Malpractice Insurance & Midwives

Midwifery advocates working on legislation are often met with the question/response, "but what about malpractice insurance? Families need to have some recourse in the event of problems during birth." This is often a close-the-door pseudo-question asked with an air of finality--as in, "now, that settles that. We're all finished here."

Reading the current issue of Midwifery Today finally helped me respond to that question and also to discern what I have always felt that questions of legislation and legalization of midwifery should not involve a need for, or a requirement of, malpractice insurance. It also helps explain why bringing up malpractice insurance need not be an avenue for closing discussion.

From author Judy Slome Cohain: "Mandatory malpractice insurance does not enable a person to sue for malpractice. Any midwife or citizen can be sued at present--insurance or no insurance. Mandatory malpractice insurance can only do one thing: increase the profitability of lawsuits."

When looking through this lens, it becomes clear that lawyers and insurance companies have more to gain from legislation mandating insurance policies for midwives than do birthing women and their families.

The article in Midwifery Today is called "Mandatory Malpractice Insurance: Increases CS Rate & Profitability of Litigation, Decreased Planned Homebirths."

Last year when the issue of malpractice insurance was raised repeatedly in the discussion of our midwifery legislation we discovered that there were no other laws (that we could find) mandating that ANY other type of professional have malpractice insurance, including OBs. If no other professionals in the state of Missouri are required by law to carry malpractice insurance, why is the issue even been raised when discussing midwifery? Yes, most hospitals do require malpractice insurance for their OBs as a condition of employment, but it is not a state regulated requirement that they have it.

Terrific piece about birth

Birth: Medical Event or Natural Process?

Excellent article with thorough citations.

Newsweek

Newsweek article on The Business of Being Born

Neonatal Mortality Rankings

Unicef just published new statistics ranking countries on the state of children.

The United States is tied for 33rd (through 41st) in neonatal mortality (at 5) with these countries: Belarus, Croatia, Lithuania, Malaysia, Malta, Qatar, Slovakia, United Arab Emirates, United States.

Quotes from Birth Book

In the early 70's, Raven Lang was a self-trained midwife in Santa Cruz, CA. She and her sister midwives opened a birth center and served many women before one of the midwives was arrested in an undercover sting operation by a law enforcement couple posing as homebirth clients. Birth Book was the first woman authored, empowerment model, homebirth-oriented book to come out of the childbirth and midwifery movement of the 70's (published even before the better known and also much beloved classic, Spiritual Midwifery). This book has recently been reprinted on a very limited basis and is being sold by Citizens for Midwifery. This week I was delighted to read it at last and I wanted to share some quotes from the introduction of the book that felt relevant to me when thinking about midwifery in Missouri:

“Birth has not only reached the absurdity of having to be relearned, it also has the absurdity of becoming a criminal offense if we are to go ahead with our ideals and do things the way we desire. And so, because of the system, midwifery as practiced in this book is against the law. It has become political. We didn’t make it that way. For us it is a beautiful, personal, spiritual, sexual experience. And for us to have that, we become criminals.”

“None of this would have happened if we had waited for organized medicine to come around, or if we had been scared of the laws we would break, or if we had waited for money. I want now to say POWER TO THE PEOPLE, AND YOU CAN DO IT IF YOU WANT.”

More from the Post Dispatch

Monday's front page carried this article about the birth center in Columbia.

I also found this section on the history of midwifery (don't know where it was in the paper).

And the "Talk of the Day" is about midwives in Missouri. Go add your comments!

Article in the St. Louis newspaper

Michelle Munz of the Post Dispatch did a terrific job with this article about midwifery in Illinois and Missouri. I only wish they had an avenue for posting comments about the story on the website.

I'll give first quote status to the opposition. After several paragraphs in which Munz has sumarized some of the extensive statistical evidence regarding the safety of planned homebirth with a certified professional midwife:

But such statistics can't tell the whole story, said Dr. Gordon Goldman, the Missouri section chair of American College of Obstetricians and Gynecologists."Most of the time, they are going to get away with" a midwife
birth, Goldman said. "But when (a death) happens — even if it's one in 1,000 — it's 100 percent for you and your baby."

This quote amuses me in light of the fact that the informative sidebar states that the BMJ study showed an infant death rate of "1.7 per 1,000, consistent with low-risk births at hospitals." The infant death rate itself is not amusing. It is a very sad fact of life that even in the best of circumstances, some babies don't make it. What amuses me is Dr. Goldman's double standard, and his random choice of a death rate that is actually lower than hospitals acheive for "low risk" births.

Some of my favorite quotes that resonate with what midwifery is all about:

Kris gets into the tub, equipped with a heater to keep the water warm. The temperature and buoyancy are soothing. About 15 minutes later, the midwife notices a twinge in Kris' grunting.
"That sounded pushy. Are you feeling like you're wanting to push?" the midwife says.
"Yes," Kris answers, the first word she has spoken in hours.

~~~

It was a difficult birth, Jenny recalled. She pushed for nearly an hour.
The midwife felt the umbilical cord wrapped around the baby's neck. She had
Jenny get on her hands and knees and lift one leg. That allowed the baby's
shoulders to come loose and tumble out of its cord. The new mom scooped up her baby girl in the warm water. It was a joyous and peaceful moment, she said. It was exactly what she wanted.
"I felt like the bionic woman," Jenny said. "I was completely exhausted, but I felt a sense of pride I never felt before."

~~~

She spends two more hours at the house, cooking scrambled eggs, cleaning and completing her notes. She packs her equipment in a rolling suitcase. She leaves Kris with a list of things to look out for, like excessive bleeding or if Drew catches a fever.
The midwife hugs Kris and tells her how amazing she was. The midwife will be back tomorrow to check on the family.
As always, she has her cell phone in her pocket, waiting for the next call.

There is also a beautiful audio slideshow accompanying the article.

Homebirths to be covered by insurance in New Hampshire!

Both the House and the Senate in New Hampshire have passed bills that mandate insurance companies to cover home births! The two bills were slightly different, so not quite ready for the Governor's signature, but the bills passed by big margins. This is a terrific development for home birth and perhaps and example that will be useful for other states.

Read more about this news here.

This is exciting news for NH and just makes me reflect on what we're working towards here in Missouri--simply the right to skilled midwifery care in our homes. It has been a difficult struggle to get this idea of legal midwifery accepted here in Missouri and so it is a refreshing change to know that in other states not only is home birth "accepted," but is also now covered by insurance! Missouri is falling even more behind the times!

St. Louis Post Dispatch Slideshow

There is a lovely slideshow of a midwife attended homebirth currently available on the St. Louis Post Dispatch website! This is what we're working towards--making births like this readily available to women throughout Missouri! :-)

Giving Birth: Book Review

From the Winter 2007 edition of the FoMM newsletter a review of the book Giving Birth: A Journey Into the World of Mothers & Midwives:

Giving Birth by Catherine Taylor is one of my very favorite books about birth. Simply put, this book is a very good read! Catherine Taylor is a skillful author and though this book is very factual and informative, it reads with the pace, intensity, and "intrigue" of a novel. It is unique among the many birth books I have read in its interweaving of her personal experiences and personal journey, with factual journalistic impressions and statistics. I finished this book in two days--it was completely absorbing and interesting. I enjoyed her descriptive style and the verbal portraits of the variety of midwives she encountered. The book also gave me some new perspectives on hospital based CNM practices as compared to traditional midwifery and homebirth-oriented midwifery practices.

The author is an Ivy League journalist who set out to study midwives after her less-than-satisfactory birth experience with her first son (hospital birth with a CNM). During the course of her research, she becomes pregnant with her second child. The book chronicles her interviews with a variety of midwives, her experiences shadowing midwives in home, birth center, and hospital settings, and her comments/observations about birth in the United States. She weaves her research together with the progress of her second pregnancy, her decisions about place of birth, her choice of midwife, and her experiences with training to become a doula (training that was inspired by her “observer” status at births during the early stages of her research. She trains with Birthing from Within and her descriptions are a very interesting sneak "peek" at the training). The book concludes with the birth story of her second baby.

In short, this is an enjoyable, informative book!

To subscribe to the FoMM newsletter visit the FoMM website!

First Day Back In the Halls

Mary Ueland (left) and Debbie Smithey (right) leaving the Capitol after the first day of the 2008 legislative session. Can you tell - it's dark and cold?!

Debbie and I along with Keith and Elizabeth headed to the Capitol early on the first day of session (Wed, Jan 9). We had an important meeting to attend with a couple of key legislators. The meeting didn't turn out quite like we expected, but we left the meeting with all parties agreeing to work out some things to allow the midwifery bill to move forward.

Afterwards, Keith and Elizabeth had to head back to their jobs. Debbie and I spent the rest of the day visiting with anyone and everyone we ran into. We met old friends all day long.

Our day mostly consisted of sitting in various legislator's offices chatting about what had happened since we saw each other last May, explaining our position on the "tocology repeal" to everyone who stopped us in the halls and asked, "What is going on with your midwifery stuff?!?" We also passed out quite a few copies of the letter from Friends of Missouri Midwives, explaining our position on repealing the tocology language.

One of the first Legislative Assistants to befriend us years ago came up to us in the hall and said, "Guess what?! I'm a lobbyist now!" Of course, she wanted to tell us what she knew and ask us what was going on. She proudly said, "I've been working on everybody in the ___ (organization she works for) office and trying to get them on board with midwifery! They don't all get it, but I still tell them about it all the time!" We spent about an hour discussing birth, breastfeeding, midwives, politics, and everything related with her in the hall... and lowering our voices when someone walked by, looking at us strangely! : )

Overheard; one lobbyist to another:
Lobbyist 1: "Good morning!" (pleasantly to someone who isn't friendly to the lobbyist's cause...)
Lobbyist 2: (whispering) "Did you really mean that?!"
Lobbyist 1: "Uh, don't believe anything I say in this building. You can ask me about anything you hear me say in this building when we leave and I'll tell you if I really meant it! Okay?"

The First Day of the 2008 Legislative Session!

Wednesday, January 9, is the first day of the 2008 Legislative Session at the Missouri State Capitol in Jefferson City. The legislators will return to the Capitol to begin working on a whole bevy of ideas and bills.

For the legislators, the first day of session is not really much of a work day. It's usually a day to catch up with all of their friends that they haven't seen since May when the last legislative session ended. It's a time to greet new friends, to bring family and friends to the Capitol for a tour or a party, to listen to speeches given by the Leadership of the legislative bodies about all of the great things that everyone hopes to accomplish, and to enjoy the day. They will head home on Thursday.

The first day of session is not a good day to lobby legislators, except by making your presence known in a friendly "welcome back!" way. Of course, small talk in the halls and elevators leads to questions about what is going to happen with midwifery this year, and perhaps an opinion offered about the way people are feeling about the issue. It's a good day to be at the Capitol, if you're good at just listening, smiling, and offering friendly hello's to everyone you see. If you want to come on a day when you can actual make appointments to see legislators to talk to them about midwifery, next week would be much better - especially Tuesday or Wednesday.

Next Week: The legislators will be in session at the Capitol next week from Monday afternoon through Thursday morning. They will have extra free time to talk to constituents about issues and bills as their days will not yet be full of committee hearings, votes, and all the craziness and business that accompanies session later in the year as hundreds of bills are moving.

If you can schedule a day or two to come help us educate legislators at the capitol, or would like to help in some other way, please email me at:
better_birth {at} yahoo {dot} com, or call me at: 417-543-4258.

Your voice can and will make a difference! Use it to change your world!