Valerie Gommon Midwife’s Blog

Archive for the ‘midwifery’ Category

Very sadly it looks fairly certain that Independent Midwifery will end in October 2013.  The Government and Nursing and Midwifery Council have for a long time been recommending that Independent Midwives should have professional indemnity insurance (negligence insurance) despite it not being commercially available in the marketplace i.e. insurers do not provide this insurance for midwives.  You can read more about the current situation here http://www.independentmidwives.org.uk/?node=11615

An E.U. Directive is now due to come into force to implement this change and our current information is that it will be illegal for us to practice without professional indemnity insurance from October 2013.  This means that women will be denied the choice of choosing an Independent Midwife and we will be denied the choice of working independently and will be forced to stop practising or to return into the NHS.

The Independent Midwives UK organisation has been working tirelessly for years to find a solution and it is just possible that an eleventh hour solution will be found but this is now looking unlikely.

A group of midwives have formed an organisation called Neighbourhood Midwives www.neighbourhoodmidwives.org.uk/ and are working towards setting up an employee-owned social enterprise organization, to provide an NHS commissioned caseload midwifery homebirth service, based in the local community.  This may prove to be a workable alternative to Independent Midwifery but at present (if it comes to fruition) the service will only be able to accept “low-risk” women and this is of concern to all of us who have supported women with more complex situations, for example first time mothers, vaginal birth after a previous caesarean, twins, breech birth and women who are not deemed “low risk”.  The aim of Neighbourhood Midwives will be to extend their remit to include more women as soon as possible.

There is already a precedent for this type of care as One to One Midwives in Liverpool www.onetoonemidwives.org have already managed to set up a caseloading midwifery service (similar to independent midwifery in that a woman will care for a caseload of women throughout the whole of the pregnancy, birth and postnatal period) within the NHS.

It is a very sad time for midwifery and for women’s choice, but perhaps good things will come out of it, I certainly hope so.

PRESS RELEASE ISSUED 8th December 2011 by IM UK

RESPONSE TO CONTROVERSY OVER
PRIVATE MIDWIFERY PROVIDER:

SOCIAL ENTERPRISE PROVIDES THE ANSWER
IM UK reads with interest the mixed reactions to news of a contract between private midwifery provider One to One (Northwest) Ltd and NHS Wirral.  The service offered is one the NHS can rarely deliver: continuity of care from a midwife the woman knows, through pregnancy, birth and postnatally. However, concerns have been expressed about the impact of profit-driven private providers on the NHS.

“IM UK believes that the answer lies in social enterprise midwifery: continuity of care delivered by an organisation run by midwives and service users for the benefit of the local community,” states Annie Francis of IM UK.

“That is why we are establishing a social enterprise, named Neighbourhood Midwives, to offer local, community based midwifery services.  Care will be free at the point of access for women but provided by a social enterprise, whose values and culture are firmly rooted in a social mission and purpose. We are well down the path and are ready to provide services from April 2012.

“We are keen to be fully integrated into the whole maternity care pathway, ideally through the planned networks currently being discussed. We will be able to offer care to women planning a homebirth but often unable to access this choice because of current shortages of midwives within the NHS.”

Historically, insurance issues have been a barrier for not-for-profit providers.  During recent debates on the Health and Social Care Bill, Baroness Julia Cumberledge emphasised the need for social enterprise organisations such as Neighbourhood Midwives to be able to access insurance via the NHS Litigation Authority (NHSLA). 
For further information contact:
Annie Francis
07977695948
annie.francis@independentmidwives.org.uk

Jill Crawford
07870924857
jill.crawford@independentmidwives.org.uk

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads This blog is on fire!.

Crunchy numbers

Featured image

A helper monkey made this abstract painting, inspired by your stats.

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 3,900 times in 2010. That’s about 9 full 747s.

 

In 2010, there were 53 new posts, growing the total archive of this blog to 172 posts. There were 2 pictures uploaded, taking up a total of 2mb.

The busiest day of the year was April 7th with 144 views. The most popular post that day was Birth before the arrival of a midwife.

Where did they come from?

The top referring sites in 2010 were 3shiresmidwife.co.uk, facebook.com, en.wordpress.com, twitter.com, and studentmidwife.net.

Some visitors came searching, mostly for midwife blog, valerie gommon, skinny women and pregnancy, albany midwives suspended, and placentophagy research.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

Birth before the arrival of a midwife May 2009

2

“Super skinny pregnancies” March 2009
6 comments

3

Independent Midwifery and snow Part II January 2010
4 comments

4

Eating the placenta (placentophagy)? October 2009
3 comments

5

Freebirthing / Unassisted birth May 2009
5 comments

It is crunch time and we really need your help if independent midwives are going to be able to practise in the UK in future. If you recognise the value of personalised, high quality midwifery care throughout pregnancy, birth and after the baby is born that an independent midwife is able to provide, then please could you let the government know NOW.

For several years the government’s new policy that all healthcare professionals have indemnity insurance has been put on hold. Last year the government commissioned the Finlay Scott Review to look at the feasibility of indemnity insurance as a condition of every healthcare professional’s registration. The Review has now been published and recommends that indemnity/insurance should become mandatory and a requirement for registration. However it also recommended for those groups for whom the market does not provide affordable insurance or indemnity (independent midwives), the relevant Departments of Health in the four countries of the UK should decide if the continued availability of this service is necessary; and, if so, should seek to facilitate a solution to the problem. (See more information in the letter below)

The Departments of Health are due to respond imminently to this Review – and their responses will be a perfect vehicle through which to address this anomaly with solutions from policy-makers.

Can you please send an email to your MP and copy it to your relevant Department of Health. Could you also print your letter and send it as a hard copy to your MP and Department of Health as although slower, receiving lots of letters is more effective. Please feel free to use any information on this page, and/or include your own feelings and experiences.

Find your MP by clicking on: http://findyourmp.parliament.uk/ and click on his/her website to find their email and constituency postal address. Don’t use the House of Commons address for MP’s at this time of year as it is in summer recess.

Departments of Health:

England:
Mike.Lewis@dh.gsi.gov.uk

Mike Lewis
Senior Policy Manager
Professional Standards Division
Department of Health
2N10 Quarry House
Quarry Hill
Leeds.
LS2 7UE

Scotland:
Catherine.clark@scotland.gsi.gov.uk
Catherine Clarke
Regulating Unit
Chief Nursing Office
St. Andrew’s House
Regent Road
Edinburgh
EH1 3DG

scottish.ministers@scotland.gsi.gov.uk
Nicola Sturgeon
Cabinet Secretary for Health and Wellbeing
The Scottish Parliament
Edinburgh
EH99 1SP

Wales:
correspondence.edwina.hart@wales.gsi.gov.uk

Edwina Hart
Minister for Health and Social Services
Welsh Assembly Government
Cathays Park
Cardiff
CF10 3NQ

Northern Ireland:
private.office@dhsspsni.gov.uk
Michael McGimpsey
Minister for Health, Social Services and Public Safety
Room C5.10
Castle Buildings
Stormont Estate
Belfast
BT4 3SQ

Please inform as many other friends, family and supporters such as local NCT groups, Women’s Institute, etc as possible.

Without positive government intervention independent midwifery will become illegal in the very near future. If a solution is provided, it could benefit maternity services in the UK for decades to come.

Thank you for your support!

Sample letter

Dear MP

RE: Finlay Scott Review

I’m writing to ask for your help in giving thousands of families greater opportunity to have safe positive pregnancies and births with support into early parenting.

The Government recently heard from the Finlay Scott Review, which had been asked, to look at indemnity insurance as a condition of professional registration. The Review recommended that the Government should make indemnity / insurance a requirement of every healthcare professional’s registration. However it also recommended for those groups for whom the market does not provide affordable insurance or indemnity (independent midwives), it should decide if the continued availability of those services is necessary; and, if so, should seek to facilitate a solution to the problem.

There are currently approximately 100 independent midwives in the UK, providing high quality, one-to-one care to families throughout pregnancy, birth and early parenthood. It is this kind of genuinely personalised care, from their own midwife, that growing numbers of women want. It has significant public health benefits in terms of increased normal birth and breastfeeding rates and saves money.

Taking on independent status is also something which offers great advantages to midwives themselves, empowering them as frontline workers, to work closely with women and with more flexibility in their working lives – crucial if the drain of midwives from the profession is to be reversed.

The barrier to independent midwives providing this service is that they cannot be indemnified or insured. This is due to the number of independent midwives currently being too small to enable the risk to be pooled and spread in a way that produces an affordable premium. There is simply no insurance available for independent midwifery services. This is standing in the way of more pregnant women benefiting from this type of care and enabling more midwives to work this way.

In 2013, independent midwifery will be made illegal under EU law if a solution is not found. EU legislation by then will require all health professionals to have indemnity/ insurance.

The benefits of finding a mechanism to indemnify or insure independent midwives will be:
• independent midwives will be able to provide care within the NHS with improved public health outcomes, reduction in costs and increased choice for women;
• women’s choice will be maintained;
• the risk reduced of some women choosing to give birth unaided if unable to access care that is acceptable to them within the NHS;
• midwifery expertise in normal birth skills will not be lost;
• more midwives staying in the profession.

The government is due to respond imminently to the Findlay Scott Review. The Review recognises that a potential problem arises from its recommendations but also acknowledges that the government could intervene to provide an affordable solution.

Please support my request to recognise the importance of this service for the safety and wellbeing of mothers, babies and families by calling for the indemnity/insurance issue to be resolved by the Department of Health.

Regards

Thank you so much for your support!

Valerie Gommon

Independent Midwife

www.3shiresmidwife.co.uk

I guess this may be more useful if you are planning to hire an Independent Midwife as with the NHS there is less choice, but you still do have a choice of midwife and should remember that if you don’t get on with your midwife you can ask the local Supervisor of Midwives (at the local maternity unit) to help you to find a new midwife.

If looking for an Independent Midwife, I would suggest that you start by looking at www.independentmidwives.org.uk where you can enter your postcode to find the midwives who live closest to you.  This website will then lead you to look at the midwives own websites and you should get a “feel” of the midwives from their websites.  The next step is to email or telephone your favourite midwife(s) to have a chat with them, again this should help you to gauge whether they might be the right midwife for you.

The midwife will want to know where you live (to ensure that she is able to travel to you), she will also want to know when your baby is due (to ensure that she is free at that time) and whether it is your first baby.  If you have had a baby/babies before I would expect her to ask about your experience.  She will also be keen to know where you plan to give birth.

Questions you may like to ask of the midwife include:

How long have you been a midwife? / An Independent Midwife?
Do you like homebirths/waterbirths?
Do you have additional skills (hypnosis training etc)?
What would happen if my baby is breech/I am expecting twins?
What is your normal birth rate?
What is your caesarean rate?
What is your breastfeeding rate?
What is your homebirth rate?
What is your transfer rate?
How much do you charge?
What can I expect from you?
Antenatal care? Labour and birth care? Postnatal care?

I would expect an Independent Midwife to outline the issue of the lack of professional indemnity insurance to you.

If you enjoy speaking to the midwife, I would suggest that the next course of action might be to arrange a consultation.  The midwife will usually be happy to come to your home to meet you and your partner to discuss things in more detail.  Many midwives make a small charge for this meeting to cover their time and petrol costs (this meeting make last a couple of hours) and will be an opportunity for you to ask any questions of the midwife and again to enable you to decide whether she is the right midwife for you.  Most midwives will deduct this fee from the final balance if you decide to book with them.

Some women do “interview” a couple of midwives, and this is perfectly acceptable and perhaps a sensible approach as it will be an important relationship.

An Independent Midwife’s fee may seem expensive, particularly when you can get a similar service for free on the NHS, but I always say to clients that you won’t have many babies and it is important to get things right!  It may be better to employ a midwife and wait a bit longer for the new car or foreign holiday!  An Independent Midwife will usually give you a lot more time than an NHS midwife is able to; she will see you more frequently and give you longer appointments.  The other main benefit is that you will see the same midwife throughout your pregnancy, birth and postnatal period.

I wish you well in your decision-making whether you choose an NHS or Independent Midwife, and if I can be of any help to you please feel free to email info@3shiresmidwife.co.uk

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

I have recently had a client birth her twin girls at home.  To give birth to twins at home is a rare event; it is obviously slightly more risky that a single birth.  My client carefully considered the risks and benefits of homebirth.  She had previously given birth at home and felt that for her home was the right place.  She knew she would feel safe, relaxed and that her labour could not be “interfered” with (for example many women expecting twins are encouraged to have an epidural and to give birth with the help of doctors in theatre).

Her pregnancy progressed well; an ultrasound scan showed that the twins were dichorionic, diamnionic which gives the best possible prognosis as each baby was in it’s own amniotic sack and had it’s own placenta.  My client chose to have growth scans which showed that her babies appeared to be growing well and equally she declined the option to see an obstetrician as she felt this might be undermining.

We were mindful that a woman with a twin pregnancy needs excellent nutrition to grow two babies, and to maintain her health and wellbeing and my client ensured that she ate well, especially iron rich foods, protein and extra salt (as suggested by Dr Tom Brewer).    As she experienced pelvic discomfort, she saw a chiropractor throughout her pregnancy and found this to be beneficial; she also experienced heartburn as might be expected with a twin pregnancy.

During the pregnancy we made extensive plans about how we expected the birth to progress; what we would do in the event of  problems and who we would have present at the birth.  We planned to aim for the most experienced team we could muster.  In the event we had four midwives – not because we felt we needed four, but because the midwives were keen to attend a twin birth, and my client was very happy to have them present.

On scan at 36 weeks we were surprised and pleased to learn that both babies were cephalic (head down).  Previously the second baby had been in a breech position.

My client laboured at 39+ weeks.  Her labour was fast and the first baby was born in the birth pool within two hours.  There was a bit of a delay but her second daughter was safely born in good condition and although initially tired, she has recovered well and is doing really well.

This was a fabulous outcome – I was blessed with clients who were strong, did their research and knew that they wanted to give birth at home.  They did not want a homebirth at all costs and would have transferred to hospital if I felt that there was a clinical need.


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