Valerie Gommon Midwife’s Blog

Archive for the ‘www.independentmidwives.org.uk’ Category

Following the recent screening of “Freedom for Birth” a film documentary discussing the plight of maternity services and midwifery world-wide I have put together an Action Plan of ideas that you may like to consider to support the midwives and maternity services.  Please do as much as you can to make things better for women today and our daughters in the future.

ACTION PLAN

Please consider joining the following Facebook groups:

Independent Midwives UK

Fighting for Independent Midwives

The Birth I Want

ARM Conference 2012

One Born Every Minute—The Truth

One World Birth

Human Rights in Childbirth

Face of Birth

http://www.facebook.com/pages/Podpora-pro-%C3%81gnes-Ger%C3%A9b-Support-for-%C3%81gnes-Ger%C3%A9b/139577179421729?v=wall

Websites:

The Birth I Want:

http://www.thebirthiwant.org.uk

Register an Interest in Independent Midwifery at:

http://www.independentmidwives.org.uk/

The Association of Radical Midwives—Midwifery Matters:

http://www.midwifery.org.uk/

The Association for Improvement in Maternity

Services:

http://www.aims.org.uk/

The Face of Birth

www.faceofbirth.com

Sign the petitions:

http://www.change.org/en-GB/petitions/amnesty-international-europe-amnesty-international-to-save-persecuted-midwives-in-europe?utm_campaign=autopublish&utm_medium=facebook&utm_source=share_petition&utm_term=4998292

http://you.38degrees.org.uk/petitions/choice-for-mothers-to-be-saves-nhs-money

http://epetitions.direct.gov.uk/petitions/34513

 

View the short version of “Freedom for Birth” available November 2012

Write a letter of support for Agnes to President of Hungary, János Áder ugyfelkapu@keh.hu

 

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

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!

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

STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS STOP PRESS

Royal College of Midwives (RCM), National Childbirth Trust (NCT) Independent Midwives UK (IM UK) Association of Radical Midwives (ARM) Association for Improvements in Maternity Services (AIMS) and the Albany Mums Support Group present:

THE ‘RECLAIMING BIRTH’ RALLY SUNDAY, MARCH 7th 2010

Please consider joining us for this important Rally to support mothers and babies.  “Mothers and babies are the foundations of our society, what is more important than getting the foundations right?”

This is a once in a lifetime opportunity – with an election coming up – to send a very loud message, there is a real sense of all the different stakeholders being united in one voice and it could, with hindsight be seen as the turning point for the midwifery profession.

We demand that all women should have a midwife they can get to know, be able to access home birth, a local birth centre, and that there should be independent midwifery available as an option for women to choose.

Meet at 1.00PM in Geraldine Mary Harmsworth Park, Lambeth Road, SE14EQ

We will march to Whitehall to hand in a petition to the Health Minister and letters to the Prime Minister

Master of Ceremonies: Peter Duncan.  Speakers include: Professor Wendy Savage, AIMS Chair Beverley Beech, Albany Midwife Becky Reed, IM UK Board Member Annie Francis, NCT CEO Belinda Phipps, Albany Mums Support Group campaigner Emma Neamish and Duncan Fisher OBE

PLEASE TELL EVERYONE ABOUT THIS IMPORTANT RALLY.

Doulas

Posted on: August 9, 2009

Yesterday someone asked me for my opinion on Doulas, so here goes.

 www.doula.org.uk defines a doula as:

“Doula” (pronounced “doola”) is a Greek word meaning “woman servant or caregiver”. It now refers to an experienced woman who offers emotional and practical support to a woman (or couple) before, during and after childbirth. A doula believes in “mothering the mother” – enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mum. This type of support also helps the whole family to relax and enjoy the experience.

It is tricky to define my feelings about Doulas.  I guess I actually started out as a doula, as I attended the births of several friends in the context of being a birth supporter (although the term doula was not in common usage then). I absolutely feel that the best person to support a labouring woman is another woman who has given birth herself (that said I have met some excellent male midwives … hello Mark and Kevin and I also know some fantastic midwives who haven’t had children themselves). My personal experience with doulas is limited, but has generally been positive – as a midwife I am always happy that a woman is supported by those she feels comfortable with and indeed it can be very helpful to me, however I am also aware that some midwives have had negative experiences of doulas who perhaps have been in conflict with the midwife (and I am sure that some midwives may view doulas less favourably than me).

I find myself slightly uncomfortable with the doulas role partly I guess because I feel that if midwives are doing a good job the midwife would be supporting her client; but also I am concerned that we may be using “untrained” support i.e. doulas or maternity care assistants in place of midwives and this may not be appropriate.  I am increasingly hearing that the role of maternity care assistants (MCAs) is being extended – again, this evokes completely mixed feelings as I know MCAs can be excellent and they should not attempt anything that they have not been trained for, but they are not midwives and have not taken a three year training course.  Are they being used as cheap labour?  Will they miss vital signs and symptoms because of their lack of training?  I don’t know.

There are many positives to employing a doula, for example they will help with domestic duties for example cooking, shopping etc and this may well be beneficial, they are certainly cheaper than hiring an Independent Midwife like myself but their role is different.  For a woman planning a NHS hospital birth where the midwife may well also be caring for other clients it is a way of ensuring that the woman is not left alone and this will be supportive for the woman and her partner.

So I guess my jury is out on this one – I guess it is down to your personal circumstances.

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.

I am really sad, but not suprised as the news has unfolded this week about the Healthcare Commission Report into care given by Stafford Hospital.  www.healthcarecommission.org.uk/newsandevents/mediacentre/pressreleases.cfm?cit_id=1640&FAArea1=customWidgets.content_view_1&usecache=false

I believe that similar situations are occurring throughout the UK, and that what has happened at Stafford is merely the tip of a terrible iceberg.  Whilst I am sure there have been mistakes made, I was outraged by Alan Johnson’s comments about poor management at Stafford.  The Government must take some responsibility for what has happened.  The NHS is in crisis.  Someone (with a greater mind than me) has to look at what is happening and make changes.  Clinical staff are overworked, indeed a year ago nurses and midwives were being made redundant in many Trusts and staff are expected to work even harder to make up shortfalls, alongside being given additional work in the form of clinical responsibility and paperwork.

The Report cited low staffing levels, inadequate nursing, lack of equipment, lack of leadership, poor training and ineffective systems for identifying when things went wrong.  I know from personal experience that the NHS is often reactive rather than proactive – staffing shortages mean that training sessions are often cancelled, and there is no time for proper planning.  Sickness levels are high due to exhausted staff.

I don’t want to scaremonger – I do believe that the NHS, on the whole, delivers “just about” safe care.  But that is it.  It is just about safe.  No TLC, no extras, and much basic care such as washing and feeding of patients is done by relatives.

It is for these reasons that I decided to leave the NHS and work in Independent Practice, www.3shiresmidwife.co.uk.  It was not an easy decision, but I felt that I was unable to give the quality of care and the continuity of care that I felt clients deserved.  I spent so much of my day apologising, and promising to get back to clients.

I am now very happy, giving good quality care, time and full continuity to my clients, but I do feel guilty that this care is not available to all, and I do feel huge respect for my colleagues who are still working within the NHS.

I believe that the public HAVE to be heard.  Staff are so exhausted that they don’t have enough energy to campaign, and they probably aren’t listed too.  As happened with maternity services in New Zealand, it is only when women and midwives work together that change can be effected.

We recently had a series of showings of “The Business of Being Born” www.thebusinessofbeingborn.com around the country; women need to mobilize to improve things.

For ideas I suggest you look at www.onemotheronemidwife.org.uk or www.independentmidwives.org.uk or feel free to contact me at info@3shiresmidwife.co.uk to discuss your ideas.


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