Midwives always talk about challenges of independent midwifery businesses getting hospital privileges. If you work for a doctor’s office or hospital directly, it is relatively easy getting privileges. There is lots of paperwork involved, but privileges happens in 1-2 months. For a midwife wanting to deliver in the hospital running her own practice, it is very challenging.
Some hospitals don’t allow independent midwives to apply. Even if you can apply, many hospitals require a collaborating or supervisor physician (depends on your states regulations and hospital preferences). Remember, hospitals are private entities and can make their own rules about who can practice and bring their patients into for care.
When hospital privileges state wording “supervisory” versus “collaboration with physician,” it is very difficult to find a physician to sign the privilege application. Most of the malpractice insurance carriers on physician side will increase coverage costs when having a relationship with a midwife. Much caution is given by attorneys stressing liability risk involved for doctor if supervisory term versus collaboration is present. Vicarious liability is feared and largely misunderstood.
Most physicians will want a financial kick back of some kind for a long term collaborative relationship. That could consists of profit sharing, consultation fee when services are required from physician, or guarantee that all patients that risk out or need surgery will be transferred to the physician directly. There are many ways to do it and goal is always to create a win-win scenario for everyone involved. Patient satisfaction greatly improves when transfers and transports go smoothly for midwifery practice and hospital staff.
Being able to have hospital privileges for home birth transfers or creating a hospital based midwifery practice is vital for long term success. Knowing that care can be handled by the same midwife during transports gives patient’s comfort and improves the relationship with local hospital. Too many home birth practices have limited communication with local physicians. Being able to talk on the unit with colleagues and attend hospital provider meetings versus rare encountered admitting doctors for your patients is really helpful.
Some hospitals aren’t used to midwives or had a bad experience in the past with midwifery care in community. Being able to create midwifery hospital privileges is much more difficult that apply for current options at your local hospital. Even amending privileges to updated verbiage with new regulations or allowing midwives to practice to their full scope is challenging. It is great to be able to care for newborns, but getting privileges to recognize that typically needs pediatricians within hospital to allow that and collaborate with midwifery practice.
I have spent over 5yrs attempting to get midwife privileges back at a local hospital. There was a bad outcome over 10yrs ago and administration still has much fear about allowing midwives to practice again. It would be a great place for midwives with their mission to help under served populations and promote alternative healing, but Director of Nursing and OB Department have great misunderstandings of what midwifery is all about. I used to work there and have lots of great internal connections advocating. It helps to have internal staff within hospital meetings and talking with colleagues to support midwifery back at the hospital again.
Be persistent and polite, change is not easy or everyone would be doing it. Think of your community and the population you serve. Having midwifery care be available in the hospital for transports and care for population that insurance only cover birth in hospital setting is so important. We can make change and get hospital privileges. Know your state laws. Create relationships with hospital administration and collaborating physicians in your area. Advocate for midwifery with objective, evidence based educational material like “Pearls of Midwifery” that ACNM has created.