The Role of Litigation in Midwifery Practice in the United States: Results from a Nationwide Survey of Certified Nurse‐Midwives/Certified Midwives

Abstract

Professional liability litigation is playing an increasing role in the practice of women's health care in this country. Although the impact of litigation on obstetricians' practices has been widely documented, data on the effect of litigation on midwifery practice are scant. The authors conducted a nationwide Web-based survey of American College of Nurse-Midwives (ACNM) members about the experience of being involved in litigation. The survey was completed by 600 midwives (17.5% response rate). Of those midwives completing the survey, 152 (25.3%) had been named in a lawsuit at least once during their midwifery careers. The litigation cases had been resolved for 114 (75%) of these respondents at the time of the survey. Forty-one (36%) reported being dropped from the case, even though the litigation continued without their involvement. Another 54 individuals (47.4%) were involved in cases that were settled before going to court, and an additional 10 cases (8.8%) were dropped without a settlement. Of the nine lawsuits (7.9%) that went to court, four favored the plaintiff (3.5%) and five (4.4%) favored the defendant. Future surveys are needed to better define the relationship between the practices of midwives and medical malpractice litigation.

The Pain That Binds Us: Midwives’ Experiences of Loss and Adverse Outcomes Around the World

“…We will gain more insight into the effect of adverse pregnancy outcomes on midwifery practice worldwide from information gathered from a national survey of U.S. midwives (McCool et al, 2007), as well as from our forthcoming analyses of communications with National Health Ministries and midwifery organizations in 98 countries globally regarding the ramifications of experiencing adverse outcomes in practice. Additionally, further research is needed to identify individual, cultural, and societal factors that contribute to midwives' abilities to cope effectively and to continue to practice after experiencing loss.…”

Professional issues related to obstacles to midwifery practice in the Americas: A pilot survey

“…Survey questions were formulated by the principal authors, all practicing professional midwives and researchers, based on evidence regarding potential reasons why experienced midwives have left clinical practice in general or from their country of origin: (1) reactions to experiencing adverse outcomes (McCool et al, 2007(McCool et al, , 2009Hood et al, 2010); (2) feelings of lack of control over changing or defending clinical practice, particularly when based on scientific evidence (Villar et al, 2001;Pettersson, 2007); and (3) migration (O 'Sullivan, 2002;Shen et al, 2004;Slote, 2011) (see Fig. 1).…”

“…In qualitative interviews conducted among American midwives between 2004 and 2006, midwives stated that adverse outcomes in practice were barriers to maintaining a midwifery practice (McCool et al, 2007). In a qualitative study of Australian midwives involved in external review and litigation, Hood et al (2010) noted that midwives commonly felt exposed, vulnerable, and uninformed during the review process following an adverse outcome.…”

“…Previous research (McCool et al, 2007(McCool et al, , 2009 has indicated that there is a relationship between increased number of years in practice and number of adverse incidences. Given that the survey did not elicit information regarding actual years in practice when the adverse outcomes took place, it is impossible to say whether the high incidence of adverse outcomes was related to increased time in practice.…”

Midwives and Liability: Results from the 2009 Nationwide Survey of Certified Nurse‐Midwives and Certified Midwives in the United States

“…In 2005, McCool et al 1 conducted the first US nationwide survey assessing the involvement of certified nurse‐midwives/certified midwives (CNMs/CMs) in litigation. The survey collected data regarding midwives’ experiences with lawsuits in their practices, the incidence and outcomes of lawsuit involvement by respondents, and coping mechanisms that were used by those who had been sued.…”