A new nationwide study has revealed the ten U.S. states where maternity care is most at risk — with severe midwife shortages and high preterm birth rates creating dangerous conditions for expecting mothers.
The research, conducted by the Birth Injury Lawyers Group, analyzed the availability of midwives and preterm birth rates across all 50 states to rank where maternity care access and outcomes are most concerning. Each state received a Maternity Risk Score out of 100, calculated using two key indicators:
- Average Births to Midwife Ratio (2023) — reflecting how many births each certified midwife handles on average.
- Average Preterm Birth Rates (2018–2022) — the percentage of babies born before 37 weeks’ gestation.
A higher score represents greater maternity care concerns, from limited access to skilled professionals to increased rates of early or medically complicated births.
Southern and Midwestern States Face the Most Alarming Risks
The results show a clear pattern: Southern and Midwestern states dominate the list, highlighting ongoing disparities in maternal healthcare. Mississippi, Alabama, and Louisiana rank as the top three states with the most severe challenges, while Arkansas, Oklahoma, and Texas also appear among the top six.
These states often suffer from widespread maternal care deserts — areas where hospitals and certified midwives are scarce or entirely unavailable, forcing women to travel long distances for essential prenatal care.
In contrast, states like Massachusetts, Oregon, and Washington perform much better, with stronger midwifery networks, better prenatal programs, and higher healthcare investment per birth.
The 10 U.S. States With the Highest Maternity Risk
| Rank | State | Maternity Risk Score (/100) |
|---|---|---|
| 1 | Mississippi | 100 |
| 2 | Alabama | 91 |
| 3 | Louisiana | 79 |
| 4 | Arkansas | 77 |
| 5 | Oklahoma | 73 |
| 6 | Texas | 70 |
| 7 | Missouri | 63 |
| 8 | Nevada | 61.8 |
| 9 | South Carolina | 61.6 |
| 10 | Nebraska | 60 |
A Growing National Crisis
The study highlights how the lack of midwives is contributing to worsening maternal health outcomes across the U.S. Midwives play a vital role not just in delivering babies but in providing essential prenatal, postnatal, and preventative care. When states have too few certified midwives, expecting mothers are more likely to experience delays in care, higher stress during pregnancy, and poorer birth outcomes.
A spokesperson for the Birth Injury Lawyers Group said:
“The research reveals that many states are struggling to provide adequate maternity care for expecting mothers, driven by severe midwife shortages and high preterm birth rates.
States with limited midwifery support and underfunded maternal healthcare infrastructure tend to create far more dangerous environments for expecting mothers than those with robust, accessible care systems.
To address these challenges, states must prioritize increasing the number of certified midwives, implementing stronger prenatal programs, and ensuring maternity care is available in both urban and rural regions. Broader healthcare reform could also play a major role in improving the safety and quality of care for mothers nationwide.”
Understanding the Maternity Risk Score
The Maternity Risk Score was developed to provide a clear, data-led comparison of how well each U.S. state supports expecting mothers. For instance, Texas, which ranks sixth overall, recorded an average of 61.31 births per midwife and a preterm birth rate of 11.04%, giving it a total score of 70/100.
While not the highest on the list, the findings show how states with vast rural populations and limited midwifery infrastructure — such as Texas, Oklahoma, and Arkansas — face unique challenges in ensuring equitable access to maternal care.
These shortages are particularly pronounced in counties where hospitals have closed maternity wards or where transportation barriers limit access to prenatal checkups and birthing centers.
Methodology
The study analyzed midwife shortages and preterm birth rates across all 50 U.S. states to determine overall maternity risk levels. Two core metrics were used to calculate each state’s Maternity Risk Score out of 100:
- Average Births to Midwife Ratio (2023) — scored out of 50 points. States with higher births per certified nurse-midwife (CNM/CM) received higher risk scores.
- Average Preterm Birth Rate (2018–2022) — scored out of 50 points. States with higher rates of preterm births (before 37 weeks’ gestation) scored higher for risk.
These two scores were totaled to rank states from highest to lowest risk, with higher scores indicating greater maternity care concerns.
Data Sources:
The research was conducted by the Birth Injury Lawyers Group, a nationwide network of attorneys advocating for families affected by medical negligence.
