After San Bernardino County mom Ericka Moliner gave birth to her daughter, she was diagnosed with a rare life-threatening heart condition linked to untreated preeclampsia.

“It could have been treated,” Moliner said. “That was my first lesson in advocating for yourself or having someone to advocate for you.”

Moliner and others asked us for advice on how to feel confident and prepared to speak up, about concerns, ask questions — and more importantly get answers— about your care during pregnancy and childbirth.

So we went to the experts — SoCal parents, doulas, midwives, OB-GYNs, doulas and a birth justice attorney— and asked for their tips on having a safe and healthy birth in an environment where you feel comfortable and supported.

Do research

Growing a human being inside your body is normal on a global scale, sure, but in your individual body, things might feel very weird.

“Everybody handles pregnancy in a different way,” said UCLA Obstetrics and Gynecology Associate Professor Aparna Sridhar. “The best thing you can do in pregnancy is not to compare too much to others, because each pregnancy is very unique.”

Your body is creating a brand new organ, making 50% more blood plasma and inhaling more oxygen. Somehow you have to go to the bathroom more, but also less in frustrating ways. And there’s a whole new vocabulary to learn, from amniotic sac to zygote.

“That was my way of advocating for myself, going in there, using the same types of big words that they were using,” Moliner said.

There’s a vast (and sometimes overwhelming and poorly vetted) world of online resources. If you don't know where to start, your provider can provide handouts or references.

If you plan to give birth at a hospital, ask about free pregnancy and childbirth education classes. Your insurance provider might also have the hook-up and you can also seek out community-based options.

Here are a few resources providers and parents recommended to LAist.

• The American College of Obstetricians and Gynecologists. The professional organization for OB/GYN’s has information on a variety of topics including COVID-19, prenatal testing, and preeclampsia. 
• Ina May's Guide to Childbirth, by Ina May Gaskin. Ojai midwife Tania McCracken likes the empowering stories and information on home and hospital births. 
• Birthing People's Bill of Rights: more tips for advocating for yourself in hospital and health care settings during the pandemic, created by California birth workers, legal experts and maternal and child health advocates.
• Birth Rights— an explanation of human rights during labor and birth, including what to do if you believe those rights have been violated created by the nonprofit advocacy groups Pregnancy Justice and Birth Rights Bar Association (BRBA).
• An overview of Black maternal health care in California from the collective Black Women Birthing Justice. 
• The library! In addition to checking out physical and digital books related to pregnancy, the Los Angeles Public Library has collected a list of maternal and family health resources. 

Don’t settle on your provider

“You should be 100% sure you are comfortable with the providers taking care of you during their pregnancy,” said midwife Kimberly Durdin. “Find a provider that listens to you and gives you informed consent about all of your options.”

We’ve been talking to a group of pregnant SoCal folks for the last couple weeks. Here are a few examples they gave of supportive prenatal care:

The provider:

• Was easy to contact and followed up quickly 
• Took time to review recommendations and did not rush the appointment
• Answered all of my questions 
• Provided additional resources and information 

Los Angeles OB-GYN Dr. La Tanya Hines suggests asking potential providers about their experience treating patients with similar characteristics as their own, i.e. weight, age, pre-existing health conditions, cultural and ethnic background.

Hines, who's been a physician for more than two decades, said a phrase like, "I treat everybody the same way," from a provider is a red flag.

"If someone thinks that treating every single person the same way, regardless of their own individualized profile, [that] tells me that they're not gonna be prepared should this patient be outside of the normal realm they're used to," Hines said.

Make it make sense

In other words, ask questions until you understand what your provider is talking about.

This isn’t about how smart you feel or how well you scored on reading comprehension in elementary school language arts. Even if you’ve done your own research, a provider might use words or introduce concepts that are unfamiliar.

”They have to make it make sense for you,” Moliner, the San Bernardino County mom said.

Even after repeatedly sharing that she had trouble breathing and sleeping, Moliner said doctors dismissed her worries as eagerness to see her baby.

The majority of women surveyed in 2018 by the California Health Care Foundation reported receiving respectful care, but that wasn't universal.

About 1 in 12 California women heard harsh, rude or threatening language at the hospital where their baby was born. Black and Asian Pacific Islander mothers were most likely to report experiencing this treatment.

Sridhar said it should never be a problem for patients to express concerns.

If you still don’t feel heard, try language like, “Hey, I know we did (insert invention here) and I’m still worried about (your concern) because of (reason), (reason) and (reason).”

Emanate Health OB/GYN Samuel Kassar said even when a doctor labels a patient’s concerns as “normal,” it’s OK to ask more questions.

“For most patients, that's not enough information,” Kassar said.

Possible follow-up questions include:

• Why do you think that's normal? 
• Can you explain the mechanism by which the pregnancy is causing this (fill in symptom here)?  

A mural by artist Rosatzin on the walls of the courtyard at birthing center Kindred Space LA.

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Chava Sanchez

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LAist

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Consider a doula

Broadly, doulas provide expecting and new mothers and birthing people with educational, emotional and physical support before, during and after a baby is born.

They are not doctors or midwives. They don't deliver babies and they do not make medical decisions on a client's behalf or tell them what to do.

Doula Daisy Hamory shows a new mom one way to carry her child.

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Mariana Dale

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"The purpose is that the clients are educated, empowered and inspired to make informed decisions for a healthy birth outcome," says Compton doula Bethany Benson.

Research shows working with a doula can improve labor and delivery outcomes and is associated with fewer preterm births and Cesarean
sections.

We’ve compiled an extensive guide to understanding what doulas do and how to find one in Los Angeles.

Build a network of support

Every person’s crew might look a bit different. It could include a partner, friends, family, neighbors, doula, home visitor or virtual community.

“The beautiful thing about support groups is that it normalizes all of the things that you are going through,” says midwife and birth center co-founder Kimberly Durdin. “It can help you relax more and have less stress.”

Durdin’s Facebook group, Beloved Birth Community, often lists suggestions.

Doula Brandi Jordan said the pandemic restrictions meant some family members couldn’t travel to support their loved ones during birth and that has helped normalize seeking help outside of family.

“If you're thinking about it, book that person in advance, have that plan, even if it's for a week or two weeks,” Jordan said.

Erika Moore, Farah Kolker and Andrea Orrego gather at Kindred Space LA in pre-pandemic times to ask questions, share their experiences and get advice about pregnancy and motherhood.

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Mariana Dale

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LAist

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Create a birth plan

Birth plans or birth preferences are a roadmap of how you envision birth. Some details to consider include: where you plan to have your baby; what kind of medicine you want to take, if any, to manage pain; and what type of support would be most helpful, whether it’s massage, a pumped up playlist or movement.

Long Beach birthworker Stevie Merino says it can be tempting to sketch out only the most ideal scenario.

“Well, that's cute, that's fine,” Merino said. ”But what often happens is that we have birth trauma, because things happen to us rather than with us, right, especially in hospitals. And so having this…plan B to the plan A of what you envision, or at least talking through them, can be really empowering and really helpful.”

That’s why she helped Jasmine Godinez-Gomez create two birth plans — one for a vaginal birth and another for a Cesarean section, even though Godinez-Gomez hoped to avoid surgery after losing her first child because of a placental abruption.

They talked about what would make another C-section feel more healing. Godinez-Gomez wanted her partner present, delayed umbilical cord clamping and an hour of uninterrupted skin-to-skin contact with her newborn.

“All those types of things I felt like made me feel like I had control over a situation where in my first birth, I felt like I had no absolutely no control over what happened,” Godinez-Gomez said. “That really made all the difference.”

If you’re not sure where to start, the non-profit March of Dimes made a template for creating a birth plan. It’s available in 14 languages including English, Spanish, Korean, Armenian, Tagalog, and simplified and traditional Chinese.

Learn to identify mistreatment

California’s 2019 Dignity in Pregnancy and Childbirth Act reads:

“Every person should be entitled to dignity and respect during and after pregnancy and childbirth. Patients should receive the best care possible regardless of their race, gender, age, class, sexual orientation, gender identity, disability, language proficiency, nationality, immigration status, gender expression, or religion.”

Some mistreatment, including physical, sexual, and verbal abuse, can be obvious, but there are other more subtle types of abuse. Here are a few examples from the nonprofit advocacy groups Pregnancy Justice and Birth Rights Bar Association.

Failure to meet professional standards of care: E.g. A lack of information about procedures or options, painful vaginal exams, refusal to provide pain relief, long delays in care, being ignored or refused requests for help, having people present during your care without your consent. 

Poor rapport with providers: Dismissal of concerns, inability to ask a provider questions due to disagreement or fear, lack of information in a patient’s primary language, inadequate support from health care workers, and denial of support persons in appointments or during labor.
 
Health system conditions: E.g. Poor physical condition of hospital, doctor’s office or clinic, staffing shortages, lack of privacy and unclear payment expectations.

What to do after a bad health care experience

If you want to speak to someone other than your direct provider or file a complaint, there are options.

Every hospital, doctor’s office or health insurance provider might do things a little differently. Ask about whether they have member services, a patient advocate or patient liaison.

“I try to be very patient with our members, I listen to them,” said Maricela Rojas, a health education advocate at L.A. Care Health Plan. “We want to make sure that we get those questions and we can go ahead and clarify that information for them. So I want them to have a good experience.”

For example, UCLA Health says their patient advocates can help address quality of and access to care, interactions with staff and general questions. There are also people who do this work independently of any single provider.

You can also escalate your issue to a state agency that regulates health care coverage and investigates complaints. Depending on what kind of health insurance you have, that’s either the California Department of Managed Health Care or the California Department of Insurance.

Understand how COVID-19 affects services

Hospitals changed their policies during the coronavirus pandemic to follow the guidance of the Centers for Disease Control and Prevention, the California and local departments of public health and other organizations.

One of the most visible changes for birthing people was how many people could be in the room while their baby was born. At this point, many hospitals allow for at least one visitor and a doula, but still have additional guidelines.

It’s worth noting that the California Department of Public Health recommended in June 2021 that a doula be permitted to accompany patients in addition to their desired support people.

The rules might be different for prenatal appointment visitors.

Doulas and hospital staff say it’s important to ask hospitals about their visitation and COVID-19 policies as your due date approaches, because during the pandemic they’ve changed from day to day.

A group of California birth workers and other advocates created a list of useful questions, including:

• How many people can come with me for labor support? Can they come and go? Do they have to wear a mask or any other special protective gear? Do you provide the mask/equipment?
• How have your policies changed because of COVID-19? Do you expect any more facility changes?
• What is your COVID-19 testing policy?
• If I am found to have COVID-19, what will change regarding my care?

Take notes

Palmdale mom Sasha Alonso has three kids —her oldest daughter had a liver transplant as a baby, so she’s spent a lot of time in doctors' offices.

When Alonso thinks of a question she wants to ask her doctor, she saves a note on her phone immediately.

“It would always keep me from having that [moment of], ‘Oh, shoot, I forgot to ask this. Now, I have to wait,’” Alonso said.

Deep breath

Short of a life-threatening emergency, you have time to consider the decisions you make for your family.

Midwife Tania McCracken suggests a deep breath and some prepared language for when someone asks you to make a choice on something you’d like to take some time to consider:

• Thank you for that. 
• I'm not familiar. 
• I need to think about this. 
• I need to talk with my partner.
• I need to do some reading.

Doula Raegan Loston said another way to create space is to ask for a minute to pray.

“Yes, maybe we are going to say a prayer, but it's also code from let's create some space,” Loston said.

Sridhar said, “Autonomy is the most important thing, No one can force anyone to do things that they're not comfortable with.”

Pausing also gives you a moment to think of questions, something Sridhar recommends.

“It's always good to understand, why that's being kind of told to them, and what's the science? Or what's the evidence behind it, and then making a decision after understanding the benefits, alternatives, and the risks and benefits of all the different alternatives,” Sridhar said. “Make the informed choice.”

Birth and postpartum resources

Early childhood engagement producer Stefanie Ritoper contributed to this guide. It was also informed by the Hey bb review committee: Maternal and Child Health Access parent coach and psychotherapist Denise Cervantes, California Black Women’s Health Project senior manager of maternal and reproductive health Raena Granberry and licensed clinical psychologist and birth doula Sayida Peprah.