To have an independent midwife?

[MrsMuffins]

We’re planning for another baby, and I’m considering booking an independent midwife. We live in an area with extremely high rates of interventions, and I desperately do not want a hospital birth. There are basically no home births in the area, so I’m concerned about either not being supported to have one, or planning one and then the midwives either making me go into hospital or being inexperienced in caring for women at home. So I’ve been looking into independent midwives, but at nearly £4K it’s a lot of money - does anyone have any experience of having one, is it worth it?

If you can afford it and it would make you feel more supported then I'd go for it.

I live in an area where the NHS is running a pilot scheme of using a group of independent midwives to provide care to women with low-risk pregnancies and it's really great. (Outside of the pilot, cost is similar to what you describe.) They have much lower rates of intervention, much higher rates of breastfeeding success (if that's something that's important to you).

I've had DC2 with them as part of the pilot when it first began and just been booked in for DC3. If I lived elsewhere and could afford it I wouldn't hesitate to pay.

Wow @soundsystem that’s amazing, lucky you! I really feel that, without an independent midwife, I’ll end up in hospital in some way, and having spent some time on the labour ward the thought of it is giving me anxiety about even getting pregnant. I’m just not sure how we would afford it

I was determined to have a home birth. NHS midwifes really supportive. Had oxygen etc delivered but 2 weeks before I was due I had reduced foetal movements. No idea why. Went into hospital was monitored and agreed c section.

Baby was healthy and I recovered quickly.

I'm only throwing this in to say nobody was more pro home birth than me, but things don't always go to plan. So no experience of independent midwife but knowing what I know now I'd stick with NHS

@Kelpiex2 thanks for this - totally understand that things don’t always go to plan, and obviously if there were any issues I’d be more than happy to be in hospital! However, unfortunately I don’t think the midwives in my area are particularly supportive of home births, and even if they were, they never see them and so aren’t experienced in caring for women at home. That’s what concerns me really.

I had once - twice. I firmly believe in the one woman one midwife model. To have the same midwife at every antenatal and postnatal appointment as well as at the birth. I didn't need a birth plan, she knew because we'd discussed every possible angle on how things might go. But she still asked permission each and every time she touched me! And things didn't go perfectly but she dealt with it and called for backup and it worked out perfectly.

The difference between my NHS births where I was subject to multiple inventions without agreement, some extremely dangerous - alongside some very potentially dangerous neglect. And rudeness and unhygienic practices across so many different midwives.

I have palpitations going onto the hospital site, 15 years later. My IM is my DC's godmother

I considered the IM route, but discovered that our homebirth MW team caseload and are absolutely gold standard. AIMS have some useful resources.
In your position I'd definitely try and afford an IM, or at least a doula to help use BRAIN in decision making. (ommama.com/2012/03/05/brain-an-acronym-for-informed-decision-making/ )

@WhoGivesADamnForAFlakeyBandit I totally hear you - I’ve spent time on the labour ward as a volunteer, and honestly I wouldn’t have believed some of what happened if I hadn’t seen it with my own eyes

Ours was worth every penny, she was brilliant.

Do you literally have no contact with NHS midwives? I wonder what your reception would be like if you did have to go into hospital?

If you can’t afford an independent midwife what about a doula instead? Someone to advocate for you when you’re most vulnerable?

(Place marking to come back later and bare my experience.)

Shar! Not bare...

SHARE, ffs.

@MynameisJune that was my initial plan, but I think having someone medically qualified would be more helpful at this point - if I were in an area that was more supportive of home birth I would 100% go for a doula

I also had two (they worked together) and they were amazing. Worth every penny. All pre and post natal checks were at home except for scans (older siblings helping to measure and weigh etc). They worked with staff at the hospitals too (training I think?) and would have had no qualms going into hospital if we had needed to. They had their roles clearly defined if that had been the case. One woman one midwife exactly. Congratulations :)

Do they have insurance and how experienced are they at home births.....so how many women do they caseload a year? How up to date are they with obstetric emergency training? Those are the questions I'd want to know.

I'd also be talking to the nhs midwives and finding out how supportive they'd be of a home birth and how achievable they think it is for you. Plus how experienced they are. No point spending 4K if you can get a homebirth for free.

If you had independent midwives and got transferred in your reception at the hospital would be fine. However it's unlikely that your independent midwife would be allowed to continue to care for you. She could be a doula/birth partner but not advise you, check you, deliver the baby, etc.

I was an NHS midwife for a long time and independent midwives can be great- IF your pregnancy is, and stays low risk. You will get very personalised care in the antenatal and postnatal periods.

During labour and delivery if all is well it’s great. If however there are complications at any point it’s her absolute duty to refer you to the hospital doctors for their opinion. It is, I guess entirely up to you whether you choose to take that advice but most independent midwives will want to know that you are all on the same page about working towards a natural birth but will use medical services if necessary. It can be impossible to predict who will need these services.

Once a mother is transferred to hospital care in labour my experience was that the IM became more like a doula but it would vary depending on whether she was registered to that hospital and they were happy with her skills ( ie caring for CTG, IVs wouldn’t usually be her skill set).

So yes, go for it but keep an open mind. Safety is everything.

I thought that independent midwives cannot get insured for the work they do, just googled and since October 2017 they can get insured. That's excellent! After my DS was born 11 years ago I definitely wanted an independent midwife for my next pregnancy/ birth, well its been 11 years and many twists and turns since then. I am currently 27 weeks and have a 50% chance of having a c section due to a number of factors so I don't think its appropriate for me now. But if I was having a low-risk pregnancy I would definitely go for it. Homebirth for low-risk pregnancy is safer than hospital birth so my thoughts follow that having a midwife that follows you throughput pregnancy and is dedicated to your care can only be even safer! I'd say follow your instincts.

@NicoAndTheNiners thanks for this - my local(ish) independent midwife is very experienced, registered with IMUK and insured (as all IMs have to be), so I’d have no concerns in that area. I’d say she’s significantly more experienced in home births than any of the NHS midwives in my trust!

Have you checked your transfer time to hospital in the event of a major haemorrhage or severe fetal distress, OP? Particularly if you live far from your nearest maternity unit, or need to be transferred during rush hour.
My DD2 would have died if she’d been a home birth. Thanks to the paediatric crash team who were on site in labour ward in less than two minutes with intracardiac adrenalin, 3 different iv anticonvulsants and a ventilator, she survived to reach the SCBU and came home unscathed a week later. Good luck to a midwife trying to do that lot singlehanded when she’s a) not carrying any of the required drugs and b) not qualified to use them.
Home birth is no doubt lovely if all goes well. But I wouldn’t gamble my baby’s life on it. Emergencies are unpredictable - DD2 was an 8lb low risk, full term, normal delivery, but arrived almost dead with an Apgar score of 1.

I had one. She was excellent and so was her partner who attended the birth. I had to transfer to hospital from home and have a c section. She came with me and supported DH. I booked her because my local NHS trust had a poor reputation (deserved - I had worked for them so knew) and I couldn't see any other way to ensure a good standard of care. The only issue was that my consultant and the antenatal midwives would not acknowledge her existence really so they repeated a lot of the blood tests etc. I didn't feel quite confident enough to discharge myself from antenatal care especially as the insurance issue had not been resolved at that point. So yes I felt it was money well spent and she came to my daughter's naming day party.

@Babdoc sorry to hear you had such a terrible time. I’ve already decided on a home birth - statistically this is safer for me, having my 2nd baby, and providing I am low risk (as I was in my first pregnancy). I hear what you’re saying, but situations like yours are extremely rare, and midwives at home births are equipped to deal with most things (as they would be in hospital).

My other concern as well as being ignored or overruled in hospital was giving birth in the car park, as there were cases every week in the local paper at that time. I should add that we're not far from the hospital, though.

@Phineyj surely the blood test results etc were in your medical records?! Why did they feel the need to overrule? But good to hear your experience was positive overall!

It depends on the midwife, the problem frequently with having the same midwife is if they miss something / make mistakes no-one else is likely to have a look and spot it. Fine if everything goes to plan, but if things start to go tits up and your midwife doesn't spot it, can end badly.

The community midwives here are great and make a lot of effort to see the same person the whole way through pregnancy and after, sometimes coming to see you in hospital too. Other areas you see someone different every time.