Open Letter to the NMC

open letter to NMC freedom for independent midwives

I’ve mentioned this in passing in a few posts recently, finally I’m able to sit down and write a full post about the farcical treatment of independent midwives by their governing body, the Nursing and Midwifery Council (NMC). The backstory to this goes back years. In very brief summary, in 2014, it became mandatory for all health professionals to have indemnity insurance. Prior to this, independent midwives (IMs) were practicing without insurance. Clients would simply sign a declaration stating that they understood this, myself and the husbeast signed such a document when we hired our IM in 2011.

This worked absolutely fine in the overwhelming majority of cases. For two main reasons; first, the client entered into this arrangement with full knowledge and acceptance of it. If it had been a deal-breaker for a client/couple, then they simply wouldn’t have hired the IM and would have sought midwifery services elsewhere, either through the NHS, or a private provider (note: independent and private midwives are very different. Private midwives are employed by a corporate/private maternity care provider. IMs are self employed, totally independent and traditionally free from corporate/insurance interests).

Second, it is generally recognised that IMs provide the gold standard of midwifery care, therefore adverse outcomes are extremely rare. In the exceptional circumstances where something did go wrong, AND the IM was found to be negligent, it was up to the client whether to pursue a legal case or not. With the relationship typically built up between woman and IM, it seems inconceivable that the woman would decide to bankrupt the midwife. Of course, there are a couple of cases of this happening, but it is essential to look at the big picture and assess whether broad strokes that affect nearly 100 midwives and the many thousands of women that they care for are proportionate to the tiny number of cases where lack of insurance was a serious problem.

The reason that IMs were practicing without insurance was that there wasn’t an insurance product available to them. Insurers, with no knowledge of birth or midwifery, considered it too high a (financial) risk.

In 2014, however, when IMs were left with no choice in the matter, they found a provider who was able to create a custom policy tailored to their practice. Any IM registered with IMUK was covered by this insurance. Everything seemed to be going smoothly, until late last year, when the NMC suddenly decided that the insurance they had in place was not adequate. To date, they have refused to explain in what way it is inadequate, or what additional coverage would make it adequate. There have been muddled statements about there not being enough money in the pot to make a single large payout. However, it is my understanding that this isn’t true, and that if a claim were successfully made against an IM, there would, in fact be adequate funds available by the time the payout was expected to be made.

The NMC refuse to accept this and simply forced all IMs to sign a contract, under duress, stating that they would no longer attend births. The lack of warning left hundreds of women without their midwife for their births. Apparently, the NMC found this acceptable.

Birthrights and other organisations have been working tirelessly on this issue. Below is an open letter, written by Birthplace Matters founders, Paula, Jeannette, and Anna. The complete document and correspondence history can be found here. Please feel free to share widely. Tweet the NMC @nmcnews and #savethemidwife and make your voice heard. IMs and birthing women need our support.

Open reply to the NMC from Birthplace Matters – March 2017

Dear Catherine Evans and Emma Broadbent,

Thank you for your response to our letter. It is clear that your goal is to focus on compensating mothers after the event of their birth. We wish to explore this in broader terms and discuss what really matters to the many mothers we hear from at Birthplace Matters.

It strikes us that when a woman is hiring an independent midwife, it is often done as an act of insurance, to protect herself and her baby from damage which she does not want to repeat from an earlier birth. Sadly, the damage we hear about is occurring far too often as a result of ‘routine’ or commonplace procedures which are happening every single day up and down the country.

As such, far from being a luxury lifestyle choice for a wealthy and privileged elite, a woman’s decision to hire an independent midwife is much more often an act of desperation following anxiety attacks, symptoms of PTSD, and feelings of anger and sadness following an experience of giving birth under NHS care. Often, they just want to avoid the same ‘routine’ procedures and treatment again.

Your statement that women still have the option of choosing non-IMUK midwives, fine though they may be, is not actually viable for some – since some women live too far from one for that to be a safe option for birth – especially for 2nd, 3rd, or 4th babies etc, who may come too quickly for a midwife to drive 3 hours to her. In such cases women are left facing the option of going back under NHS care, choosing to birth alone with no midwives, or, as we have been hearing more and more recently, actually choosing not to have any more children. All three of these options are unacceptable when taken as acts of desperation. Do you see now what peril women are in because of this insurance fiasco?

Without exaggeration, some stories we have heard by women describe their birth in the language that rape victims use about the violation of their bodies by strangers. Some are triggered for weeks, months and even years afterwards, often suffering silently. Even if a birth appears on paper to have been a success, with no legal category for suing a hospital, it doesn’t always mean that a woman walked away from her birth experience unscarred. There are invisible wounds which cannot be accounted for in a tick-box on an insurance claim form. Some feel too beaten down to fight anyway.

We are hearing frequently from women who say they were ignored, laughed at and even abused by NHS staff – ironically, your actions in preventing IMs from practising is pushing some women to have to go back to the same place and potentially go through the same traumas all over again.

When we allow insurance companies, governments, and lawyers to determine the T&C’s of birth, it can be interpreted as a carte-blanche to behave appallingly, in the arrogant guise of rescuing women and protecting babies by a highly interventionist approach. The onus on deciding what is safe is therefore shifted away from the mother, where it rightfully belongs, and is assumed by her care team. When a woman is not trusted to make informed decisions, but is instead bullied, this undermines/violates her rights over her own body and her own baby.

This is why so many women seek out an independent midwife – because the word independent means just that – they know full well that whilst their midwife is insured for what is to most mothers, a reasonable and reassuring sum, these midwives are not entirely in the pocket of insurance companies so are not motivated primarily to satisfy insurance company tick boxes over and above the wishes of the mother. They often avoid the same knee-jerk interventionism that is offered within NHS settings, providing instead truly 1:1 watchful, continuous care with the time and space to be with-woman in the way that midwives in hospitals cannot due to restraints outside of their own control. Without wishing to offend individual midwives within the NHS who offer sterling care, we feel that this continuity actually makes independent midwifery a much safer model.

Even the very best NHS midwives will sometimes admit they are just too busy to truly give the full care and attention they would wish they could give to women, knowing that CTG monitors are a poor substitute for 1:1 care and have not been shown to have saved even one life. Even in those places where the NHS aspires to offer truly holistic care, it is not always consistently available for all women coming through the doors. When women are lucky enough to receive truly individualised and holistic care it is more often than not at a personal cost to a midwife’s career progression.

There are so many good NHS midwives working within the system who are being disciplined and over-ruled to satisfy bosses who are thinking of insurance and malpractice tick-boxes first and foremost. Many are leaving the system altogether due to stress and burnout in their attempt to balance gold standard care with restrictions from on high. As well as working within ever more restrictive insurance company T&C’s, it must also be said that the over-riding of mothers’ wishes within the NHS is done in a spirit of old-fashioned paternalism which is very tiring for women to have to put up with in 2017 after all the gains we have made to improve women’s rights elsewhere.

In the light of what we have discussed above, we at Birthplace Matters feel that the NMC’s definition of what it means to protect women and their babies needs to be re-evaluated. In 2017, it ought to mean so much more than a woman’s ability to claim financial reimbursement in the event of lifechanging birth complications – since no insurance company should have a monopoly on defining what those complications are. Clearly, many women are left scarred by their birth experiences in ways that are invisible, but are very real and life-changing for themselves and their babies in ways that affect whole families. Offering a wildly inflated sum like £10m is meaningless to a mother who has to drive a 10 mile detour so she doesn’t have to go past a hospital where she gave birth and who does not want to relive the trauma all over again by pursuing a legal case – especially if the hospital closes ranks and proposes what constitutes harm by their own definition only, ignoring or belittling her complaints.

The insurance cartel that is taking over birth practice is turning this very natural process into an increasingly clinical event with unhappy consequences for many mothers and babies. If such insurance-dominated practice was translating into safer and more satisfying birth it would make sense – yet the opposite seems to be true, judging by the soaring rate of inductions and other interventions which drive up the cesarean rate.

We ask that you pay attention to the voices in the #savethemidwife campaign and recognise the ridiculousness of telling independent midwives they are not insured for enough without stating what ‘enough’ is, leaving them and their clients in a state of confusion and despair. Why not let mothers decide on what level of insurance they want to choose rather than letting the insurance companies dictate whether a woman can afford an independent midwife, or not? Independent should mean just that – forcing them to fall in line with the NHS suggests you do not appreciate the difference between the two uniquely different models. They should remain separate as they have been to date, and women should rightfully be at the helm in choosing what they need.

Yours in frustration,

Paula, Jeanette and Anna – The Birthplace Matters Team

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A Miracle Morning Hack for Busy Mums

Delving into the world of bullet journalling has led me into this whole world of productivity systems. It’s vast and can be overwhelming. Which shiny new thing do I try first? What will work for me? Are these gurus genuine or trying to make a quick buck?

I make no claim to know all of the answers. But I have found a hack that is working for this busy mama… so far.

miracle Morning Hack for Busy Mums

The Miracle Morning is a book by Hal Elrod, which, I must admit, I haven’t actually read (you should see my to-read list!). But I came across the concept during my many hours of watching bujo videos on YouTube!

The idea is that you get up early and do certain activities first thing, before anything else. Hal calls these the Life S.A.V.E.R.S.

Silence

Affirmations

Visualisation

Exercise

Reading

Scribe

You can interpret them in a variety of ways and do them in any order, take as much or as little time as you like. Find a way that works for you. For example, you might meditate for half an hour, do a half hour workout, read a blog post, write your shopping list, tell your reflection how awesome you are and imagine meeting all your goals that day.

Or you might spend 90 minutes in the gym before doing anything else and knock out the other tasks in five minutes.

It’s totally up to you. But the idea is to get all of these things done before most people are even out of bed, giving you a head start on the day and setting you up for a super productive one.

I am not a morning person. At all. I have always struggled to get up, no matter what time I go to bed. This was true before children and is even more so now. When I started on this productivity/intentional living adventure last autumn, getting up early was one piece of advice I automatically dismissed. Nope, not going to happen. It was Allie Casazza’s course that got me started on this journey and she says that waking early is the key to her intentional lifestyle. But, she also acknowledges that there are seasons for this. If you have a young child, for example, and are having to wake frequently at night, then this might not be the right time for you to start getting up at 5am. That’s not really true of me these days, but I do sometimes have trouble sleeping.

But when I came across the Miracle Morning, I felt this might be something worth changing my ways for.

bujo bullet journal Miracle Morning Hack

My spread in my Bullet Journal

This is still very much a work in progress and I totally hack this whole idea to suit my needs and my family at this point in our lives. I do not, as Allie Casazza recommends, rise before my children, so that I am waking up for my children, rather than waking up to their noise and demands. My kids are always up before 7am, often around 6. I need 8 hours sleep. In order to get up at 5, I would need to be asleep by 9pm. My kids don’t go to sleep until 8pm. I would need to be getting ready for bed right after they go to sleep! I would get literally no time alone with the husbeast, no time to chill out in front of the TV. So I know this routine wouldn’t work for me.

So I fudge it.

I quickly realised that the S.A.V.E.R.S. could be combined quite effectively. Yoga, for example, is both exercise and meditative (silence). I decided to embark on this 30 Day Yoga Challenge as part of my hacked Miracle Morning. It is never in silence, as not only do I have the video playing on my TV or iPad, but the kids are already up and making the noise that comes with that. But I make do. I shut the door, I tune them out as best I can and focus on my yoga session. The flows in this challenge are only 10-15 minutes, so it’s not too demanding of my time, and is a lovely way to start the day. It clears my head, which is the main purpose behind the first S.

Next, I head to the shower (most days I actually do a kettlebell workout after yoga, adding to my exercise, but this isn’t strictly part of my hack) and do my affirmations and visualisation while showering! I can’t hear the kids from the bathroom, so it’s me and the running water. Bliss. I have a list of affirmations and usually pick three or four to repeat a few times while shampooing my hair. Then I close my eyes and picture the things I want to get done that day, I imagine myself completing my tasks. I often picture a longer term goal being completed too, and crucially, the steps to get there.

Once I’m dressed, I read through a bit of my bullet journal, checking my schedule for the day and week, then write something in it. This might be another task that has occurred to me since planning the day out the previous evening, or logging my morning so far (I have various trackers in there, including my Miracle Morning).

And that’s it. That’s my hack. It takes just over half an hour!

It’s probably not what Hal Elrod had in mind, but it is my way of incorporating what I can of his system into my life with two young children who rise early!

Morning Pages notebookThis month, I decided I would start doing Morning Pages too, which also ticks the “Scribe” box. This is a truly beautiful idea and really, I think it’s a must for most people, especially parents and creative people. The idea is very simple, you write three pages, stream of consciousness style, before doing anything else after waking. Realistically, I go to the loo first haha! But then I get back into bed, get out my lovely journal – I have a separate notebook for this, but you could use your bullet journal – and write. Granted, it’s only day two of this for me, so it remains to be seen if I will keep it up. It does stretch out my Miracle Morning substantially, so it isn’t practical on days when we need to be out of the house in the morning, but on the days when we are in no rush, it’s a peaceful and therapeutic way to begin the day.

It’s a brain dump, a way to vent frustrations, note dreams, draw attention to the positives too. It’s a chance to get everything out of my head and onto the page. Unexpected things might crop up, tasks to do, project ideas, a conversation from the previous day that has been on my mind. Getting it all out clears way for all the day’s new input. I find it works really well in conjunction with Getting Things Done, by David Allen, another productivity system that I am implementing in my life. More on that in another post, I think 😉

I really love my Miracle Morning hack. Maybe one day I will be able to implement it all in full, taking my time, and actually getting the Silence in there too! But this is a step along the way. Feel free to implement this idea into your routine, or take it and turn it into something that works for you. My mantra ever since becoming a mother has been “do what works”. So far, that approach hasn’t let me down.

Do you incorporate anything from the Miracle Morning into your morning routine? Let me know in the comments if you have a hack of your own!

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