‘Gold standard’ maternity care under death sentence

Threat to independent midwifery services posed by new legislation making insurance compulsory

An important element of Britain’s midwifery provision is under threat, thanks to a ‘catch-all’ piece of Government legislation that could mean the end of independent midwifery and of choice for all pregnant women.

The threat to the practice of independent midwifery, which complements NHS hospital-led provision, follows planned changes in legislation scheduled to become law, according to the Government, in 2008.  This will require all health professionals to have professional indemnity insurance.

This may sound very logical - after all, you wouldn’t drive a car without insurance – in fact, many people are surprised to learn that this is not the case already. However the big difference is that, while midwives employed by the NHS are insured via vicarious liability, there is simply no insurance available for independent midwives. The government knows this. It’s like them saying that it is illegal to drive a car without insurance but there are no companies who provide it. Unless independent midwives are successful in fighting this proposed change in legislation, independent midwifery will become illegal.
 
This is not because of huge claims against independent midwives – far from it. In fact the issue arose because of two claims against uninsured private dentists!, but there will be major ramifications for women and midwives if this change in legislation goes through.

Childbirth and insurance do not sit well together. Birth is unique in that occasional poor outcomes are expected, blame is often hard to prove and yet insurance payouts run into millions of pounds because life-long caring is taken into account. Insurance companies are not altruistic; they are in insurance to make profit and there is no profit in childbirth. Even if all independent midwives put money into one pot there would not be enough to cover the pay-out for one baby with cerebral palsy. 

Now, the Independent Midwives Association which represents the country’s 200-strong body of independent midwives, who are seen as a vital part of home-centered, one-to-one midwifery provision, is battling to obtain exemption from the legislation OR to ensure that affordable indemnity insurance is made available to all midwives, regardless of their employment status.

If this is not achieved, the practice of independent midwifery - which helps ease the burden on the country’s under-pressure NHS hospital-led service - will be forced out of existence. Independent midwives will disappear.

And that could mean an end to what is regarded as a ‘gold standard service’ of one-to-one care, resulting in yet more pressure being put on NHS hospital-based midwives, who are struggling to cope with demand and staff shortages as it is.

Independent midwife Amy Sutton, who jointly runs Cambridge Independent Midwives with Siobhan Taylor, says the public must be made aware of what is at stake. She says: “The sad reality is that independent midwifery services will be among the worst affected, even though the legislation was not aimed at them in the first place. The standards and recognition of independent midwifery has never been in question.”

Virginia Howes of Kent Midwifery Practice Adds: “It appears that those who are framing the legislation do not realize what is at stake. Independent midwifery could be killed off completely; taking away a service which fulfils many of the Government’s declared objectives for maternity care. The one-to-one care provided by independent midwives has been shown to result in more normal births, reduced Caesarean section rates, improved mother-baby bonding and more breastfeeding, all of which has a major beneficial impact on the health of women and babies across the country”.

How does this affect women? It does if they:
• simply want to know who will be their midwife when they go into labour and have the opportunity to develop a relationship with them prior to the birth
• are thinking of having an independent midwife for their first baby
• are pregnant with twins or a breech baby or wanting a normal birth after caesarean section; in which case an independent midwife is often the only choice for a normal approach to this kind of birth
• have had a difficult time with their first baby and are thinking of having an independent midwife for the second
• have already had an independent midwifery care and assume that they can have it again
• have a daughter who will want have babies of her own someday and want to protect her choices
• simply believe in a woman’s right to choose the maternity care she needs

If independent midwifery disappears then these choices will disappear overnight.

Independent midwives may be small in number, but what they stand for are two vital principles: choice for women in birth to be attended by a midwife they have chosen, and choice for midwifery to be practiced in the way midwives and women choose. The NHS finds difficulty in providing this.

If this proposal goes through it will mean that the only maternity care available to women will be dictated by the cash-strapped NHS and the insurance companies.
 
Independent midwives need all the help they can if they are to fight this proposed change or find a way in which they can get affordable insurance.

If we do nothing it will mean the end of independent midwifery in the UK.

NOTE TO EDITORS:

•  Since 1994, when The Royal College of Midwives chose to exclude independent midwives under its indemnity scheme, independent midwives have had no insurance available. While independent midwives feel this is far from ideal, they are fully registered and adhere to the Nursing and Midwifery Council’s professional guidelines and standards.

• Should the legislation be passed in its present ‘catch-all’ form?
it would inadvertently ‘outlaw’ the care of pregnant women and birthing mothers by self-employed midwives working outside the NHS, making their practice illegal, as they would no longer be able to register as midwives.

If you need further information, or wish to interview mothers and independent midwives, please do not hesitate to contact the Independent Midwives Association Press and Publicity team:

Amy Sutton RM, BSc (HONS)
07857382123