Costs threaten midwife practices

Expectant mothers in the Washington metropolitan area are finding fewer hospital-based midwifery services as malpractice insurance costs continue to escalate.

Georgetown University Hospital in Northwest recently announced it will cancel its nurse-midwife program by the end of June. A medical group in Frederick, Md., cut a similar program three months ago.

The demise of both programs is part of a national trend that expectant mothers and some doctors argue stomps on women’s freedom.

“It’s a very bad trend for several reasons,” said Dr. Marsden Wagner, former director of Women’s Health for the World Health Organization. “When the hospital fires the midwives, they are stealing options, taking away from the freedom of women.”

Dr. Wagner was one of more than 100 doctors, expectant mothers and midwives who rallied yesterday outside Georgetown University Hospital to protest its decision to end the Georgetown Midwives program. The hospital laid off its three midwives.

“In every other country except ours, over 80 percent of births are attended by midwives, not by doctors,” Dr. Wagner said. “And in many, many countries, they lose fewer women and they lose fewer babies than we do.”

Some doctors say there is a stigma attached to midwives in the United States.

“There’s still a tendency to say, ’Midwife? That’s old, that’s second-class care.’ We’re still trying to dispel that image,” said Ruth Lubic of the D.C. Birth Center in Northeast.

Miss Lubic, a midwife who has a doctorate in applied anthropology, said she sees her low-tech approach to emotional and physical needs as a model for other caregivers.

“We’re putting health care in its social setting,” she said. “We talk to the moms and find out about their lives. We want to know [the mother] is in the best physical, emotional health possible to give birth.”

Still, the profitability of such an approach is questionable, and that might be why so many midwife programs are foundering.

The Frederick OB/GYN Professional Group, a private practice in Frederick, Md., fired their four midwives — the last in the county — in January because of escalating malpractice insurance costs.

Officials at Georgetown Hospital cited decreased cost-reimbursement and higher liability insurance rates when they let go the hospital’s last three nurse-midwives.

Stephanie Stone, a midwife who led the Georgetown program and left last December, argued that midwives are cheaper than doctors and that her program was profitable.

“My understanding is that, on average, insurance companies reimburse $2,000 per birth, whether you’re a doctor or a midwife,” she said. “It’s pretty obvious to us that if you take our salaries and compare that to about 20 births a month, you’re going to get a profit.”

Ms. Stone could not provide exact numbers to overhead costs such as insurance rates because she didn’t have access to that information.

However, Karen Alcorn, vice president of public affairs for Georgetown, said that the program wasn’t profitable and that the midwives were covering the overhead costs.

Of the 1,763 deliveries at Georgetown University Hospital last year, 154 were attended by midwives, Mrs. Alcorn said.

“That’s less than 9 percent,” she said. “The volumes speak for themselves.”

Still, Georgetown will welcome midwives who apply for the privilege to use the facilities. Private-practice midwives would not be employed by the hospital, but would retain access to it, Mrs. Alcorn said.

“Our doors are still open to nurse-midwives,” she said.

Erin McDavitt, a student nurse-midwife at Georgetown University Medical School, said that might not be good enough.

“It means nothing. It’s telling the auto worker in the factory line, ’You’re fired, but if you want to go out and build cars, you can,’” she said.

She said there now is no pre-existing infrastructure in the area that she and her fellow students can join.

“Unless we open our own practice,” Miss McDavitt said. “We’d have to take out a humongous loan, which is hard to do because I don’t have any collateral to open a building and buy all the medical equipment.”

The only other autonomous hospital-based nurse-midwife practice in the area is in Loudoun County, Va.