URGENT - INDEPENDENT MIDWIFERY UNDER THREAT
Independent midwives are fully qualified, registered midwives who work on a one-to-one basis giving private midwifery care in the UK - more details below. Most of them specialise in homebirth and many are experts in areas such as natural twin or breech birth, and they generally pride themselves in keeping at the forefront of evidence-based care and giving mothers genuine support. This service is under threat in the UK. The government is proposing to make it compulsory for all health professionals, including independent midwives, to have professional indemnity insurance (against negligence claims). At present there is no such insurance available for independent midwives in the UK, and the government has refused to provide any. They are effectively proposing to make it illegal for midwives to work on a self-employed basis. This is an outrageous restriction on choice for women and midwives - having insurance would not improve outcomes for mothers or babies. For more on this issue, and how to campaign against the government's proposals, please see the 'Save Independent Midwifery' campaign website and the campaign page on the Independent Midwives' Association website. You can also sign a petition on the 10 Downing Street website.
Independent midwives are fully-qualified, carefully-regulated midwives who work on a self-employed basis outside the NHS. Most of these midwives specialise in home birth, and they are often experienced in more complex cases such as home birth after caesarean, or breech or twin birth at home or in hospital. Because independent midwives specialise in working in the home, they take great care to keep their emergency skills up-to-date and are usually very passionate about their job, and about supporting women's choice. We are very fortunate in the UK to have this legal, but independent, choice.
There are many midwives working in the NHS who are also passionate about their jobs, committed to supporting women's choice, and who provide brilliant midwifery care. However, for the majority of women in the UK, community midwifery services are provided on a team basis and you may not know which midwife will attend your birth. There is currently a campaign to provide one-to-one midwifery care on the NHS - the One Mother, One Midwife campaign - which would offer NHS midwives the opportunity to work on a caseload basis if it suited her. Please visit the OMOM website for more information and to find out how to support this campaign.
(www.onemotheronemidwife.org.uk)
You might consider an independent midwife if:
Independent midwives usually provide all your antenatal care in your home, as well as attending the birth and visiting for up to a month afterwards. They can refer you for scans and other antenatal tests, which will normally be provided on the NHS in your local hospital. They can also refer you to an NHS obstetrician if you need obstetric assessment. Many independent midwives can also attend your birth in hospital if a transfer becomes necessary, although this varies between areas.
In some areas you may have a choice of independent midwives - in London and the South East there may be three or four practices which cover your area. Many midwives have quite different approaches, and if you have a choice, it is best to meet with all the midwives you could use before making your decision. Are you looking for a midwife who will be hands-on, and guide you through every step of labour, or would you rather that she sat in the corner and did not touch you or your baby unless there was an emergency? Who do you feel most comfortable with? Which member of the practice would actually be attending your birth?
Depending on the area you live in, fees may be from £1,800 to £4,000, average around £2,750 (prices in 2006). Some allow you to pay in instalments, perhaps over a year or more. The fee will also depend on how much antenatal care you require and the stage at which you make your booking, and on how long you would like the midwife to keep checking on you and your baby after the birth. There might be different rates for two weeks of postnatal care compared to four, for example.
Some independent midwives are very flexible about fees - there are some families who keep an ongoing direct debit for a small amount every month, regarding it as a sort of 'insurance policy' for future babies! Some midwives come to an arrangement where clients (or their families!) pay partly in goods or services. Fathers who are decorators, builders, plumbers etc.. are particularly in demand! It is always worth asking - it may be that if a midwife is having a quiet period, she would rather earn a reduced fee than no fee at all. Please don't feel embarrassed about asking - it's common to hear from midwives that they wish women would just make contact, even if they think they can't afford to pay. Because many IMs are passionate about their jobs, some will also take on 'special cases' on a greatly reduced fee basis because of the experience it offers them, or because they feel strongly that a woman should have the support she needs. Clearly this can be a delicate balance - midwives are not always in a position to offer concessionary rates, but if you don't ask, you won't find out.
Many of the women who hire independent midwives are by no means well off, but they believe it is worth making sacrifices to give themselves and their babies the best chance of the birth they want. If you run into real opposition within the NHS, you may feel that it is worth spending the money just to avoid stress and conflict, and to feel that you can fully trust your caregivers whilst in labour.
It's common for mothers to feel that they cannot justify the cost of an independent midwife, even if they can find the money. That's fine if you are happy with the service provided by the NHS in your area. I have been in this position myself for the births of my first four babies. It is also common for women to say that they can't bring themselves to spend all that money on "just one day". But most people spend a lot more than that on their wedding day - and the "just one day" of birth is far more important for the health and happiness of your family than the flowers and venue for your wedding reception! It's not being selfish - if the mother is happy, the rest of the family is more likely to be happy. And it's not "just one day" - it's all your antenatal care as well, plus the postnatal period, and it will be important for the rest of your life. What price peace of mind?
Independent midwives are not for everyone - some women prefer the greater anonymity and perhaps sense of distance that they may get with a large community team, while in other areas, NHS community midwives provide such a great service that an independent midwife may seem simply unnecessary. But if the option does appeal to you - we are very lucky in the UK to have such a range of committed, and well-qualified, professionals - make the most of them!
Why I hired an independent midwife, by Diana Clement : "I'm someone who thinks twice before spending 50 pence. So it may seem odd that I'd pay £2,000 for a service I could get for free from the NHS....." Diana explains why the difference in attitude meant it was worth it.... (Read Diana's article here)
In my first pregnancy my community midwife becoming more twitchy as my due date approached, especially after a routine blood test at 34/35 weeks showed I had a low platelet count, which meant that my blood may not have clotted quickly enough and had I had a PPH at home I might have "bled to death" or something similar !!
I was not at all happy at this stage about going into hospital and ultimately decided to book with an independent midwife. I had to pay the full whack (£1900) as the majority of their work comes around the labour rather than the antenatal care and, although I had the money saved, it was a big decision to make. I would have to say though that it was the best money I have ever spent.
From that moment onwards all worries were taken away from me and my midwife was superb in researching my "problem" and helping me with ensuring that at least my count didn't fall any more. I had a brilliant standard of care and I believe the best birth experience that it was possible for me to have.
Having total confidence your midwife is so important. Maybe I could have had my son at home on the NHS with no problems - I'll never know; but I knew that if my independent midwife said I had to transfer I would have done so without a doubt. Had the community midwife said the same, I would always have been left wondering if I had to go in for my benefit, or for her lack of confidence in delivering me.
I think it's disgusting that the standard of care in the NHS meant that I had to go the private route, but I would thoroughly recommend it. Peace of mind in the late stages of pregnancy is very valuable.
When we had our first baby, we desperately wanted a home birth. Our midwife supported us all the way, and went far beyond the call of duty when we ran into complications when my wife's waters broke and the hospital wanted to keep us in. We went home and Meg went out on a limb to support our needs. In the end we had our home birth, and this was down to Meg.
David Seymour
I had heard so many stories about women being told they weren't "allowed" a home birth or had to be induced or have a caesarean that as soon I found out I was pregnant with Chelsea I decided to book with an independent midwife.
I was so glad I had an independent midwife because it meant that there was no pressure from health professionals to be induced, although I did receive some negative comments by well-meaning acquaintances about the risks of going overdue (Jo-Anne went over 43 weeks!)....Sarah arranged for me to attend hospital for a biophysical profile. I was glad she accompanied me to the appointment as I had visions of being admitted and induced, but the consultant who performed the scan was lovely and the scan reassuring, so Sarah went home with me to do another stretch and sweep.
Jo-Anne (Read her full birth stories)
From Oddny, whose second baby was an undiagnosed footling breech:
I was going to go on the NHS as I thought that I could do this without having to pay for it (having had an independent midwife with our first baby), but my husband convinced me to hire the independent midwife again with the reason that since we had a great birth last time why spoil 2nd time around if something were to happen. For that I'm eternally greatful as I would have not liked to be in that situation with an inexperienced midwife.
Joy Mottram's second baby, Malachi, was born at home at 43+3 gestation, weighing 10lb7oz. Joy had some trouble with an unsupportive NHS midwife in late pregnancy, so she delayed calling a midwife on the day; she is unsure whether she would go through the "Russian Roulette" of NHS maternity care again.
Nataliya did not originally consider homebirth, but was unhappy with her local NHS hospital's approach, and the private alternatives when she wanted a second VBAC. She had a straightforward homebirth with independent midwife Deborah Jackson.
Many independent midwives provide other services as well, which may be useful if you cannot afford to book them as your primary carers. For example, they may run local antenatal groups, workshops or seminars on active birth, home birth, water birth etc, which are open to all women and not just their clients. They will be well acquainted with resources for pregnant women in the area, and many will provide one-off consultations to discuss your options, or if you want a second opinion, for a small fee.
Please note that I no longer link to individual independent midwives' websites as the IMA website is now so good, there is no need for me to duplicate this information. I will still be linking to individual midwives' websites from birth stories, where that midwife gives permission. If you are a midwife and one of your clients has her birth story on this site, please contact me if you would like a link added from the story. You can reach me on angela at homebirth.org.uk .
The Independent Midwives Association has a list of independent midwives in the UK and you can search by postcode to find the midwives nearest to you.
(www.independentmidwives.org.uk)
Home birth with independent midwives is an article on iVillage by Clare Winter, herself an independent midwife in the UK.
Putting Mothers and Children First, by Eliza O'Driscoll - article about private maternity care, independent midwives, doulas and postnatal paid help, from the Daily Telegraph, 17 August 2001
You might also be interested in the article on this site about Doulas (professional birth assistants).
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