to think that outlawing Independent Midwifery will have far reaching consequences for women's birth choices?

(131 Posts)
TaggieCampbellBlack Sun 03-Mar-13 16:10:16

C&Pd from the Choose your Midwife, Choose your Birth. MNHQ - If you think is is the wrong place for this could you perhaps move it?

Come join us in protest. An end to legal independent midwifery practise is an end to freedom and choice for women. Don't accept this loss. We are planning a demonstation in London on Monday 25th March at 11am

As of October 2013 it will become illegal for independent midwives to practise without insurance. This leaves Independent midwives unable to practise legally. It also has implications for employed midwives in regards to autonomy and registration. Woman will be unable to access the one to one,gold standard services independent midiwves provide unless the midwife is willing to break the law. The Government say it the new law will improve safety. Insurance does not make midwifery safe, good standards do. There will always be women who do not want to use the NHS and therefore may give birth unassisted or use a midwife who will be unregulated through a governing body. This is what will compromise safety. Midwives want insurance to cover their practice but it is not available to them world-wide. Insurance companies are commercial businesses and want to make a profit. They can-not do so with less than 200 midwives currently seeking insurance in the UK and a typical claim reaching into millions of pounds. This is not about practice it is about finance. Please show your support for a woman’s right to choose how they birth where they birth and with whom.

VivaLeBeaver Sun 03-Mar-13 18:03:12

Signing a disclaimer isn't enforceable. If negligence is proven then the family could sue the midwife for everything they have. Which would mean the midwife would lose her house, car, savings, etc. but realistically it would mean the family get 200k if they're lucky......one of the most recent compensation payouts I saw for negligence around childbirth was for £12million.

Most independent midwives are fantastic......but I have to agree that been independent doesn't mean better. Though they definitely have more time to spend with you. I know two independent midwives who have never worked in the Nhs, went straight to independent practice on qualifying. Personally I think you need experience to move away from the safety net of having colleagues around you, etc.

RedToothBrush Sun 03-Mar-13 18:07:05

It is the Agnes Gereb film.

I think if you were to look at it, there would be a potential stumbling block - the key would be able the availability of and what home birth services offer under the NHS.

If you can argue, they are insufficient or refuse to support you (without a very very good reason), but an IM would then I think there is some mileage in it.

Its certainly something that puts in law some rights that could be used to help support women who want an IM rather than to use NHS services.

WhatNow2013 Sun 03-Mar-13 18:07:58

OK the thing with this is that it isn't actually going to affect just independent midwives but ALL midwives. Put very simply:

Currently it isn't (feasibly) possible for midwives to buy their own insurance.

You are insured through your employing NHS Trust if you are employed by the NHS or through your private hospital if employed by somewhere like John's and Lizzie's or the Portland.

If they make it unlawful to be registered without insurance, this has serious implications for qualified but unemployed midwives (of which there are many; those who've taken career breaks, time out for children, or moved area, or like in Scotland where jobs are like hen's teeth). And what about newly qualified but not yet employed midwives? If you don't have insurance, you can't register, but you can't be employed unless you register. So you can't apply for jobs which would give you that insurance.

It really has not been thought through. It isn't just about IMs. Also I don't believe IMs should be 'outlawed'; I think affordable insurance should be available but women do make the choice to give birth with an IM knowing that she/he is not insured, and that is their choice to do that. IMs all tell their clients the possible repercussions of their choice. I know many, and I was considering it myself. I think that it's being presented as 'IMs are dangerous and women are put at risk by these uninsured midwives' but actually a woman's no more or less likely to suffer poor care from an IM, than an NHS midwife (and they'd all have been trained in the NHS anyway, and registered to the same standard!!) when actually the effect on midwives who've no intention of going IM could be career-destroying...

FarBetterNow Sun 03-Mar-13 18:08:13

If you employ an IM for a home birth and you are in labour for 24 hours or more, how does the IM manage to sleep in that period, or to organise her own personal life, ie her own DCs.
How does an IM manage two or more homebirths in different locations if the women go into labour at the same time?
What if she has to go straight from one birth to another labour with no sleep?

I'm biased against home births as I have a friend whose baby died because it was a home birth.

FarBetterNow Sun 03-Mar-13 18:10:05

I cannot think of any other 'business' that by law does not have to have Insurance.

WhatNow2013 Sun 03-Mar-13 18:15:22

Most IMs work in pairs and have a backup midwife who will be their 'second'. Some don't but that would be agreed with the woman at booking (if you don't like the way she works, don't book her). Many IMs work with colleagues in small practices so there will be two or three who work together regularly within a geographical area.

Also, most women in normal spontaneous active labour requiring someone to stay with her will not be at home with a midwife for 24 hours (I'm speaking as an NHS homebirth midwife here so I do know what I'm talking about). If progress is slow we'd recommend transfer in, and in that case, the IM wouldn't be practising as the case midwife anyway but may be there as an advocate (but wouldn't be allowed to do clinical care in the hospital unless she had an honorary contract which most places won't do). Yes, you can be in labour for 24 hours... but I can't think of any situation where normally progressing active labour would go on for 24 hours. You don't need a midwife there for early labour.

DontmindifIdo Sun 03-Mar-13 18:16:29

I think it's shocking that independent midwives have been allowed to practice in the UK with no insurance.

If there was money to be made, insurance companies would offer insurance, however it would be very expensive. It probably would push up IM costs, but they are already a luxuary choice, I don't know anyone who wanted a home birth who wasn't able to have one on the NHS for anything other than medical grounds - the only people I know who have booked home births with IM rather than NHS midwives have been very very rich types who looked at it as an option along with private hospitals. If you can afford a £10k birth, you can afford for IM to double/triple their prices and still pay.

also, can someone explain why an independent midwife is the gold standard? Are they much better than an NHS one in your home? They normally rock up as a team of two round here to deliver babies at home...

Strangemagic Sun 03-Mar-13 18:17:34

I would not get in a car with an uninsured driver,why would I entrust the most precious thing in my life to an uninsured midwife,In my experience the NHS midwives were brilliant.

WhatNow2013 Sun 03-Mar-13 18:28:24

The IM being 'gold standard' thing is a bit of a fallacy; what it is, is that for some people, knowing their midwife is really really important and they are prepared to pay for that security that they will know the person who will be there throughout their pregnancy and birth. Or they might be making a choice that they feel bullied about by the NHS ('against the policy' decisions- like VBAC at home, or breech vaginal birth, or twin vaginal birth etc). Some Trusts are great and will facilitate these things for women; some will just say 'no, you HAVE to do XYZ and many women aren't up for a fight when they are pregnant and vulnerable.

Also a lot of IM clients aren't rich. They will go without a lot of other things in order to pay £3k for an IM. I know people who pay it off over years. Or who do without holidays or a car etc to pay for it. Not all, obviously, but there are a fair amount of people who go to an IM who aren't loaded!

Another thing is, midwives are all regulated by the SAME body. The NMC. We all have to meet the same standards to re-register including yearly supervisions, a minimum number of practice hours, professional development and evidence of study each year. All midwives in the UK are trained by the NHS. You cannot train outside the NHS. Therefore the basic standard for a new registrant is the same across the board.

Also, there are things that NHS midwives learn from IM colleagues that are very valuable. Many teams have been set up in the NHS based on a continuity model that is based on independent practice, because studies show that outcomes are better when women know their caregivers. Also, there are some very experienced IMs who have immense skill in the more unusual birth scenarios, such as vaginal breech birth, because those skills all but died out in the NHS not because of good evidence but because of incredibly flawed policies based on evidence that wasn't credible (eg: the Term Breech Trial which was heralded as saying 'breech birth is unsafe' but actually the study has so many flaws it's not useful to use, it was retracted but policies were still written with this as its basis and it's only now that evidence shows breech birth can be managed safely we're seeing more vaginal breech births).

FarBetterNow Sun 03-Mar-13 18:28:33

The ultimate back up of an IM is the NHS or The Portland presuming the parents have the means to pay this.

If you are out of London the NHS is the backup.

Similiar to suffering massive injuries in an accident - the NHS provide a fantastic emergency care and cover the cost.
We are so lucky.

WhatNow2013 Sun 03-Mar-13 18:34:15

Kind of right, FBN- the NHS is ALWAYS the backup of an independent practitioner whether it is a private hospital or not.

If an IM transfers a woman into hospital it will be to an NHS unit. If there is a major problem with any patient in a private hospital they will be transferred to the local NHS intensive treatment unit because private hospitals don't have ITU or NICU etc.

IneedAgoldenNickname Sun 03-Mar-13 18:34:31

So are ims currently uninsured? What happens if something goes wrong?

WhatNow2013 Sun 03-Mar-13 18:37:32

If something goes wrong, the woman can sue the midwife personally- but don't forget you will only get a payout if negligence is proven.

Bad outcomes do not happen solely because a midwife is negligent.

IneedAgoldenNickname Sun 03-Mar-13 18:40:41

Thanks whatnow I've got a couple of uni interviews coming up for midwifery, and it's always possible they might ask me about this kind of thing as it's in the news smile

TaggieCampbellBlack Sun 03-Mar-13 18:42:08

Sorry. I posted and ran. But thanks WhatNow. You've written much better than I can.

Thinking about the Tooting IM practice (which I looked into) it was then (I think) £6K which we could just about have afforded at the time, although not without making very serious cutbacks in a whole bunch of areas. For that you got regular antenatal appointments with your named mw and her named second (more frequent than with NHS IIRC), all your scans at the FMC in Harley Street, two midwives at your birth (at home or in their birthing centre which was effectively in the back garden of St George's hospital so you'd be only a couple of minutes' trolley ride from emergency assistance), postnatal care and checkups and a discount on future births with them. It got cheaper the further along in pregnancy you were when you booked them, but obviously they were more likely to be fully-booked the longer you waited.

We didn't go with them in the end because we just couldn't justify the cost. I'm reasonably sure that if we had used the IM practice I'd have avoided my EMCS with my firstborn (because it was a positional issue that if it's picked up early enough can be rectified by an experienced mw. I actually met someone else locally who'd delivered with the Tooting IMs, had the same positional issue and they identified it and sorted it early on in the labour when she was dilating very slowly. In contrast, no one identified DS's positional issue until I'd been pushing for an hour and a half and he was well and truly wedged) but I'd have been £6K down. And my NHS VBACs with the other two were very positive.

ReallyTired Sun 03-Mar-13 18:48:49

I have mixed feelings on this. Many women who employ an indepedent midwife do so because they are high risk and want a homebirth. It is understandable why home births such a situation are uninsurable.

I think that one way around the issue of high insurance for IM would be to get the patient to take out insurance against anything going wrong. Patients could be made to sign a disclaimer that they are providing insurance for anything going wrong. A low risk woman could probably get insurance for her birth plan at a reasonable rate whereas a high risk woman might have to take financial responsiblity for a negative outcome.

I fear that making independent midwives illegal will endanger homebirth in general. Someone will decide that NHS homebirths are far too much of a legal risk.

TaggieCampbellBlack Sun 03-Mar-13 18:53:42

ReallyTired - your last paragraph is a frightening reality.

thebody Sun 03-Mar-13 18:55:56

I simply can't believe anyone would allow an uninsured person to provide them with any medical intervention at all let alone deliver your baby.

Absolute madness. Home births are not without danger. My friend lost her baby during delivery at home.

For every accident in hospital there's one at home.

But you can sue a hospital.

RedToothBrush Sun 03-Mar-13 18:56:24

I fear that making independent midwives illegal will endanger homebirth in general. Someone will decide that NHS homebirths are far too much of a legal risk.

They can not legally outlaw homebirths in the UK. We have the European Court of Human Rights to thank for that. They might try, but anything that effectively makes it impossible to have a homebirth, is illegal.

lougle Sun 03-Mar-13 18:58:25

It doesn't mean that Midwives can't be registered without an employer. It means that they can't be practicing without insurance, which requires NHS or private employment or private insurance, which is incredibly costly.

Phineyj Sun 03-Mar-13 18:59:00

I used an IM. I am certainly not 'very very rich'! It was the only way to ensure one to one care and to make sure I was not left alone in labour -- something I was very worried about. Also, you don't just get the birth covered -- the fee also includes all antenatal care, at your house at times to suit, taking as long as you need, coming to any appointments where you need an advocate (e.g. Consultants etc), daily visits the first week after birth followed by regular visits until the baby is a month old.

I wasn't concerned about the insurance situation, as I felt it was less likely anything would go wrong with two experienced midwives of my choice there throughout.

If I were being cynical I would say it's not in the NHS's interests to offer IMs honorary contracts as the contrast in what's offered would be too noticeable.

I also don't think the NHS can guarantee they will send you midwives for a home birth, or certainly not in London. If there are staff shortages, which there always are, they're going to come up with any reason they can not to send two midwives to someone's house if the hospital is short-handed?

Imagine though, thebody, that you've done your research and come to the conclusion that in your particular set of circumstances an IM (let's say an IM in a birthing centre with emergency backup easily available) will be safer than an NHS birth. Would it really automatically be madness to choose "less likely to have a bad outcome, but if there is one I won't be able to get significant compensation" over "more likely to have a bad outcome, but if there is one at least I might be able to sue someone"?

In support of WhatNow2013's comment that sometimes people just "save up" or prioritise expenditure to afford an IM, I'd just like to say that for me it was the best £££ ever spent. I had the desired home birth, just partner and IM (and her lovely labrador made himself at home with my animals!). We even shared a chinese takeway during labour and I stayed in contact with her for several years. Yes, we could have had a holiday with the money but that was the price we chose to pay for the personal care - and I had to fight for this too, being 35 and wanting a home birth for first baby - but that's another story.

IM's play an important role and whilst MY choice would not suit everyone (and I'm not disrespecting NHS midwives at all as have a family member and close friend with this occupation) the matter of choice is, imho, very important.

Viviennemary Sun 03-Mar-13 19:10:33

I don't know the ins and outs. But somebody raised the important question that if there is negligence or mistakes by the independent midwife who pays the bills. So yes I do think midwives must be regulated and insured. Surely the answer is to go to a private hospital and have their midwives if people don't want an NHS midwife.

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