Birth Injury Marketing
Data · analysis

Where the birth happened is not where the family lives

By Kevin Schwaner, Founder; Chief Marketing OfficerUpdated

1,217 U.S. counties recorded births in 2024 and contain no hospital confirmed by CMS to provide inpatient labour and delivery. Those counties account for 296,913 births. Every one of those families travelled to deliver, which means the defendant facility, the treating clinicians and the family's home address can sit in three different counties. Media bought against residence and a venue analysis built on residence will both be wrong in those places.

The size of it

This is not a rural curiosity. Thirty-six of those counties recorded a thousand births or more in 2024. Berkeley County, South Carolina recorded 3,035. Gloucester County, New Jersey recorded 3,032. Kaufman County, Texas recorded 2,754 with twenty-eight lawyer offices in the county.

In each of those places, several thousand families a year leave the county to give birth and come back. The county looks like a market on a births map and behaves like a catchment on a venue map.

Twelve counties with 1,000 or more births and no confirmed delivering hospital. Sorted by births.
CountyStateBirths 2024Lawyer offices
Berkeley CountySC3,03568
Gloucester CountyNJ3,03284
Kaufman CountyTX2,75428
Shelby CountyAL2,46978
Johnson CountyTX2,41139
Sarpy CountyNE2,40224
Clermont CountyOH2,16634
Lake CountyOH2,05066
Paulding CountyGA1,91129
Harnett CountyNC1,82230
Livingston ParishLA1,81828
Randall CountyTX1,77123
States with the most counties recording births and no confirmed delivering hospital. Count of counties per state with 2024 births and no CMS-confirmed inpatient labour and delivery service. Texas 102Georgia 93Virginia 90Kentucky 68Missouri 63Tennessee 50Illinois 46Nebraska 39Indiana 38North Carolina 37Arkansas 34Alabama 33
Figure 1: where residence and delivery come apart most often. Counted by county, not by births, so a state with many small counties ranks high.

What it changes

Three things, and only the first is obvious.

Three counties, one case. A family lives in one county, delivers in another, and the records sit with the delivering facility. County of residencewhere the media is bought County of deliverythe defendant facility Records custodiansometimes a third state Venue follows deliverynot residence
Figure 2: the three places a single matter can sit. Only the first is visible in a county births map.

Media targeting. A campaign weighted to county of residence spends against families who will deliver somewhere else, under a different hospital's protocols, with a different defendant. That is not wasted spend, because the family still lives there and still needs a lawyer. It is mis-weighted spend, because the county's births tell you nothing about which facility's practices generated the injury.

Referral relationships. In a county with no delivering hospital, the relationships that produce cases are not with the hospital down the road. They are with the paediatric and developmental clinicians who see the child afterwards, and with the facility an hour away that handled the delivery.

Where the record is. The delivery record sits with the facility, in another county and sometimes another state. Every hour of the records workflow in the screening manual gets longer when the request crosses a state line.

What each geography is good for.
GeographyUse it forDo not use it for
County of residenceMedia targeting, because that is where the family readsVenue, defendant identification, referral mapping
County of deliveryVenue, the defendant facility, records requestsMedia targeting, because the family does not live there
Neither, on its ownNothing. The two have to be held togetherA single-county view of any market with no delivering hospital

What this does not say

Absence of confirmation is not absence of service. 971 hospitals in the CMS file carry no affirmative obstetric indicator either way. A county counted here may contain a facility that delivers and does not report it.

It says nothing about the rate of injury. Travelling to deliver is not evidence of worse care, and this analysis makes no claim in that direction. It is a statement about geography, not about outcomes.

Clinical measures and legal measures are never joined on this site. Adverse-event rates describe medicine; litigation describes a legal process. Where both appear together it is to describe a market, not to suggest that one predicts the other.

Sources

  1. U.S. Census Bureau: County Population Totals and Components of Change, 2024: births by county, 2021–2024
  2. CMS Care Compare: Maternal Health · Hospital: PC-02, PC-07a, PC-07b, SM-7; 2024 reporting period
  3. CMS Care Compare: Footnote Crosswalk: definitions for suppression codes

Cite this analysis

Free to reproduce with attribution, including commercially. Charts may be embedded as published.

Birth Injury Marketing. “Where the birth happened is not where the family lives.” 25 August 2026. https://birthinjurymarketing.com/insights/where-families-leave-the-county-to-give-birth/

Journalists and researchers: the underlying data is already published as CSV at /data/, free and without conditions, no form. Need a different cut, by state, county, hospital or year? Ask, and I will also tell you what the data cannot support.

More

Data · analysis

Where births and legal capacity are furthest apart

Joining county births to Offices-of-Lawyers establishments produces a market map nobody has assembled, and a measure much weaker than it looks.

Data · analysis

Where the births actually are, by county

The distribution of U.S. births is far more concentrated than most geographic media plans assume, and the tail is longer than it looks.

Data · method

The hospitals that never say if they deliver

The federal file most people treat as a hospital census carries no obstetric indicator either way for a fifth of the hospitals in it.

Practice economics

What a slow callback costs you here

A familiar marketing rule, worked through for a category where one inquiry can cost more than a month of another practice area.

Practice economics

The counties your advertising cannot reach, and what does

The counties with no lawyer office at all are not a media opportunity. They are a referral problem, and a different service line answers them.

Economics

Cost per lead can fall while cost per signed case rises

In birth injury both movements are real at the same time, and only one of them matters. Here is the mechanism, and how to tell whether it is happening to you.

Operations

Why more spend stops producing more birth injury cases

Signed case volume is limited by how many inquiries a firm can competently review, not by how many it receives. Above that ceiling, additional spend buys a queue.

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Authorship & review

Author
Kevin Schwaner, Founder; Chief Marketing Officer. Credentials.
Last reviewed
Corrections
Found an error? Tell me and it goes in the dated corrections log, whether or not it flatters me.