Midwifery and malpractice insurance: Improving access to care or limiting practice? A case study of the Washington State Joint Underwriting Association for Midwifery and Birthing Centers

Susan J. Myers, LM, CPM, MPH, Seattle Home Maternity Service, 216 32nd Avenue, Seattle, WA 98122, 206 323 5259, suzymyers@comcast.net and Jo Anne Myers-Ciecko, MPH, Seattle Midwifery School, 2807 32nd Avenue South, Seattle, WA 98144.

In 1994, the Washington Legislature mandated the creation of a Joint Underwriting Association (JUA) for Midwifery and Birthing Centers to provide liability insurance, a requirement anticipated for all health care providers under recently adopted health care reform legislation. Licensed Midwives could not obtain liability insurance at that time. Licensed Midwives practice primarily in out-of-hospital settings, including free standing birth centers that are state licensed and generally owned by the midwives themselves. By assuring that midwives and birth centers could obtain liability insurance, public officials took one more important step in assuring access to midwives and out-of-hospital births in Washington State. Now, ten years later, what has been the impact of this unique program? This paper will describe the history, implementation and experience of the JUA. Midwives’ experiences with liability insurance will be explored and the current situation examined. The following questions will be addressed: • Has the availability of liability insurance improved access to midwifery and out-of-hospital maternity care in Washington? • What is the relationship between evidence-based practice in a clinical context and risk management in an insurance context? • How do escalating premiums or policy restrictions threaten the practice of midwifery? • Can the JUA be sustained in the current political, legal and economic climate?

Learning Objectives:

At the conclusion of this session, the participant will be able to

1. Describe three important factors in the creation and implementation of the Washington State Joint Underwriting Association for Midwifery and Birthing Centers.
2. Recognize the public policy implications of assuring access to liability insurance for midwives and birth centers, particularly the impact on women’s access to maternity care.
3. Describe the relationship between evidence-based practice in a clinical context and risk management in an insurance context.
4. Discuss the effect that liability insurance can have on midwifery practice, both positive and negative.
5. Apply lessons learned from the experience in Washington State to other proposed state and federal solutions to the growing malpractice crisis.

Keywords: Midwifery, Access to Care

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Member, Board of Directors, Washington State Joint Underwriting Association for Midwives and Birthing Centers

Policy and Financing of Women and Children's Health

The 132nd Annual Meeting (November 6-10, 2004) of APHA