Wednesday, April 04, 2007
That to my mind is the essential core of good care of women giving birth. The woman needs to be at the centre of decision making. The Midwife should be the lead professional concerned (not doctors). The structure is one-to one care. The aim is to provide the best chances for the woman and for her child, including psychological and emotional.
We had a bit of a fight with the head of maternity services in our area but we got our way. Afterwards he was heard boasting about “his model home birth!”. This was possibly influenced by all three of us (yes including the baby) and our midwife gate-crashing a lecture by Sheila Kitzinger at our local hospital training centre two days after the birth – just to show him off …
So I am pleased that the government is emphasising the acceptability of home births.
No one should be forced into having a home birth, there should be full range of options including hospitalised birth support and birth centres outside hospital structures.
But are we willing to put the resources into making this a practical possibility?
For starters can we campaign for the adoption in the UK of the Community Midwife Model? The concept of this is that
……..when a woman gets pregnant, she has direct access to a list of midwives local to her, she contacts them, meets one or two and chooses the one she feels most comfortable with. That midwife then enters into a standard contract with the NHS who pays on a set fee per case basis. This is the start of a relationship between the midwife and the woman which can develop over the months of pregnancy and provide a firm foundation for an equal partnership based onThe Independent Midwives Association, in promoting its petition for this, says:
trust. This, as the research shows, makes for good outcomes and positive experiences for everyone involved and it isn’t just about home births, the midwife would have full access to NHS facilities so her client could choose the place and type of birth that most suits her needs. It would be available to those women who want it, no matter where they live or what socio-economic class they come from.
We want every UK woman from whatever background and socio-economic status to have the opportunity to choose their lead professional and be provided with a maternity service built upon choice, information and partnership….. Under the IMA's NHS Community Midwifery Model women will be cared for by the same midwife throughout pregnancy, labour, birth and post-natally, allowing a relationship to be built between the woman and the midwife. ..Dare I say it – something of a Liberal approach?
Will it Work?This model was introduced throughout New Zealand in the early 1990s and is the basis of all maternity care in N.Z. Over half of all N.Z women choose a midwife practicing independently as their lead maternity professional for their pregnancy, birth and the postnatal period. A further 21% chose an employed midwife who holds her own caseload.
This model will run alongside existing maternity services, giving women choice about the kind of care they wish to receive and midwives the choice of the way they wish to practice.
BUT there is a threat to independent midwifery presented by the UK Government and EU initiatives on indemnity insurance:
All independent midwives have been sent a letter by the Chief Nurse, with the information that the Government is intending to pass legislation to make professional indemnity insurance (PII) a prerequisite for registration. In parallel moves, the European Parliament is also considering similar legislation.The solution would perhaps be to bring independent Midwives back within the Royal College of Nursing Indemnity Scheme.
Although the initial impetus for this legislation arose because of uninsured members of other professions, it will have a far bigger impact on midwives, because there is no PII available to independent midwives. This legislation will therefore impose a condition on their practice which it will be impossible to fulfil. Independent midwives will no longer be able to register as midwives and they will be committing a criminal offence if they continue to offer care to pregnant and birthing mothers.
There is a lot of work to do if the current initiative on maternity services is not to be just another breeze of New Labour hot air.