Having a baby on Orcas.

Start here

There is no hospital or birth center on Orcas. Every island family either plans a trip to the mainland or plans a home birth with a midwife, and either way a good birth starts with a good plan. Here is the whole plan on one screen:

• First trimester: start prenatal care and health coverage, and choose where you’ll give birth.
• Second trimester: sign up for a childbirth class, and look at air ambulance memberships.
• By week 30: ask your clinician when to leave for the mainland and where you’ll stay, ask about priority loading on the ferry, and find out whether your hospital wants you to pre-register.
• By week 36: bag packed, car seat installed, and your ferry plan and backup plan written down where you can both find them.
• Any time: if you’re in labor on the island, or something feels wrong, call 911.

Follow your baby’s growth in Pregnancy week by week.

Where island families give birth

Three mainland hospitals deliver babies within reach of the Anacortes ferry terminal. Drive times are from the terminal, in ordinary traffic.

None of the three has a Level III newborn intensive care unit, so ask each one what happens if your baby needs more care than it can give.

Birth centers and home birth

Freestanding birth centers, run by midwives, are in Bellingham (Bellingham Birth Center, 360-752-2229, and Birthroot Midwives, 360-734-2182) and in Mount Vernon (Mount Vernon Birth Center, 360-336-9997). For a home birth on the islands, San Juan Island Midwifery serves Orcas: 360-298-2429.

Apple Health covers a planned birth at home, in a licensed birth center or in a hospital, attended by a licensed midwife, a nurse midwife or a physician. Not every midwife or birth center takes every plan, so ask each one about yours.

Washington law requires every licensed midwife to keep a written plan for emergency transfer to a hospital. If you’re planning a home birth, ask to walk through that plan from your own front door: who gets called, how you would travel, and what happens when weather stops the flights. Talk honestly with your clinician about which setting is safest for you and your baby, given your health and the distance.

Prenatal care close to home

Some prenatal care can happen without a ferry ride. Ask about each of these early:

• Island Primary Care – Orcas (7 Deye Lane, Eastsound, 360-376-2561) lists women’s health and obstetrics and gynecology among its services, and an OB-GYN nurse practitioner is among its visiting specialists. Ask which of your prenatal visits can happen on the island.
• Video visits. Island Health’s family doctors who care for pregnant patients offer virtual visits, at the same cost as in person: 360-293-3101.
• A midwife who comes to you. San Juan Island Midwifery does prenatal visits in homes on all the islands. For families planning a mainland hospital birth, it offers prenatal and postpartum care on the island and transfers your records around 34 weeks.
• A ride from the ferry. San Juan County residents can get a free round-trip taxi between the Anacortes terminal and Island Health appointments. Call Mert’s Taxi the day before: 360-708-6358.
• Travel help with Apple Health. Non-emergency medical transportation can cover ferry tickets and mileage, and sometimes lodging and meals, when it’s approved ahead of time. Call the Northwest Regional Council at 1-800-860-6812 a week or two before your appointment.

Getting on the ferry

• Reserve a spot. Vehicle space from Orcas to Anacortes is released in three waves: two months before each season starts, two weeks before each sailing, and two days before. Reserve with Washington State Ferries or at 888-808-7977. Arrive 45 to 60 minutes early: if you haven’t checked in 30 minutes before the sailing, you lose the spot.
• Ask about Medical Preferential Loading. If a long wait on the dock would put your health at risk, your doctor, nurse, midwife or clinic can apply online for priority boarding, for a single day, 30 days or a year. Only the provider can apply. Bring the printed confirmation email and matching ID, and arrive 30 minutes before the sailing. It isn’t for routine appointments.
• Know the crossing. It takes 55 minutes direct, and up to an hour and a half with stops at Shaw or Lopez.
• Know the gap at night. On the fall 2026 and winter schedules, the first ferry leaves Orcas for Anacortes at 6:50 a.m. and the last at 9:55 p.m. Schedules change with the seasons, so check the current schedule.
• Get the alerts. Sailings can be cancelled or run late. Sign up for email or text alerts for the Anacortes and San Juan Islands route.

In labor on Orcas? Call 911. Washington State Ferries asks people in labor to call 911, so an ambulance can take them on the ferry when possible.

If labor starts on the island

Call 911. Orcas Island Fire & Rescue has a paramedic on duty around the clock in Eastsound, with volunteers across the island, and it arranges about 300 flights off the island every year from seven landing sites.

• Who flies: Airlift Northwest (helicopters based in Bellingham and Arlington), Island Air Ambulance (airplanes, based in Friday Harbor) and Life Flight Network (helicopters based in Coupeville and Port Angeles). Emergency crews call the aircraft, and weather can decide where it takes you.
• When nothing can fly: local news has reported two workarounds. In December 2025, in high winds, crews sent ambulances across on the ferry. In September 2020, when smoke grounded the aircraft, the sheriff’s boat carried two women in labor to Anacortes, and one baby was born on the way.
• Who can come along: a family member can often ride with the patient if the pilot approves, Island Air Ambulance says. Plan how dad gets there if he can’t.

Learn the signs that mean call now: signs of labor and preterm labor, and warning signs to never ignore.

What a flight costs

Federal law bars surprise out-of-network bills from air ambulances. Apple Health pays for a flight when your condition needs it, and people on Apple Health aren’t billed a balance, so the flight companies tell them not to buy a membership.

With other insurance you can still owe a deductible or co-pay. Each company sells a membership that covers what your insurance leaves unpaid, but none covers the other two companies’ flights, which is why Orcas Island Fire & Rescue recommends holding all three. The memberships work alongside insurance that covers air ambulance; they don’t replace it. As of November 2026:

• Airlift Northwest: $85 a year, 888-835-1599. Tell them about a new baby within 30 days.
• Island Air Ambulance: $39 a year for a household, 360-378-2376.
• Life Flight Network: $85 a year, 800-982-9299. Benefits start 72 hours after you pay.

Staying near the hospital

No hospital, county office or midwife publishes a rule for when island families should move to the mainland, so ask your own clinician. Bring these questions to a visit by about week 30:

• When do you want us on the mainland, and what would make you want us there sooner?
• What should we do if labor starts at night, after the last ferry?
• Will you apply for Medical Preferential Loading for us, and when?
• If our baby needs extra care, where would our baby be taken?

Help with the cost of staying near the hospital:

• Hotels. Island Health says many Anacortes hotels give its patients a discount, and PeaceHealth St. Joseph lists nearby hotels with special rates. Ask when you book.
• Apple Health. The transportation broker can approve lodging and meals when your care is away from home: 1-800-860-6812.
• Orcas Community Resource Center. Emergency medical ferry tickets, case by case, when funds allow: 360-376-3184.
• County Transportation Voucher Program. Help with ferry fares, taxis and water taxis for residents with an income under $25,000, among others. Medical requests are still accepted while funds last: [email protected].

Classes and tours

• Island Health, Anacortes. “From Bump to Baby” runs for five Tuesday evenings or one Saturday and includes a tour of the birth center. It costs $115 for one person or a couple, and Apple Health covers it. Register at 360-299-4204.
• Skagit Regional Health. An online childbirth class you can watch any time, in English or Spanish, for $50: 360-814-2283.
• Bellingham Technical College, with PeaceHealth. In-person childbirth, breastfeeding and infant care classes. Fees are waived with Apple Health, and half scholarships are available: 360-752-8353.
• San Juan County. Breastfeeding classes in English and Spanish. Call or text 360-298-5140.

Prices are as of November 2026.

Coming home

• The first checkup comes at 3 to 5 days old, so book it before the birth. Island Primary Care – Orcas has a pediatrician: 360-376-2561.
• Feeding help, day or night. The county’s peer counselors answer 24 hours a day, and the Orcas line is 360-298-5827. For a weight check, call 360-298-5150. See Feeding your baby.
• Visits at home. Growing Families San Juan Islands sends a nurse or community health worker to your home, free, until your child turns 2: 360-378-4474.
• The car seat. Your baby rides rear-facing from the very first trip. Island Health hosts car seat check clinics in Anacortes: ask its Health Education office at 360-299-4204. Orcas Island Fire & Rescue has had a car seat program too, so ask whether it’s running: 360-376-2331.
• The birth certificate. You’ll fill in a form at the hospital, but that doesn’t order a copy. The county office in Friday Harbor issues certified copies for $25 in person or by mail. You can also order online, where the fees vary: see birth certificates.
• Coverage for your baby. A baby born to a mother on Apple Health is covered automatically. Report the birth within 30 days at Washington Healthplanfinder or 1-855-923-4633.
• Dad’s paperwork. If you aren’t married, the hospital can help you both sign an Acknowledgment of Parentage. See Becoming a dad.

For the weeks after that, see New baby & parenting.