In a warm classroom on a hot Miami night, I sat listening to the head midwife lecture about the evils of malpractice insurance. She said that having malpractice insurance was “like painting a big red bullseye on yourself.” She impersonated attorneys salivating, licking their lips, and twiddling their fingers ominously when they find out that a midwife has malpractice insurance. In Florida, Licensed Midwives are required by regulation to carry malpractice insurance. According to my preceptor, the reason that midwives did not fight this regulation was because they thought it would make them look more “respectable” to have malpractice insurance. “Respectable!” she scoffed. “If I wanted to look respectable, I’d wear a bra!”
In South Carolina I was not required to carry malpractice insurance, and due to the warnings of my preceptor and my understanding that it was difficult to find and expensive, I did not carry it at first. I knew that this meant that if anything went wrong at a birth, I could personally be sued for all I was worth. I wasn’t really worried about this, though, because at the time I wasn’t really worth anything. We didn’t have money or assets to speak of; we owned our home, but had almost no equity in it. I knew that if anyone tried to sue me, they would have a hard time finding an attorney to take the case. “You can’t get blood from a stone,” I thought to myself.
Once the birth center was up and running and we started making real money, we revisited the idea of malpractice insurance many times. We carried liability insurance (known as “slip and fall”) on our building, but avoided purchasing malpractice. At some point, it came to our attention that if we had malpractice insurance we could become in-network with insurance companies, specifically Medicaid plans. We knew this would be a lucrative move, so we looked into it. We were sold a very inexpensive “professional liability” policy that covered the four partner midwives. I was told that this was different, somehow, from “malpractice” insurance. I was never clear on exactly what it covered. I was afraid if we asked too many questions, the underwriters would realize they had undercharged us, so I didn’t press for answers. A cheap policy that stood to help us open our doors to lots more women? Take it and run!
It never occurred to me to be concerned about people with a birth-injured newborn needing to be able to recover damages from us so they could afford all the extra care their baby would need. Never. We midwives thought only of our successful business, all the lovely births that all these women were going to have with us, and all the cute babies we would catch. If something bad happened, well, that was life!
After I left the birth center I read this: Do State Midwifery Laws Matter? This report indicates that Licensed Midwives in Florida, the only state to mandate malpractice insurance for midwives, have a much lower neonatal mortality rate than midwives in other states where midwifery is legal but malpractice insurance is not required. (The neonatal mortality rate for Licensed Midwives in Florida is still much higher than the hospital nurse-midwife rate for term babies.) It seems that midwives who carry insurance may actually be safer for babies than midwives who do not.
If you are using a midwife, ask if she has malpractice insurance. If so, ask to see the policy. Find out if the payout limits are enough to help you get all the care your baby might need in case of a birth injury or brain damage. (Babies born at home are significantly more likely to suffer from brain damage than babies born in a hospital.) If not, consider that many families who had a poor outcome with a midwife have become bankrupt and have to rely on Medicaid and other forms of assistance to care for their child. It’s a pretty serious gamble.