Why Choose an Independent or Private Midwife?
You’ve been feeling a little strange … food tastes odd … your boobs are sore … could it be? You take the test, hardly daring to believe but that line creeps across the pee stick and – congratulations! You’re pregnant! It’s always a bit of a shock, even when you’ve been trying for a baby, and even more of a shock if it is completely out of the blue. All sorts of thoughts are probably swirling around in your head and it’s natural to feel some ambivalence even for a much-wanted baby. Hopefully, after a few days you begin to get used to the idea and start to feel excited about the miraculous spark of life inside you. So what comes next? What support is out there for you on this adventure of pregnancy and birth?
Perhaps you connect with your friends on Facebook or Instagram, join a few pregnancy groups. You realise that there’s a lot of Stuff to Do – for a start, how to do you book for maternity care? What does that look like? That’s going to be different depending on where you live in the world, but I am a midwife based in the UK so I thought I’d talk through one of the many options that are on offer here – the option to have some or all of your midwifery care carried out on an independent (private) basis.
I guess before I go into that, I should say that the standard approach for maternity care in the UK is to have care that is led by an NHS midwife, which is arranged usually by calling your local GP surgery. This is a different system to those in other parts of the world and we’re fortunate in the UK to have midwifery care available to everyone via our wonderful National Health Service. Midwives are the lead clinicians for the majority of women in the UK, and are skilled and dedicated professionals. Even where a consultant obstetrician is also involved, the woman will still see midwives on many occasions during their pregnancy and birth. However, one disadvantage of NHS care is that not everyone has a continuity midwifery team in their area. In this case, or if you simply want different care to what is offered within the NHS, you may want to consider the services of an independent (or private) midwife. Independent or private midwives are registered midwives who are able to carry out care for pregnancy, birth and the postnatal period outside (sometimes alongside) the NHS. They are qualified midwives and are registered with the Nursing and Midwifery Council.
Ten Advantages of Having an Independent (Private) Midwife
The following points reflect what clients have shared with me over 14 years of being an independent midwife (IM) as some of the main advantages of this kind of care. Please let me know in the comments if you have any experience of an independent (or private) midwife.
• Continuity of care by a known midwife
The gold standard of maternity care is continuity of care (COC). COC has been shown to make a big difference for mothers and babies, is “associated with significant benefits for mothers and babies, and had no identified adverse effects” (Sandall, 2017). With an IM you automatically get gold standard continuity of care, either with one midwife or with a very small team practice in some areas.
• Being able to choose your midwife
You get to choose your own lead midwife. We are all different and we all have different personalities. It is a huge bonus of IM care that you get to decide who you work with during this very significant time of your life. Usually, people meet (sometimes via Zoom nowadays) all the independent midwives in their area and then choose who gels best with them (and other members of the family). Please don’t feel self-conscious about ‘interviewing’ a few different IMs. We are very used to it, and appreciate that you need to feel as comfortable as possible with the midwife who will walk alongside you during this very important time of your life.
• Appointments at a time convenient to you in your home
This might seem a relatively trivial point, but in fact it can make a difference to the quality of your maternity care if you aren’t having to wait around in clinic waiting rooms. Plus, during the COVID-19 crisis, most independent midwives have been able to continue with face-to-face appointments (using appropriate PPE) so our clients still receive the warmth and engagement of an in-person meeting for normal appointments.
• Relaxed, unhurried appointments
The appointments are usually at least an hour in length, which gives you plenty of time to ask any questions and to share any concerns or worries you may have. My philosophy of midwifery care that means I want to listen very carefully to what women tell me and as an IM I have the time to do this. I believe that when encouraged to trust their own instincts, women are rarely wrong about their own and their baby’s wellbeing. Listening to women in this way can prevent unnecessary medical intervention but also it can ensure that if you do need help (if you feel that something isn’t right) then your independent midwife can move quickly to arrange any investigations and treatment you might need.
• Involvement of partner and other family members
One of the big advantages of an independent midwife is that we are fortunate to work in a very family-centred way. If you would like visits at odd times of the day to fit in with your own or a partner’s work patterns, we can often accommodate this. And I can’t speak for all IMs, but I know I’m not alone in absolutely loving the opportunity to involve family members such as grandparents and siblings in the preparation for birth. Pregnancy can give a wonderful opportunity for bonding with yet-to-be-born baby for the whole family – plus it’s great fun!
Phil measures Sarah’s bump (baby Inca). He was spot-on!
• Support for your choices
An IM will always unconditionally support your choices. This doesn’t mean we won’t talk to you about risk – it’s very important that you’re aware of all the pros and cons of your decision-making for pregnancy and birth. But you are in the driving seat. How is this different to NHS care? Well, it shouldn’t be different, and there are many examples of brilliant NHS care of course. But sometimes women find themselves facing opposition for their choices within the NHS. Whatever your situation – whether you have an uncomplicated pregnancy, or you are wanting a vaginal birth after previous caesarean (VBAC), are considered to be an older mother, have a raised BMI, have been diagnosed with gestational diabetes or other condition during pregnancy, or perhaps induction of labour has been suggested – we will not prejudge or try to force you into any decisions. As an IM and an evidence-based midwife, I (and other IMs) will talk you through the pros and cons of any tests and interventions that might be on offer, and unconditionally support your informed choices.
• Preparation for birth
A crucial factor in how you experience labour and birth is the preparation for birth. As an independent midwife, I have invested in training in active birth plus I have many years of experience in supporting undisturbed physiological births. I also have experience in planning for and supporting gentle (‘natural’) caesareans. So I can’t speak for all IMs, but many of us do have these and other skills that we are delighted to share with you to make your birth experience the best one possible. You have heard of the baby blues? How about post-birth euphoria! Yes, it really can and does happen. And while not everyone can be euphoric after birth, you will be supported to process your emotions so you integrate whatever path your birth journey takes.
• Expert confident support for home birth
While not everyone who books an IM will want a home birth, increasingly this is being seen as a sensible option for many – even more so with the current COVID-19 situation. It has always been the case that for many women, home birth is a sensible and safe option. In common with many other IMs, I am a confident and skilled home birth midwife. Fear and anxiety are as infectious as any virus! You need to be surrounded with people who have faith that women’s bodies can give birth without intervention in the majority of cases. If extra help is needed, hopefully this knowledge of your independent midwife’s confidence and experience with a range of situations will also be helpful. You will have an advocate who can support your birth plan throughout all circumstances.
• International clients and/or those with medical insurance
In common with other IMs, over the years I have supported many international clients, or those who already have medical insurance for another reason and who can therefore use an insurance company to pay for their independent care. This can be easily accommodated by most IMs without the hassle of dealing with a huge bureaucracy.
• Postnatal care
Often called the ‘Cinderella’ service, I would like to make my final point about the importance of postnatal care. As an IM, I usually visit at least four or five or more times in the first ten days, and then weekly until four weeks postnatally – more often if the client needs extra support, for instance with breastfeeding. Other IMs will have slightly different postnatal packages, but all will place emphasis on the importance of postnatal care. Sadly, the standard NHS postnatal care offer is often one home visit by a midwife, with any follow-up appointments happening at the clinic and then by the health visitor. I consider home visits by a midwife essential, unless the parents are very experienced. And even if they are experienced, it can be so useful to actually know the person you can call at any time of the day or night if you have a concern about your baby. Independent midwives can provide expert triage for any problems, and make referrals for investigations or emergency treatment. This can be invaluable if there are any concerns about a mother’s or baby’s health – and is a huge advantage of continuity of care models.
Disadvantages to independent care?
The only thing that can be considered a disadvantage to independent midwifery care is that you do need to pay for it! Of course, this isn’t a disadvantage to me (the IM) as I need to run my business and be paid fairly. It can be a large sum of money for a family to find, but I think there are even some advantages to paying directly for your care in this way. You can expect a certain level of service (to be agreed between you and the midwife). In particular, you know that if you call or message, you will always receive a prompt reply. And when you go into labour, you know the midwife you’re calling and you can have a relaxed conversation or messages without worrying that you’re calling too soon (or too late!). Still, there’s no denying that continuity of midwifery care isn’t yet universally available which is a great shame. Many independent and private midwives are involved in campaigning and charity work to try to ensure that this wonderful, positive model continues to be rolled out in the private and state sectors so that every mother and baby can be cared for in this way.
If you would like to go ahead with independent midwifery care but are worried about the financial side, a way forward can usually be found. Many of my own previous clients were not wealthy but either had help from family members or made payments plans. So please don’t let finances put you off – do contact me or another independent or private midwife to talk through all your financial options. I hope and believe it will be a wise investment in your health and your family that will have long-lasting – even lifelong – positive benefits.