One birthing center has already closed and another may meet the same fate after the last insurance company offering malpractice coverage to independent nurse-midwives in Kansas dropped its coverage. And that could leave many expectant mothers in the state with no viable midwifery options.
Ashley Mercado of Hutchinson, Kansas, had three of her four children with Birth & Women’s Health Center in Yoder, Kansas. She said she would have had all four there if she could have.
“I really enjoyed, like, not being hooked up to monitors or anything like that,” Mercado said.
Mercado said if she hadn’t found any birthing centers in Kansas when she had her children, she would have moved out of state to find one. Or she might have opted for a home birth.
But the place where Mercado gave birth to three of her four children may have just been dropped by its insurance provider, MMIC Insurance.
Earlier this year, New Birth Company, also insured by MMIC, closed its practice in Kansas City, Kansas, after MMIC said it was concerned certified nurse midwives unsupervised by physicians face greater legal exposure — even though studies show midwives are less likely to be sued than physicians.
“They've left me hanging and they're about to leave Yoder hanging,” said Kendra Wyatt, co-founder of New Birth.
Yoder Birth Center midwife Angel Schmutz said they’ve heard about New Birth Company and are tentatively waiting for word from MMIC about their own center. In the meantime, they’re preemptively looking for other insurers.
Wyatt says that the Kansas Health Care Stabilization Fund, the state agency created to ensure that health providers have medical malpractice coverage, has not protected birth centers as health providers.
“You can't say you're a licensed facility and that you have to carry $2 million of malpractice and then go, ‘No, not really, you don't matter,’” Wyatt said.
The Health Care Stabilization Fund says it has no control over the factors that led to the closing of New Birth. Clark Schultz, a spokesman for the agency, said it can’t force companies to offer insurance to midwives.
“We don't have authority to approve plans or disprove plans,” Schultz said. “We're here just… as a more narrow focus of providing the extra coverage after they bought a policy.”
The Kansas Department of Insurance likewise says there’s no requirement that insurance companies provide coverage to birth centers.
“Physician supervision is an option for midwives,” said Lee Modesitt, a spokesman for the department. “There are a variety of reasons some may not want to go that route, but it is an option and we believe there is coverage available.”
Rebecca Williams, New Birth’s insurance agent, said the Health Care Stabilization Fund is favoring physicians over midwives.
“I feel like they're just not listening to the plight of this group and others that are midwives that are independent, that are not part of a physician group,” she said.
Williams said she tried to advocate for New Birth. The practice never had to pay out a claim, she said. It operated on a low-risk model, more careful than other birth center models. But MMIC said it won’t insure unsupervised midwives regardless.
Wyatt said that will hurt underserved populations. Wyatt also operates a birthing center in Overland Park, which does have a relationship with physicians and has managed to remain open.
The closed center in Kansas City, Kansas, served the urban core, giving many expectant mothers a place within walking distance to give birth. Now, those mothers will have no choice but to travel farther and give birth at hospitals such as the University of Kansas Medical Center or Providence Medical Center.
Black and brown families, who make up about half the population in Wyandotte County, are more at risk when giving birth in the medical system. In Missouri, Black mothers die during or within a year of pregnancy at four times the rate white women do. In Kansas, according to a 2020 March of Dimes report, women in minority groups die during or within a year of pregnancy at twice the rate as white women.
Nationally, premiums are rising for midwives. Cynthia Flynn, a birth center owner in Washington, D.C., and a former president of the American Association of Birth Centers, said midwives all over the country are having to close their businesses because of rising premiums.
It’s a repeat of the 1980s, she said, when malpractice insurance was so unaffordable for midwives as to be out of reach. A 1986 University of Pennsylvania Law Review article said such crises, though common, were unwarranted for midwives, who tend to face fewer liability claims than obstetricians.
Decades later, not much has changed. A 2009 studyshowed that 32% of certified nurse midwives had been sued for malpractice. By contrast, another study showed 91% of obstetricians faced liability claims the same year.
“The medical model is not the answer,” Wyatt said. “Health and wellness and physiologic birth and midwifery is the answer. But try telling that to an actuary who sits at an insurance building.”
It all comes down to midwives’ sense that they are undervalued.
“What it really gets down to, if you want to think of it this way, is we — midwives and birth centers — are not paid for what we do,” Flynn said.
A 2014 American College of Nurse Midwives surveyfound that 50% of insurance plans don’t pay midwives the same as physicians for performing the same service. Transfers (emergency transfer of a mother to a hospital), which one 2014 study said occurs from 10% to 32% of the time, cost midwives money and make insurance companies flighty about covering midwives.
“For the higher quality, you expect to pay more money. It's not that way in maternity care,” Flynn said. “We do produce significantly better outcomes, but we get paid actually less.”
Wyatt said she’ll be asking mothers and midwives to attend legislative sessions in September to lobby for change. In the 1980s, midwives lobbied for a Senate bill that would have allowed them to self-insure. Insurance companies responded by forming an insurance consortium for nurse-midwives.
It’s a multifaceted national problem, Wyatt said, but it’s something midwives can start solving here in Kansas.
“The reality is we have as much of a chance to solve this and prove it in Kansas City as anywhere else,” Wyatt said.
