The women would like to open another practice, but said there could be obstacles in partnering with another hospital, including the high cost of malpractice insurance. Mercy covered the more than $50,000 a year in malpractice insurance costs for each midwife at Kathleen Slone CNM & Associates.

Mercy said it also is concerned about limited choices for women. The hospital said it is helping with the transition of patients at Kathleen Slone to other practices.

"We are deeply concerned about the potential for reduced health care access for Maryland mothers because of the increasingly unsustainable medical liability environment," its statement said.

David Ellin, a Baltimore-based personal injury and malpractice lawyer, said the number of medical malpractice cases in Maryland has remained steady in recent years at about 600 annually, but the size of awards has risen along with health care expenses.

Even given the state's cap on malpractice payouts, Ellin said, the cases are expensive for all parties. He said it's unfortunate that the city is losing the midwife group at Mercy, but the public needs a means to hold health care providers responsible for the birth injuries they cause.

"Generally, it's sad if you're going to lose a good group like the group over at Mercy," Ellin said. "[But] it's hard to say it's anything other than the cost of doing business. Things get more expensive and costs go up; they don't go down. The cost of providing for an infant that has suffered a brain injury is astronomical."

Another major influence on malpractice insurance costs is lower returns on investment, said Donald H. Beskind, a professor at Duke University School of Law and a litigator for more than 30 years. Studies have shown that insurance companies routinely increase liability premiums to compensate for diminished returns.

"The largest driver of insurance premiums is not claims or payouts but interest rates, and interest rates are basically zero," Beskind said. "In my judgment, that is a flawed system."

Tina Johnson, director of professional practice and health policy at the American College of Nurse-Midwives, said the Mercy midwife group drew expectant mothers from as far away as Frederick and Pennsylvania.

While Chase Brexton Health Care provides midwifery services at Sinai Hospital, as does University of Maryland St. Joseph Medical Center in Towson, options in the region are limited, she said.

One place with services comparable to the midwife offerings at Mercy is Special Beginnings Birth and Women's Center in Arnold, which Johnson said is "bursting at the seams" with demand.

Johnson, a certified nurse-midwife, said the college is "distressed" over Mercy's decision to sever ties with the midwife group. She served as director of midwifery services at Maryland General Hospital until administrators eliminated obstetrics as part of the restructuring with the University of Maryland Medical Center.

Johnson said Kathleen Slone CNM & Associates had excellent outcomes for mothers and babies, rarely requiring expensive medical interventions.

She worried that women may seek other options that aren't as safe, such as choosing health care professionals with fewer credentials or driving longer distances to give birth.

"We want more practices like this practice,'" she said. "I would like to see if another hospital will be wise enough to take this practice on."

To find a midwife

The American College of Nurse-Midwives provides an online database of midwifery services by ZIP code at

y ZIP code at