I read an autobiography years ago about a girl in the US who had grown up in fairly extreme poverty. She ended up going on to great things. I unfortunately can’t remember the name of the book but it was a really good read.
Anyway, one of the things that stuck with me was that home births with no hospital intervention were fairly common mostly because of cost but (and my memory on this is hazy) I think also this kind of “avoid the government” basis. They had midwives / nurses come on an unofficial basis.