That and the way that funding for rural hospitals has been declining for decades and more and more rural hospitals are closing. This could be avoided by a bipartisan bill to change the way in which medicaid/medicare payment rates are determined. However, insurance companies, and the far right, are, of course, working against this.

That and the point that childbirth in a hospital with all the medical protection and support for mother and child is simply something a number of people cannot afford. And even with insurance, co-pay can make a baby a ruinous venture. So they give birth at home (“like the founding fathers”, err, mothers did), with maybe a midwife. Any serious complication, and child and/or mother are done for.

Another reason is the low vaccination level in the USA. At least low for a rich country.