In preparing for the birth of our first child, we considered all the available options. Our research was not reassuring. Expectant mothers could talk to midwives, but it may not be the one who would assist at the birth. There was a birthing pool, but it might not be available when the moment came. Yes you can give birth at home, if a midwife was free. When it comes down to it, the mother’s preferences and plans for birth might, or might not, have some application when labour starts
Our friends’ experiences of the NHS didn’t reassure us either, and it seems they were not untypical. A recent study reported women feeling unsafe and frightened while in NHS facilities, describing their experience as being treated “like cattle” or being “on a conveyor belt”.
What is more, it is clear from the wild variations within and between developed countries of the rates for Caesearian sections, that many women who accept what happened to them as necessary and perhaps life-saving were, in fact, the victims of unnecessary major surgery, with life-long implications for their future fertility.
The possibility of modern medical interventions in childbirth are part of the reason for the developed world’s historically low maternal mortality rates. Their misuse is part of the reason for our low birth rates and low rates of breastfeeding.
Midwives would not all disagree. Many feel unable, within the NHS, offer the care to mothers which they would like. They are short staffed and bound to rigid protocols. Perhaps there is no other way of running hospitals economically, but over the years a number of midwives have decided to offer their services directly to clients. These are ‘independent’ midwives, fully trained and subject to the same laws of medical negligence as everyone else, but employed by women, not the state.
For expectant mothers wanting a home birth, or a natural birth; for those deemed ‘high risk’, after a Caesearian or perhaps because they are over 35; and for those who like the idea of continual care before, during, and after birth by the same midwife, independent midwives are an attractive option, and perhaps the only one.
We chose an independent midwife. My wife’s labour was slow. The conversation round the bed in a hospital is not difficult to imagine. A ‘failure to progress’ would have led to artificial induction, which in the circumstances would have failed, leading to a c-section.
What actually happened was that, since our daughter was not in distress and Lucy felt confident to let the labour continue, the baby was born naturally. Having had one Caesarian the pressure to have every birth by section would have been immense, as would pressure to limit the number of pregnancies to three or four. The calm professionalism of our midwife at this critical moment has made a fundamental difference to our family life.
The option of choosing an independent midwife ceased, however, on January 11 this year, when a Government body effectively banned them. The Nursing and Midwifery Council (NMC) told Government that independent midwives’ insurance cover, arranged through their professional body, Independent Midwives UK (IMUK), was inadequate, and that, with immediate effect, if they continued to work they could face prosecution. What is more, the NMC has repeatedly refused to say what would count as adequate cover. It is simply impossible for independent midwives to comply with the law.
Thanks to their extraordinarily dedicated personal care, independent midwives’ safety record was vastly better than that of the NHS, despite looking after women with a higher risk profile than the average.
It is difficult to think of a more fundamental and practical service to life and the family than the work of independent midwives. That they should be prevented from working by an arbitrary decision of this kind beggars belief, and deserves to be more widely known.
IMUK is currently considering seeking judicial review of the decision.