Independent midwives

Do you want to know who your midwife is when you go into labour? Clare Winter on how and why you might hire an independent midwife.

Independent midwifery is not a new concept. It has been in evidence for thousands of years. Biblical references from 2000 BC show midwives to be ‘preservers of life’. Throughout history, midwives as independent practitioners are identified as the guardians of normal childbirth. Their knowledge of women's health has been seen as mystical, having power over nature and concerned with matters not understood by men. If a midwife had a good reputation she could earn a living, whereas the unlucky ones could be burnt as witches.

Before the 1600s there was little regulation of midwifery or medicine in England. Midwifery training often passed from mother to daughter, learned by experience and passed on without formal instruction. During the 17th Century midwives were licensed by the Bishop’s court, and had to produce letters of reference of good character from clients.

In 1902, the Midwives Act was introduced. Registration became compulsory and they had to undergo a training period provided by obstetricians. Doctors began to influence much of midwifery practice and education. Slowly their independent status was relinquished. In 1970, it was decided that all births were to take place in hospital. This changed the midwifes’ independent status to doctor’s assistant.

The Independent Midwives Association

In July 1985, ten midwives formed The Independent Midwives Association.The Association exists for

  • the dissemination of information about, and support for, independent midwives
  • to lobby for the traditional role of the midwife
  • to support midwives interested in setting up in practice, speaking to interested parties and being a contact for information on their individual practices
  • providing support and information to women’s personal inquiries
All independent midwives are qualified midwives and practice in accordance with the Midwives’ Rules. They are self-employed, required to inform the local NHS Supervisor of Midwives when practicing and allow yearly inspection of their equipment. Like NHS midwives, independent midwives have to provide evidence that they are continuing education to keep their practice up to date.

Insurance

Indemnity insurance was originally provided by the Royal College of Midwives but in 1994 they withdrew their cover. As a result most independent midwives now practise uninsured. Insurance costs between £8000 and £15000 pounds per year. Midwives earn between £12,000 - £21,000 per year. The cost of insurance is beyond most of us. This lack of affordable insurance has discouraged many midwives from becoming independent.

The Independent Midwives’ Role

Independent midwives have chosen to work outside the NHS in order to practise the midwife’s role to its fullest extent. Providing continuity of care through pregnancy, labour and up to 28 days post-natally.

Though individual practises vary, the aim of our care is to work in partnership with our clients, providing information from research and experience so they are able to make an informed choice about their care. Most people approaching independent midwives want home births. Women who need to transfer to hospital have an extra problem as uninsured midwives are often not allowed to practise in NHS hospitals. Some will be issued with honorary contracts and can continue the care in hospital, but in other areas, the midwife can only accompany the woman as a ‘friend in labour’.

The cost

Fees for an independent midwife vary and each area can differ. In London, most midwives charge £2300 for maternity care, the insured midwives will charge from £4500. Some midwives will only take clients on for the whole care whereas others are prepared to provide only part care, the remainder of the care provided by the NHS. Most midwives offer a free consultation, giving potential clients the opportunity to find the midwife they feel happy with. The relationship is extremely important, and built on mutual trust and respect. The expertise of an independent midwife provides an environment for the woman and her partner to take responsibility for the birth of their own baby.

Details and further information can be found in The Register of Independent Midwives. Copies are available from Andrea Dombrowe, Secretary of the Independent Midwives Association, 1 The Great Quarry, Guildford, GU1 3XN, Tel: 01483 538615

or visit: The Independent Midwives Association website If you are interested in the work of the Independent Midwives Association and would like to be kept informed of the ongoing developments, then join as a Friend of the IMA, we would welcome your support. Friends of the IMA receive a six monthly newsletter. Subscription: £5 annually or £20 for five years. To join please contact Clare Winter, 65 Lonsdale Ave, London, E6 3JZ or e-mail c.f.winter@city.ac.uk