2013 A New Era in Midwifery or Withdrawal of Women’s Childbirth Choices?

I original wrote this at the beginning of 2013 when Independent Midwifery was seriously under threat of becoming illegal if they failed to obtain professional indemnity insurance (PII) before 25th October 2013. At the 11th hour we have a glimmer of hope due to the hard work of Independent Midwives UK (IM UK). These dedicated midwives have failed to give up, and have found a workable insurance product. Whilst having compulsory insurance was not welcomed by every member of IM UK, it will soon be the only way of legally continuing to work as a midwife in the UK.

For the majority of women the loss of independent midwifery will make no difference to them as they’ve never even heard of Independent Midwives. Many are happy doing what everyone else does, not questioning their care providers, assuming health professionals will care for them when their time comes to give birth. Some may have a rude awakening as they find themselves in hospitals which are short staffed and therefore ill-equipped to care as well as they’d like. When women are denied their choice of birth at home due to staff shortages, or are not supported in their choices they may seek out an alternative. Birth trauma and caesarean rates rise each year, and women deserve choice in care provider and alternatives to the NHS model if needed .

Independent Midwives are fully qualified, Registered Midwives who have chosen to work outside the NHS to fully practice their midwifery skills. They are regulated like any other midwife, and provide one to one care for women during pregnancy, birth and up to 28 days postnatally. Unlike midwives that are employed by the NHS, Independent Midwives have not been able to purchase Professional Indenity Insurance (PII) since 1994. Since then Independent Midwives have practiced without insurance which means we are personally liable for any clinical negligence claim against us. This has not discouraged women from hiring Independent Midwives as they value the benefits of individualised care.

Independent Midwives provide one to one care for women. This type of working relationship allows women to get to know and trust the person who will be present at the birth of their child. Women really value this professional relationship, and midwives get a great deal of job satisfaction from working this way.

So why are they under threat of becoming illegal? Because a European directive has been passed which makes it compulsory for professionals allied to medicine (which includes osteopaths, chiropractors, midwives etc.) to have Professional Indemnity Insurance (PII). Our government decided to implement this in England this year, despite being informed that Independent Midwives cannot obtain PII due to being self employed. A deadline to have insurance was initially set for October 2013, but this has now been moved to February 2014. Nursing and midwifery council published this statement at the beginning of October. Without professional indemnity insurance Independent Midwives will not be legally be able to care for women in labour, although some may be able to provide antenatal and postnatal care. Independent Midwives will lose their livelihood and women will have less choice in childbirth.

This is a human rights issue, as women will no longer be able to choose who cares for them throughout pregnancy and childbirth. Unlike other areas of healthcare, women will be denied the option of privately employing a health professional of their choice. This doesn’t sound too important for the majority of women, but it is very important for the women who do not have good NHS midwifery services in their area. Some women who’ve had previous caesareans would like to give birth at home, women who’s baby is in the breech position often have difficulty finding a midwife skilled in breech birth, women who’ve been scared or scarred by previous NHS experiences may like an alternative, some want to know there will be a midwife available for their homebirth, or just to know the midwife who will be caring for her. These women will be denied choice.

IM UK have been liaising with the government to implement our insurance but they are slow coming to our aid. See more about the campaign, donate or find out how you can help here.

So what choice will women have after February 2014 if the government does not help us implement our insurance? Women would then have the choice of NHS midwifery care, or no midwifery care. This worries many midwives, as although childbirth is normally a straightforward biological function, it can be advantageous to have a midwife present at times when a rare complication occurs. Of course women have the right to take responsibility for their birth and give birth unassisted, but this should be an informed descision, and not one made through lack of choice or fear of NHS care. But why should women have to give birth alone to guarantee a peaceful, uninterfered-with birth?

There is hope that women will demand one to one midwifery care be available to all, on the NHS. It worked in New Zealand so could it work here? There are small pockets of case loading midwives appearing such as one to one and neighbourhood midwives but not enough to care for all women who need them. If women are denied the choice of nothing other than NHS care there would be a possibility of an underground movement of illegal midwives, or unqualified birth attendants, called to attend birthing women. There are similar situations in parts of America where women seek alternatives to institutionalised care, and again I don’t condemn this if it is what women want. Would women be able to discern if an illegal midwife has been previously trained and qualified as a midwife, or if she is a doula? Would it matter to most women who opt out of NHS care? My fear is, that like other parts of the world, those who continue to answer women’s calls to be cared for in this way will be penalised for doing so. It may come in the form of fines, bad publicity, or as in Hungary, the imprisonment of midwives. But also that women may not know if they have fully qualified caring for them if they are deemed illegal.

Taking away women’s choice of legal birth carer will not stop women making choices, it will only encourage women to make alternative and possibly illegal choices.

 

For further information on Independent Midwives see Independent Midwives UK

For Information on childbirth rights and choices see the Association for the Improvement in Maternity Services (AIMS)