really surprised that independent midwives don't have to have insurance

[2shoes]

here
seems crazy that it isn't compulsory to have public liability insurance

[harpsichordcarrier]

if it was made compulsory, then effectively independent midwives would cease to exist, as insurance is impossible to obtain.

[lulalullabye]

They have no insurance for liability but if there is a problem you can go through the nursing and midwifery council and get them struck off, if they think it is justified. To me it is more important to have them not practicing anmore than money.

[kidcreoleandthecoconuts]

Who would want to practice without insurance? It's scary.

[harpsichordcarrier]

they don't want to. they have no option if they want to practise at all since the group insurance was withdrawn in 2002.
they are doing it at risk to their homes.

[2shoes]

but if the birth all goes wrong and you end up with a baby with severe brain damage, just getting a mid wife struck off is not going to help the baby.

[GlastonburyGoddess]

imo it was a silly decision on both the mothers behalf and IM part to have a home delivery when she knew she had gestational diabetes, there must of been a part when she was told this could result in further complications, bigger baby etc. If, the IM was aware of her GD she was irresponsible to go ahead with the delivery IMO.

[kidcreoleandthecoconuts]

The only independent midwife i've encountered in my job (nicu nurse) was a total fruit loop. She delivered twins at the mothers home both of which ended up on NICU with birth trauma/asphixia. She was trying to get one of the ventilated babies to latch on to mum whilst they were having cuddles.
She totally ignored me when I explained that a ventilated and sedated baby would not latch on.....all she seemed to be bothered about was establishing bf when the baby was obviously gravely ill. I later found out that she was banned from working for the trust where I worked and that was the reason she was practicing independently.

[mumtoted]

I had two home births with an independant midwife. She told me upfront at our first meeting that she was unable to get insurance. She was very professional at all times and I can't recommend her highly enough.

[2shoes]

but what if things go wrong?

[mumtoted]

Things can go wrong wherever you give birth but does that make it the midwives fault? Giving birth at home with someone I knew and trusted was the safest place for me.

[piprabbit]

Listened to a really interesting discussion on this very topic on Women's Hour this week. You should be able to listen here if you want to.

[ClaudiaSchiffer]

In South Australia, where I am, midwives have been forced to take out insurance. This is prohibitively expensive and has had the affect of basically outlawing home births and independent midwives.

The medical establishment here seems to be very against home births, much preferring the "safety" of hospitals.

I think it is appalling. Particularly as one of the driving forces for this legislation is the gvmts reluctance to pay for the extended care of children who have been damaged by a home birth going wrong.

[sabire]

Hmmm.

Sounds to me like this is a brachial plexus injury resulting from a shoulder dystocia.

I really can't see how being in hospital could have made things any better in this mother's case.

It really comes down to the skill of the health professional at the birth - people attending homebirths need to very well drilled in resolving shoulder dystocias, stay calm and act fast.

I know people who have had an SD in hospital where it's been really badly handled and people who've had it happen at home where it's been handled very well. The only benefit from being in hospital with a SD is if your baby needs advanced resucitation afterwards.

Otherwise I suspect being in hospital actually predisposes you towards having this happen in the first place, as you're more likely to give birth in supine positions and you're more likely to have an assisted birth - both of which things I think are connected with higher rates of SD.

I had a SD happen at home in very similar circumstances to this mum, as I also had GD and also had an independent midwife. In my case my midwife handled it very well and both my baby and I were fine.

"imo it was a silly decision on both the mothers behalf and IM part to have a home delivery when she knew she had gestational diabetes, there must of been a part when she was told this could result in further complications, bigger baby etc. If, the IM was aware of her GD she was irresponsible to go ahead with the delivery IMO."

As I said - I had gd and chose to have a homebirth. My consultant wasn't happy about it, but a consultant midwife at a large teaching hospital reviewed my obstetric history and circumstances and advised me that it was reasonable to go ahead. From my POV it was a toss up between choosing possible substandard care in a hospital where I'd had poor care before, or choosing to give birth with a midwife I knew and trusted five minutes away from hospital. For me there was no contest, and I feel the events surrounding my son's birth totally vindicated my choice. I'm one of the very few people I know who's come through a SD with a very large baby, with a healthy baby and an intact perineum. I personally think that a lot of the problems associated with GD labours are iatrogenic.

Would want to add that I'm quite shocked this couple weren't aware this midwife was uninsured. My understanding is that IMs explain this issue to women before a contract is signed. Mine was very clear about it.

kidcreole - have to say, for every story I've heard about dodgy IMs, I've heard another one about nurses in SCBU who are pig ignorant about breastfeeding.

[kidcreoleandthecoconuts]

Sabire - I agree some NICU nurses are ignorant about bf, as are some midwives, doctors and health visitors etc. The point I was trying to make was that this particular midwife seemed fixated with breastfeeding the baby when it was basically dying . Whether or not the baby was going to breastfeed was irrelevant at that time as the baby was so sick. I just wonder looking back whether the couple knew that the midwife delivering their twins was effectively banned from practising in the local NHS trust.

[2shoes]

if you have a home birth and an IM and it goes wrong, you have no way of getting compesation for your child. if this happens in hospital you can then sue.
if you have a child that is brain damaged at birth, you have to try to get compensation, that is unless you are happy to settle for a second class life.
I think this shocked me beacase people put more thought in to their house, you wouldn't hire a builder that didn't have public libity insurance, incase he burnt your house down, but people seem happy to allow someone to be involved in the most important moment of ther babies life, with out insurance.

[LuluMaman]

2shoes, i am pretty sure indie midwives want insurance.. but they simply cannot get it.

it is a travesty that this situation has been allowed to happen

i think that any woman booking an indie midwife for a homebirth will have done her homework and weighed up the pros and cons and odds of things going wrong.

[LuluMaman]

i agree with sabire, it sounds like an injury due to shoulder dystocia, which can be due to the size of the baby... i don;t think it is entirley fair to blame the MW. if the woman knew she had GD and that increased her risks, then it was incumbent on her to weigh up the increased risks and decide whether or not to continue with her planned home birth.

[MrsHappy]

If you have a hospital birth and your child ends up damaged in some way you still have to prove that the hospital was negligent and that their negligence contributed to your child's condition. This is not always easy.

The fact that IMs don't have insurance is a little scary (I have an IM but will be giving birth in hospital). A lot of IMs seem to do bank work for local hospitals so in fact you can check on them pretty easily by talking to your community midwife or other mums. In any event a good IM will have quite a low threshold for transfer - what I am saying is they are IME not generally gung-ho nutters who will put you/your baby at risk. Nonetheless, things can go wrong but that does not make it the fault of the midwife.

And of course they would love to have insurance, but as my IM puts it regardless of the insurance position, she would be devastated if something went wrong that caused damage to my baby. And thus she will do everything she can to ensure a smooth delivery. I'm not sure that the box-checkers who mismanaged my hospital labour with DD1 had my interests at heart in quite the same way.

[foxytocin]

"I had developed diabetes while pregnant and Daisy was a very big baby ?If I had known about this I would have gone to hospital instead. "

Er, not trying to blame the mother decisions she made ante nally or even during labour however the above quote has alarm bells ringing. Is she actually saying that she did not know that she had GD? Why? It is a medical complication of pg and any pg with a medical complication can make child birth more hazardous.

it is not as simple as what you say at 12:04:49 2shoes. Some women have had such terrifying hospital experiences with one child that they have become phobic about giving birth in a hospital again. Some also develop such deep distrust of NHS staff from previous experience that they do not want these bods near them with subsequent pg. Please don't think that everyone who will pay out for an IM or sometimes go into debt to have an IM just because for an ideal or do so unthinkingly.

[sabire]

"if you have a home birth and an IM and it goes wrong, you have no way of getting compesation for your child. if this happens in hospital you can then sue."

Yes - but you will only be compensated if you can prove malpractice! Cases where there has been substandard care resulting in serious injury to child do often get huge payouts, true, but then they're also more likely to happen in the first place because of conditions within the NHS, with staff working under ridiculous pressure.

Personally I'd rather reduce the chance of my child suffering a catastrophic birth injury in the first place by employing a health professional who I trust, who knows my obstetric history, who is concentrating only on my care and who has a vested financial and professional interest in keeping me and my baby safe - as IMs do (if you sued them they would be liable for damages - many of them are home owners, so might risk losing their homes if they were found to be responsible for a serious birth injury).

"but people seem happy to allow someone to be involved in the most important moment of ther babies life, with out insurance".

[2shoes]

i am not knocking IM, just the fact that they don't have insurance. they play a vital role(midwives) but sadly as I so well know things can go terribly wrong, terrible to think a midwife would loose her home,.surely a goverment run insurance scheme would be a good thing.

[ILikeToMoveItMoveIt]

The insurance is not available for IM to take out. I think there is going to be a ruling at the end of this year on the way forward for IM.

I had a IM for ds2. She made it very clear from the onset that she did not have insurance. I weighed up the pro's and con's and decided it was the best way forward for ds and me.

[piprabbit]

My understanding is that there are no companies in the UK prepared to offer liability insurance to independent midwives. Therefore they cannot buy insurance - not their fault.

The govt. is coming up with a scheme where IMs contract to the NHS and are then covered by the same scheme as NHS midwives BUT I rather think this undermines the whole point of having IMs??

[craftynclothy]

I had an IM for dd2's birth and it was made very clear to me before I booked that they no longer had any insurance because no-one would provide it.

I also felt that an IM who is risking her house & livelihood if anything goes wrong is going to be paying a lot more attention than someone with the backing of the NHS, their insurance and their lawyers.

I felt that my first birth (on the NHS) was not managed well (was given pethidine too close to the birth without a VE) and that the response to my complaint letter was basically "We don't care, we can say we followed our policies".

One thing that was always clear to me with my IM was that they were happy to discuss my options but it was ME that should make an informed choice about my care so this bit:
"I had developed diabetes while pregnant and Daisy was a very big baby ?If I had known about this I would have gone to hospital instead.
seems v odd to me.

[Dubh]

IMs want affordable insurance but insurance companies won't offer it. The background is below, but basically the govt is proposing making this insurance compulsory meaning noone will have the option of booking their own dedicated midwife.

www.independentmidwives.org.uk/?node=8765

From Independent Midwives UK:
"Up until 1994, all midwives were covered by the Royal College of Midwives (RCM) indemnity scheme, regardless of their area of work. Midwives within the NHS were also covered by their employer?s vicarious liability. However, in 1994 the RCM withdrew insurance cover from independent midwives amidst much controversy, and although there were one or two insurers willing to offer cover at first, the premiums rose to £15,000 per midwife per year and the number of providers fell over the next few years until 5 years ago, the last provider withdrew from this market and since then there has been no insurance available to independent midwives in the UK."