New PLF report finds state regulations block women’s access to safe, affordable birth centers

Washington, DC; October 14, 2025: A new report from Pacific Legal Foundation reveals that outdated state regulations are restricting women’s freedom to choose where and how to give birth—despite overwhelming evidence that midwife-led birth centers offer safe, cost-effective maternity care.

The report, State Regulation of Birth Centers: A 50-State Survey of Women’s Birth Freedom, authored by PLF researchers Caitlin Styrsky and Jaimie Cavanaugh, analyzes state laws governing birth centers across five key areas: licensure, accreditation, certificate-of-need (CON) laws, physician involvement, and hospital transfer or proximity requirements. The findings show that excessive regulation—not medical risk—often prevents birth centers from opening, particularly in rural and underserved communities.

“Women should be free to decide where they give birth without needing permission from their competitors,” said Caitlin Styrsky. “Our survey shows that states with fewer regulatory barriers have more birth centers and better access to maternity care. These laws don’t protect mothers—they protect entrenched hospital monopolies.”

Birth centers, which are typically midwife-led and independent from hospitals, have been shown to reduce C-section rates, lower costs, and improve outcomes for low-risk pregnancies. Yet, according to the report, 17 states still have no operational birth centers, and many others impose burdensome requirements that deter healthcare entrepreneurs and midwives from opening new facilities.

For example, many states require written transfer agreements with nearby hospitals—even though emergencies are rare and hospitals frequently refuse to sign agreements with would-be competitors. Other states still mandate costly CON approval before opening a birth center.

“Policymakers should be focused on expanding options that improve Americans’ healthcare, not restricting options,” said Jaimie Cavanaugh. “When government gives hospitals a veto over birth centers, it’s women and families who pay the price—in higher costs, longer travel times, and fewer choices.”

The report highlights how states can expand access to maternity care by removing unnecessary regulatory hurdles. Reforms could include repealing CON requirements, eliminating mandatory hospital replacing transfer agreements with transfer plans, and recognizing accreditation as a substitute for redundant state licensing.

“America spends more than $100 billion each year on maternity care but ranks 60th globally in preventing maternal deaths,” Styrsky added. “Removing arbitrary barriers to birth centers is one of the most effective, evidence-based ways to improve maternal health and restore women’s birth freedom.”