My children and husband really admire the back of my head; my long hair appeals to them and the gentle slope of my shoulders is a comforting sight. I convince myself of this, as this is pretty much the view they have had for the past 12 months as I have been immersed in the campaign to save Independent Midwifery and find an insurance solution that will enable me to continue working.
This week, the Department of Health (DH) announced that they would not be supporting IMUK's solution to the problem; despite that fact that IMUK have found, written and are ready to launch an insurance product that is adequate, affordable and meets the EU requirements to enable IM's to continue in practise. Apparently the £1M we applied for from the DH to (as a one-off payment) to get the product off the ground in the early years, is not a good use of tax payers money. IMUK has estimated it saves the DH and the NHS around £13M a year - do the maths.
The DH have invited IM's to return to the NHS where we would be 'welcome', or to find employment with one of the two groups who have PII to provide midwifery outside of the NHS. Simples! Or is it?
Let us start with the question of WHY women choose to use an Independent Midwife before I politely decline the offer to return to the NHS at present (I may one day, but for now being an IM is the right way of working for me and my family). I would like to introduce you to some very special women:
This is Catherine.
Catherine's first baby was Breech and she was invited to have a caesarean section. Having read all the evidence, Catherine and her husband new they wanted a vaginal birth. IM's were the only experienced practitioners able to support her and she birthed Billy at home safely and swiftly.
This is Synah.
Synah's first baby was born by Caesarean section. Synah and her husband explored the risks and benefits and decided to give birth at home. The NHS would not support this choice, and the 'other midwifery' groups out there were unable to facilitate this due to insurance constraints.
This is Jasmine.
Jasmine and Alex are both registered professionals. They wanted a midwife who would support them throughout their pregnancy and birth without the use of screening, ultrasound or routine intervention. IM's have the confidence and skills to support women in this way.
This is Neile.
Neile and her husband wanted to birth at home (as Neile had been). Neile wanted to know the midwife who would attend her on the day, and how her midwife viewed childbirth. The NHS unit could not guarantee they would know who would be with them through the birth of their baby.
This is Sam.
Sam and her husband planned a home birth with their first baby, however in labour they were advised there were no midwives to attend and had to go to hospital. Two weeks before the birth of their second baby, they were advised that there was a staff shortage and once again they would be unlikely to be supported at home. They choose an IM at this very late stage so they could stay at home for the birth.
This is Cath.
Cath's first baby was born by caesarean section. Cath has a genetic condition which meant that at every appointment with a different midwife she had to go through the painful history of lost pregnancies. She chose an IM to support her at home - and whom she only had to share her story with once. Other midwifery services would have been unable to support her.
This is Emilie.
Emilie and Stuart have had a tough journey with each of their three babies. With each baby they have had the same midwife they knew and trusted. Emilie needed two caesareans but was supported through each pregnancy with making the choices that were right for her and not driven by hospital policy or insurance constraints.
This is Cathy.
Her first baby was breech and once again it was IM's who were experienced to support her choice of a breech vaginal birth. When she needed a caesarean it was the IM's who noticed this. And when she chose to have a VBAC (vaginal birth after caesarean section) at home, it was IM's again she called in to provide the support she needed.
These women, all spent time and thought in choosing to step outside of the NHS. They did this as the NHS was unable to provide the care they needed. Their pregnancies required a midwife who worked to evidence (not policy) and who was able to individualise the care they needed to meet their needs.
I cared for all of these women; and many more besides. Many of my clients are traumatised by their previous experiences of birth and will not return to the NHS. Some of my clients have 'risk factors' that other midwives insurances would not allow them to provide care. Some of my clients would choose to birth alone if they could not have a midwife who was able to support them. They would not be choosing to 'free birth' (a choice some women actively make as empowered individuals) but would be forced to consider birthing alone as they might feel there was no other option.
I have two teenage daughters; I struggle to believe that in the future their choices around birth will be dictated to by the men in suits, who are so short-sited that they cannot see the bigger picture, cannot accept that women have rights and cannot accept that the one-size fit's all NHS does not always meet the needs of women. They bang on about choice, supporting women and supporting midwives: midwives continue to leave in their droves (or cannot get a job as 30% of newly quailed midwives are unable to), women need other safe alternatives and the commercial insurance market can dictate how midwives work (or withdraw their insurance at any time - as will happen in Germany next summer).
I am legal until the EU directive is passed and will continue to search for the way to fund the insurance along with my IMUK Board members. In the meantime, I pay attention to the back of my head. It's the least I can do for my family. And for the future; I guess I can't see any other way of working and I certainly could not leave women who need care outside of the system without another choice. Even if that makes me illegal.