Do midwives have the midwives — basically nurses — have the medical knowledge and insight to provide consultation for mothers or help them make decisions that are a matter of life and death?
My feeling is that some do and some don’t. But I think, on balance, why not have an OB/GYN? If you are having a child, you want to mitigate risk. The best way to mitigate risk is to find the best doctor you possibly can to guide you through pregnancy and deliver your child.
- Why midwives are both easier and harder to sue
What are midwives?
Midwives are health care professionals who provide specialized care for women, specifically their reproductive health. They offer different kinds of services including gynecological examinations, contraceptive counseling, prescriptions, and delivery care. Midwives are best known for providing care before, during, and after labor and delivery. The services that midwives provide may vary from state to state, as they each have different regulations that determine the kinds of credentials they have.
There are five types of midwives, each of them with different credentials and experiences. They comprise certified nurse-midwives (CNM), certified midwives (CM), certified professional midwives (CPM), direct-entry midwives (DEM), and lay midwives. Certified nurse-midwives are licensed professionals who are trained in both nursing and midwifery. They are also required to possess a bachelor’s degree.
A certified midwife is trained in midwifery only. Like CNMs, CMs are also required to possess a bachelor’s as well. The American College of Nurse-Midwives certifies both CNMs and CMs. A certified professional midwife is one who meets the North American Registry of Midwives’ standards. To become a CPM, one must have several educational backgrounds. A direct-entry midwife is one who has trained to become a midwife through different experiences. They include an apprenticeship, midwifery school, and a college program. DEMs are not necessarily certified like CNMs, CMs, and CPMs. A lay midwife is an individual who has received neither a certification nor a license to be a midwife. However, they have received informal training, such as studying the profession on their own or an apprenticeship.
Advantages of having a midwife
I’ll admit there are some advantages to seeing a midwife. They are more accessible than an OB/GYN and may spend more time with a pregnant woman. Midwives are also trained to have a more casual relationship with patients, which allows for the development of personal relationships that is hard to get with doctors in 2019. This puts the mother at ease regarding the pregnancy and birthing process. Midwives are also trained to look for anything out of the ordinary regarding pregnant women. They also provide assistance regarding lifestyle related-issues such as nutrition, exercise, relationships, breastfeeding, and parenting. Some doctors, by contrast, do not spare the time for this touchy-feely stuff and mostly provide help on substantive acute medical issues.
Drawbacks of having a midwife
While midwives might be more convenient for expectant mothers, there are many drawbacks of using them to facilitate the birthing process. Much of these drawbacks is because midwives are not qualified to handle high-risk births involving multiple babies or complications. Midwives cannot offer comprehensive tools such as ultrasound or anesthesia. They are also not qualified to deal with high-risk pregnancies or even acute complications that might occur during birth. Mothers experiencing complications from birth must seek emergency care from a physician. Midwives are also not well equipped to deal with multiple births such as twins and triplets. They also struggle to deal with mothers who have previously had a Cesarean section, stillbirths, or other pregnancy-related complications. Women with medical conditions such as high blood pressure and diabetes can be too complicated for midwives to handle.
I could delete this entire paragraph and just say that a midwife is not an OB/GYN. Because that really is the difference. There are so many risks involving childbirth. You want to put your kids in the best hands statistically and that is with an obstetrician.
Should I use a midwife?
In my opinion, your best bet is to see an OB/GYN instead of a midwife. While midwives might be okay for a low-risk birth, you never know what could go wrong. Sometimes, a low-risk birth can turn into high-risk at the blink of an eye. Giving birth at a hospital with an OB/GYN provides easier and quicker access to comprehensive medical care than giving birth at home with a midwife.
Verdicts and Settlements involving Midwife Malpractice
- 2019, Oklahoma: $7,500,000 Settlement. A baby’s parents claimed that a tribal hospital’s mismanagement of their baby’s labor and delivery caused a brain injury that resulted in cerebral palsy and quadriplegia. They hired a birth injury lawyer who sued the nurse, nurse-midwife, and physicians violated the standard of care. Specifically, the parents alleged that they improperly administered Pitocin, failed to apply intrauterine resuscitation measures, failed to notify the physician in a timely fashion of the child’s fetal distress, and failed to perform an emergency C-section. They claimed that their son suffered hypoxic-ischemic encephalopathy, which developed into cerebral palsy and quadriplegia. Tragically, the 2-year-old boy at the time of trial was non-verbal, experienced delays in development, and was microcephalic. Medical experts hired by the family determined the boy would need lifelong specialized care. Cases like this should settle and this one did. One key to this case is having the doctor and hospital as a defendant. It is unlikely that a midwife would carry $7.5 million in insurance coverage.
- 2019, New Jersey: $1,747,505 Verdict. A mother alleged that the midwife’s mismanagement of her labor and delivery caused her son to sustain a brachial plexus injury. The delivery was complicated by shoulder dystocia. The mother alleged that the midwife responded to this by applying excessive traction to her baby’s head, causing a brachial plexus injury. She claimed the injury caused her son to sustain significant nerve damage to his left arm. As a result, he underwent multiple surgeries to treat his nerve damage. The boy also sought treatment at a brachial plexus clinic. He ultimately gained 50 percent function of his left arm. However, the family’s medical experts testified that he would not regain complete function of his arm. The boy’s mother sued the midwife. The primary allegation was the midwife panicked and used excessive traction. It is scary when a baby is stuck in the birth canal. But if you are delivering a child, there is an obligation to make reasonable decisions to solve the problem. The jury found this midwife did not make reasonable decisions.
- 2019, New Jersey: $1,700,000 Settlement. This is a negligent genetic counseling wrongful birth case. A 25-year-old mother alleged that the maternal-fetal specialist and nurse-midwife failed to notify that her son showed signs of Down syndrome during her pregnancy. The mother alleged that the fetal-maternal specialist failed to notify her that the ultrasound results showed Down syndrome soft markers. She further alleged that the nurse-midwife failed to tell her Quad screen test’s quantitative results showed an increased Down syndrome risk. Instead, she told her that the results were “normal.” The mother claimed that their actions prevented her from choosing to undergoing a diagnostic amniocentesis, which would have revealed Down syndrome. As a result, her baby was diagnosed only after being born, rather than during the pregnancy. The mother claimed that she would not have continued with the pregnancy, had the baby been diagnosed in utero. More directly, she is saying she would have had an abortion. This case settled for $1,700,000.
- 2019, Massachusetts: $1,150,000 Verdict. A newborn’s estate alleged that the nurse and midwife’s failure to recognize fetal distress caused in a hypoxic brain injury and the child’s death. The mother presented to the midwife and nurse, following an otherwise normal pregnancy. They induced her because her due date already passed. The midwife then noticed that the fetal heart rate became non-reassuring because of a protruding uterine fibroid. However, neither the nurse nor the midwife immediately consulted an obstetrician. But that midwife is not performing that the child most likely needs: an emergency C-section. The baby suffered severe hypoxic encephalopathy. She only survived for 13 months. The entire time, she had a feeding tube and suffered respiratory problems. An awful 13 months. Her mother sued the midwife and nurse for negligence, alleging that they failed to respond timely to her daughter’s distress. This case settled for $1,150,000. The crazy paradox of these kinds of cases is that they are worthmuch less when the child dies.
Listen, you can go to our website and find tons of birth injury settlements and verdicts against great obstetricians. So terrible mistakes happen. Do terrible mistakes happen more often with midwives than great obstetricians? Yes.