Midwives provide essential care, often serving families who want a more personalized experience than traditional hospital births. But when it comes to insurance, midwives face unique challenges. Carriers weigh risks differently than they do for other healthcare providers, and understanding those factors can mean the difference between affordable coverage and a costly premium—or even a coverage denial.
At Homewood Insurance, we work with midwives every day. Here’s what you need to know about how insurance companies view your practice, what drives premiums up, and how you can position yourself for the best possible coverage.
What Drives Premiums Higher?
Insurance costs for midwives vary widely depending on several factors. Here are the big ones underwriters look at:
- Location: Midwives in states like California and Florida typically pay more because these states don’t cap malpractice damages. That makes claims riskier for insurers, and they price policies accordingly.
- Coverage Type: A claims-made policy is usually cheaper at the start, but you’ll need “tail coverage” if you switch carriers or retire. An occurrence policy doesn’t require tail coverage, but it can cost 20–30% more upfront.
- Experience: Newer midwives often pay 10–20% higher premiums until they build a track record of safe practice.
- Volume & Procedures: Carriers look at your annual birth numbers and procedures performed. They often follow ACNM (American College of Nurse-Midwives) guidelines to assess risk, with red flags around cases like shoulder dystocia.
Why Some Practices Are Flagged as Higher Risk
Certain practice settings and policies raise concerns for insurers. Carriers may add surcharges or decline coverage if they see:
- Out-of-hospital births: Home births, in particular, can mean 30–100% higher premiums due to higher reported rates of neonatal and maternal injuries.
- No hospital affiliation: If you don’t have admitting privileges or a collaborative relationship with a hospital, underwriters view that as a gap in emergency preparedness.
- Lack of transfer protocols: Carriers expect written, time-sensitive transfer plans in case complications arise.
- No informed consent: Insurers want clear, signed documentation that families understand the risks of out-of-hospital births.
Market Trends for 2025
The broader healthcare professional liability market is tightening. Industry data shows premiums are up 5–15% in 2025, driven by inflation and larger jury verdicts in malpractice cases. That pressure spills over into midwifery insurance, making it even more important to present your practice as low-risk and well-prepared.
How Midwives Can Improve Their Insurance Profile
The good news: there are concrete steps you can take to improve your risk profile and secure better terms. We recommend:
- Keep detailed records of every encounter and procedure. Strong documentation is your best defense.
- Collaborate with OB/GYNs or local hospitals to show continuity of care.
- Work with A-rated carriers—especially those that understand VBAC coverage and out-of-hospital practices.
- Let us shop around for you—at Homewood, we often find midwives can save 20–28% by comparing multiple carriers, especially with clean histories.
- Review your policy annually, especially if you’re practicing in states like Florida, which require APRNs (including CNMs) to carry professional liability coverage.
The Bottom Line
Midwifery is deeply rewarding work, but it comes with risks that insurers watch closely. Understanding what drives premiums and how to mitigate those risks is key to keeping your coverage affordable and reliable.
At Homewood Insurance, we specialize in medical malpractice and liability coverage for midwives. With access to nearly 100 carriers, we can help you find the right policy—and the right price—while advising you on how to strengthen your application in the eyes of underwriters.
👉 Learn more or request a tailored quote here: https://homewood.insure/insurance-for-midwives/