Do as you’re told, dearie, or the end of independent midwifery.

I am fuming.

At the beginning of January, and with almost no warning, the NMC (Nurse and Midwifery Council) declared IMUK (Independent Midwifes UK) insurance policy not fit for purpose.

And just like that, without warning, they put an end to independent midwifery practise in the UK.

This has left many expectant mothers who had booked them (including some who were expecting to birth within the next few days) without the support that they had chosen and paid for.

What the fuck?

Who on earth decided to made such a stupid, unconsidered decision?

Shouldn’t they have given some warning? some time for independent midwives to at least, finish provide support to the women who had booked them?

As independent midwife Virginia Howes rightfully stated, if 80 male Drs were being treated in the same way ( 2 weeks notice of not being able to work and loss of income ) an action they believed to be unlawful, by their regulator, the whole country would be up in arms.

Also the 80 independent midwives in question might represent only a small fraction of the 25 000 or so NHS midwives in the UK, BUT (and that is a big but) they represent a unique service that exists nowhere else, and will disappear if they go.

I have an interest in this at both a personal and a professional level.

On a personal level, 7 years ago for the birth of my second child, I hired independent midwives.

Why did I do this? when I gave birth to my first child 11 years ago, the NHS system was different to what it is today. Community midwives in Cambridge still had case loading midwifery, which meant that I saw the same midwife all through my pregnancy. She even came to visit me at home on a few occasions. I had her mobile number so if I had any questions I could just call her. When I went into labour she was on call so she came to support me through my birth. I got to know properly and I liked her a lot.

Fast forward 3 years later, the system had changed. Case loading was no more, replaced by team midwifery, meaning you were unlikely to see the same midwife through your pregnancy, let alone know the one who would turn up at your birth.

In the meantime I had also trained to become a doula, and was halfway through my degree as an antenatal teacher. So I knew quite a lot more than before, and the idea of having someone turn up in my birth space that I hadn’t met before (read, someone I didn’t like) didn’t sit well with me at all.

So this was the deciding factor in hiring an independent midwife. I just couldn’t leave this to chance. I had visions of an grumpy  midwife who didn’t like homebirth inventing a spurious reason to transfer me to hospital. I had kind of had a taste of this at my first birth because I didn’t like the second midwife who came to join my named midwife right at the end before my baby was born.

So we hired two fantastic independent midwives, Siobhan Taylor and Amy Cole, of Cambridge midwives. I had a doula too. My husband took some convincing due to the costs, and at times I wondered if this was a little bit too indulgent. But, trust me, your birth is a very important day in your life, which is probably going to impact the rest of your life in a more significant way than your wedding day. Yet if it was your wedding day you wouldn’t think “I can’t have a honeymoon/flowers/cake since I already have a venue and a caterer” right?

Siobhan and Amy came to do all the antenatal care at my house. We got to know each other over many 2h long appointments. I developed a deeply trusting relationship with them. The respect was mutual. They respected and supported my choices. There never was a fight or dispute over my choices. It was wonderful. It was relaxed, warm and friendly. Most importantly, it meant that I was really looking forward to seeing them during my labour AND that I was completely trusting of their support. If they had said we needed to go to hospital, I would have trusted them completely. Together with my doula, Maddie McMahon, they provided the most supportive and seamless birth team ever. It was a wonderful, life affirming experience and worth every penny.

Now compare this to what women get today: they rarely see the same midwife twice during their pregnancy. Most appointments are a rushed, 10 min box ticking affair, where there is no time to ask them how they are feeling for example. They have no named midwife, and when they leave a message on the answer phone of the practise, it doesn’t get picked up until 8am the next day (I tell my clients to always call the hospital if it is urgent).  And course, when they go into labour, they have no idea who they are going to meet, and whether they will get on with them or not (I also tell my clients that they can ask for another midwife if they do not get on with the one assigned to them). I also know that this system is also something many midwifes also dislike very much, because it stops them from working in a way that is fulfilling for them too. As Milli Hill said in her recent article, it is “cattle care”.

On a professional level I am completely irate at the idea of choice being taken away from women. And having supported women who hired independent midwifes, I know how much of a difference it makes to them too.

Evidence demonstrates without a shadow of a doubt that continuity of care is safer for women, as well as being more satisfactory. The Cochrane database review concluded that

This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.”

So how does removing the rights of independent midwives to practise will affect women?

First of all, right now, across the UK, there are women who had booked independent midwives and paid for their services, and are left with no other choice than to go back to the NHS.

I can only imagine how devastated they are.

Only last week I supported a mum through a homebirth. The mum in question had had a horrible experience during her previous birth. She was treated such an appalling callous manner, that she has made a formal complaint against the hospital. Of course she then didn’t want to go back to that hospital. And because she also knew that with the current homebirth service being pared down to its bare bones she was running the risk that nobody would be available to come and support her at home, she hired an independent midwife. She had a beautiful, peaceful , healing birth at home, with the kindest, gentlest most respectful support. Luckily for her, she birthed 20h before the time that the NMC announced as a cut off date after which independent midwives wouldn’t be able to support women during labour anymore. Can you imagine how she would have felt if she had birthed only 1 day later? The independent midwife was also beside herself with stress whilst facing the prospect that she may not be able to support this mum.

It is similarly devastating for the 80 or so independent midwifes who are left with the option of not doing the job they loved and trained for, or to return to work within the NHS. I can’t see many wanting to return to the NHS because the very reasons most became independent was because they wanted to provide a different model of care to the one currently in existence within the NHS (namely, one to one midwifery and continuity of care). It most likely means that, in a system that is already stretched beyond belief, we will lose yet more midwives.

Beside making the situation intolerable for women who had booked them, it also drastically diminishing women’s birth choices and options for now and for the future.

It means that, for example, a woman who had a traumatic experience within the NHS will have no other choice but returning to the same hospital/trust care, or to birth alone It means that women whose pregnancy or birth choices fall “outside the guidelines”,  for example, women over 40 with their first baby, or women wanting to wait for labour to start naturally after 42 weeks pregnancy, women who are “too old”, “too big”, too or not enough whatever constitutes low risk within the forever tighter NHS guidelines, especially if they want to birth at home, will now find it almost impossible to find someone to support their choice without having a massive fight on their hands.

It means that women who do not trust the NHS system will probably chose to birth alone (Birthing alone is completely legal in the UK-and a choice some women make, because it feels right for them -but I feel very strongly that women choosing to birth alone should do it out of positive choice, not out of fear).

Ultimately it this lack of choice is neither safe nor desirable.

It means that many mothers planning a homebirth won’t be able to find a midwife to support them, because some trusts have stopped providing homebirth support and many other trust have reduced the service so much that many times no midwives are available to support women at home. I have written about this before.

It means that we will lose a lot of skills and experience from these amazing independent midwives. For example the only midwifes I know who are confident supporting a breech vaginal birth at independent midwives.

This just isn’t right.

So what can we do to help?

Write to the NMC-birthrights have written them a letter which you can use as a template

Write to your MP, and to Jeremy Hunt, Secretary of State for Health.

Sign this petition

Fill this survey

Join the “save the midwife” alliance -they also have template letters to write to the NMC, your MP etc.

Share this blog and help raise awareness of this situation.

  1. Dorothy Norris on January 23, 2017 at 9:17 am

    I am absolutely horrified that midwives and women have been treated this way. The insurance question is a total farce. Women can only sue for negligence. Independent midwives have very, very rarely been sued because of the time and care they take with women. They discuss the choices available to women and decide together the care that is appropriate. Women don’t need to sue their midwife

  2. Florence Bouzekria on January 23, 2017 at 11:05 am

    To take away care from vulnerable women is a disgrace. To put professional law a biding, hard working midwives out of work at a drop of a hat is criminal. This decision does not with the intention to protect or care for women, it is about control and infantilising women, taking away their choice.

  3. SARAH COSSEY on January 23, 2017 at 6:24 pm

    A wonderful blog that so eloquently reflects my personal opinions as a Doula – lets hope a legal challenge is made to this decision very soon.

  4. francoise freedman on January 23, 2017 at 6:41 pm

    Thank you Sophie for not just comments on this indespicable decision but also insights into the gradual erosion of the quality of home births in your personal experience as a mother and doula. This was long coming, but like you I just can’t believe the disrespect of discontinuing care for pregnant women, it hurts. I will send the letter to J. Hunt but believe something more is needed. Not sure what, thinking about it…

  5. Louisa on January 24, 2017 at 2:46 pm

    Thank you for writing this piece. I am due to give birth in three months and was working with a wonderful independent midwife. Currently no idea what I’m going to do and am completely bereft and utterly irate at this nonsensical and harmful decision. Shocked that my choice has been taken away from me and that I am not in control of how, where and with whom I choose to birth.

    • sophie on January 24, 2017 at 3:00 pm

      So sorry to hear this, Louisa. I really hope a solution is found before you give birth.

  6. Dorothy Norris on January 24, 2017 at 5:59 pm

    I love this very wise reflection on Virginia Howes’ IMUK page
    from Archie McIntyre

    Dear Virginia,
    Do not confuse her (your daughter) birthing with a NHS controlled (dehumanising) incident. No reflection on NHS midwives who are marvellous.

    I have taught hypnosis for childbirth to more than a thousand of them and nurses, even very senior obstetrician, in the last ten years, but they have to work within their own disciplinary parameters. They are wonderful people.

    But this is utterly disgraceful. No law forces her to go anywhere. So she stays at home till she approaches parturition as is her right. Too late then. If someone is present at that juncture and is asked by her to help, whoever that person may be, she/he can help in a private capacity just like a cabby driving to hospital who helps; or a father stopping on the road/motorway to deliver a baby, and there are many such cases.

    Insurance does not enter the equation. Ask any cabby. It is nonsense.

    Regardless of any qualifications of any individual, it is a request for help, given the circumstances, which she can request from anyone and can accept from anyone.

    It’s her body and her baby. The State owns neither her body nor her baby. This country is not yet completely Orwellian, where faceless fools decide people’s freedoms and lives.

    Let her follow her wishes, stay at home as is her right, then call as she wishes for passer-by, mother, husband, partner or friend – none for a particular medical expertise, just love, help and support.

    That would be my position and if necessary I would fight it in court and be sure of winning. I am equally certain that under the aforesaid conditions no case could or would be brought.

    But don’t be present professionally as a booked midwife (very important) – just be a person who was there and called upon.

    If further talks would help – contact me.

    And of course, as always, in the (very small) event that obstetrical help proves necessary – well that is where her NI payments over the years come in and whatever proves required happens. But that is a fall-back position and all statistics show is highly unlikely.

    Very, very best wishes.

    Archie

  7. DebB on January 29, 2017 at 10:32 pm

    It is upsetting to know that some people have so many boundaries and hurdles to overcome to achieve the most natural thing in the world. I know I was very lucky and privileged over 10 years ago to have the same (NHS) midwife consistently through my only pregnancy and support me through my home birth

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