Following their insurance victory last year, Independent Midwives UK have gone from strength to strength.
Earlier this week they launched their new website, giving us the perfect opportunity to speak to their chair Jacqui Tomkins about the dramatic events of last year, and the future of independent midwifery…
Jacqui, could you please explain to our readers the background to the Choose Your Midwife, Choose Your Birth campaign?
Two years ago, IMUK members were told to walk away from their midwifery practices, their thriving businesses that thousands of birthing women depended on for their care. European Directive 2011/24/EU was looming and the government was telling us that there was no going back and no further exemption for midwives who had chosen to practice outside of mainstream employer of the NHS.
The dwindling membership of IMUK had a small working party that called an emergency special general meeting from which the membership voted for a new board to find a solution or go down fighting. We began by drawing attention to the removal of rights for both women and midwives, to the destruction of a maternity model which meets all government targets.
Our supporters sent thousands of postcards to both MPs and the Department of Health, and we organised a rally in London. We started to compile a response to the government consultation on the proposed legislation, and finally secured a weekly meeting with the team at the Department of Health.
IMUK continued to work on putting together a business plan and collating data on previous clinical negligence claims, and developing our own insurance product. We also continued to engage and educate the commercial market on the actual midwifery risks associated with maternity care as opposed to obstetric risk.
We eventually had three possible options on the table when the implementation of the legislation was unexpectedly brought forward and we moved forward with one of these. We were supported by thousands of women and their families, students and other birth organisations who offered their skills and time to help get our voice heard, for which we will be forever grateful.
It must have been a tremendous relief to finally secure a resolution.
It was an incredibly difficult and stressful 18 months. Most of the board were juggling a full clinical caseload as well as meeting the many deadlines required for initially unfamiliar work; compiling our business plan, presenting our clinical data and numerous presentations and meetings. Although we all felt huge relief, I think we mostly felt exhausted. There still hasn’t been time to have a proper celebration!
Where do you see the future of independent midwifery now that the insurance issue has been resolved?
Independent midwifery is one of the major cornerstones in the future of our profession. We must find the strength to help direct our way out of the wilderness that midwifery has been allowed to stumble into.
I see independent practice as the guardian of autonomy. If midwifery is to own its moniker as ‘the experts in normal’ then we must challenge the accepted norms of obstetric care for all women. It’s not enough to point to small pockets of excellence where midwives have been ‘allowed’ to practice autonomously. We must reclaim a midwife’s right to practice within a respectful and supportive environment where she is the lead clinician until there is a need to seek surgical assistance. Midwifery needs strong leaders and I believe the independent world is the best place to find them right now.
What advice would you give to midwives or students who might be interested in independent midwifery?
Come to an IMUK ‘Making the move’ workshop. Talk to independent midwives in your area and assess your personal circumstances to determine if you can succeed in business at this time. Remember, you will need money for set-up costs, a supportive network of family and friends and perhaps a reduced income while you build your practice and reputation. That said, if you do make this choice, we will be delighted to meet you and look forward to welcoming you to IMUK and to an incredibly supportive network of midwives who wouldn’t work any other way.
Are you seeing more midwives wanting to work independently as challenges in the NHS increase?
IMUK is seeing a marked increase in enquiries for membership. Most of the midwives who are seeking to become independent are expressing a desire to practice midwifery skills and experience opportunities to provide continuity of care.
Do you think that the recent NICE guidance will see more women requesting a home birth?
Increasing numbers of women were already requesting home births having done their own research into clinical evidence, but now that we’ve seen this change and some mainstream press, I do think more women will be thinking about whether or not it could be the best option for them. I just hope that NHS home birth service can and will respond to this demand.
What would you say to sceptics who suggest that home birth isn’t safe?
There isn’t a lack of good quality evidence supporting home birth for uncomplicated pregnancies. If there are still issues of scepticism, I would suggest that the individual examine their motivation for refuting clinical facts and consider the harm this does to women attempting to make their own, evidence-based choice. Women are not going to give up wanting to give birth in the surroundings most appropriate for them, so what is this war for? We need to move on.
What is the main reason women choose independent midwifery care?
Birth is physical but also emotional. Many women have an innate and intense desire to find a carer who is skilled, trusted and compassionate. Therefore it makes complete sense that they have an opportunity to choose and build a relationship with this carer. Nearly all women seeking independent care will cite this as one of the reasons for choosing an independent midwife. Many have been previously traumatised within a system which can’t always deliver this and a good number are seeking midwifery expertise no longer available within our health system.
What is most challenging about being an independent midwife?
There is still a lack of trust and understanding between the independent world and some of our professional NHS colleagues. At worst, it can lead to red tape which undermines the provision of excellent care or to a sense of isolation when working within an NHS setting. I think for me, it’s the occasions where an independent midwife, perhaps because of her relatively unusual choice, is made to feel alone. Ironically, this is something we rarely feel in our day-to-day practice.
What do you enjoy most about being an independent midwife?
There are so many things about being an independent midwife that I love; getting to know women and their families, professional autonomy and flexibility around my work and family life. But by far the most important element of my life as an independent midwife is the incredibly generous and skilled midwives I work with.