Independent midwives to march in London today to protest impending shutdown of indie midwifery

There are apparently no insurers in the UK willing to extend cover to independent midwives, and so independent midwives and their clients operate in an insurance-free zone, which is risky, but it was apparently a risk everyone was willing to take. However, a new EU regulation mandates that midwives operate with insurance, and once that regulation is implemented locally, it will end the practice of independent midwifery in the UK unless there's some drastic action to create an insurance policy to which independent midwives may subscribe.

We had our daughter at home with an NHS midwife, and it was wonderful. Not everyone is lucky enough to live in the cachement of a hospital with midwives who'll help mothers deliver at home (especially now as NHS budgets are being slashed to ribbons across the country). If this rule comes to pass in the UK without any insurance fix, having a baby safely at home will become effectively illegal for families across the country.

A silent protest is scheduled for today at the House of Commons:

This campaign continues with a Silent Protest and march in Westminster on Monday 25 March, from 11am, to lobby Government to protect women's right to choose their maternity care and find a solution to the issues raised by an EU Directive.

Independent Midwives are registered midwives who have chosen to work outside the NHS to be able to offer continuous care and support to women who choose it. This is the kind of autonomous midwifery that you see in the hugely popular programme “Call the Midwife”. Nowadays it is mostly only independent midwives who are able to provide what David Cameron once called “gold standard care”. Due to staff shortages and budgetary pressures very few NHS Trusts are able to provide this kind of care.

Sally Randle is an independent midwife in Bristol, offering local women an alternative to NHS care. Sally says, “I was lucky enough to practise this way in the NHS in London, but local maternity services did not provide this way of working. I decided to become an independent midwife so I could continue this rewarding work. I love my job; I don't even mind getting up in the night to go out to a birth because I know the family well and feel privileged to be involved in this amazing time in their lives”.

I can't figure out why insurers can't sort this out. The actuarial data set is robust and well-established. The potential liability, though high, is calculable. If you can get insurance to juggle machetes in Covent Garden (high potential liability, small data set, massive individual variation), why the hell can't indie midwives get cover?

Silent Protest and March (Thanks, William!)


    1. That’s not what they want either, there’s just no insurance option so far. Some women would rather have a midwife with no insurance than have another option, even with insurance.

      We were in a different situation (outside of the UK and not keen on using the local hospitals for a number of reasons) so we flew a professional midwife over from another part of the country to help with the birth. It was so much more relaxed, my wife was able to stay at home without being bothered by anyone (we just watched movies with the midwife and my wife’s teaching assistant while we waited for the contractions), then the midwife left a short time after the initial checks had been finished. We did have contingency plans if something were to go wrong, but nothing did and it was as relaxed and natural as it could have been.

    2. But can I ask, why do they need Insurance?

      In this case It’ll be illegal, not unlawful, illegal under an EU directive, what a complete joke. If the midwife is negligent and causes harm and loss then there are law of the land based on common sense that deal with these situations rigorously called common law, there is no need for commercial law here at all.

      Besides, if a consenting adult decides to have the baby at home and chooses a birthing partner, the midwife in this case, and is fully aware of the consequences if something happens that is beyond the capacity of the midwife to resolve, then who has the right to sue anyone or make an insurance claim? Are they saying your personal insurance will be null and void if you proceed?

      Women do die in Hospital from child birth, they can perform surgery which a midwife cannot, but beyond that the same level of care is provided, maybe more due to the midwife being highly available.

      At the end of the day we’re talking about a rather traumatic and very natural act where the chances of dying are real wherever you are, and when it comes to mitigating against the worst, these midwifes, those that are not incompetent, can handle most scenarios including being able to make a 999 to get emergency services on the scene and to get to the hospital in the few occurrences when things go wrong.

      The only thing I could think of that would go someway towards justifying this EU directive is to deal with cranks and shills that could harm a women during labor, but again common law can deal with those quite easily and effectively. Beyond investigating dodgy midwifes and dealing with them under common law, I don’t see much of a problem here or anything needing to be dealt with under an ACT and EU Directive; Keep in mind not all the shills and cranks are on the street, hospitals have their fair share.

      1. But the cranks and shills in hospital are insured so adequate recompense is at least available.
        Common law is fine for dealing with someone who makes a hash of plastering your wall, but it’s ridiculous to assume a midwife will have the resources to cover damages that can run into millions.

        1. I have million-dollar insurance on my tow truck.  As does almost everyone else with a tow truck.

          1. Good for you! It’s a pity it doesn’t come equipped with contextual awareness or irrelevance detectors though.

          2.  Irrelevance detectors on vehicles will never catch on. They’d pop all their fuses everytime someone in the suburbs fired up their SUV to go to the shops…

      2. “Besides, if a consenting adult decides to have the baby at home ….. and is fully aware of the consequences …. then who has the right to sue anyone or make an insurance claim?”

        Governments as a rule and in the various flavors of social welfare states especially, do not particularly care for the governed making these decisions on their own.

        It sets a bad precedent and can lead to people finding out they don’t need their hand held by the Nanny state nearly as much as the Nanny state tells them they do and nothing good (from the government point of view) can come from having fully informed, competent citizens making their own personal decisions.

        A managed society is always a good thing…for the managers.

        1.  This has more to do with NHS budgets being fucked over than our Eeeeevil Soshlizmz. Seriously, the last thing the shower of bastards getting ratarsed on subsidised booze and jeering at each other in the Houses of Parliament are, are vigorous proponents of the Welfare State…

      3. beyond that the same level of care is provided

        I guess that you haven’t been in a hospital since Victoria was on the throne.

  1. They can’t have it both ways.  If they are going to require midwives to have insurance, then they have to require insurance companies to issues such insurance.

    Otherwise it is the same as requiring midwives to ride unicorns to work.  Since there are no unicorns, they can’t go to work.

    I have no position one way or the other regarding midwives, but I know that it is purely bullshit to require them to have something they can’t get.

    1. “They can’t have it both ways.  If they are going to require midwives to have insurance, then they have to require insurance companies to issues such insurance.”

      Easier said than done. I’m no fan of insurance companies, but it seems a tad OTT to force them to insure something if they don’t want to.

      1. If given the ability to, insurers would drop all high risk clients and keep only the ones who never post a claim.

        1. You’re speaking as though insurers don’t already do that. Admittedly I know there are places where they can’t, but in places where they still can drop customers for any, or no, reason they’re fighting tooth and nail to keep that power.

        2. Of course. But this isn’t a high-risk client, it’s a specific form of insurance.

          The government can tell an insurer not to discriminate between customers (even though they routinely do), but I don’t see it as fair to tell them what they can and cant insure.

          Obviously if they’re refusing to insure them then there’s no business case for it. They’re a private enterprise, not a public service. If the government wish it to be a requirement then the government needs to make provisions for it.

          1.  Here’s another example that might help you see what I’m trying to say.  In the early 90’s in CA and MA, auto insurance premiums were skyrocketing.  Very high fees.  So people were opting not to be insured.  Well, the courts were getting clogged with civil suits for accident victims suing uninsured people at fault.  The government had to intervene, in both states (although they came up with different solutions for how to do it.)  The states mandated 1. auto insurance for every driver 2. insurers to insure anyone asking and 3. premium price control.  Now, whether it worked is a call, but I think it did.  Courts were unclogged.  Premiums went down.  General safety and well-being, in terms of auto-accidents, was improved.  The insurance industry didn’t die.  They squawked but kept raking in the bucks.

            I see an analogue in this midwifery business, because midwives serve the public good, aren’t necessarily high-risk, and the risk of not having an insured midwife, should the worst happen, is outweighed by the government’s ability to step in and mandate what’s fair.  I think the government should intervene and protect a valuable form of health care.

          2. But in that case there was a business that sold auto-insurance; they were just being regulated.

            From what I understand of this situation there’s no midwife insurance, because no one offers it.

            I appreciate you likely see these differences yourself, but it’s these differences that prevent me from seeing this as a solution. If the insurance were simply too expensive, then I think it would be fair for their being some kind of price regulation; but if they don’t even want to offer the insurance in the first place isn’t it a little oppressive to force them to?

            Kind of like if the government came to me and said “So, your company creates digital products, that’s all well and good, but now as a legal requirement you also have to offer print services”.

          3. It’s not like telling a company they need to produce something else.  It’s telling them they needto extend malpractice insurance to another group of health care workers.  Hell, if they will insure chiropractors and acupuncturists, they ought to insure midwives.

          4. “But this isn’t a high-risk client, it’s a specific form of insurance.”

            For a high risk field.

    2. “They can’t have it both ways.  If they are going to require midwives to have insurance, then they have to require insurance companies to issues such insurance.”

      My guess is that “independent midwifes” are not licensed.

      Is this not the case?

    3. Sure they can.  In the US, state legislatures do this all the time.  They drive out independent, nongovernmental services they don’t want – such as abortion providers – by legislating requirements that are effectively impossible for the services to meet. 

      In fact, my first thought when I read this was, “Who wants to eliminate midwives, and why?”

  2. You cannot mandate insurers to insure something. Sad to say: If insurers decide the risk is too high for them to issue an insurance, it probably is. It’s not that insurances would usually want to walk away from making money. That any health practitioner should be properly insured is a no-brainer for me on the other hand.

    1. Oh yes, you can.  Insurers can be made to insure anything and everything the law prescribes.

      Midwifery is superior to doctor intervention in uncomplicated pregnancies.  There is no reason to be treating midwives this poorly. 

      I can’t think of any advantage to either midwives, doctors, patients or insurers by treating them so badly.

      1. And even if the insurers can’t be *made* to insure them, then because the Govt is requiring them to be insured then the Govt has a moral obligation – at the very least – to become the ‘insurer of last resort’ themselves.

        1.  why would the *government* have to do that?

          say rather, if there are so many people who want this service provided, and only need for their service providers to be insured for that to happen — well then, let those prospective customers pool some money and start their own insurance company. problem solved, amirite?

          1. And isn’t that idea synonymous with “government”?  i.e. “people banding together and pooling their money to solve a problem for the public good.”  Amirite?

          2. no, even i am not enough of a socialist to actually EQUATE government with private enterprise. each has a place, and sometimes the way to solve a problem is in fact to start up a company instead of petitioning government.

          3. “why would the *government* have to do that?”

            Because the private sector won’t do something the government requires to be done. See “unicorns” example above.

      2. “Midwifery is superior to doctor intervention in uncomplicated pregnancies.”

        Shame that complications due to pregnancy are why they are refuing to insure midwives.

    2. This may not be an issue of whether the insurance companies want to or don’t want to insure midwives. It may be that hospitals don’t want to see insurance companies insuring midwives and are willing to to pay the insurance companies MORE money to not insure midwives than the insurance companies would make insuring midwives. Insurance.

      1. “It may be that hospitals don’t want to see insurance companies insuring midwives”

        Ah, a 911 truther-level conspiracy.

    3.  Here in the US, the gov’t most certainly can mandate that insurers insure something. In most states, insurers must cover pregnant women, as proscribed by law. When we moved to Texas, from Massachusetts, there was no such law in the lone star state, and hence to coverage for pregnant women, since the insurers considered pregnancy to be a per-existing condition.

      1.  “…Insurers consider pregnancy a pre-existing condition.”
        I laughed, and then I cried.

        1. On my short term disability paperwork (which I’ll be sending to the state of California in a week), my pregnancy even has a “disease code”.  

          I crack up every time I read it.

    4. Recent studies have found that home birth attended by a trained midwife is actually safer than hospital birth attended by an obstetrician.  Both are quite safe, here in the first world, but midwives are safer by a small-but-statistically-significant margin.

      I suspect you’re right on the “insurers don’t want to walk away from making money” angle, but wrong on the exact mechanism.

      As @facebook-1000418730:disqus suggests – there’s a lot more money in insuring a hospital than in insuring small midwifery practices.  Probably if a single midsized hospital somewhere has said, strictly off the record of course, “we won’t buy insurance from any company that insures midwives”, then that potential loss of business outweighs the gain to be had by insuring every single midwifery clinic in the entire UK.

      Even small hospitals are very big business; even big independent midwifery practices are very small business.

      EDIT – and I wouldn’t be the least bit surprised that a hospital had, in fact, made such a threat – the level of mistrust of midwives among medical professionals who ought to know better is surprising.

      1. The level of mistrust of predominantly FEMALE midwives among predominantly MALE medical professionals (obstetricians) who ought to know better is not so surprising. The antagonism goes back to the seventeenth century.

      2. That is not what the studies show. The data that I’m familiar with shows that home midwife delivery has a 300-800% higher risk of infant death. Here’s one example:

        The issue is not midwives vs. OBs so much as home birth vs. hospital birth. Hospitals have a pediatrician in house 24/7. If something goes wrong in the hospital, the baby can be saved. If something goes wrong at home, the baby will die. 

        Having a home birth is like riding a bicycle without a helmet. The risk of getting hit by a car is low in absolute terms, but if you do get hit, the helmet makes a big difference. I rode a bike my entire childhood without a helmet, and I’m fine, as are all of my friends who did the same thing. Parents don’t let their kids do that any more. It’s all about how much risk you’re willing to accept, but the data clearly shows that home births are much higher risk, even though that risk is small in absolute terms.

        1. Interesting.  I wonder what the difference is between Oregon USA and British Columbia Canada

          “The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00 – 1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician.”

          That is a pretty big difference, from “300-800% higher” risk, to about 47% lower risk.

          1. I partially agree with you and partially disagree with you. Let me try to clarify.

            There are a couple of problems with the study that you cite. The first is that the study doesn’t have nearly enough patients to detect, much less quantify, any difference in the rate of perinatal mortality. The problem with studying rare events is that you need lots and lots of patients. 12,000 patients sounds like a lot, but in a case like this, the sample size really isn’t the number of patients, but the number of deaths. This study basically says one baby died at home, and two died in the hospital, and that’s not statistically significant, so that means there’s no difference in risk between the two. The correct interpretation is that the study simply didn’t have nearly enough subjects to detect a difference between the two, much less quantify it.

            The second thing is that the study doesn’t control for differences in the two populations well enough. There are a number of risk factors that aren’t included in their analysis, suggesting that the patient pool of hospital births was a higher-risk pool. Their data showing that home births had lower rates of meconium aspiration, the infants required less oxygen, etc. support this interpretation, that the home birth group was a lower-risk pool to start with.

            I agree with you about midwife certification. In the US, we have a certification called Certified Nurse Midwife, who are real medical professionals with degrees and training comparable to other first-world countries. We also have something called Certified Professional Midwife (CPM), which is basically a certificate that any high school graduate can get with no in-hospital training. These are the people who perform the majority of home births in the US, and in my opinion, this certification should be abolished.

            One important difference between the study you cite and the statistic I cited is that the Canadian study only looked at low-risk pregnancies. One problem is that in the US, CPMs deliver high-risk babies at home, and that’s probably the major component of what drives the difference between the numbers. Although I only cited the Oregon numbers, the numbers from the rest of the country are similar, so in that sense I agree with you that the primary problem in the US is undertrained people who aren’t properly risk stratifying their patients.

            In my opinion, the big problem with this topic, and the reason why you see studies with conflicting conclusions, is that it’s a difficult topic to study epidemiologically. First, you have a rare event, requiring massive sample sizes, so most of the time you see studies like the one you cited that are properly interpreted as simply inconclusive. Second, it’s virtually impossible to do prospective studies in which you randomly assign people to have home births vs. hospital births. People in the US who choose home births tend to be wealthier, more educated, more health-conscious, get better prenatal care, etc. It’s like those studies showing that men who shave daily live longer than men who don’t. People can attempt to control for this nebulous socioeconomic factor, but it inevitably leads to a systematic bias underestimating the risk of home birth relative to hospital birth.

            If you look at all the data, not just one study, my interpretation is that home birth (even in the Netherlands, where a lot of the best studies come from) is still higher risk than hospital birth, but the absolute difference in risk is extremely small for low-risk pregnancies, so I think a reasonable case could be made either way. However, one large study in the Netherlands stratified patients into three groups: low, medium, and high risk. They had the low-risk group have home births, and they looked at outcomes. They found that 12% of those home births required emergent transfer to a hospital. To me, that’s really high, and that’s the lowest-risk group. Maybe I’m a wimp, but to me, calling 911 is a big deal. I’ve only called 911 twice in my life. If someone told me they were going to do something at my house that would create a 12% chance of someone needing to call 911, I would tell them to do it somewhere else.

          2. One important difference between the study you cite and the statistic I cited is that the Canadian study only looked at low-risk pregnancies.

            Well, they looked at all births that met the eligibility criteria for home births – whether they opted for a home birth, or a hospital birth.  So, yes, they excluded high risk births equally from the considered home births, and the considered hospital births.

            Their data showing that home births had lower rates of meconium aspiration, the infants required less oxygen, etc. support this interpretation, that the home birth group was a lower-risk pool to start with

            That’s exactly what it doesn’t support.  In the hospital birth group considered – the one with significantly worse outcomes – they only included pregnancies that would have been eligible for home births had the parents preferred it (and been able to find a midwife accepting clients). What’s the big, obvious difference? Whether they opted to have a surgeon attend a birth (who will naturally be biased toward using all the tools of surgery they’re used to and trained in), or only call on the services of a surgeon if surgery is truly indicated.

            As for homebirth-choosers getting better prenatal care – who is it that is delivering better prenatal care then? Right, midwives. So, yes, midwives provide better prenatal care than obstetricians, which leads to better birth outcomes. That supports my argument, not yours.

            In particular, the Canadian study divided the births according to where they were initially planned, not where they ended up happening. So, where midwives detected developing risk factors (thanks to that superior prenatal care you point out) they steered clients toward hospital births, so that obstetric surgeons, ICUs, etc., would all be near to hand if needed.

            One thing I agree with you on – the correlation of education with both home births and positive outcomes, and difficulty controlling for that.  On the other hand, what does it tell you, that people with more information available and better able to assess it, are the ones choosing home births…

        2. Aaaaaand here’s your answer to the question “what’s the difference”:


          In a survey sent to current CPMs in 2009, 45% of respondents were trained by apprenticeship, 33% through a MEAC program, 12% through a non-accredited program, and 7% were self-taught.

          Currently, 27 states allow midwives; only in Oregon and Utah is a license for midwives optional.

          In Canada, you can’t get a license to practice midwifery without a 4 year degree in midwifery, from an accredited university program. Practicing midwifery without a license is illegal.

          In the UK, it’s a 3 year degree, and again, you can’t practice midwifery without a license.

          In the USA as a whole (didn’t find stats for Oregon quickly), only 1/3 or so of licensed direct entry midwives (i.e. those who didn’t enter the profession via nursing) have a degree from an accredited medical institution. And in Oregon, you don’t even need a license to practice midwifery, so I’d guess it’s even less than 1/3 there.

          You can’t compare outcomes in Oregon to places where midwifery is part of the modern medical world.

          (Edited for clarity)

          1. (obligatory snark: I said “here in the first world”, but you countered with statistics from Oregon.)

  3. Not being from the UK I don’t really understand the nuances of the situation very well. What I’m curious about though is whether there are “independent doctors” or other health professionals that operate outside of the NHS? If so, are they insured? If not, why have midwives been allowed to operate outside of the NHS previously? If so, why won’t these insurers work with independent midwives?

    1. Consultants are self-employed, and many work in the NHS part of the month and in their private, independent practice (or for private hospitals) for the other part. My understanding is GPs (family doctors) tend to form a practice partnership or a limited company, and they are contracted for services by the NHS. However, GPs tend to work full time on NHS work.

      I wonder if these independent midwives have formal midwifery/nursing qualifications. There was an episode of Quincy years ago on an independent midwife in the USA. She stood outside of the traditional mainstream medical profession. That’s the reason for asking. 

      1. Independent midwives in the UK are fully qualified, as required by law. The situation in the USA is different; some states outlaw midwives altogether, and so to be a midwife at all is to be “outside the traditional mainstream medical profession”.

    2. The NHS is essentially an insurer.  It doesn’t have a monopoly on providing health care; it’s just the free/cheap option, so virtually everyone uses it.  There are private providers, as well, for those who want faster service or services that aren’t covered by the NHS.

  4. My guess is that independent midwives are independent for similar reasons to alternative medicine being alternative. See Tim Minchin. My only experience of independent midwifery was when a friend used one for ideological reasons – it turned out to be a fairly dangerous nightmare.

    1. I ought to point out that this was in Germany, where although treatment is generally good, medical science is subordinate to private-sector ‘choice’.

    2. So, you believe that there simply can be no failure for the NHS to provide adequate service, for instance due to inadequate funding, either locally or nation-wide? That seems unusually sanguine, and I have a feeling that several million people might disagree.

    3. I’d have similar worries, but the reality of the matter is that the UK government is currently cutting everything they can, which means nurses and midwives are increasingly made redundant, so they are forced to set up shop on their own.

      This would actually be a great opportunity for the government to actually push a real vision for an integrated public/private NHS, if they were interested in such a thing. Instead, they’ll do nothing and just keep selling off NHS property to their cronies, because that’s what this Lib-Con coalition is really about.

      Edited to add: not to mention that independent midwives are natural supporters of at-home deliveries, which make a lot of sense if you’re busy closing hospitals. But as I said, the current rulers are a bunch of incompetent fools who can’t even keep us out of recession for 12 months, let alone elaborate any decent policy for the common man.

    4.  Your guess is wrong.

      They are independent for the same reason dentists who run their own clinics are independent – because being your own boss has advantages.

      1. I think it may be a mixture of both. Midwifery services are being cut back at a time when the Royal College of Midwives is warning of a potential serious deterioration in the availability of midwives as the UK is experiencing something of a baby boom right now. People who have left the profession at times of adequate provision are being encouraged to return when there are no hospital vacancies to return to.

    5.  A midwife (at least in Germany where I know how this thing works) does a lot more than provide medical service. It’s as much about making the future mother comfortable, prepare her for birth (and help her rehabilitate after birth), and generally be around for questions and of course during the event. You wouldn’t want to pay a doctor for this, it would be too expensive, and it would be unnecessary, too.
      Usually, children are nevertheless being born in hospitals, simply because being in a hospital is the safer choice, just in case. But usually, proper doctors only need to be marginally involved unless something goes wrong.

      This is not at all about “alternative medicine” or any of that. It’s because as a human being, a pregnant woman has more requirements than ultrasound images, a handshake and the assertion that it’s going well, goodbye, see you in four months.

      Sadly, in Germany the insurance (that midwifes are required to have, and do have) has become ever more expensive (more than doubled in a few years), to the point where it’s threatening their professional existence and requires them to take on so many more patients that the type of care described above is difficult to give. Interestingly, you don’t pay per patient but per month… i.e.: Twice as many patients: more than twice the risk of doing something wrong, but same costs of insurance. There was a bunch of rallies against this, but no-one has really explained what the increase of insurance costs was about — there was no sudden increase in births gone wrong to go with it, and in the decades before it worked seemingly well — and I think the matter is still not resolved.

      There must be some fundamental problem with insuring midwives, but I don’t get it. Maybe the midwives’ insurance market is broken for some reason?

  5. Seems like it would make sense under the circumstances for the independent midwives to set up a mutual insurance company.  Do UK regulations allow mutual insurance companies?  This seems like pretty much the paradigmatic case for one.

    1. was about to say just this. Many insurers in the UK are actually mutuals, so I know the law allows for it. Seems like the obvious solution to me

  6. Re: “If you can get insurance to juggle machetes in Covent Garden (high potential liability, small data set, massive individual variation), why the hell can’t indie midwives get cover?”: machete jugglers generally aren’t taking risks daily with other peoples’ children.  If the potential liability of a machete juggler is “high”, the only appropriate term for the potential liability involved in fooling around with a procedure that involves childbirth and infants can only be described as “astronomical”.

    So I think there’s a good chance the potential insurers have counted the beans, multiplied their estimates of the probability of something going Horribly Wrong by the potential liability should it happen, and come up with a number too high to sell to midwives at a price they’re likely to be able to afford.  That certainly seems to be the conclusion the folks who wrote The Feasibility and Insurability of Independent Midwifery in England reached.  (See section 8.)

    1. Your surmise is pretty much correct. Insurance used to be available but at a steadily increasing cost often in excess of what some midwives earn. I presume the the price hikes weren’t so much a gouging effort on the part of insurers but a result of a constant fall in policyholders increasing the short-term risk for the insurer. Eventually the number of policyholders became so low that the last insurer pulled out of the market.
      The only practical solution that I can see is for the Royal College of Midwifery to negotiate a policy covering all independent midwives with a single insurer, which is likely to result in something much more acceptable to both insurer and midwives.

      1. That’d mean there’s only one insurer which all midwives would be obliged to use, which means they could choose whatever price they want, the the midwives would have to pay, which means it would be decoupled from the actual risk and much much higher.
        There must either be competition or (if that cannot be obtained) a price set by an independent institution with nothing to gain from giving an unfair advantage to either party.

        1. No. The policy would be purchased by the RCM and they would be free to shop around for the best deal.
          Bear in mind that the reason why insurers stopped offering cover was because the number of independent midwives got so low (40) and only a shrinking fraction of those were buying insurance. The virtually non-existent economies of scale combined with the increased short term risk guaranteed spiralling premiums which no-one would realistically be able to afford.
          Now, though, with over 200 independent midwives who must be insured, the situation may be sufficiently different for insurers to start offering policies again spontaneously. However, I would suggest that a packet of 200 bundled policies is much more appealing to insurers and so would generate much greater competition.

    2.  Machete jugglers in Covent Garden entertain audiences of children (not their own) all day long, every Saturday and Sunday.

      1. Yes, but jugglers and spectating children are separated by sufficient distance that for the former to hit the latter with a machete aiming would be involved. I doubt insurance covers that.

  7. Should it be up to the government or parents to decide what is best for the health of mother and child? The real difference between the NHS midwife and independent midwife is one is covered by insurance, the other is not. Parents employing an independent midwife who is otherwise fully qualifed, make the decision to suck it up or sue the midwife if something goes wrong. The midwife without insurance is really the only one taking any real risk.

    1. So you’re saying that a baby brain-damaged as a result of a midwife’s professional negligence isn’t really any worse off if the midwife doesn’t actually have £4 million to cover a lifetime’s treatment and round the clock nursing care?

  8. This is part of a deliberate depopulation policy by the 1%ers, who can afford midwifery, against the 99%ers, who soon wont be able to.

    Cutting off the insurance for midwives is effectively eliminating that profession.

    The 99%ers don’t get a choice in the matter. They get to go somewhere with expensive machines that go bing that also happen to be where they take people to die, of antibiotic resistant infections that they wouldn’t get if they didn’t have to go there.

    Any society that cant afford to give birth is depopulating itself. (Meanwhile the risks don’t seem to be bothering certain more religious segments of society in less advanced regions of the planet.)

  9. Damn! I didn’t want my first ever comment on a Cory story to be “Cory, you’re wrong”. Because normally you’re so right about everything.

    “Dr Crippen” no longer writes about independent “madwives” as he calls them, but you can still find some of the articles in the wayback machine. This is one such:

    I really urge you to read that article, as you will understand why insurers will not touch independent midwives. Comparing an independent midwife to your wife’s NHS midwife is comparing apples and pears.

    In particular there is no one-to-one relationship between home births and independent midwives. So the demise of independent midwives doesn’t mean the demise of home births. The NHS wants home births. Of course they do: they cost less. But home births with NHS midwives—who can be trained, to ensure that they call for backup when they need it and who can recognise the risks. The example in the link is a classic, showing how things can go badly wrong, without the independent midwife understanding the risks even after they have gone wrong.

    1. Actually there has been a real loss of expertise amongst NHS midwives where there has – for whatever reason – been a move towards more and more medicalisation of birth. I would suggest that independant midwives in the UK are a highly skilled group especially in attending homebirths. They can still deliver breech babies without resorting to c-sections – something that is no longer available in the NHS as the skills have been lost. And whilst the NHS often refuses to support women to have vaginal births after a c-section birth (VBAC), independant midwives still have the skills to do this. 

      Independant midwives are often independant because they are appalled by the way women in labour are treated in hospital. You need to read about the physiology of birth, but basically if you feel safe (familiar surroundings and people, calm and quiet atmosphere) during labour then your birth outcome will be much better than being somewhere you don’t know with people you don’t know being subjected to ‘treatment’ you don’t want/need.

      There is plenty of evidence showing hospital births have far higher rates of intervention than homebirths esp. those with independant midwives. Hospitals are sometimes the right place to be for birth…sometimes. That is why skilled independant midwives have an ambulance on standby to take you to hospital if they feel there is any chance of that being necessary.
      And yes, ultimately it is my body, my birth, my money and my choice.

  10. Simple – the medical/obstetricians’s lobby is very powerful and apply enormous pressure to stop the govt and insurance  industry support for midwives and home birth – there is a fight right now internationally to control women’s care – pregnant women are part of an industry – this lack of insurance for midwives is happening in Australia too. Our govt passed a law in 2009 requiring all health professionals to have PII – no product available for homebirth midwives. Thousands of women and families protested at Parliament House and exemptions have been granted so midwives did not face $30,000 fines or even jail for just going to work. This is not the solution. We need to protect and support our midwives who care for women, babies and their families. Birth has become an industry. Women will give birth at home as they always have and always will – they must have midwives available to do so safely for them and their babies.

  11. I used to work with a grassroots organization to try to get a freestanding birthing center staffed by midwives in the town in NC where I lived. The group had connections to midwives that worked at the local hospital and we also reached out to other towns in our area to learn what they were doing.

    As we learned about the tremendous amounts of cash that the Ob/Gyns were paying to be insured, we slowly realized that we would not be able to get any doctor to sign up to supervise our birthing center (considered risky by insurers).

    We shut down our attempts and redirected them toward supporting the hospital based midwives and encouraging women to hire doulas. 

    Insurance is putting pressure not just on midwifery but on all Ob/Gyns to the point that fewer and fewer doctors are going into that field, or they will move to a state with lower insurance requirements to practice leaving some states without enough doctors, let alone competent midwives.

  12. Well, they have done the same to us here in Germany but they may as well have abolished independent midwives as the insurance is so extortionately high that midwives are running away to change occupations like rats from a sinking ship. (the insurance costs about €5000 per year) So the end result will be the same, midwives will have to criminalize themselves in order to carry on working. If they don’t get you one way they will get you another way. Basically, as with all scare tactics today, the end result is that those in charge want total control. P.S. The midwives would gladly pay an insurance which wasn’t totally insane but this is obviously the next step in a long running ploy to eliminate independent midwives by using unfounded scare tactics concerning a totally natural process which isn’t (and never was) a medical procedure.

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