Valerie Gommon Midwife’s Blog

Archive for the ‘Independent Midwives Association’ 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.

No two pregnancies are the same, so it is very important that you continue to look after yourself by eating and resting as much as you possibly can.  Remember this time you are also looking after your little one(s) too.  You may feel better or more tired this time around; and certainly having a toddler is hard work.  If your toddler sleeps then you should rest and not rush around doing housework!  If you are exhausted try asking a friend if they would have your toddler for a couple of hours so you can rest.  I can’t stress enough that you need to eat a good diet – ensure that you eat plenty of protein and iron rich foods.

You may notice that you “show” earlier second time around, this is because your tummy muscles have been stretched before and is quite normal.  You may also notice baby movements a little earlier because you know what you are looking for, but don’t worry if you don’t!

Some women say that they are anxious about labour second time around; if you had a difficult labour talk to your midwife about it – ask her what happened and why it happened and what are the chances of it happening again, however second births are usually much easier and shorter.  It is usual to be a bit anxious about labour – most women are, but remember you did it last time and you can do it again!

I think it is definitely worth attending childbirth classes if you can – I had four children and I went to classes each time – it gives you time to concentrate on this pregnancy and this new baby; and a birth plan is a great idea, second time around you are better prepared as you know what to expect, you know what you want and don’t want to happen so put it down into a birth plan and if you need advice speak to your midwife.

Successive reports have called for one-to-one care in labour as all outcomes are improved, for example women are more likely to have a normal birth if they receive one-to-one care.  However, to some women this means having the same midwife from booking, through the antenatal period, labour and birth and until postnatal discharge – this type of care may not be available in your area unless you employ an Independent Midwife www.independentmidwives.org.uk.

Consider having your baby at home, there are so many benefits, women usually have shorter and easier labours and this time you will be better able to read your body and can stay at home if you feel comfortable and relaxed and you won’t have to leave your first child whilst you are in hospital.  Staying upright and active will help with the contractions and also keep the baby in the best possible position for birth, but your body will tell you what you need to do; try to relax and have faith in the birthing process.

Women generally recover quicker second time around, this is partly because labour is usually quicker and easier – and also because being an experienced mother usually helps to establish feeding more quickly.

Unfortunately, the more babies you have, the stronger the after pains usually are – this is because your uterus is having to work harder to contract.  Ask for paracetamol which will help and is perfectly safe to take.

Remember that your other child(ren) will need extra love and reassurance – your new baby is much tougher than you think, try to involve the older sibling(s) in what you are doing and have patience – it is usual for children to regress a bit when they have a new baby in the house.  Accept any help that is offered and consider staying in your pyjamas for a few days – it shows that you are not at full strength.  I think women try too hard to be superwoman, just allow yourself some time to enjoy your new baby – they aren’t babies for long, although it sometimes feels like it when you are in the thick of it!

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

Yesterday I was asked to speak at the Hinchingbrooke Maternity Services Liaison Committee AGM.  I think it went okay.  The title of my talk was Normal Birth Successes and I spoke about some of the clients I have in my Independent Midwifery Practice www.3shiresmidwife.co.uk (obviously stories are anonymized to protect client confidentiality).

I spoke about five beautiful births, one was a lovely waterbirth of a 10lb plus baby, another was a normal birth when the mother had been so frightened that she was planning an elective caesarean when she booked me.  There was also a story of a woman whose first baby had been born by caesarean, her second had been a forceps delivery and her third son (11lb) was born, at home, at Term + 18 days and a client whose first baby was born at home in the breech position and finally a client expecting her first babies who had twins at home.

I spoke about the benefits of having a known midwife at the birth, women are:

  • more likely to have a normal birth
  • less likely to have a caesarean or forceps delivery
  • have shorter labours
  • need less drugs
  • more likely to breastfeed
  • more likely to be happy with their experience
  • less likely to experience postnatal depression

All outcomes are improved when women have a midwife they know and trust.

I often work with women who are considered to be “high risk”, but these brave women sometimes make the difficult choice to labour at home because they want to be left alone, in an unpressurised environment, to get on with their labour in peace.  We know that oxytocin (the hormone needed for labour) flows better when women are relaxed and feel safe.  Often the journey to hospital, or meeting a new midwife will be enough to stop contractions (if only temporarily).

I am passionate about caseload (or one-to-one) midwifery – I believe every woman deserves to have a midwife she knows with her throughout her pregnancy and birth journey.  I fully appreciate the difficulties this provides for an under-staffed, under-resourced health service – but there are many areas that make this work for a large majority of their clients – why can we not make this a reality for more women?

There are several campaigns to improve things for women (and midwives), please visit  www.independentmidwives.org.uk or www.onemotheronemidwife.org.uk for details.

Following my recent posting when I mentioned that some women choose unassisted birth as a result of previous trauma, I have recently read that  American actor and talk-show host Rikki Lake has revealed that she was sexually abused as a young child.

Ricki Lake bravely discusses her past in her new book “Your Best Birth”.  Lake discusses her past battles with her weight and body image but goes on to describe the healing that she has experienced through her own birthing experiences, and I have to say that this concurs with my experiences as a midwife – I absolutely believe that a positive birth experience can be healing and empowering for women whether their past trauma was sexual abuse or a traumatic birth experience and am very happy to speak to women about this subject www.3shiresmidwife.co.uk.   It is well recognised by midwives that pregnancy and birth are significant times for women who have experienced sexual abuse – memories may well come to the fore, or a woman may remember events that she had previously buried and forgotten.

The documentary “The Business of Being Born”, www.thebusinessofbeingborn.com, which Lake made with filmmaker Abby Epstein, has touched many people and was championed by both the Independent Midwives Association (IMA) www.independentmidwives.org and the National Childbirth Trust (NCT) www.nct-org.uk and has been shown to packed audiences around this country and abroad.

Help is available for survivors of child sexual abuse from a number of sources including:

www.thesurvivorstrust.org

www.childline.org.uk

www.sheilakitzinger.com


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