Many of you have been asking me either on social media or in person about the decision of the Nursing and Midwifery Council (NMC) to suddenly ban independent midwives (IMs) from attending births because they have deemed our indemnity scheme to be inappropriate.
Read their side of the story here:
Firstly I want to address the bit in the NMC statement which states that, ‘It is extremely disappointing that the NMC learned today that some IMUK* midwives have only just informed their clients of the issues connected with their indemnity cover, despite knowing of the NMC’s concerns for several months’. *IMUK = Independent Midwives UK
It seems actually they decided months ago that our indemnity was inadequate. However, I had been reassured by the NMC’s own guidance on this subject which is as follows:
‘We are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice. You should seek advice as appropriate from your professional body, trade union or insurer to inform your decision. You need to be able to demonstrate that you fully disclosed your scope of practice and to justify your decisions if asked to do so.’ See https://www.nmc.org.uk/globalassets/sitedocuments/registration/pii/pii-final-guidance.pdf
So yes, the NMC has been writing since August, but not (as far as I was concerned) giving any kind of formal notice that they would with immediate effect prevent me from attending births. Indeed, I have a letter dated 21st October 2016 which states that, ‘we will write to you after that meeting to update you about the investigation into the appropriateness of the indemnity arrangements’. I don’t regard this as formal notice that the NMC will stop me from attending births – it says they are making an investigation. But as the NMC is not a financial or insurance regulator – why were they investigating? They have said that it’s up to me (as the registrant) to decide if my indemnity is fit for purpose. I have been naive with hindsight, but at the time I did not realise that the NMC could or would suddenly remove the freedom of my current and future clients to use my services as an IM. It would make more sense to me if the regulator had concerns about indemnity that these concerns were reported to the Department of Health, who could have instituted a fair and transparent process of investigation, that might also apply to all other professionals. We could also have been issued with some guidance. Instead, IMs have been (as far as is known) the only group of professionals to have their indemnity scrutinised and our practice affected – and there has been no transparency and no due process for this scrutiny.
Now, when making decisions about whether the IMUK membership scheme was adequate, I did not take the decision lightly – but neither am I an actuary. I was given far more information about that indemnity than any other scheme or insurance I hold, and taking into account all my risks as a homebirth IM and previous claims history for IMs – I did and do judge that my indemnity held via membership of IMUK is appropriate for my practice as an IM. I believe that this meets the requirements of the NMC.
So why has the NMC made this decision? I think there is a subtext to the NMC’s statement which involves misapprehension about both the role of the independent midwife and about our clients. There is an implication that we and our clients are a tiny and unimportant niche. However, what has not been realised is that though relatively small in number, we often act as a sort of safety net when the NHS has been unable to meet the needs of women for whatever reason. Not all, but some of our clients may have issues with anxiety, or physical or emotional trauma including previous birth trauma. They may have complex medical or other needs which require a high level of midwifery skill and expertise and the time to either liaise with other professionals such as consultant obstetricians or, in some cases where the woman wishes – to assist the woman in declining unwanted medical interventions. Or sometimes the NHS service has simply been unable to provide even basic services such as home birth. In these cases, while the number of IMs is relatively small, we are providing a vital service which cannot be allowed to simply disappear. It isn’t melodramatic to say that lives are at stake – and the NMC has carried out no risk assessments of the impact of the withdrawal of independent midwifery services. There are significant harms and avoidable risks being imposed by the NMC which is ironic as their role is one of public protection.
Finally, I also want to address another paragraph in the NMC statement:
“A very small number of the UK’s midwives work on a self-employed basis, providing midwifery support to women during childbirth on a private basis. The majority of these independent midwives have adequate indemnity insurance. The decision today only applies to around 80 members of IMUK who rely on their indemnity scheme. In contrast, more than 41,000 midwives in the UK operate with adequate indemnity cover.”
This statement is inaccurate on many levels. The ‘IMUK 80’ are the ONLY midwives who work for themselves rather than for an employer hence the NMC statement that ‘the majority of these independent midwives have adequate indemnity insurance’ is totally wrong. The NMC has at one fell swoop destroyed independent midwifery in the UK. I could weep as I read my own words. Not for myself. But for the women who have been traumatised and sometimes physically damaged by poor care in the NHS (not the fault of midwives but of an overstretched system which sometimes fails) and now those women have no independent option. And just who are these mythical 41,000 midwives? According to the Royal College of Midwives there are fewer than 25,000 midwives practising in the UK. Just where has the NMC got its figures from? https://www.rcm.org.uk/sites/default/files/RCM%20State%20of%20Maternity%20Services%20Report%202015.pdf
I am a passionate supporter of the idea that all women deserve excellence in midwifery care. I help run a popular home birth support group in Nottingham, on a totally voluntary basis, which has helped hundreds of women to achieve better births with the NHS as well as some who choose to birth outside that system. I don’t think that independent midwifery is a solution for all women – but it should be a choice. If we allow that choice to be removed, midwifery is weakened as a profession and women’s choices have been seriously diminished.
We must not allow the NMC to destroy independent midwifery in the UK. Please write to your local MP http://www.parliament.uk/mps-lords-and-offices/mps/ and to the NMC https://www.nmc.org.uk/contact-us/complaints-about-us/ . Join the Facebook campaign group https://www.facebook.com/groups/443681876022589/. Check out the hashtag #savethemidwife which emphasises that this decision affects ALL midwives and not just IMs as it’s part of the undermining of midwifery as a profession.
And in the longer term, get ready to join the campaign for a new midwifery regulator. Let’s be the change we want to see – look out for the new Midwifery Council and join us as we work to support women, babies, families and their devoted professional midwives.
The campaign is being led by the Association of Radical Midwives (ARM) and other amazing organisations such as the Association for Improvements in Maternity Services (AIMS) so please join ARM (I’m proud to be a trustee of this brilliant charity) and help us to help midwives to help women. You can learn all about the proposals at the next study day/conference in Wigan on 18th March and the booking form is arm-study-day-booking-form-march-18th-2017 if you’d like to download, print, fill in and send off to book your place (ARM is currently working on a new website so soon we may have an automatic booking system but for now we’re still low tech.)
Edits 13/02/2017 I realised that I missed off two important issues.
The first is I didn’t mention that some IMs have managed to find NHS contracts with their local Trusts to enable them to fulfil their contractual obligations to the women who had engaged them. I would like to give credit to the Trusts that have made these arrangements and the Heads of Midwifery who have facilitated them. This is a wonderful example of putting women’s choices and needs at the heart of decisions around care provision. Other IMs have approached their Trusts but been unsuccessful in making these arrangements which has already resulted in some women giving birth in very difficult circumstances. I am in the process of attempting to make such an arrangement with my local Trust and am very hopeful that this will help in the very short term.
The second point is to do with the definition of an ‘independent midwife’. For my purposes, I am defining an IM as being directly contracted by the woman rather than being employed by a third party. By this definition, there are IMs who only provide antenatal and postnatal care and who may not be members of IMUK. I didn’t mention these as my point is about attending birth rather than anything else – I hope that’s clear and I don’t want to cause anyone to feel slighted. As an aside, I am a great believer in diversity of provision and think that what is being offered by some of the private companies such as One-to-One or Neighbourhood Midwives is absolutely brilliant, to say nothing of our amazing National Health Service. Hopefully it will be seen that my point is that the IMs who have been affected by the NMC ruling are providing a service that isn’t provided in the same way by anyone else and that withdrawal of this service has been done without any proper assessment of impact on women.