Since 2014, all health professionals are required to have professional indemnity insurance in order to practice legally. In order to comply, independent midwives had to find and secure commercial insurance that did not exist. IMUK, a membership organisation for self employed independent midwives, worked with actuarial and medico-legal teams to create its own indemnity product, managed by a separate board, for their members.
A determination of what specifically constitutes appropriate cover was requested from both NMC and the Government, and both refused to advise, instead referring them to existing guidance on their website that it is for the midwife and the indemnity provider to determine what is appropriate according to the scope of their practice.
An investigation was launched shortly after the legislation changed, as a result of a complaint from a private midwifery company to the NMC, claiming the indemnity insurance used by IMUK members may not be sufficient for the highest level of claims.
IMUK have been trying to work with the NMC and the insurance provider to ensure the matter is resolved, and whilst hopeful that having shown the cover was in fact appropriate and sufficiently capitalised for any large claims (under common timescales), were unpleasantly surprised to have the final decision determine the insurance in place as "inadequate". Independent midwives using this insurance are no longer legally able to support women in labour, not even in an NHS setting in a doula or support role. To do so could leave the independent midwife open to legal proceedings and being struck off by their own regulator.
This ruling is disappointing on many levels, but not more so than for the women who are due to give birth imminently. Women who will have researched their options extensively And met with these care providers to ensure they are the right choice for them. Women who will have discussed in detail what insurance the care providers have.
"Allow women their rights during labour (Independent Midwives' crisis)" petition.
"Declare NMC action unlawful and replace with an organisation fit for purpose" petition.
What else can we do? Make your voice heard.
Write to your local MP to highlight this issue - click here for some example letters and a template.
Write to the NMC to complain and highlight just how unjust this ruling is and demand a way forward to give us back our choice! Click here for example letters (some responses we've had already) and a template.
Join IMUK as a "friend" member and show your support - here.
Independent midwives provide a service that has been shown time and time again to promote better outcomes for both mother and child. The gold standard of midwifery care, where-ever and however provided, is described as the provision of "continuity of carer," meaning that the family sees the same few provider(s) throughout the childbearing year. In the NHS it is very difficult to provide this continuity just because of the realities of hospital and shift work.
Attempts have been made within the NHS to provide a similar model of continuity of carer to that which non-NHS midwives can more easily and naturally provide. One good example, which suffered a very similar fate to the independent midwives' current crisis, is the Albany Midwifery Practice. This practice
"ran from 1997 to 2009 in Peckham, South East London, caring for an all-risk caseload of local women within the NHS. The unique model of midwifery care included continuity of carer with two named midwives and choice of place of birth. The midwives looked after over 2500 women with excellent outcomes, achieving a home birth rate of over 40% alongside a low perinatal mortality rate. Their contract with the local Healthcare Trust was terminated in December 2009, with the Trust citing ‘the safety record of the practice’ as the reason."
An investigation into the statistics and outcomes of the Albany Midwifery Practice to determine the reason for its closure was recently completed and the findings published in the journal Midwifery. The retrospective study found that the Albany Midwifery Practice had better outcomes than its parent trust and nationwide on all metrics, especially in high-risk clients. There was no evidence of the statistically-significant rate of compromised babies admitted to SCBU that was cited as the cause for immediate closure.
The study concluded that this, rather than an unsafe practice that needed closure, should be a model of care that is replicated widely.
The true motivation for King's College Hospital to abruptly close this practice -if not simply because of faulty data analysis- was never ascertained.