Childbirth Choices Matter
We are a collective of women, doulas, NHS midwives and independent midwives (IMs) who have come together to strengthen the rights of women and birthing people to choose the circumstances in which they give birth to their babies, including place of birth and midwifery led continuity of carer.
The key objectives of the Childbirth Choices Matter Campaign are:
·to strengthen the rights of women and birthing people to choose the circumstances in which they give birth to their babies
·to enable self-employed midwives to be able to provide maternity care that is dignified and driven by choice
·to ensure that midwifery is a profession that is autonomous and able to support women and birthing peoples choices by working independently of the NHS if needed
·to facilitate increased choice for women and birthing people who are at increased risk of negative outcomes and experiences in maternity care, through the provision of affordable (or free) personalised care to mitigate these risks and improve disproportionate adverse outcomes for Black and brown women and birthing people
The key objectives of the Childbirth Choices Matter Campaign are:
·to strengthen the rights of women and birthing people to choose the circumstances in which they give birth to their babies
·to enable self-employed midwives to be able to provide maternity care that is dignified and driven by choice
·to ensure that midwifery is a profession that is autonomous and able to support women and birthing peoples choices by working independently of the NHS if needed
·to facilitate increased choice for women and birthing people who are at increased risk of negative outcomes and experiences in maternity care, through the provision of affordable (or free) personalised care to mitigate these risks and improve disproportionate adverse outcomes for Black and brown women and birthing people
About the Campaign
Our need to unite and campaign to protect women’s birthing choices, and for midwives to be able to provide maternity care that is personalised and safe is now a matter of emergency, particularly during the global pandemic for a number of reasons:
NHS England’s policy document ‘Better Births: improving outcomes of maternity services in England’ (2016) directs services to ensure the majority of women are able to access continuity models of care such as those offered by independent, self employed midwives to improve outcomes and ensure personal and safe care. Unfortunately, we have seen the opposite. For several years independent, self employed midwives have faced barriers due to issues relating to indemnity insurance, which is linked to the practice requirement by Nursing and Midwifery Council (NMC). To overcome this, IMs have created innovative social enterprise business models to provide gold-standard maternity care such as Neighbourhood Midwives, and One to One Midwives. Both these organisations were unsustainable due to constraints presented at the commissioning level.
Indemnity insurance
The NMC stipulates that adequate indemnity insurance is required for IMs to practise. However, commercial insurance premiums have increased to £7500 per birth, which means Independent, self employed midwives will be unable to support women from the end of June 2020. Midwives don’t want this and neither do women (Birthrights 2017, Quashie 2017).
Independent, self employed midwives have the professional skill and expertise to provide evidence based safe care in midwifery led units (birth centres) and home settings to ensure women’s choices, human rights, physical and mental well-being are protected in all types of birth including multiple birth, vaginal birth after Caesarean section and vaginal breech birth.
Midwifery expertise is grounded on the social model of care, with an emphasis on advocacy, supporting well-being and protecting public health. The threat to this type of care has been witnessed globally during COVID 19 when women and birthing people’s choices have been withdrawn or dramatically limited due to fear and centralisation of maternity services. In many instances, women’s rights have been violated and midwifery led care marginalised.
During the COVID-19 pandemic maternity units have restricted women’s choices by withdrawing home birth provision, closing midwifery led units and ceasing the use of water for labour and birth. Midwives were redeployed from community settings to support their colleagues on obstetric units. This presented many with a barrier to providing personalised care and cause upset amongst the midwifery profession.
Justification for such decisions were cited as:
These decisions contravened national and global evidence to support maternity care in the community setting wherever possible (Renfrew et al 2020). It also introduced an increased risk for women being exposed to individuals who had not been self-isolating. In addition, decisions made compromised options for pain-relief as well as physical and mental well-being. Potential consequences may be apparent for years to come.
For many women and for various reasons the actions taken meant the risks were too great. For them, the only options were to give birth alone or seek out independent midwives to support their individual needs and plans for birth.
However, a number of NHS organisations have continued to prioritise personalised and safe care (Byrom and Newburn 2020) one of those being Chelsea and Westminster NHS Trust in London. This service also worked closely with independent midwives.
‘Women deserve to have the care provider and choice of place of birth that is right for them. They deserve to have the choice and personalisation of care described in Better Births. This means that they should be able to have that care with an independent midwife if they choose. At the Chelsea and Westminster NHS Trust in London we are committed to working in partnership and collaboratively with independent midwives to ensure that they have indemnity insurance needed to practice, and the additional layer of support and education. This in turn means that women have streamlined access to our services enhancing safety for them and their babies. We are very proud of the strong trusting relationship we have developed with our local independent midwives and hope that others around the country will develop their services to be able to work in this way’. Victoria Cochrane, Director of Midwifery and Gynaecology.
Both women and the midwifery profession cannot afford to be without independent, self employed midwives who guarantee genuine choice and midwifery skills to mobilise care and support their midwifery colleagues in times of need and crisis.
We want to ensure that midwifery is a profession that is autonomous and able to support women’s choices by working independently if needed and we have every intention of making this a reality.
References
Birthrights (2017) Birthrights Criticises NMC for Independent Midwives Decision. Available at: www.birthrights.org.uk/2017/01/13/birthrights-criticises-nmc-for-independent-midwives-decision/
Byrom S, Newburn M (2020) Where to be born during COVID-19? Positive practice to share. Available at:
www.all4maternity.com/where-to-be-born-during-covid-19-positive-practice-to-share/
NHS England (2016) Better Births: Improving outcomes of maternity services in England
A Five Year Forward View for maternity care Available at www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
NHS England’s policy document ‘Better Births: improving outcomes of maternity services in England’ (2016) directs services to ensure the majority of women are able to access continuity models of care such as those offered by independent, self employed midwives to improve outcomes and ensure personal and safe care. Unfortunately, we have seen the opposite. For several years independent, self employed midwives have faced barriers due to issues relating to indemnity insurance, which is linked to the practice requirement by Nursing and Midwifery Council (NMC). To overcome this, IMs have created innovative social enterprise business models to provide gold-standard maternity care such as Neighbourhood Midwives, and One to One Midwives. Both these organisations were unsustainable due to constraints presented at the commissioning level.
Indemnity insurance
The NMC stipulates that adequate indemnity insurance is required for IMs to practise. However, commercial insurance premiums have increased to £7500 per birth, which means Independent, self employed midwives will be unable to support women from the end of June 2020. Midwives don’t want this and neither do women (Birthrights 2017, Quashie 2017).
Independent, self employed midwives have the professional skill and expertise to provide evidence based safe care in midwifery led units (birth centres) and home settings to ensure women’s choices, human rights, physical and mental well-being are protected in all types of birth including multiple birth, vaginal birth after Caesarean section and vaginal breech birth.
Midwifery expertise is grounded on the social model of care, with an emphasis on advocacy, supporting well-being and protecting public health. The threat to this type of care has been witnessed globally during COVID 19 when women and birthing people’s choices have been withdrawn or dramatically limited due to fear and centralisation of maternity services. In many instances, women’s rights have been violated and midwifery led care marginalised.
During the COVID-19 pandemic maternity units have restricted women’s choices by withdrawing home birth provision, closing midwifery led units and ceasing the use of water for labour and birth. Midwives were redeployed from community settings to support their colleagues on obstetric units. This presented many with a barrier to providing personalised care and cause upset amongst the midwifery profession.
Justification for such decisions were cited as:
- Shortage of midwives
- Prioritising obstetric led units and hospital setting.
- Midwives not experienced in supporting birth out of hospital.
- Not all midwives have the skills to act in an emergency.
- Midwives not confident in supporting water birth.
- NHS refusing to work with independent midwives to cover home birth provision.
- Transfer issues
These decisions contravened national and global evidence to support maternity care in the community setting wherever possible (Renfrew et al 2020). It also introduced an increased risk for women being exposed to individuals who had not been self-isolating. In addition, decisions made compromised options for pain-relief as well as physical and mental well-being. Potential consequences may be apparent for years to come.
For many women and for various reasons the actions taken meant the risks were too great. For them, the only options were to give birth alone or seek out independent midwives to support their individual needs and plans for birth.
However, a number of NHS organisations have continued to prioritise personalised and safe care (Byrom and Newburn 2020) one of those being Chelsea and Westminster NHS Trust in London. This service also worked closely with independent midwives.
‘Women deserve to have the care provider and choice of place of birth that is right for them. They deserve to have the choice and personalisation of care described in Better Births. This means that they should be able to have that care with an independent midwife if they choose. At the Chelsea and Westminster NHS Trust in London we are committed to working in partnership and collaboratively with independent midwives to ensure that they have indemnity insurance needed to practice, and the additional layer of support and education. This in turn means that women have streamlined access to our services enhancing safety for them and their babies. We are very proud of the strong trusting relationship we have developed with our local independent midwives and hope that others around the country will develop their services to be able to work in this way’. Victoria Cochrane, Director of Midwifery and Gynaecology.
Both women and the midwifery profession cannot afford to be without independent, self employed midwives who guarantee genuine choice and midwifery skills to mobilise care and support their midwifery colleagues in times of need and crisis.
We want to ensure that midwifery is a profession that is autonomous and able to support women’s choices by working independently if needed and we have every intention of making this a reality.
References
Birthrights (2017) Birthrights Criticises NMC for Independent Midwives Decision. Available at: www.birthrights.org.uk/2017/01/13/birthrights-criticises-nmc-for-independent-midwives-decision/
Byrom S, Newburn M (2020) Where to be born during COVID-19? Positive practice to share. Available at:
www.all4maternity.com/where-to-be-born-during-covid-19-positive-practice-to-share/
NHS England (2016) Better Births: Improving outcomes of maternity services in England
A Five Year Forward View for maternity care Available at www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf