Jordan Ellis
The number of birthing hospitals in the US is difficult to pinpoint, as there are many different types of birthing facilities, including freestanding birth centers, hospital-affiliated birth centers, and hospitals with maternity wards. According to one source, there are over 400 freestanding birth centers in the US, which offer a more natural and personalized approach to childbirth in a homelike environment. Another source states that there are 415 freestanding birth centers in 40 states and Washington, D.C. However, it's important to note that over 35% of US counties are considered maternity care deserts, meaning they lack access to birthing hospitals, birth centers offering obstetric care, or obstetric providers. This issue particularly affects rural areas, where women may face long drives to reach the nearest hospital or birthing center.
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What You'll Learn
There are over 400 birthing hospitals in the US
Birthing hospitals in the US vary in terms of the level of care and support they provide. Some hospitals offer one-to-one nursing care during labor and birth, while others have nurses attending to multiple women simultaneously. Hospitals also differ in their policies regarding the number of individuals allowed to be present for support during birth, with some allowing only one or two "visitors," while others allow the woman in labor to choose.
The availability of certain labor support tools, such as birth and peanut balls, hydrotherapy options, and telemetric electronic fetal monitoring, also varies across hospitals. Additionally, hospitals differ in their routines and interventions, such as the use of routine IV lines, blood draws, and oral intake. Some hospitals emphasize low-intervention births, while others offer interventions as needed or desired, such as augmentation of labor, continuous fetal heart rate monitoring, and medication for pain management.
In recent years, there has been a growing demand for birth centers in the US, which offer a more natural and personalized approach to childbirth. Birth centers provide a homelike environment, certified midwife care, and lower intervention rates for procedures like cesarean sections and epidurals. They are also more affordable than hospitals, with the average cost of a vaginal birth at a birth center being about half the cost of a hospital birth. The COVID-19 pandemic further highlighted the advantages of birth centers, as they were considered safer alternatives to hospitals due to lower risks of viral exposure.
Despite the availability of birthing hospitals and birth centers, it is important to note that over 35% of US counties are considered "maternity care deserts," lacking access to birthing hospitals, birth centers, or obstetric providers. This affects over 2.3 million women of reproductive age and contributes to poorer health before and during pregnancy, lower prenatal care, and higher rates of preterm birth.
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35% of US counties are maternity care deserts with no birthing hospitals
The United States is facing a crisis in maternity care, with a significant number of counties lacking access to essential birthing resources. A recent report by March of Dimes revealed that approximately 35% of US counties, amounting to 1,104 counties, are classified as maternity care deserts, signifying a dearth of birthing hospitals, birth centres, and obstetric providers. This issue affects over 2.3 million women of reproductive age and contributed to 150,000 births in 2022.
Maternity care deserts disproportionately impact low-income women and women of colour, exacerbating existing health inequities. The absence of local birthing hospitals and obstetric care in these counties results in longer travel distances for pregnant women, often requiring ridesharing services or lengthy drives to the nearest city. This lack of accessibility leads to inadequate prenatal care, with one in six babies in maternity care deserts not receiving sufficient prenatal attention. Consequently, there is a 13% increased risk of preterm birth for patients in these areas.
The shortage of maternity care options also extends beyond hospitals. Freestanding birth centres, which operate separately from hospitals and often follow a midwifery model, provide an alternative for families seeking a different birthing experience. However, there are only 415 of these centres across 40 states, and they cater to less than 0.5% of births in the US. While they can offer a valuable choice for those seeking a more personalised approach, they are not a widespread solution to the shortage of birthing hospitals.
To address this crisis, various approaches are being explored. Community-led initiatives, such as the Roots Community Birth Center in Minneapolis, aim to serve communities of colour and low-income families by providing positive birth outcomes and low hospital transfer rates. Additionally, states are testing new approaches through funding opportunities like the Transforming Maternal Health (TMaH) Model, which supports community-based providers and freestanding birth centres to improve maternal and infant health outcomes.
The situation in maternity care deserts underscores the urgent need for strategic and collaborative efforts to improve access to care. Policy changes, improved support for rural hospitals, and increased utilisation of telehealth services are among the suggested solutions to tackle this complex issue and ensure that all families have the opportunity to receive the essential care they deserve.
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Home-like birthing centres are rising in popularity
This trend is driven by several factors. Firstly, many women are seeking to avoid invasive procedures common in hospital deliveries, such as epidurals, induced labour, and high rates of C-sections. They want to feel more empowered during their birthing experience and are attracted to the midwifery model of care offered by home-like birthing centres, which emphasizes low-intervention births. This model has been shown to reduce adverse birth outcomes such as preterm births, low birth weight, and NICU admissions.
Additionally, the pandemic played a role in accelerating this shift as hospital births became riskier and more challenging due to COVID-19 protocols. The existence of "maternity care deserts", where there is limited or no access to birthing hospitals or obstetric care, also contributes to the popularity of home-like birthing centres. Over 35% of counties in the US are considered maternity care deserts, affecting over 2.3 million women of reproductive age.
Home-like birthing centres typically cater to low-risk pregnancies and are led by licensed midwives who provide personalized care. They offer a continuum of maternity care, often partnering with hospitals for seamless transfers in case of emergencies. Efforts to establish new birth centres are also being driven by socially-minded entrepreneurs and community-based organizations seeking to improve access to maternal healthcare, especially for communities of colour.
While the rise in home-like birthing centres provides an alternative for those seeking a different birthing experience, it also highlights the need to address disparities in access to maternity care across the US and ensure that all families have safe and satisfactory birthing options.
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Birth centres are more affordable than hospitals
The US has over 1,100 counties without a single birthing facility, affecting over 2.3 million women of reproductive age. These "maternity care deserts" highlight the need for accessible and affordable birthing options. Birth centres, freestanding facilities separate from hospitals, offer a more affordable alternative to hospital births.
While hospital births can be complicated and expensive, birth centres provide a cost-effective option. For example, a woman who gave birth at a hospital in Georgia paid $5,032.48, while her friend, who used a midwife at a birth centre in Minnesota, paid a total of $2,900 with insurance. This lower cost is partly due to the shorter stay at a birth centre, as mothers and newborns are discharged as soon as they are healthy, reducing the overall cost.
Birth centres also offer personalised and comprehensive care, including midwife-led prenatal, birth, and postpartum services. This continuity of care is valued by many mothers, who appreciate the comfort and privacy that birth centres provide. Additionally, birth centres often have partnerships with local hospitals, ensuring seamless transfers in case of emergencies or more intensive medical interventions.
Furthermore, birth centres are committed to making their services accessible to all. They accept various insurance plans, offer self-pay discounts, and provide interest-free payment plans. Some birth centres, such as the Willow Midwife Center, even have scholarship programs to assist those who cannot afford their services otherwise.
While birth centres may not be the right choice for everyone, they offer a viable and more affordable option for low-risk pregnancies. By providing a nonmedical, private, and cozy environment, birth centres empower mothers to have a positive and cost-effective birthing experience.
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High maternal mortality rates are driving hospital alternatives
The United States has the highest maternal mortality rate among developed countries, with 22 maternal deaths for every 100,000 live births in 2022. This rate is more than double, sometimes triple, that of most other high-income countries. The maternal mortality rate has been increasing in the US since 2000, and most of these deaths are preventable. Within the US, the maternal mortality rate is highest for Black women. Research has found that Black people receive worse-quality care than white people, and racial disparities exist in maternal morbidity outcomes both within and between hospitals.
The high maternal mortality rate in the US is partly due to a shortage of maternity care providers relative to births. The US has the lowest supply of midwives and obstetrician-gynaecologists (ob-gyns) among developed countries, with 16 providers per thousand live births. This shortage is expected to worsen in the coming years, and nearly 7 million women in the US currently live in counties with no hospitals or birth centres offering obstetric care.
To address this crisis, policymakers and healthcare delivery system leaders are seeking alternatives to hospital births. One alternative is freestanding birth centres, which provide a choice for families to deliver outside of a hospital or their home. These birth centres, led by midwives, have been shown to help reduce adverse birth outcomes such as preterm births, low birth weight, and caesarean sections. They also provide postpartum care, which can improve mental health and breastfeeding outcomes while reducing healthcare costs.
Community-based birth centres, built by and for communities of colour, are another alternative that has the potential to transform maternity care. These birth centres address health inequities and improve maternal and infant health outcomes, particularly in low-income communities of colour. For example, Roots Community Birth Center in Camden, a neighbourhood with a high concentration of low-income Black families, has achieved low rates of caesarean delivery, higher-than-average breastfeeding rates, and low hospital transfer rates.
Funding opportunities, such as the Transforming Maternal Health (TMaH) Model, are supporting the development of these community-based birth centres. States can also broaden the availability of birthing centre models through provider and payment policies, leveraging Medicaid to improve access to maternity care.
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Frequently asked questions
There are over 400 birthing hospitals in the US, including both freestanding and hospital-affiliated birthing centers.
Freestanding birth centers are separate entities from hospitals, but they often partner with hospitals and provide a full continuum of maternity care. They provide a more natural and personalized approach to childbirth, with a focus on a homelike environment and midwifery care.
Yes, over 35% of counties in the US, or 1,104 counties, are considered maternity care deserts, meaning they do not have access to birthing hospitals or obstetric clinicians.
