by Red Griffiths Haynes
Shortcut to Petition
The Importance and Context of Midwifery
Historically and anthropologically, across continents and through time, our Ancestors have regarded birth as a sacred process. In many cultures, the journey of labour and the mystery of birth was celebrated and accompanied by rituals designed to ensure the safe passage of the soul into human existence. A primal and unspeakably powerful initiation (Buckley 2001), birth was, and still is, a deeply personal and individual rite of passage. The experience of which, has the ability to transport a woman from the social and psychological state of non-mother to mother, from 'self as world' to 'baby as world’ (Kelpin 2002). The presence of a midwife in this often difficult process is essential, not only in facilitating the survival of both mother and child, but also in creating the sacred space in which this physical and spiritual transformation can occur. Kitzinger (2006) describes the midwife as a guide and mediator on a journey in which the mother confronts spiritual and psychological challenges. As a Student midwife working within the Druid tradition, caught within the confines of the NHS, I celebrate the flow of life and death, the stories of our ancestors as they are passed from mother to baby. The blood, fluid, sweat and tears that is the journey of birth. Birth is my goddess and I her priestess as I walk its path.
UK Maternity Care
At present in the UK there are two main ways in which maternity care is provided, both valid, vital and equally safe. The first is the care provided by the NHS, the kind of care which the majority of women will experience during their pregnancy and birth. This usually involves both mother and baby being cared for by a community midwife, GP and hospital staff if she chooses to give birth in a hospital as the majority do. This kind of care offers services for women experiencing a ‘normal’ pregnancy as well as those which have become medically complicated in some way for example by diabetes or raised blood pressure etc. This service provides essential free maternity care to all who qualify for it in the UK.
The second way in which maternity care can be provided is through the services of an independent midwife, a midwife who is self employed and is appointed by the pregnant mother herself. This kind of midwife works outside the NHS and is therefore not governed by trust policy but is still ruled by the professional standards of her governing body the Nursing Midwifery Council and, as with all midwives must adhere to strict regulations in order practice. She will provide private, individualised care to her clients for the entirety of their pregnancies including the birth and postnatal care. This results in a close working partnership where the mother is jointly responsible for both her own well being and that of her unborn child. Most women will opt to give birth at home (a service not always available on the NHS) and she may have particular needs that she feels the NHS may not be able to provide for in her area, such as a water birth. She may feel strongly that she would like the continuity of care provided by an independent midwife and that she wants to know for certain the midwife who will be caring for her in labour, unlikely within the NHS. Despite this type of service not being free of charge it is not only wealthier women who will appoint an independent midwife. Women from all walks of life choose independent midwives for many, many reasons, and midwives will usually charge women in relation to what they can afford or are able to exchange, creating honourable relationship with the women and families they work with.
The offering of both private and NHS maternity care within the UK is essential as it provides women and their families with a choice in the way they birth and in those who support and care for them through this exciting, transformational and potentially vulnerable time. Not only this, but it provides midwives with a choices in the way they work, vital in a job which is physically and emotionally demanding.
The Threat
Currently, independent midwives in the UK work without insurance and this is for a number of reasons. Firstly independent midwives work by creating a relationship with their client which holds a joint responsibility for well being. This not only rejects the litigation culture overtaking our society and in particular our maternity services, but also actively promotes well being and as evidence shows, positive outcomes for all involved. But, more importantly independent midwives work without insurance as there is no company or agency, government or private which provides it and the last time that insurance was offered in 1994, the premium was over £15,000, more than a midwife’s annual salary at that time and therefore, unaffordable.
The government are this year proposing to make illegal the practice of independent midwifery without insurance and this is due to come into force within 12 to 18 months. Mid wives without insurance will no longer be able to practice and will not be able to renew their yearly registration without it. This will force all independent midwives in the UK into unemployment or back into the NHS where due to cuts, there are few jobs being offered despite the national shortage of midwives.
There are few independent midwives who are against having insurance in principle, most would gladly take on an affordable insurance policy in order to be able to practice. Independent Midwives only practice without insurance because they are forced to do so by the lack of provision. Although the government plan to make practise illegal without it, there is no proposal to provide any. In other circumstances where this problem has arisen the government have underwritten insurance costs and could do so easily and affordably in this case.
This proposal will effectively make independent midwifery in the UK illegal by the back door.
The rational behind all this of course, is that demanding insurance as a prerequisite for practice improves safety and this may be a valid argument if it were true. However, having insurance does not make practice safer, it only means that you can be sued. The threat of litigation does not improve practice, it only increases the culture of fear surrounding it. This can be clearly seen within the NHS where litigation particularly within the field of obstetrics continues to rise and the culture of fear continues to grow. There are many hundreds of cases brought against the NHS and the maternity services each year, rarely, if ever is a case brought against an independent midwife.
The Consequences
The consequences if this proposal were to become manifest, and it looks likely at present that it will, will be dire. Over 200 valuable midwives will be forced into unemployment and out of a profession about which they are passionate. Women's choices about where and how they birth will be reduced, the only option will be birth within an NHS environment, where in many cases there is no provision for birth at home or within a midwifery led birth centre. The only choice is a high tech ‘delivery suite’ where intervention is increased and a womans chance of achieving a ‘normal’ birth diminishes. Independent Midwives are responsible for over 4,500 uncomplicated births a year, if these births are moved into hospital, home birth rates will fall, caesarean rates will rise, as will the admission of babies to neonatal intensive care units due to these procedures.
The Independent Midwives Association has voiced it’s concerns that should this proposal go through, many women will simply refuse to go to hospital, potentially increasing rates of unplanned home birth, unassisted home birth and babies born before the arrival of a midwife, all factors known to increase morbidity and mortality in both mother and baby. I truly believe that this is just another step along the road of the privatisation of the NHS and just a small step away from the ancient profession of midwifery itself becoming illegal and ‘outdated’ as it is in some states of the USA.
The proposal to make the provision of independent midwifery services illegal in the UK is an infringement of human rights and civil liberty for mothers, babies and midwives and must be countered. The Government must re think this proposal and provide independent midwives with the ability to access affordable insurance if this is to become a requirement for practice. If you are a midwife working within the NHS and would never consider becoming independent, or someone who would never employ an independent midwife, this issue is still important. It is a violation of the informed choice that midwives fight so hard to provide and that mothers value so much and removes a model of care and a way of working rarely provided on the NHS. Solidarity with our independent midwives as colleagues and fellow women as they prepare to be made unemployed is essential as the potential loss of over 200 midwives would be tragic in a climate where the government acknowledge the shortage of midwives but does nothing to counter it. The consequences outlined above should alone be enough to convince us that independent midwives really do matter.
Of course, if you are an independent midwife or a mother who has employed one, you already know, without question, just how important this is.
The Independent Midwives Association has started a petition to counter this threat, demanding that either that the government exempt independent midwives from the proposal or provide adequate, affordable insurance. The petition has to date been signed by over 3,600 people. Please, follow the link below and add your signature.
The Petition
http://petitions.pm.gov.uk/midwives/
March 2007
References
Buckley S (2002) Healing Birth, Healing the Earth http://www.womenofspirit.asn.au accessed 9/10/2006
Kelpin V (1992) Birthing Pain in: Morse J (ed) (1992) Qualitative Research. Sage; London. P 101
Kitzinger S (2006) Birth and Spirit, Birth in its Social Context http://www.shielakitzinger.com/MiM/2B.htm accessed 9/10/2006
Nursing & Midwifery Council (NMC) (2004) Midwives Rules and Standards NMC; London
Links
http://www.independentmidwives.org.uk/
http://news.bbc.co.uk/1/hi/health/6435279.stm
http://www.radmid.demon.co.uk/links.htm
http://www.bbc.co.uk/radio4/womanshour/03/2007_10_tue.shtml
