Online Program

Professionalization of midwifery and its ramifications for midwife malpractice

Tuesday, November 5, 2013

Sarah A. Hexem, JD, James E. Beasley School of Law, Temple University, Philadelphia, PA
Kari R. Hexem, MPH, Division of Community Oral Health, University of Pennsylvania School of Dental Medicine, Philadelphia, PA
The vast majority of women today give birth in hospitals, but more women are turning to midwives to provide pre- and post-natal care both in hospitals and at home. Research, science, and policy have yet to achieve consensus about the safety of alternative birthing models, including professional midwifery services.

Most midwives in the United States hold nursing degrees and receive credentials based on standards set by the Accreditation Commission for Midwifery Education (ACME). Other midwifes are generally called “direct-entry midwives,” a term that includes non-nurse-midwives trained under the ACME standards, Certified Professional Midwives (certified by the North American Registry of Midwives), and lay midwives who have learned their trade through self-study or apprenticeship. The distinctions among these professional midwives has particular relevance when evaluating state law.

Professional midwives, like all professionals, due to their education and expertise, are expected to provide patients and clients with a heightened standard of care. When professionals breach their respective standard of care, and the breach proximately causes an injury, the patient/client may sue for damages. Professional midwives are no exception to the basic rule of malpractice. Thus, as states increasingly professionalize midwifery, and more women hire midwives, there will be more opportunities for midwife malpractice.

This study, through a review of the history of midwifery in the United states, a survey of current professionalization status, and an in-depth analysis of Pennsylvania midwifery law, suggests that professionalizing midwifery can reduce negligence by promoting quality standards and avoid unnecessary litigation by valuing intra-professional communication and respect.

Learning Areas:

Diversity and culture
Ethics, professional and legal requirements
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Describe how the role of midwives has changed over time in the United States. Explain current trends and perspectives on home birth and midwife-attended birth. Compare the professional associations that currently train and credential midwives in the United States. Evaluate relevant statutory law and consider the implications of increased regulation.

Keyword(s): Accreditation, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have studied women's health history and law for the past 8 years and worked as a case-manager for women at an abortion clinic, as a crisis counselor for a rape hotline, and as research associate for a court-reform organization in Philadelphia, PA. I currently work on issues related to the implementation of the Affordable Care Act at a public health research and management non-profit, and am in my 3rd year of law school.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.