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.

Top 10 States for Maternal Healthcare 

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 

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.”