UK Midwifery Archives
These archives contain extracts from discussions held on the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. Open to midwives, students, mothers, and anyone interested in improving maternity services in UK. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
Independent Midwives in the UK
Please note: this archive page has not been updated for over ten years. It is preserved as a record, but the situation regarding independent midwifery in the UK is under threat. Please see Independent Midwives UK for more information.
- Working as a midwife in the UK
- How much autonomy do midwives working in the NHS have?
- Independent Midwives in the UK
- Midwife-led units in the UK
Interested in working as an independent midwife?
Contact the Independent Midwives Association (IMA) – you can write to the secretary who is Andrea Dombrowe at (IMA) 1 The Great Quarry, Guildford, Surrey, GU1 3XN Tel: 01483 821104. Also, there is a very good book written by Lesley Hobbs, one of the contributers to this list – it is ‘The Independent Midwife – A Guide to Independent Midwifery Practice’ published by Hochland and Hochland. You’ll be able to get a copy via your university library.
You can also contact the IMA via their website at www.netcomuk.co.uk/~pvan/ima.html ; this includes a register of independent midwives in the UK, and many have email addresses listed, so you might be able to contact a few and ask for suggestions.
Most Independent Midwives charge £2000 -£2500 give or take £100 or so and are as flexible as they can afford to be, and can often arrange for staged payments over a period of time ( though we do have our equipment to buy, our cars and communication systems to pay for, and maintain to a high standard), not to mention our motgages to pay! It might be worth getting hold of the Register of Independent Midwives from our Secy Andrea Dombrowe at 1, The Great Quarry Guildford, GU13XN or visit our Web site There is only one Private Maternity service charging (in the region of £4,000) that I know of.
An Independent Midwife practising at home has no obligation to have anything to do with a NHS trust, though most will inform the Supervisor of midwives of bookings within her area and many of us inform the hospital when the woman goes into labour. I feel that this is good practice as, in the unlikely event of the woman needing to transfer, the hospital knows about her. In the Home situation the midwife certainly does not have any requirement to follow hospital policies and protocols, nor does she need anybody’s permission to provide midwifery care.
Mary Cronk MBE
When an independent midwife is caring for a woman in labour who has chosen to go to hospital, is that midwife expected to follow the policies and protocols of that unit?
As an independent midwife, if I were to have a client who wished to birth in hospital or needed to transfer to hospital, as long as everything was very straightforward, I would not ‘do’ anything other than I felt the woman needed me to do. In fact, last year a client booked me to assist her in hospital because she had problems first time and wanted to birth in hospital. I left her and her partner alone a lot in the earlier phase of labour, which in hospital, I did not tend to do. I do not perform more BPs (blood pressure checks) or temps or fetal heart listenings than I do at home either.
Another client had to be transferred, and the unit requested a CTG tracing. We obliged with that, but only after she had settled into the new environment. I believe a colleague of mine was looking after a lady in hospital as she was doing a stint in the labour ward for 2 weeks (she is on the community) and a consultant obs came in and said she was to rupture the lady’s membranes and put her on a CTG ‘so we can see if your baby becomes distressed’ – the lady was told! I think my colleague did this, or though I am not sure. I nowadays would question that, and if the consultant insisted, I would advise him that he could do and I would not, but it would be documented that in my opinion there was no indication for doing this.
If problems are arising, or the lady requests an epidural as another of my clients did, I would follow the unit’s policy on administering that, i.e. IVI, but I would not necessarily perform VEs anymore frequently than I thought was necessary. If the unit’s policy was to put up syntocinon with an epidural after a period of time, I would discuss this with the client and the labour ward staff for advice. If the woman was contracting adequately, but not as strongly, I would wait a while. After an epidural, and any messing about with the birth process, the woman’s body normally may take a few hours to feel safe enough to continue……….
The hospital policies are usually guidelines. An antacid may be given to all women when they are admitted to labour wards these days because of the ridiculously high CS rate. I would discuss it with the woman. These women are being set up for surgery really…….in many instances.
So, the labour ward guidelines should be just that, for all midwives, not just those who question their practice with each individual client. It helps knowing the birthing woman before labour obviously. I would not follow the policies, but I would continue to keep copious and full notes.
Debs, Independent Midwife – next client booked for hospital birth!
Policies and protocols are written as a guidelines and should not take the place of autonomy. As a midwife, whether NHS or Independent, we are responsible for our actions, or lack of.
Policies and protocols should reflect evidence based practice, but do they? As an independent midwife I would base my practice on the needs of the women/ researched based evidence, while having knowledge of the policies and protocols or that unit and document all rationale and decisions.
Even as a NHS midwife, if a protocol said so would you continuously monitor a women in normal labour for example knowing its detrimental effect?? Would policy and protocol protect a midwife if her practice was not evidence based but abided by the protocols?? I doubt it!!
If you want a black-or-white answer to your question: Yes, she is obliged to follow policies and protocols of the unit…………..however that is not taking into account all the other issues which I am sure most independent midwives would.
Virginia Howes, Independent midwife
Speaking as an NHS midwife, I am not expected to follow any policies or protocols if the woman I am caring for does not wish to accept what is on offer – if she is exercising informed choice. I have no problem as an NHS midwife not following policies or protocols also, if I believe it to be detrimental to the care of any woman.
If an independent midwife is not employed by the trust whose premises she is working on (eg the hospital), can the trust (in theory) attempt to ‘control’ her practice in return for ‘allowing’ her to use their premises? Does the midwife’s completion of ‘intention to practice’ negate any such control by the trust?
Each IM (Independent Midwife) is different, but here is what I think. If an IM is with one of her clients in hospital, without a contract to provide midwifery services, she is there as the woman’s support and advocate. Hospital guidelines and policies are there to be implemented if there is any need for interventions; until then, surely the woman/couple get on with the labour as she wishes, and the baby is born.
The IM who is employed by the woman/couple will provide company and the security of knowing that a professional whom she trusts is there for her. The woman may ask the IM to palpate her abdomen or listen to her baby or assist her with personal hygiene etc. She may also ask her advice and the IM will give that advice. Where the hospital policy prescribes something that the woman does not want, the IM may act as the woman’s advocate.
Where the IM has a contract to provide midwifery care, she does just that, and her guidlines are her UKCC Midwives’ Rules and Code of Conduct. One would hope that no hospital has guidlines or policies which are not in keeping with the UKCC rules ???
I recollect caring for a woman in hospital who had a previous Caesarean Section. The hospital guidlines were different to mine and contrary to what the women wanted. I cared for her in labour I hope safely, as I felt right for her,and the lovely thing was that a hospital colleague who relieved me for a short break abided by what I had been doing, even though it was not according to the hospital’s “policy”.
A midwife is an accountable practitioner and is responsible for her practice. If, in a particular case, she feels that the hospital policy is not right for this case, she should not implement it. Active Management of labour is one example where hospital policy may be contrary to a woman’s wishes, or in fact contraindicated in a particular case. In my view it is contraindicated in all but a few cases, but that is another story!
Why would an independent midwife be attending a client in hospital without a contract to provide midwifery services?
The contract question is quite complex, but I will try to explain.
An IM can only practice midwifery on the premises of a trust if that trust gives her an honorary contract to work as a midwife without remuneration. Some trusts are happy to provide these contracts, while others will only make them available if the Midwife has indemnity insurance of 3 million pounds. The premiums for this put it at present beyond the means of most independently practicing midwives. Therefore such midwives can only accompany their clients into hospital as a “birth attendant”.
Some trusts enable the midwife to be employed as a bank midwife for the time she is attending her client in hospital this enables her to provide the client with her services as a midwife in a hospital. A lot seems to depend on the attitude of the trust and its midwife advisors towards midwives practising independently. If the trust has the will a way can usually be found.
Mary Cronk MBE
If we are working with a contract for the hospital, or if we are working with the woman as an advocate and with another midwife, the control still remains with the woman and her partner. Who is responsible? The woman.
If there are complications and there needs to be discussion with a medic, the decision to intervene is discussed with the woman and her partner. The IM is still responsible for her own practice, even if working within the hospital with a contract. Careful note-making is of the utmost importance, and discussion with the medics, other midwives and woman is essential.
Our independent midwifery practice has an honorary contract at one hospital, which we only use very occasionally. We do not usually book women for a hospital birth, although in theory we could give them midwifery care at this one hospital, simply because we feel that we are going to be restricted by hospital protocols, even although indirectly. Looking after a woman in labour is intensive enough as it is, without having to fend off people knocking at the door and wanting to come in to check that we have been following protocols. To us it seems clear that, if we wish to continue to have entry as midwives to that hospital, we have to agree to fit within their guidelines – otherwise the contract simply won’t be renewed next year.
I recall a woman we cared for there with pre-eclampsia. We agreed to follow their guidelines, but kept the door closed. So although we did an awful lot of blood pressure readings, and she required medication to bring her blood pressure down, she nevertheless remained mobile and achieved a vaginal birth in the standing position with a good supportive atmosphere and minimum, but still far more than usual, intervention. It was her first baby, but labour established well following ARM (Artificial Rupture of Membranes). We used a lot of homeopathic remedies – which were not in the hospital guidelines…
Personally I don’t think that confrontation is always very helpful. It is important to us to keep a working relationship going at that hospital with both midwives and doctors, and so far we have found that good communication and good record-keeping have seen us through. We both have to be there though – one to look after the woman, and the other to do the hospital running – note-keeping, liaising with staff outside the room, writing up the computer, etc. Which is another reason why we don’t undertake it willingly or often.
At all the other hospitals to which we may have to transfer a woman, we attend only as supporter and advocate. Only the primary midwife does this; the hospital midwives do the hospital running. We have found that it usually works well – we would only transfer a woman in if she needed to be seen by a doctor anyway, or very occasionally for more pain relief.
AH updated 22 May 2001