Women, Midwives, Everyone-You Have Every Reason To Be Concerned.

For the past few weeks I’ve had this grey cloud hanging over my head. It stops me from returning to sleep when I wake in the night to feed my baby. When I do eventually get to sleep I wake up hoping that it was just a nightmare but then the realisation returns in the form of the grey cloud and heavy heart that I just can’t ignore nor can I remain silent about. My mind is haunted with the knowledge that pregnant women have had their chosen midwife taken away from them, a midwife who they know and trust. I hear from women that they are experiencing feelings of fear, vulnerability, helplessness, solitude, all adding to their feelings of anxiety. Feelings I can relate to. I worry for these women and the impact these feelings are having on the future of their growing babies.

I have started to write my thoughts down to help offload them and aid my pathway back to sleep. The notes are getting longer and new worries are being added to the list as the plot thickens and as I hear others share their concerns.

It all started when I received a message informing me that when the clock struck 12 on the previous evening of 11 January 2017 independent midwives were forbidden to attend women during labour and birth. If they were found to be doing so they would be stuck off the registrar and a fitness to practice investigation would be commenced. This was due to a decision made by the Nursing and Midwifery Council (NMC) as they feel the indemnity cover provided by IMUK is inappropriate. You can read their official statement here. You can also hear the chief executive of the NMC Jackie Smith being interviewed by Beverly Turner for LBC about the latest decision here. After listening to this interview I am finding it hard to believe that Jackie Smith, who doesn’t seem to understand what makes an independent midwife different from other midwives, nor can she specify what form of indemnity would be considered sufficient, who actually said in this public interview that it is for independent midwives to determine what level of indemnity is sufficient, has been able to stop independent midwives supporting women who have hired them due to insufficient indemnity?

IMUK followed the NMC guidance about professional indemnity arrangements and ensured that each midwife HAS in place cover that is relevant for her role and scope of practice. Each midwife is confident that she has done this!

So what is the issue here?

Is there something I am missing?

How has this been allowed to happen?

Why hasn’t someone who has the power seen just how ridiculous this whole situation is and put a stop to it immediately for the safety of women?

Why hasn’t this made the headlines?

This news felt like a punch in the stomach, a kick in the teeth. It has only been a matter of weeks since I had experienced a form of care that I had never experienced at any of my previous 3 births. It was a form of care that met my needs physically, emotionally, fully respected my choices and ensured I was safe whilst I birthed my baby. This new found care was provide to me by an independent midwife called Kay Hardie. It was a revelation, a gold standard form of care that has my full support and approval. The type of care that I would only ever expect and seek for my daughter, my nieces, my loved ones, my friends and for all women. You see thats why I feel so sad, because I know that mainstream forms of maternity care cannot guarantee that women are cared for and supported at birth by a midwife they know and trust. For some women the alternative forms of care are now their only option. I have spoke to women who will now choose to birth alone rather than birth in an environment where they have experienced traumatic care and the reason they choose an independent midwife in the first place.

It is no secret that the NHS maternity system is in crisis and that there is a shortage of 3,500 midwives. Over a third of current midwives are due to retire which will only add to the shortage. Newly qualified midwives are experiencing depression and are being signed off sick due to the pressure they are facing at work, you can read an example of a brave midwife sharing her story here. Many fantastic midwives are suffering burn out due to extended shifts, lack of breaks and support when needed. Bullying is also an issue for both midwives and women within the NHS maternity system. Recruiting new midwives is not going to be easy now that the bursaries have been cut – fees for midwifery training runs into the thousands. Midwifery is no longer a profession that can be pursued by everyone due to its affordability. We know that midwives are struggling to provide the best maternity care, both women and midwives are suffering the consequences. In the current climate things will only deteriorate even more.

There are many fantastic midwives working in the NHS, striving each day to ensure women receive the individualised women centred care they deserve. But how long can they keep their momentum up in a system that is in crisis. How many of these midwives have found it easier to serve the system rather then women which was their original intention. How many of these midwives have morphed into obstetric nurses without even realising?

Midwives don’t let this happen, put your heads above the parapet and fight for your profession, for your autonomy, and your right to truly be with woman as intended.

It would seem that as the number of midwives fall, medicalisation of birth rises as does prenatal mental health. Are all three linked? I find this a huge concern for women and society as a whole.

“We hear from our members everyday that they are struggling to provide the best maternity care they can because of understaffing. We know if there were enough midwives their time could be spent helping new mothers to breast feed or to stop smoking. The less time midwives have with women the more likely it is that signs of post natal depression for example could be missed”

Taken from the RCM website

I would argue that that if there were enough midwives, women may be offered the gold standard of care is continuity of CARER. This type of care ensures trust, honesty, privacy, respect, dignity, autonomy, one message, choice, individualised care and information. The type of care that is guaranteed and that I experienced with an independent midwife.

Instead the NMC has forbidden around 80 midwives to support women and their families during birth, meaning that this year a potential 960 families will be added to the workload of midwives who are already struggling to provide best care for women. This figure will rise as time goes on.

I completely agree with Rebecca Schiller from Birthrights when she wrote to Jackie Smith and said that the actions of the NMC “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”

Who is actually benefiting from the NMC’S decision?

It’s not women.

It’s not NHS midwives.

It’s not independent midwives.

It’s not even society as a whole.

Since this decision has been made by the NMC it has also brought in question midwives supporting or being presenting at friends or family’s births an example of this can be seen here. It has been brought to my attention that some NHS midwives are being told that they are not insured to attend a friend or family’s birth either?  I have also been told that If a midwife has been supporting a woman antenatally and the woman goes into labour when the said midwife is not on the working rota then the midwife is also not allowed to attend the birth. This completely goes against evidence and research that shows that having continued midwifery care and being supported at birth by someone you know and trust can enhance the physiologic labour process reducing the need for obstetric intervention and increases a woman’s feeling of control and competence. Women are also less likely to experience pre term birth and are at lower risk of losing their baby. The benefits of continuity of carer are huge and should be what the NMC are striving for for all women, not putting barriers in the way for those who are ensuring this!

For many women across the country hiring an independent midwife is the only  guaranteed form of support for them to birth their babies at home feeling safe and secure. Some trusts offer no home birth service at all, whilst other trusts have been known to ask a woman who has planned her home birth to come into hospital due to staff shortages. This can be very distressing for a woman to have her plans for birth abolished at the last minute. The negative effect on a woman’s emotional well being can stay with her for life.

If England had a fantastic maternity service that met the needs and facilitated all choices for women it wouldn’t be such a concern but the harsh reality is that it doesn’t and women and midwives are suffering as a result. The NMC have removed a woman’s right to choose who she wants to support her at birth and for some women, where they choose to birth. It also denies many midwives their right to work as self employed individuals forcing them to work for an institution facing working conditions that are proving difficult for many midwives. Independent midwives are also suffering financially being that they cannot provide the full service that women want. The NMC has also put an end to Statutory Supervision of Midwives and the role of the Local Supervising Authority Midwife Officers (LSAMO) from the end of March 2017. I am very concerned about this decision. The LSA has been a huge form of support for me in the past offering support outside of the trust that I believe was acting on cultural beliefs embedded in the trust that was a huge barrier in gaining the care I needed. I see women who are struggling to find support almost daily, most of whom are making choices outside of guidance, often only finding solace in the form of a Supervisor of Midwives (SoM). I cannot help but wonder if it is the lack of midwifery leadership within the Nursing and Midwifery council that has made these decisions that affect women’s care possible.

I am pleased to see that many are finding the actions of the NMC concerning. This is triggering alliances to be formed to protect women’s rights and the midwifery profession. The Association of Radical Midwives have launched a campaign in response to recent developments to demand a separate regulation for midwives as recommended by the law commission. You can join the campaign and find out more information on #savethemidwife here.

Women who make choices outside of the national guidance struggle to have their voice heard and their choices supported. It can prove very stressful and only those who are prepared to battle and go up against the system might stand a chance of achieving the birth they hope for.

I myself am a woman who made choices outside of guidance.

I am a woman who is known by many who work within the trust responsible for my care. They know my story, they know that I am well read and that my decisions are made based on researching evidence based information. I am a woman who story has been used for training on supporting women who make choices outside of guidance. I am a women who still struggles to have my voice heard and gain the necessary support for my birth choices.

I know the midwives who I came into contact with during my care want to support my choices, but it seems that their confidence to act autonomously and provide me with the support I needed is suppressed by the demands of the system. The system that determines a woman’s care not by her individualised choices, but by what the institution will allow once its met the criteria of every box ticking policy. When the care package looks familiar to the senior obstetrician. Only when I have sat through every pain staking conversation that emphasises only the risks of my choices,( with no discussion regarding the risks of the recommended care path) when I have acknowledged that my choices potentially threaten the life of baby and I and only when I sign on the dotted line to confirm this conversation has taken place, will I then be offered a care package that only considers my physical needs of my bodily functions, so long as my body conforms to general expectations and time limits, constantly reminding me of interventions I should be prepared to accept as recommended.

I found this institutionalised care made no provision for my emotional and mental well being. It made no acknowledgement of my previous personal experiences or understood how these experiences shaped my choices and still haunt my memories.

The holistic aspect of midwifery seems to have been washed away whilst sanitising the hospital environment leaving the care feeling cold like the white bare walls that surrounded me at each appointment. Written communication forms that of a template once again meeting the needs of the system with no benefits or individualised care plan in place that supported my choices. This care not only fails women but it fails the midwifery profession slowly eradicating anything that is integral to it beliefs.

I had poured my heart out and explained my reasons for choosing to birth at home and away from the hospital.

I didn’t want to experience painful sweeps whilst being told to count back from 10 and bare it.

I didn’t want routine examinations that left me feeling violated and that had put my baby and I at risk being that my membranes had ruptured.

I didn’t want strangers entering my birth space without acknowledging me yet observing my genitalia that was fully exposed.

I didn’t want my midwife to fall asleep because her priority was to observe the technology that was monitoring me.

I didn’t want to be stitched up by a newly qualified midwife who had told me she wasn’t experienced enough to suture me, but was made to regardless, who once she had finished was told to redo the whole thing. She was then advised to buy some pork and practice her suturing on that whilst I was lying there feeling scared and in pain.

I didn’t want to lay in a bed feeling out of control fearing for my life.

These were just a few of the reasons why I didn’t want to birth in hospital and asked to for assurance that I would be supported by a midwife who was confident in caring for me at home and who was experienced enough to ensure my safety but competent to support me at home unless it was only in my best interest to transfer to hospital.

I was told I could not have a bespoke package and they did not know who would be scheduled to work at the time of me going into labour. They could not guarantee me a midwife I know and trusted.

By 37 weeks I was left feeling drained, my voice fell quiet, my mind felt unstable, my body and my baby was begging me for some relief. I needed to feel cared for.

I needed to exercise my right and ensure I had a midwife I knew and trusted, I couldn’t birth any other way.

It was then that I made the decision to hire an independent midwife. My primary concern was only to feel safe and supported, to know that Kay was experienced and competent to care for me. I needed to feel fully supported in my birth choices and know that Kay had the necessary skills to act should birth take a turn in the wrong direction, to be able trust that she would transfer me to her colleagues in the  NHS should she feel that that was the best place for me.

Indemnity was not my priority, indemnity would not ensure my safety. I was made aware of the issue with the indemnity and hired Kay Hardie regardless. Indemnity insurance would only be of benefit to me in the event that my baby or I suffered due to negligence and only if this was proven would the indemnity be relevant. Taking this into consideration I would have hired Kay regardless as the need to feel safe far exceeded the ability to sue her, this thought didn’t even enter my mind. I find it insulting that the NMC claim to have our best interests at heart by making this their priority whilst denying some women their only chance of feeling safe whilst birthing their baby.

Compared to my previous experience, some of which could be considered negligent and comprising my safety, Kay’s care was superior and left little room for negligence.

I believed and trusted her and this was reciprocated. I was the only woman in the room, the first priority, the only focus. My voice was listened to, I was treated with dignity, my privacy maintained, my sanity protected.

If you have a daughter, a niece, a wife or care about women and society as a whole, then you too should be concerned about the NMC latest decisions. One day a woman who is close to you may find themselves pregnant with limited choices regarding her maternity care and birth, possibly limited or no midwifery support, during a monumental time of her life. This is a time when a women leaves her footprint on the world and time when a mother is born. Birth has the ability to shape a woman for life and will effect who she is as a mother and a member of society as a whole.

I would urge the NMC to be transparent and admit they have made a huge mistake by reinstating independent midwives right to practice in their full capacity and support women during birth. I would also urge the NMC to bring independent midwives into hospitals for training, to share their knowledge, expertise and experiences of supporting women outside of the hospital setting. Bring the art of midwifery back into the heart of maternity care and provide women with the holistic care they are missing.

If you would like to join the alliance and #savethemidwife you can found out how to here.