This week I was celebrating a friend's birthday with a big group of women. They came from many different backgrounds and quite a few had gone to the Women's March in London.
Over deep fried seaweed and rice balls (which are very nice, in case you see them on a menu anywhere) I got chatting to a civil servant and once she realised my background she said, 'oh you must hate Jeremy Hunt too, then'. I replied that I didn't hate anyone.
I am, however, concerned with the rights of women, particularly their childbearing rights and my conscience wouldn't forgive me if I didn't speak up.
Midwives tend to be the most sensible, humble, responsible, self-sacrificing, hardest-working, busy, and devoted people on the planet.
This is why I'm excited when I see midwives taking political action because these qualities are, in my opinion, what's lacking in the way governments are run.
This week I've seen many letters and posts from midwives and others who have had enough in terms of the independent midwives' crisis and other concerns in midwifery.
I wrote and complained to the NMC about independent midwives' current inability to give labour care and am now progressing to the second stage of the process. I've got quite a few emails about this and a few wanted to know what I put.
I hope you can use my own letter to write your own, it's attached at the bottom of this post.
The independent midwives' crisis is concerning. I don't want to minimise that.
But also I think the global time of change and awareness of women's rights we are experiencing is exciting.
I want to give you courage and confidence in the movement of maternity care towards dignity, equality and choice.
4.8 million people concerned with women's rights have just got very political in terms of the Women's March and this situation seems to me to fit in with that voice.
Maybe we are waking up.
Maybe the good that will come of this adversity is that midwives will be more politically aware than before and that opens up new possibilities.
In a democracy, you can't get into trouble for complaining about the actions of a government body.
We can, however, find ourselves in a lot of trouble if we don't speak out about women's rights early and loudly.
And of course, women's rights are human rights.
If you can't get involved right now, that's ok, I have a fair amount of responsibilities too and I get it.
But please know how powerful you are in terms of sharing the message of what's going on in the midwifery world.
Leave me a comment below with any thoughts or correspondence you have in terms of this situation.
I'd like to leave you with this quote that for me sums up the pragmatic approach of midwives appealing this decision:
'How wonderful it is that nobody need wait a single moment before starting to improve the world.' - Anne Frank.
You can also join the Women's Equality Party, see the student and reduced income options.
Have a wonderful week,
I have the privilege of an education and a public voice, something most women in the history of the UK have not had. I take this responsibility seriously and therefore I must state my concerns.
I have been a practising midwife in the UK and New Zealand and currently run a support group of around 13,000 aspiring, student and qualified midwives.
I am aware of the legal background of indemnity insurance and understand the need to safeguard women and families.
I have taken a broad range of views into consideration including those from NHS midwives, independent midwives, obstetricians, civil servants and clients accessing maternity care.
After consideration, I believe that independent midwives not being able to offer labour care based on your recent decision to be unethical and deeply wrong. The NMC may have excellent intentions in terms of ensuring indemnity cover but in haste, may have overlooked the bigger issue of controlling what a woman can or cannot do with her body in labour.
The European Court of Human Rights has held that women have the right to autonomy during childbearing.
Professor Ann Oakley, an acclaimed sociologist, stated in her seminal work Women Confined that a core question in maternity care is ‘who owns my body, myself or the state?’.
It is not a government body’s role to decide what women choose in labour.
This NMC’s decision also seems in contradiction to The Lancet’s definition of a midwife:
“… (part of a midwife’s role is to give care) respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families.”
Making this decision for women is paternalistic and robs them of these capabilities.
I also have concerns in terms of the practical impact of your decision:
- Independent midwives often take clients with complex needs, relieving the burden on a short staffed and underfunded NHS. Their care is in line with current recommendations from Better Births and MBRRACE-UK. They are currently unable to do this.
- Independent midwives often lead practice, with important trickle-down effects – see this MIDIRS case study of outstanding care of a young woman able to have the birth of her choice in a bereavement situation, with ongoing positive impact on her and her family’s health.
- Many women who have chosen an independent midwife based on their psychological and physical needs being unmet by NHS care are currently forced into considering free birth, something I know that a UK government body with the interests of women and babies central to its function will be exceptionally concerned by.
- And I refer you to this excellent letter from midwife Hannah Thompson who has outlined the pathway of clients most affected by your decision
I am furthermore confused by the NMC being able to identify that current indemnity insurance is not adequate, but not identify what would be. Given the qualifications and experience of staff at the NMC, it would seem well placed to specify what indemnity insurance must include.
If this insurance is now neccessary based on the government requirements added in 2014, it may be a wonderful opportunity for the NMC to be part of progressive and excellent maternity care for women and families, perhaps a step towards the midwife-led models of care shown to have such good outcomes in last year’s Cochrane review.
Admitting a decision was not optimal is difficult but I believe it can be the strongest, most respected move possible. I ask whether this could be part of the NMC’s four-year Transformation Programme.
I know the NMC is focussed on ensuring the confidence and wellbeing of women, families and midwives so I hope for a speedy resolution.
In particular, this resolution should include the steps identified by the charity ‘Birth Rights’:
- 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 will not face disciplinary action for fulfilling their midwifery role
- Urgently making a public recommendation on what constitutes adequate insurance.
On a final note, I am very happy to work with the NMC in terms of communicating with the members of my community. We often have ‘Q and A’ sessions with experts and perhaps a member of your team could come and chat with us for an hour or so to discuss some of these issues.