Posted by Madeleine Speed, the Pelvic Partnership, January 2017
In November 2016, NHS England published the next steps in its strategy to enhance maternity care and safety, recognising that women should have greater choice about how and where to have their babies. Linking good policy into practice in this way is a move that both women and healthcare professionals approve. So it's regrettable that the Nursing and Midwifery Council (NMC) took steps this week which appear to undermine women's access in the UK to a group of independent midwives. Concern has been raised by two campaigning organisations, who have asked charities and organisations supporting pregnant women, to raise awareness of the issue, and we share these concerns that women’s choice and access to safe care are being undermined by this action, which is why we have written this blog.
What has the NMC announced?
The NMC is the regulator for nurses and midwives and exists to protect the public by setting standards of practice for nurses and midwives. The NMC announced on 13th January 2017 that the indemnity scheme used by some independent midwives is inappropriate and inadequate. This scheme is provided for midwife members of the organisation: Independent Midwives UK (IMUK).
This action by the NMC prevents independent midwives from practising if they are using this IMUK indemnity scheme. Following an investigation, the NMC believes that IMUK has inadequate funds to settle any significant claims that might arise if a woman or her baby came to harm during childbirth attended by an IMUK member. However, the NMC has not been able to confirm what it does consider to be adequate insurance, which leaves these midwives in a very difficult situation.
While the NMC is right to uphold the importance of suitable indemnity insurance, the way it has gone about this seems unhelpful and heavy handed. The Government brought in the change to legal requirements only in 2014 for all health professionals including midwives to have an indemnity arrangement in place, for very good reasons. The IMUK has met this legal requirement and set up an indemnity scheme. What seems to be at issue here is that the NMC is stating that the IMUK scheme is insufficient while not providing an explanation about what would be acceptable. The Association for Improvements in the Maternity Services (AIMS) says that "this apparent level of obfuscation is unacceptable and we urge the NMC to immediately clarify the position on insurance requirements". Birthrights, the organisation protecting human rights in childbirth, has written to the NMC expressing its criticism of the NMC’s action, and the full information about this can be found here.
Why is this situation undermining women's access to midwives?
The NMC outlines in its press release on 13th January 2017, that there are only a small number of midwives in the UK who work on an independent basis and of these, most independent midwives have adequate indemnity insurance. The NMC states that therefore its decision applies to around 80 members who use the IMUK indemnity scheme. However, these midwives often provide care to women who have experienced traumatic pregnancies or births and choose an alternative, supportive package of care from highly skilled independent midwives. Some of our members come into this category.
Meeting specific, individual needs
Independent midwives can be invaluable through their care for women from all backgrounds with specific needs, who may fall outside the usual scope of an NHS setting. For example, for mothers who have experienced traumatic births or who wish to birth breech babies or twins, triplets, etc vaginally. These women's needs may not be supported within the NHS where hospital guidelines and protocols are aimed at best practice for a majority and not the specific needs of the individual. It may be a small minority of midwives who have been stopped from practising because their insurance is not thought of as adequate by the NMC, but for the women they were supporting during pregnancy and hoped to have been attending at the birth, this news is potentially undermining their choice about ongoing care with someone trusted and chosen to support them.
There is a wider concern here that the important role of midwives is being undermined and undervalued and the role of independent midwives in particular is very vulnerable. In 2014, a report by the Public Accounts Committee outlined that although there was an overall increase in the number of practising midwives, there was still a shortage of 2,300 required to meet current birth rates at that time. The report noted that the mechanisms used to record the amount of midwives needed, was inadequate and it is still the case that the numbers of midwives are insufficient in many parts of the country.
To support women’s choice and offer flexibility to meet individual care needs, we need the number of midwives both within the NHS and outside to grow. How do we generate more independent midwives and encourage their training and support and how do we ensure maternity care is truly women-centred? It is detrimental to women in the UK, that the Department of Health and any regulatory bodies, take steps that can undermine and discourage maternity services and particularly those provided by the independent midwife whose role extends and supplement the care provided by the NHS. If we do not safeguard and grow midwifery services both within the NHS and independently, then there is a real danger that actions like these from the NMC will undermine the scope of maternity services. The Pelvic Partnership adds its voice to AIMS and Birthrights in encouraging a quick and helpful resolution from the NMC to solve the problems they see with the IMUK indemnity scheme.
Next steps if this directly affects your maternity care
The Pelvic Partnership supports AIMS in highlighting the issues that are raised for women who have engaged an independent midwife who is now stopped from practising because that midwife is a member of IMUK and IMUK indemnity scheme. AIMS has also issued advice to help women in this situation here.
AIMS is gathering the voices of women and families who are affected by the independent midwifery crisis. Please complete this questionnaire if this is affecting you and share this survey so that they can hear from as many people as possible.