More women are opting out of having babies in hospitals and choosing birth centers instead.
These midwife-run centers for low-risk patients are especially popular in rural Western states, according to a report published on Tuesday by the Commonwealth Fund, a health research foundation.
Nationwide, in 2024, about 0.6% of births, or around 23,000, happened in these centers. That may not seem like much, but it’s three times greater than it was two decades ago. The trend has been partly driven by the COVID-19 pandemic, when some people didn’t want to go to hospitals.
“Women were looking for alternatives, and some went to a home birth, and some went for a birth center birth,” said study co-author and Boston University professor Eugene Declercq.
Many see birth centers as a happy medium between having a home birth and a hospital birth where midwives offer services throughout one’s pregnancy.
In Western states, long drives to hospitals could also be driving the trend, as local labor and delivery units close up shop for financial reasons.
Idaho ranked third nationwide for the largest proportion of babies being born at birth centers, adding up to about 2%. Birth centers accounted for more than 1% of births in Colorado and Utah, with New Mexico and Arizona shortly behind.
Wyoming and Nevada were the only states in the region below the national average.
Declercq said this could be because it’s hard to make birth centers sustainable.
“Financially and structurally they have trouble staying open,” he said.
To help with that, he suggests states let Medicaid reimburse centers for overhead and operating costs. That’s something Wyoming did last year, though the effects haven’t been immediate since birth centers first have to get licensed by the state.
Earthside Birth and Wellness Center in Cheyenne has spent a year trying to do that, according to co-founder Sarah Morey. She said the center will likely have to move to a new building to get licensed.
“We're basically eating $4,000 to $5,000 per [Medicaid] client,” Morey previously told Wyoming Public Radio and the Mountain West News Bureau.
Declercq encourages states to get rid of onerous restrictions and red tape, so birth centers can help serve patients — especially those with few delivery options nearby.
“[Birth centers] are a piece of the solution to the problem, and can be a very important piece to that,” he said. “But they have to be integrated with the rest of women’s healthcare.”
Declercq said that includes community health centers where women can get more general care, as well as hospitals where patients can be transferred if they become higher risk.
Not everyone, however, sees birth centers as part of the solution for filling gaps in maternal care. That includes Dr. Derek Ewell, an OB-GYN at Ivinson Memorial Hospital in Laramie, Wyoming.
“Not to say that those services aren't great, but in my opinion, I just would prefer to see the hospitals carry that burden rather than brand new birthing centers,” he said, raising questions about safety at birth centers.
A 2024 study found no significant difference between babies dying or having seizures at birth centers versus hospitals — as long as the pregnant patient is accurately screened as low risk. A previous study showed worse outcomes at birth centers, but it included cases where centers served patients with higher-risk pregnancies.
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
