April Valentine wrote down the future she envisioned and read it aloud each morning.
A recent photo of her affirmation board showed Valentine’s most recent additions. They include:
“I will have a healthy baby. I will have a healthy and beautiful pregnancy. I will not have any complications. I will have a good birthing experience. I will have a vaginal birth naturally with a little to no pain.”
The 31-year-old Inglewood woman died at Centinela Hospital Medical Center on Tuesday, Jan. 10. Her daughter Aniya was born by emergency cesarean section.
Valentine’s death underscores a critical shortcoming of the U.S. health care system. Black mothers and babies are more likely to die in childbirth or experience life-threatening complications than white, Latino, or Asian people. In California, Black people die from pregnancy complications at a rate nearly four times higher than the general population.
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This story talks about the death of a pregnant Black woman in childbirth and disparities in maternal and infant health.
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Language
You might notice this story uses the term pregnant or birthing people. That's because our newsroom uses language in reproductive health that includes people of different genders who can give birth.
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“Me and Aniya, we'll get stronger over the situation, but it'll never get better,” said Nigha Robertson, Valentine’s partner and the baby’s father. “For the rest of my life, I have to look at my daughter and relive that moment.”
The family doesn’t yet know the cause of Valentine’s death. Autopsy results are still pending. Valentine’s family said she complained of pain, swelling, and numbness in her legs for hours and that she was denied access to a doula who had long been a part of her birth plan.
How health care workers handle concerns of Black women is a longstanding issue. A 2022 Pew Research survey found 71% of young Black women said they've had at least one negative health care experience. The study found Black women 18-49 were the most likely to report their pain and health concerns were not taken seriously and that they were treated with less respect and received lower quality care than other patients.
Valentine’s family said she sought out a Black woman physician and a doula for her health care, knowing Black women are more likely to experience poor outcomes in their pregnancies.
“How do I explain to my daughter that the same day you gotta celebrate a birthday,” Robertson said, “you gotta celebrate the day your mama left?”
Valentine’s family and supporters are seeking answers. They've called on public officials to investigate Valentine’s care and the hospital.
The California Health & Human Services Agency confirmed to LAist on Monday, Feb. 27 that it’s investigating the circumstances surrounding Valentine’s death.
In a written statement to LAist, a Centinela Hospital Medical Center spokesperson said: “Despite the highest standards of care, there are certain medically complex and emergent situations that cannot be overcome. Our hospital community grieves along with the family during this deeply sad and difficult time.”
Reached by phone, Dr. Gwen Allen, Valentine’s OB-GYN, offered condolences to the family and directed questions to her attorney.
“My client is not going to make any statements regarding the facts of this case, because she is prohibited from doing so by federal law,” wrote Ludlow B. Creary II in response to an LAist inquiry about Valentine’s care. The federal law Creary referred to is the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA, which protects the privacy of information about an individual's health.
(Editor's note: Valentine’s physician, Gwen Allen, participated in a May 2019 LAist event about wellness for Black moms.)
Valentine was the youngest of six siblings. Her older sister Kesiah Cordova often called her “princess,” and said Valentine had a diamond necklace with the nickname.
“She always kind of stood out in the room,” Cordova said.
Valentine’s friends and family say she loved to bring people together.
“She would be the first person [to ask] 'What are you doing for your birthday?'” said cousin Alexus Alexandria. “She was ready to celebrate people.”
Alexandria said Valentine lifted her out of a funk on her last birthday with Mexican food and margaritas. Another friend, Nikki St. Clair, said Valentine showed up at her house with surprise flowers.
She liked the process of beautifying people and making people look pretty and making people feel confident because she was very confident.
Valentine, a Cal State Northridge sociology graduate, worked part-time in a group home and braided and styled hair.
“She liked the process of beautifying people and making people look pretty and making people feel confident because she was very confident,” said her cousin Mykesha Mack, who called Valentine the family’s “queen of edges.”
The flexibility of her job also meant Valentine could step in when her family needed help. Valentine’s father had a “debilitating stroke” in 2019.
“We had a nurse, but April demanded that she have one day with my dad alone once a week,” Cordova said.
Nigha Robertson’s job in disaster cleanup brought him to Los Angeles in October 2021. After getting off the plane at LAX, he stopped at Melody Bar and Grill. He remembers Valentine, who was there with her cousins, struck up a conversation.
“We just connected, ‘cuz next thing you know, we was just hugged up in the corner,” Robertson said.
Valentine’s desire to start her own family was no secret.
“I think we was together for a month and she told me, she was like, ‘If you not trying to have a baby with me, you might as well go down the road,’” Robertson said.
Valentine hung a pink onesie over the bed they shared in her Inglewood apartment, he remembered.
“She always would say if you speak it into existence, it would come,” Robertson said.
And she succeeded. In 2022, Valentine became pregnant, part of a larger transition in her life as she looked toward the future and rethought everything from how she dressed to how she spent her free time.
“We had many talks about who she was as a young, carefree girl in her twenties,” Cordova said. “She was ready to be, ‘OK, I'm 30, I'm going to take life serious.’”
Birthing people and babies in the U.S. die at a higher rate every year compared with other developed countries. The vast majority of pregnancy-related deaths were preventable, according to the Centers for Disease Control and Prevention.
For every mother who dies, dozens more experience short- and long-term health problems after birth, and those rates are also on the rise.
“We have to start looking above the individual level to really think about what is happening in the hospital setting, what is happening in the community setting, and what is happening at the policy level,” said Rebekah Israel Cross, a postdoctoral researcher at the University of North Carolina’s Gilling School of Global Public Health.
Cross' dissertation examined the relationship between gentrification and pre-term birth. She found the soaring cost of living can push Black and brown families into neighborhoods with fewer health care resources.
“It's also about access to resources, access to care that can allow us to have more healthy births, more healthy babies in the long run,” Cross said.
Research shows the factors that contribute to the disparities in maternal and infant health are varied and systemic.
For example:
Valentine’s family said she was aware of these factors and that motivated her in choosing her health care providers and advocating for her own healthy pregnancy, including her pursuit of a doula.
Doulas provide people and their families with educational, emotional, and physical support before, during, and after a baby is born.
Research shows people who receive this kind of continuous support are less likely to have pre-term or cesarean births, use fewer pain medications, and have improved labor and delivery outcomes.
Valentine connected with Rancho Cucamonga doula Stanis Askew through a program called Frontline Doulas, which pairs Black families with Black birth workers. Frontline Doulas emphasizes in its mission that its doulas "are more likely to witness and support clients in navigating institutionalized racism and cultural incompetence within the medical setting."
The initial arrangement was for three prenatal and postpartum appointments and support during birth. Early on, Valentine asked Askew if she could talk weekly.
“She advocated for herself,” Askew said.
Askew remembered when she’d visit Valentine at her sister’s home in Los Angeles. Their meetings included Robertson and immediate family, and occasionally members of her extended family.
“It was her having her first baby experience, but she was sharing it with her family,” Askew said.
They stretched and practiced breathing exercises together, Askew said. Valentine would specifically request “the thumb one.” Alternating nostril breathing is the practice of inhaling through one nostril and out the other; it can be calming and soothe anxiety.
Through these visits and phone calls, Askew said she helped Valentine create a plan, from taking childbirth classes to pain management and exercise.
Valentine wanted to be surrounded by family in the delivery room, Askew said. Knowing that many hospitals restrict the number of visitors, Askew said she helped Valentine narrow down the list to her partner Nigha Robertson, sister Kesiah Cordova, and the doula herself.
In the early months of the COVID-19 pandemic, hospital policies often limited the number of people in the delivery room and restricted doulas from providing in-person support to their clients.
But by June 2021, the California Department of Public Health recommended that a doula be permitted in the room in addition to the patient’s desired support people.
“We weren't circumventing the system,” Askew said. “April had done her due diligence in asking, repeatedly [and] getting confirmation.”
Robertson, Cordova, and Askew each said Valentine discussed her birth plan in multiple prenatal appointments with Allen and with Centinela staff during her hospital visit. That included her desire to have a doula present.
A list of preferences for your childbirth experience that can include everything from how you plan to manage pain to whether you want to move around during labor. Patients can share this with their provider and, if relevant, the hospital they plan to birth at so everyone’s on the same page.
“I was there and I heard the promises,” Cordova said of the hospital visit. “I was there and I heard the words.”
Valentine was in the early stages of labor during the weekend of Jan. 7, said her family and doula. Valentine walked with Cordova up and down the hills of her sister’s Los Angeles neighborhood on Saturday, and again Sunday at a Baldwin Hills walking track with the addition of her doula, nephew, partner, and their pitbull-mix dog Ace.
Askew showed her how she could feel her stomach tighten by putting her hand on her belly.
“She was like ‘ooooh,’ just like enlightened by those little, little things,” Askew said.
Cordova said she took Valentine to a doctor’s appointment the afternoon of Monday, Jan. 9.
Cordova said she watched Allen call and tell Centinela Hospital staff Valentine would arrive in a few hours.
“[Allen] hung up the phone and she looked at me right in my face and said, 'I'll meet you guys there,'” Cordova said.
Valentine checked into the hospital, along with her sister and Robertson that evening, both said.
Askew said she was already on her way when Valentine called to say the hospital staff told her the doula wouldn’t be let in to see her.
“I'm still gonna be able to provide support to you,” Askew said she told Valentine in texts and phone calls that night. “You're not being left.”
In response to questions from LAist about its doula policy, the Centinela Hospital Medical Center spokesperson wrote that patients are permitted two visitors in addition to a doula, who is considered a support person. Physicians can also make exceptions to visitation policies “in the best interest of patients and families and in compliance with public health regulations.”
“We accommodate our patients and their birth plans and we welcome the presence of doulas,” the spokesperson wrote.
Robertson and Cordova said Valentine asked for staff to call Allen to ask about her doula, and a nurse responded that the physician would get upset if they contacted her. Robertson and Cordova remember the nurse said Allen “will cuss me out” if called. The nurse said the doctor would arrive the next morning, they said.
Hospital staff gave Valentine an epidural to manage the pain, Robertson and Cordova said. Both said Valentine started to complain of numbness, pain and swelling in her legs.
“That’s normal, that’s normal, that’s normal,” Robertson said they heard over and over. In a statement, the hospital said “leg numbness after placement of an epidural for labor anesthesia is not uncommon.”
“This is what we went through for hours,” Cordova said. Valentine’s questions, concerns and the hospital staff’s replies play in a loop in her head: “Where's the doctor? Can you look at my leg? That's normal.”
“Even if they didn't know what it was, why didn't they check?” Cordova said.
Robertson and Cordova said Allen didn’t see Valentine until Tuesday afternoon — almost a full day after she checked into the hospital.
Robertson and Cordova said they did not hear an explanation for what the doctor would do next. “It almost looked like she shoved her hand in,” Cordova said, describing how Allen examined Valentine. “The way she jerked her arm out, I said, ‘Wait a minute, what did you do?’”
They said Allen manually broke Valentine’s water.
Valentine again asked for her doula to be admitted and the physician denied her request, Robertson said. Allen’s attorney did not respond to LAist’s questions about the doctor’s view of a doula’s role in maternal health care.
Cordova said while hospital staff prepared the room for delivery, Valentine complained again about her leg.
“For the last time, she said, 'I can't feel my leg,'” Cordova said.
Robertson said Valentine complained of nausea and threw up a thick spit. He said they heard again from hospital staff that this was “normal.” Soon after, Robertson said he could tell Valentine stopped breathing. Cordova said her sister’s eyes rolled back and locked into place.
Robertson said he ran into the hallway screaming “Yo, help, help! My girl not breathing. Help! Please help, get a doctor!”
Robertson said while he waited, he started performing chest compressions on Valentine. Robertson said he called out again: “Help me, she ain’t breathing.”
He said Allen re-entered and soon thereafter performed an emergency C-section.
Robertson said starting with her birth plan, Valentine was relying on the support of her physician and the nurses.
“But when it came down to April[‘s] last moment, she didn't have no support from nobody,” Robertson said. “I'm the only one [to] touch April and try to save her life and it leaves me feeling like at times I failed cause I couldn't bring her back.”
As of Sunday, Feb. 26, the L.A. County coroner had not released a cause of death, “pending additional investigation.”
Cordova said she’s learned more about the larger maternal health crisis since her sister’s death, including Serena Williams’ life-threatening birth complications. Williams wrote about how she had to press her nurse repeatedly for help when she felt something was wrong with her body after her daughter’s delivery.
“Why are these women dying and how can we stop it?” Cordova asks.
“I hope that my sister's death is not in vain,” Cordova said. “I hope that it means something. I hope that it saves one life.”
Valentine’s family, friends, and supporters have held rallies outside of Centinela Hospital, her physician’s Gardena clinic, and spoken out during public comment at city and county government meetings, asking for investigations of both Centinela and Allen.
“We can come together and we can fight for what's right,” said Mykesha Mack, Valentine’s cousin, standing outside of the hospital in mid-January. ”We can do it in a just and righteous way.”
Mack has organized a movement named Justice for April Valentine. Mack said dozens of people have responded to Valentine’s story on social media by sharing complaints about care received by loved ones at Centinela Hospital.
On Jan. 31, Mack and Robertson were among those who asked the L.A. County Board of Supervisors to support an investigation into Valentine’s death.
“We cannot afford to neglectfully and carelessly lose another Black mother and healer of our community,” Valentine’s friend Cheyenne Sims told the board. “I'm begging you guys to step in and use your influence to help us raise awareness and justice.”
The supervisors broke from the norm and responded during the meeting.
“On behalf of the entire board, we are expressing our deepest heartfelt condolences,” said Supervisor Holly Mitchell. “For me, I'll add anger, because we know of the disproportionate rate at which Black women die during childbirth and shortly thereafter.”
The following week, the board unanimously voted to send a letter asking Gov. Gavin Newsom, the state’s Health and Human Services Agency, the attorney general and legislative leaders to investigate the “care and circumstances surrounding the death of Ms. April Valentine.”
We can come together and we can fight for what's right... We can do it in a just and righteous way.”
Cordova, who’s the mother of two, said it’s hard to understand why people are dying in childbirth, not just in L.A., but throughout the country.
“Why is it that my sister laid in a bed fearing for her life?" Cordova said. "All I feared was the next labor pain.”
Her son recently got married.
“We've been telling them, when is the baby coming?... Now, I feel like I wouldn't dare ask her because now I'm afraid,” Cordova said. “We don't expand our family because we wanna keep the ones that are here? That's scary.”
In response to a complaint filed in February, the California Department of Public Health visited Centinela Hospital in the weeks after April Valentine's death.
Investigators examined the cases of several patients who gave birth at the hospital. In their final report, obtained by LAist in June 2023, investigators found Centinela staff failed to take preventative measures to reduce the risk of blood clots, which could lead to serious injury or death — creating a situation known as “immediate jeopardy.”
CDPH has a separate investigation still active in response to a request from the L.A. County Board of Supervisors.
Assemblymember Tina McKinnor represents the district that includes Centinela Hospital. She said in an emailed statement that she’s worked with State Sen. Steven Bradford “to help Ms. Valentine’s family get answers to the many questions that remain by requesting that the state [Department of Public Health] fully investigate Ms. Valentine’s death.”
On Feb. 23, DPH notified the Board of Supervisors that it intends to do just that.
“During the investigation, [The California Department of Public Health] will review medical records, interview staff and patients, and assess the hospital’s policies and procedures,” Health and Human Services Secretary Mark Ghaly wrote to them. “The investigation will determine whether any violations of state or federal regulations have occurred.”
More From AirTalk: What Rights Do Birthing Parents & Doulas Have In Hospitals?
Ghaly also wrote that the hospital could have to take corrective action, and faces fines, the loss or suspension of its license and additional investigations.
Creary II, Allen’s attorney, told LAist via email that “all of the accusations come from family members and associates of the patient, not the patient herself.”
In response to LAist’s questions about internal and external investigations, a hospital spokesperson wrote: “We are cooperating with all investigations, and also conducting our own internal review with quality and clinical care teams. While we cannot comment further on pending investigations, we can tell you that our mission is to heal, and we share in the grief of this family.”
The statement also pointed to several favorable evaluations of its care.
The nonprofit Cal Hospital Compare named Centinela to its Maternity Care Honor Roll for meeting or surpassing the state’ goals for low numbers of births via C-section.
However, Cal Hospital Compare also ranked the hospital “poor” for its breastfeeding rates and episiotomies, a surgical cutting of the vagina that “actually may lead to more short- and long-term harm.” Centinela also ranks below average for patient experience, which is based on how well patients reported they could communicate with doctors and nurses, receive information, and whether they would ultimately recommend the hospital.
Leapfrog, another nonprofit that analyzes public data on hospitals, gave Centinela an A in safety but also noted below-average rankings for how well patients felt they could communicate with staff.
The path forward for the people and families harmed in the course of their care during pregnancy and childbirth is often unclear.
“There is such a dearth of information. It is so hard for people to get help,” said Indra Lusero, director of the Colorado-based birth justice organization Elephant Circle.
A few years ago the group helped put together a resource meant to help people defend their human rights during birth and seek redress when they’ve been harmed.
While most anyone who is 18 years or older and who has experienced some kind of harm can file a civil lawsuit in California, winning one often takes expert legal help and the money to pay for it.
"But not all harms can be quantified into a money judgment and not all claims are clear cut or safe enough to bet on,” Lusero said, explaining why attorneys might not take on a case.
A California law signed in 2022 triples the damages for pain and suffering that victims of medical malpractice can seek. The widower of a woman who died during a scheduled C-section at Cedars-Sinai Medical Center was one of the bill’s supporters.
“People know harms happen. They feel it,” Lusero said.”It's just gonna take time to make sure that the law is responsive to those.”
Lusero said other steps people can consider after experiencing a violation include filing a complaint with the hospital or health system, the state agency that licenses physicians, or their state representatives.
If you believe you’ve experienced a violation during pregnancy or labor, it can sometimes be challenging to know what course of action to take. In their resource on birth rights, Pregnancy Justice and Birth Rights Bar Association (BRBA) offer the following options as a place to start.
There’s no one right approach, so it’s important to weigh the pros and cons of each of these strategies, and keep in mind that some come with risks or may not be realistic for everyone.
Each of these actions has potential benefits but also costs, including the discouragement that comes with the absence of meaningful changes.
“I think sometimes people don't get justice, at least not in their lifetime, and so if they can't get justice, what I hope for people is to get some healing,” Lusero said. “I do think that we have more in our control in terms of healing than justice sometimes.”
“But also at the same time, there's always something to do,” Lusero said. ”I truly, deeply believe in the value of people doing what they can with what they have.”
Baby Aniya has the same big, brown, light-filled eyes as her mama.
Robertson sees beauty, happiness, and joy when he looks into them. He also sees Valentine’s absence.
“She wanted this baby so bad and never just got to hold her, never even got to lay eyes on her,” he said.
Robertson’s mother flew in from Mississippi to help care for the infant. Valentine's doula, Askew, still supports the family. She recently helped Robertson select a formula to replace Valentine’s plan to breastfeed for the first year.
Askew said continuing her service as a doula to help other families feels necessary.
“It’s a way to honor April,” Askew said. “Her birth story is not in vain.”
Robertson is a constant presence at the Justice for April Valentine public events, though not the center of attention or the one leading the chants.
“I try to stay behind, like closed doors,” Robertson said. “I would wear glasses all the time. I wear hoodies now, but then I told myself this is not something I did or something I gotta go put myself in the dark hole for.”
He’s largely avoided social media since Valentine’s death, but Robertson said he’s grateful for the attention to Valentine’s passing.
“I wanna take the attention and use it to really shine light on this situation,” Robertson said.
How To L.A. Newsletter host Aaricka Washington contributed to this story. Early childhood engagement producer Stefanie Ritoper created the lists of resources.
These resources were recommended by California birth workers and families. Have a suggestion? Email sritoper@scpr.org.
For more on specific topics, see LAist’s pregnancy guides.
Mental Health
Breastfeeding
Doulas / Postpartum Support
Doulas provide expecting and new mothers or birthing people with educational, emotional, and physical support before, during, and after a baby is born. Postpartum doulas’ services can include cooking, help around the house, and various healing modalities. Pro tip: many postpartum doulas are available pro-bono while they are seeking certification.
Support Groups
Many support groups and parent and me classes exist throughout Southern California, and the best way to find one is to search online for groups in your area. You might also find these groups through your hospital or places where you find breastfeeding gear. It sometimes helps to look for activities you enjoy (eg. yoga, swimming, dancing) and see if they have “baby and me” classes.
A few places to start:
For Black Parents-to-Be
For Partners / Fathers
Loss / Grief
Social Services
