Revealed: The Best and Worst States for Maternity Care 

A new study has uncovered the states providing the most comprehensive maternity care and revealed the states that need improving.

• A new index ranking has revealed Louisiana as the best state in the country for maternity care, scoring 90 out of 100 across 10 metrics.

• Louisiana is followed by Oklahoma, with a score of 84.9, and California, which gained a score of 80.2.

• At the bottom of the study, South Dakota scored just 13.5, with Alaska coming second from bottom with a score of 16.4.

The study, conducted by Birth Injury Lawyers Group, assessed 10 different metrics related to state-specific costs, services, and policies for maternity care. Scores were totaled to provide each state with a score out of 100. The data is sourced from the National Academy for State Health Policy, Kaiser Family Foundation, FAIR Health, and The Policy Center for Maternal Health.

Metrics include the average cost of C-sections and vaginal births in and out of network (in-network means there is a contract with the healthcare provider and the insurance for a reduced cost), whether the state provides a maternal health task force of commission, Medicaid expansion (giving Medicaid to all below a certain income without additional requirements to qualify) and Medicaid postpartum cover, and if the state requires doctors to screen for mental health disorders pre-and post-birth.

Top 10 States for Maternal Healthcare

The research revealed Louisiana scored the highest in the ranking, receiving a score of 90 out of 100. The state has the lowest cost of giving birth in the country across all types of delivery and both in and out-of-network prices. The average in-network cost for non-C-section births comes to $8,923. Alongside this, the state is one of just three in the US that has both a mental health task force for new mothers and requires doctors to screen for mental health disorders both pre and postnatal.

In second place is Oklahoma, which gained a score of 84.9. In Oklahoma, the state has the fifth-lowest cost of in-network birth delivery at $10,681 and follows Louisiana in having both a mental health task force and mental health screening that is required for mothers pre-and-post-birth – the second of three states to do so.

California comes in third place with a score of 80.2. Whilst the state is one of the most expensive states to give birth in, costing an average of $17,791, they have extensive Medicaid cover, including postpartum cover, and is the third and final state which has both a mental health task force and required mental health screening for mothers.

Next in line is Maryland, which gained a score of 65.9. Maryland has below-average costs for birth at $11,033 on average in-network, overall being the fourth lowest cost in the country. The state missed out on a higher position here due to there being no requirement for care organisations to carry out pre- and post-natal screenings for mental health issues. However, there is a maternal mental health task force, Medicaid expansion, as well as postpartum Medicaid support in place.

In fifth place, with a score of 65.3, is Illinois. Although ranked as the 22nd most expensive to give birth in across both in and out of network costs, in terms of mental health maternal policies Illinois, along with New Jersey, ranked joint fourth as it is a requirement for doctors to screen mothers for mental health issues both before and after birth with state Medicaid. Additionally, while there is no maternal mental health task force or commission, state Medicaid covers postpartum care.

Ohio ranked in sixth place with a score of 64.0, followed by Arizona in seventh place with 59.3. Both states have below-average costs of delivery and have a maternal mental health task force.

In eighth place is Massachusetts with a score of 58.1, then finishing off the list are Oregon, with a score of 57.7, and Pennsylvania with a score of 55.3.

Bottom 10 States for Maternal Healthcare

On the opposite end, South Dakota received the worst score at just 13.5 out of 100. The state ranked 28th cheapest for all types of birth in the country, with this figure standing at $13,294 for in-network vaginal delivery. Despite this, there is no mental health task force or commission, expanded Medicaid is not offered, nor is postpartum Medicaid included – one of only three states not to offer one of either- and there are no requirements for pre-and-post-natal mental health screenings.

Following South Dakota are Alaska, with 16.4 out of 100, and Nevada, with a score of 19.8.

Commenting on the findings, Bob Goldwater from Birth Injury Lawyers Group said: “Maternity care has always been a big issue for Americans, though it is interesting to see the support now on offer that wasn’t there even just 30 years ago – specifically in postpartum mental health.

“The study highlights the difference in standards between neighbouring states, such as California and Nevada wherein the former ranked highly on the list with good mental health support, whilst the latter doesn’t have Medicaid expansion policies, nor does it have any requirements to check for mental health screenings before or after birth.

“Only five states’ Medicaid requirements have measures in place where health care providers need to screen for mental health issues post-partum. Alongside this, only seven states currently have measures to screen for prenatal mental health disorders with state Medicaid, and it is important more is being done to expand both these figures so mothers in all states can receive the help they need, especially as the CDC suggests one in eight women may suffer from postpartum depression.

Whilst our society is becoming better at discussing mental health issues in general, more is needed in the maternal healthcare world. Openness in relation to mental health issues is crucial in creating the best environment for new mothers and their babies, important to diminish any stigma surrounding pre-or-postpartum depression and anxiety so families and individuals can receive the support they need.”

Metrics and weightings

From Fairhealth:

• Median charge value for vaginal delivery, out of network: 4.88%

• Median charge value for vaginal delivery, in network:7.32%

• Median charge value for C-section delivery, out of network: 4.88%

• Median charge value for C-section delivery, in-network: 7.32%

From the Policy Centre for Maternal Mental Health:

• State has Maternal Mental Health Task Force or Commission: 14.63%

• State requires OB-GYNs to screen for maternal mental health disorders: 19.51%

From the National Academy for State Health Policy:

• State Medicaid requires managed care organizations to collect the “prenatal depression screening & follow-up” HEDIS measure: 4.88%

• State Medicaid requires managed care organisations to collect the “postpartum depression screening & follow-up” HEDIS measure: 4.88%

From the Kaiser Family Foundation:

• Medicaid Expansion: 14.63%

• Postpartum Medicaid Extension: 17.07%

These weightings were chosen so that factors like policy and social support/Medicaid would have a higher impact on a state’s overall score than the overall cost of receiving care in a hospital. This was done so that the states where care is generally cheaper would not dominate the rankings.

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