Q: Is malpractice insurance for homebirth midwives standard and what is a reasonable transfer rate? - Page 4 - Mothering Forums

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#91 of 104 Old 05-21-2012, 11:52 AM
 
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Originally Posted by Buzzbuzz View Post

 

Providing that what a midwife does to protect their assets is legal, I have absolutely no issue with it.  However, people who hire an uninsured midwife must understand that she may have absolutely no assets that are reachable in a lawsuit.

 

I think if a person hires a midwife knowing they do not have insurance, they know they are taking a chance that, in the unlikely event of medical malpractice, they may not be able to get money. You cannot get money from someone who does not have any.   A reminder if fine though, for those of us living under a rock.  smile.gif

 

GoBecGo….I am sorry you are losing your midwives.  greensad.gif

 

If you are an activist, or know any activists, it might be useful to look at models of how other countries with universal healthcare arrange malpractice insurance for their midwives.  In Ontario (Canada) it is provided through the Ontario Association of Midwives.  I am not sure how much it is - but I doubt it is exorbitant (high, but not exorbitant) 

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#92 of 104 Old 05-22-2012, 10:12 AM
 
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I think if a person hires a midwife knowing they do not have insurance, they know they are taking a chance that, in the unlikely event of medical malpractice, they may not be able to get money. You cannot get money from someone who does not have any.   A reminder if fine though, for those of us living under a rock.  smile.gif

 

GoBecGo….I am sorry you are losing your midwives.  greensad.gif

 

If you are an activist, or know any activists, it might be useful to look at models of how other countries with universal healthcare arrange malpractice insurance for their midwives.  In Ontario (Canada) it is provided through the Ontario Association of Midwives.  I am not sure how much it is - but I doubt it is exorbitant (high, but not exorbitant) 

That was certainly the case for our family kathy. :)

 

I'm involved with the activism, we're looking at it every which way.  The ontario scenario (sorry!) is what we USED to have.  The problem we're up against is that any "body" that comes together to get insurance then has to start having rules about what an acceptable level of risk is, and generally some random Ob gets to dictate them (or a layperson!  I'm not kidding laypeople are on the board to judge of negligence occurred or not in the UK!), and at the moment some midwives will for example support HBAC but would be prevented from doing so if they joined a collective with affordable insurance.  Midwives who would previously judge each case on its merits would be forced instead to do blanket risking-out.  So though it wouldn't be joining the NHS, in many ways it might as well be.  Ultimately the risks which the NHS won't take are legal ones more than medical.  Autonomy is leaving midwifery, which is very very sad.

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#93 of 104 Old 05-22-2012, 01:00 PM
 
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I've been reading this thread off and on for a while, but this is the post that's going to get me to comment.

 

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Originally Posted by Buzzbuzz View Post
A midwife in my area earns between $3500 and $4500 for the prenatal care and birth (usually whether or not she actually makes it to the birth).  A doula is paid between $300 and $500.  I would note that an OB in my state gets paid around $800 for the prenatal care and birth of a Medicaid patient.

 

I believe overhead costs are relatively low compared to doctors -- frequently no brick and mortar office, no or only one secretarial staff, no r.n.s on staff, some disposable supplies (and sometimes food) being provided by the patient, no malpractice insurance costs and no or extremely limited continuing education costs and licensing costs as compared to doctors. 

 

Assuming payment of $4,000 per birth and 2 patients a month, a midwife would be earning around $96,000 less her operating costs for a career that does NOT require a college degree (and until the last month or two did not require a high school degree or GED).  This assumes she does not earn additional income by offering placenta encapsulation services, moxibustion, etc., etc. I have also heard second-hand of a midwife in our community that received "referral payments" for directing her clients to certain alternative medicine providers (acupuncturist, herbal medicine supplier, placenta encapsulation specialist).

 

The median income in the United States is around $45,000.   To pretend that there is no money to be made in natural childbirth and its various accessories is simply crap.  It is a business like any other.

 

 

I think you really have no idea what costs may be behind the scenes for a MW.  Have you ever been self-employed?  Do you have any idea of the costs associated with being self-employed?  From what you typed here, the answer is obviously no. 

 

Here a LM earns roughly $4000 per birth (sliding scale though, that's the higher end).  A doula earns $1000.  An average MW or MW team might take 2-3 clients per month.  That's maximum, that's not a guarantee.  In an average year, that might mean 18-20 moms, not 24-36.  Very few MWs fill up every month.  Some MWs will have more, some will have less.  I know a few MWs who only take 1 client per month.  Around here there are always 2 trained professionals at a birth.  Sometimes that means a MW and an assistant (paid), a MW and a late-in-training apprentice (paid), a MW and a back-up MW (paid).  These people are all paid out of the MWs pocket.  My MW with my last pregnancy had an apprentice.  This pregnancy (a different MW), she'll have a back-up MW.  I don't know what it costs her, but I know they're not doing it for free.  In addition to the cost of hiring a 2nd pair of hands for the birth, there are other costs involved, both for the birth and throughout the prenatal care. 

 

The cost of the copying and binding she does for all the paperwork involved in the client packet (list of resources, birth questionnaires, new client questionnaires, birth supply lists, etc.).  Kinko's doesn't make copies for free.  Many of the MWs here hand these out at initial consultation interviews, before they're even hired, so they have to make way more than they ever get reimbursed for.  Cost of transportation to and from every visit, around here might include tolls for the bridges, includes parking meters or garages, parking tickets, and I know at least one instance where a MW had to double park to catch a precipitous birth, and then you have to deal with the cops and impound fees and all that lovely jazz.  Not to even mention that gas is about $4.50/gallon ATM, she has to have a reliable car (including regular upkeep), and decent insurance on it, so that she's never stranded.  Any visit that involves testing - test strips aren't free, neither are gloves.  If you have an internal exam (prior to labor), the cost of those supplies comes out of her pocket as well, not out of the birth kit.  Every piece of paper that you have to sign has a cost attached to it... I've had to sign several, one each time I decline a test to cover her butt that she did in fact offer it to me.  Requesting copies of records from other practitioners, not only costs for the paperwork, but then for the stamp, the phone calls to follow up, and if they fax it back, the supplies for printing it out.  On the other end, if she gets a request for records on a former client, she has to pay to copy those records and get them to the new practitioner also, and that money comes off her bottom line, since that client may have been years ago.  There's also the cost associated with billing insurance companies, which she doesn't do herself, she hires someone (who knows what they're doing) to do, on the off chance there might be a few dollars to reimburse the parents.  There are in fact continuing education costs, there are professional conferences to attend, there are books to buy, there are certifications to keep current, there is equipment to update or replace when it fails.  And then there are the birth supplies that are not provided by the parents.  Oxygen tank is a big one.  Suturing equipment, extra everything, just in case.  Sterilization fees.  There are some things where the costs get passed along to the parents, but she still has to eat them up front, like lab fees or drug fees (RhoGam comes to mind).  And then there's basic overhead, like my MW is right now switching over to paperless chart keeping.  She has to pay for that system, the software, the subscription service, the online support, the hardware.  She has to pay for her cell phone plan AND her beeper so that she's available 24/7.  And when it comes down to it, she also has to pay taxes.  Being self-employed, she has to pay a LOT of taxes.  And I'd be willing to bet that in my 39 wk pg haze I'm forgetting any number of costs.  And all of that is assuming that she didn't barter for part of her fee, take the low end of her sliding scale, and that she actually gets paid in a timely manner, which doesn't always happen. 

 

In the end, I'd be surprised if she were keeping even half of her global fee per client.  And this is for a person who answers the phone when I call at 2 am a few days pp and comes over in her pjs, regardless of how much/little sleep she's gotten.  Who easily spends 2-3 hours talking to me at every single prenatal visit, just to make sure that I'm comfortable, prepared, and have any concerns addressed.  Who likes me to keep her updated via email with what is going on with me - when I had my tooth extracted last week we kept in touch via email so that she could support me through the pain, give me advice on keeping the baby inside until I heal, without making it worse (by talking on the phone).  Heck, my MW and I discuss what books we're reading, so that we have a mutual frame of reference, and she brought me 2 books at yesterday's visit so that I have something to read while I'm waiting for labor to start.  How many doctors do you know who will make that sort of effort with a patient? 

 

I'll also point out that while the median income in the US may be around $45K, in this area, that income would barely be enough to keep a roof over your head.  They're not in it for the money.  In no way shape or form is this about the money. 

 

And yes, my MW does do encapsulation.  She's not charging separately for it, though.  Any more than she's going to charge me separately for the PP smoothie she'll make me, or the BFing support she's going to be giving me.  Even though she would be within her right to charge me extra for the encapsulation (around here it goes for $250 on it's own). 


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#94 of 104 Old 05-22-2012, 01:19 PM
 
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Yeah, the taxes ALONE strip her of at LEAST 30% of whatever she brings in...if she has people working for her and she's paying payroll tax, freaking forGET about it...payroll taxes are insane for small business people.

 

MWs aren't rollin' in the money....anybody who goes into midwifery because they want to make it rich better think twice.
 


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#95 of 104 Old 05-22-2012, 05:44 PM
 
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MWs aren't rollin' in the money....anybody who goes into midwifery because they want to make it rich better think twice.
 

 

Exactly. It costs a ton of money even to get to the point of being a midwife. And most people can't take out student loans for that.

 

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Originally Posted by cristeen View Post

I've been reading this thread off and on for a while, but this is the post that's going to get me to comment.

 

 

I think you really have no idea what costs may be behind the scenes for a MW.  Have you ever been self-employed?  Do you have any idea of the costs associated with being self-employed?  From what you typed here, the answer is obviously no. 

 

 

 

Thanks so much Cristeen! That post was so off-base, I was hoping someone with a clear and level head would chime in soon.


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#96 of 104 Old 05-23-2012, 11:05 AM
 
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To be honest I do not know of too many midwives who have it...in NH we have an insurance mandate and still not all midwives have insurance...it is hard to afford when you are not seeing many clients. I am fortunate to have a busy practice and the ability to work in birth centers so to me it is worth it. 


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#97 of 104 Old 05-23-2012, 11:42 AM
 
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To be honest I do not know of too many midwives who have it...in NH we have an insurance mandate and still not all midwives have insurance...it is hard to afford when you are not seeing many clients. I am fortunate to have a busy practice and the ability to work in birth centers so to me it is worth it. 




Well but the insurance mandate in NH isn't mandating that MWs carry MP insurance...it's a mandate which forces insurance companies to cover MW services.


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#98 of 104 Old 05-24-2012, 08:52 PM
 
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Quote:

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.

 

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

 

 

Quote:

Just like DR's there needs to be a way we can feel comfortable knowing there will be repercussions for MW's that do mess up.

 

There is recourse available for parents whose midwives have practiced outside the standard of care. You can file a complaint with their licensing body in states with licensing, with the nursing board if they're a CNM or with NARM if they're a CPM.


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#99 of 104 Old 06-18-2012, 02:51 PM
 
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CNMs can be reported to Board of Nursing. CNM's carry malpractice insraunce.

 

NARM  does not really suspend anyone that often.

 

Malpractice insurance protects the interest of the patient. If the child i injured as result of malpractice, who do you think should pay for care? Parents who do not have any money? Tax payers who did nothing wrong?

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#100 of 104 Old 06-21-2012, 03:41 AM
 
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What if rather than malpractice it was simply a tragic outcome that no one could have prevented?  Do we sue God?  A lot of the time no one is to blame, and some of the time the person who IS to blame is untouchable because they not only have malpractice insurance but lawyers you can't even afford to phone to defend them.  So often the poor outcomes in the hospital are incredibly unlucky and one of those things, whereas the similar situation at home is a witch hunt for the evil negligent midwife.  That is why many of us are ok with "risking" an uninsured careprovider.  There are midwives (i am fantastically lucky to know one) who are very educated, very astute, and highly motivated to AVOID problems.  In the NHS hospitals i can have a Dr who is happy enough that he can correct (to the detriment of my baby and myself) most situations his negligence or constraints (such as might be enforced by his ridiculous patient lists and the dangerous staffing levels his team operate with) allows to occur.  For me the "risk" associated with booking care from someone whose general practice is to look after 8 or more women at once so i am more or less a faceless belly with a patient number then run in with a scalpel to save me when it's gone so wrong that it's the only recourse is higher than that of booking someone who can provide dedicated one-to-one care centred on normality and no intervention who might perhaps possibly one day make a mistake.

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#101 of 104 Old 06-21-2012, 10:49 PM
 
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You do not get money for simple accidents, you get money if there was instance of malpractice.
 

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#102 of 104 Old 06-22-2012, 01:46 AM
 
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Yes, i know and malpractice of a wealthy doctor with an army of expensive lawyers is very hard to prove.

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#103 of 104 Old 06-22-2012, 06:15 AM
 
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You do not get money for simple accidents, you get money if there was instance of malpractice.
 

 

 

This statement is about as naive as asserting that "guilty people always get convicted and innocent people never end up punished for crimes they didn't do".

 

Half of my family works in med malpractice as attorneys and paralegals. They work for some of the top and most "reputable" firms in the entire country....not some ambulance chasing outfit or whatever...and let me tell you, some of the cases that are settled with huge payouts or that are tried and the defendants receive payouts are ABSOLUTE bullshit. Like, you or I would NEVER think they were even worthy of time in court...we wouldn't see malpractice, we would say "it was a clear accident".

 

 

These days, people don't sue when they feel someone has made a terrible error or was negligent...people sue -and win- for outcomes that simply were not ideal. A doctor can honestly do the very best anyone could have and still end up sued because the outcome wasn't good.

I am shocked at the cases I hear about on a regular basis. Malpractice law isn't some shining beacon of moral correctness...attorneys charitably helping injured people or grieving families "get what is rightfully theirs" - it's a disgustingly money-saturated industry. I'm not saying nobody ever gets a fair shake because of med malpractice laws! I can think of a few people off the top of my head who were absolutely victims and I'm so thankful that they have the payouts they got so they can afford the treatments they need etc. I can think of one little girl who was a bright, active, normal toddler...who, because of a negligent doctor who arrogantly brushed off real signs of danger, is now severely brain damaged, can barely walk and will require life long care from nurses, etc. Thank goodness her family got the payout they did so they could set this little girl up and they don't have to worry about losing their home, or "what happens when we are old" etc...


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#104 of 104 Old 01-29-2013, 01:46 PM
 
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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.  

No one in the U.S. is ever "forced" to give birth with a CPM. No one.  There is a law that provides for ANY laboring pregnant mother to be treated at ANY ER in the country, whether or not she is insured, has citizenship, a job, a home, whatever. You can simply walk in and have your baby with the resources of the hospital at your disposal. It is ridiculous to say that anyone is "forced" to give birth with a CPM.  

 

 Insurance should be mandated, because until it is, CPM's will continue to cry "poverty!" at every turn. If CPM's want to be licensed, they should also carry insurance and truly start to act like professionals. Consumers need to be protected! You should have heard the outcry when CAR insurance became mandatory! Oh, it's so unfair! People can't afford CAR insurance! That's so wrong, to force people to pay for insurance! But we're all used to having to have CAR insurance now. It's a fact of life. No one is going broke over it. And if you're hit by an uninsured driver, and you have insurance (depending on your coverage) you will still receive recompense.  Most of you are probably too young to remember when car insurance was NOT mandatory, but now it is just routine.  If midwives want to be recognized as legal and professional they should carry insurance like all other maternity providers. What's the big deal? If you practice safely and responsibly, then insurance will be reasonably low and will not increase much over time. If you're able to accept more clients and bill insurance as well, then you can balance your costs of insurance. Crying "poverty" doesn't release the midwife from the obligation to be professional and also to be able to be held accountable for any mistakes, negligence or gap in care.


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