Is Insurance Necessary?

What I believe about this question sees me part ways rather drastically with many Midwives who are currently fighting the proposed legislation. As I could go on and on about this subject, I will endeavour to keep it to the basic minimum. Feel free to contact me if you would like more, or have questions.

the pros for insurance
We live in a litigious world. Like it or not, insurance is a necessary part of everyday life. We have insurance for our car, our house, our income, our life - - - public liability insurance, third party insurance etc. You cannot advertise a meeting in a park without making sure you have insurance to cover it first. Some see private indemnity insurance for Midwives as a woman’s right. They see that it is an important and valuable part of modern society to have the protection of this insurance. What does it protect against? Basically, it gives the woman the security of understanding that her Midwife will not operate outside of the standard guidelines of her profession, and that in the event of a tragic outcome, have a pathway for some financial recourse. Care for the chronically disabled is very expensive and can cripple some families financially. Receiving a payout from an insurance claim is the only way some families can meet those financial burdens.

the cons of insurance
The legal system as it stands is a very expensive and roundabout way of seeking financial compensation. Clogging up our legal system, it certainly keeps the pockets of lawyers nicely lined. Many cases that are brought are frivolous, and raise the cost of insurance premiums for everybody. Without insurance, nobody sues a home birth Midwife, but with insurance, the court cases will sky rocket. If you doubt my words, history proves what I say.

Asking a private Midwife to take the responsibility for the outcome of your birth is basically unfair. While parents have the right to expect that their Midwife will act responsibly, and within the bounds of her practice, her sole role is to support the woman and partner in THEIR choices. Some couples may see the risk of a breech birth for example as too high and choose medical management, but other couples may choose to proceed with a home birth. So long as the midwife fully informs them of the implications of each choice, the choice should remain the couples to make, and the responsibility of the outcome theirs. If a couple does not wish to take on the responsibility, then they need to birth within the medical system, which assumes the responsibility for keeping them safe, and has the insurance to cover it.

Along with an insurance policy, a list of ‘conditions’ will be attached to a Midwife’s practice. She will no longer be able to support parents in their choice for a breech birth at home, or a vaginal birth after a previous caesarean, or a home birth when the woman has a history of a previous haemorrhage. There will be no twin births allowed at home and probably no first time mother’s having the freedom to birth at home, or perhaps a home birth will be denied in cases where the mother declines some or all standard prenatal testing. There will be a list as long as your arm of the women who will be denied their right to choose a home birth – all in the name of insurance.

How a midwife practices will be determined not by what is right or truthful or best for the individual woman, but by her insurance policy. Planned home births will have to be cancelled when a woman goes beyond 41 weeks, women will have to be transferred in when their labour goes over a certain time limit or their placentas take a little longer to birth, vaginal examinations will be required routinely, fetal heart monitoring to the extent where it interrupts a mother’s labouring rhythm will be required - - - once again the list goes on and on.

A family who sues for financial gain (needed or not) will ruin the career of a dedicated Midwife who went out on a limb to stand up for their rights. Fault will have to be found and blame attributed for something that may not have been the Midwife’s fault. This is true now in cases where Obstetricians and hospitals are sued. The difficulty with obstetric cases is it is very difficult to know whether somebody was really at fault, or if the outcome would have been different had different action been taken. Nobody can re-wind the clock and do it a different way – it is all speculation. I have no doubt that many Obstetricians are sued because of an outcome that was not their fault. It was once thought that cerebral palsy was purely a birth injury, but now it is thought that many of these cases happen in utero pre labour, and there is no definitive way of proving when exactly the injury occurred. What has happened within the medical community is that Obstetricians and Doctors intervene in a woman’s labour when there is only a remote possibility of an injury in fear of being sued for doing nothing. This has resulted in over-intervention in birth and many traumatised women suffering at the hands of a fear based system. We should not want the practice of Midwifery to walk a similar path. For the most part, home birth Midwives work outside of the medical system and base their practice on faith and trust in birth. Insurance would completely destroy this.

In effect, insurance for private midwives will allow the complete domination of birth by a medical philosophy. Those who seek a truly natural birth will have to choose a person other than a Registered Midwife to help them achieve their desire.

is there an alternative?
As far as I can see, the only thing in favour of insurance is the availability of financial assistance for families who have to care for an injured child. I would like to see a system in place in Australia that bypasses the legal system, but provides funding for families in these situations. Not only birth injuries, but for all families who find themselves caring for a family member with special needs. This would include car accidents, spinal injuries, birth injuries, chronic diseases etc. If the Government provided more adequate care and support for these families – in practical as well as financial ways, this reason for insurance would not be valid. This would make insurance far cheaper, (and in some cases invalid) and free our court system from multiple insurance claims. Examples like the one seen on the Gold Coast several years ago would not occur. (A family was successfully sued for a substantial sum because their boundary fence had a flat top and was an “invitation” to a drunken 18 year old youth to stand on it and dive into the canal. His dive resulted in a broken neck and he became a paralysed from the neck down.)

Families would still be able to seek disciplinary action against a Midwife is she acted negligently through the appropriate channels. This would prevent a midwife from practicing if indeed she was unsafe and prevent harm to future families.

Unfortunately, such a system would involve a complete overhaul of our laws and our legal system. It would meet with much resistance – particularly from the legal profession. But still, I see this option as the most logical and fair - - - and I hope and I pray.