Wednesday, May 16, 2012

What We're Seeking: Is your midwife insured?

"What We're Seeking" is a bi-weekly series that expands upon Safer Midwifery for Michigan's statement of purpose.  This week's post examines the issue of malpractice insurance, or lack thereof, and its implications for the practice of midwifery in Michigan. 

No one likes to consider bad outcomes when they’re expecting a baby and often they ask the question much too late, does my midwife have insurance?  Some midwives claim that they won’t carry insurance because they can’t afford it or would have to raise their rates which could eliminate potential clients due to higher costs

I would argue that many midwives, particularly nurse midwives, do carry malpractice insurance.  I would also argue that the majority of a midwife’s clients are not low-income families as some may have us believe.  Charging upwards of $4,000.00 per birth is something many families are paying out of pocket to have a midwife attend their birth.  Not to mention that Medicaid now reimburses for out-of-hospital birth, as do many other insurance companies.  (Not because it's safer care, but because it's less expensive for them than a hospital birth.)  The truth is that some midwives don't like to carry insurance because the restrictions that accompany it are too limiting.  Perhaps there is a reason insurance won't cover a breech delivery outside a hospital setting or cover a provider who has had repeated instances of death and injury.  If your midwife is refusing to carry malpractice insurance, it's an enormous red flag about her beliefs and the safety of her practice.  

Let’s think for a moment about the important role insurance plays in the scheme of things.  In order to obtain insurance, a midwife must achieve and maintain a specified level of educational standards.  She must continue her education and be practicing as a licensed care provider.  She must also practice midwifery within a specific scope of practice, agreeing not to take on more than what she can do safely in an out-of-hospital setting.   In order to maintain insurance coverage, she must have a record of safety and good outcomes.  Malpractice insurance serves to protect the midwife from losing everything in the event she makes a mistake.  Insurance also protects families who have experienced negligence. 

What happens when my midwife doesn’t have insurance?  She can practice with or without a license in MI, without being required to have insurance.  (Just because you hire a CNM, doesn't mean she's insured either.)  She may or may not have any defined educational training.  She can attend any kind of birth she wants to attend in spite of what research has determined unsafe.  She can have repeated outcomes of death and injury, but no one will know about it because she doesn’t have to report her outcomes to anyone.  In the event she has acted negligently, she can walk away without reprimand, consequence, or review of any kind.  She puts her own assets at risk in the event of a lawsuit (unless she has placed all of her assets in someone's name other than her own or funneled her profits out of the country…no I’m not making this up, true examples). 

A midwife who refuses to carry malpractice insurance is making a clear statement about the responsibility, or lack thereof, she takes for your care.  The choice not to protect herself by carrying insurance is likely an indicator that she likes to play by her own rules, being accountable to no one.  Choosing a midwife who carries malpractice insurance helps families instantly know that the person they are hiring operates within some sort of safety guidelines & educational standards, and in the event of negligent actions, families will have recourse.  Don't take more risks that you need to: Hire an insured midwife.  


  1. I just had a quick question regarding a statement in this post. You say that a CNM (certified nurse midwife) "may or may not have any defined educational training". I feel a little confused - it was my understanding and CNM's were typically registered nurses who had obtained a graduate degree. Is this not correct? Thanks!

    1. Thank you Lansing mom for asking! You're correct that CNMs are registered nurses. In fact they are considered "advanced practice nurses", many having a masters degree. They are the most educated in terms as far as midwives go and have years of education, clinical training, and experiences with emergency care. The are not however required to carry malpractice insurance when practicing outside the hospital, nor is their care limited to low risk. They also are not required to have and keep up to date, skills in Neonatal Resuscitation.

      In the post, I'm referring to all midwives, including lay midwives and CPMs too, who have little to no standardized educational training, which is why I had to say they "may OR may not" have defined educational training. Some do and some do not, particularly those practicing outside the hospital setting. This is part of the reason why it's so confusing to know exactly what you're getting when you hire a midwife. There is a vast spectrum of education, philosophy, and no guidelines for practice. Sorry for the long winded answer, and I'm glad you asked!

  2. Excellent post. Every professional carries insurance - doctors, lawyers, roofers, plumbers, accountants, etc. If midwives want to be taken seriously as professionals, there is absolutely no excuse for them not to carry insurance. And it's NOT unattainable, or too expensive, or whatever else they want to whine about. They need to be insured.

  3. Is there any midwife practicing independently you know of that has malpractice insurance? The cost of malpractice insurance for a solo midwife would be the same as her annual salary. I feel that your blogs do not take into consideration the business aspect of midwifery and staying successful long term. This discussion needs to be pushed towards malpractice insurance companies to make costs more affordable for smaller/lower income professionals, not the midwives.

    1. Thank you Leslie for your comment. I do know there are midwives in other states who do carry malpractice insurance. I do not know of any in Michigan. There are many counter arguments to the "midwives can't afford insurance" argument. The one that is most critical to me is that if it isn't affordable, it certainly should be and it doesn't excuse midwives from practicing without it for their own protection and that of their clients. I don't disagree with pushing insurance companies to offer more affordable coverage. I also think there is potentially great power in midwives soliciting insurance coverage as a group. The problem I've seen is that midwives don't have any interest in having insurance coverage because many believe it limits their scope of practice. They don't want anyone telling them what they can and cannot do, and therefore leave the burden upon the families they serve in events of negligence, injury, and death that happen far too often. Instead of working to find a way to practice responsibly, they skip measures of accountability and safety altogether and work behind the scenes. There are many, many midwives in the state of MI practicing with insurance, but they are functioning as part of our larger healthcare system. The point of our blog is to advocate for the way things should be, an ideal, not for what is easiest. When we hired a "midwife", we didn't understand how much hiring an insured midwife really matters in terms of safety practices and accountability. If this blog helps one family understand that aspect, and understand they do have options in MI for licensed, insured midwives, then we will have served the community well.

  4. Hiring an insured midwife does not make them any safer. Before posting about topics, you need to do your research regarding the topic. Malpractice insurance companies vary greatly and very few even offer malpractice insurance to Certified Nurse Midwives in the hospital setting, let alone other midwives and out of hospital births. Please do some research regarding insurance companies and which one actually cover midwives (CNM, CPMs, and lay midwives) and what the coverage options actually are. There are many different claims and occurrence levels on top of actually getting a tail to follow you. The tail is the expensive part and most important with protection against lawsuits (can be sued for up to 21yrs later). That is the most important part if you consider malpractice insurance. There are very low coverage malpractice insurance options and high coverage insurance options. Each level doesn't affect the safety of a midwife, only how much protection she can actually have with that insurance company. By your rationalization, every midwife that practices in Michigan out of hospital is not safe.

  5. Hi Leslie,
    Thank you for your comment and honest thoughts on this topic. I have several points I'd like to make in response.

    First, from the perspective of the consumer, every mother has the right to be directly told that a midwife does not carry malpractice insurance with an accompanying explanation of how that will affect her care in the event of an injury or loss. She deserves to be told that if harm comes to her or her baby, that she will foot the bill, sometimes for a life time. She deserves to know that mistakes to happen, babies do die, although not often...but if she is by chance a victim of negligent care, she will have NO recourse.

    I do not disagree with your point about limited options in terms of malpractice coverage for midwives. I do disagree with the notion that this somehow excuses midwives from practicing responsibly. Any professional who calls herself an "expert in birth" and receives money to deliver a baby safely in homes or hospitals, also has a responsibility to carry malpractice insurance.

    Insurance protects midwives, and it protects the families they serve by further defining scope of practice and practice guidelines. Insurance companies will not insure dangerous practices, and they will not insure practitioners who repeatedly have to file claims.

    Perhaps the reason there are not many options is because OOH birth is risky business, whether you are pro home birth or not. Inherently there is greater risk when emergency care is not immediately available, and when educational/practice standards are not clear. Every single midwife who practices in a hospital or hospital affiliated birth center IS insured. Women deserve to know that there are highly educated, insured, licensed midwives to choose from, and how choosing otherwise does directly affect their care.

    If midwives want to be respected in the OOH birth world, then high, consistent standards for education, and for practices are a must. Perhaps then insurance companies would offer better options. I'm so weary of midwives who think they are above the rules of responsible practices...above having insurance, above having a sound education, above the law. Just because insurance companies don't offer what you want them to, or even what I want them to, doesn't make it right to go around delivering babies w/o it, and pretending that is somehow safe/responsible. It's reckless. Perhaps the "Big Push" ought to be pushing for standards we can rely on, and for insurance companies to diversify instead of misleading licensing.

  6. I had a homebirth May 24,2013. I was pregnant with twin girls. The midwife did not show up. My second daughter had prolapse cord. I had an unassisted childbirth with twins and all I could do was write to the review board and the midwife continues her life and continues to deliver babies. No one see nothing wrong with it.
    This is the worst time in my life