Dame Karlene Davis, General Secretary of the Royal College of Midwives, says England will need the equivalent of 22,000 full-time NHS midwives to deliver the plan. "The College believes that it is being realistic about how quickly this could be achieved, and we want to see the equivalent of at least 20,000 midwives by 2009, rising to at least 22,000 by 2012," she tells.

But there is a national shortage of midwives and, in a parallel move, the Government and the European Parliament have put forward proposals that could remove 200 independent midwives from the Nursing and Midwifery Council and make them illegal. The plans would require independent midwives to have professional indemnity insurance as a requirement for registration. However, for the past five years no insurers have offered professional indemnity insurance to independent midwives.  The Department of Health says the Secretary of State will consult "appropriate persons" before introducing legislation making Professional Indemnity Insurance mandatory for midwives and other professions.

However, the Independent Midwives Association says "Whilst this is a move in the right direction, it does run contrary to previous communications from the Department's Chief Nursing Officer and the Midwifery Advisor that a policy had already been introduced in 2005. We shall therefore be seeking further clarification of this because the problem will not go away."

Virginia Howes, an independent midwife from Kent Midwifery Practice warns that, in order to survive, independent midwives will need contracts with PCTs. Working with the Independent Midwives Association, midwives have considered becoming a social enterprise and have developed an NHS Community Midwifery Model which would run alongside the NHS model where money follows the patient.  "We have developed this model and it should allow us to contract with PCTs," says Ms. Howes. "Our suggestion is that it sit alongside the current NHS provision and be available to any midwife interested in working in this way and to women who would like to have genuine continuity of care.

Ms. Howes explains that the concept is simple: when a woman falls pregnant, she would have direct access to a list of midwives local to her, She contacts them,  meets one or two and chooses the one she feels most comfortable with. That midwife then enters into a standard contract with the NHS which pays on a set fee per case basis.  The arrangement would be the start of a relationship between the midwife and the woman which could develop over the pregnancy and provide a foundation for an equal partnership based on trust, she tells.

"This makes for good outcomes and positive experiences for everyone involved and it isn't just about home births, the midwife would have full access to NHS facilities so her client could choose the place and type of birth that most suits her needs.  It would be available to those women who want it  no matter  where they live or what socio-economic class they come from," she says.

Ms. Howes is also campaigning to pressure the Government to exempt independent midwives from professional indemnity insurance or for the Government to provide an insurer who is prepared to cover independent  midwives  at a reasonable cost.  Previous costs have averaged  £15,000 per midwife per year