Unveiled: America’s Top and Bottom Performers in Maternity Care

• The latest rankings place Louisiana as the nation’s leader in maternity services, achieving a score of 90.0 out of 100 across ten evaluated indicators.
• Close behind are Oklahoma with 84.9 and California at 80.2.
• At the opposite extreme, South Dakota scores a mere 13.5, while Alaska earns 16.4.

A comprehensive analysis highlights which states excel in maternal support and which fall short.

The Birth Injury Lawyers Group’s report examined ten measures—spanning costs, service availability, and policy provisions—to calculate each state’s score out of 100. Data were sourced from the National Academy for State Health Policy, the Kaiser Family Foundation, FAIR Health, and The Policy Center for Maternal Health.

Key metrics include median charges for C-sections and vaginal births both inside and outside of network (in-network rates reflect negotiated, reduced pricing), whether the state maintains a maternal health task force or commission, if Medicaid has been expanded to low-income residents without extra eligibility hurdles, availability of postpartum Medicaid coverage, and mandatory prenatal and postnatal mental-health screening requirements. Additional support services, such as resources for tracking ovulation, can also play a crucial role in improving reproductive health outcomes and supporting family planning efforts.

Top 10 States for Maternal Healthcare 

Rank	State	Rank – Delivery Costs	Rank – Policy	Rank – Medicaid	Score (/100)
1	Louisiana	1	1	6	90.0
2	Oklahoma	5	1	6	84.9
3	California	49	1	1	80.2
4	Maryland	4	6	6	65.9
5	Illinois	28	4	6	65.3
6	Ohio	11	6	6	64.0
7	Arizona	34	6	6	59.3
8	Massachusetts	39	6	6	58.1
9	Oregon	41	6	6	57.7
10	Pennsylvania	30	15	1	55.3

Louisiana tops the list, benefiting from the lowest childbirth expenses nationwide—both in-network and out-of-network. Non-C-section in-network deliveries average $8,923. It is also one of only three states combining a maternal mental health task force with mandated prenatal and postnatal mental-health evaluations.

Oklahoma follows, scoring 84.9. The state’s in-network delivery rate sits at $10,681 (fifth-lowest nationally). Like Louisiana, Oklahoma requires both a mental health task force and dual-timeframe screenings—again one of three states with these provisions.

California earns third place at 80.2 despite steep birth costs averaging $17,791 per delivery. The state offers broad Medicaid coverage, including postpartum benefits, and is the last state to link a mental health task force with required screenings before and after childbirth.

Maryland secures fourth at 65.9, with an $11,033 average in-network delivery cost (fourth-lowest). While Maryland provides Medicaid expansion, postpartum support, and has a maternal mental health commission, it does not enforce mental-health screenings around birth.

Illinois ranks fifth at 65.3. Although delivery costs place it 22nd most expensive overall, Illinois (tied for fourth-most active) mandates prenatal and postnatal mental-health screening under state Medicaid. There is no formal task force, but postpartum care is covered.

Ohio (64.0) and Arizona (59.3) occupy sixth and seventh, each offering below-average delivery costs and maintaining maternal mental health task forces.

Massachusetts (58.1), Oregon (57.7), and Pennsylvania (55.3) round out the top ten. 

Bottom 10 States for the Maternal Healthcare 

Rank	State	Rank –       Delivery Costs	Rank – Policy	Rank – Medicaid	Score (/100)
50	South Dakota	31	15	50	13.5
49	Alaska	50	15	40	16.4
48	Nevada	48	15	40	19.8
47	Wisconsin	43	15	49	20.5
46	Arkansas	36	15	40	27.4
45	New Hampshire	33	15	40	27.8
44	Texas	29	6	50	28.5
43	Idaho	23	15	40	29.3
42	Utah	21	15	40	29.7
41	Kansas	32	15	32	30.3

South Dakota ranks last with 13.5 points. Its in-network vaginal delivery costs $13,294 (28th-cheapest), yet the state lacks any mental-health commissions, Medicaid expansion, postpartum coverage, or screening mandates for maternal mental health.

Alaska (16.4) and Nevada (19.8) follow.

Bob Goldwater of the Birth Injury Lawyers Group commented:

“Maternity care has advanced, especially in postpartum mental health, over the past three decades. However, stark differences persist between adjacent states—California leads in mental health support and screening mandates, while Nevada offers neither Medicaid expansion nor mental-health checks around childbirth.

“Only five states require postnatal mental-health screenings under Medicaid, and just seven mandate prenatal checks. Given that one in eight women may experience postpartum depression, expanding these requirements nationwide is vital.

“Promoting open dialogue on perinatal mental health is key to reducing stigma and ensuring mothers receive the support they need.”

Methodology

• Ten distinct metrics formed the basis of this index. For each metric, raw values were first cleaned, validated, and then mapped onto a uniform 0–10 scale—where 0 corresponds to the least favorable observed value and 10 to the most favorable—to ensure consistency across measures. Any metric in which a higher raw value indicated a poorer outcome was inverted by performing (10 – normalized score).
• Each normalized metric was then assigned a weight reflecting its relative importance in the overall analysis. After applying these weightings, the weighted scores were summed to produce a single index value (out of 100) for every state, which determined the final ranking.
• Data on postpartum depression were drawn from the Centers for Disease Control and Prevention.

Sources 

• FH Trackers: Cost of Giving Birth Tracker – September 2023 – FAIR Health 
• Policy Center for Maternal Mental Health  
• State Use of Behavioral Health Performance Measures in Medicaid Managed Care Contracting – April 2023 – National Academy for State Health Policy 
• Status of State Medicaid Expansion Decisions: Interactive Map – May 2024 – KFF  

Metrics & Their Assigned Weights

Fairhealth.org – Delivery Cost Metrics:

• Out-of-network median charge for vaginal birth: 4.88%
• In-network median charge for vaginal birth: 7.32%
• Out-of-network median charge for C-section: 4.88%
• In-network median charge for C-section: 7.32%

Policy Center for Maternal Mental Health – Mental Health Policy Metrics:

• Existence of a state Maternal Mental Health Task Force or Commission: 14.63%
• Mandated OB-GYN screening for maternal mental health disorders: 19.51%

National Academy for State Health Policy – Medicaid Behavioral Health Measures:

• Requirement for managed care plans to report prenatal depression screening & follow-up (HEDIS): 4.88%
• Requirement for managed care plans to report postpartum depression screening & follow-up (HEDIS): 4.88%

Kaiser Family Foundation – Medicaid Coverage Measures:

• Status of Medicaid expansion: 14.63%
• Availability of extended postpartum Medicaid coverage: 17.07%

These weightings emphasize policy and social-support provisions (Medicaid coverage and mental health measures) more heavily than raw delivery costs to prevent lower-cost states from disproportionately leading the index.

Full Table 

Rank	State	Rank –  Delivery Costs	Rank – Policy	Rank – Medicaid	Score (/100)
1	Louisiana	1	1	6	90.03
2	Oklahoma	5	1	6	84.9
3	California	48	1	1	80.15
4	Maryland	4	6	6	65.88
5	Illinois	28	4	6	65.32
6	Ohio	11	6	6	63.97
7	Arizona	34	6	6	59.34
8	Massachusetts	39	6	6	58.09
9	Oregon	41	6	6	57.7
10	Pennsylvania	30	15	1	55.26
11	Indiana	17	15	4	52.87
12	Washington	42	15	1	52.2
13	New Jersey	50	4	6	52.12
14	Virginia	6	15	6	50.31
15	West Virginia	7	15	6	50
16	Kentucky	10	15	6	49.49
17	North Dakota	13	15	6	48.86
18	Michigan	14	15	6	48.67
19	Colorado	40	15	4	48.14
20	Rhode Island	18	15	6	47.66
21	Hawaii	20	15	6	46.81
22	Tennessee	22	6	32	46.58
23	Vermont	25	15	6	46.11
24	New Mexico	26	15	6	46.01
25	Delaware	35	15	6	44.63
26	Maine	37	15	6	44.5
27	Minnesota	38	15	6	44.1
28	Florida	44	6	32	40.02
29	Alabama	2	15	32	39.96
30	Missouri	3	15	31	39.69
31	North Carolina	12	15	30	39.35
32	Connecticut	45	15	6	38.69
33	New York	46	15	6	37.07
34	Georgia	16	15	32	33.57
35	Montana	8	15	40	32.71
36	Iowa	9	15	40	32.54
37	South Carolina	19	15	32	32.26
38	Mississippi	24	15	32	31.55
39	Wyoming	27	15	32	31.35
40	Nebraska	15	15	40	31.17
41	Kansas	32	15	32	30.28
42	Utah	21	15	40	29.65
43	Idaho	23	15	40	29.27
44	Texas	29	6	50	28.49
45	New Hampshire	33	15	40	27.77
46	Arkansas	36	15	40	27.44
47	Wisconsin	43	15	49	20.46
48	Nevada	47	15	40	19.77
49	Alaska	49	15	40	16.44
50	South Dakota	31	15	50	13.48