Thursday, 2 February 2017

Midwifery REALLY Matters.

A rather hurried update for my blog this morning. The coffee in my system is only mildly adding to the stress I’m feeling at recent events affecting UK midwifery.’s supposed to be a blessed day off! Give me strength! I joke that I’ll die fighting for midwifery but surely, and not so slowly, I’m wanting to walk away before it takes my last breath.
We’ve all had that feeling of not being wanted? Been excluded by an unfriendly and ‘clique’ gang in the playground? Every single working day I fight to provide the kind of midwifery I want to see provided by the UK National Health System. You know the kind of thing, woman centred care, compassion, continuity of carer etcetera. It works, it saves money, and it really isn’t rocket science. Our model of midwifery care within the failing and tired NHS system is no longer fit for purpose. But instead of embracing a good old shake up, they seem to be happy for us just to creep off into the quiet and dark to be forgotten about. Who needs midwives anyway?
Hmmm. That’s ONE winge over, but not the one that’s spurred my need to take action this morning.

You may have seen my earlier posts, a couple of years ago, about midwives working OUTSIDE of our National Health Service having to find professional indemnity or insurance? Before this ruling, that all health care professionals have some form of insurance in order to legally practice, independent midwives (IM) mostly had NO insurance.
Many moons ago, before NHS, midwives would be paid minimally or ‘in kind’ by the locals they cared for. With the arrival of NHS, midwives were directly employed, but still collected a small payment by those who could afford to pay. This independence has remained, but numbers have massively dwindled. This decline brought with it a decline in provision of indemnity for midwives, and at their level of pay (excruciatingly less than obstetricians) they couldn’t afford the massive expense of obstetric insurance. Royal College of Midwives provided some indemnity cover only until 1994. So, midwives just informed clients that they had no indemnity should the family wish to sue for negligence. This was legal, but left the family very much wanting for compensation, should birth damage occur.
So, our government forced ANY midwifery being provided outside of the NHS (and this, by rights, includes even phone advice not given within an NHS midwife’s working hours) to have full indemnity. Some midwives have agreed contracts with certain NHS trusts. This could arguably NOT be independent midwifery. IMUK, the biggest independent body of midwives, thankfully rallied together and made funds available for the necessary insurance. Lawyers at the time deemed this cover to be adequate. End of story, you might think.
However, at the end of last year the NMC ‘decided’ this indemnity cover was inappropriate. Worryingly, they couldn’t actually tell midwives what level they thought WAS appropriate. From the moment of that decision, they deemed independent midwives would be acting illegally if they continued to support their clients in labour. They were not even ‘allowed’ to be present at the birth. They could not ‘Doula’, they could not even be a comforting friend.
Can you imagine the panicky situation this is leaving women in? Women pay quite a whack of money to have an IM provide their care, and they’ve often taken this choice because they feel the NHS has failed them. To suddenly be ‘told’ they can’t have their choice of birth companion is utterly abusive to that woman’s birth choice. I’ve no doubt that incidents of women deciding to birth alone will increase directly because of the NMC’s decision. This is helping nobody.
In my mind, independent midwifery is the most woman centred, holistic, continuous, compassionate care a woman can get. If the NMC do not work with midwives to provide this, we may as well kiss midwifery as we know it goodbye.
Do we just go? Quietly? Kicking and fighting? Is it a struggle just for midwifery? Or for the whole blinking lot of us?
Today I’ve written to the NMC. I’ve heard a lot from friends and colleagues, and would like to know more facts and check out the reasoning behind this madness. It feels like a witch hunt. Women birth. It’s what they do. It keeps the human race going. I bet you’ve noticed. How women birth is their choice, and it is essential that rights and choice isn’t taken away.
I’ll let you know the response....

''Dear NMC,
I am shocked, panicked, and totally disheartened by recent issues between yourselves and independent midwives.
I have been a midwife for many years and follow a family tradition. It’s in my blood. I struggle on a DAILY, even hourly, basis to provide true woman centred care within the current NHS. I view independent midwifery as the absolute essence of being ‘with woman’. I provide a small amount of antenatal and postnatal care, I volunteer my skills and services, and provide overseas training to low income countries. I thought I would spend my last breath fighting for midwifery (It speaks volumes that we should see continuation of our profession as a constant battle, eh?).
The way I am feeling about NMC’s lack of support and positive direction for my profession and colleagues, is indeed taking my breath away. Do we say ‘OK, you win’, and walk away? Does anyone WANT a country without midwifery? I would freebirth before I put my body and birth in the hands of an obstetric nurse, and this is what we’ll end up with.
I’d welcome any statements and facts you can provide for me, which supports your actions. My goodness, I pay enough every year to warrant your time and attention. Please can you forward these links and information.
Thank you.
Trudy Brock''

Please, share your thought with NMC, your MP's, RCM, hospital trusts, and here.

Independent Midwives UK
Nursing and Midwifery Council
Royal College of Midwifery


  1. Trudy, this is a really fabulous articulation of the situation. The most clear, most precise I've read. Well done! If progress is to be made, clarity is key. You've captured the issues brilliantly. I'd only suggest you consider drawing out some equally precise questions against which you seek replies. By asking for 'facts' you could be fobbed off with a rather circuitous reply. Sharp specific questions on what would be acceptable, how this is to be achieved, what role they will play and what accountability they in fact have to the IM community might be some of your focus areas? That way, they are pinned down to reply to your issues (you stay in control of their reply)and you can take it up with them if they don't address particular points. Hope that's helpful. Do say if a chat is useful. Rachel. x

  2. Thank you, Rachael. This looks to be really useful advice. I've already sent the above letter, but I envisage more being necessary. And any others who feel inclined to express their concern can use your 'specific questions' suggestion, too.