Q: Is malpractice insurance for homebirth midwives standard and what is a reasonable transfer rate?

[JudiAU]

I met with my first homebirth midwive yesterday. The meeting went well and i think she is very, very competent. I did find her fairly conservative and that there are a lot of not very risky reasons why she would refer you out of pracice.

Two things stuck out and I can't tell if they are issues or not: She mentioned that she didn't have malpractice insurance and that we would have an arbitration agreement in place. Do homebirth midwives usually care malpractice insurance. I can only imagine it would be godawful expensive, if it could be purchased at all. I just wanted to compare her experience to others.

Also, of about 100 births she and her partner did last year (now a planned 70 this year) there were only 2 transfers. I find that shockingly low, given the number of transfer stories I've read about. Even if she only delivers very, very low risk babes at home is that normal? It seems like there are plenty of reasons to transfer, even just physical fatigue.

[Haelmoon]

I don't know about the insurance.  I live in Canada, and midwives can practice at home and in hospital, but as a collective have malpractice insurance (mandatory).

In terms of the transfer rate, that does seem very low.  Do they have many years in there practice to review numbers - this could just be a very good year!!  Do they have the numbers for transfer of care that occured before labour?  There are studies out of Holland and England that address transfer rates.  For first time moms the rate can be as high as 50%, but that includes pre-labour transfers too.  For multips it was less.  I don't have the studies on hand, but I think is was still around 25%, but less that half of those were in labours.

Essentially, if they only delivered low-risk multiple who remain low-risk throughout their pregnancy, and only counted in labour transfers, that number would not be out of range.  The caution would be are they truly selecting the best candidates for a home birth, or like you are asking, missing transfers that perhaps should have occurred.

Good luck with your pregnancy.  I wish you the best.

[dogmom327]

I've had three midwives over the years and none of them carry malpractice. Around here at least that seems to be pretty standard.

2% transfer is low but I agree with the PP, it's just a matter of their client make up. If last year they had all very low risk clients, etc. it's quite feasible for it to be that low.

[phathui5]

I don't know any homebirth midwives who carry malpractice insurance.

I wouldn't be shocked by her transfer rate if she's only done a hundred births.

[JudiAU]

She and her partner did 100 births last year. She has been doing hombirths for ten years and prior to that was a CNM in a hospital setting.

[conniebonnie]

I assume by her low transfer rate that she truly only takes low risk clients.

[Plummeting]

Do they take first time moms? If not, I think that would make their transfer rate a lot lower than midwives who do, because first timers are a lot more likely to transfer.

[JudiAU]

Thanks all.

[FarmBirther]

My midwife has an overall transfer rate of about 3%. She is very experienced so I'm guessing it is because she can handle things that come up without having to transfer. She also has a very good relationship with the hospital in our area and encourages me to call the OB office if I have any medical concerns that are out of her scope (like hyperemesis) that you would need medical interventions for. So maybe this close relationship helps to lower the chances of finding a complication during labor?

[BroodyWoodsgal]

My MW has a transfer rate of 18%....most of those are FTMs and most of them are not for super emergent situations..epidural requests, tired moms who want to go, etc. I know my MW is very "pro-transfer"...when a woman says she wants to go and she means it, my MW doesn't try super hard to convince her to stay home. She has a truly good relationship with the OB practice (a group of really awesome women) which backs her up at the hospital in our area and transferring is a really, really supported and comfortable decision for women who work with my MW. I'm super comfortable with that higher number, though, because I think the number is made higher by a MW who has recently left the center who was willing to take on much, much higher risk cases. I'm actually sad that the other MW left, because I liked that she had a little "cowboy" in her. She was really great and made a wonderful team with my main MW, who has a much, much more "by the book" and cautious take on things.

My MW does not carry malpractice insurance. She has some kind of sort of rinky-dink insurance for "something-rather"...I can't even remember what it is, but it's nothing close to the kind of insurance policy carried by an OB at a hospital. It's really nothing worth mentioning. My MW is very upfront about the fact that she doesn't carry malpractice insurance. I don't know of any MWs in my state carrying malpractice insurance. It's prohibitively expensive.
 

[iowaorganic]

nope no insurance here either.  and a 4 % transfer rate.  I think probably a lot of this is because our area is so rural that it is quite a trip to the hospital- so something like fatigue or pain would still mean a 45 minute trip to the hospital- during which time if you stay home you can hopefully work through it.

[Buzzbuzz]

" It's really nothing worth mentioning. My MW is very upfront about the fact that she doesn't carry malpractice insurance. I don't know of any MWs in my state carrying malpractice insurance. It's prohibitively expensive."
 

I think the website 10centimeters looked that this (at least for California), did some pricing and found that the expense was not nearly as great as might be assumed. 

In my mind the failure to obtain malpractice insurance shows a fundamental disrespect for the gravity of the midwife's tasks and the fact she holds lives in her hands.  However, it is clear that there is no motivation by midwives to obtain such insurance until consumers demand it or it is required by law. 

Imagine having a child with a severe birth injury, who will never live independently -- and then imagine the difference that a malpractice settlement might make in providing for special therapies, educational opportunities, respite care and assistance for you at home, modifications to your home to make it handicapped accessible, purchasing a vehicle that will accomodate your child's wheelchair, etc., etc., etc. 

[iowaorganic]

Buzzbuzz- a lot of us live in states where we are forced to deliver with a CPM- and if I remember correctly from the other thread you only believe in legalized CNMs.  Obviously underground midwives aren't going to be able to get malpractice insurance- it doesn't matter what the cost is- they won't be able to get it.  However- I have no problem not holding the mw responsible for my decision.  

[Alenushka]

Responsible health providers carry malpractice insurance. Real professional do not use the expense of the insurance not to have one.  I would not use a provider without one. There companies that provide insurance to HB MW.

There was hearth breaking case in TX, where child suffered life long disability because of CPM's negligence and parents could not get a penny for the child's care.

Things happen and things go wrong, if something happens to your child because of midwives incompetence , would not you want to have money to provide best care for her?

At least with the OB and hospital you know you can get financial aid should thing go wrong.

[BroodyWoodsgal]

All the MWs I know and know of in my state do not carry MP insurance. I can assure you that they ARE professionals and are NOT irresponsible.

All the MWs I know and know of in my state are up front about this and require that expectant mothers and their partners sign a form acknowledging that they have discussed this and the implications of no malpractice insurance being available with the MW.

It is my choice as a parent to have care under a MW, knowing that being cared for by a MW in my state means my provider has no MP insurance.

Informed consent is a beautiful thing. How is my MW being irresponsible?

If anyone here is being irresponsible, it would be ME, right Alenushka? Since I'M the one deciding to bring my child into the world in a situation where I couldn't sue if something happened to her during her birth?? My MW is not holding a gun to my head, I CHOSE her and happily agreed to continue care under her with the full knowledge that she is not covered by malpractice insurance. So I'M the one "dropping the ball".

However, it is clear that there is no motivation by midwives to obtain such insurance until consumers demand it or it is required by law.

BuzzBuzz- Why the HELL IS THAT NECESSARY? Seriously...why the hell do you think it needs to be mandated? What is WRONG with people like you, who want this kind of thing mandated all the time? I do not understand this compulsion. Why don't I have the RIGHT to feel comfortable choosing to receive my prenatal and birth care from someone who doesn't carry malpractice insurance? Seriously.

[Imakcerka]

Originally Posted by BroodyWoodsgal 

All the MWs I know and know of in my state do not carry MP insurance. I can assure you that they ARE professionals and are NOT irresponsible.

All the MWs I know and know of in my state are up front about this and require that expectant mothers and their partners sign a form acknowledging that they have discussed this and the implications of no malpractice insurance being available with the MW.


It is my choice as a parent to have care under a MW, knowing that being cared for by a MW in my state means my provider has no MP insurance.

Informed consent is a beautiful thing. How is my MW being irresponsible?


If anyone here is being irresponsible, it would be ME, right Alenushka? Since I'M the one deciding to bring my child into the world in a situation where I couldn't sue if something happened to her during her birth?? My MW is not holding a gun to my head, I CHOSE her and happily agreed to continue care under her with the full knowledge that she is not covered by malpractice insurance. So I'M the one "dropping the ball".




BuzzBuzz- Why the HELL IS THAT NECESSARY? Seriously...why the hell do you think it needs to be mandated? What is WRONG with people like you, who want this kind of thing mandated all the time? I do not understand this compulsion. Why don't I have the RIGHT to feel comfortable choosing to receive my prenatal and birth care from someone who doesn't carry malpractice insurance? Seriously.

What's wrong with having a differing opinion about it? When I looked into hb I wanted the MW to have malpractice insurance. I also think it should be mandatory.

[flatlander]

On the informed consent form I got from my CPM, it says that she doesn't carry malpractice insurance. When I asked her about this, she said that CPMs in our state aren't able to get malpractice insurance and that the state requires she discloses this information with mothers.

I'm no expert, but from the research I've done it looks like everything related to midwives varies from state to state. In some states CPMs are not legal, in other states they are. In some states CPMs can deliver breech babies, in other states they must transfer the mother to a hospital. In some states CPMs can assist with twin births at home, in other states the mothers have to go to a doctor. After reading the various previous posts, I'm wondering how available insurance for CPMs varies from state to state, like seemingly everything else related to midwifery. 

For me personally, someone having the "right" insurance doesn't reassure me that the CPM/CNM/doctor is the best care provider for my situation. Personally, what I want is to hear lots of stories from different mothers that have birthed with the CPM, CNM, or doctor present and use that information along with asking the CPM/CNM/doctor direct questions about their statistics. And if I happen to know mothers who have had unexpected complications with the CPM assisting, how did the CPM handle it? What was the partner's perspective on the CPM? At least, these are the types of things I tend to consider when making the important decision of who should be a present at my baby's birth.

Clearly there is no "one right answer" for every mother. And each of us has to weigh the available options in our perspective states and countries and make the decision that feels best for ourselves and our families. I am feeling pretty lucky to live in a state where CPMs and home birth is legal, and that I can choose where to birth and with whomever I feel most comfortable. It's a shame that women everywhere don't have this choice.

[Turquesa]

Personally, the red flag I see here is  not the lack of malpractice, but the arbitration agreement.  Is this an arrangement of binding mandatory arbitration, by which you waive your right to sue?  To be clear, I'm very pro-midwife and soon to have a midwife-attended birth.  But I wouldn't agree to that with a doctor OR a midwife.  You need to retain your right to sue in the unlikely scenario of an adverse event, (and if she doesn't carry malpractice, you probably won't get compensated, but at least bankruptcy would keep a negligent provider from practicing).  With these BMA agreements, the provider usually gets to pick the arbitrator, so you end up in some decidedly non-neutral kangaroo court.  BMA is an ongoing problem with everyone demanding it---banks, auto dealers, realtors...I just do everything I can to avoid it. 

[Buzzbuzz]

"However- I have no problem not holding the mw responsible for my decision."

This makes no sense to me.  Malpractice is negligence or wrong-doing on the part of the provider.  So you're okay with having a provider who provides negligent care?  Its all on you for who you chose to hire?

I think no one would agree that when they're hiring a midwife without malpractice insurance that what they're saying is "its okay -- you can do a crappy job and I'll just smile and say thank you".  Though I think those who do hire such midwives should acknowledge that that in fact that may be the reality of their outcome if she does end up committing malpractice.

[Buzzbuzz]

"BuzzBuzz- Why the HELL IS THAT NECESSARY? Seriously...why the hell do you think it needs to be mandated? What is WRONG with people like you, who want this kind of thing mandated all the time? I do not understand this compulsion. Why don't I have the RIGHT to feel comfortable choosing to receive my prenatal and birth care from someone who doesn't carry malpractice insurance? Seriously."

Well, I'm just one of those nazis who think that motorcycle helmets should be required by law, that there should be some limits on the activities of insitutions that are too big to fail, that building codes are a good idea and that medical providers should have malpractice insurance.