This story was produced in partnership with the investigative reporting program at the University of Southern California’s Annenberg School for Communication and Journalism.
Sigita Cahoon’s 16 September 2024 marathon stretched through the night.
From 3am to 6am, she bolted among three rooms in the Los Angeles general medical center, until three babies were safely delivered.
Staying up all night to deliver babies is a big part of Cahoon’s job as the hospital’s vice-chief of obstetrics and gynecology. But with more Los Angeles-area hospitals closing their maternity wards, emergency rooms are expected to shoulder even greater patient loads.
At Los Angeles general medical center, a public teaching hospital in LA’s Boyle Heights neighborhood, more than 1,400 women passed through the emergency room doors to access care during labor and delivery from 2016 to 2023.
“We don’t have the ability to turn patients away,” said Briah Fischer, who worked as a resident at the hospital until last fall. “And when a patient shows up, we want to take care of them because we know that they often will now have to drive an hour to two hours to the next hospital.”
Los Angeles county has seen at least five maternity wards close since 2023 and 16 since 2014.
As these maternity wards have shuttered, the county has seen a rise in emergency room visits and admissions from people for labor and delivery. From 2016 to 2023, more than 26,500 people, roughly 64% of them Latino, went to an emergency room in Los Angeles county to seek birthing care, according to data obtained through a public records request from California’s department of health care access and information.
The number of babies born in the county has dropped drastically and steadily in those years. But emergency room visits and admissions of people for labor and delivery have not kept pace with that decline. Roughly 14% more women sought birthing care at emergency rooms in 2023 than in 2016, despite a 26% decrease in births countywide in that timeframe.
Healthcare experts say the shift comes at a peril. Access to prenatal care decreases when maternity wards close, research into closures nationwide shows. And as these units close, other hospitals are seeing an influx of patients with complex pregnancies. Cahoon said that her hospital has been seeing more pregnant patients who have high blood pressure, seizure disorders, psychiatric needs or placenta accreta, a condition where the placenta invades the wall of the uterus and makes it harder for the two to detach.
Some people giving birth at emergency rooms may also struggle to access post-natal care, according to Angela Ocampo, who contributed to the 2025 California Equity in Maternal Health Report led by non-profits Hispanas Organized for Political Equality and Black Women Organized for Political Action.
And not all emergency rooms’ staff are as well-equipped to handle deliveries or pregnancy complications, Fischer said.
Meanwhile, the closure of maternity wards has meant more pressure on doctors. “It can be hard to provide safe care if you’re working so much,” Cahoon said. “You need people to be fresh so they can catch things – so that we’re not experiencing morbidity and, you know, God forbid, mortality.”
Los Angeles county’s severe maternal morbidity rate, which measures medical complications during pregnancy and childbirth that result in significant health consequences, has steadily increased in recent years. The county’s rate is higher than the state average at 122.1 morbidities per 10,000 deliveries in 2023, according to the state’s department of public health. Patients of color, who face more barriers to accessing care, have even higher morbidity rates.
Healthcare workers and advocates worry it could get worse, as federal funding cuts further strain hospital funding and certain populations become more hesitant to seek routine medical care.
David Pisani, a director of advocacy and government affairs at March of Dimes, a non-profit organization focused on maternal and infant health, said he’s concerned about patients who are undocumented and avoid seeking medical care for fear of being detained.
“We already have unacceptable maternal mortality and maternal morbidity rates,” Pisani said. “Could we see those numbers go up? At this point, I think anything, frankly, is quite possible.”
If hospitals aren’t able to provide more comprehensive maternal healthcare and increase their staff, healthcare professionals fear higher patient loads could lead to more complications – especially for Black women, who are roughly three times as likely to die from pregnancy related complications.
Current concerns
More than 35% of US counties are considered maternity care deserts, largely concentrated in rural areas, including in the south and midwest. But cities are not exempt from this trend. Research published by the Journal of the American Medical Association shows that 537 hospitals lost their obstetric services nationwide from 2010 to 2022, 299 of which were located in urban regions.
The closures are driven partly by cost. Maternity wards, which require 24/7 coverage, are comparatively expensive. Hospital administrators and experts in the state have also attributed the closures to declining birth rates, along with increased costs and shortages in labor; California could be short by 1,100 obstetriciansby 2030. Medi-Cal, California’s version of Medicaid, has a reimbursement rate for obstetrics below the national average, despite covering almost 40% of California births.
There’s fear that those financial pressures will only increase because of widespread cuts to the federal Medicaid program.
The cuts under the Trump administration as part of its “Big Beautiful Bill” are causing increased concern among maternal health advocates that even more labor and delivery wards could be gutted.California governor Gavin Newsom recently signed a law that will enable “standby perinatal services” – which are provided from the beginning of pregnancy through an initial postpartum period – to be established during a 10-year pilot period, but only at up to five rural hospitals.
Disproportionate impact
Severe maternal morbidity rates in Los Angeles county are highest among Black women, who sustained a rate of 193.5 morbidities per 10,000 deliveries from 2021 to 2023, followed by Asian/Pacific Islander and Hispanic patients, who maintained rates of 114.5 and 111.2 per 10,000, respectively.
Mashariki Kudumu, the founder and director of the California Black Birth Equity Summit, a gathering of stakeholders focused on improving birth equity, says the problem lies in widespread shortages in prenatal care providers in communities of color – coupled with a medical system that many women of color feel is unresponsive to their needs.
“People are not going to get the care that they need in their communities, and so they’re going to be giving birth in less ideal situations, like the emergency room,” said Kudumu.
Roughly 64% of people who went to an emergency room at a Los Angeles county hospital from 2016 to 2023 to give birth were Latino, according to the state data. Roughly 15% were Black, and 11% were white.
The repercussions of delivering in the emergency room rather than a maternity ward can go beyond the delivery. In some hospitals, “there’s really no follow-up at home [or] system in place to follow and care for these women and their children afterwards”, Ocampo said.
“People are not going to get the care that they need in their communities, and so they’re going to be giving birth in less ideal situations, like the emergency room.”
Mashariki Kudumu, the founder and director of the California Black Birth Equity Summit
Alternate supports
To state senator Akilah Weber Pierson, California has an obligation to invest in maternal healthcare.
“The current state of the maternal healthcare crisis is incredibly apparent,” said Pierson in a statement. “The maternal complications and mortality rates for women of color are abysmal and completely unacceptable. California has both a moral and structural obligation to act now.”
Weber authored a measure during the 2023-24 California legislative session that would have required hospitals to notify the state of potential maternity ward closures, but it was vetoed by Newsom. Last year, she authored another bill that would have created standards for the “geographic accessibility of perinatal units” across the state – but it did not make it through the state assembly.
Short of opening new maternity wards, maternal health advocates say there are other measures that could help fill in the gaps, including expanding access to midwives and doulas, who help coach pregnant patients through the birthing process.
Birthing centers often rely more heavily on midwives and doulas, but more of those have been closing, too. And even with Medi-Cal covering the cost of a doula as of 2023, only 306 people gave birth at a Los Angeles county birthing center in 2024 – compared with 410 five years previously.
During the last legislative session, Newsom signed bills into law that will expand midwifery training and streamline the licensing process for alternative birthing centers.
A unique approach
In the meantime, some hospitals are coming up with their own solutions.
Martin Luther King Jr community hospital, a non-profit hospital in south Los Angeles, has been working to build a staff of midwives to address staffing concerns.
The hospital, which has endured significant financial hardships and said it was nearly unableto pay its bills in 2023, plays an essential role for a community that suffers from racial disparities in healthcare and has already seen maternity ward closures. Many expectant mothers have had no access to prenatal care, according to the medical director of maternal child health, Danny Dan. And more than 3,300 women came into its ER in labor from 2016 to 2023, state data shows.
In most cases, when a woman comes in to deliver, they are sent up to the hospital’s labor and delivery ward, where they are immediately supported by a midwife and have ongoing access to a regular staff of physicians, according to Dan. Financial reports show the hospital has increased its staffing and had 15 board-certified, hospital based OB-GYNs as of 2024.
“Everybody gets the same care. The midwife is the one that will be taking care of the patients from the beginning, from triage, if it was uncomplicated … to delivery and postpartum care,” Dan said. “That way, that model, that collaboration, allows us to have a very personalized, holistic, patient-centered care that the midwife can provide for the patients with the safety net of the physician.”
The hospital has four full time midwives, two part-time and one per diem, which Dan said is enough to ensure there is a midwife present 24/7.
In 2023, despite financial hardship, the Martin Luther King Jr community hospital opened a prenatal care clinic to try to expand access to care throughout the duration of a pregnancy. But that isn’t the case everywhere.
“Do we as a society decide that this patient population is worth taking an extra step for because of how important it is?” asked Laila Al-Marayati, an associate professor of clinical obstetrics and gynecology at the University of Southern California’s Keck School of Medicine. “Are we OK with the maternal mortality rate increasing in the United States because women don’t have access to good care?”