Goodbye to All That

So, we have been discharged from midwife care, mother and baby doing well. I am going to take this opportunity to reflect on my experience of independent midwifery.

Having an independent midwife was great. I really felt supported and that there was someone I could call and ask dumb questions to if I needed. On the NHS you always feel a little like you are taking precious resources away from somewhere else and so you don't like to make a fuss. When you have an independent midwife the whole point is that you are paying for the privilege of having dedicated care. Even our great experience with NHS midwives in Essex was not the same as we always had that feeling that we didn't want to be seen as too demanding. While my personality will always be to not make a fuss and not be a diva, it was nice to know someone was there if I needed them. I had exactly the care that I wanted. It was a lot of money but worth if for my peace of mind. I honestly think that if I had been on the NHS there would have been no midwife present at the birth as everything was so quick that by the time the contractions became close and regular enought to call someone I was about to give birth.

I should never have had to be in this situation as I should have had continuity of care on the NHS. The government bleet on about giving women choice but the system is stretched to breaking point.

Anyway we will miss M_ and would like to say a big thank you to M_, our great midwife. Here we all are at our final appointment. She gives a discount for repeat business but I don't think I'll be taking that offer up as I AM NEVER GIVING BIRTH AGAIN! NOT EVER, EVER, EVER, EVER, EVER.

You'll Either Kill Me or You'll Save Me

When I go on maternity leave and have a bit more time on my hands I must get around to writing some letters. Just in case you live in the UK and have more time on your hands than me I would encourage you to support the Save Independent Midwifery campaign - you never know when you might need it!

http://www.saveindependentmidwifery.org/

Hope for the Future

M_, the midwife, did a visit again today. Despite a hectic week at work my blood pressure was good and low and no problems were identified. The midwife is still unsure about the position of the baby as it was hard to tell whether it was a bottom or a head she could feel. Judging by the huge kick that was administered to my cervix the other day I would say she is still breech, but no cause for concern for the moment.

Other than that there is nothing much to report. She is coming back next week and we will start doing the birth plan.

She Spends Your Money On Me

For the benefit of S and others who may be wondering the same thing, I will briefly explain how the whole IM things works. You can generally select from a range of packages - antenatal care only, postnatal care only, antenatal + birth, birth + postnatal or the complete works. Most IMs don't tend to offer birth only as it kind of defeats the object of having IM care. We have the full package of antenatal care (generally they offer around 10 appointments and as we have booked later than some we are now on weekly appointments until the birth), home water birth including pool and 28 days postnatal care. You don't pay per hour or for the duration of your labour etc, it is a flat fee with a slightly higher rate for a home birth than a hospital birth. The cost also includes the main IM being on call from 37 weeks and the attendance of a second midwife (also a local IM) for the delivery.

I am still entitled to access the full range of NHS facilities including blood tests and scans and these can be facilitated by my IM. For example our baby is currently breach, which at 31 weeks isn't too much of a concern, but if she is still head down towards the end of the pregnancy it may be necessary to have an additional scan to verify the position of the baby and if definitely breach then have external cephalic version (ECV) to turn the baby prior to birth. If required then both of these procedures will be arranged by the IM and performed on the NHS.

Without going into details about our personal finances with regard to cost, I will quote the IM Association on the subject:

Q: How much do independent midwives charge?

As we are all self-employed, we are all able to choose what we charge but many of us are flexible in how you pay us. The going rate for an IM at the moment is from about £1800 to £4500 (approx) for the whole package of care - this will vary as to where you live in the UK. Most IM's will want to have received payment in full by the time you are 36 weeks pregnant.

The Great Escape

Independent Midwivery has taken some knocks recently that have threatened the very existence of the profession.

The Independent Midwives Association (IMA) state that 'Independent midwives practise outside the NHS, usually not because of a desire to have private clients but because it has become increasingly difficult within the NHS to provide the standard of woman-centred, autonomous midwifery practice they wish to give.' Midwives have become disillusioned with the care they are able to provide on the NHS and want to be able to practice the sort of care that made them want to become midwives in the first place - one to one care to support women to have normal births with minimal intervention. Government proposals to make professional indemnity insurance (PII) compulsory for all independent healthcare providors is not a problem in itself, the problem is that the lack of providers of such insurance and the prohibitive expense of policies will effectively put IMs out of business. The government response to this is to suggest various models that would enable midwives to work under NHS trusts. They suggest that 'The Government are committed to supporting independent midwives to find a method to access indemnity cover, as this is clearly in the public’s best interests.'

The future of the profession remains unclear. The upshot at the moment means that IMs are still legally allowed to practice without PII but possibly not for much longer. For the client this means that although insurance can be obtained for pre-natal and post-natal care it is not currently possible for IMs to obtain insurance for the actual birth. This does not mean that we could not make a claim in the event of negligence causing injury during the birth but it means we would be suing the midwife as an individual and not a professional and so any claim would be settled against their personal assets - house etc. Not good...

The IMA latest new section indicates that as of March 08 'Work on The White Paper ‘ Trust, Assurance and Safety – The Regulation of Health Care Professionals in the 21st Century’ is not expected to be completed before end of 2009 / early 2010. A consultation period will then follow. It is under this White Paper that any changes required to make Professional Indemnity Insurance (PII) mandatory will happen. We will be informed if there is any alteration to this timetable.'

Checkout the Born Stroppy blog for more info and opinion on the subject.

Start Over Again

So, back to beginning, today we started midwifery care again with another booking visit. M_ will be doing weekly visits from now on, at our home and at a time convenient to me. She came over and took a medical history as well as doing all the usual things, urine tests, blood pressure, fetal hartbeat and palpation to determine the position of the baby. All way well.

F_ wasn't there as he has rudely abandoned us to go off on a short holiday with his Dad and brothers but he will get to meet her again next week.

With care and constant attention

Ok, so I went away and checked out the Independent Midwives (IM) Association and found the details of some IMs in our area. Things didn't start too well when the first one I contacted was fully booked and told me another was fully booked also. She did, however, recommend the final IM on my list and said it was worth contacting her as she thought she might have some capacity. We dropped the IM an email and she confirmed that yes, she did have a vacancy, as sadly someone previously booked with her had lost a baby - eeek.

So M_, the midwife, and I arranged an initial meeting for me and F_ to meet with her, talk about her services and see if we clicked and wanted to go forward with her providing our care.

She came round the next evening and we spent about 90 minutes chatting. This represented more time than all the antenatal care I had had in the preceeding 29 weeks put together! She seemed very nice.

The success of the meeting left me with a major problem - how we would ever finance this enterprise. Having recently moved we are still recovering from the financial strain of the move and have to pay off our furniture in October. I couldn't see how we could go ahead and felt despondent. The next day however, lady luck intervened and some unexpected money came my way meaning that we only had a modest portion of the total to find ourselves and so I went ahead and emailed M_ to book her.

Word cannot describe how I feel a great weight has been taken from my shoulders. I hadn't realised just how much stress I had built up over the whole issue of my midwifery care until the issue was taken away. I now feel that I can have the personalised care that I need to have a happy pregnancy, birth and postnatal period. The stubborn part of me does think that I should have been able to have this care on the NHS, as I did in Essex, but I will do what it takes to have the care that makes me feel safe. I will, however, be writing to the Superintendent of Midwives to express my disappointment with the NHS service I have been offered.