The Federal Quality Standard for Maternity Care
The CMS Birthing-Friendly Designation is a quality credential from the Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates Medicare and Medicaid. It was introduced in 2023 to help patients identify hospitals committed to evidence-based, safe maternity care.
As of 2026, 2,264 US hospitals have earned the designation — out of over 4,400 hospitals that provide maternity services.
What Does a Hospital Have to Do to Earn It?
To receive the Birthing-Friendly Designation, a hospital must:
- Participate in a statewide or national perinatal quality improvement collaborative — programs like ACOG’s Alliance for Innovation on Maternal Health (AIM), the California Maternal Quality Care Collaborative (CMQCC), or a state-specific perinatal quality collaborative.
- Actively implement the collaborative’s evidence-based patient safety bundles — these are standardized sets of protocols designed to prevent the leading causes of maternal death and injury: hemorrhage, hypertensive disorders, sepsis, and others.
- Report to CMS on their participation and implementation as part of the Maternal Morbidity Structural Measure program.
Why Does This Matter for Your Birth?
Hospitals with the designation are more likely to have standardized hemorrhage protocols, staff trained in early recognition of complications, and are part of a learning network that actively tracks and improves maternal outcomes.
The US has one of the highest maternal mortality rates in the developed world. Choosing a Birthing-Friendly hospital is one concrete step expectant parents can take to reduce risk.
Is It the Only Thing That Matters?
No. The Birthing-Friendly Designation is a strong baseline indicator, but it doesn’t cover everything. You should also ask about NTSV C-section rate, VBAC availability, NICU level, 24/7 in-house anesthesia and OB coverage, Baby-Friendly designation, and whether a doula is permitted.
See our full list of questions to ask →
Is Your Hospital Birthing Friendly?
Find out if your hospital has earned the federal CMS Birthing Friendly designation — the #1 thing to check before choosing where to give birth.
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