Childbirth costs, outcomes, and access to care differ between rural and urban hospitals. Rural areas have fewer short-term general acute care (GAC) hospitals, with only about 35% of all GAC hospitals operating in rural locations in 2023. As rural hospitals continue to face financial distress, many unprofitable service lines, such as hospital-based obstetric service units have closed. A recent study found that the decline of hospital-based obstetric services was associated with more out-of-hospital births and preterm births. 

This brief examines price differences for childbirth between rural and urban hospitals for people who get their health insurance through their employer. While hospital childbirth costs vary by location, the total cost involves more than just the hospital stay. Other factors include the type of delivery, length of stay, insurance coverage, and physician fees.

Most childbirth deliveries occur in urban hospitals.

The vast majority of childbirths in the US (more than 90%) take place in hospitals in urban areas. Even though 33% of hospitals were in rural areas, less than 10% of employer-sponsored insurance (ESI) childbirth deliveries took place in rural hospitals from 2012 to 2022. The share of ESI childbirth deliveries in rural hospitals decreased from 9.5% of all ESI deliveries in 2012 to 8.6% in 2022.

Prices for inpatient childbirth deliveries in rural hospitals are 16% lower than urban hospitals.

From 2012 to 2022, inpatient childbirth prices were consistently higher at urban hospitals, and prices increased at a faster rate. On average, prices for inpatient childbirth deliveries in rural hospitals were 16% lower than those in urban hospitals. Figure 1 illustrates this price difference. In 2022, the average price at urban hospitals was $11,852, while at rural hospitals it was $9,941. Urban prices also grew more quickly, increasing 67% between 2012 and 2022, compared to 63% for rural hospitals.

One factor contributing to lower average childbirth prices at rural hospitals is the rate of C-section deliveries. It has been well documented that C-section deliveries cost more than vaginal deliveries, and this analysis finds that difference across urban and rural hospitals. Rural hospitals also consistently had lower rates of C-section deliveries during the study period. Prices for C-section deliveries were higher than vaginal deliveries in both urban and rural hospitals. In 2022, the average price for a C-section delivery in a rural hospital was $13,333, while average price of vaginal delivery was $8,259 (Figure 1). In urban hospitals in 2022, the average price for a C-section was $15,238, and the average price of a vaginal delivery was $9,909. Accordingly, the average price of all deliveries will depend, in part, on the proportion of deliveries that are C-sections.

Rates of C-section delivery were lower in rural hospitals every year from 2012 to 2022. In 2022, 33.2% of childbirths in rural hospitals were delivered by C-section, compared to 36.5% of childbirths in urban hospitals.

Length of stay is shorter in rural hospitals, driven by shorter stays for C-section deliveries.

A difference in how long birthing people stay in the hospital also may be contributing to lower average prices in rural hospitals. In 2022, the average length of stay was slightly shorter in rural hospitals (3.0 days) compared to urban hospitals (3.2 days). Figure 2 shows that the difference in length-of-stay is driven by C-section deliveries with an average length of stay of 3.8 days in urban hospitals but 3.4 days in rural hospitals.