INDEPENDENT midwives are calling for the UK government to underwrite their high-risk professional liability exposure before incoming legislation makes the way they operate illegal.

Hundreds of independent midwives could be forced to quit their jobs or go to prison under new rules drawn up by the Department of Health (DoH), which would make it illegal to work without liability insurance. The rules under Section 60 of the Health Act 1999 were originally due to come into effect in mid-2008.

National Health Service (NHS) midwives receive protection from the NHS Litigation Authority and currently 80% of the authority’s costs relate to obstetrics - the branch of medicine concerned with childbirth - with individual claims running to millions of pounds.

Independent midwives, who are not covered by the NHS, have been unable to source cover from commercial insurers because of the size of potential payouts and the small numbers of independent professionals.

They therefore have had no choice but to work without professional indemnity (PI) cover and have been advised by the Nursing and Midwifery Council (NMC) to make their clients aware, from the outset, that this is the situation.

Campaigners say the lack of commercial options could drive midwives from the independent sector - hailed as the gold standard of their profession - into extinction. Midwives worldwide face a similar dilemma. In Canada the government stepped in as insurer of last resort in 2003, providing cover via the not-for-profit Health Insurance Reciprocal of Canada.

Jane Evans, of the Independent Midwives Association, wants the British government to do the same. "This now seems to be the only realistic way we can continue to work independently. We are not a commercially viable option for insurers because there are so few of us and the risks are perceived to be high.

"When the chief nursing officer, Christine Beasley, met us we asked her whether we were all going to go to prison. She said we would be ‘fitted in’ (to the clinical negligence scheme for trusts) somehow. But we don’t just want to be fitted in.

"We are keeping the old skills of midwifery alive because we are not restricted by protocols and policies of clinical negligence cover for NHS staff. Instead, we work to the rules and the codes of the NMC, which means we can give women broader options such a normal birth for breech babies rather than Caesarian. We’re giving women choice."

Commenting on the rules, a spokesman for the DoH said: "The policy was first introduced in 2005 to ensure that the public was protected in the event of a claim against any healthcare professional for negligence/harm. We recognise that this is particularly challenging for independent midwives, because they are unable to source PI insurance commercially. We know that they have left no stone unturned to find insurance."

He would not comment on the proposal that the government step in.

The British Association of Insurers (ABI) met the government’s chief nursing officer this week to discuss the crisis, which was first reported by Insurance Day in April (IDnewscentre, Apr 13). Commenting on that meeting, an ABI spokesman said: "With relatively few independent midwives around and the potential risk so great it is very difficult for insurers to build up any claims data. That is why cover is virtually impossible to get. It is very rare for the market not to be able offer some kind of product - something always tends to be available somewhere."

Heidi Dore

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