Nurse-midwives, whose professionalism is indispensable in America's birthing rooms, are about to become dispensable to the health-care industry. Liability insurance companies are no longer able to provide malpractice coverage. As a result, a large percentage of the nation's 2,800 certified nurse-midwives may be forced out of the hospitals in which they serve or from the birth centers they operate.
The nurse-midwives are the last ones to deserve ejection. Although they assist at only 2 percent of the nation's annual births, their services are near 100 percent in personal care and warmth. While they only deliver in cases of uncomplicated, or low-risk, births, they are soothers and nurturers whose hands and heads know how to make childbirth a joy, not a trauma.
Their rewards are not in money, with salaries averaging $25,000 a year, against $110,000 for obstetricians. Their rate of malpractice suits is low: 6 percent have been sued since 1974, against 60 percent of obstetricians having been sued at least once. From that it is fair to say that large numbers of the women they serve tend to swear by them, while many women who use obstetricians merely swear.
Nurse-midwives have no moneyed lobby, as do physicians, to protect their interests before regulators or legislatures. Their interests are anything but special and are based only on a wish not to be driven from business by expenses beyond their control.
Marion McCartney's story is typical. She is a licensed nurse-midwife at the Maternity Center in Bethesda. In 10 years of practice and in more than 600 deliveries, McCartney has never been sued. Four years ago, her insurance was $125 a year. It doubled to $250 two years ago and this year went up to $800. She was braced for even larger hits except that her carrier, Mutual Fire, Marine and Inland Insurance Co., which covers 1,400 other nurse-midwives, terminated all its malpractice policies.
McCartney is in practice with four other nurse-midwives. In all, they have assisted at 2,500 deliveries. None has been sued. It is important to keep that record in mind, because it underlies the unfair treatment that is suddenly burdening the nurse-midwives. An official of Mutual Fire in Philadelphia explains that his company is leaving the medical malpractice field because of the soaring risk of claims. In the past, Mutual Fire was reinsured by more than 10 other firms, but now the reinsurance market is avoiding high-risk medicine.
That raises an obvious question: Why should nurse-midwives, who practice low-risk medicine, be treated as if they had created the problem? The answer, according to Richard Guilfoyle, the president of Mutual Fire, is that the insurance industry has yet to establish a separate category in obstetrics for nurse-midwives. Guilfoyle is sympathetic to the sudden financial problems of a group that provides low-cost health care. He praises the nurse-midwives for their record and says that he favors separating them from the physicians.
As the loudest protesters, physicians, most of whom earn high salaries, are quick to blame lawyers for the million-dollar verdicts that are increasing in malpractice suits. They blame patients for their high expectations for risk-free medical care. With insurance premiums rising as much as 400 percent in some states in the past five years, physicians see their profession in need of emergency-room rescue. Whatever heartburn doctors may be suffering, it is far less severe than the pain being endured by the nurse-midwives. Many obstetricians are conscientious and high-skilled professionals ready to make any sacrifice for the women who come to them. But one explanation for their high rate of malpractice suits is that too often an atmosphere of personal warmth and human trust has been lost on the way to, and in, the delivery rooms. The wizardry of technology is often paid greater attention than the emotional needs of the woman.
Much of the technology means better health care; it can also mean impersonal care. As bonds weaken or break between obstetricians and mothers and fathers, fewer restraints are present against suing the doctor. Why not sue? He is a distant figure, not a confidant with whom you can discuss differences.
One reason nurse-midwives are rarely slapped with malpractice suits is that they are sought out by pregnant women who share their belief that birth is a profound emotional experience, not a passing medical event. Nurse-midwives don't dominate the process with machinery and drugs, they nurture it with hands-on skill and personal attentiveness. They gird their medical expertise with woman-to-woman friendliness and understanding.
None of that is to sentimentalize the practice of people like Marion McCartney. She and the nation's other licensed nurse-midwives are asking only that insurers, insurance commissioners and physicians see them as skilled professionals providing low-cost quality care. They are independent and deserve to be separate.