Choosing an independent midwife

Independent midwives are fully qualified midwives who have chosen to work outside the NHS in a self-employed capacity. This article covers: where independent midwives work; how they operate; issues to consider; and receiving NHS care alongside private midwifery.

The legal role of a midwife encompasses the care of women and babies during pregnancy, birth and the early weeks of motherhood. Usually one independent midwife gives care to a woman and her family throughout a pregnancy. Having established a trusting relationship, the same midwife cares for the woman as she births her baby and supports the family afterwards.

Research has shown that many women want this type of midwifery care and that it helps women to cope with the challenges of labour and the transition to parenthood.

Where do independent midwives work?

The majority of births attended by independent midwives are home births, but they can also be present at planned hospital births. There are also a small number of independent midwifery services in the UK with their own birth centres.

How do independent midwives operate?

Independent midwives have more freedom to practise individualised care compared to those working within the NHS, who may be restricted by guidelines and protocols. Independent midwives are still regulated by the Nursing and Midwifery Council. They are subject to the same supervision as NHS midwives, are required to keep up to date with their practice and are only allowed to act within their sphere of competence as midwives. There are currently approximately 150 independent midwives in the UK. They often work in partnerships or have close connections with other independent midwives, enabling them to provide seamless care to the women who use their services.

Independent midwives form relationships of trust with pregnant women, which then help women to feel safe and supported when they go into labour. Many independent midwives have become very experienced in areas of childbirth that within the NHS are usually dealt with by obstetric management. These include:

• breech birth
• twins
• vaginal birth after caesarean (VBAC).

You can book an independent midwife at any stage during your pregnancy, no matter how close you are to your due date. Some will give free consultations to women who are considering all their birthing options.

What issues should I consider when booking an independent midwife?

Before you decide to book a birth with an independent midwife, there are several issues you may wish to consider. You can also find out more information about them, including those working in your local area, from Independent Midwives UK.

Independent midwives do charge for their services. The amount will depend on where you live and the type of service they provide. You can book their care for the postnatal period too. Most independent midwives will accept payment in instalments.

Most independent midwives attend births at home, or occasionally in private birth centres. If you are planning a hospital birth or need to be transferred to hospital, you will need to consider the role of your midwife. Very few, if any, hospitals will give 'honorary contracts' because of the insurance issue. If you transfer to hospital with your midwife, you will be attended by a hospital midwife, and the independent midwife can remain with you, but only as a birth companion or advocate.

Can I still receive NHS care if I book with an independent midwife?

You can receive NHS care combined with that of an independent midwife. The Department of Health has made it clear that women who choose to have their midwifery care provided by an independent midwife are not opting out of the NHS. You are fully entitled to all the blood tests and scans that a woman under full NHS care can have. Should you require any specialist input or emergency care the NHS will provide it. Independent midwives have the same referral rights as NHS midwives and are able to arrange a consultant appointment or hospital admission if required.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.  We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

The former Independent Midwives Association is now Independent Midwives UK. The new organisation is a social enterprise and, with Government support, it is working towards making independent midwifery available to all women who are entitled to NHS maternity care. This will be achieved by contracting their services to Primary Care Trusts (PCTs). Independent Midwives UK continues to provide information about, and support for, independent midwives.