If you practice midwifery or operate a birth center, you’ve probably heard this line, often from thoughtful, experienced colleagues:

“If I don’t carry malpractice insurance, I’m not a deep pocket. An attorney won’t bother bringing a claim if there’s no money to be gained.”

This belief is widespread in community birth. It’s also far less protective than it sounds, especially in a state like Washington, where birth outcomes, regulation, and litigation intersect in very real ways.

Let’s unpack what’s true, what’s misleading, and what midwives and birth centers are actually risking when they practice without coverage.

What Malpractice Insurance Really Does

At its core, malpractice (professional liability) insurance does two things:

1. It pays for legal defense when a claim is made.
2. It pays settlements or judgments, up to the policy limits.

The key word here is claim. Coverage is triggered by an allegation, not by proof that you did something wrong. In birth-related cases, where outcomes can be complex and emotionally charged, that distinction matters a great deal.

The “No Insurance = No Lawsuit” Idea: Why It Persists

There is a grain of truth behind this idea. Plaintiffs’ attorneys do think about collectability. Insurance can make a case financially viable.

But that’s not the whole picture. And in Washington, it’s often not the deciding factor.

Birth-related litigation is frequently driven by grief, shock, or pressure from others. Families may be told, sometimes insistently, that they “need to talk to a lawyer,” regardless of whether insurance is in place. Once a claim is filed, the absence of insurance doesn’t stop the process; it just shifts the burden squarely onto the provider.

Being Uninsured Does Not Make You Invisible

A midwife without insurance can still be sued. An uninsured birth center can still be named. And once litigation starts, additional defendants are often added as the case unfolds.

Birth-related claims rarely stay neatly focused on a single provider. As a case develops, attorneys often look broadly at everyone involved in the episode of care. That can include other midwives in a practice, a birth center entity, consulting providers, EMS responders, or facilities involved after a transfer. In other words, a lack of insurance does not prevent a claim from being filed. It only means you face it alone.

Washington State Reality Check

Washington is generally considered a plaintiff-friendly jurisdiction in medical liability cases. Birth-related claims — particularly those involving neonatal injury or death — can remain legally viable for many years. That means a birth you attended long ago can resurface as a legal matter well into the future.

Many midwives assume they are “judgment-proof” because they don’t own much or don’t earn hospital-level income. But courts can look beyond current bank balances. Future earnings, business income, property acquired later, and sometimes shared marital assets may all be relevant. The idea that there’s “nothing to go after” is often truer in theory than in practice.

The Hidden Cost: Defense Alone

One of the most misunderstood aspects of malpractice risk is defense cost.

Even a claim that ultimately goes nowhere can require extensive legal work: reviewing records, responding to discovery, retaining experts, and preparing for depositions. In birth cases, those costs add up quickly. Tens of thousands of dollars is not unusual. In complex cases, it can be far more.

Malpractice insurance covers those costs from the start. Without it, every hour of legal time is coming out of your own pocket — often while you’re still trying to run a practice.

Why Uninsured Providers Often Fare Worse

There’s an uncomfortable irony here. Midwives sometimes assume that being uninsured reduces exposure. In reality, uninsured defendants may face more pressure to settle, and on worse terms.

Without insurance-backed defense counsel and structured negotiation, providers are negotiating under personal financial and emotional strain. Plaintiffs’ attorneys know this. Insurance doesn’t just pay claims; it provides strategy, experience, and leverage.

Birth Centers: A Different Scale of Risk

For birth centers, malpractice insurance isn’t just about individual clinicians; it’s about the survival of the organization. A single claim can involve multiple providers, facility liability, and both maternal and neonatal allegations. Policy limits can be reached quickly, and the downstream effects on licensing, accreditation, leases, and staffing can be profound.

In practical terms, operating a birth center without malpractice insurance is not sustainable.

The Bottom Line

Choosing to practice without malpractice insurance isn’t a sign of confidence or low risk. It’s a bet: one that assumes no serious adverse outcome will occur, no claim will ever be filed, and no attorney will decide to test the theory.

Malpractice insurance doesn’t mean you expect to be sued. It means you recognize that birth care carries inherent risk, and that protecting yourself, your practice, and your future is part of practicing responsibly.

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The information provided through this activity is for educational purposes only. This information is intended to provide general guidelines for risk management and those involved in claim process. It is not intended and should not be construed as legal or medical advice.