Most healthy, low-risk pregnant people are eligible for care with a Licensed Midwife and may be good candidates for an out-of-hospital birth. Your midwife will review your individual health history and pregnancy to make sure community birth remains an appropriate option throughout your care.

Licensed Midwifery care is ideal for people who want to allow labor and birth to unfold as naturally and undisturbed as possible, while having skilled midwives present to closely monitor the wellbeing of both client and baby and provide guidance or intervention when needed.

Out-of-hospital birth is especially well suited for those planning to labor without medical pain medication. Midwives use portable and waterproof monitoring equipment, allowing you to move freely, change positions, eat and drink, and use water throughout labor while still receiving ongoing clinical assessment and support.

This freedom of movement, combined with hands-on comfort measures and continuous emotional and physical support from your midwife team, can provide more options for coping with the intensity of labor and creating a birth environment that feels comfortable, familiar, and your own.

The question of what is considered “low risk” can be confusing because risk is assessed differently depending on the provider, the individual pregnancy, and the planned birth setting.

Some factors that may lead to additional monitoring or consultation in traditional obstetrical care—such as advanced maternal age, a history of pregnancy loss, or a previous cesarean—do not automatically mean someone is unable to have an out-of-hospital birth. With individualized assessment, appropriate monitoring, and collaborative care when needed, many people with more complex histories may still be good candidates for midwifery care. At the same time, certain lab findings, ultrasound results, or changes that develop during pregnancy may make hospital birth the safer option.

The best way to know if you are a candidate for midwifery care is to schedule a consultation with our midwives so we can review your personal health, pregnancy, and birth history and discuss whether out-of-hospital birth is an appropriate option for you. We regularly work with people who have more complicated histories and provide individualized care aimed at supporting the healthiest pregnancy possible.

Choosing an out-of-hospital birth also means being an active participant in your prenatal health. Nutrition, hydration, appropriate supplements, movement, keeping recommended appointments and testing, and communicating openly with your care team all play an important role in maintaining health throughout pregnancy.

As your midwives, we take your health and your baby's wellbeing seriously. Our goal throughout prenatal care is to support you in having the healthiest pregnancy possible while continually assessing that out-of-hospital birth remains a safe and appropriate option.

We often hear from people later in pregnancy who waited to reach out until they knew they were “low risk.” While this makes sense, the best time to begin care with a Licensed Midwife is as early as possible—and some of our clients even begin care before conceiving.

There are two important reasons:

1. “Low risk” can mean different things in different models of care. Being considered low risk by an OB does not automatically mean you qualify for an out-of-hospital birth. Midwives assess risk specifically for community birth, and certain health history, lab values, ultrasound findings, or pregnancy conditions may need additional attention. Starting early gives us more time to support your health, address concerns when possible, and prepare for birth together.

2. Midwives intentionally limit their monthly client load.
We accept a limited number of births each month to ensure our availability throughout each client’s due window. If you wait until later in pregnancy, we may already be full.

Licensed Midwives can order routine labs, genetic screening, ultrasounds, and other pregnancy testing, while giving you time to understand your options and make informed decisions. Beginning care early also allows more time for nutrition, movement, education, childbirth preparation, and building a relationship with your birth team.

Already later in pregnancy? Still reach out! When space is available, we may accept late-transfer clients. We’ll review your history and records, determine whether community birth is still an appropriate option, and help you prepare as thoroughly as possible.

In many ways, giving birth at our birth center or in your own home is very similar. Your midwife team brings the same level of care, monitoring, and emergency preparedness to both settings. Both options include access to water labor and birth, emergency equipment and medications, a birth stool, rebozo, and the other tools and supplies we use to support labor and birth.


Benefits of Birth Center Birth
Birth center care is offered at a lower cost because your midwife team does not need to transport, set up, and break down our extensive birth equipment and birth pool or travel to and from your home. You also don't need to purchase a home birth kit, prepare your home for birth, or gather the additional supplies needed for a home birth.

For some families, location is another benefit. Our birth center is close to several hospitals that we are familiar with and comfortable transferring to if additional care becomes necessary. Depending on where you live, this may offer easier access to hospital care than your home location.


Benefits of Home Birth
The biggest benefit of home birth is exactly that—you are home. There is no need to travel to the birth center while in labor or transition back home several hours after your baby is born. You can labor, birth, recover, and settle in with your baby entirely in your own space.

Ultimately, both options provide the same relationship-centered midwifery care and preparation. The choice often comes down to which environment feels most comfortable and practical for you and your family.
 

No. Beginning care later in pregnancy often means longer and more frequent prenatal visits so that we can get up to date on the care, education, and preparation that would normally take place over several months. The majority of the time, preparation, and clinical responsibility involved in midwifery care also occurs during the final weeks of pregnancy, labor, birth, and postpartum.

For late-transfer clients, our team must obtain and thoroughly review previous medical records, transfer relevant information into your chart, review your complete health and pregnancy history, identify any outstanding labs or testing, and provide months of education, recommendations, and birth preparation within a condensed timeframe. This can require many additional hours of clinical and administrative work to make sure everything is complete before your due window.

Our goal is to have your records, required testing, labs, and overall clinical picture complete and appropriate for out-of-hospital birth by 37 weeks, when your midwife team goes on call for you. If important records or testing are still outstanding, or a health concern has not been adequately evaluated or resolved, we may not be able to safely attend an out-of-hospital birth until those requirements are met.

For these reasons, our full midwifery fee applies even when care begins later in pregnancy. The earlier you begin care, the more time we have to prepare together and make the transition into midwifery care as smooth as possible.

 

You can birth with your midwife from week 37 of pregnancy until week 42. This is the legal “safe window” in California. If you go into labor either before 37 weeks or after 42 weeks you must be transferred into the hospital for delivery.
 

There are different types of transfers – either non-emergent, or emergent transfers, which can both happen before, during or after labor. 

The most common time to transfer is a non-emergent labor transfer. This typically happens because someone has a long labor, become exhausted, and stops making progress. 

Occasionally we have a prenatal problem that risks someone out including genetic condition of baby, preterm labor, hypertension, or lab values that become high risk. 

Even more uncommon is to have a transfer that is emergent and happens by ambulance during labor or shortly after birth. If emergency situations arise, your midwives have the skills and tools to help stabilize and care for you or baby as the situation if unfolding, and almost always transfer with you in the ambulance, often continuing to provide care during the transfer during any urgent or emergent situation. 
 

Typically, with any emergent or urgent reason for transfer, your midwife WILL accompany you to the hospital and stay with you until the situation is stabilized. 

For non-emergent transfers, your midwife does not typically accompany you. Your midwife DOES arrange and facilitate the transfer with you, recommending and organizing which hospital to transfer to based on your wishes, personal factors, and current situation. Your midwife will call the hospital and speak directly to the staff who will be receiving you, giving them a full report of your situation and reasons for transfer, and fax over all your records. This way they are expecting you, prepared to receive you and have your prenatal history for reference.

Throughout your hospital experience, your midwife is available for virtual support as needed, available for input, support and recommendations.

Because non-emergent transfers typically happen for exhaustion of the birthing person during very long labors (multiple days), your midwife has generally been up without sleep for many hours as well. Most often in this situation you are transferring to the hospital to receive pain relief (Epidural) in order to sleep and recover strength to continue laboring.

Non-emergent types of transfers usually take many more hours of labor in the hospital before delivery, and it is not safe or practical for your midwife to be up for such an extended period of time without proper sleep or food, especially since she is still on call for other families who might go into labor at any time. 

Your midwife IS available for virtual support throughout the time you are at the hospital, and you can call or message her at any time for advice and input. We want to be kept updated on everything you are experiencing, especially any hospital recommendations that seem invasive or unnecessary.

Once you are discharged home from the hospital, your midwife and team will resume all your standard postpartum care, including your home visit, followed by multiple in-office visits, for both you and your baby.

Even if you transfer, your midwife is still your primary care provider. However, we do not have hospital privileges, so while you are at the hospital we provide virtual counsel and support as needed, and then our active, in-person medical care resumes immediately when you are discharged back home. 

No matter what type of transfer you experience, once being discharged from the hospital, your midwife provides your complete postpartum care, beginning with your postpartum home visit, followed by three in-office postpartum visits scheduled through 6 weeks postpartum. 

Transfers do not qualify clients for a discount. Transfers are almost always difficult situations that take more time investment and experience from your midwives than low-risk birth, and so require payment for your midwives’ time, skills and services rendered.

Also, when you hire your midwife team, you are reserving one of the limited spaces in your due month, as midwives can only take a certain number of clients per month in order to ensure our availability – and so in essence, you are also “purchasing your space”. 

Very rarely, we may have a client who needs to transfer care very early on in pregnancy (before 33 weeks) because of a rare, high-risk situation. Those clients do have the choice to either continue co-care and keep their midwife team for supportive and emotional care throughout their experience, or transfer completely out of care and discontinue midwifery services. 

If clients choose co-care, they pay in full, as we give complete care including prenatal, birth and postpartum support in conjunction with your hospital team. If clients (who are transferring before 33 weeks) choose to discontinue care, then we do not continue to follow you through your pregnancy, birth or postpartum experience and you would only pay for services rendered.

Out-of-hospital midwifery care is designed for low-risk pregnancies, and part of our responsibility is continually assessing that you and your baby remain appropriate candidates for community birth. Certain labs, screenings, and ultrasound findings provide important information about your health, your baby's wellbeing, and any factors that may affect your birth plan.

There are many options for prenatal labs, genetic testing, and ultrasounds, and we discuss these with you in detail throughout your care so you can make informed decisions. For healthy clients without specific risk factors or concerns, some optional testing may be declined if desired.

However, we do require certain basic prenatal lab panels and at least one complete anatomy ultrasound. Additional testing or monitoring may also be required if a concern develops or your pregnancy continues past your due date. These requirements help us provide responsible, informed care and continually assess that out-of-hospital birth remains an appropriate option for you and your baby.

Yes! Doulas are amazing and we highly recommend hiring a doula to be part of your birth team. Your midwives are your medical care providers, and as such, we must always prioritize your medical health before emotional and mental support. Kindness, informed consent and shared decision making are built into our care, so we are never “checked out”, and always give care with informed consent, gentleness and love. 

However, it is still so helpful to have a doula, who’s dedicated role is for emotional and mental support – not only for you, but for your partner, and even your other children and family members.

It is also within the doula’s role to accompany you in transfer situations. This can be a huge support for clients that may need to transfer non-emergently to the hospital, as having your doula by your side throughout is so supportive and reassuring.

Doulas also offer postpartum care and visits, which is beyond helpful to families in the first few weeks of adjusting and surviving with a newborn. There are some scholarship options for doulas here in LA, as well as a new MediCal bill covering doula care as well. We will discuss all the options together and partner you with the support you deserve.