Unfortunately there are still very limited services for birth outside of hospitals in the US. Providers have a hard time getting regulatory approval and insurance, so they are selective in who they will take as homebirth or out-of-hospital birthing center clients. Basically, only people with very low risk profiles can make it through all the qualifiers for an attended out-of-hospital birth.

I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.

I don’t recall. It’s a long time ago. I do remember that there were some other factors like proximity of home to hospital.

Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.