 Consumer Report study.

Another study conducted by the Centers for Medicare and Medicaid Services from 2013 to 2017 discovered that birth centers, coupled with a midwifery model of care, resulted in lower rates of preterm birth, lower rates of low birth weight and lower rates of C-sections.

Neither the California Department of Public Health nor the Medical Board of California tracks the number of birth centers in Southern California. The Los Angeles County Department of Public Health also doesn’t collect that data.

Exasperation at state regulations

Across the state, midwives say they have grown weary of the roadblocks they face in California to license their birth centers.

When Bethany Sasaki opened her Midtown Nurse Midwives birth center in Sacramento, she tried to do everything by the book. She received national accreditation, but her California licensing application was still rejected by the state because the building that housed her center was too old.

“There are systems in place in California that make it almost impossible to have a birth center,” Sasaki said. “It’s like a never-ending cycle.”

The California Department of Public Health, which handles the licensure process, recently changed the building code criteria for birth centers, she added, requiring the same rigid standards for them as hospitals.

“No one is going to get a license until we change it,” she said. “It’s just a nightmare.”

When Sasaki was launching the California chapter of AABC, she reached out to birth centers to join the organization and discovered that out of 45 centers across the state, only nine had a license.

Sasaki, who is now president of the California chapter, said the difficult licensing process is hurting MediCal recipients.

“We have a big problem in the state of California with birth center licenses,” she said. “We need to be able to license birth centers so they can be medical providers, so they can serve underserved communities.”

Accreditation ensures safety

Still, the American College of Obstetricians and Gynecologists said accredited birth centers and hospitals are the safest places to give birth.


Obstetrics Service Chief Dr. Mya Zapata says the birth center at Ronald Reagan UCLA Medical Center in Westwood supports all births from hypnotic to high-risk births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Dr. Mya Zapata, an obstetrician and gynecologist and the chief of the obstetrics service at Ronald Reagan Medical Center at UCLA, said she wouldn’t recommend attending an unlicensed birth center.

“Licenses mean oversight,” she said, “And that the individuals that are running that center are going to follow standards to keep that family safe. … And in the event of an emergency, they have the means to get that patient to a higher level of care in an expedited manner.”

She recommended asking birth center owners how they handle emergencies.

“In the case that there was something unexpected, an emergency such as bleeding or something happening with the baby,” she said, “how would you handle it? What are your tools and what is your plan when you need assistance to help with a complex situation?”

‘Sacrificing everything’

Lawler felt proud that she was able to open a birth center that predominantly served Black women, who are about four times more likely to die during pregnancy or childbirth than White women.

As she talks about the center closure, Lawler tries not to be bitter.

“The whole entire time it was open, it was there to serve the community,” she said. “It was to fill in where there wasn’t a place for so many people that were wanting out-of-hospital birth. It made out-of-hospital birth accessible for a lot of people, but I literally was sacrificing everything in order for it to exist.”


A painted yard sign sits outside a building on La Cienega Boulevard in Los Angeles which was once Midwife Racha Tahani Lawler’s dream, a birth center for the black community. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Belzer, of the California Nurse-Midwives Foundation, said she was putting together a group of midwives to push for easing the licensing process for birth centers.

The hurdles to obtain a license impact not just low-income women who want to give birth, she said, but also midwives who are willing to help them. Belzer’s foundation also advocates for sustainable MediCal reimbursement rates for birth centers.

“They lose money or break even on most MediCal patients so they do it because they know it’s the right thing to do,” she said. “But it often will put birth centers in jeopardy and often birth centers were closing because of that.

“We need to create quality within the birth center community without creating barriers that are unattainable. Traditionally, people think they are creating safety for people by making it impossible to even open your doors or stay open. These things have to change.”

Olga Grigoryants’ reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.   

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Pregnant during pandemic: Programs, midwives step up to support Black mothers

| FIRST IN A SERIES: Pregnant during Pandemic | Coming Monday: Black midwives have been in high demand during pandemic. But is it enough of them to handle influx of clients? |

Aysha-Samon Stokes’ Mother’s Day went just as planned.

She arrived at Kindred Space LA birth center around 10 p.m. on May 9, stepped into a bathtub and shortly before midnight pushed her newborn son, Nikko, into the arms of her boyfriend, Dennis Richmond.

Minutes later, she climbed into a bed, wrapped her arms around the baby and breastfed him as “Heartbreak Anniversary” by Giveon played in the background and Richmond massaged her feet.

She felt relieved and happy, surrounded by her niece, boyfriend, sister and two midwives, who carefully guided her through labor. There was something else giving her peace of mind: Her childbirth bill was covered by the Victoria Project, a nonprofit that helps women in Los Angeles County pay their childbirth-related expenses.

Stokes found out about the Victoria Project during her last trimester from midwives Allegra Hill and Kimberly Durdin, who run Kindred Space LA.


Pregnant with her third child Aysha-Samon Stokes, 26, plays with her children Nyla Richmond, 6, and Wyatt Richmond, 17 months, at a Culver City park close to her daughter’s school on Thursday, April 8, 2021. Looking for a better birthing experience Stokes found a midwife to deliver her baby. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

It was not a single event that made her consider home birth, she said, but rather a series of memories from her previous two pregnancies: An obstetrician-gynecologist who couldn’t remember her name, a nurse who ignored her plea for an epidural when her pain became intolerable and a C-section with her first pregnancy that she felt was unnecessary.

Something else was at stake once she began learning about the high mortality rate among women like herself.

“A lot of Black women die in the hospital and that does concern me,” said Stokes, 26.

The coronavirus has wreaked havoc on many women’s birth plans, forcing them to adjust to quickly changing hospital policies, and in some cases labor in isolation and even opt for home birth. The pandemic has been especially hard on mothers like Stokes, who even before the pandemic had been part of terrifying statistics that show Black women in the U.S. have more than a three times higher risk of dying during pregnancy and childbirth than White women.

Black mothers and infants have been disproportionately affected by pregnancy- and birth-related complications. Nearly 700 women die each year in the U.S. as a result of pregnancy-related complications.

In Southern California…

  • In Los Angeles County, mortality rates among Black mothers from perinatal complications are four times higher compared to White women. Black infants are three times more likely to die before reaching their first birthday.
  • In Riverside County, Black newborns are three times more likely to die than their white counterparts.
  • Officials in Orange County reported in 2020 the death of one Black infant out of 392 African American births. So far in 2021, no infant or maternal deaths have been reported among Black infants or mothers, according to the Orange County Care Agency’s preliminary report.
  • San Bernardino County, meanwhile, reported 11.3 deaths for every 1,000 Black infants born, the 2011-15 data show.

In 2018, the Los Angeles County Department of Public Health pledged to work on reversing the trend and reducing the county’s gap in Black and White infant mortality rates by 30% by 2023.

Dr. Deborah Allen, deputy director of the Los Angeles County Department of Public Health, said “midwives are a very important voice but they are a very small group of people. They’re all wonderful, but they have to be part of something bigger. It has to go way beyond that. It has to include medical professionals.”

There needs to be a movement, Allen said, that would involve systematic changes on the part of hospitals, medical professionals, and federal and state government agencies to make sure Black women feel safe to deliver their babies, whether at home or at hospitals.

“When we really want to have equality in birth outcomes, we need more than equal health care — we need equal lives,” she said.

  • Dennis bathes Wyatt and Nyla on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha, who played basketball in high school, plays ball with her kids at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Wyatt watches his mom make healthy snacks at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha keeps her eye on Wyatt as she makes healthy snacks at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha makes Wyatt a carrot snack at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha helps Nyla with her homework while feeding Wyatt and her lunch at home in downtown LA on Thursday, April 19, 2021. Nyla is in a dual language Spanish immersion program. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha plays with Wyatt at home in downtown LA on Thursday, April 19, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Wyatt and Nyla jump in their father’s arms as he comes to their downtown LA apartment to have dinner and bath them after work on Thursday, April 28, 2021. Dennis Richmond is Aysha’s fiancé. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis bathes Wyatt and Nyla on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis and his children Nyla and Wyatt have dinner while Aysha takes time for herself in her room on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha plays with Wyatt at home in downtown LA on Thursday, April 19, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

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Many of the county’s programs, Allen added, focus on addressing the consequences of intergenerational racism on the health of Black women.

The Los Angeles County African American Infant and Maternal Mortality Initiative, launched by the Los Angeles Department of Public Health and First 5 LA along with community partners, is offering no-cost doula care to Black pregnant people in Antelope Valley, San Fernando Valley, San Gabriel Valley and South L.A.

Doulas work with pregnant and birthing mothers before, during and after the delivery to provide emotional and physical support and guidance. Studies show that doula care proved to be effective with reductions in the use of C-sections and medications during labor along with promotion of breastfeeding.

“Having a well-informed, articulate, supportive person by your side, who knows the health care system and can be a buffer and a bridge when you’re dealing with medical providers and so on,” Allen said, “can really make the experience much more positive, much less stressful and, therefore, healthier for Black women.”


Aysha craves ice which she learned from her midwife was a sign of anemia. Her doula gave her a plant based iron supplement for her iron deficiency since she was not tolerating prescription iron from her obstetrician. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

The program, which just finished its first year of operations, has served 363 clients while supporting 199 births, and health officials say it can potentially become one of many aimed at reversing trends in high mortality rates among Black mothers.

“It’s time for Black women to stop feeling guilty when they have an adverse outcome and recognize it as a social phenomenon rather than a personal failing,” Allen said.

When the pandemic hit, Victoria Project co-founder Janelle Green couldn’t stop thinking about women who were afraid to go to the hospital to give birth and lacked the means to hire a midwife or doula to deliver their babies at home. As a trained midwife, she also knew that out-of-pocket expenses could easily become a financial burden for many families because insurance reimburses only a fraction of the costs.

She wanted to help women to have other options, she said.

Green reached out to a friend, Deja Rabb, and together they launched the nonprofit to finance midwifery and doula care, breastfeeding support, childbirth education services for pregnant women. The Victoria Project was born in September 2020.

“We named it after a victorious pregnancy that I hoped to one day have,” she said.

Green and Rabb connected with doulas and midwives in Los Angeles, offering assistance to their clients.

Currently, the nonprofit enrolls about 200 people and is close to its capacity, Green said. But as more families are hearing about the program, Green added, the goal is to start sponsoring more people, including those from Santa Barbara, where Green and Rabb now live.

Clients mostly learn about the nonprofit through word of mouth. Its funding comes from private donations and fundraising and is open to anyone who considers giving birth at home or a birth center, regardless of their income. The program, though, prioritizes requests from marginalized communities.

“We are trusting that they will put forward what they can and then they’ll ask for what it is that they need support with, so sometimes it’s a hundred percent and sometimes it’s the remaining balance,” Green said.

The Victoria Project covers birth center midwifery care, doula care, acupuncture, home birth and chiropractic care, lactation support, and doula care for pregnancy loss and miscarriage. In some circumstances, the nonprofit may cover therapy, especially in the postpartum period.

Some families reach out seeking not just emotional and physical support but food assistance and medication, Green said. And those types of requests are something the nonprofit will try to fulfill in the future.

“I imagine as we grow it might be one of the things we hope to do is connect with other organizations who are providing some support in other areas so that we have a good referral system in place,” she said.

During her third trimester, the pandemic was still raging, forcing hospitals to alter their visitation protocols, and Stokes worried about whether her sister and boyfriend would be allowed to be by her side at the hospital and whether she would be allowed to move freely during labor.

“I had a C-section with my daughter, vaginal with my son and I feel like in order to have a successful labor, I need to be able to roam around and move around and I’m not going to be able to do that at the hospital so then what are my chances of having the successful” vaginal birth after cesarean? she said. “Probably slim to none.”

In the spring, Stokes made up her mind to find a midwife who would help her deliver her baby at home.

“I told my partner if I can’t find what I want, to be prepared to deliver this baby at home with just me, him and our kids,” she said.

In April, as she was waiting for a response from The Victoria Project, Stokes, who has Medi-Cal, prepared to dig into her savings if her application wasn’t approved.

It was very important for her to find a Black midwife, she said, someone who would understand her and be “aware of the battles I face without me having to mention it.”

Beginning with her first visit to Kindred Space LA, Stokes noticed the difference between the care she received at obstetrician-gynecologist appointments during her first two pregnancies and what the midwives provided.


With her children Wyatt and Nyla in tow, Aysha has her first prenatal appointment with midwife Kimberly Durdin at Kindred Space LA, a birthing center Durdin opened during the pandemic with another midwife in South LA, on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Meetings with Durdin and Hill sometimes stretched to more than an hour as Stokes’ 18-months-old son and 7-year-old daughter played on a patio. Midwives offered homemade lentil soup and asked whether she felt weepy, took her vitamins and consumed enough water. After each appointment, she received a bag filled with fresh produce grown at the center’s garden.

When she started having pain in her lower back, the midwives offered her free-of-charge acupuncture. A woman who volunteered with the center stopped by her apartment to bring a warm homemade meal. When the midwives offered to deliver the baby at the center, she agreed.

Those appointments with the midwives met all of her expectations, Stokes said.

“They listen and they care and it is everything I wanted,” she said. “They got my name right and the hospital couldn’t even do it.”

  • Wyatt jumps up on his mother as midwife Kimberly Durdin begins to check Aysha’s baby at Kindred Space LA, a birthing center Durdin opened during the pandemic with another midwife in South LA, on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha has a prenatal appointment at Kindred Space LA in South LA on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Kimberly Durdin picks greens for Aysha and Nyla to take home after her prenatal visit at Kindred Space LA on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

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On the evening of Mother’s Day, Stokes began feeling her contractions grow intense. She asked her sisters to pick up her kids at her apartment and headed to the birth center in South L.A. When she arrived around 10 p.m., her pain grew so intense that she began crying.

“Each breath and each push brings you closer to the baby,” her sister, Lauri Powell, kept saying, taking turns with Richmond to massage Stokes’ back and shoulders.

When Nikko’s face finally emerged from the water as Stokes was sitting in a bathtub, she said could feel a wave of happiness and relief. “He was here and all my worries have gone out of the window,” she said.

  • Guided by her midwife Dennis catches the baby under water as Aysha delivers at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis massages Aysha as she labors at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. Aysha’s sister Lauri Powell, right, and her 13-year-old daughter Leena were also there for the birth. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis touches their son as Aysha rests in the birthing bath at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwifes Kimberly Durdin and Allegra Hill help Aysha out of the birthing bath at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. The two opened the center during the pandemic. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha’s sister Lauri Powell and her 13-year-old daughter, Aysha’s niece, and Dennis watch over Aysha after she delivered her son at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Kimberly Durdin gives Aysha a tincture after she delivered her son at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Student midwife Maryam Karim takes the heartbeat of Aysha’s baby during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where he was born on Mother’s Day night. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Allegra Hill checks Aysha during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where her son Nikko was born on Mother’s Day night. Student midwife Maryam Karim holds Nikko. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Nikko is weighed by midwife Allegra Hill as Aysha and her children Wyatt and Nyla join her for the postpartum visit at the South LA birthing center on Wednesday, May 26, 2021. Student midwife Maryam Karim is left. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha and Nyla watch midwife Allegra Hill and student midwife Maryam Karim take the heartbeat of two-week-old Nikko during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where he was born on Mother’s Day night. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

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Her entire $6,000 birth-related bill was covered by the Victoria Project.

Holly Smith, a health policy chair at California Nurse-Midwives Association, said it’s crucial to have a package of legislation that would contribute to systemic changes to support parents of color.

The so-called California Momnibus Act, authored by state Sen. Nancy Skinner, seeks to establish doula care for all pregnant and postpartum people enrolled in Medi-Cal. The bill, SB 65, will require medical investigations into maternal and child death, collecting data on socioeconomic factors that contribute to negative birth outcomes, expanding postpartum health care and offering options for doulas and midwives.

The bill would allow expecting mothers to have at least four appointments with a doula during the prenatal period and delivery, and at least eight appointments during the postpartum period. Doula care, which can cost from several hundred dollars to $2,000, also would also be available during miscarriage, stillbirth and abortion.

In addition, the bill would establish an advisory board to standardize competency requirements and certification for doulas.

The Legislature also would expand coverage for a postpartum period for people on Medi-Cal from two months to one year, invest in midwifery care and create a maternal mortality board, which would advise on how to close racial disparities in maternal health.

SB 65 has been passed by the state Senate and will head to the Assembly.

Earlier this year, Gov. Gavin Newsom said three pieces of the legislation will be part of his budget proposal, including Medi-Cal coverage for doulas, Medi-Cal postpartum coverage and a guaranteed minimum income pilot program for low-income families.

“Racial disparities are preventable and we can turn back the clock on that if we really want,” Smith said. “We have to have all hands on deck and we have to have multiple strategies.”


Aysha nurses three-month-old Nikko after he wakes from a nap at their home in downtown LA on Tuesday, August 10, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Olga Grigoryant’s reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.   

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