Effects of changes in professional liability insurance on certified nurse-midwives.

A stratified random sample of 500 ACNM members was surveyed by mail in June, 1987, using a questionnaire designed to describe the effects of the liability insurance crisis on the practice of nurse-midwifery. A majority of the 286 respondents indicated that the increased cost and decreased coverage of liability insurance is having a direct and negative impact on midwifery practice in terms of financial burden, increased defensive interventions, increased cost of care, decreased availability of care, restricted practice privileges, and stressed employer/employee relationships. A dramatic increase in insurance premiums has occurred without a comparable increase in income. The increased use of defensive medicine reported by CNMs has produced higher costs to the public. Job opportunities have diminished due to loss of insurance coverage, physician back-up, and hospital privileges. The active political involvement of nurse-midwives is needed in order to reverse the negative effects of the liability insurance crisis.