Malpractice costs cause a ripple effect

By Alison Snyder

The medical malpractice insurance crisis not only has Long Island obstetricians anxious, but midwives – who take a more natural approach to childbirth – are also feeling the crunch.

In the New York metropolitan area, midwives – who provide prenatal care and assist women through childbirth, albeit without a medical degree and the corresponding high salary – have seen their insurance rates skyrocket from an annual payment of $11,000 in 2002 to $27,000 in 2007, according to the New York State Association of Licensed Midwives.

Midwives provide a more personalized style of obstetrics care, usually for women with low-risk pregnancies, and support more natural birthing methods. In New York State, licensed midwives attend approximately 11 percent of births.

Midwives on Long Island make about $85,000, said Kristen Walsh, president of NYSALM. Independent midwives, who are not employed by hospitals or physician-owned practices (who both typically pay malpractice insurance for midwives), are the greatest affected, Walsh said. And rising insurance rates are adversely impacting the profession.

Dale Cook, an independent midwife who owns Gaia Midwifery in Greenlawn, is a case in point. She pays about $25,000 for her malpractice insurance. In 2000, when she entered the profession, she was paying $5,000. She said the high rates are limiting independent midwifery practices like hers as such practices look to absorb the rates into their budgets.

The rates are also keeping potential midwives from entering the profession, Cook said, and current ones from growing their practices because they can’t afford it.

“If I could afford more midwives, I would probably expand my business to cover more parts of the island … but it’s hard to keep up the much larger fees now,� she said.

There’s a trend away from independent practitioners with more midwives working for hospitals, Cook said. Midwives also are opting to join physician-owned practices, but physicians may shy away from hiring midwives because of the higher cost of their malpractice insurance.

“Years ago, [midwives] were cost effective because our malpractice was so low that more doctors would have midwives in their office. Now they look for nurse practitioners (with similar abilities),� she said, because their malpractice rates are lower.

Nicole Rouhana, director of the nurse midwifery program at the Stony Brook University School of Nursing, said that though independent midwives will be the hardest hit, the problem will affect the entire profession.

She said that the high cost of medical malpractice insurance is discouraging some students from entering Stony Brook’s program. She said she gets several calls a week from those investigating midwifery that are concerned about the costs. Due to the higher rates and the widespread nursing shortage, she said enrollment has dropped from 40 new students each year to between 10 and 20.

Like many ob/gyns, midwives are looking to cut back to just gynecological care, or are caring for mothers during pregnancy, then referring them to another practitioner for labor and delivery in a move to lower their insurance rates, Rouhana said.

Midwives traditionally work with self-pay and Medicaid patients, NYSALM’s Walsh said. The issue most affects low-income patients who might have difficulty accessing a health-care provider to care for them through pregnancy and birth, and for which a midwife is a lower-cost option.

However, she said she thinks the profession will transcend the many challenges.

“We recognize that it is a real issue that is affecting our profession in many different ways, she said. “However … I think that we will most likely get through this. But I think it’s going to change the way we practice and we’ll have to be creative in revising our practice role.�

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