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.

TaggieCampbellBlack Sun 03-Mar-13 16:13:24

Oh. and I haven't anything to do with the organisation. But I believe passionately in womens rights to choose whatever care they want in pregnancy and birth. Government changes mean that choices are being denied.

sleepyhead Sun 03-Mar-13 16:15:48

To be honest, the choice of an Independent Midwife has always been far out of the reach of most women for financial reasons.

But, I think the change in the law is stupid and won't improve safety in any meaningful way.

CloudsAndTrees Sun 03-Mar-13 16:16:10

This leaves Independent midwives unable to practise legally

No it doesn't. It means independent midwives need insurance. I'm actually quite shocked that they don't already have to have insurance. Insurance is strongly recommended if you are doing manicures, never mind delivering babies!

gordyslovesheep Sun 03-Mar-13 16:16:23

lots of women cant access this 'gold standard' due to lack of money

I am confused as to why they can't get insurance

I am not sure if yabu

sleepyhead Sun 03-Mar-13 16:20:28

I don't think there's any company in the UK at the moment who will insure an Independent Midwife. Birth damage can be claimed for decades after the event and claims can run into the millions - not a good risk for insurers.

So, in effect this law has the result of banning independent midwifery.

AmberLeaf Sun 03-Mar-13 16:21:31

I think that the insurance is not available to them. As in the insurance companies won't provide it?

I heard about this quite a while ago.

edwinbear Sun 03-Mar-13 16:27:57

Having had an independent midwife for dc2, after a horrific NHS midwife led birth for dc1, I hadn't realised this was being made law. When I had dc2 my IM and I obviously discussed the insurance issue but this was 15 months ago and I haven't kept up with the discussion. I won't be having a dc3, I am having major corrective surgery on tuesday to fix the damage the NHS caused during dc1's birth, but if I were, I have to say, hell would freeze over before I let an NHS midwife anywhere near me again.

Fleecyslippers Sun 03-Mar-13 16:40:22

I agree that insurance will not automatically make a midwife 'safer'. I do however believe that there has to be a move towards more regulation of independent midwives in light of the findings of Claire Teagues inquest.

CloudsAndTrees Sun 03-Mar-13 16:45:56

Ok, I didn't realise that they couldn't get insurance.

How's that going to work then?

cory Sun 03-Mar-13 16:55:57

So currently what happens if an insured midwife does make a mistake and the baby is born with lifelong disabilities? Who picks up the tab?

If a mistake is made by a hospital midwife, you can sue the hospital and hope to get support paid for by their insurance- who can you sue if there is no insurance?

Remembering that this may make the whole difference to the quality of life to that person for the next 70 year, it is a question worth asking.

Not because there is anything wrong with independent midwives; just that mistakes will inevitably happen sooner or later in any birth situation and then money needs to be found. Of course it doesn't make the midwife safer- but disability comes expensive.

Softlysoftly Sun 03-Mar-13 17:09:40

While I'm sorry to hear about pps birth injuries I would presume an independent mw would have at one point been an NHS mw for experience/training therefore discounting NHS mws is a little confused.

I don't think they should be practising uninsured sorry so disagree with the protests.

A better approach would be to increase the availability of NHS mws for continuous community care and home birth if that is the mothers choice.

Softlysoftly Sun 03-Mar-13 17:11:29

Or encourage independent mws services to become part of a private care organisation so they could get insurance cover as part of the wider business medical cover eg BUPA hospitals

EuroShaggleton Sun 03-Mar-13 17:26:27

I agree OP. There used to be a wonderful independent birth centre in Tooting. That closed a few years ago because of the insurance issue. Now it seems that women who want a home birth with the continuity that an independent midwife offers will not be able to do that. Women should have the choice.

Softly I think I can safely say that none of them wants to be practising uninsured. If sued, they would be personally liable and could lose all their assets. But they are providing a valuable service.

Currently it is my understanding that you can have a private consultant-led birth at a number of hospitals around the country, but it you want a midwife-led birth, your choices are NHS or the Portland in London (which costs far more than an independent midwife does or the Tooting centre used to).

sleepyhead Sun 03-Mar-13 17:28:02

Cory, as far as I know (and it's not a choice I'd make for myself so I don't know that "far"), currently the IM makes the woman employing her aware of the insurance situation in advance - whether that's a legal requirement or not I don't know, but all women employing IMs should be aware of it and I'd be amazed if it didn't come up with the most cursory research into a decision that you're paying over a grand for.

So, if the midwife makes a mistake you could presumably sue her for everything that she has, but that would be peanuts compared to a payout from the insurance company. It's a risk you take when employing an IM.

But many women employing IMs have had previous bad birth experiences on the NHS as a result of routine practice and presumably have made a calculated risk that the IM is likely to result in a better outcome for them this time.

The NHS picks up the short and long term medical tab, but that happens when private hospitals make mistakes too.

VivaLeBeaver Sun 03-Mar-13 17:35:26

The govt need to look at setting up/facilitating an insurance scheme for independent midwives. Not necessarily directly but by helping with talks with insurance companies to sort it out.

As a midwife I'd never be an independent one while I can't get insurance.

And it does worry me that a family could have a devastating consequence due to the actions of an independent midwife and have no compensation. Bringing up a seriously disabled child is not cheap.

TraineeBabyCatcher Sun 03-Mar-13 17:36:09

I belive you sign a disclaimer to say you will not sue her if anything happens while you or the fetus/infant is in her care.

Bue Sun 03-Mar-13 17:38:48

I'd rather the government focussed, as softly says, on schemes that provide continuity of care for women, such as One to One Midwives in Wirral. Every woman deserves this option, not just those who can afford to go private.

RedToothBrush Sun 03-Mar-13 17:39:30

TaggieCampbellBlack, are you aware of 'Ternovszky vs Hungary'. If you aren't I suggest you find out about it, as I think it might be relevant and might help you with what you are trying to do. Its not exactly the same situation, but I don't think its hugely different.

A film was made about it called Freedom for Birth: The Mother's Revolution.

The Huffingtonpost ran an article about it, and linked to a shorted version of it which is here

RedToothBrush Sun 03-Mar-13 17:41:40

Basically I think there might be a case that to answer using that ruling that the legal situation is the UK government have a legal obligation to ensure that independent midwives are able to get insurance.

I could be wrong, but I would look very closely at it.

Insurance can be found for IMs. Its difficult but it is there. The problem is that the annual premium is around £ 40k. Most IMs wont earn anything like that figure.

That wouldn't be legally enforceable, though, surely, TBC? You can't exclude liability for death or personal injury caused by your negligence.

Is that the film about Agnes Gereb? A mw offering home births who is or was under house arrest for offering women this choice?

ilovesooty Sun 03-Mar-13 17:47:01

The govt need to look at setting up/facilitating an insurance scheme for independent midwives. Not necessarily directly but by helping with talks with insurance companies to sort it out

I agree. I'd always assumed they had to be insured and am shocked to discover they aren't, but I can see why it's problematic on thinking about it. However, if the government has to contribute financially to make that insurance viable I'm not sure that ought to happen.

toobreathless Sun 03-Mar-13 18:00:06

I am STRONGLY in favour of insurance for IMs though I agree that there needs to be a way of doing this in a more affordable fashion. It is however not unusual for some Drs working privately to be paying premiums of over £10,000 a year but clearly this needs to be balanced against income.

I also strongly in favour of tighter regulation of the working practices of IMs. While the vast majority are competent professionals practicing in a safe manner and providing an indispensable service (admittedly to those who can avoid to pay them) the few dangerous ones are more dangerous than they would be in other professions die to the lack of adequate regulation.

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 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.

piprabbit Sun 03-Mar-13 19:13:02

You can sue an IM, but I believe that many take steps to ensure that they have minimal assets in their name. Who would want to risk their family's home for the sake of their job (no matter how passionate they are about it).

RedToothBrush Sun 03-Mar-13 19:17:50

I've said the following on another thread tonight about a slightly different subject.

I'm of the firm belief that women do not endanger the life of themselves of their baby willingly or deliberately. If women do something that goes against all advice or evidence, then they do so for a bloody good reason; you need to get to the bottom of those reasons and you need to make sure that woman is supported as much as possible to minimise her risk as much as humanly possible.

If a woman does, she generally will have some sort of belief or ideology at the heart of it; most generally I'd say there's probably a previous trauma of some description at the bottom of it.

Which makes her a vulnerable woman who needs help not judgement or controlling.

So when you are talking about a woman who considers using a IM without insurance, then ask the question 'WHY?' Why would someone take what others would deem, such a risk?

The answer involves a very strong need to avoid the alternative. And if women are prepared to use an IM who they know is uninsured now, then simply banning IMs from practising if they do not have insurance leaves women who are seeking to avoid something high and dry.

This has the potential in some cases where a woman is desperate to avoid a hospital birth, to now try and attempt to give birth either illegally with a willing IM or to try and give birth unattended.

It has parallels with banning abortion. What are the real consequences and just how far will a woman who is desperate go?

thebody Sun 03-Mar-13 19:18:01

Tolliver I do get your point.

TaggieCampbellBlack Sun 03-Mar-13 19:20:04

Well said RedToothbrush.

<<wish I could write eloquently>>

Arithmeticulous Sun 03-Mar-13 19:25:13

To me, the care that IMs give- woman centred, one woman one midwife, long AN appointments at time/location convenient to the woman, experience in more unusual births (breech, twin VB), 6 weeks of PN care - it's expensive if you compare the single cost of birth in an NHS hospital. But if you calculate the cost to the woman work/child care wise, the additional cost of instrumental/CS birth, treating PND/AND etc etc - is it that much more?

I think they are providing the care that the NHS should be.

HolidayArmadillo Sun 03-Mar-13 19:25:35

Very well said Red Toothbrush, I'm not an IM, although I am a midwife, I fear that this ruling coming into force will see a lot more unattended births as women who wish to avoid hospitals and the NHS in general go to extreme lengths to do so. I love the NHS, I love the service we provide, however, I do recognise that it isn't for everyone and IMO we need to have another option, because of the way the NHS is run we have a 'one size fits all' approach to maternity care, and anyone who falls outside the realms of normality has a 'fight' on their hands to get anything other than the prescribed NHS care, which may be wholly unsuitable for her needs. This woman needs another option, she may choose not to use it but to remove that option is very dangerous.

MrsHoarder Sun 03-Mar-13 19:27:09

Redtooth iswym but the other way to look at it is that women are approaching a medical practitioner who they are putting their faith in and will trust because if how they present themselves and because it is easy to trust real individuals they can see. They should feel that these individuals have the same protection a they would expect from their doctors, dentists, layers, a accountants and are protected if things go wrong. Even if this is explained people will think that it can't happen to them (why we need compulsory car insurance).

You can't have it both ways, these are either vulnerable people who need protection or they are capable adults who will find other medical care.

A friend of mine hired an IM for her labour. After a perfectly straightforward pregnancy she was being pressured to accept induction of labour despite daily monitoring showing a healthy baby and placenta. She had planned for a home water birth and didn't see the need to change that. She had a lovely home birth with her IM rather than an IOL which she feared.

The choice should not be taken away from women as to how and where they have their babies. As a student MW I find it very concerning that the culture around birth is becoming more and more medicalised. I fear that a hospital birth may soon be the only option available sad

TaggieCampbellBlack Sun 03-Mar-13 19:34:21

It boils down to choice. Informed choice. I believe that women have the right to choose the birth they want and to choose who they want to care for them through it.
Currently in the NHS you don't have much choice. If you are lucky you'll be allocated a midwife you like who will give you choices within whatever policies exist in that trust. These might be completely different to those in the trust next door.

There is good care within the NHS. But you shouldn't be 'lucky' to get it.

Do you want to be in control of your birth? Or do you want your birth to be controlled by others?

Also what are the chances that after this the government will make freebirthing illegal? Possibly with women being investigated by social services for opting out of the only birth option available, NHS hospital birth.

RedToothBrush Sun 03-Mar-13 19:37:55

You can't have it both ways, these are either vulnerable people who need protection or they are capable adults who will find other medical care.

You can. You can help these IM get the insurance they need, so they can get the care that they feel is appropriate to them, to protect these women. In the end, we will end up footing the bill one way or another; either through the NHS or the benefits/care system dealing with the fail out. Or even the cost of a lengthy court case at the European Court of Human Rights by someone challenging what the UK government is proposing. We don't get out of it, just by banning something! The reality is never exactly what the authorities want, because they don't account for or understand emotions and desperation.

You also need to look very hard at the reasons why women don't feel they can get this on the NHS, and why the NHS is failing them and change that from the ground upwards.

The two go hand in hand, whilst there is a lack of trust in NHS services.

The NHS are IMO unlikely to employ IMs to run practices. Look at the Albany practice, as close to an IM practice within the NHS and they closed it down despite fantastic experience and outcomes for mothers in their care.

RedToothBrush Sun 03-Mar-13 19:40:18

MsIngaFewmarbles Sun 03-Mar-13 19:34:40
Also what are the chances that after this the government will make freebirthing illegal? Possibly with women being investigated by social services for opting out of the only birth option available, NHS hospital birth.

Do you think this would work either? I don't. Many women go into labour and give birth very quickly before they are able to get to a hospital for a lot of different reasons. How do you distinguish between the two, without running the risk of prosecuting perfectly innocent women?

MrsHoarder Sun 03-Mar-13 19:40:38

Is it currently illegal for someone not registered as a midwife to be the only birth attendant (ie for a doula to agree to be present and plan for no midwife)? If so then surely this is just adding one more condition, women already don't have free choice on who they will pay to assist them during birth.

Bogeyface Sun 03-Mar-13 19:42:24

It does seem to be a backdoor way to ban IM, however I agree with PP that MWs shouldnt be practising without insurance.

If insurance is not available to them then surely it would be better to campaign for a good, affordable (state run if necessary) insurance scheme?

As someone with a child who suffered brain damage at birth, I would not want to have babies born with no hope of proper redress if something goes wrong as a result of negligence on the part of the MW, independent or otherwise.

Bogeyface Sun 03-Mar-13 19:44:02

It is already illegal to plan a birth with no medical assistance, but its very hard to prove that someone has done that. It is not illegal to give birth alone if circumstances mean that they can't access care in time, so anyone suspected of doing this could claim that they didnt know they were in labour until it was too late.

somewherewest Sun 03-Mar-13 19:44:46

I'd rather the government focussed, as softly says, on schemes that provide continuity of care for women, such as One to One Midwives in Wirral. Every woman deserves this option, not just those who can afford to go private.

Absolutely. IMs are just not an option for the vast majority of women.

ChairmanWow Sun 03-Mar-13 19:46:57

Two points - a PP responsed that established labours of 24 hours or more were rare (or words to that effect) on the last page. I would challenge that, firstly with my own experience of established labour in hospital of 24 hours including 3 hours of pushing. I wouldn't have wanted an exhausted MW to deal with such a difficult end stage. I also have 2 close friends who had longer established labours ending in EMCS due to foetal distress. Again, exhausted MW plus distressed baby is not a good mix. Of course it's anecdotal but I would think we all know people who have had long, established labours. .

Secondly this cannot be compared to abortion because banning abortion leaves no alternatives for women wishing to terminate pregnancies. Stopping IMs from practicing without insurance still leaves women with the choice of hospital, MLU or home births attended by regulated and insured NHS midwives.

I'm sorry for anyone losing their livelihood or their choice of an IM but I really do think it's scary that anyone engaging in an activity which carries such devastating risks can do so uninsured.

Redtoothbrush a lot of things implemented by governments don't work and mean people are persecuted unfairly sad

I have only been on a community placement for 5 weeks and know of 2 babies born before a MW could attend or the woman could get to the hospital. It happens fairly frequently.

RedToothBrush Sun 03-Mar-13 19:51:07

Stopping IMs from practicing without insurance still leaves women with the choice of hospital, MLU or home births attended by regulated and insured NHS midwives.

I'm sure there are women out there that don't consider this a choice though. This is the problem. The choice is NHS or not NHS in minds of a few.

But it doesn't Chairman. Many women are excluded from a MLU or a home birth because they don't fit into the policies and guidelines of the particular NHS trust they live in, see my earlier post for an example. The NHS is very risk averse, understandably so, but if a well informed woman no longer has the option of an IM then they are forced into a hospital birth.

Bogeyface Sun 03-Mar-13 19:55:04

Private hospital births are a choice too, for those who have money, and only those with money can afford IM.

I never cease to be amazed that despite having the best free healthcare system in the world, even with all its failings, we are not happy. Try living in America and then see how you feel about NHS births!

TaggieCampbellBlack Sun 03-Mar-13 19:58:34

The 'choice' between hospital, MLU or home, within the NHS is only a choice if you fit in with their criteria.

5th baby? Hospital.

Previous caesarean? (even if you have had VB since) - Hospital.

Short staffing? - No home birth

Raised BMI? -Hospital

Breech? -Caesarean

Older than 35? -Induction at 38 weeks

'Overdue'? - More thsn 40 weeks? 40+10 in some places, 40+14 in others? - Induction. Or your baby will die.

That's 'choice' within the NHS.

MrsHoarder Sun 03-Mar-13 19:58:47

X-post it isn't the government's responsibility to provide insurance for private businesses over whom they have no say in the running. The rcm could help the ims negotiate with the insurance companies and i'm sure they will be able to find a price. Given the level of risk involved this may be high, they will then have to decide whether to put prices up or close.

I expect the government to ensure that all businesses facing individuals have suitable insurance in case of damage to those individuals. Especially businesses wise target market is vulnerable people.

I would also expect a private abortion clinic to be required to have the same level of insurance if that kills that straw man.

RedToothBrush Sun 03-Mar-13 19:58:50

Bogeyface Sun 03-Mar-13 19:55:04
Private hospital births are a choice too, for those who have money, and only those with money can afford IM.

Only really if you are in the right areas. The only private hospital wards are in London. There a few private midwife units but these are very limited in number.

The myth that private maternity is available throughout the uk is a frustrating one.

Bogeyface Sun 03-Mar-13 20:02:13


No one can force anyone into hospital, and they have to provide a MW for a homebirth by law. I had my 6th at home, despite a determined consultant trying to talk me out of it with dire warnings of me bleeding to death on my lounge floor.

MrsCB I luffs you. It's so nice to hear a qualified MW speak out as opposed to just going along with the status quo. Our lecturers are fired with enthusiasm but practicing MWs just seem to have run out of fight sad

Bogeyface Sun 03-Mar-13 20:03:38

I agree that there are not many units, but they do exist. I am just pointing out that the argument that it is NHS hospital or nothing is not true. As I said, I had my 6th at home with an NHS team and it was fantastic!

TaggieCampbellBlack Sun 03-Mar-13 20:06:08

They can if there are no midwives availabe for homebirths. It happens frequently when staffing levels are low. Then the 'choice' for women is to do it on their own or go to hosptal.

HolidayArmadillo Sun 03-Mar-13 20:11:16

Yes but as I said earlier its about getting what you want without a fight. Because that fight is designed to exhaust you and wear you down and put you back in your box. Only the very strong will fight against the might of the NHS 'pathway of care', I'm all for informed choice, I'm all for consultants explaining why they wouldn't recommend a particular course of action and in many cases it is completely reasonable, in other cases it is just a case of 'the rules' being blindly applied without examining the woman as a whole.

If that woman has the option of discussing things through with an IM, an IM who knows her stuff and has experience in providing care to women who don't fit the tricky boxes the NHS prescribe this can only be a good thing?

HolidayArmadillo Sun 03-Mar-13 20:12:19

Actually, I have known of cases where IM's have been sent out instead of NHS midwives when staffing levels don't allow...

ReallyTired Sun 03-Mar-13 20:15:04

Some people are just anti homebirth under any circumstances. There is a huge lobby of doctors who feel that homebirth should be completely illegal like some parts of the states.

It is an interesting question who takes liablity when someone does choose to have a homebirth against all medical advice. Should a high risk mother who was advised against a homebirth for twins in a footling breech position really be awarded compensation by the NHS when it all goes hideously wrong because she insisted on her "right" to a homebirth?

How do we allow women to take responsiblity for their bodies and the consequences of their decisions when things go wrong?

I think that patients of independent midwives having to pay for insurance depending on their circumstances would be the best way to allow independent midwifery to continue.

Exactly. With my last pg I had borderline diabetes, mostly controlled by diet. Growth scan at 37 weeks estimated a 4.5kg baby. I was planning a home birth. Was told by 3 different consultants that I was endangering mine and my baby's life. I tried to argue that I had a 4.48kg baby previously with no issues during delivery but this didn't change their view.

I gave up fighting and had IOL at 39 weeks. Bearing in mind how fiercely I fought and I was relatively well informed it doesn't look good for Jane Bloggs who wants a choice in birth. Women should have options and not have to fight.

TaggieCampbellBlack Sun 03-Mar-13 20:23:32

The RCM used to offer insurance but stopped a whie back.
As far as I know there is no company offering insurance at any cost for independent midwifery.

Bogeyface Sun 03-Mar-13 20:28:59

Really sometimes things just happen and no court would award damages in that case if there was no medical negligence. If the woman chose a homebirth and the MW screwed up then it would be different. But someone doing something that they know is risky and despite the best work of the MW, a baby died or was brain damaged then there would be no case for the MW to answer.

TaggieCampbellBlack Sun 03-Mar-13 20:32:04

With the NMC 'supporting' her it will always be the midwife's fault. cynical and 2 glasses of wine down

sarahtigh Sun 03-Mar-13 20:33:03

dentists doctor s etc all have to have insurance the insurance for an obs/gyn doctor is nearly 3 times that of a general surgeon almost 10k a year but then the defence union will pick up tab if necessary, I do not think anyone should be practising without insurance

while I was on a maternity break by insurance with dental insurance company was put on hold, ie still officially a member but could not practice but still covered if anyone complained about what i did in my last job, it also covered for good samaritian acts but I could not do dentistry without restarting the insurance which I did do when I restarted work a few weeks ago

I am just surprised it was not illegal to practise without insurance already

signing a disclaimer when there is no alternative may well not be legally binding anyway

I am not against choice but I am pro making it illegal to practice without insurance,if there is a demand insurance will become available

same as having to have your car insured but if you are so big a risk no-one will insure you that is not the governments problem it just means you can't legally drive or have car on the road

Redbindy Sun 03-Mar-13 20:39:25

l'm surprised that you think it acceptable for anyone practicing midwifery to be uninsured. Anything that keeps charlatans out of medical practice has to be a good thing.YABU

EuroShaggleton Sun 03-Mar-13 20:44:28

You seem to be confusing professional qualifications and insurance to provide financial compensation in the event that something goes wrong.

TaggieCampbellBlack Sun 03-Mar-13 20:47:49

There is no insurance.

Independent midwives are not 'charlatans'.

because a hospital has insurance does not mean that they are best.

Midwifery is not 'medical practice'.

I want choice. I want all women to have choice. I want my daughters and their daughters to have choice.

TaggieCampbellBlack Sun 03-Mar-13 20:49:23

Independent midwives are trained and registered professionals.

tilder Sun 03-Mar-13 20:49:24

I'm quite shocked that anyone working as a midwife would do so without insurance. Making it a legal requirement is a good thing imho.

If it stops independent midwives, then I guess that is bad news for them and for those who would choose that route.

I presume, although may well be wrong, that insurance companies take a risk based approach to working out first if they can or will provide insurance and second the cost of that insurance. I guess they look at the risks entailed in the work, how likely they are to happen, and then work out a cost for the insurance. They want to make money and therefore need to provide insurance, but the amount they charge for insurance needs to cover the cost of overall claims against them plus provide a profit margin. I would assume, perhaps wrongly, that if insurance is very high that it is a reflection of the money they expect to have to pay out.

tilder Sun 03-Mar-13 20:55:08

I didn't mean that post to sound anti independent midwives. Tbo, it really doesn't matter to me personally as I am not having any more children.

I would just question the risk of being involved in childbirth without insurance and why insurance as an independent us so high.

ReallyTired Sun 03-Mar-13 20:55:34

"But someone doing something that they know is risky and despite the best work of the MW, a baby died or was brain damaged then there would be no case for the MW to answer. "

You would think so, but insurance is to cover the costs of fighting an entirely ridicoulous court case. Many people may take the happless midwife to court becuase they have a no win no fee lawyer, even when there is no case to answer for. This regularly happens within the NHS already.

I feel that insurance should pay out when there is a brain damaged baby whosever fault it was. I can't help wondering that if there was no lawyers or court fees whether there would be more money for brain injured children.

Giving birth will always be risky whether you choose a hospital or give birth at home. Even with the best of medical expertise brain damage happens. Prehaps we should all take out insurance to protect us in the event of having a brain damaged child, or even some other special need.

sarahtigh Sun 03-Mar-13 21:08:39

just to be clear I am not against independent midwives or indeed independent anything but I am against anyone in medical or related areas chiropody/ osteopaths/ people doing botox/ private physios etc etc working without professional indemnity insurance. midwifery is a medically related profession

as with any other medical type profession you must not act out of your area of competence and must refer on urgently if necessary if things get beyond your scope, so a midwife could be sued whether in NHS priivate or what for failing to spot trouble and no referring on /calling ambulance/ obstetrician etc and rightly so

I do agree that the ambulance chasing type lawyers may need some curbs but that does not mean that compensation should be limited because the independent can not personally pay out

HolidayArmadillo Sun 03-Mar-13 21:12:31

Redbindy, IM's undergo exactly the same training as NHS midwives. And many of them also practice within the NHS as well.

Bogeyface Sun 03-Mar-13 21:16:27

Really but no one would take out that insurance as it always happens to someone else. Until the day it happened to me or more accurately, my son. Would I have insured against it? No, same as I didnt insure against a multiple birth.

I still think that any medical professional, and a midwife IS a medical professional, should be insured.

tilder Sun 03-Mar-13 21:19:44

It's not about how good they are, how professional, how well trained etc. As saratigh said, all those in medical profession should be insured, if nothing else to provide a safety net should something go wrong. If things go wrong in obs and gynae it can be very expensive.

ReallyTired Sun 03-Mar-13 21:21:22

"as with any other medical type profession you must not act out of your area of competence and must refer on urgently if necessary if things get beyond your scope, so a midwife could be sued whether in NHS priivate or what for failing to spot trouble and no referring on /calling ambulance/ obstetrician etc and rightly so"

A midwife who was incompetent would be disciplined by Nursing and Midwifey Council and risk losing her career. I feel that displinary action by a regelatory body is best way of managing bad practice.

"some curbs but that does not mean that compensation should be limited because the independent can not personally pay out "

At the moment compensation is limited to what an IM has means to pay. Insurance has a maximum limit of what will be paid out. I believe that more money might be available if there was no need to prove blame.

HolidayArmadillo Sun 03-Mar-13 21:50:16

It's not about how good they are, how professional, how well trained etc. As saratigh said, all those in medical profession should be insured, if nothing else to provide a safety net should something go wrong. If things go wrong in obs and gynae it can be very expensive.

I agree, but I was correcting the assumption that IM's were charlatans. As it stands all midwives in the UK have exactly the same standard of training.

ilovesooty Sun 03-Mar-13 22:00:51

I doubt if anyone is disputing their level of training or professional competence. Professional liability insurance is a separate issue.

tilder Sun 03-Mar-13 22:11:37

I hope my posts didn't sound like i was questioning anyones professional competence. It just shocked me that any medical professional would work without insurance.

It is expensive to get insurance as a medical professional, and premiums are affected by things like specialty, seniority etc. If the cost of insurance is prohibiting someone from practicing, I would want to know the justification for such high costs.

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

No it was in specific response to the post by RedBindy that said insurance was a good thing to prevent charlatans from practising. I was just pointing out that IM's were just as qualified as the next midwife smile

edwinbear Sun 03-Mar-13 22:20:48

When I chose to use an IM for dc2, the question of how much money could I get if things went wrong, never crossed my mind. My over riding priority was to ensure the safety of my baby and myself. Having been left for periods of between 4-5 hours alone, despite an epidural, as well as being left alone with dh to push for around 30 mins whilst the NHS midwives did paperwork for a possible EMCS, there was simply no question in my mind that my baby and I would be safer with an IM who had 25 years experience, had spent many, many hours with me during my pregnancy, who would not leave me and knew my medical history inside out. Thankfully, I didn't need that NHS EMCS, they managed to get dc1 out with forceps, which they had placed over his eye. He was so distressed/cut/bruised he struggled to bf for weeks. I suffered PTSD and my bowel and bladder have been hanging out my vagina for 3.5 yrs.

Now, of course those things could have happened with an IM, but I truly believe a major contributing factor to my first birth was how frightened, abandoned and alone I felt in labour. This was not going to be an issue with an IM. A happy, relaxed, secure mum in labour surely has to have some positive effects.

tilder Sun 03-Mar-13 22:30:32

Edwinbear I hope no-one goes onto childbirth thinking if things go wrong I could get £x. Am sorry you had a bad experience with your first and things went so much better with your second.

FWIW I think the insurance is as much protection for the midwife as the parent. In an ideal world, no-one would need such insurance. But sometimes things go wrong and it is not necessarily anybodies fault.

HarderToKidnap Sun 03-Mar-13 22:36:54

The cost of insurance is so high for IMs because there are so few of them. About 200, IIRC. Insurance relies on spreading the coast between lots and lots of users, when there are so few people paying into the pot and such huge payouts for claims, it doesn't make sense for insurers to offer it as a product. It's not a reflection on the skills or competency of the IMs, it's just a maths problem!

Bogeyface said upthread said it's illegal to plan an unassisted birth. It's NOT. It's illegal to "attend" a woman in labour unless you are a qualified midwife (attend in this case means carry out midwifery duties, basically), doctor, paramedic etc. It's an old law designed to stop the Sairey Gamps or handywomen from midwifing women. You cannot be compelled to seek medical assistance in any circumstances, unless court ordered because you are not competent to make that decision.

tilder Sun 03-Mar-13 22:44:18

Thank you hardertokidnap. That does make sense. Does make it tricky though, doesn't it. I have no idea what the solution is.

Revengeofkarma Mon 04-Mar-13 00:10:05

Why does insurance need to be balanced against income? That's plainly ridiculous. Insurance needs to be balanced against risk. iMs aren't any more or less risky than NHS midwives, but the damage that can happen if they're negligent is astoundingly large just like any other midwife or obstetrician.

I'm for independent midwives, but it is lunacy they aren't insured now, and I'm glad they will be insured in future. What will happen is the cost will get passed on to the consumer. If the consumer wants it, they'll pay it. Faced with high costs, they may well opt not to use IMs. But every other medical provider in this country is required to have insurance, so why shouldn't IMs?

MerryCouthyMows Mon 04-Mar-13 00:58:20

I would guess that the exceedingly high premiums are related to the fact that though a DC sustaining brain damage through a mismanaged birth by an IM is incredibly small, they payout in the event of that far exceeds the premiums.

A premium of £40k pa as compared to a payout of £12,000,000...

It doesn't seem such a large payment then, does it.

The part that's causing the issue is that their services do not command that sort of price. Or they would be entirely unaffordable to even more people.

Even if you got 10 IM's in a room, all of whom had been IM's for 20 years, you might find that only one had ever had an issue that caused a baby to receive brain damage.

So it's not the frequency that this scenario happens causing the cost of insurance, it's not that the IM is more 'risky' to use - it's purely and simply that the payout for a baby that is brain damaged in labour because of something the MW did or didn't do is HUGE, because it has to take into account therapy costs, care costs AND loss of future earnings for the lifetime of that baby...

It's the payouts that drive the premiums, unfortunately.

Bogeyface Mon 04-Mar-13 01:29:17

Sorry Harder I stand corrected. My understanding was that if you planned a birth with, say, your DH as your "midwife" then that was illegal if he was not medically trained which is correct. However I also thought that it was illegal to plan to act as your own midwife (which if you pick the wording apart, it probably is!) by purposely not having attendants at all, which is incorrect.

I think the point that is being missed, although has been pointed out by some PP is that the insurance is as much for the protection of the MW as it is for the mother. An IM could feasibly lose everything she has to one court case. However, insisting on buying insurance where there is no insurance available to buy is wrong and that needs to be dealt with in tandem with the new legislation. Not much point in telling me I need car insurance if there are no companies selling car insurance in the UK.

VivaLeBeaver Mon 04-Mar-13 06:42:40

One of the problems of sorting out insurance is the amount of paperwork and box ticking that has to be done to work out the risk involved and therefore the premium.

Hospitals have to be able to evidence all sorts of stuff, are their guidelines in line with research, are they auditing their paperwork, are people adhering to guidelines, has everyone had annual training on resuscitation, breech, shoulder dystcia, ctg interpretation, perineal repair, are there regular practice emergency skills drills......the list goes on. IMs would probably need to be able to demonstrate similar.

RedToothBrush Mon 04-Mar-13 07:16:59

The very guidelines and policies that women choosing an IM are probably trying to avoid for one reason or another.

Which is the irony.

And the proof of the lack of choice and flexibility in the current system.

munchkinmaster Mon 04-Mar-13 07:23:49

I'm sorry you had such a horrendous birth. The long term solution is better free care for all within the NHS though in my opinion.

Interestingly the incessant note taking and form filling during labour is all about having notes so you can defend self in court if sued.

If your IMs get more clued up about getting sued (no insurance is head in sand) they'll be form filling too.

VivaLeBeaver Mon 04-Mar-13 07:29:54

The insurance companies would be demanding that they're form filling.

HolidayArmadillo Mon 04-Mar-13 09:15:50

Yeah, the amount of work that goes into getting a department CNST ready is astounding. And quite stupid sometimes. I'd prefer to spend my time being with woman rather than with paperwork which is how it works most of the time, duplicating info that can be found elsewhere.

cory Mon 04-Mar-13 09:20:28

edwinbear Sun 03-Mar-13 22:20:48
"When I chose to use an IM for dc2, the question of how much money could I get if things went wrong, never crossed my mind. My over riding priority was to ensure the safety of my baby and myself."

Absolutely. But supposing something had gone wrong and the baby had ended up brain damaged. This is something that does happen from time to time in both home births and hospital births. We have had posters on MN to whom this has happened during a homebirth, as well as those to which it has happened in hospital.

Brain damage means need of support that lasts a lifetime- and the lifetime of the child may be longer than that of its mother. Would you not rather that there was a system whereby money for that support was available? Otherwise, who would feed and dress that child once you are gone?

What we need is not to make IM's illegal: we need a new system that makes insurance available for them.

ReallyTired Mon 04-Mar-13 12:00:10

"What we need is not to make IM's illegal: we need a new system that makes insurance available for them. "

Completely agree. However insurance is just as much for the mother and baby as the midwife. If insurance was taken out for every birth with an independent midwife then each birth situation would be looked at carefully. Ultimately the customer pays for the insurance either directly or indirectly.

Prehaps people opting for NHS births could have the option of taking out insurance in case something nasty happens. It might bring down the costs for providing insurance generally.

zzzzz Mon 04-Mar-13 12:08:33

I think IM should have insurance.

ReallyTired Mon 04-Mar-13 13:03:29

The problem with IM having insurance is that they may end up paying 40K for insurance to deliever 2 or 3 babies a year. Hosptials do have to pay insurance costs but an NHS midwives may end up delivering far more babies so the costs aren't so bad.

A lot of the work of IM is supporting women ante natally and postnatally rather than actually attending to a mother during birth. The IM should have insurance for these other duties which would not be quite as high as the actual birth.

I feel that women who want to give birth with IM in attendence should pay a top up to cover her insurance for a particular event. (ie. prehaps an extra 5 to 100K decided by an actuary depending on obstrictic history and experience of the midwife)

HolidayArmadillo Mon 04-Mar-13 13:10:11

I don't know the answer to this but I. Bet someone does, has anyone sued an independent midwife for negligence in labour?

DontmindifIdo Mon 04-Mar-13 15:26:52

ReallyTired - wait, is that right, do IM really only do 2-3 deliveries a year? This is over a total number of IM of around 200? So this 'gold standard' that isn't to be treated as something for posh people is a choice only about 600 families a year pick? So in 2011, there were 807,776 live births in the UK, so we are talking about a change that will effect 0.07% of births a year? That sounds a very low number.

MrsHoarder Mon 04-Mar-13 17:26:41

There was the Sue Rose case Holiday. I don't know if it was successful or not though.

ReallyTired Mon 04-Mar-13 17:49:15

DontmindifIdo, I haven't a clue how many women give birth with independent midwives, I am just guessing. I agree that 0.07% is a tiny number of births.

Given that only 2% of births are at home and most of them are NHS home births or accidents, I would be surprised if there are many takers for an independent midwife service. I had an NHS midwife for a NHS homebirth; she told me that she gets to deliver a baby once a month and half of homebirths are planned. Its quite easy to get a homebirth in my area and I don't know anyone who has used a private midwife.

Paying for a private midwife is out of the reach of normal families rather like private education. If we assume that the percentage who go private for a home birth is similar to the percentage who choose private education then 0.07% would not be a crazy guess.

I am surprised that anyone can make a living out of being an independent midwife. Prehaps they can offer luxury breastfeeding support for the rich and famous.

Shagmundfreud Mon 04-Mar-13 18:01:49

OP - I support the campaign.

I had an IM for my second baby, and she did me a BOGOF, so I had her for the third as well.

"Paying for a private midwife is out of the reach of normal families rather like private education."

This is completely false. A year's private education would cost 12,000 pounds minimum in London. A full, wrap around service for midwifery care, involving all care during pregnancy, the birth and a month's worth of visits after costs around 3500. In my case I booked 2 weeks before my due date and paid 1800. It was worth EVERY PENNY. I borrowed the money to pay for it, and it cost no more than a fairly shite second hand car.

In other words - it's not out of the reach of those people on lowish to middle-incomes.

The average spend by new parents on expensive buggies, new cots and clothing is 1800 in the UK. I bought my cot from ebay, and my pram and clothes from an NCT nearly new sale and saved a fortune. Some of the money I saved went towards a private midwife, and the fact she made sure I could breastfeed by standing over me for a full week probably saved me 400 in formula over the cost of the year that followed!

Seriously ReallyTired - I have three friends who have also had an IM. Not one of them has a higher rate tax paying husband, they all buy their clothes in the supermarket, and they all drive crappy old cars. IM is NOT only accessible to the wealthy.

Shagmundfreud Mon 04-Mar-13 18:05:25

"do IM really only do 2-3 deliveries a year?"

No - the IM I know are turning people away constantly because they're fully booked. They generally do about 20 odd births and lots and lots of antenatal and postnatal care. Many do postnatal 'packages' of care.

In the NHS a team of 20 midwives would be expected to provide case loading care (which is what IM do) to about 220 women over the course of a year.

Shagmundfreud Mon 04-Mar-13 18:07:14

As for number of planned homebirths - it depends where you live. On the South Coast and in some parts of Wales, the planned home birth rate is over 10%. In the north of England it's 1%.

Many women don't have a planned hb with an IM. My friend had twins by c/s and had care throughout pregnancy from her IM, and care afterwards.

Shagmundfreud Mon 04-Mar-13 18:17:39

"It just shocked me that any medical professional would work without insurance."

I agree. But I'm glad I had the choice to accept or decline the services of an uninsured midwife.

She made it very clear to me before I booked with her, that in the case of malpractice leading to birth injuries to me or my baby, the most I could get would be her home and her car.

I was prepared to accept that because I felt she was competent and conscientious. I felt that my NHS birth had involved a lot of incompetent care and I wasn't prepared to risk that again. I didn't find the thought that there would be financial compensation NHS incompetence resulted in a very damaged baby a particular comfort at that point in my pregnancy. I just wanted to maximise my chance of getting myself and my baby through the birth in good health.

organiccarrotcake Mon 24-Jun-13 09:23:31

*IMs are just as regulated as NHS midwives*. Their outcomes are, statistically, outstanding compared to the NHS. The NHS practice defensively - the culture is defensive, bullying of midwives (and other staff) is endemic, and even the most woman-centred, caring, giving midwives in the NHS cannot give the same level of care as an IM because they simply are not given the time necessary with a woman to build up a relationship with her.

The cost of an IM, which may be from around £2,000 to around £3,500 (with variables, depending on where you are and numbers of visits, etc) is NOTHING compared to what people spend on weddings nowadays. Frankly, I feel that the birth of one's baby is far more "the biggest day of your life" than one's wedding day.

Of course they might make a mistake, and yes that could be catastrophic. But statistically they are FAR, FAR less likely to cause damage to mum or baby with a mistake than NHS provision. And as has been said before, my choice would be a much lower risk of damage to me and my baby, with the downside that if damage is caused by negligence then I can't sue anyone.

organiccarrotcake Mon 24-Jun-13 09:29:35

On a personal note, a friend's baby was very, very severely damaged at birth due to negligence by the hospital staff. It took 21 (count them, TWENTY ONE) years for the hospital to accept liability and pay out for the 24 hour, 7 days a week care that she needed. By the time that arrived her parents had become bankrupt and divorced with the stress and cost of everything. So it's hardly as though the NHS insurance situation is really that great.

organiccarrotcake Mon 24-Jun-13 09:35:03

I would certainly like IMs to be able to access good insurance, but because it would encourage more midwives to be IMs, not because I'd be bothered about it for myself. IMs earn very little money, and they do it for the love of being able to truly work "with women".

Note - not only is there no evidence that having insurance makes practice safer, there is in fact evidence that it can make practice less safe. This is because practice can then become led by insurance requirements, not best personal clinical practice. The two are often not the same, which is why NHS services can put individuals at risk of unnecessary treatments "just in case", which themselves have risks.

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