Independent Midwives are fully qualified midwives who, in order to practice the midwife’s role to its fullest extent, have chosen to work outside the NHS in a self employed capacity, although we support its aims and ideals. The midwife’s role encompasses the care of women during pregnancy, birth and afterwards. www.independentmidwives.org.uk

What is your business model?

We are a collective of freelance midwives, working independently of (but
co-operatively alongside) the NHS. We believe that the NHS is precious and
should not be privatised, and we aim to protect and promote caseloading
and evidence-based women-centred midwifery in a way that we hope will be
part of a well-funded, well-staffed NHS in the future.

Working independently may mean we earn less and are on call more than our
NHS colleagues, but it gives us the freedom to be the best midwives we can
be, providing continuity of carer and a known and trusted presence before,
during and after birth.

Currently, we are self-employed midwives working collaboratively, but
ethically are most attracted to the social enterprise business model.

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2018 – can you definitely still attend home births currently?

Independent midwives based in Yorkshire are very lucky in that we continue to work in partnership with Airedale Trust (as per the March 2017 announcement below) to attend any birthing woman who wishes to book with us. You can book with us in confidence. Read Francesca’s birth story for feedback on this unique partnership.

Dec 2019: Currently Debs and Sharyn are on Airedale’s staff bank and covered by the below arrangement for birth attendance. Chris has just returned to the NMC midwifery register so we are looking into getting her indemnified for birth attendance again; all three of us are covered for our antenatal and postnatal work through our Royal College of Nurses membership.

Hundreds of UK Women prevented from accessing birth care from their known and trusted midwives

On January 11 2017, in an unprecedented situation by the Nursing and Midwifery Council, all the UK’s independent midwives were stopped from using their negligence cover indemnity package (despite it being designed especially for them, and approved by actuaries).  See the press release here from the Independent Midwives UK Network, and “Birthrights Criticises NMC for Independent Midwives decision.”

With the passionate backing of many, many affected birthing women, some of the affected IMs took the NMC to a judicial review as a result. We were stunned to have the judge find against the IMs; you can read more here. Independent midwives and birthing women around the UK are currently regrouping and considering what options are available to them. A handful of Trusts in the UK have taken the local IMs onto their bank staff as per our local arrangement below, but they are in the minority. and the vast majority of women in the UK still CANNOT access the care of the independent midwife for their births.


March 8 2017: Airedale NHS Head of Midwifery Mary Armitage, Deputy Head of Midwifery Sarah Simpson, and the independent midwives based in Yorkshire, are delighted to announce a plan that will not only support women in their region to continue to access their booked midwives for birthcare during the current NMC/indemnity-related discussion, but also aims to have a much wider benefit.

Airedale Trust is welcoming the independent midwives to apply to join their midwifery bank, and together look forward to supporting normal birth and woman centred care through discussion, skill-sharing, and cooperative working between the Trust’s midwives and the IMs, and exploring the possibilities of supporting the personalisation agenda in line with the Better Births report.

After a series of meetings with Trusts in the regions who offered sympathy for the women affected by the NMC’s ban on independent midwives using their bespoke indemnity package, but felt unable to offer any arrangement enabling those women to birth with their booked midwives, Airedale’s choice to see the current difficulties as an opportunity for teamwork feels both visionary and a victory for common sense.

The Royal College of Midwives, Birthrights, AIMS, Birthplace Matters, and many other organisations have been encouraging Trusts to act to protect the birth plans of the often vulnerable women affected by the NMC’s ruling, in just this way, and Airedale NHS should be congratulated for the example they have set to other Trusts. Yorkshire independent midwives feel this partnership has lots of exciting possibilities for Yorkshire women and midwives in the future.

If you feel like sending messages of appreciation to the Airedale folks who made this happen, feel free!  Sarah Simpson is on Sarah.Simpson@anhst.nhs.uk.


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They’ve said I’m “high risk”, will you still take me on?

If you’ve booked for NHS care, there will be a lot of tickboxing regarding ‘risk factors’ during the booking process. Sometimes that leads to a ‘high risk’ label and may initiate certain pathways of care in theory. Those pathways are for you to either opt out of, or to opt into, entirely your choice. We regularly care for women who have been given a “high risk” label, and support them to access whatever pathways they feel are best for themselves and their baby.

Another reason for trying to use those tickboxes to determine your general chance of encountering certain complexities in your pregnancy/birth/postnatal period, is one that is rarely explained to woman:

NHS trusts are allocated certain tariffs for every woman during episodes of maternity care.

There is an antenatal tariff, a birth tariff and a postnatal tariff.

Different ‘risk profiles’ trigger different amounts of tariff for those episodes of care. A ‘higher risk profile’ triggers a higher tariff amount. This means that if you, simply by looking at your general circumstances seem to have higher chance of certain complexities which MAY require extra care, the NHS Trust gets to claim the higher tariff.

In the current climate of a struggling and underfunded NHS maternity provision, it makes sense for individual trusts to claim as high a tariff as possible for each individual woman, which sets the motivation for ticking as many ‘high risk’ boxes as possible very high, understandably. Independent midwives charge the same fee regardless of added complexities, so this does not apply to us.

We have found that knowing that it is a matter of claiming adequate financial compensation for care makes it much easier to understand why at booking many women are labeled as ‘high risk’ or ‘consultant led’ or referred for a certain pathway of care…..it also takes away some of the pessimism women often feel after booking.

Whether or not your individual circumstances make you more likely to have a somewhat more complex pregnancy is something much more suited for meaningful discussion with your care providers (and we will have ample time and resources for that), rather than something that can be determined by the filling of a form.

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Why choose to book with Independent Midwives?

Independent Midwives are fully qualified midwives who, in order to practice the midwife’s role to its fullest extent, have chosen to work outside the NHS in a self employed capacity, although we support its aims and ideals. The midwife’s role encompasses the care of women during pregnancy, birth and afterwards. www.independentmidwives.org.uk

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How do I know you are bonafide midwives?

Only a registered midwife can use this title. You can confirm we have valid registration by contacting the Nursing and Midwifery Council.

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Is birth at home really safe?

Yes. Research shows that birth at home for most women is as safe, if not safer, than hospital birth.

AIMS have got good evidence based literature on homebirth safety, www.aims.org.uk and www.homebirth.org.uk has got a wealth of information on homebirth to help you with your decision about place of birth.

The government has been pushing homebirth in its new Maternity Matters Policy. This at last gives guidance about choices and documents that home birth is a valid and safe choice for women.

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What if things go wrong?

If your pregnancy, labour or postnatal period don’t go to plan or problems develop, we refer you to an appropriate care provider of your choice but will stay involved with your care. If you need or want to go to hospital for your birth, we will accompany you, or meet you there and stay with you as a support person and advocate until your baby is born and you have had a chance to cuddle and feed.

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What emergency equipment do you carry?

Independent Midwives carry all the necessary emergency equipment to ensure that if a baby is born needing resuscitation, this can be performed. All midwives are trained in emergency resuscitation. Independent Midwives also carry emergency drugs in case a woman is bleeding heavily. We update ourselves on a yearly basis in emergency neonatal resuscitation and many of us have attended emergency skills workshops tailored for independent midwives attending homebirths.

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How messy are home births?

Generally not very messy at all. It does vary, and a little blood in a couple of pints of amniotic fluid can look rather gory but an old towel on plastic sheeting will minimise the spread and protect your flooring. Birthing pools are an extremely good way of containing any mess and are relatively inexpensive. We provide some padded mini sheets, but it does make sense to protect any expensive carpets or Kashmir rugs! In the general run of things babies create more mess than the birth.

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Am I allowed to have just a midwife?

Yes. Your midwife can provide all your maternity care, antenatally, during the birth and postnatally. We are specialists in caring for women having normal pregnancies and births and provide care up to 6 weeks afterwards.

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Do I have to see a doctor?

No. As long and everything is straightforward, doctors do not need to be involved. Where appropriate, we will refer you to the right care provider of your choice; eg a physiotherapist, obstetrician, anaesthetist or osteopath.

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Can I still receive NHS care if I book with an IM?

Yes. You are fully entitled to all the blood tests and scans under the NHS. You are having independent MIDWIFERY care and this does not exclude you from NHS treatment. It is similar to being told you cannot have NHS care if you see an osteopath

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Can I still see my NHS midwife?

It is possible for you to share care with your NHS midwife if you wish. Sometimes especially if you live a long distance away from us it is very helpful to have a local care provider for you to access. We do however occasionally find that conflicting advice and information can become an issue.

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Can I still have care from my GP?

Yes you can, but not many GP’s enjoy maternity care and very few will be happy to support alternative birthing practices as they are not used to them. Those special GPs who are involved in maternity care are unique and we love to have them on board and are very happy for you to see as much of them as you want. If you have a medical condition managed by your GP, we will work with them to ensure you receive the best care for you.

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How many midwives will I meet?

There are four of us in our team, and our model of care means you will have plenty of time to get to know us all (especially if you have biscuits!) and us to get to know you, your family and your wishes. Our visits are mainly on weekdays/office hours but we’ll fit in some weekend/evening ones if that’s the best way to get to know your partner/family. Sometimes geography may mean you have two main midwives and see them a bit more than the others. If you give permission, student midwives may come along to an AN or PN visit, but we will always ask first. We would not ask for a student to attend your birth, as that is usually not appropriate, but if you feel you’ve made friends with one of the students and feel yourself that would be a positive thing (extra pair of hands for backrubs, tea-making, childminding), you are welcome to invite them along.

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How often do you come?

We have an average schedule of visits but can be very flexible and will see you more if you need it and less if you don’t want to see us so often. We usually visit monthly until 28/30 weeks, every 2 weeks till 36 and weekly until you have your baby. The visits generally last about an hour and give us time to get to know you. This makes it easier to know how best to support you at the birth and after.

Once your baby has arrived, we will visit daily initially and then less frequently, again depending on your needs, tailing off to weekly before we discharge you at around 6 weeks.

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I have been told I can’t have a homebirth by my consultant but still want one, will you take me on?

Independent Midwives support women’s choices. If a woman has made a fully informed choice then in most circumstances we will support you. Many Independent Midwives take on the care of women who are deemed “high risk” for example: women who have had previous caesareans, women with pre-existing medical conditions and women carrying twins to name a few. Your Independent Midwife will discuss all your options with you.

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If I have to have a caesarean do I still have to pay?

Yes. You have booked an Independent Midwife for midwifery care. Sometimes a transfer to hospital will become necessary and your midwife will have been acting properly and within her midwifery rules by detecting a problem and referring appropriately with your consent. There are never any guarantees in labour and birth and your midwife will have still worked many hours with you, been on call for you often for many weeks and supported you.

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As I am booking so late do I have to pay the full amount?

Yes. Your midwife will often have to work harder within a short space of time when a woman books late. There is much behind the scenes work in the life of an Independent Midwife!

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Can my homeopath be at the labour?

We frequently work with complementary therapists and often make referrals. We work holistically and value the work of complementary therapists. You can have whoever you chose to be with you at home but in hospital the number of your attendants is sometimes restricted.

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Who can I have with me during labour?

Anyone you want – you may prefer to labour on your own with just your midwife present or you may want your mother, his mother, your baby’s siblings, a doula, or your sister or friend there. It has been shown that it is helpful to have another woman who has given birth present. Younger siblings are best supported by having an other adult around. Recent analysis of randomised controlled trials have agreed with the findings of much earlier studies that continuous, individualised, and emotional support throughout the labour provides many benefits for mothers and babies (Rosen 2004) (Grandads at the birth story)

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What if I want a water birth?

That’s fine, women generally benefit from labouring and birthing in water. Traditionally water has many uses in labour, e.g. hot water bottles or wrung-out hot towels across your back or under your bump. The use of the water from a shower head on the small of your back will stimulate natural endorphin release and be very relaxing. You can hire a birthing pool or use your own bath for this. Birthing pools provide the freedom to move weightlessly and to more easily change your position, which is especially useful in the pushing stage at the end of labour. We have attended many waterbirths since 1983 and feel that they are a positive experience for mother and baby. Women often feel safe in their own space in a pool. Not all women benefit from emersion in water and for some the full effect of gravity is useful in birthing their baby or babies.

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Can I just pay for a stretch&sweep without booking for care?

This is unlikely to be possible for a couple of reasons (but read on to address your concerns further).

Primarily, we would generally consider that a stretch and sweep is an intervention that wouldn’t be considered appropriate when you are not “overdue” – and then whether you are or not depends on your definition! Recent research suggests that labour may actually be started by the baby’s lungs giving off a “finished” hormone, which suggests that triggering labour before the body does so itself could be innapropriate as the baby may not be “done” yet – normal pregnancy can last approx 37-42 weeks (and longer in some cases). For this reason, we don’t even recommend a sweep when our clients are beyond 40 weeks.

Aside from that, because it is an intervention, in most circumstances we would feel uncomfortable agreeing to do a sweep for someone for whom we had not been clinically caring before this. Because we are autonomous practitioners, not guided by hospital policies as NHS midwives are, we must put a lot of personal thought and study into our care decisions and this includes an overall picture of you and your pregnancy.

However, there is another issue with us doing a stretch and sweep for you: as independent midwives we are only legally indemnified to conduct cervical sweeps for a client if the client has been booked for birth care, so (even if you didn’t then access the birth care) this means the cost for you would be disproprortionately high.

If you are wanting a sweep because you are worried about going “overdue” and then having an induction, then you can ask yourself – is there a good clinical reason why induction has been recommended to me? The NHS tends to offer induction somewhere after 40 weeks gestation, but as NICE guidelines advise, it should simply be an offer, and you are perfectly free to decline and await events as normal (with extra monitoring if you like). NICE estimates that 5-10% of women have pregnancies longer than 42 weeks – for some of us this is simply normal. Induction is not a neutral process and it is fine to look at the pros and cons for yourself.

You are welcome to arrange a one-off consultation with us to discuss this or any other issue about your care choices, even if you are not booked with us for your care. You can also ask for a free appointment with a Supervisor of Midwives at your local NHS Trust. One of their roles is to ensure that women’s individual choices are respected and no-one feels pressured into anything. Read more about them here…

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What if I change my mind after booking with you?

If you change you mind about us providing your midwifery care after booking with us you can “de-book” meaning we stop acting as your midwives and you revert back to a care provider of your choice. We will retain the £500 non-refundable deposit and charge for any care given as we may have had to turn other clients away in to be able to be on-call for your birth.

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