Sunday, 29 January 2017

The NMC and their ban on Independent Midwives

I am due to give birth to Baby #2 in just over eight weeks' time. Until early January, I knew that birth would most likely - and hopefully - take place at home, in a pool, with an Independent Midwife (a self-employed midwife who works outside the NHS) I knew well and trusted.  My midwife has looked after me throughout this pregnancy, and cared for me during my previous pregnancy and birth too. In an ideal world, every pregnant woman should have the opportunity to receive such comprehensive and consistent care. I can highly recommend it - it's brilliant.

However, on a practical level, the NHS cannot offer this: shift work patterns, organisational complexity, lack of funding and lack of midwives mean that continuity of care for most is just a pipe dream. The vast majority of women muddle through the system just fine. Some have a great experience. For others it's just OK, but they get a healthy baby at the end of it, so they count themselves lucky. For others still, pregnancy and birth can be a waking nightmare that leaves them with PTSD or worse. It is a bit of a lottery.

The female body is designed to gestate and birth a baby. However, that doesn't mean that things can't go wrong - we're designed to defecate too, but that doesn't mean nobody ever gets constipated. That is why we have trained midwives, obstetricians, and paramedics to help us through (with birth, not constipation, obviously. Although my midwife did have some handy hints about piles).

The issue comes when your care provider doesn't do the right thing for you and / or your baby. At the minor end of the scale, they may fail to consult you, mistrust your instinct or belittle your intelligence. This is pretty common, and as women many of us will be depressingly familiar with this kind of treatment so we may not even notice. At the more serious end, they may intervene when no intervention is necessary, or fail to intervene when they really should have done. This can lead to terrible outcomes.

People make mistakes. I've made plenty in my line of work and my Independent Midwife has probably made a few too. She is human and I am not naive. It is therefore reassuring to me to know that, should she get it majorly wrong, she has indemnity insurance that will pay out in the event her mistake leads to a life-changing injury to my baby, or worse my own or my baby's death. However, did I choose to go with her because she has that insurance? No. I chose her because I felt it was less likely there would be a terrible outcome with her caring for me: continuity of care has been shown repeatedly to improve safety and reduce risk. My choice. When I had Duckling, Independent Midwives couldn't even get insurance. I still booked in full knowledge of this, because a good, calm birth with a skilled, informed practitioner who followed evidence and trusted me to understand my options and the risks involved felt like a pretty good deal. It was a choice I paid for yes, so a choice I could only make because I am privileged enough to be able to afford it. I recognise that. But still, my choice, and indeed my right.

My right has now been taken away. The Nursing and Midwifery Council (NMC) has decreed that the level of indemnity cover offered by a plan specially set up by IMUK, the official membership association for Independent Midwives, is "not appropriate". Specifically, should a catastrophic claim arise tomorrow, they believe the insurance fund would not contain enough to pay out a full settlement immediately. Despite the fact claims usually take several years to process, by which point much more will have been paid in and the funds would be adequate. And it has been accredited as financially sound and Solvency II compliant, which is more than the NHS' own compensation scheme has been. And that the NMC's actions have been deemed unlawful as they themselves state that it is not their role to speculate what an appropriate level of insurance cover might be for non-NHS practitioners.

All 80+ Independent Midwives (IMs) around the country are covered by this insurance and they simply can't get any alternative cover - it took years of hard graft to get the current scheme working. Yet in full knowledge of this, with just three days' notice before Christmas, the NMC stepped in to ban IMs from offering care to their clients (or even being present) during labour and birth, unless they found cover elsewhere, apparently "in the public interest". I understand the basis of their concerns, but as I stated in my letter of complaint to them, I do not feel this is in my interests. My choice and my right have been taken away, and I now have no idea where my birth will be or who will attend it, which is more than a little stressful.

I have faith in the NHS. I think it's an incredible institution full of incredibly caring people. I genuinely believe they will do their best for me and I don't want to appear an elitist snob about having to have a baby the same way most other women in this country do. If I didn't have an informed IM as a sister, I'd no doubt have been NHS all the way with my first. Indeed, I am very glad and very lucky the NHS will be there (I hope) to support me now it looks like my chosen midwife can't. It will be OK in the end I'm sure.

But I'm certainly not as sure about that as I was before Christmas, when I could be reasonably confident that the woman who brought my son into the world (and stemmed my blood loss from a freak laceration, called an ambulance and nearly got arrested speeding after that ambulance on our way to the hospital) would be there to welcome my daughter. Plus I don't know how I am going to navigate my way back into a system I have been out of since my 8 week booking appointment. Nothing causes more of a spanner in the intricate workings of NHS bureaucracy than a set of patient notes in a non-standard format with uncharacteristically legible handwriting. I strongly suspect I'll spend far more time repeatedly explaining my entire back story to my assorted NHS friends than I will telling them about my contractions and how I REALLY can't take them anymore. And don't get me started on the battle I'm likely to have over internal examinations. I had no idea at any point in my last labour how dilated my cervix was because my midwife was experienced enough to know what stage I was at without poking about. I was just left to get on with it. Excruciating pain aside, it was great and I gave birth feeling entirely unstressed and unmeddled with.

The really worrying thing about this decision though is the impact it will have on women who didn't, like me, have a good birth experience the first time around (and it was good, even with the pain and the drama at the end.  I will get round to writing about it one day). Women who have been traumatised by the treatment they endured at their local hospital, who scraped together enough cash to pay for an IM, and now they have no alternative route for receiving care, would rather give birth at home alone than risk returning to a place full of awful memories and mistrust. Leaving these women stranded is not in their interests. Concern about possible long-term financial difficulties that would only arise were something very unlikely to happen does not excuse an action which puts women and their babies at very real and immediate short-term risk. The NMC's decision is not about women's safety or the competence of their midwives - their real remit as a regulator. It's about money. And it's sad that they have chosen to put the latter before the first two in the assumption that this is what matters the most. This could have been handled SO much more compassionately and sensibly.

So sort it out NMC.  By the time you do, it'll probably too late for me, but you owe it to the thousands of women who will need a choice in the future, and the dozens of caring, dedicated midwives out there who have bravely stepped outside the system to offer the level of support they feel women truly deserve.


To find out more about this issue, you can read the official IMUK and NMC press releases, plus a great post from Philosophy, etc.

You can also sign a petition to get the NMC to allow women their rights in labour.

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