Most of us are in the middle of study or practice and getting ready for Christmas and are incredibly busy, but still wanting to know what’s going on with Independent Midwifery, so here we go. I don't know how to put a positive spin on this so I'll just tell you what I know.
*Please see the updates at the end of the post.
The court case started last month and was about the Nursing and Midwifery Council’s decision to end UK independent midwifery based on finding the insurance model lacking. This is for 'intrapartum' (labour and birth care).
This insurance is important as you know because if a mistake is made in midwifery care, money might be needed for potentially a whole life of care for a disabled person.
The model of insurance that Independent Midwives used had to be affordable while still doing its job. These are Independent Midwives, meaning a tiny group of highly skilled and brilliant people attending women with often complex needs. They are not from huge private practices with loads to spend on insurance.
The insurance they had was tested by medicolegal lawyers and good ones too, from what I hear. Don’t quote me on this but the conversations I had were about the insurance being similar to that used by the military to cover fighter pilots.
Not to mention the care being of such a high standard (based on high quality evidence and track record) that Independent Midwives are far, far less likely to ever need this money to be paid out.
But the High Court found yesterday that the insurance wasn’t good enough, so Independent Midwives will not be able to practice.
We don’t want to cause panic, I don’t think anything is changing right this second and some independent midwives will have insurance agreements with hospitals in place so they can still keep going.
But this does look like it will come to pass and this means at the very least, independent midwifery will become a lot rarer.
At the level of individual women, this means independent midwives cannot be hired to attend their birth. Pregnancy and postnatal care is fine. But often the bit that women really want is labour and birth care from someone they’ve got to know. For women who have trauma from sexual abuse that may well be triggered during labour, an independent midwife was a guarantee of not having to retell the story at a crucial moment. Not to get cliched, but this is life changing care we’re talking about.
There is a trickle down effect of such care that I've have written about before. See here for an example of care for a woman having a baby with a terminal condition who was cared for by an independent midwife. This article and example of care given is highly unlikely to have happened without independent midwifery.
I don’t really know what this means for midwifery, or on a more selfish note, for me.
Though I’m a proper staunch atheist, and don’t think of myself as ‘spiritual’ I have experienced these things called ‘future memories’ where I can see in vivid detail something that’s still to happen. Have you ever has this? It might be utter rubbish but it adds a bit of joy to life and to date they’ve all come to pass.
One of these vivid imaginings is me in a birth pool at home pushing my baby out and I’m being attended by someone I know and love. I don’t think it’s NHS care. Something about the mode of dress (dungarees). The mood is hardworking and intense but very happy.
The second is me working somewhere, I thought up North, being driven around in another midwife’s car late at night to go and care for someone. Again, this feels like independent midwifery to me. She has a wind catcher car charm.
Does this mean independent midwifery will be something achievable in the UK longterm? Am I seeing these imaginings because I’d really like this to happen? Or am I going to end up moving to another country?
IMUK will keep fighting and I’ll do everything I can too. I hope you’ll join us.
Leave a comment letting me know:
How does the soon to come lack of independent midwifery in the UK affect you? Whether you’re an aspiring midwife, student midwife, NHS midwife, Independent Midwife, healthcare professional, parent, woman or someone else, I’d love to hear.
This is from someone close to Independent Midwives who fought with them:
'I've been a lot closer to this then most people so I will see if I can do it some justice. The IMs need to rest and have some emotional space. This has been a long year for them many without the ability to have full time jobs and doing what they love so we need to be sensitive to them and give them time.
Lucina is the name of the insurance policy of IMUK. it was built by an insurance actuarial after a complex search of the market when no provider would put in place a policy that didn't limit the type of care IMs could provide. It's the only policy in the market place that did this (NB - other posts are circulating about another type of insurance right now and I know that IMUK haven't gone this route so far. Not all insurance policies are the same).
Every single high risk situation was calculated out including the likelihood of a cerebral palsy incident which SEEMS to be the most high risk type of incident as care and coverage for the condition is lifelong. However CB is almost next to impossible to know straight from birth and it's hard to tell where in the birth cycle it happens. It's also often the likelihood of a myriad of factors. But anyways, for the point of this discussion (not to debate CP) it's the magic situation that insurers prefer to use and the risk of coverage has to be £10m. Or so we think. We don't actually know what adequate insurance is in high risk situation because the NMC failed to tell anyone. And won't tell anyone. ALL BECAUSE .... if they deem what adequate insurance is for the IMs they are setting precedent under U.K. case law which would then apply to the NHS. This is highly problematic because the NHS pay out pot for negligence isn't sufficient; it doesn't have enough money to meet all the current claims or future claims. So basically, the IMs could break the entire healthcare system.
In terms of payout, it is not all at once. The calculations were run on the basis of member numbers, annual contributions to Lucina, etc to work out the pot fund. And the pot, given all these complex factors that go into actuarial science meant that should one of those claims arise and when taking into account the likelihood of such a claim happening, that even from today the pot would have been sufficient to meet the payout requirements over the 21 year liability period required.
So the IMs were practicing with ADEQUATE insurance. But no one was willing to address what defines adequate and what MEASURE is to be used for appropriate coverage and care. So please don't say they didn't have adequate insurance as they did. But the NMC deemed it not fit without adequate due diligence. However the JR said they did; but being honest none of us not the complexities of law and the detail. So until then the IMs will have to continue half practices, missing birth for most of them, until a new solution can be found which will take time and effort. May not be all the factual details, but this Is the nutshell version.
Also lastly, if you aren't aware this is a huge blow for women's rights meaning many women won't have the option to choose whom, where, when and how they birth. Freebirthing will likely be on the rise and this poses huge risks in its own rights. Gonna stop there and let that be a place to ponder.....' - AC
This is the latest update from IMUK: