Saving choice for pregnant women

[lizzybeltane]

I believe in a future where women know and trust their midwife, have unhurried appointments, at their own convenience, in the privacy of their own home. A midwife who is on call and available to attend her in labour. Not only does this model improve women's experience it also has effects on the outcome of labour. Increasing the rates of vaginal birth, reducing the length of labour, the need for interventions and pain relief (Hodnet.et al 2012).

Every year thousands of women make this choice and vote with their feet, paying for care from a midwife they know and trust, yet this choice is about to be permanently removed. There are over 200 midwives working this way currently. Some in fledgling organisations but the majority are self employed. In the UK this year Midwives will become one of the very few professions that can no longer be self-employed. This is not because of safety or regulation; this is because of a European directive that has brought a change in the law. We need the government to support Independent Midwives, and this is within their power, but they need to hear from women that this is a choice that they want to remain.

I would very much like Mums net to take up the campaign to protect choice in the UK for pregnant women by taking up the campaign to support independent midwifery.

www.ncbi.nlm.nih.gov/pubmed/23076901

I already have this on the nhs with one to one midwives.

I might be misunderstanding, but can you explain how the government can ignore an EU directive? I believe they have direct effect, and governments can't just 'opt out', although they have discretion about how they implement the objective.

Apologies if this is explained in the link - can't click on it as on iPad and it's not a clicky link.

thanks

This is such a desperately needed option. While companies like One to One (and others) are in some places, many others are not being commissioned by the NHS and there is not this option. They are still NHS affiliated though, and therefore not acceptable to some women who may have seen the worst of trauma through the NHS.

I absolutely support this campaign 100%. Without Independent Midwives we would lose so much of the desperately needed skills that the NHS seems determined to drive down, such as supporting breech birth or multiples born vaginally.

How the law is implemented is down to individual governments. There is a plan on the table that they can assist with if they choose to do so.

Also - can someone tell me what the insurance position is with independent midwives? I would have thought the premiums would be crippling.

Ah - I have found this link which explains: www.independent.co.uk/life-style/health-and-families/health-news/new-eu-directives-put-independent-midwives-under-threat-9020226.html

The directive states that independent midwives must have professional insurance - not a bad idea as this is what is paid out if something goes wrong and can be millions of pounds as it often pays for lifetime care for an injured child.

It is suggested that the govt contributes £10m to a central fund for this purpose. Sounds sensible to me - if the govt refuse to fo this, someone from Dept of Health needs to explain why.

we need to raise awareness so that the government can see this is an issue that people care about.

I'm not sure the government are that interested in what people care about - they certainly don't seem to care about being unpopular.

However, they care a lot about saving money. The plan makes financial sense so perhaps that is what we should focus on if we want them to take any notice. Perhaps another tactic for IM UK (as well as raising awareness as they are already doing) would be to put together a financial statement showing that the plan would actually save the government money and publicise that.

Neighbourhood Midwives was set up for just this reason, it is 100% employee owned, social enterprise with full insurance. OK, it's not self employment but pretty good all the same.

We had our son 5 months ago at home due to the terrible treatment we had to endure from the nhs previously. If independent midwives and doulas didn't exist I think we would have probably free birthed. There was no way going back into the nhs was even a remote possibility.

I am self-employed.. To work in my area I have to have appropriate insurance which is not funded by the government. The government ensures a standard of midwifery for everyone, if people want to opt out of that system they should pay the full costs, including appropriate insurance.

Why can't the nmc organise this as a group?

Independent midwives offer a higher standard of care. They accept women that the nhs deem high risk support and information to make informed decisions. They make the time to know their clients.
As for insurance, what feels a better motivator- midwife who's premiums might go up or a midwife who loses her house if she screw up? Insurance doesn't make a safer practitioner, it just provides premiums and a business for insurance companies ( which, as they won't get enough profit means they aren't attractive to a profit making company).
The insurance is the insistence of EU law- IMs have worked for years in this country without an issue. Sadly nhs healthcare options are driven by insurance, the costs for the nhs being sued are huge.
My plan was to know the midwife when in labour ,but the antenatal care and postnatal care was so different to what I expected- I hadnt anticipated knowing my midwife would make such a wonderful difference.

I had wonderful NHS ante-natal care in my first pregnancy, unfortunately it was wonderful right up to the point they suspected I might become a risky birth (I didn't) and they refused to have me in the local Maternity Unit. As soon as that happened I experienced the worst of the NHS - a cascade of intervention, four different midwives, more and more invasive procedures with no clear explanations or choice and post-natal care that left me with crippling depression, PTSD, difficulty breastfeeding and trouble bonding with my baby for nearly a year.

I fully intend to go with an independent midwife when I am next expecting. Thanks to my previous experience I suspect I will need more one to one care than last time, the NHS will offer me less. I want to be assured that a midwife I know and trust, who knows me, will be with me when labour occurs, because I don't trust NHS staff after my last experience. Please please please let me have that choice to make.

Women who have had a good experience with the NHS may not understand how essential indie MW care is, but even thinking that my only option may be to go through the NHS again makes me panic and feel very anxious.

Mumsnet - can you put your considerable weight behind this matter? I turned to you after my terrifying experience for support. Help protect me and others like me. Please

It is imperative this choice stays. All of my clients are women who cant have their needs met in the NHS. Many have traumatic experiences from previous births they wish to avoid, many have received sub standard care, are frightened. If independent midwifery is lost, women will have no safe alternative to go to. If we are lost, the nhs system will be stretched even further. Immediately it will cost £13 million to accomodate all our clients! This doesn't take into account the additional cost that comes with our caseload being (70%) high risk, and therefore more likely to receive intervention in the nhs. Interesting, not with an independent midwife. Despite the majority of clients having risk factors our caesarean and instrumental rates are half that of the NHS!

independent midwives also support the nhs when they are short staffed. I have attended women in labour when there were no midwives available. We have supported midwives when they have needed extra skills.

and what about the midwife shortage? If the government support the insurance solution IMUK have found, 5000 midwives who are already registered and qualified could work self employed. Our survey said 90% would! This would relieve NHS midwives greatly. It would be better fir them and for the women accessing the NHS as their midwife wont be as stretched. Thousands if midwives leave through burnout. This is a way not to lose them. 30% of students each year will never get s job in the nhs as there are no vacancies! This wastes £10 million of tax payers money every year in training!

please support the choose your midwife campaign.

I don't think demanding the government funds the insurance for your private businesses is fair though. Even if you indirectly benefit the nhs, every other self-employed person or small business has to pay their own insurance premiums.

Yes the nhs needs to employ more midwives under better working conditions but the government is trying to provide midwives through direct employment, not providing financial support for private healthcare actually maybe that's what they are doing to dismantle the nhs Private healthcare should be able to find itself including adequate insurance for when things go wrong.

10 million across 5000 is only 2000 a head if there's genuinely that many midwives wanting to practise independently. That's not loads more than I pay as a computer type.

It's not about the government funding a private business Mines (although they effectively do this every time they cut tax for small businesses). It's the fact that the choice is £10m to enable independent midwifery to continue or £13m at least (according to a PP's figures) if all the women who would have had independent mws come to the NHS. It's actually saving the government money AND providing better/more diverse care.

To clarify the insurance is funded through premiums paid for by the midwives. This is a substantial sum. The financial support we are asking for is in the unlikely event of a large claim the govt will honor a claim which the company cant fund. The risk assessment shows in the last ten years we may have accessed a couple of hundred thousand pounds of this govt grant or guarantee. This is in comparison to £3.2 billion spent in compensation in the nhs over the last 10 years. This is because the one to one care we give results in less opportunity for negligence and less reasons for complaint.

the govt can give a guarantee which means they don't even have to hand the money over! It will def save them money and get more midwives working and improve maternity options. They have done this for insurance companies involved in housing and other areas already so a precident is set.

if IMs could buy insurance they would. The fact is insurance companies can make more money on other projects so there are no policies available to buy. So, midwives are setting up their own company (which is usual in these circumstances) and asking for govt over the initial years. This is a public health issue and the department of health have a responsibility to do what they can i believe.

Independent midwives are SUCH an important option. I "couldn't afford" an IM if I had any more children. I'd probably have one anyway. It is SO IMPORTANT to be able to trust your care provider, and to have the option of continuity of care. The effect on the labour and birth itself is huge.

I do worry that standard of care will slip if the gold standard is no longer there to aspire to. I know in some areas it's not that fantastic anyway.... can it afford to slip further?

Why I chose an independent midwife...

My independent midwife took over my care at 36 weeks, conducting all of my antenatal check-ups, going personally on-call so she would be guaranteed to attend my birth, and visited us many times up until 28 days afterwards to support me in my journey to motherhood and ensure that all was well.

This service was not available on the NHS in west Cornwall. Due to staffing issues, homebirth provision is not guaranteed, and most homebirthers haven't met the attending midwives. In fact, when mentioning the value of caseloading midwifery and continuity of care at a maternity stakeholder event, I was informed by our local community midwifery manager that women apparently "don't care" about being attended by a familiar midwife during birth!

I wanted to choose who would attend me. I had been trained as a student midwife in London that caseloading was the gold standard... and I wanted it for myself! I didn't want a stranger to be there, entering my home at my most private moments. Instead I wanted to invite a chosen and trusted person I'd built up a relationship with, who knew me and what I wanted. Instead of rushed 10 minute antenatal appointments with an NHS midwife in a GP surgery, my check-ups with Evony were in my own home and at least an hour long each, during which time we planned, laughed, drank tea and looked forward to the birth together.

You can read my birth story here if you wish: www.birthsupport.org.uk/maya/html

For me this is about choice and equality and a woman's right to choosing what sort of maternity care she wants. The one to one service is fabulous but only available in a few areas (same as neighbourhood midwives).
Just yesterday I read (in the daily fail, sorry) about a hospital trust that is not 'allowing' homebirths any more.
Women's choices are getting taken away and it is massively important that independent midwifery continues to give the gold standard care they provide.

Also choice for midwives to practice how they want to, safely.

Please support the campign MN.

Surely all women should be able to choose their birth support?
I can't understand why we can't have similar to the NZ model where I could choose to spend my allocated funds on a hospital, birth centre or midwife care at home.

Everyone should be able to have continuous care from a known practitioner and we shouldn't have to crimp and save and borrow to do it.

It's cheaper and safer, what else could possibly be an issue?

It is an important choice to have. I opted for an independent midwife for my first child - because the NHS didn't have a midwife/ midwife team available for me between 25 and 37 weeks for antenatal care due to restructuring. I would have had to seen my unsympathetic doctor for routine appointments and wouldn't have had anyone to discuss birth plans with etc. I also realised that it was important to me to have met the midwives who would be with me in labour beforehand so that I felt comfortable with them in my own home. By the time I got round to having my second child, I realised I wanted the care of the same midwives again - who knew how my first labour had progressed and my pregnancy/postnatal history. Their postnatal support was excellent and I credit them with a smooth start to breastfeeding for both children.

It's crucial that as women we stand up for ourselves and our choices, and to my mind this touches the very heart of who we are.

To have some faceless EU bureaucrat, or money-minded uk politician deciding to remove the choice from you, you best friend/ daughter/ daughter-in-law/sister/special woman in your life for no better reason than money, is outrageous and something we should fight against every step of the way, with every fibre of our being.

Those of you saying that 'independent businesses fund their own insurance so why should this be any different?' don't have a clear picture. As I understand it the largest negligence payouts from the NHS by millions are Obstetric negligence claims. Most (all?) UK Insurance companies are unwilling to take on this level risk by insuring IM's so finding a company willing to insure has been, until this year impossible (never mind that the % of IM's who have been sued for damages is teeny-tiny in comparison to % of NHS Trusts). Now there are one or two considering it, though as I understand it nothing concrete yet. Of those insurance companies who are considering it, the annual premium that they have mentioned as being worth their risk is hugely more than the annual salary any midwife could ever hope to earn, independent or not (remember this is not a business, like a cafe or something that can expand indefinitely. In the end it's limited by how many women one Midwife can safely look after in any given year). So if Independent Midwifery is to continue and be legal under EU law it needs help. Our Government needs to act, it must ensure that AFFORDABLE, and appropriate insurance is available to IM's. This is important.

This IS important. Most women will give birth at some point in their lives, and yes - we are blessed with a non-fee paying at point of service NHS, but for a small but significant (and growing) few this is not the service they want. They want a midwife they've had a chance to build a relationship with, one they know and trust, they need to give birth the way they chose - not the way an institution dictates because of protocol. The need to make decisions based on what is best for them, and their particular circumstances, not what's best for the 'average woman in this situation' (NICE, CNST, Trust protocols etc etc). So for that sake of these women, for the sake of the women you love who might be one of those women in the future, please fight to maintain this choice. Even if it's not your currently your choice, even if you think it never will be.

Independent Midwives do something special. They do it quietly and with dignity. This something special is available to you and those you love. Please don't let this choice slip through our fingers just because an unthinking political quango somewhere has made a decision. You only have to cast your eyes across the pond at the terrible birth situation in the US and Brazil to see where allowing choice to erode leads us. 90% Caeserean rates in some Brazilian cities - a whole generation of women who have never met anyone their whole lives who have given birth vaginally. Really? Do we really think that only 10% of women can give birth vaginally. Anyway -that's another thread. Sorry to digress. So this is about more than just a small bunch of self employed Midwives working for women who can afford to pay for them (another commonly presented myth), it's about another erosion of the rights for women. The right to chose how they birth their own babies, what happens to their bodies and who will be with them to help them through the stormy seas of the perinatal period. This is something that should be decided by YOU, not by insurance, or by politicians but by you - Women who can give birth, and the women who love them.

Thankyou.

CarefullyAirbrushed Potatoe - totally agree and this is a model of care we have suggested to Dan Poulter Health Minister. The NHS is paid slightly more for each woman than an independent midwife would charge as well!

As father of two choosing the type of birth we had was very important. We had a torrid experience with the NHS for our first child, where we had to fight for a home birth; leaving my Wife in no fit state to birth naturally. I feel this had further repercussions with my wife's post natal depression. It took us three years to regroup and feel ready for another child, mainly because I was afraid of watching my wife go through the same ordeal. However thankfully we had the amazing fortune of meeting an independent Midwife. Under her care she made us feel empowered and in control. Consequently we experienced an amazing home birth.
I believe without the choice women will continue to endure births that are not owned by them, but are of the convenience to the nhs. Women need to feel in control and relaxed to birth.
Saving independent Midwifes is the only way to retain this choice for women and couples.