Monthly Archives: March 2013

Please Help Save Independent Midwifery by commenting on the Professional Indemnity insurance consultation document

A public consultation is now open to the public until the 17th May 2013. It is your chance to say why professional Indemnity Insurance should not be linked to Midwives registration. This will have far-reaching implications after 25th October when it will become law – unless we can convince the powers that be to not implement it. This is where you can help by commenting on the consultation document. It is a long and wordy process and the issue is hard to get your head around unless you know the history so read a short version here at Birthrights

Question 6 is the most important one, but answer as many questions as you can.  Below are some of my comments. Please feel free to use any part of this to help you phrase your own answers:
“Linking Professional Indemnity Insurance (PII) to midwifery registration will discriminate against Independent midwives. Independent Midwives will be unable to purchace professional indemnity insurance as they are self employed. They are not part of, and most do not want to be part, of a corporate structure. They have chosen to work independently of the NHS to provide a better quality of service to women. As individuals it is impossible to purchase PII.
It suits many Independent midwives to be self-employed for many reasons. Continuity of carer provides better outcomes, and working this way means being on call for all the births on your caseload. The commitment to attend every booked birth requires the ability to re-scedule planned appointments on a daily basis. Many independent midwives also have young children/ elderly parents to care for, and working independently gives a greater flexibilty to their working day. Working for the NHS doesn’t offer this provision.
Women choose Independent Midwives for many reasons, but the majority have found their needs are not met by NHS care. Another group have had bad experiences with the NHS in previous births and need an alternative. The restrictions that insurance companies place on care is the reason many women opt out of NHS care. These same restrictions will apply to the care independent midwives can provide if indemnity insurance becomes compulsory. Just because something is high risk doesnt mean women should not have the right to do it.
The court of human rights have ruled that women are able to choose the circumstances of their birth including where, and with whom they choose to give birth. Making it impossible for midwives to practice independently without insurance is removing women’s human rights!
And what about the rights of Independent Midwives to work and provide for their families? is that not a human right too? Hundreds of Independent midwives will lose their livlihoods, thousands of women will be denied individual choice in pregnancy and birth if it becomes illegal to practice without insurance.
Independent Midwives are highly skilled in facilitating normal birth, including breech birth, and physiological third stage. These skills are in short supply in the NHS leading to an ever increasing caesarean section rate. Caesarean surgery carries serious risks and makes subsequent births high risk – costing the NHS extra time and resourses used, and in compensation claims. Wouldn’t it make sense for the NHS to save money by government supporting the contribution Independent midwives make to the normal birth rate?
I’m afraid that independent Midwives will not simply join the ranks of their NHS colleagues, they will leave the profession. One colleague recently told me she would rather die than return to NHS hospital midwifery. I know that sounds over dramatic but it’s not. Having worked as an Independent midwife for 7 years I understand how the same level of Midwifery care is impossible to achieve on the NHS. Independent Midwives pride themself on their professionalism and high standards – and to some, returning to NHS work would mean lowering those standards. It is impossible for many independent midwives to contemplate returning to giving piecemeal care, on under-staffed wards, with not enough time to provide quality care. It would break many midwives hearts to have to work this way, seeing the daily distress of women uninformed in pregnancy, left alone in labour and unsupported in their attempts to breastfeed.
Without an option to NHS midwifery care women will look for alternatives. I have already heard of the growing movement of unassisted births and women giving birth with doulas, are we to add qualified but illegal and unregistered midwives to the list of choices?
  Many independent midwives want women to be financially compensated for negligent care but fear the restrictions insurance companies will put on the type of care given. Is there any way a no-fault compensation scheme could be provided for these families? I understand there is such a system in New Zealand.
I am truly saddened to think that when my daughter gives birth she will only have the option of NHS midwifery care or illegal birth attendants.
PLEASE DO NOT LET THIS HAPPEN!”

In response to the question on cost I wrote:

“I do not have the necessary monetary cost data to hand, as I’ve been a caring, professional midwife for 12 years, not a politician, statistician or… research fellow.
The important costs that I’ve witnessed are not just of monitary value, so may not be viewed as valuable to this consultation, but they are of paramount importance to women and their families! Women and their experiences should be at the centre of this consultation rather than how much the monitary costs to the NHS will be.
I care for women. I care about what quality of life they have as a consequence of the maternity care they’ve received. I care about the unseen cost of dammaged women and how that impacts on their children, relationships, and our society in general. What cost is there to the traumatised woman who sees herself as dammaged, and unable to realise her own potential as a result of her birth trauma. What cost in terms of postnatal depression, child neglect and abuse, the need for foster care and the potential for future criminal behavour, maternal self harm and even suicide. Suicide is a leading cause of death for women in the period around childbirth. What cost to the children who have lost mothers and partners who’ve lost the love of their life? Do these costs count for anything under our current government?
If you’d like to hear about direct financial costs I’d like you to consider the additional future costs to the NHS of caring for  thousands of women previously cared for by independent midwives. These are often women with complex physical and/or psychological needs, requiring specialised one to one care, to ensure optimum outcomes. Without this specialised care, women have the potential to be further traumatised, with the consequenses already mentioned above. Lack of compassionate, one to one care for vulnerable groups also holds the potential for women who’s needs are not fully met, to sue for negligent care – costing the NHS millions in payouts and increased insurance premiums.
And what about other specialised groups such as those wishing for a peaceful breech birth, or vaginal birth after caesarean? Breech birth skills are woefully lacking in the NHS, and women are informed (often because there is no one knowledgeable or skilled to help with breech birth) that they have no alternative but to undergo abdominal surgery (with all the known risks) to deliver their baby. Independent Midwives are highly skilled in caring for women choosing these types of births. It is well known that surgical birth costs more than straightforward vaginal, midwife-led birth. The complications associated with caesarean surgery cost the NHS much more than normal birth, and the longer term costs of such complications are far reaching. The short term costs of preventing and treating wound infections, and giving blood transfusions are well documented. The longer term costs of caesarean surgery may not be as easy to cost. Treating subsequent postnatal depression (and the future cost implications for the child), further surgery to divide adhesions and the increased risks (and associated costs) on future pregnancies also need to be costed in. A broader view also needs to be taken of the cost implications of women who’ve had a caesarean being less likely to breastfeed. Children who are not breastfed are prone to many more health problems, at huge financial cost to the NHS!
Independent Midwives are highly skilled in facilitating normal birth so wouldn’t it make sense for the NHS to save money by government supporting the contribution Independent midwives make to the normal birth rate?”

I don’t have the comments I wrote on whether this will discriminate against anyone as I was so mad at this point to remeber to copy it. Needless to say it was a lengthy post.

Please, Please comment and ask as many people as you can to do likewise. The more people who bother to add their comments, the more potential we have to halt this requirement to link PII to registration before it becomes law. Respond to the government ‘consultation’ with your views http://consultations.dh.gov.uk/professional-standards/indemnity_for_regulated_healthcare_professionals 

OTHER WAYS TO HELP INCLUDE:

Join the Facebook group: https://www.facebook.com/pages/Choose-your-Midwife-Choose-your-Birth/223503274456877 it doesnt take long and you’ll receive up to date information as it happens.

Email your MP now, find who your MP is here:  http://findyourmp.parliament.uk/

Sign the petition http://epetitions.direct.gov.uk/petitions/44382 this takes just seconds to do.

Ask the Royal College of Midwives union to support us https://www.facebook.com/MidwivesRCM

March with us on the 25th March in London. It will be a peaceful protest to highlight our campaign. The more people attend the more the Government may take us seriously. More information here: https://www.facebook.com/events/337186596400907/

See what this type of care means to women;

here in this Independent article written by a woman who’s given birth with independent midwives twice.

and here on you tube where a woman discusses the importance independent midwifery made to her when her baby was born breech.

There is also a plea from a well respected obstetrician to leave Independent Midwives alone.
 

Choose your midwife choose your birth campaign 2013

As mentioned in my previous post Independent midwives will be unable to work without professional indemnity insurance after October 2013 and there is no affordable insurance available to them. After this date Independent Midwives will not be able to remain on the midwifery register, and therefore will be unable to provide midwifery care legally. This may not be a problem for every woman, but a significant number of Independent Midwives and the women they care for will be affected. Nhs midwives will also be affected although many are unaware how. Worse still it signals a reduction in choices available to pregnant women which has far reaching consequences.

A wonderful student who is supporting the Choose your Midwife, Choose your Birth campaign created the document below, on what linking PII to registration really means. Please share with all Midwifery colleagues and women.

1. It will cost you MONEY.

Every time a new midwife finishes her training or an NHS midwife moves job, takes a break between jobs or goes onto maternity leave she will have to be either added, removed or amended on the NMC register. There are over 38,000 midwives on the register moving around every week. The NMC will have to administer this scheme. That’s the NMC that is “failing at every level” and has just increased its’ registration fees by 32%. So where will the money come from to fund this extra work? Exactly. YOU.

 2. It will take away your AUTONOMY.

If you have to be insured to be a midwife from October then it follows that you have to comply with any stipulations that the insurers make to be a midwife from October. So if the NHS insurance underwriters decide one day after a nasty lawsuit that homebirth/VBAC/Whatever is too risky for them they might say you can no longer do these things in practice. And you’ll have to obey, else you won’t be insured which means you’re breaking the law. Making a link between registration and insurance puts policy decisions in insurer’s hands, not midwives. Bye-bye autonomy. And talking of breaking the law… 

3. You may be PRACTISING ILLEGALLY without even thinking about it.

Shift running over but still caring for a woman? Stopped in the street to answer a question for a woman or friend? Want to care for your friend in labour who lives outside of your Trust area? Covering a shift for someone else in a different area? Supposed to be on annual leave but offered to cover? Better be checking the terms of your NHS insurance policy to make sure you’re covered, or you’ll be practising illegally. 

4. It will take away CHOICE from women.

Not everyone wants to birth within the NHS. That doesn’t mean the NHS is bad, it isn’t. But some women just don’t want to go into hospital or for whatever reason, they can’t get the birth they want on the NHS. Taking away more choices from women about ANYTHING (but especially about birth) is a bad thing and will lead to…

 5. It will HARM women and babies.

With no alternatives to NHS care, scared women may decide to go it alone. This could have truly devastating consequences for mothers and their babies. 

6. Your WORKLOAD will increase.

Women who would otherwise be cared for by independents may now turn to the NHS. This will further increase the NHS workload and birth rate at a time when resources are already stretched and the birth rate is off the chart. All of this further contributes to burned out midwives and unsafe practice. 

7. Midwifery will LOSE fundamental skills.

Vaginal breech birth, homebirth of twins, homebirth after caesarean section, routine physiological 3rd stage; these are a dying breed in some parts of the NHS. Independent midwifery keeps many of these skills alive in our communities, these are skills that we need to see as thriving and routine if we are to keep from being turned into obstetric nurses. 

8. It will change the perception and future of YOUR profession.

Insurance does NOT keep women safe. One-to-one care from a known skilled midwife keeps women safe. Forcing Independent Midwifery underground due to lack of insurance could bring your profession into disrepute and result in qualified midwives facing criminal charges for delivering care to women who would not otherwise be supported in their choices.

 9. Because our DAUGHTERS and GRANDDAUGHTERS deserve more.

They do. They deserve more than to have their maternity care dictated to them by insurance companies. Insurance does NOT keep women safe. One-to-one care from a known skilled midwife keeps women safe. THIS HAS TO BE STOPPED.

see the original document here: 9 reasons why PII and registration should not be linked

 

WAYS TO HELP INCLUDE:

Join the Facebook group: https://www.facebook.com/pages/Choose-your-Midwife-Choose-your-Birth/223503274456877 it doesnt take long and you’ll receive up to date information as it happens.

Email your MP now, find who your MP is here:  http://findyourmp.parliament.uk/

Sign the petition http://epetitions.direct.gov.uk/petitions/44382 this takes just seconds to do.

Respond to the government ‘consultation’ with your views http://consultations.dh.gov.uk/professional-standards/indemnity_for_regulated_healthcare_professionals This takes a bit longet but is very important. See my response to some of the consultation questions here. Please feel free to use any part of it in your answers.

Ask the Royal College of Midwives union to support us https://www.facebook.com/MidwivesRCM

March with us on the 25th March in London. It will be a peaceful protest to highlight our campaign. The more people attend the more the Government may take us seriously. More information here: https://www.facebook.com/events/337186596400907/

See what this type of care means to women;

here in this Independent article written by a woman who’s given birth with independent midwives twice.

and here on you tube where a woman discusses the importance independent midwifery made to her when her baby was born breech.

There is also a plea from a well respected obstetrician to leave Independent Midwives alone.

Please do whatever you can to ensure women retain choice and midwives are enable to support women in their choices. Please share as widely as possible. x