Save Independent Midwifery Campaign

Introduction

Independent midwifery may have less than a year to live.
All independent midwives have been sent a letter by the Chief Nurse, with the information that the Government is intending to pass legislation to make professional indemnity insurance (PII) a prerequisite for registration. In parallel moves, the European Parliament is also considering similar legislation. Although the initial impetus for this legislation arose because of uninsured members of other professions, it will have a far bigger impact on midwives, because there is no PII available to independent midwives. This legislation will therefore impose a condition on their practice which it will be impossible to fulfil. Independent midwives will no longer be able to register as midwives and they will be committing a criminal offence if they continue to offer care to pregnant and birthing mothers.

Background
Independent midwives practise outside the NHS, usually not because of a desire to have private clients but because it has become increasingly difficult within the NHS to provide the standard of woman-centred, autonomous midwifery practice they wish to give. They are specialists in normal birth and use midwifery skills unfettered by Trust policy and protocols, which are often obstetric-led and therefore focus on the abnormal. Independent midwives are subject to the same requirements as any midwife to practise within the Nurses’ and Midwives’ Council (NMC) Rules and Code of Conduct and they fulfil the same requirements of professional updating and supervisory reviews. They are free to practise within any geographical boundaries and to choose their own case-load. They give one-to-one care, working intensively to give parents information so that they can make informed choices throughout the antenatal, intrapartum and post-natal periods. The number of independent midwives fluctuates but is currently around 200; most now care principally for women planning home births. The concerns surrounding indemnity insurance and liability have already resulted in a restriction of choice for women as the provision of honorary contracts to allow independent midwives to care for their clients within NHS hospitals has by now all but disappeared.

Up until 1994, all midwives were covered by the Royal College of Midwives (RCM) indemnity scheme, regardless of their area of work. Midwives within the NHS were also covered by their employer’s vicarious liability. However, in 1994 the RCM withdrew insurance cover from independent midwives amidst much controversy, and although there were one or two insurers willing to offer cover at first, the premiums rose to £15,000 per midwife per year and the number of providers fell over the next few years until 5 years ago, the last provider withdrew from this market and since then there has been no insurance available to independent midwives in the UK. Four years ago, the NMC proposed to make insurance a ‘requirement’ for registration; a campaign then resulted in it becoming a ‘recommendation’ and every midwife practising without insurance therefore has an obligation to make the implications of the situation clear to every client she or he books. Independent midwives are not happy to be forced to practise without insurance but have had to accept it as the only way to be able to continue to practise. The Independent Midwives Association (IMA) has continued to campaign publicly and negotiate privately with innumerable insurance providers over the years, all to no avail.

The IMA has also thrown much passion and energy into drafting the NHS Community Midwifery Model, a case-loading model which provides for one-to-one midwifery care for NHS clients and would provide an ideal framework within which the NHS indemnity scheme could be extended to independent midwives. However, proposals to explore the development of the scheme, work out model contracts and create service level agreements within the Social Enterprise Unit’s Pathfinder scheme have been rejected.

What Could Happen
If the Government’s current proposal becomes a reality, the death of independent midwifery will not only have an impact on those midwives who will lose their livelihood. It will reverberate throughout the profession, as independent midwifery is seen as a vanguard and a beacon to all midwives (Kirkham, 2003). It will at a stroke remove from practice a group who fulfil many of the Government’s declared objectives for maternity care – the Maternity Services module of the National Service Framework calls for ‘real choice’ and ‘flexible individualised services’. The care offered by independent midwives has the best possible outcomes for mother and baby, both short and long term, and is held up as the gold standard of maternity care. It results in more normal births, reduced caesarean section rates, improved mother-baby bonding and more breastfeeding, all of which has a major impact on the health of women and babies across the country. Independent midwives also consistently provide high rates of normal births even to women usually classified as ‘high-risk’ ( Milan, 2005). It will impact on women, whose choices will become the poorer. Women who want one-to-one care with a known midwife will find it much harder to obtain it. Women who want to give birth naturally to their breech babies, their twins, their HBACS, will be less likely to find support (unless they are lucky enough to live in the one of the few NHS areas that offer these things, but they are rare) as independent midwives are one of the last repositories of these valuable midwifery skills and keep them alive through research and skill-sharing. If independent midwifery care is no longer available, a small but growing proportion of women will choose to give birth alone, which is the most dangerous option of all. Reliance on insurance cover is by no means synonymous with good practice, as has been seen in other countries, and frequently leads to defensive procedures, driven by policies deemed acceptable by insurance and legal officials, rather than by evidence based and client centred care.

The Campaign

The IMA is therefore launching a campaign with the support of other stakeholders in maternity care such as AIMS, ARM, and NCT, to fight for the survival of independent midwifery. We will be lobbying for the Government either to ensure that affordable indemnity insurance is made available to all midwives, regardless of their area of work, as has been done in other countries, or to exempt independent midwives from the requirement to have PII. We will be seeking to bring the situation to the attention of all midwives, as this will have an impact on every midwife, not just those who currently practise independently. We will be working with the support of mothers and families, whose choices in childbirth ill be seriously restricted by the Government’s proposals. We will be fighting not only for our own survival but for the survival of choice and control in birth for women and midwives.