Tuesday, November 30, 2004

Are hospital midwives an endangered species?

Here’s a nice interview with Penny Simpkin. She talks about her own birth experiences, her reaction to the 2003 birth data (see yesterday’s Doulicia post) and the changing climate for caregivers and parents.

As evidence of this, look at recent headlines of nurse-midwife practice closings. Last week a Florida practice announced it was laying off its nurse midwives. This week a North Carolina practice made a similar announcement, this time in North Carolina.

The culprit, as always, is malpractice costs. In the North Carolina practice, even though the midwives were well received by their patients and their physician partners and despite the fact that their practice was growing in size, they were the expendable piece in an office facing $250,000 annual malpractice insurance premiums.

Interestingly, one of the financial problems was the hospital’s policy that a physician must accompany a nurse midwife in the delivery room. So for every CNM-attended birth, an OB had to be present (and paid). This seems extremely wasteful, not to mention insulting to the nurse midwives. But, once more, look to malpractice litigation as the driving force. A hospital that’s named as a defendant in a birth injury or death suit would rather show that a doctor was present supervising the birth than say it trusted the nurse midwives enough to let them deliver on their own. And, sadly, the hospital’s hunch is probably correct: juries are likely to think it more responsible (and therefore less blame-worthy (and therefore less financially liable)) to have doctors delivering babies than nurse midwives.

Something for a rainy day would be to look at jury awards against hospitals/care providers based on whether a CNM or an OB did the delivery. Would we see a bias toward doctors and against nurse midwives? I suspect we would.

Which means that it is very important for anyone who values alternatives in pregnancy and childbirth care to educate at every opportunity. Even though it might not seem worth your breath to explain to your uncle why you chose to have a home birth or to tell your skeptical girlfriends how skilled and trained certified nurse midwives are, please do. You never know who will be selected to a birth malpractice case. The fewer misconceptions they take into the courtroom with them, the better.


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