ON A COLD DECEMBER NIGHT in 2022, Autumn Walsh, a Gualala resident and expectant mother, and her husband decided to take Meyers Grade — a rural road in northern Sonoma County that leads to California state Highway 1, followed by state Highway 116, and eventually to more populous cities. In the ninth month of her pregnancy, Walsh was headed to the obstetrics unit at Providence Santa Rosa Memorial Hospital.
Long rural drives like this are not unusual for pregnant women in Mendocino County, where the nearest birthing clinic is often several hours away. Although the distance may seem like a simple inconvenience for some residents, it can delay critical medical care for those facing an emergency or needing to reach a medical center quickly — including, frequently, during childbirth.
After visiting Providence Santa Rosa, Walsh returned to Gualala and planned to spend the night at home. By the time she got back, she and her husband were exhausted from the nearly four-hour round trip and relieved to be home.
However, by the evening, Walsh was experiencing back pain, and it was increasing in intensity. She called her midwife for advice, and while on the phone, experienced her first contraction. That’s when she and her husband decided to take the lengthy trip back to Santa Rosa.
By the time they reached Meyers Grade, Walsh’s water broke. When they reached Duncans Mills, an unincorporated community on the way to Santa Rosa, Walsh reached past her pelvis and felt her daughter’s head. She realized she couldn’t wait any longer.
“I felt my daughter’s head, and I said to my husband, ‘you need to pull over, this is happening now,’” Walsh explained in an interview. “He got out of the truck and came around; I pushed one time, and she came right out.”
Just a few hours later, an EMT arrived to assist the family and escorted Walsh, her husband and her baby to the nearest hospital. Walsh’s baby, fortunately, was happy and healthy despite being born under unusually difficult circumstances.
Walsh’s experience is all too common for mothers in Mendocino County. For expectant parents inland and especially on the coast, birth plans and preparations often give way to the logistical challenges of traveling to a local birth center or hospital while pregnant. Over the years, expectant mothers have faced shrinking access to birth centers and other medical resources in the rural county, forcing them to make difficult compromises to have a safe and healthy pregnancy and birth.
The realities of rural pregnancies
In Fort Bragg, about an hour and a half from Gualala, Mendocino Coast Hospital was once a well-regarded birth center, where expectant parents could easily find support with delivering their babies.
However, in April of 2020, the Mendocino Coast District Hospital joined a partnership with Adventist Health, a Seventh-day Adventist nonprofit that originally began in Roseville, to become an Adventist Health Hospital. After this partnership was announced, it was also shared that the Fort Bragg hospital’s labor and delivery center would be closed, largely due to financial constraints.
In the state of California, at least 56 hospitals have shuttered their labor and delivery departments since 2012, mirroring the trends in rural counties like Mendocino.
For Walsh, living in the town of Gualala has meant facing the same challenges many women encounter when giving birth in the county. Although she hoped to deliver at a nearby medical center, there were no local resources that could provide the care she needed. Occasionally, Walsh has considered whether living in a rural town is worth the struggle of finding medical resources.
“We’ve had a lot of stressful things happen during both of their birth journeys,” Walsh said of her daughters. “Sometimes you wish you lived closer to the city, but then you take into account where you are, and you are just grateful that at least you can get there (the hospital).”
Financial struggles force closures
While Adventist Health in Fort Bragg offers some services for women, the 2020 closure of its labor and delivery department produced a wave of disappointment in the coastal community, with Ukiah and Santa Rosa now the nearest cities with labor and delivery departments.
Over the past decade, Mendocino County has also seen a decline in birth rates, following a nationwide trend. According to data from the California Department of Public Health, the county had 3,068 births from 2015 to 2017, which dropped to 2,650 births from 2021 to 2023. Although not a drastic decline, the decrease has affected the birth care resources available at local hospitals.
This is one of the reasons rural hospitals throughout California — including in Mendocino County — have closed their obstetric units. Falling birth rates, combined with low insurance reimbursement rates, has affected the financial stability of these rural hospitals.
Medi-Cal, which covers just under 40% of all births in California, has a low reimbursement rate for labor and delivery services. When rural hospitals — already operating on thin margins — lose money by keeping labor and delivery departments open, those departments are often among the first to be closed to save money.
A California Health Care Foundation report explains that while the percentage of reimbursement from Medi-Cal can vary depending on the type of birth, including vaginal births, C-sections, and others, Medi-Cal rarely covers the full cost of care. When reimbursement takes place, the rate is lower than that of private insurance, according to that same report.
Labor and delivery units also require a large number of staff to remain operational, including OB-GYNs, anesthesiologists and nurses specializing in birth care. When insurance does not cover the full cost of each birth, it becomes increasingly difficult for medical centers to justify maintaining such a large team.
Roadside deliveries, long-distance flights
The Mendocino Voice reached out to the Mendocino County community via Facebook to better understand the concerns of expectant parents, including both people on the coast and inland, and how losing an obstetrics department has affected them. More than 100 comments detailed the challenges people experience giving birth in the region — including stories of mothers delivering on the side of the highway, being flown to San Francisco during high-risk pregnancies, or having to detour away from their specific birth plans.
“I’m currently 8½ months pregnant and about to plan my C-section due to a lack of resources here on the coast,” commented Sierra Rea, a coastal resident. “I’m scared I won’t make it to the hospital because my daughter is already measuring large. It may be an emergency C-section, so planning it seems like the safer route due to our remote location in the mountains.”
While Mendocino Coast Clinics, a nonprofit medical center in Fort Bragg, offers some prenatal care, it does not have a labor and delivery department. Willits, about an hour east from Fort Bragg, is home to an Adventist Health hospital, but it also lacks a labor and delivery unit.
The Mendocino Community Health Clinic, with locations in Willits, Ukiah and Lakeport, offers a program called “Care for Her,” which provides prenatal care and other family services, but does not have a labor and delivery unit. The Ukiah location is called Hillside Health Center.
The only licensed labor and delivery unit in all of Mendocino County is Adventist Health Ukiah Valley, also located in Ukiah.
Carley Miller, a mother of two who lives in Fort Bragg, said she felt anxious about having to travel to Hillside Health Center for prenatal care and to Adventist Health Ukiah Valley to deliver her children. Although she received some prenatal care on the coast, she switched that care to Ukiah to coordinate between Hillside and Adventist Health since they were located near each other.
“Most of my friends feel the same way I do — the care we get here is great, and the staff is wonderful, but without labor and delivery on the coast, there’s only so much they can do. You have to transfer care, there’s no choice,” Miller noted in an interview. “Most people do transfer to Ukiah.”
Miller added that after Fort Bragg’s labor and delivery unit closed — and more mothers began traveling to Ukiah for both prenatal care and delivery — it became harder for her to get routine appointments at Hillside Health Center when she needed them.
“I can only imagine the number of pregnant women they’re seeing has probably quadrupled, especially since there’s no longer an option to give birth here, unless you do a home birth,” Miller explained. “I was kind of shocked when I called and they said, ‘We can’t get you in for a month, and we have to review your file first.’ You’re literally growing a human. You shouldn’t have to worry about getting in to see a doctor.”
Midwives fill gap in maternity care
One result of the county’s limited medical care is an increase in the use of midwives and other home birth resources, whether by choice or by necessity. Several mothers on the “Mendocino Locals” Facebook page have commented that hiring a local midwife — someone experienced and trusted in the community — is sometimes preferred to giving birth in a hospital.
In Ukiah, there is a midwifery center called Bloom that locals can choose if they prefer an alternative to hospitals. But Bloom’s midwifery services can cost thousands of dollars, and many insurance providers usually do not reimburse the entire expense. Despite the financial burden, some women choose Bloom for its intimate atmosphere and care, saying the experience is worth the investment.
“I wanted a hands-off birth and no checks or interventions,” commented Gowan Batist, a Mendocino County resident who used Bloom’s midwifery services. She said midwives give moms more latitude in choosing how they deliver. “I delivered upright, with my family around me.”
Dana Estevo, a clinical midwife at Hillside Health Center, said that while some mothers want more access to medical centers, others prefer working with a midwife to avoid the atmosphere of a hospital setting.
“I think the difference is that it just doesn’t have that hospital vibe, you know? The bells, the lights, the noise, other people, sick people — it’s a lot,” Estevo explained. “Even though that’s not all happening in your room, there’s still so much going on. The nurses are required to ask all these questions and fill out forms, do surveys — stuff like that.”
Estevo is a certified nurse-midwife, meaning both a registered nurse and certified in midwifery. She noted that the combination of modern medicine and traditional midwifery gives moms more options when they want a holistic approach.
Many expectant mothers go to Hillside Health Center for their prenatal care and to make a birth plan, then ask one of the certified nurse-midwives to help with the delivery at Adventist Health Ukiah Valley. This means that a midwife can be present for the mother in all stages of the pregnancy and birth.
But Estevo said that, due to limited access to prenatal and birthing resources in the county, it has been difficult for mothers to make appointments at the local clinics in a timely manner.
“We have relatively limited appointment availability. We provide prenatal care, but we also offer gynecology services. Right now, we have four OB/GYN doctors, and we’re hiring a fifth to serve as a backup,” she said. “Their schedules are packed with referrals for gynecological cancer and other concerns. As a result, it can take months to get an appointment with them, which can be frustrating for patients.”
Estevo also said that while midwives play a crucial role in the county’s pregnancy and birth resources, some mothers feel intense anxiety if there are not clinics or hospitals nearby in case of a serious emergency, whether they have hired a midwife or not.
“There’s the emotional impact of not having a hospital nearby. The amount of time I spend talking to people about their anxiety over these issues is often a bigger burden — for both them and me — than the number of bad things that actually happen,” she said.
“The fact that someone’s sitting at home, worrying about it for weeks, and bathing themselves and their baby in cortisol, that’s not good either.”
Some mothers, including Autumn Walsh, are hoping to expand pregnancy and birth resources on the coast to support others who have had to travel long distances for prenatal and delivery care.
“I was kind of shocked when I called and they said, ‘We can’t get you in for a month, and we have to review your file first.’ You’re literally growing a human. You shouldn’t have to worry about getting in to see a doctor.”
Carley Miller, Fort Bragg resident
“I’ve seriously considered becoming a doula or a midwife, just because being pregnant here is really stressful,” Walsh said. “Even just getting to an appointment is a two-hour drive one way — to a hospital or to see a midwife. Your whole pregnancy feels stressful. You can’t just go in and get checked if something feels off.”
She also said she’s considered becoming a postpartum therapist to support mothers dealing with the aftermath of stressful births.
“I’m in the middle of taking a course to become a postpartum therapist,” she added. “Women just kind of get forgotten after they have a baby, and they need so much love and care. It’s not something that’s talked about or recognized enough, and I think that’s the hardest part — what they call the fourth trimester.”
Fortunately, Walsh has two healthy daughters. She explained that while each mother may have a specific birth plan, living in a rural part of Mendocino County often means parents must roll with the punches.
“It’s never going to go exactly as you plan,” she added. “You can account for everything and there’s things that you can definitely stand by but you can’t go into it thinking this is how I’m going to have my baby. You don’t know how it’s going to go and what’s going to happen.”
This story originally appeared in The Mendocino Voice.
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