I'm busy working on my blog posts. Watch this space!
Rock and a Hard Place; Part One
January 17, 2017
This week has been exceptional in terms of midwifery care and women’s rights to choose who they want at their birth. It’s all over Facebook and there are various petitions doing the rounds but do you actually know what’s going on? If you’re anything like me you might have a tendency to skim articles when you’re in a hurry, so here’s the lowdown in quick bullet points.
1. The Nursing and Midwifery Council (NMC) announced on 13th January that independent midwives who are members of Independent Midwives UK (IMUK) do not have sufficient insurance cover to keep working. This decision has been brewing since August 2016, when a provisional ruling was made, which became final in December 2016. IMUK is regulated by the NMC and are legally bound by its decisions.
2. What prompted this decision by the NMC? A complaint, that’s as much detail as we’re given:
Following receipt of a complaint, the NMC’s Registrar investigated the appropriateness of the professional indemnity arrangement relied upon by independent midwives who are members of IMUK.
This investigation resulted in the NMC deciding that the IMUK scheme is not appropriate because it is not able to call upon sufficient financial resources to meet the costs of a successful claim for a payment of damages for a range of situations. These include rare cases of catastrophic injury, such as cerebral palsy. This could have the effect that mothers and babies who suffer injury through the negligence of an attending midwife are not properly compensated for their injury.
…. The NMC supports a woman’s right to choose how she gives birth and who supports her, but we also have a responsibility to make sure that all women and their babies are provided with a sufficient level of protection should anything go wrong.
3. As things stand at the time of writing it’s illegal for an IM to provide care until they change their insurance cover. IMUK have published their response to the NMC’s decision:
We are confident that the indemnity arrangements that are in place for our members are appropriate and that they comply fully with the requirements of the law.
We have been advised that the decision the NMC has taken is unlawful and some individual members of IMUK are pursuing a legal challenge; their solicitors are awaiting a formal response from the NMC as to whether they will withdraw their decision. We cannot comment further on the proposed legal proceedings at this stage.
4. Not to be left out, the Royal College of Midwives have issued their own press release, which is understandably somewhat peevish in tone, given that they haven’t been consulted at any stage of the proceedings. They’re only the trade union and professional organisation for all midwives, that’s all….
The RCM has not been party to this investigation by the NMC and so cannot comment on how their decision has been reached. This is undoubtedly a very difficult situation for the midwives affected and the women they care for.
It is true that midwives who cannot access adequate indemnity can continue to work either in the NHS or with small groups of midwives who have adequate insurance cover. It is however clear that the affordability of adequate indemnity insurance is potentially a significant barrier for some independent midwives.
5. The CEO of the charity promoting human rights in childbirth, Birthrights, responded with an open letter to the NMC. Rebecca Schiller wrote:
Many women choose the care of an independent midwife because they are unwilling to access NHS services, often because of previous traumatic experiences. Without the support of their chosen independent midwife, women have already told us that they feel their only option will be to birth without any medical or midwifery assistance. We hope that you will share our urgent concern about the avoidable harm that could come to women and babies in this situation.
So there you have it, consider yourself up to speed!
If you’re currently under the care of an independent midwife she will no doubt have been in touch with you to discuss your options, which pretty much boil down to ‘choosing’ NHS care or ‘choosing’ to freebirth. You're stuck between a rock and a hard place. In my mind these aren’t choices at all, if a woman has gone to the expense of hiring an independent midwife (£4000 is a ballpark figure) then you can be damn sure that she’s put some thought into it and made a carefully planned and informed decision.
So if women really don’t want to be under NHS care what other option is there? Freebirth. Also referred to as unassisted birth, however the term freebirth is generally preferred within the community of women who birth this way. Freebirthing is quite simply choosing to give birth without any medical staff present. You may be reacting to this with utter horror, curiosity or excitement. As a doula I’ve attended planned freebirths because I always support the choices of my clients. As a side note, I rather enjoy them, the atmosphere is serene, undisturbed and quite different from other types of birth. There are undoubtedly risks in declining the attendance of midwives, but women who choose to freebirth take the responsibility for this and they don’t do so lightly.
You might be wondering if this is legal – well yes, it is, with the following caveats:
The mother has full mental capacity; and
Nobody present acts as if they were medically trained. So for example as a doula I couldn’t legally perform any medical tasks such as suctioning the baby’s airways or checking the mum’s perineum. If a person is found to have done this they can be prosecuted and fined up to £5000.
There’s a lot more to be said about freebirthing and I’ll cover this next week in the second instalment of this blog. I’ll talk about reasons for deciding to freebirth, the demographic involved and provide resources if you want to investigate further.
If you have any specific questions please leave a comment below and I’ll address them in Part Two.