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

Dubh said what I wanted to say.

IMs want insurance. There are no providers. Don't blame the IMs.

I don't blame the IM's
I was just suprised by this.
knowing so well myself how easily a birth can go wrong, I thought there would be better protection in place for midwives.

2shoes can understand your POV

But had I been able to get an IM, insured or no (just too damned poor ) I would have done

Saved myself the stress of fighting for a HB

The way my birth went I coulod not hae delivered in a hospital, 35 minutes start to delivery, by the time I ahd boys in car no bloody chance of getting there.

I think its bloody disgusting that IM's cant get insurance, but also that flexibility allows for teh widest range of birth circumstances to be handled.

but if it goes wrong, you have no come back, that is the bit i don't understand.

That's true 2shoes, but I think people make an educated bet almost on that.

The chances of soemthing going wrong are slim after all, and if you're well off enough (and most people hiring an IM will be, if not all) that will at elast mitigate worries 9and how many people really know the true costs of disability without haveing been there?)

And IM who amkes her clients aware is fair enough IMVHO, esp. as the reactio0n of soem people who hire an IM would seem to occasionally be of the free birthing type which I do not hold with.

I disagree with the chances being slim, but then of course I know loads of people who have disabled children.

Ah we both do 2shoes, but as a potion of overall the chances of disability through fault is slim, I think

many other reasons and it does happen, but as part of a risk assessment it would seem unlikely though of course not impossible

argh. they cannot by law get indemnity insurance anymore!!!

I get that, But do not understand why in that case they can still practice.

I usedtobepeachy, most of the young people I know, ahev a disability caused by the birth.

I'll pin my colours to the mast here. I had an independent midwife for the pregnancy, birth and post natal care of my second DC. It is the best health care I have ever received.

She explained at our very first meeting that she didn't have insurance for the birth itself. They can get insurance for ante and post natal birth.

She chose to practice without insurance because for some women NHS care is just not an option due to previous experiences. I think as women it is good to have choices. I was one of those women who had deep seated distrust of the NHS maternity system ( and I work for the NHS).

As it happened I was unable to have a home birth, but I always trusted the care and advice I was given by her.

For what it's worth I'm not well off. We saved like mad and I have taken shorter mat leave to be able to afford the £2500. It was worth every penny.

If they can't practice without affordable insurance then it removes choice of care from women. I think this is a very sad state of affairs.

Something else that hasn't been mentioned is that all independent midwives have a supervisor of midwives who generally works for an NHS trust. So any problems with their practice should really have been picked up via that route.

I think it needs to be acknowledged that even if they are insured, then insurers would only ever pay out if malpractice / negligence were proved. Insurance will certainly not cover all those unfortunate people whose DC are damaged due to birth.

Sorry have rambled a bit. I'd be very sad if women couldn't have the choices regarding midwife care that I'd had.

2shoes perhaps thats the difference between the asd and CP worlds, both fairly misrepresentative of averages?

And some of those birth injuries would have been justa s severe in hospital, and though it is shit a birth injury doesn't equal guaranteed negligence payments

But you know, our worlds aren't average. We see disability everywhere and know it as our reality, for otehrs disability isn't part of their life at all, and I suppose easily discounted as a real threat

2shoes - I understand what you're saying and if I'm honest, I have absolutely no idea what I'd have done if dd had ended up with a disability because of the birth. I'm certainly not well off (I'm using my Maternity Allowance payments to pay for my IM). I think that the way I looked at it was that the birth could go wrong in hospital, at home, with the NHS or with an IM and no matter which way it happened I'd probably have to fight hard for any payout, so in some senses I didn't really consider it an issue when deciding on my care. However other things - continuity of care, more freedom to make choices & therefore less stress (no pressure to just follow policy), extra postnatal support were of HUGE value to me (knowing I was at risk of pnd).

the answers are really inreesting, I understand that woman want more choice, but doesnt this put an IM in a very vunerable position, how ever good she is things can go wrong

YES!!! IM are the victims here!!!! they would love to be able to get liability insurance but can't!

why are you shouting?

Independent midwives are not victims - they can get insurance but it costs loads of money just like doctors/obstetricians/GPs malpractice insurance costs.

They have to figure it in to the costs of their business. They need to stop bleating and cough the cost.

As to anyone with diabetes giving birth at home - the mother needs their brain examined.

IMs cannot get insurance, as there is no one will supply it to them - its no longer a cost issue there just isn't any insurance policy available.

Whether or not a woman with GD should give birth at home is a very personal question - there are a number of conditions that increase the risk of birth wherever you are, and depending on your personal circumstances and history you'll evaluate the risk of home vs. hospital birth differently. DH and I chose to go for a vaginal breech home birth with IMs (very experienced in vaginal breech birth) as, after a lot of reading and talking to different HCPs, we felt that was a better and lower risk option for us than a planned CS in hospital, and a much lower risk option than a medicalised vaginal breech with HCPs that had more practice with a mannequin than a real live human female!

IMs choose to support higher risk women and so give those women a choice that the NHS often deny them (or make very hard to obtain) - I don't consider them wrong to provide that choice as long as they are clear with their clients as to how any complications increase the risks of chilbirth and how care would be different in hospital, including how those differences may affect those risks.

I find it hard to believe that a woman could have a confirmed diagnosis of GD and yet be unaware of it - if the IM had really not discussed these issues with the mother then the IM was negligent, but that's a big if. I hope for all their sakes that the ante-natal notes are comprehensive, as they form a large part of an IMs defense in cases of this type.

the question is then should thay be allowed to practice with out insurance

shouldn't the question be whether women have the right to hire the professional of their choice if the NHS can't (or won't) provide the care they want.

so basically i shouldn't be allowed to exercise my choice to have an independent midwife because you deem that my right to litigate should something go wrong is more important than allowing me to make my own choices with regard to the birth of my child.

wow.

Although it would be preferable for IMs to be able to get insurance, as long as they are upfront about the situation and the implications I don't see it as a real problem. FWIW, every IM I have spoken to has been very clear on this point.

I think it is better that they continue to practice uninsured than women not being able to access qualified care for homebirths and perhaps ending up giving birth without someone competent to help.

Would you prefer high risk women to free birth as they either refuse to set foot in hospital after a bad experience or cannot get support for the birth of their choice through the NHS? I think everyone agrees that in an ideal world IMs would have insurance, but at the moment I'd rather be able to exercise my choice as a mentally competent adult. As long as IMs are clear about the situation then its up to the parents to decide whether they are happy to accept this risk or not.

If you look through the site linked to By Dubh on Sat 29-Aug-09 15:09:39 you'll see that there's a very strong liklihood that it will very soon be illegal for IMs to practice without PPI (curent estimates are later this year). Personally I don't see that as a step forward, but then I don't think we should legislate for every step of our lives.

thanks for the replies, I understand it better now, and can see it is more about womens choice than an insurance issue. I like to get the full picture and you can olnlu do that sometimes by being a bit......
(sophable I won't thank you as you have an axe to grind)

charming!