Amy Tuteur on Liability Insurance Underwriting as a Quality Control Mechanism

I don't know Amy Tuteur. I do know that someone who writes so authoritatively about relative risk in hospital and non-hospital births probably ought not wait until the last quarter of a New York Times Article to disclose "Personally, I would always opt for a hospital birth." If you have strong opinions, it seems to me, that you should  announce them at the start. That way, people can read what you say in comfort instead of wondering "who is this?"  And, then you will be better at avoiding sounding like you are making claims to either neutrality or expertise that you lack. Her recent New York Times article is powerful, though it does nothing to explain why C.P.M.'s flourish in a system where C.N.M.'s are available — much of the real story behind C.P.M. use by American women. And if you think that American women simply misunderstand relative risk, then the easy fix is better education of women about risk. What if choice of a C.P.M. isn't about genuine choice at all but rather where most women who want a home birth end up because licensed midwives often require, as a condition of licensing, obstetrician backup which many providers and their insurers will not allow to be provided in the home?  Ah, but then it would be so much more complicated, so much harder. 

Here is Amy Tuteur asserting that midwives ought be required to obtain and carry liability insurance because no insurer will cover them if they are not safe. If she's relying on the liability insurance industry to police the health professions for quality, she is going to be waiting for a while.  Malpractice insurance underwriting is not as simple as that — neither in the distinction between community rating and experience rating (or merit rating) nor in its time frame for responsiveness to both claims and payouts.