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Malpractice Crisis Closing Birthing Centers

July 12, 1985

NEW HAVEN, Conn. (AP) _ Like many women, Mary Klaneski intended to have her new baby in the homey surroundings of a childbirth center. But now lots of expectant mothers are making other plans, as a nationwide malpractice insurance crisis threatens to put such centers and nurse-midwives out of business.

The Family Childbirth Center of New Haven, where Mrs. Klaneski had planned to deliver her third child, is one of 10 whose malpractice insurance was being canceled this week.

And an official of the 130-center industry said about one-third of the facilities would end or curtail services by year’s end, forcing many women to hospital delivery rooms.

″I don’t feel that a hospital is any place to have a baby,″ said Mrs. Klaneski, who lives in Plymouth. ″Birth is a normal, healthy thing to be doing and a hospital is a place to be sick.″

At the New Haven center, she received guidance and exercise in natural childbirth, and her husband and two young children were educated about the process of birth.

At the centers, birthing rooms look like bedrooms rather than hospital rooms. Efforts are made to avoid the use of high-technology equipment, and the center staffs can include midwives, nurses and doctors.

Malpractice insurance policies for the New Haven center and nine others were terminated by Mutual Fire, Marine and Inland Insurance Co. of Philadelphia.

The company, which wrote group policies for 40 to 50 birthing centers and half of the nation’s 2,900 nurse-midwives, said it has been unable to find risk reinsurance, the practice used by insurance companies to cover themselves against losses.

Mutual Fire President Richard Guilfoyle said the rise in malpractice claims is forcing insurers out of the birthing field.

Several childbirth centers have closed, and others, like the New Haven center, are curtailing services, said Pam Townshend, director of the Family Childbirth Center.

″They can’t write insurance if they can’t get reinsurance,″ Kitty Ernst, director of the National Association of Childbearing Centers in Perkiomenville, Pa., said Thursday of the insurance industry’s reluctance to continue offering malpractice insurance.

Ms. Ernst expects that another 30 centers will be ″closed or on hold″ by Dec. 31 as policies come up for renewal.

Birthing centers, which typically charge about half the cost of a hospital delivery, have delivered about 30,000 babies in the last decade. There are about 3.6 million births a year in the United States.

In recent years, some hospitals have included wings that cater to women much the way birthing centers do.

Ms. Townshend attributed the problem of liability insurance to litigious consumers, trial lawyers, insurance companies and competition between obstetricians and a growing number of nurse-midwives.

In Connecticut, annual malpractice premiums run more than $30,000 and reach $80,000 in some states. The insurance industry lumps birthing centers and nurse-midwives in with obstetricians when calculating risk of malpractice claims.

This is inappropriate, Ms. Townshend, Ms. Ernst and others claim.

Only 6 percent of the nation’s nurse-midwives have been sued for malpractice since 1974, compared with 60 percent of obstetricians, according to the American College of Nurse-Midwives in Washington, D.C.

Ms. Ernst said there have been only 15 such suits against her association’s member centers.

The centers care for low-risk mothers, and if complications occur, the mother is usually transferred to a hospital, Ms. Ernst said.

Resulting malpractice claims don’t cite only the hospital, Ms. Ernst said. ″Everyone gets named who handled the mother. In insurance, it’s called buckshot.″

Medical malpractice claims nationally have tripled in the last decade, with more than 16 claims filed for every 100 doctors, according to the American Medical Association. The average settlement is $300,000.

Fear of litigation has resulted in a 2 percent increase in the number of Caesarean sections, many of which are performed without regard to medical need, according to Diony Young, public policy liaison for the International Childbirth Education Association.

While the numbers of babies born in childbirth centers is small, ″to each woman the birth of her baby is a singular event,″ Ms. Young said. ″It would be a tragedy if that avenue were closed off.″

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