The 10 U.S. States With the Worst Maternity Care Revealed

A new nationwide study has uncovered the American states where expecting mothers face the greatest risks — and the findings point to major gaps in maternity care across the South and Midwest.

Researchers from the Birth Injury Lawyers Group analyzed the latest data on midwife shortages and preterm birth rates across all 50 U.S. states. The goal: to find where mothers are most at risk during pregnancy and birth.

Each state received a Maternity Risk Score out of 100, calculated using two main indicators:

• The Average Births to Midwife Ratio (2023), showing how many births each certified midwife is responsible for.

• The Average Preterm Birth Rate (2018–2022), which tracks how often babies are born before 37 weeks.

A higher score means greater risk — reflecting both limited maternity care access and higher rates of early or medically complicated births.

Southern States Dominate the List

According to the report, Southern and Midwestern states face the most serious maternity care shortages. Mississippi, Alabama, and Louisiana took the top three spots, followed by Arkansas, Oklahoma, and Texas.

These states are struggling with both a shortage of certified midwives and high rates of preterm births, creating dangerous conditions for mothers and newborns. In many areas, women must travel long distances to reach hospitals or birthing centers, with some counties lacking a single maternity ward or certified midwife.

In contrast, states such as Massachusetts, Oregon, and Washington performed far better thanks to stronger healthcare infrastructure, more midwifery programs, and accessible prenatal care.

The Top 10 States With the Highest Maternity Risk

Experts Warn of Growing Maternity Deserts

The study’s authors say that the shortage of midwives and unequal access to care are fueling what they describe as a “maternal care crisis.”

A spokesperson for the Birth Injury Lawyers Group explained:

“The data shows that several states are failing to provide adequate maternity care for expecting mothers. Severe midwife shortages and high preterm birth rates are creating dangerous conditions for families.

States need to prioritize increasing the number of certified midwives, improving prenatal care programs, and expanding access to maternity services — especially in rural and underserved areas.”

Midwives are often the first line of defense in preventing complications. They monitor pregnancies, support natural births, and help detect problems before they become emergencies. Without enough midwives, many women are left with delayed care and limited choices during delivery.

What the Data Reveals

The study shows that Mississippi faces the greatest maternity care challenges in the nation, scoring 100 out of 100 on the risk index. Alabama (91) and Louisiana (79) follow closely behind.

Even states that didn’t make the top five — such as Texas and Missouri — still show troubling signs, including higher-than-average preterm birth rates and gaps in maternity infrastructure.

These findings align with broader CDC data showing that Southern states consistently record preterm birth rates above 10%, compared to around 8% in more resource-rich states.

Methodology

The study conducted by the Birth Injury Lawyers Group analyzed maternity data across all U.S. states using two primary metrics:

1. Average Births to Midwife Ratio (2023) — scored out of 50 points. This measures how many births each certified nurse-midwife (CNM/CM) oversees in each state.

2. Average Preterm Birth Rate (2018–2022) — scored out of 50 points. This measures the percentage of births that occur before 37 weeks of pregnancy.

The two scores were added together to create each state’s Maternity Risk Score out of 100, ranking states from highest to lowest risk. Higher scores indicate greater maternity care concerns.

Data Sources:

• Preterm birth rates by state: CDC

• Number of Certified Nurse-Midwives (CNM/CM) by state: American Midwifery Certification Board (May 2023)

• Full research dataset: Google Sheets – Birth Injury Lawyers Group

The research was conducted by Birth Injury Lawyers Group, a nationwide network of attorneys advocating for families affected by medical negligence.