We have a number of independent midwives in the group now, and for those of us not working in that role, one of them answers questions in order to explain why some midwives work independently.
1. Why can midwives not get indemnity insurance?
The law and the regulator require adequate indemnity insurance but none is available from any commercial organization. The government is not prepared to provide it, as it used to with crown indemnity, and only continues to fill the gap for certain other professional groups for a limited time.
The whole question of indemnity insurance needs to be looked at because it does not provide a satisfactory service to women. As a comparison, midwives in Sweden, New Zealand, France and some other countries (at the time of writing) all continue to practice even though indemnity insurance is an unavailable requirement.
Human rights law may provide a defence for those who work without insurance.
2. Do you receive supervision?
Supervision continues to be possible as with any profession. It is something I often engage in yet very few midwives appear to have supervision until it’s too late and there’s a problem. Even then it’s very rare to find midwives engaging in supervision. I encourage people to have professional supervision however it is a choice and supervision in the hospitals inevitably can lead to a conflict of interest as often the supervisor can be a manager or they make their own referrals to the NMC. However, hospital supervision was very good when it was done well and it provided exactly what supervision needs to to support insight and a safe space for midwives.
3. How do you get clients?
Very often I get clients through word of mouth, occasionally they may have encountered a midwife website or some other recommendation. Trust is essential in all relationships and particularly with independent midwives and their clients so word of mouth seems to be the best way that we get our clients.
4. Do you work for an agency and utilise their indemnity insurance?
Independent midwives do not work for agencies – working for an agency is an entirely different matter.
I often did both. Working for an agency means you are their employee, and being independent means you are employed by the mother. This provides a much greater focus on giving appropriate individualized care rather than having to please an agency and employer or any other potential conflict of care.
Whatever the financial arrangements or amounts are, the mother pays that direct to the midwife. They ought to be able to reclaim this and in very few rare cases, for example, where the NHS was unable to provide care, they can get reimbursed by the NHS, possibly by an insurance company. It’s extremely rare but ought to happen more and it possibly will happen more if there are cases of people claiming against their local care commissioning organizations.
5. Does the mother have to pay the agency an amount and you get a salary from it?
It’s the same as an agency nurse in a hospital. In many other countries, an independent Midwife is reimbursed for their fees by the insurance company. In New Zealand, where independent midwives make up 45% of the midwives, and some other countries like Holland, the state funds independent Midwifery.
We can’t get indemnity insurance for many reasons. One is that there are so few of us to make it worthwhile for insurance companies. Although the likelihood of an adverse event is low, potentially it could [lead to] a huge payout. St Thomas’s were made to pay out £35 million last year for negligence when the child developed CP.
Recently an Insurance company quote us premiums of £7000 per birth. We are judged against hospital obstetric care which uses loads of interventions and drugs which potentially can produce an adverse outcome.
We only do physiological births, do not augment labour or induce, so our risk is really small but insurance companies do not see that.”