by Carrie Macintosh (Independent Midwife)
Ok, so I’m an independent midwife. What’s that? I hear you ask. Well, it’s just as it says on the tin – I’m a midwife, but I’m independent, therefore, I don’t work for the NHS or anyone other than the clients who employ me.
When I began my training as a midwife, I believed that I was embarking upon a career where I would be helping people, building up relationships with families and helping to bring new life into the world. My time in university focused on not only the clinical skills and science knowledge I needed to do the job, but on communication, psychology, reflection and counselling skills. Imagine my shock and dismay then to discover that there are far more skills required to be a midwife in the NHS that they don’t teach you at University – such as the ability to simultaneously “care” for three women in various stages of labour in three separate rooms, build up relationships with said women over a period of a few hours, sometimes minutes, in order to understand their needs. All the while trying to do all the necessary associated paperwork (LOTS). Other things I didn’t bargain on were the bullying culture in the NHS. Working in an environment where you constantly have to argue and justify your care plans simply to try to help the woman you are caring for achieve a normal birth wears you down very quickly.
Midwifery is often described as an Art AND a science. The art is in being with woman, TRULY with woman, understanding her needs and knowing when all that is needed of you is to be there and do nothing. So here’s the science bit……and it’s a well kept secret….Woman’s body + conception + full grown baby = design capability to give birth(most of the time) The missing bit in the equation is that the medical profession has little or no faith in that fact.
Midwifery, like medicine, is supposed to be an evidence based profession. Policies and clinical decisions should be based on best possible evidence. However, it appears that many policies and decisions are based on a desperate bed shortage and the need to move women quickly through the system. There are many fantastic midwives working within this system who desperately want to provide good care to women and despite a shortage of beds, money, equipment and staff etc they do so but there is only so long that a human being can carry on working within such a stressful environment before they become burnt out.
Faced with all these facts, it became clear to me that if I wanted to be a Midwife in the true sense of the word then opportunities to do that were few and far between in the NHS so I took the leap of faith and set up independently.
Working as an independent midwife means that I meet the woman in her own home at whatever point in her pregnancy she decides to contact me. I have had calls from women who have just done a positive pregnancy test on the first day on their missed period and I have had calls from women in labour suddenly realising that their midwife is not supportive of their birth plans. Once a woman has booked her care with me then I see her at each antenatal appointment, in her own home, and at a time that suits her. Appointments usually take around an hour, sometimes more, and this gives both of us LOTS of time to get to know each other, discuss her plans for the birth and do all the other clinical checks required. Most of the women who book their care with me choose to birth at home and I go on call for their birth at 37 weeks pregnant. If women choose to give birth in hospital then I attend her home when she is in labour and we mutually decide when the best time to head to hospital is and I accompany her and act as a birth supporter and advocate once she is in the hospital.
Continuity of care is not only beneficial to the pregnant woman but it actually makes my job much easier when caring for that woman during labour. I don’t need to spend time looking through her notes to find out information about her or to ask her endless questions during a time when all she should be doing is concentrating on having a baby. The main benefit though I think is during the postnatal period. When I have attended the birth of that baby it is so much easier to make assessments of the baby’s wellbeing when I am then the midwife visiting that mother and baby daily. Conditions such as jaundice are easier to monitor when subtle changes in baby’s skin colour are a very subjective measurement. I also visit for 28 days postnatally (more commonly 10 days in the NHS). I have found that many of the common problems postnatally, particularly with breastfeeding, do not materialise until after the first couple of weeks and this is often a time when I find that more support is needed.
My one dislike of working independently is the need to charge women money for a service which I believe should be free. The Independent Midwives Association is currently campaigning for all women to have access to independent midwifery care. More information is available at www.saveindependentmidwifery.org. Something I do to give something to ALL women and not just the women who pay for my services is help out in running two support groups. The Birth Resource Centre in Edinburgh runs a monthly homebirth support group for parents thinking about or planning a homebirth on the first Sunday of every month. I attended the group as a pregnant mum and have continued to attend to help answer any questions of prospective homebirthers.
Earlier this year I also got together with another independent midwife, Jenny, a mum of 3, Rachael and student midwife Kim to set up a group for pregnant women/parents, other health professionals and basically anyone who was involved in working with pregnant women and families. We wanted to provide a forum for pregnant women/parents to ask questions in an unhurried environment and find out information in order to make decisions about their care or the care of their baby/child and also to gain support from others who had possibly been through similar situations. Choices for Childbirth has been running in Portobello for seven months now and is providing very popular with mums/couples attending from all over the Lothians. We have a set topic each month where we will cover subjects such as waterbirth, place of birth, pain coping strategies and sometimes have a guest speaker. The second half of the meeting is always devoted to general chat/questions.
Given the huge variances I have described in the two different midwifery jobs I have done many of you may be wondering why not every midwife would want to work in that way. Well that is another article in itself…..