to think that outlawing Independent Midwifery will have far reaching consequences for women's birth choices?(131 Posts)
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 womans right to choose how they birth where they birth and with whom.
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.
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.
*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.
"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.
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.
"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.
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.
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.
There was the Sue Rose case Holiday. I don't know if it was successful or not though.
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.
I don't know the answer to this but I. Bet someone does, has anyone sued an independent midwife for negligence in labour?
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)
"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.
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.
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.
The insurance companies would be demanding that they're form filling.
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.
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.
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.
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.
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.
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?
Thank you hardertokidnap. That does make sense. Does make it tricky though, doesn't it. I have no idea what the solution is.
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.
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