As one of the most essential skills within the health sector, midwifery commands respect as a profession. However, the latest moves within the industry are proving controversial, with a new EU directive essentially rendering independent midwives unable to work. Independent midwives (usually trained by the NHS and then later moving onto self-employment) are popular amongst mothers-to-be who want access to one-to-one care and to have their antenatal visits at home.
So what is it?
Essentially, the new directive is based on insurance. IMs have typically operated without insurance: if something goes wrong, the family’s option is to individually sue the midwife, unlike NHS midwives who are insured under the service. The new regulation, though, will make it illegal for midwives to operate without insurance.
What’s the issue?
IMs typically can’t get insurance. Not because they are any riskier than those under the NHS banner, but because the data presented to insurance companies about midwifery is put together in one lump, making it incredibly hard for them to make an informed decision and therefore grant insurance. Despite the Prime Minister describing IMs as “the gold standard”, little has been done by the government to aid their predicament.
What could a lack of IMs lead to?
Essentially, it could potentially lead to there being simply not enough midwives out there. The Royal College of Midwives released a statement in January noting the “massive shortage” of those looking to take on midwifery as a career, and stated that maternity services had currently reached “a tipping point”.
Currently, figures aren’t actually too alarming – with 2,500 new over-subscribed midwifery student places becoming available each year. However, there is currently simply not enough funding to offer them all jobs.
Cathy Warwick, the chief executive of the RCM, spoke to the Guardian and noted that England was currently around 5,000 midwives short and that newly qualified midwives were currently in a “dead man’s shoe situation” where they are waiting for people currently in posts to either die or retire.
With a lack of funding for NHS midwifery and the apparent shortage, it has to be considered essential for IMs to be able to operate if those who wish to give birth at home are to be allowed to do so. Whilst the NHS currently does have a legal duty to support a woman who wants to give birth at home, hospitals can counter this by stating that they don’t support her choice of birth for reasons such as there not being enough midwives to attend a birth away from the ward.
Indeed, the latest research from the RCM indicated that one in five women do not feel supported by the NHS during their pregnancy and their birth.
The controversy has been further stoked by reports of a hospital in Ireland last month that applied for a court order to carry out a cesarean section on a mother-to-be who refused to have the surgery on the grounds that she had already had one when giving birth previously and now wished to try to give birth naturally. In the end, the mother conceded and had the surgery before she was ordered by the court to do so.
This does give some indication as to the value that independent midwives can still offer Britain.