My Story | MyBirthLA

We'd love to hear about your experience!

Full Name

Email

Phone

Are you currently living in Los Angeles?

Yes

No

How old were you at the time of your birth experience?

Did you experience any pregnancy complications that were a threat to you or your baby's health? If so, please share.

Please share your birth story in your own words.

How would you describe your postpartum experience?

Were there any health risks, complications, or warning signs you wish more mothers knew about?

Did you feel heard and respected during your birth experience? Why or why not?

What do you wish someone had told you before giving birth?

What advice or encouragement would you offer other mothers?

If you could change one thing about maternal care, what would it be?

Are you interested in becoming a MBLA (MyBirthLA) digital advocate, enabling us to uplift your story to empower other mothers?

Yes, with my full name

Yes, but anonymously

Yes, with first name only

I would like to discuss this further

Are you comfortable with us sharing your story as content in either caption + photo form, a carousel, or a reel, while crediting you?

Yes

No

If you'd like for us to share your story publicly on social media, what is your Instagram username?

May we lightly edit your story for clarity while preserving your voice?

Yes

No

Please share up to 6 images or videos around your pregnancy, birth, or postpartum experience.

Consent & Release

By submitting this form, I confirm that this story is my own experience. I give MyBirthLA permission to share my written story, images, and videos across social media, website, educational materials, and advocacy campaigns. I understand I can request removal of my story in writing at any time.

Do you agree to the consent statement above?

Yes

No