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

[SuseB]

I don't have personal experience of independent midwives, but I did have three home births and am outspoken about how amazing they were and how important I think it is to have genuine choices in childbirth. I would love to see the power of Mumsnet support this campaign.

[SidandAndyssextoy]

I had that gold standard care of case loading NHS midwives that so few women can access. They supported me through two pregnancies with medical issues, gave me strength to question hospital protocol, spent as long with me as I wanted in my own home talking about my worries and getting to know me (and my partner), and celebrated with me as I had two births as I wanted them. I was unbelievably lucky. If this care cannot be rolled out across the NHS (and it would save money if it were) then the next best option is to ensure that independent midwives can still practice. Hopefully Neighbourhood Midwives will soon be commissioned like One to One and deliver care within the NHS.

[Sm1ley]

It is all about choice and who we trust to make decisions on our behalf. The hospital midwives answer to the trust who set procedures and protoc

[Andcake]

Shame on you mumsnet for supporting this campaign. I don't like this govt but I don't think helping independent mw out with insurance is a good use of tax payers money. Improving Nhs care yes not subsidising the wealthy who want something different

[Sm1ley]

Whoops!!
Trusts set protocols to be one size fits all. They cannot take account of individual wishes.
As to paying, I've heard many stories of women in need being supported regardless and a charity is being set up to widen access based on need.
IMs do so much more than catch babies. They provide real choice for new families.
As to NHS funded companies like one to one, they will be subject to the same (similar) protocols. You will only be 'allowed' them if deemed low risk (if not currently then just wait until budgets start to bite.

[moongroove]

Choice for women and for the midwives. Simple.

you.38degrees.org.uk/petitions/save-independent-midwifery-in-the-uk/?state=sign

[mrsmacaroni]

Independent midwives are not just for the wealthy, I've known women who really can't afford it choose turn to IMs when they are let down by very badly by the healthcare service. In fact where I live women have remortgaged their houses or got loans from family. Some women irrespective of their financial means choose to prioritise the care they want during pregnancy and birth because it's important to them and their family. The care you receive far exceeds anything I have seen in the NHS and has an impact on long term emotional and physical well being.

Yes, I think the DOH should invest more in maternity services, we all do, but the investment in IMs is small change for them and keeps choice alive for women everywhere.

[ixqic]

No woman ought to choose to birth alone due to the bad behaviour of midwives. Until the NHS can consistently provide a sterling service to every woman who wants a supported home birth then there will be a need for Indy midwives. The government needs to protect the choice for all women not just try to force everyone to a service which is letting down many. Here is someone's description of going alone after poor NHS care therabbitinthemoon.blogspot.co.uk/?m=1

[EatsCakeForNoReasonWhatsoever]

AndCake - shame you didn't read the thread before posting, one of the posters above has explained very clearly that the government would only be backing up the IMs, not funding them.

Not to mention the fact that Mumsnet isn't supporting the campaign, we're just hoping they will. Honestly. What a half-baked post.

And IMs are not 'for the wealthy'. They're for terrified women who are willing to pay extra for the support they need. And some of the IMs I know offer discounts for the impecunious, or payment plans, or skill swaps (if relevant). This isn't some nebulous luxury item, you know. This is desperately needed healthcare that the NHS can't be bothered to fund, as far as I can see. Women's healthcare just isn't a priority.

[MinesAPintOfTea]

EatsCake we've been told that independent midwives are cheaper than NHS ones. Maybe if you charged a bit more you could afford to insure yourselves and not rely on the government.

And agreeing to underwrite is a big ask. Especially as the campaign doesn't make it remotely clear that that is what they want or what measures will be put in place to make sure that only responsible midwives operating in a reasonable manner are covered. Even that petition only calls for the health minister to look after you, without saying what is actually wanted.

Yes currently independent midwives are rarely sued but that is because:
a. you have to be pretty determined and confident to practise uninsured when a small case could take you out financially.
b. few solicitors will take on a case against an uninsured private practitioner because its not worth it: they wouldn't have reasonable payout for the damages involved.

b is of course why the EU has demanded that midwives be insured for the protection of pregnant women and their babies. Out of interest, are there any EU countries with independent midwives and are they insured?

[joyfull]

I'd seriously consider using an IM if I were to get pregnant again ;) I've had great treatment in NHS with both a home and a hospital birth. Things were a bit more complex with the last birth and I think IMs have retained more skills outside of blanket, one size for all, lawsuit prevention rules. I'd at least like there to be a conversation and a choice... Anyway, I thought the government were pro privatisation?!

[Sammyniccy]

Come on mumsnet support this cause......fundamentally , its a human rights issue. X

[BanSidhe]

Minesapintoftea
on your point b)
The EU regulation was actually developed to have an avenue of compensation for those individuals who choose "health tourism". If your boob job in the Baltics develops a complication which can be proven to be result of negligence, then you have the the means for redress.
I would also like to say that having insurance does not "protect" against anything. Having good quality continuity and consistency of care is far more protective of the health of the mothers and babies.
As has for your point about charging more: that would take IM care way beyond the ability of some families to afford the IM care.
Several IMs provide pro bono care dependent in need and some even take payment in kind.

[Onesleeptillwembley]

Please don't support this, MN. Subsidising private enterprise is just not on. And frankly, what percentage of women can afford a private midwife? This isn't about 'women's right of choice' this is about subsidising a privileged few.
I do agree the choice should be there, but not subsidised by the people that can't afford to access it.

[Arohaitis]

Well I guess if they do this for private organisations then they will have a hard time defending why they don't do it for all health care staff and then who else will want the gov to pay their insurance? and since they have very little direct control over who they are insuring to practice independently they perhaps don't see this as a useful line to take.

Just wondering

I'm not familiar with what someone earlier was talking about (the gov bailing private companies out) but it is presumably linked to the 'too big to fail' thing and I guess only time will tell whether that was the right decision)

[EatsCakeForNoReasonWhatsoever]

MinesAPint - just to clarify, I'm not an Independent Midwife, or anything similar. Just someone who believes in what they do and who has put off having a second baby for quite a while to ensure we can afford an IM when the time comes.

[wessexindependentmidwifeErika]

This is def not asking tax payers to fund a private business. Midwives will pay premiums which will cover the majority of all claims if they come in. The insurance needs underwriting for large claims (which are not expected due to the risk assessment) over the first years as the company establishes. This is a public health issue. The consequences of losing this choice will have detrimental affects on women, their rights and choices, their future and their health. IMs are the only maternity system currently meeting their own targets.

[Midwifeangela]

I am an IM; I care for many woman who have been traumatised by birth and need the care from a known midwife to support them. The DH's own report commissioned by them says that IM's should remain an option. This is not about 'private care' or not have insurance; this is about choice outside of the NHS and its policy driven culture, and about enabling IM's to put into the place the insurance as requested so that we can continue to provide the care women seek.

[Pollymummy]

MN please support independent midwifery. It is so important women have this option.
I had an independent midwife for the birth of my second child. This was after a traumatic experience with my first. (Thankfully he was fine, but I was left in a real mess). When it came to even thinking about having a second child I was terrified of going through the same thing again.
Being able to build up my trust in the person who would be attending to me was critical to me feeling safe. It meant so much to me that she understood completely my history, fears and hopes for my second child's birth. My second child's birth was hard (aren't they all?!). But, with her support during, and importantly before, the labour I did it. Emotionally I was in a completely different place (a much happier place) then after my son's birth. This not only benefited me but my children too.
The level of support I received from my midwife just was not available on the NHS. While I wish it was, it isn't, and we need to ensure having an indep midwife is an option.

I don't think indep midwives are just for the rich. They also set the gold standard of care (which good maternity services in the NHS are modelled on). Finally, it's about choice. Women should be able to choose who provides their care. We should be supporting and aiming to extend this choice to all women, not letting it slip through our fingers.

[BabyWitch]

Please support this campaign, MN. This is about CHOICE. For women to have genuine CHOICE in how they birth, and for midwives to have genuine choice in how they work.

I have had one baby on the NHS, and never again. I hope to have another baby, but only with an IM. The thought that this choice is being taken away from women, both personally and professionally, is outrageous in this day and age.

Even though I had a poor birth experience on the NHS with my baby's birth, initially I was not fully behind supporting IMs. I inaccurately thought they were only for pampered women who could afford to throw money at something they've already paid for through their taxes.
I was wrong. All types of women can benefit from independent midwifery care - and it is the vulnerable women and those who do not fit into the ever-shrinking 'low risk' box who need access to this choice the most.
My choices were eroded, ignored and belittled under NHS care. I was coerced and forced into unnecessary intervention that only served to hinder my recovery. Breastfeeding support and advice consisted of continuous bullying. I was never once treated like an individual.
If we lose IMs we all lose. IMs hold the knowledge and experience in dealing with special types of birth, such as vaginal breech. If IMs are allowed to go out of business, this font of knowledge and expertise will die with them.
I could never be pregnant again, fearing not 'the worst', but that something might come up, such as the baby's odd position, where I would be forced into having a c-section simply because I was being dealt with by medical staff who had no experience or confidence in the 'wait and see' approach.
IMs were asking the government for a One Off payment of £10m to help to set up their insurance kitty. This is less than their equivilent productivity would cost the NHS - and they are also relieving the NHS of these women. (However, the trusts do not support IMs because they are effectively losing clients).
IMs are worth their weight in gold. To us, and to future generations.

[mum1976]

IMs are not just for the rich - we used hard earned savings to pay for an IM with baby no. 2 because the NHS would not support our choices.

First time around we suffered through fighting for a home birth, being bullied to tears by consultants, having midwives who were total strangers at the birth, multiple changes of midwives through labour, not being allowed to be in a position of my choosing, and finally the cascade of intervention which made me feel totally powerless and ended in a c-section, which i still believe may not have been necessary if they hadn't been bound by arbitrary NHS protocol (time-limits in my case).

In contrast, our IM really did provide the gold-standard of care - she spent time to get to know us and what we wanted, provided information to help us make informed choices, supported those choices, was with us for the whole labour and ultimately helped me birth a 10lb 3oz baby at home. It was a wonderful, healing, empowering experience. The NHS wouldn't have "allowed" me to do this because my 3 hour 2nd stage would have breached protocol. I probably would have ended up with another c-section.

I'm not trying to criticise the NHS, they mostly do a great and very necessary job. However, their one-size-fits-all policies did not work for me and it would be a sad day for women if our choices regarding our own births were to be removed. Losing IMs would mean exactly that for women like me. As I understand it, midwives will be the only branch of medical practitioners who are unable to work independently as they are the only ones for whom commercial insurance simply isn't available. They are not asking for special treatment, not asking for the government to pay for or subsidise their insurance premiums, just to make insurance available for them to buy so they have the same opportunity and right to work independently as anyone else. The government should be helping find a solution...the only midwives who even meet the governments own standards of midwifery care are IMs!

[WaitingAndSpinning]

This is about women's rights. Their choice of where to birth, how to birth, and who they want with them during and after pregnancy and labour.

It's not just about homebirth either. I had an amazing independent midwife for second birth after a terrible prior experience. Sadly I couldn't give birth at home as I'd planned but she was there to support me all the way from early pregnancy to during and after my eventual C-section.

With NHS care I felt like my pregnancy and birth were one long fight. Constant interference and bullying about how and where I should give birth and pushing for constant unneeded interventions. Choices that were mine were presented to me as something I had to do with no understanding or explanations of risks. The thought that I would not be able to choose my own midwifery care in future pregnancies terrifies me.

For women that have been traumatised by past NHS birth experiences they may feel that their only choice is then to birth unsupported.

It can only benefit all women, that those who choose to, can access independent care. It relieves the burden on the NHS allowing better care from them for the women that do choose it.

In addition to all of this, independent midwives keep alive skills and knowledge that are being lost in the NHS, for example regarding natural breech births.

If this goes ahead, not only are we saying women in the UK may not choose who cares for them during labour and birth, we are also saying that midwifery as a profession may only exist via the NHS. Given that most midwives are women, yet another choice removed. It shocks me that in 2014 we would countenance less choices in pregnancy and birth care than in many other years before.