Wow, our recent post on the growing shortage of ob/gyns and the possibility that it points to a broader trend really sparked a lot of interest. One of the things that several of our readers commented on was the potential role of midwives in mitigating some of this shortage, so I thought we’d spend a little time looking at that subject and midwife malpractice insurance today.
As several of the comments mentioned, in addition to delegation of some tasks to PAs and RNs, midwives and nurse practitioners could serve a vital role in providing care to pregnant women across the country. Not only do many women prefer to work with a midwife, but often midwives are a much more feasible option for women in rural parts of the country or regions where the number of ob/gyns that do delivery is critically low. But there are different kinds of midwives and different certification and liability needs to consider.
First, what are the different designations under which a midwife or labor assistant might operate?
- Certified Nurse Midwife (CNM) – A Certified Nurse Midwife is an advanced practice registered nurse (APRN) who has been trained in both nursing and midwifery. They have accreditation through the American College of Nurse Midwives (ACNM) and typically operate in hospitals or birthing centers. CNMs are able to practice in all 50 states.
- Direct Entry Midwife – Direct Entry Midwife is an umbrella designation that refers to midwives trained in midwifery and certified or accredited by one of a number of different accrediting organizations. Direct entry midwives typically assist with home births or deliveries in birthing centers. They do not usually work in conjunction with a doctor or ob/gyn.
- Certified Professional Midwife (CPM) – Certified Professional Midwives are midwives who are accredited through the North American Registry of Midwives (NARM). This accreditation is legally recognized in 28 states, and legislation pursuing its recognition is being pursued in several others.
- Certified Midwife (CM) – Certified Midwives are midwives who, while not nurses, have been trained and certified in midwifery by the American College of Nurse Midwives (ACNM), the same body that certifies CNMs. CMs are only currently recognized by New York, New Jersey, and Rhode Island, however they are authorized to practice in Delaware and Missouri as well.
- Licensed Midwife – A Licensed Midwife is a midwife licensed to practice in a particular state. As of 2011, 27 states allowed for licensed midwifery.
- Lay Midwife – Lay Midwife is a general term applied to anyone who practices midwifery but is not certified or licensed by any particular body. These may be women who learned midwifery by informal apprenticeship or who have been practicing since before licensing was commonly available and simply have never pursued licensing.
- Doula – A doula is a non-medical person who simply assists the mother throughout the pregnancy and delivery. Doulas are not medical professionals. Their job is to ensure the comfort of the mother, help with communication, and provide encouragement. Training is available for doulas, but it is not required and anyone can claim the title.
While the relative risks and benefits of midwife care seem to be a matter of perennial debate the fact is that midwifery is a service and a vocation that has been around as long as we have and it is something that many women want and some need. Likewise, there may be merits or drawbacks to pursuing any of the forms of certification or training mentioned above, or of seeking someone with one of these backgrounds to assist with your pregnancy, but there is one thing all of them have in common. They are all liable to lawsuit, and all carry an inherent risk.
Even though there are conflicting opinions and even legal codes and court precedents from state to state as to whether midwifery constitutes the practice of medicine the reality is that whether it does or not, lawsuits can be brought against midwives and even doulas in the event of a health issue involving the mother or child. The good news is that the rates of suit for midwives are substantially lower than those for ob/gyns—a midwife is less likely to be sued than a doctor.
However, it still happens. A 2008 survey of CNMs in Michigan found that around 35% of midwife survey respondents reported having been sued at some point in their career. And it doesn’t take too much poking around the internet to find cases where midwives have been sued, in some cases for millions of dollars.
What does this mean? Simply put, it means that to practice midwifery without malpractice insurance is to take a major risk. Even if the likelihood of being sued is low, it only takes once. And even if a midwife is defended successfully the legal costs of mounting that defense can be overwhelming. Further, while no one wants to shell out hard earned money for insurance, especially when they aren’t forced to by law, the reality is that insurance for midwives is substantially cheaper than it is for ob/gyns and the protection it provides is really an investment in the longevity of ones career and the protection of ones assets.
Ultimately the decision lies with the midwife, and the details of who can get insured, where, and what practices or circumstance may be excluded or deemed too risky to be allowed under particular policies will play a role in making that decision. But if you are a midwife who can get malpractice insurance (and there are companies who specifically provide insurance to midwives, even for home births), or if you are a client seeking a midwife, malpractice insurance is a safeguard against financial ruin for both of you.
For information about malpractice insurance for midwives be sure to contact us here or give us a call at 1 (855) 857-8746.
