On 18th and 19th October, members of IMUK (the membership organisation for independent midwives in the UK) will bring to court their judicial review of the Nursing and Midwifery Council’s decision that their indemnity cover is inadequate.
In January Birthrights wrote to the NMC to express concern about the decision stating that their actions “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”
Ahead of their court date, IMUK Chair Jacqui Tomkins has shared her thoughts and hopes in this guest blog.
I became an independent midwife almost 20 years ago. It has been an overwhelming joy to be able to determine my own volume of work and to work with women and families that I can take the time to listen to and get to know very well. This has also been hugely beneficial for my family who know that I will be at most of the big family events we want to share but if I do have to miss the occasional celebration they are to be found helping me pack the car inan excited state as I get ready to help another family welcome in their newest family member.
I work with a collective of like-minded midwives who provide me with a wealth of knowledge and skills that are fast becoming lost to us as a profession and ultimately to women. We have a supportive network that holds us and lifts us when it’s needed and allows us all to thrive in a supportive and emotionally intelligent environment. It’s not all unicorns and rainbows but it is a safe space to work within and its the way forward for a lot of midwives who need to feel they can provide the care they have been trained to give with the time needed in order to give it.
This way of working is so important to me, my colleagues and the women we work with as we all value the relationship that is at the centre of this very important life event. The women I have helped look after in the past and the present are shocked to understand that this right to choose for them, but also for midwives, is at risk of being lost forever. So many women have been telling me that they feel they have nowhere left to turn as for various reasons they feel they cannot use the local maternity providers. As Chair of IMUK I have also been hearing about how some of those women have made the difficult decision to birth alone during this enforced period of redundancy for self employed midwives. This is the most terrible consequence of the decision made around insurance supposedly and in the name of public protection as these woman had not set out to do this.
As an organisation we are ready to move forward and resume our plans to help with the training of student midwives and help the government to deliver the vision of “Better Births” by supporting pilot NHS groups and continuing to work closely with NHS England.
Overwhelming throughout the struggle for independent midwifery to survive, my concern has been both for the midwifery profession generally but also the thousands of women per year who seek out our care. This woman centred model gives women a skilled and safe option for their care, with a guaranteed assertion that they will know who is coming to support them on the day and that they trust that person implicitly to be able to turn up and of course will respect and protect their carefully thought out choices.
The importance of clinical autonomy is fast being eroded within employed models and self employed midwives understand that this is the thing we must protect and enshrine within our profession at all costs. That is not to say we do not work collaboratively with other health professionals, we are very skilled at communicating our clients needs and best interests so will be making appropriate referrals and accompanying women when they need to make alternative care plans for their pregnancies and births.
Midwives are fast becoming a scarce commodity so it makes no sense to remove the right to be self employed from the profession. We need help and support to be able to continue to practice and for there to be an understanding that these issues highlighted in court this week are not about safety but about finances. Finances that have been confirmed by two independent actuarial firms to be perfectly adequate for our scope of practice.
Four years ago when this board of IMUK decided not to accept the future in front of us, we had only midwifery experience between us. Since then, the team and our members have been joined by supporters and experts from all walks of life, almost all of them having previously benefitted from independent midwifery in some way. We have become very knowledgable about insurance, both its benefits and its restrictions, we have experienced the political arena, press and legal worlds all of which have given us surprising new life skills but most of all I’m proud of how far we’ve come as a small group of health professionals with a big problem and my hope is that next week we will find out that it has been enough.
Following the recent NMC decision on the indemnity cover that IMUK members have taken out, Birthrights has been working to support women who now find themselves without the midwife of their choosing. I wanted to give you an update on what we have been doing to help and to respond to some requests for information.
Letter to the NMC
As you may know, I wrote to the NMC’s Chief Executive, Jackie Smith, as soon as the decision was made public to express my concerns and ask for clarification. I have now received a response from Ms Smith and am asking the NMC to allow me to make that response public. I hope to share it with you in due course.
I now have permission to share Jackie Smith’s response to my letter. You can read it in full here.
In the meantime Birthrights posted some information with suggestions about how independent midwives might seek honorary or bank contracts from their local NHS Trusts to enable them to continue to care for indviduals already booked with them. While some Trusts have been able to grant these contracts, others haven’t. I am in the process of writing to Heads of Midwifery who have refused to grant contracts to independent midwives along with the Trust Chief Executives and the MSLC chairs.
In my letters I am making it clear that NHS Trusts (and Head of Midwifery post-holders as Trust employees) are under a legal obligation to facilitate women’s right to make choices about birth (Human Rights Act and Article 8, European Convention on Human Rights). In order to discharge their obligations lawfully, they must diligently consider all the mechanisms in their power to enable women’s choices and decisions in childbirth to be respected. I am informing them that they must consider the individual circumstances of the woman and her particular situation rather than invoking a blanket policy, and insisting that when the Trust has made a decision it must give its full reasons for their decision and these reasons must be clearly justified.
Given that some Trusts have swiftly been able to arrange honorary and/or bank contracts with local independent midwives in this situation, it is not clear what justification other Trusts have for refusing to grant a similar arrangement. So, I am asking them to consider their legal obligations carefully, to investigate how other Trusts have been able to accommodate independent midwives and to reconsider the options available.
I have also included some information about the likelihood of some women feeling forced to freebirth, particularly in the absence of any equivalent provision for continuity of carer within the local NHS services. And I have expressed an urgent concern about the avoidable harm that could come to women and babies in this situation, as well as the difficult position that Trust staff could find themselves in should a disengaged and fearful woman need to access emergency care in labour or the broader perinatal period.
In these circumstances, the granting of honorary or bank contracts may represent the only way for vulnerable women to access any maternity care at a critical time in their pregnancies.
Concerns about midwives attending the births of friends and family
There has been recent publicity, linked to the independent midwives’ situation, concerning the legal position for all midwives attending a close friend or family member in the intrapartum or broader perinatal period.I am aware that, until now, it has been perfectly routine and accepted practice for midwives to attend their close friends and family members in labour, both in a supporter role and as a practicing midwife.However, Birthrights is not in a position to give legal advice to those seeking clarity on the current legal position on this matter. We suggest that midwives contact the RCM, the NMC and speak to their NHS Trust to get clarification on the situation in their area and their particular circumstances.
We will continue to do all we can in public and behind the scenes to support women and their midwives at this challenging time.
Birthrights strongly criticised today a decision by the Nursing and Midwifery Council (NMC) that prevents many independent midwives from caring for women in labour. The decision (which relates to the level of indemnity insurance arranged for many independent midwives by their umbrella body, IMUK) has resulted in the regulator instructing pregnant women to make immediate alternative arrangements for their birth care.
In an urgent letter to NMC chief executive Jackie Smith, Birthrights CEO Rebecca Schiller said that the NMC’s actions, “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”
Schiller adds that “the NMC has a key role to play in protecting public safety, yet this decision directly jeopardises the health and safety of the women it is supposed to safeguard. Beyond the very real physical health implications of this decision, it is causing emotional trauma to women and their families at an intensely vulnerable time. To date, it appears that the NMC has shown no concern for the physical and mental wellbeing of pregnant women who have booked with independent midwives.”
In the letter, Birthrights highlights the unnecessarily tight timescale imposed by the NMC and lack of attempt to communicate what constitutes adequate levels of insurance. Schiller expresses her concern that some women will now feel forced to give birth alone adding, “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.”
Birthrights is urging the NMC to remedy the damage caused to date by taking urgent steps that include:
- Guaranteeing that all women who are currently booked with independent midwives using the IMUK insurance scheme will be able to continue to access their services
- Reassuring Birthrights, IMUK and the women who have already engaged the services of independent midwives that the midwives caring for them them will not face disciplinary action for fulfilling their midwifery role
- Urgently making a public recommendation on what constitutes adequate insurance.
Today is the final day for responding to the Department of Health’s consultation on mandatory indemnity insurance for all healthcare professionals. As Birthrights regulars will know, implementation of the proposals will spell the end of independent midwifery. As we have explained in our response, the loss of independent midwives will have serious repercussions for women’s choice in childbirth, as well as threatening the safety of mothers and babies. If you haven’t sent your response in yet, we encourage you to do it now.
You can download our response here: Why Independent Midwifery Matters