Creating A Birth Plan When The Nearest Hospital Is 2 Hours Away
Written by Kailyn McCord, Alta Journal
Photography by Anfisa & Friends
How does one plan for birth when the nearest hospital is over 2 hours away? Originally published on Alta Journal, Kailyn McCord, a Fort Bragg-based writer, recounts her experience of creating a birth plan for her first child while living in a trailer in a remote section of the rugged California coast. Read her story, below.
On a cold February evening, sitting on the couch in our 28-foot travel trailer, my husband, Benjamin, and I read aloud to each other about how to deliver a placenta. A human placenta, generally speaking; specifically, my placenta.
“So it sort of seems like you just…let it come,” he says, looking up from Penny Simkin’s The Birth Partner.
I am 12 weeks pregnant, and I’m the sort of person who finds information comforting, particularly when it comes to difficult decisions. That night, Ben and I are learning about what might happen if we don’t make it to a birth center for delivery. For most parents-to-be, this is a worst-case scenario, so much so that they wouldn’t bother considering it. But in Fort Bragg, the town in Mendocino County where we live, there is no labor and delivery at the small, rural ER, and in the past few years, at least two local women I know have had their babies on the remote mountain highway that connects us to the nearest hospital. A dozen or so others, I’ve been told, have come close.
When I go into labor, Ben and I will travel that same remote highway—Highway 20, most often referred to simply as “20”—all the way to Ukiah. If the weather is good and there’s no traffic or roadwork, the drive will take about two hours, redwoods rushing by the windows, the sweeping, familiar vistas of Jackson Demonstration State Forest whipping past. We will not have cell service, or any other way to communicate an emergency, aside from a dozen or so bright yellow call boxes stationed roadside every two or three miles.
I set The Birth Partner next to our bed. Our floor is bare particleboard and our walls are plywood, results of a functional if unfinished repair job from a leak we had last winter, when we spent a freezing week building a second roof—the pergola, I call it—over the entirety of our trailer. We slept in Ben’s woodshop. We cooked bacon nightly on the woodstove, ate standing next to it, plates on the drill press. We read aloud, as was our custom, on a mattress on his workbench.
Rage at the leak aside, we like this sort of living. It was part of why we moved here from Oakland, where we’d both grown up. We had a lot of reasons for leaving—the extreme cost of living, the prospect of being forever-renters, traffic, a general dislike of urban life—but we had a lot of reasons for choosing Fort Bragg specifically, too. We wanted to stay close to our families in the Bay. We loved the ocean. Ben was drawn to the local woodworking community, and I got a job adjuncting at our area’s Mendocino College satellite campus. But more important, we liked the lifestyle here, something slower, more connected to community, more invested in relationships among people. In the woods, we’ve found that the choices we make are our own. In this, there is freedom as well as agency. It comes out in all sorts of ways, not the least of which is meeting the challenges the land presents and doing what is required—actually required—of us.
Now, I put on the kettle, and Ben and I sit down to review what we know. If the baby comes while we’re driving on 20, I will know. I’ll tell Ben it’s happening. He’ll pull over, put on the brake, and get into a position to catch the baby, preferably with a towel or piece of clothing ready, since, as Simkin tells us, newborns are slippery. As the baby emerges, Ben, whose medical training I should note consists of earning a Boy Scout first aid badge, will support my perineum and the baby’s head; if we need to, we’ll wait for another contraction between the baby’s head and the shoulders. Once the baby is born, Ben will set them on my naked chest and check to make sure their nose and mouth aren’t obstructed by remnants of the amniotic sac, called a veil. He’ll cover the baby and me in something warm, and if the baby has not vocalized, and especially if their color is dark or bluish, he will rub their back vigorously, to stimulate the instinct to breathe.
“You OK?” I ask him. What I am actually asking: Are you scared?
“Yeah,” he says. “You?”
When people hear I’m nearly two hours away from my prenatal care, they’re shocked. It’s worth noting that most of these people live in cities, where care providers are minutes away and where the expectation of immediate medical assistance is all but a given. It’s worth noting also that, when I moved here, I was one of those people.
Ben and I knew that in Fort Bragg, medical care would be more limited, but once I started to dig into prenatal and delivery options, I was surprised at the lack. How could a town that boasted nearly 7,000 people, or that number once or twice over again if you included “nearby points beyond,” as our local radio station’s slogan did, not have an obstetrician? Or a labor and delivery (L&D) department? We had an ER and some basic services (geriatric care, hospice, some surgery); what happened to maternity care? I was anxious for answers, as if the answers would somehow force such care to appear. So, I looked.
Founded in 1971, the Mendocino Coast District Hospital was one of several hallmarks of a boom time on the coast. Back-to-the-land hippies flocked to Mendocino, commercial fishers docked their boats three deep in Noyo Harbor, and Georgia-Pacific purchased Fort Bragg’s mill. Employing over 2,000 locals in well-paying, benefits-rich jobs, the mill drove growth and attracted young families. The benefits were no small part of the draw; the millworkers used their private insurance (and its high reimbursement rates) at the newly minted MCDH.
By the early 1980s, Fort Bragg was well established in logging and fishing, and women in town were having more than 200 babies a year. “Young people came with industries,” says Davey Beak, the emergency transport manager at Fort Bragg’s ER and a lifelong coastal resident. “Families came with industries.”
MCDH offered a full L&D department, complete with OB nurses, obstetricians, and—a rarity in U.S. maternity care at the time—a cadre of in-hospital midwives. It was one of the first hospitals in the country to encourage partners and siblings in the delivery room, and it regularly supported home-birth transfers when women needed additional assistance. In the ’80s, women having babies on the coast had an impressive array of choices.
By 2002, things were looking different. The big trees were gone, fuel costs were up, and after a decade of losing money, the mill split its last piece of timber. As the mill went, so went the economic center of Fort Bragg.
At MCDH, patients were already aging, and as the mill slowed down and then closed, those private-plan holders who remained either left town or transitioned to Medicare. For the first time, MCDH was faced with operating primarily off of state-funded reimbursements, and its financial solvency began to slip. After several organizational and administrative shifts, the midwives were cut in 2005. It didn’t help that the coast was seeing fewer young families and, as a result, fewer babies: In 2012, the year MCDH filed for bankruptcy for the first time, Fort Bragg saw just over 150 births. In 2019, the last full year the hospital’s labor and delivery would be in operation, that number dropped to 95 births, only 56 of which took place at MCDH. The following year, the hospital would dissolve entirely, giving governance over to Adventist Health, a large-scale corporate provider.
Despite years of public outcry, meetings, hearings, and protests, in 2020, just months before the handoff to Adventist, the board of MCDH voted to close labor and delivery.
Early in my first trimester, my pregnancy still a secret from most of the world, Ben and I weighed our options for care. Basically, there are four. We can go through Adventist, with early prenatal in Fort Bragg and a third-trimester switch to Adventist Ukiah Valley, where we’ll also deliver. We can go through Care for Her, a high-volume midwifery clinic with a rotating staff of midwives and OB oversight, also in Ukiah, with delivery at Adventist Ukiah Valley L&D. We can go to Bloom, a freestanding birth center in Ukiah with a home-birth-like environment, where we’ll see one of two midwives for every visit, including delivery and postpartum care. Or we can go with the only option that’s truly local: find one of the few practicing midwives who will still attend a home birth on the coast and try our luck in the trailer.
While it’s not what I’d call a plan, births can and do still happen at the Fort Bragg ER, now operated by Adventist Mendocino Coast. In the past two years, more than a dozen women have shown up there in labor; of those, at least two gave birth in the ER, and the rest were transported over the hill to Ukiah via ambulance.
I ask Beak whether his EMTs have ever helped deliver a baby in the ambulance. “No,” he says. “Labor often slows in transit. Birth is rarely an emergency, although we do travel at level three: lights and sirens.” The EMTs have had childbirth training, especially since the L&D closed, but, Beak says, “most of the time, we don’t do anything, because we can’t. You’re the one who has to do the work. At some point, there’s a come-to-Jesus for mom, or between mom and dad. Sure, we can support them, but there’s only one person who can have the baby.”
This attitude bears out in coast deliveries, especially when considering the differences between the obstetric and midwifery models of care. Briefly: In the obstetric model, birth is seen as a medically “managed” event. In midwifery care, the birthing parent is largely expected to do the work on their own, and medical management and intervention are viewed as causes of distress, rather than its solution.
“I grew up in Mendocino, and home birth was the norm,” says Mary Anne Cox, a nearly 20-year birth educator and doula currently living and practicing in Ukiah. Birthplace statistics from three decades ago are scant, but when I speak with Susan Wells, one of the most respected and longest-practicing midwives on the coast, she backs this up. Between 1980 and 2005, she estimates, she attended over 2,000 births, both at home and in the hospital, and especially in the beginning, home was the more popular option.
“People were really into natural childbirth,” she says. And, although it’s nowhere close to half, in 2020, Mendocino County boasted the third-highest out-of-hospital birth rate in the state, 6.6 percent, up from 5 percent in 2018. In 2022, that rate went up to 7.4 percent. Coincidentally or not, this increase was occurring at about the same time as the shuttering of MCDH’s labor and delivery services. For context, the statewide out-of-hospital birth rate is currently about 1.2 percent, up from nearly .5 percent in 2007, which follows a nationwide trend: from 2019 to 2021, the national home-birth rate went up by more than one-third.
I talk to Oscar Stedman, who had her babies in nearby coastal Caspar in the ’80s. She labored with her first daughter, Lea, in an 8-by-16 trailer. The birth was attended by a then–student midwife who’d been apprenticing with a local practitioner. “It was all pretty shady, hippie stuff,” Stedman says. I can hear her smiling on the phone. She was young, she says, a pioneer woman, trying to make it in a remote part of the world. Things were exciting, scary, new.
Her next two births took place in what she refers to as the Octagon, a 28-foot-diameter yurt-like house her husband built out of old-growth redwood and reclaimed railroad ties. She speaks of out-of-body experiences, of visions. This is the stuff of birth, she says.
“You want to know the secret to labor?” she asks me, and of course I do, desperately I do, sitting in my own trailer, listening to her voice on the phone. “It’s…let me try to explain this. It’s hard to put into words. It’s the moment that you meet a dog, a real aggressive dog, a barking dog, and you have to soften it. And you know you can. You know that if you relax, the dog will too. You bend down. You hold out your hand. You open up to it. That’s birth. That’s what birth is.”
Later, people will ask me about this analogy, whether the dog ever bites, whether it isn’t a bit naïve not to build some kind of wariness into my consciousness when it comes to birth. When they ask this, what I think they are actually asking is “Somewhere deep down, isn’t birth dangerous?” Regardless of the answer to that question, the more I learn, and the more stories I hear, the more I begin to think that fear is not a helpful ingredient, that danger is not the same as risk. It’s something you understand a bit more every season, living in a place like this.
“A lot of people have this fear of birth,” Wells tells me. “I just basically think it’s going to be OK. I trust it.”
I talk to Carlos Cervantes and his wife, Brianda Pech. When Brianda went into labor with their fifth, they drove over the hill and were told that Brianda wasn’t far enough along. After they arrived back home in Fort Bragg, labor progressed rapidly.
“We tried to make it,” Cervantes says. “We get in the car, we start driving like crazy. And then…just at Irmulco Road, she says, ‘Stop the car!’” Irmulco Road, a common local reference marker, is some 10 minutes from cell service and 40 minutes from Ukiah. “I said, ‘Why?’ She was like, ‘No, I can’t wait anymore! The baby’s coming!’”
Cervantes stopped the car, turned his wife’s body toward him, and caught his daughter’s head as it was crowning. When I ask him how the baby was, he cracks a huge smile. “She cried right away. It was crazy. I was so happy! We didn’t have anything to cut the cord, so I tied it.” His eyes are suddenly far away. Then he picks up a piece of string sitting on my desk and demonstrates the knot. I watch him, fascinated, forgetting to ask about the placenta.
An ambulance came to transport the three of them to Adventist Ukiah Valley. Mom and baby were both fine. What Cervantes remembers about the hospital is not its care but that the receptionist followed him around from the moment they got there, asking him how he was going to pay for their visit.
When Ben and I choose Bloom as the place we want to have the baby, our decision is, hugely, about continuity of care, but it’s also about the midwifery model. Admittedly, I’ve always been drawn to the idea of out-of-hospital birth, but like most people raised in a Western medicalized narrative, I was iffy on the idea that helping a child actually traverse its way out of my body was something I was capable of without pain medication or the oversight of a doctor. As I do in the face of all deep questions, I read exhaustively, and I found that given certain provisions (proximity of a backup OB; the presence of a qualified birth attendant—i.e., a midwife), outcomes for home birth and hospital birth for low-risk pregnancies were very similar. What I feared—risk to our safety, pain—weren’t actually things I had to fear.
When you choose to live far from other people, you learn that panic and alarm are rarely helpful in any scenario, especially an emergency. Generations have understood the importance of this kind of calm, and the personal responsibility it’s built on, but I am just now beginning to understand it as fundamental to my life. When I first moved here, I used to burst out of bed at every nighttime noise, heart pounding, flashlight at the ready, and my hand poised on our joke of a dead bolt. Now, when the dog barks or we hear the trash can topple, I get up slowly (if at all), check the window, open it, and holler if some animal is rooting through the bins.
Recently, we woke at four in the morning to a sound like nothing I’d ever heard, like something dying, a mournful, raspy keening that echoed down the valley. It was a bear cub stuck in our neighbor’s chicken coop, and we spent the dawn hours trying to facilitate the cub’s exit while avoiding the aggressively circling mother bear. The chickens had long fled, but the cub couldn’t figure out how to get out, and the mother couldn’t figure out how to get in. We waited. We shouted. We flashed our flashlights.
No one called for help, or even thought to, since who could do anything other than what we were already doing? Eventually, our neighbor scared mama off long enough to prop open a side door, and when mama came back, she and her baby trundled off into the woods. As for us and our neighbor, we’d been patient, collaborative. We’d solved a problem. Largely, that solution had involved waiting and staying out of the way.
When I imagine my own child’s birth, which I do often, it’s no accident that it’s this story, and not the dozens of birth stories I’ve heard, that comes to mind.
The stories I hear from coast women are not all perfect, but what sets them apart from the other stories I hear—stories where women’s faces go dark as they list the incremental steps by which they were made to feel abused or out of control—has something to do with choice, and a surrender to the unpredictable. Whether they birth via C-section in a surgical theater or in a pool of water surrounded by fairy lights, what seems to make birth positive is when a woman is able to remain herself and true to her own wishes. The shift underway on the coast, then, is not that our L&D care is physically farther away but rather that the options we have are shrinking. The chance for selfhood, for agency, for a type of care that aligns with our lifestyles—and our births—is disappearing.
At one in the morning on September 5, I wake up to contractions. It’s a full 12 days past my estimated due date, and I’ve spent weeks in a borderline psychological collapse, the reality of very late pregnancy. Every day that passed, I became more certain that I would actually be the first woman in history to be pregnant forever. When labor comes, I am grateful more than anything else. When labor comes, I hold out my hand to the snarling dog of Oscar Stedman’s vision. I have been waiting for you.
The trailer is dark. In bed, I breathe through a few contractions before I wake Ben. We are expecting the norm for most first-time moms: a slow ramp-up; a longish early labor; 6, 8, 12 hours of early dilation that I intend to weather at home, waiting until my contractions are five minutes apart before we get in the car and head over 20.
Thing is, I do not get 12 hours, or even 6. Just 2 hours in, we’ve called the midwives twice, and Ben is packing the car. I am sitting on a birthing ball in what passes for our living room. By the time we drive away from the property, my contractions are three minutes apart.
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