surprised that there isn't a thread on the midwife being struck off and the

[2shoes]

call for independant midwives to be made to have insurance only link I could find to story

about time imo

Independent midiwves have been campaigning for a long time to get insurance.

It wasn't that long ago (couple of years) that independent m/ws were at dangerour of diseapperaing as government were saying they must be insured (but no insurance available).

There was an outcry, including on this board that the gov should back off and leave indy mindwives alone.

The thing is, even if that midwife had had insurance, the mother would still have had damage to her bowel, the baby would still have had erb's palsy, living room would still have looked like a murder scene.

Wouldn't the better argument be that independent midwives must follow protocol, must record all findings, must keep up to date with current practice, must seek help if obstetric emergency.

I am sure that the majority of midwives out there are very professional and adhere to all rules, but is there a system in place to police this, such as random checks on notes etc?

It seems to me like there are many fantastic independent midwives out there, but this one seemed to make too many mistakes.

I'm glad the midwife in the story has been struck off, the care she delivered sounds appalling.

I had two fantastic midwives for my home births. They were well trained in breech births, twin births and knew how to deal with complications, and crucially, knew when to call for help if necessary.

They kept notes on everything, did absolutely everything by the book and kept themselves well up to date with current practice.

glintwithperspiration - the risk of a home birth are only the same as a hosptial birth if the woman has a low risk pregnancy and the midwives (there should be two for the delivery) knew what they are doing. This was failed on both accounts for the woman in the story.

it is absolutely the right thing that this MW was struck off

the 'care' she provided was dangerous and inadequate

however, as i think i commented on a thread about this a while ago, surely it is also incumbent upon the mother to ensure she is getting the right care ? surely you would notice that the MW was not taking something as basic as the fundal measurement? she also had sugar in her wee, and broached this with the midwife, so obviously had a concern.

not that this is the mothers fault, or that she was in any way responsible , she had a terrible ordeal and it is a good thing that she and her baby survived, although with health issues of their own.

i think that undertaking a home birth means you should really take itno consideration , more of the 'what would i do if.....?' scenarios

however, i do not believe for one moment that this is representative of homebirths as a whole or of indie midwives as a whole

i believe this indicates this was an extraordinary case involving a totally inadequate MW

Oh my god!

So appalled by this story!!!

The thing is that a lot of the talk about home birth doesn't have the cautious attitude to independent midwives you might expect for such an important (not to say expensive) service. The IMs for people's second births often come across anecdotally as positively angelic in terms of kindness and expertise, perhaps because they're being compared with quite impersonal NHS care. But at the end of the day as with absolutely any professional service you can get someone doing it who screws up badly.

From the document, if I read it right, this MW was practicing for about three or four years after this birth. But who would have booked her with this sort of enquiry hanging over her head? How do you find out if an IM could have a pending disciplinary issue like this?

My great niece has erbs palsy as a result of her birth. Very similar situation, my niece had gestational diabetes but wasn't aware as the results were lost, my great niece was over 11lb and got stuck leading to paralyis of her arm and shoulder. The difference being that this birth happended in hospital. My niece laboured without midwifery support for the majority of the labour as they were short staffed.

thedollshouse - that's awful. Things can go wrong during a hospital or home birth which is why it's vital for midwives to follow standard practise and keep notes, to protect the patient and themselves.

""I'd honestly question why a midwife would choose to be an independant midwife and imagine that some are doing it because hteycan't get work with NHS"

I know a few IM. Almost to a woman, they've chosen to work outside the NHS because they feel they can't provide safe and optimal care for women within the NHS - such are the crap conditions that many midwives are working under in hospital.

Some of our most high profile midwives like Mary Cronk MBE and Caroline Flint (former head of the Royal College of Midwives) have had long careers as independent practitioners...... "

I am an IM, although currentlt not practicing due to my maternity leave. These are the exact reasons I became an IM. I was a community Midwife at an inner city hospital and expected to work on the labour ward when on call, if they were short of staff (virtually every shift), this meant the planned homebirth were often cancelled because of lack of staff. I could be looking after 3 high risk woman in labour on one shift, moving from room to room, providing the best care I could in those circumstances. I longed to give one to one care to women I felt I was more at risk of being struck off working in an understaffed NHS system than as an IM with no insurance. I now care for women I know well, ones I can build a good relationship with, ones who are not afraid to share sensative information with me, that they often feel unable to share with midwives they have only met for 10 mins. This all goes a long way to building a two way partnership that means the client gets optimal care.

I would love to be able to obtan insurance, however the Royal College of Midwives removed PII cover for IMs in the 1980's and despite many searches, it has been imposible to find insurance to date. Currently IMs are under threat of being unable to practice as the govenment are pushing through a bill to ensure all health care givers have PII, a great idea but flawed if IMs are unable to obtain it anywhere. Obviously all my lients are aware that I have no insurance, as well as informing them verbally they sign a contract which has the information in. However PII does not make a care giver a safer person, it mearly offers (often very needed) compensation to the person who has recieved negligent care. What does make a care giver safer is having up to date knowledge, clear clinical research and knowing their client. I am in the lucky situation where I can refuse to provide care to a family who wants to book if I feel I cannot give the appropriate care or that there is a conflict of interest. I would not, however "unbook" a woman if a clinical factor became apparant in her pregnancy.

I don't feel that it is appropriate for me to comment on the case in issue as I am noy aware of the full details, I just wanted to post to help people understand why I became an IM.

As a side note I have recently found out that a builder I employed to build a large extension on my house has not built it to plan and we have a structurally unsound house that is going to cost £60,000 to repair. He informed us he had insurance.....we have now found out he hasn't. I understand fully that the insurance would have helped cover the hige costs of rebuilding we now face, however it would not have made him a better builder in the first place.

that;s awful re your house, curlywurly

thanks for sharing your own story as an IM

I tried for a HB with an independent midwife, knowing she had no insurance. I felt I got better care than my previous HB attempt with an NHS midwife. The IM showed up when I went into labour (on the NHS we had an agonising wait while the only midwife on duty that night was at another birth), I was attended in labour by the same people who had given me my antenatal care and felt supported, not least because there was at least one midwife with me throughout. DC2 had late decelerating heartbeats so we went into hospital where the consultant told me DC2 and I were lucky that my midwife had spotted the risks and got me into hospital so promptly. Contrast that with my friends' experiences in hospital, left to labour on their own due to a shortgage of staff. I could have had a much worse outcome in a hospital.

This story is a real tragedy for all concerned. But I don't think it tells us anything about the safety of home births nor of independent midwives generally. The midwives who looked after me would have taken out insurance if it was available.

I think essentially this woman had huge failings in her midwifery practice and this is irrelevent as to whether she is an IM or one working within the NHS. It's all down to personal and professional accountability. My colleagues and I were discussing this last night and the question arose if she had worked in the NHS would these failings in her practice been picked up by her colleagues? If so supervision would have come into the equation.

Picture this - in an NHS hospital, the midwives in charge of the ward will make sure that the midwives working under them are properly trained and up to date with post qualification training. So hopefully a midwife who is not doing a good job will be picked up on.

aren;t indie midwives still subject to supervision/ keeping up their practice requirements etc to ensure they are still registered? IMs are not operating outside any sort of framework..

The problem was the quality of ante natal care and being realistic about the risks of a home birth. It is sucidal to have a homebirth if the baby is excessively large or the mother has diabetes or other health complications.

For a low risk mother having a homebirth is safe. You get one to one care from a midwife for the first stage of labour and two to one care during the second stage. In a hospital a midwife often looks after four women at once. A good midwife will pick up problems swiftly. Generally it takes 20 minutes to get theatre ready for a c- section. If a homebirth gets into problems the theatre will be got ready while the mother travels in an ambulance.

For low risk women who give birth quickly homebirth an nhs is a good option. Being at home has to be safer than giving birth in a car.

yes Lulu, I have a supervisor of midwives, the same as a NHS midwife. I have to meet with her yearly and show that I have met the required PREP (study hours) and clinical hours needed to continue to be a Registered Midwife. She also checks I am up to date with my obstetric emergency training (e.g. PPH, Shoulder Dystocia, Cord Prolapse drills), neonatal and maternal resus, if I am struggling to find appropriate training she allows me to acess the hospital training days as she is there not only to support me but also to ensure the safety of the public. She checks my equipment and drugs and also reads through and discusses a recent set of maternity notes. She is also there whenever I need her to discuss any issues I may have, such as child protection or a woman requesting/declining care that I am not particularly comfortable with. I also work within the NMC(Nursing and Midwifery Council)'s Midwives rules and code of practice.

thanks for detailing all of that.

"It is sucidal to have a homebirth if the baby is excessively large or the mother has diabetes or other health complications"

Horse shit.

How do you know how dangerous it ACTUALLY is if there is no research comparing outcomes between higher risk women giving birth at home and those giving birth in hospital?

I know a dozen women who have given birth to babies over 10lbs at home. I know a type 1 diabetic who has given birth at home. I know of several women like myself with GD who have given birth at home. Also mothers of breech babies and twins. None of the women that I know has had a poor outcome at home. In fact I'd say that almost all have had a better outcome than they might have expected in hospital, in terms of their physical and mental health and their baby's health after birth.

I think you should remember that the majority of women in very poor countries who have no access at all to antenatal care or emergency obstetric treatment don't die in childbirth.

I'm not recommending high risk mums routinely give birth at home or making a case that OVERALL it is safer for women to give birth out of hospital if they or their babies have health problems. I am taking issue with your use of the word 'suicidal'. I can assure you that I didn't have a death wish when I chose to give birth at home, and I was very well informed of the risks and the benefits to myself and my baby. I wasn't giving birth out in the bush, 30 miles by bike from a hospital and attended only by a old hag with a dirty rag and a bit of broken glass to cut the umbilical cord. I had two highly trained health professionals on hand with medical equipment and an operating theatre five minutes drive away.

standandeliver, I have had a homebirth. I know the risks and the advantages. My homebirth had the blessing of my community midwife and GP. I did not have to "fight" for a homebirth as it was medically the most sensible option for me.

I had good antenatal care and like you I had a highly trained and experienced midwife deliver my baby. I only had one midwife as my labour was so fast that the second midwife did not get there in time. If I had attempted a hospital birth my daughter would have been born unassisted in the car.

There is little point in having good quality ante natal care and highly qualifed health professionals looking after you if you do not follow advice. You might as well the poor women in Afganistan who has no ante natal care. It is not just the life of the mother that is being risked, but that of the baby as well. Life is not fair and the most important thing is a healhy mother and baby.

I know women who have sucessfully given birth to large babies at home, but they have been large women themselves. Problems come when the baby is out of proportion to the mother. Good ante natal care will pick up that sort of situation.

If my nhs community midwife had said that I needed to go to hospital then I would have been there like a shot. I respected her opinon and trusted her.

"There is little point in having good quality ante natal care and highly qualifed health professionals looking after you if you do not follow advice".

Whose advice?

The advice of my community midwife, who had vastly less experience of home births than my IM, and who had spent no more than 10 minutes assessing my obstetric history, or my IM, who had delivered babies at home weekly throughout her entire career, who had spent many hours going through my obstetric history with me, and who had discussed my case at length with an NHS consultant midwife?

Or my obstetrician, who had never attended a home birth during his career?

Homebirth rates in the UK vary from under 1% in some areas, to over 15% in others. That's because in some areas midwives are lacking in confidence to deliver babies outside of a hospital environment. As a home birth support volunteer I have known many women who have come up against a huge amount of negativity and shroud waving from health professionals towards even a low risk home birth. Those who are strong enough to fight their corner almost always find that talking to an experienced, confident midwife slightly higher up the NHS 'food chain' brings a marked change in attitude. In my own particular case I didn't even try to get further support from the community team because I wanted to be cared for by someone who I knew and trusted - which wasn't possible in my area as they don't do case-loading.

"You might as well the poor women in Afganistan who has no ante natal care".

That's a silly and thoughtless comment. In my own case I never said I disregarded all the advice and information I was given. Only the advice on place of birth. And I didn't actually disregard it. I just chose not to follow it. I still took the information into account.

" but that of the baby as well. Life is not fair and the most important thing is a healhy mother and baby"

Sorry - but that's INCREDIBLY insulting. Do you think I put my own feelings above the welfare of my baby? I didn't have my baby at home because I thought it would be 'nicer' for me, but because I thought it would result in a safer and healthier birth for both my baby and myself.

"I know women who have sucessfully given birth to large babies at home, but they have been large women themselves."

Ah well - I'm 5ft 6inches, am a size 10/12, and yet successfully delivered a
11lb baby at home, with no damage to myself or my baby. I know half a dozen women like myself who have given birth at home to babies over 10lbs with no problems at all.

"Problems come when the baby is out of proportion to the mother. Good ante natal care will pick up that sort of situation"

Sometimes. But sometimes the opposite can happen. One of my friends was advised by an obstetrician to have a section for her first baby as her baby was thought to be measuring very large for dates by scan.

She had a section. Baby was 9lbs 3oz. Mum is a strapping, healthy girl in her 20's.

If she goes on to experience scar rupture during her next labour, or is one of the 50% of women who don't have another baby following c-section, or -good forbid- loses the next baby (because risk of unexplained stillbirth in pregnancies following c-section appears to be higher), or ends up with a hysterectomy following another c-section, who or what will be to blame?

Risk is a complex issue and NHS protocols to reduce the chance of a poor outcome are useful at a population level - but they won't provide the optimal model of care for every individual mother.

I seriously doult that many IM deliver babies weekly. The majority of women cannot afford an IM. IM give a high level of care because they don't have many clients.

My nhs community midwife is on call for a homebirth once a week. She told me that she gets to do a homebirth about once a month.

I have had a hospital birth as well. The care I had in hospital was good. My first birth was not what I intended, but sometimes birth plans have to be thrown out the window. The midwives took time to talk to me and explain options to me.

In general midwives and doctors are caring people. They don't want mothers or babies to suffer.

My midwife is part of a VERY busy practice. She books more than one client a month and she acts as back up midwife for the two others in her practice as they have two midwives at each delivery.

"IM give a high level of care because they don't have many clients."

Yes - and unfortunately the reason NHS midwives can't always give a high quality of care is because they have too many.

I'm glad you had good care in hospital, but I didn't and both my daughter and I suffered as a result. I'm a user representative at my local hospital and I hear many stories about women's care in labour. Yes - most women get reasonable, sometimes excellent care under the NHS but others don't. Its true that doctors and midwives are caring people on the whole - but in parts of the NHS they are working under profoundly difficult conditions, and this affects the care they're able to offer and their attitudes to the women they look after.

The point I'm making is you are being naive to take your own experience as being representative of what happens to others. Women have a very wide range of experiences within the NHS - some outstanding, some acceptable and some poor.

Would also want to point out that I don't just judge the quality of NHS care from my experience as a mother and a user rep, but as someone who has worked in maternity services as well.

And it's an undeniable fact - doctors and midwives are happy to accept this - that there are thousands of women having unnecessary c-sections every year, operations which could have been avoided had they had better intrapartum care. I honestly think I would have been one of these women, had I had NHS care with my third baby, who was born healthy and happy in hospital after a very long labour at home supported by an IM.

interesting. i had a planned cs with dc1 because she was scanning large (they told me she could 10lb 13oz) and i am tiny. the obstetrician told me he would operate the next day because it would be too risky for me to go into labour. (she was 8lb 6oz)

vbac1 went ok - dc2 was back to back and the obs tried internal rotation, (which i have to say was the most painful thing i have ever experienced) which failed. after 24 hours i was given 20 minutes to get him out or i was back off to theatre. i got him out.

vbac2 was interesting. i obviously wasn't eligible for a cs because i had a 'successful' vbac under my belt, but was told i had to labour in the 'theatre' suite, not the comfy homey soft-furnishings one lol, due to my history. i was asked if i minded a student, i said sure, new midwives have to learn etc. anyways, dd2 has cerebral palsy. she had shoulder dystocia (which broke her clavicle - interesting to read re protocols) which was resolved in one contraction, cord round the neck, and, we can only surmise, a lengthy period of hypoxia due to cord compression about an hour before birth, when the trace was lost.

i do often wonder whether if i'd started with a home-birth, the whole sorry mess of my child-bearing past may have been a litle different. but it's largely academic, as i also know that post birth the hospital saved dd2's life...

on insurance - hmm, in our case, there is no 'proof' of causation, because there was no monitoring during the period thought to be responsible for dd2's cp. hence no hospital insurance will pay out anyway (we are 3 years into a legal query concerning standards of care and supervision of trainees). so i'm sceptical about insurance being the panacea for all evils.

as lots of others have said - this IM was clearly operating outside of the guidelines. unfortunately, this seems to have resulted in a very poor outcome for the mother and for the baby in this case (but apparently there are other mothers extolling her virtues who sport healthy able babies that she has delivered successfully)

i still wrestle with the decision to start legal proceedings over dd2's birth. the 'supervising' midwife was someone i was familiar and happy with - she had carried out all my ante-natal care. the trainee was left utterly traumatised - one of my first questions once we knew dd2 was alive (they didn't tell me for 4 hours - if not necessarily for long) was about her welfare.

none of these women break babies/ mothers on purpose. but it is up to them to make sure they follow all relevant procedures and keep up to date on their training, if only to be able to salve their consciences when things inevitably go wrong. it seems this mw didn't.

i am always very sad at these stories, not just for the family involved, but for the midwives as well, whether indies or nhs.

RT my lanbopur was like yours,no 2nd MW as so fast etc but I had to fight for it,there was a blanket no history of high BP rule even though I had given birth twice since with no HB rise (first was PET). I wasn't exactly comfy with the AN MW who amde the decision- her calling me a liar who had forgotten how many children I had didn't help(?? WTF).

So absolutely I fou8ght for it, the Obst agreed o0n the provision of a few basic ruloes which I was more than happy to adhere to; Comm MW told me that she couldn't see an issue: I had been refused a HB at the last mo with ds3 becuase my iron had slipped .1 under the cut off and that MW had said afterwards that I had been a perfect candidate for a HB and she thought the rule was too inflexible.

So absolutely I fought for the HB but I was right to, like you he would have been born in the car. the trick isn;t not to fight i think, but to get as informed as you can and be aware that soemtimes a no is right. I listened with ds3 so beleived in my case with ds4.

if the mother has a history of diabetes that rings alarm bells as to why she wasn't having hospital births. surely her care should been consultant-led?? big babies seems to be a big give-away....

also if I'd known the patient's history there's no way I'd have went near her with a bargepole!sorry, but why on earth would you open yourself up for all sorts of litigation as a HP??

From looking at all the failures in the NMC report it comes across that the MW panicked when she realised things were going t*ts up. She was on her own with no back-up (not the brightest move - as far as I'm aware the delivery is usually witnessed by another midwife).