Midwife Crisis

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$QUEEZED OUT: The Elizabeth Seton Childbearing Center, a midwife facility popular with celebrities like Ricki Lake, is being forced to close because of skyrocketing malpractice costs.

Jeff Miller was kind enough to send me a link to this sad news story.
I do have one issue with the wording of this (and similar stories). The cost that is skyrocketing is not that of actual malpractice, it is for insurance to protect against claims of malpractice.
In the mid-1980s, there was a similar crisis with malpractice insurance costs. The one company then providing malpractice insurance to privately insured CNMs (certified nurse-midwives) decided, for reasons that were never explained, to simply non-renew all policies held by midwives. This resulted in the loss of hospital privileges for several dozens of CNMs across the country and the closure of several thriving private nurse-midwifery practices. Practices in public hospitals serving mostly the uninsured and the poor were not affected, as their coverage was generally through a large pool.
A more cynical soul than I might have thought that this was one salvo in an economic war - as long as midwives restrict their practice to the poor and uninsured they could be tolerated or even encouraged (as long as they leave enough poor women to be available for resident training purposes). However, we all know that there isn't really economic competition to care for childbearing women - it is all about providing the highest quality of service at the lowest cost. The insurance companies just don't understand that CNMs (and other midwifes) cost less, have comparable or better outcomes than other OB care providers, and are less likely to be sued. They only see that they are liable for potential suit for 18 years plus the statute of limitations, and lump them in with OB doctors who also do surgeries, and with family practice docs who also deliver babies.
A premium that a doc can roll into their overhead and absorb (albeit with a lot of pain) can kill a midwifery practice.
Something needs to be done. I just don't know what.


I don't have comment, except to say that was a very clever title. Nice job!

Well, you know I find it just as frustrating as you do.

Sometimes I wish I lived in New Hampshire so I could have a baby with a Catholic midwife who favors God's design but doesn't have any misguided ideas about natural-above-all -- might make up for the whole hospital environment -- but then I realize that hospital CNMs and many other licensed midwives everywhere are probably pretty restricted in what they can do and whom they can serve, whatever their personal convictions.

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This page contains a single entry by alicia published on August 13, 2003 9:33 AM.

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