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Before 1989, birth locations had two categories: in-hospital and out-of-hospital. Data on in-home births, birthing center births and other locations were not specifically recorded. After 1989, there was enough diversity to begin recording different location.

There has always been controversy surrounding out-of-hospital births in the presence of a midwife. In the late 19th and early 20th centuries, it was not uncommon for the mother to give birth in her own home. After the rise of medical education, things began to change leading the majority of laboring women to hospitals.

There are rules and regulations in place to ensure safe treatment and delivery in the care of a midwife before, during, and after labor. Natural birthing centers have contracts with physicians within nearby hospitals in case of emergencies or a need for consultation. The majority of midwives have been formally trained in the practice of midwifery and many, additionally, are trained in nursing.

A bill concerning midwifery in Texas is pending in the Texas House Public Health Committee. Though many believe it is aimed more toward making sure that uncertified and unlicensed midwives are following safe procedures, it would ultimately change the transfer process of laboring women from the care of a midwife to a hospital in an emergency situation. Emergencies are incredibly rare, but midwives in Texas are beginning to see the possible consequences of these changes.

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