N.B. Names abbreviated in this online version to maintain confidentiality
FAO Jackie Smith. Chief Executive and Registrar of the Nursing and Midwifery Council
Dear Ms Smith,
I write to express my extreme disappointment in the recent decision taken by the NMC regarding indemnity insurance for members of IMUK, the association of Independent Midwives.
I am currently 30 weeks pregnant and under the care of the ABC independent midwifery team. This is my second baby: my son was delivered by A of ABC nearly three years ago. I engaged A after suffering three miscarriages and a very difficult first trimester with my son. Having undergone endless tests and hospital appointments, I wanted minimal further medicalisation of my pregnancy; a truly informed, pragmatic and evidence-based approach to my care; and a single, compassionate point of contact to whom I could address all my concerns and who would see me through every step of my pregnancy, birth, and the early days with my newborn.
A and her team provided all those things and more. They trusted my intelligence, instinct and judgement and I trusted theirs. During the calm (but quick), drug free birth of my son at home, I sustained an inaccessible vaginal laceration that ruptured a small blood vessel and caused significant blood loss. It was an unusual and unforeseeable complication, but A was not fazed - on assessing the damage, she called an ambulance immediately, packed the wound and ultimately saved my life with her quick thinking, skill and calm under pressure.
Given my history, both my husband and I desperately wanted A and her team to be there for the home birth of our daughter, due late March 2017. It is clear that this will not now be possible, and as I understand it, A will not even be able to attend as a friend or advocate. This is heart breaking for us, and for A too. I have faith in the NHS, and I am confident that they will do the best they possibly can for me, but I now face the prospect of a home birth overseen by midwives I have never met (having not seen an NHS community midwife since my 8-week appointment), or a birth in (or given a likely rapid second stage labour, on the way to) a hospital I do not want to be in. Even with the issues I had last time, I was not remotely stressed about my upcoming birth because I knew I would be cared for by midwives that I trusted implicitly. This is no longer the case, and I have no idea how easy it is going to be for me to reengage with NHS care, nor what impact this stress will have on me or my baby during the remainder of my pregnancy and birth.
As the UK's regulator for nursing and midwifery, you are tasked with protecting the safety of members of the public. I want to formally record that in this instance, I do not feel like my (nor my baby's) safety or interests have been protected; indeed, I feel the decision has placed me in a much more vulnerable and uncertain position, with my immediate well-being and security sacrificed to protect me against a far more remote and unlikely risk. For women traumatised in previous births while under NHS care (a common reason independent midwives are engaged), the implications could be even worse, with women potentially choosing to give birth with no trained midwife present at all.
Furthermore, as I understand it, IMUK's legal advice when issues were first raised by the NMC in August 2016 stated that you, as the registrar, were acting outside of your power in claiming that the Lucina Ltd indemnity product on offer was inappropriate, an assertion reiterated by the Professional Standards Authority (PSA). The IMUK Board were thus unprepared when given just three working days before Christmas to respond to your notice that their members would be barred from attending births from early January, particularly as even now, you have still not indicated what you consider an appropriate level of cover to be - presumably because this is beyond your remit. There is no indication that their insurance is not fit for purpose, given that any claims made today would not result in a pay-out for many months, if not years, by which point the funds would be more than adequate to cover the sum likely to be required. IMUK has also demonstrated that it is able meet the stringent requirements of Solvency II regulations that indicate a financial product is adequately and appropriately capitalised. As you will no doubt be aware, the NHS Clinical Negligence Scheme for Trusts does not currently meet these requirements, which makes the claim in your press release that the 41,000 non-independent midwives in this country do operate with "adequate indemnity cover" somewhat disingenuous. You will also be more than aware that it is simply not possible for Independent Midwives to be insured through any other means if they are to continue to operate in a self-employed capacity, so your actions have effectively curtailed their ability to provide full care to their clients, and thus severely damaged their livelihoods and the impression that uninformed individuals may have of their professional integrity.
I understand and respect your desire to protect families financially from the devastating consequences of birth injury or death, but I would nonetheless appreciate a more detailed explanation of the reasoning behind your actions, and given the points made above, how you have reached the conclusion that preventing my carefully chosen, known and highly skilled midwife (and those of many others) from caring for me in labour is ultimately a smaller risk to me than her potentially being under-insured. Once this frustrating situation has been satisfactorily resolved - and I trust that this is your absolute priority at the present time - should it be warranted, I also call on the NMC to provide a full apology and, where appropriate, compensation to all those affected, midwives and clients alike.
I look forward to hearing from you on this matter.
The Different Duck