Independent Midwives – Crisis in Maternity Care

by Emma Ashworth

Last week, we published Emma Ashworth’s birth story. She gave birth at home with an independent midwife. As it will effectively become illegal for independent midwives to practice from September 2013, she is campaigning to save independent midwives.

What are Independent Midwives (IMs)

IMs work outside the NHS, caring for women and their partners throughout pregnancy, birth and the post natal period. Usually IMs support women who are delivering their babies at home, although they will stay with their clients if a hospital transfer is required.

Why are IMs important?

Despite the Government’s targets, it is not common for mothers to see the same midwife throughout her pregnancy, and usually she will have a different midwife (or multiple midwives) for the birth, even if she chooses a home birth. Antenatal appointments may be just 10 minutes long, which does not allow either the midwife or the mother to really discuss any issues or questions properly. IM appointments can be however long the IM and the mother agree – usually an hour or longer – giving plenty of time to really develop a deep relationship between the IM and the parents, as well as to give time to get really in-depth clinical support. The trust that can build up between an IM can make a huge difference to a labouring mother, allowing her to relax better in labour, making it more likely that the mother will experience a safe, positive birth.

During labour a mother will know who will be with her, and her midwife will usually stay with her throughout the labour, giving 1:1 care rather than 1:4 or so in a hospital. That continuity of care is very important to many parents and has been shown to give a better birth outcome.

IMs have skills which in many cases have been lost within the NHS. Many IMs will be skilled in assisting women who are delivering multiples or breech babies (bottom first) vaginally. Because they are able to really get to know each and every pregnant woman that they work with as individuals they are able to really evaluate the risk of anything which deviates from straightforward in a person by person way, rather than solely on the basis of risk across the whole community. Using the relationship then built up with the parents, mutual respect and understanding, a very personal care plan can be implemented giving the best chance of the very best outcome for mother and baby. A healthy mother and baby and a positive, enjoyable and empowering birth experience.

Some women choose IMs because they recognise that they are more likely to have a positive, natural birth. Others choose IMs because they have had a traumatic experience within the NHS (in a previous birth or for other reasons) and they are afraid that their experience may be repeated. There is a serious risk that without the option of IMs, these women will be forced to risk delivering their babies in fear (which is much more likely to lead to problems with the labour), and some women have indicated that they would rather deliver alone, without medical care, than engage with the NHS again.

No IMs = No Choice of care leaving the NHS as the only option for maternity care within the UK, a situation not found in virtually any other area of health care in the UK.

Independent Midwifery is in Crisis!

In September 2013 it will no longer be legal for IMs to practice. For years IMs have had no choice but to practice without insurance. This is because there were not enough IMs in the country for any insurance company to believe it worthwhile to put together a specialist insurance package. Parents have had to accept this situation for the past 10 years, reassured by the statistics showing the excellent outcomes with IMs. Tragically, in September 2013 a European Directive comes into force which makes it illegal for a whole range of practitioners – which just happens to include IMs – to practice without insurance. This essentially makes Independent Midwifery illegal and takes away any choice in maternity care in the UK.

What can be done?

The situation is now desperate because once we get to early 2013 IMs will no longer be able to take on clients if they are due from September onwards. Various supporters of Independent Midwifery including NCT, AIMS (Association for the Improvement in Maternity Services), Independent Midwifery UK and many passionate individuals have been trying to work out solutions, both through legal channels and the Government but the problem has been that not enough parents have been aware of the problem and that’s where we need you.

Could you:

• Write to your MP and MEP stating your concerns and asking them to get involved with finding a solution (see letter template below)

• Contact Independent Midwifery UK to offer any skills or time you may have (http://www.independentmidwives.org.uk/)

• Tell as many people as possible! Spread the word, talk about what’s happening and try to encourage other people to write letters, too

• Check out Facebook Groups like http://www.facebook.com/groups/fightingforims/

We cannot lose our Independent Midwives. We must find a solution, for ourselves, our daughters and our grand daughters we need choice, and most importantly we need those skills that, once lost, can never be recovered.

See: http://www.nct.org.uk/sites/default/files/Independent%20midwives.pdf for the NCT statement on Independent Midwifery

MP Letter Template  

You can find details of your MP here, your MSP here, your AM here or your MLA here. Many MPs, MSPs, AMs and MLAs also have websites which give their contact details including email address. You can also attend a constituency surgery to discuss your concerns with your representative – again their website usually explains how to arrange an appointment. He or she may also be on Twitter (you can check here for MPs and here for MLAs), in which case you can remind them about the fight to save independent midwifery publicly too.

[YOUR ADDRESS]

[DATE]

[NAME OF MP/MSP/AM/MLA]
[House of Commons
London
SW1A 0AA]

[Scottish Parliament
Edinburgh
EH99 1SP]

[The National Assembly for Wales
Cardiff Bay
Cardiff
CF99 1NA]

[Northern Ireland Assembly
Parliament Buildings
Ballymiscaw
Stormont
Belfast
County Down
BT4 3XX]

[By email to [MP’S/MSP’s/AM’s/MLA/s EMAIL ADDRESS]]

Dear [NAME OF MP/MSP/AM/MLA]

INDEPENDENT MIDWIFERY

I am one of your constituents and I am writing to draw your attention to the imminent threat to independent midwifery in the UK. This threat comes against a background of an increasing birth rate and a shortage of midwives within the NHS, leading to a higher demand for independent midwifery services. Currently, women have the option to opt out of the NHS system of maternity care by using an independent midwife. The reasons why women may wish to do this are many and varied but the key benefit to them of using an independent midwife is continuity of care throughout their pregnancy and labour. You can find further information from the professional association for independent midwives, Independent Midwives UK: www.independentmidwives.org.uk. The UK Government heralds independent midwifery care as the gold standard towards which the NHS should strive.

However, by October 2013 it will become illegal for independent midwives to practise as they do now. EU Directive 2011/24 on patients’ rights in cross-border healthcare, once implemented in the UK, will require all healthcare professionals to have professional indemnity insurance or an equivalent guarantee or other scheme to be in place. The legislative proposals for implementation of this Directive have not yet been published for consultation but it is assumed that insurance cover will be made a condition of registration as a midwife with the Nursing and Midwifery Council. In 2002 the last commercial insurer offering insurance to independent midwives withdrew from the market as it was not commercially viable given the small numbers of independent midwives in the UK. As a result professional indemnity insurance is no longer commercially available for self-employed independent midwives. 

The Government in England has worked with Independent Midwives UK to provide a solution whereby independent midwifery-style care can be commissioned into the NHS (through schemes such as Neighbourhood Midwives and One-to-One). It is not yet clear whether all women will be able to access this care or what areas it will cover. Independent Midwives UK has invested a colossal amount of time and energy in looking for a solution and continues to explore options with commercial insurance brokers to make professional indemnity cover available to independent midwives who continue to work entirely outside the NHS, but there is no guarantee that this will be available by October 2013. The situation at the present time is that women will lose the option to have their maternity care with an independent midwife outside the NHS from next year. Many independent midwives will of course lose their employment. [It is not clear what action is being taken by the healthcare administration in [Scotland/Wales/Northern Ireland] and I should be grateful if you would investigate this and report back to me on what is currently being done.]

[ADD A COUPLE OF SENTENCES ABOUT HOW THIS ISSUE AFFECTS YOU PERSONALLY E.G. IM FACED WITH LOSING LIVELIHOOD, USED A IM FOR PREVIOUS BIRTHS, WOULD LIKE TO USE A IM FOR FUTURE BIRTHS, PREVIOUS EXPERIENCE OF POOR CARE OR TRAUMATIC BIRTH]

There is growing support for real choice in maternity care from women and their families, evidenced by campaigns such as Freedom for Birth (www.freedomforbirth.com) and The Birth I Want (www.thebirthiwant.org.uk). The loss of independent midwifery would be a further limitation on a woman’s fundamental human right, recognised at the European Court of Human Rights in Strasbourg in the case of Ternovsky vs. Hungary in 2010, to determine the circumstances in which she gives birth.

In its response to the Finlay-Scott Review of the requirement to have insurance or indemnity as a condition of registration, the [Department of Health/Scottish Government/Welsh Assembly Government/Department of Health, Social Services and Public Safety] has pledged to take forward work on a case-by-case basis to facilitate a solution to enable the continued availability of services provided by groups for whom the market does not provide affordable insurance or indemnity. Please would you write to the [Secretary of State for Health, Jeremy Hunt MP/Cabinet Secretary for Health and Wellbeing, Alex Neil MSP/Minister for Health and Social Services, Lesley Griffiths AM][Minister for Health, Social Services and Public Safety, Edwin Poots MLA], asking [him/her] to:

*set up a guarantee or other scheme equivalent to professional indemnity insurance to satisfy the requirements of Directive 2011/24; or

*delay implementation of the professional indemnity insurance requirement under Directive 2011/24, if necessary seeking a derogation from the European Union, to give more time for a solution to be found from the commercial insurance market.

Thank you for your attention to this matter and, I hope, for your support in saving independent midwifery.

Yours sincerely

[NAME]

 

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