All need not be lost:
Independent Midwives
The Solution
Sarah Joy Jones RM BSc Hons, RGN
Independent Midwife Practitioner, Professional Midwife Advocate
Board member of IMUK (Independent Midwives UK) and Director of With Mother and Child Ltd.
Myth: -
The training and Governance of Independent Midwives are different and therefore poses a potential risk to women and families
Truth:-
This statement has no factual foundation.
Independent Midwives and NHS Midwives are both qualified and regulated clinicians.
The difference is not in training or Governance but in the model of care provided.
Midwives within the NHS have to adhere to standardised care pathways with a set of scheduled appointments to ensure a consistent level of care for all women. Independent Midwives can and do, go above and beyond these pathways and draw on their clinical judgement, expertise and experience. They use wider evidence-based research including recommendations from investigative reports and inquiries. Further, they draw on the information given by women. Having real time to actively listen and respond, providing that level of individualised care and support through the Continuity of Midwife carer relationship.
Independent midwives are truly autonomous practitioners governed by the same professional body the NMC (Nursing and Midwifery Council) and adhere to the same code of conduct.
What is Governance?
How does this apply to Independent Midwives?
Though Independent Midwives have chosen to work outside of the NHS, like any other midwife they are fully registered and accountable for their actions or omissions through Governance to their client, their Professional NMC (Nursing and Midwifery Council) regulator and to themselves.
Accountability
NHS organisations are accountable for continuously improving the quality of their services and safeguard high standards of care by creating an environment in which clinical excellence will flourish- (Department of health NHS England April 2025)
This then also applies to Midwives in independent Practice who are conceivably individual provider units of maternity care.
All Midwives are accountable for continuously improving the quality of services, managing risks and safeguarding high standards of care.
How is Accountability through Governance assured?
All midwives including Independent Midwife Practitioners need to demonstrate to their Professional Regulator the NMC that they are keeping their skills and knowledge up to date and maintaining safe and effective practice.
They must do this through the 3 yearly revalidation process some of which are: -
● Clinical Practice experience:
- 450 practice hours, or 900 hours if renewing two registrations (for example, as both a nurse and midwife)
● Continuing Professional development,
a minimum of 35hrs.
● Peer review, Audit,
Feedback from Women and families that is directly related to the Midwife’s practice.
● Self-audit and analysis,
actively reflect on one’s own practice- many midwives support each other in this and also have access to a Professional Midwife Advocate
Failure to do this will result in registration being revoked and no longer being able to practice as a Midwife. Independent Midwives need to go that extra mile and demonstrate this expertise and high standards essentially to the women and families in their care. Putting women right in the centre and in charge.
What about Training?
All Midwives including Independent Midwives have had to complete rigorous training and then adhere to the NMC (Nursing and Midwifery Council) Governing principles in order to maintain the required level of experience and expertise.
You cannot call yourself a Midwife unless you have met the rigorous standard of training required and continue to maintain that standard.
This is the law- and found in
The Nursing and Midwifery Order 2001
What are the Training Standards? :-
nmc-standards-for-competence-for-registered-midwives.pdf
A short summary: -
At the point of registration
all registered midwives including Independent Midwives will:
• practically apply sound, evidence-based knowledge of facilitating childbirth and caring for the newborn;
• act on their understanding of psychological, social, emotional and spiritual factors that may positively or adversely influence normal physiology, and be competent in applying this in practice;
• use skills in managing obstetric and neonatal emergencies, underpinned by appropriate knowledge;
• be autonomous practitioners and lead carers to women experiencing normal childbirth and being able to support women throughout their pregnancy, labour, birth and postnatal period, in all settings including midwife-led units, birthing centres and the home; and
• be able to make critical decisions to support the appropriate referral of either the woman or baby to other health professionals or agencies when they recognise that normal processes have been adversely affected and compromised.
And Furthermore
‘Midwives optimise normal physiological processes, and support safe physical, psychological, social, cultural and spiritual situations, working to promote positive outcomes and to anticipate and prevent complications’
‘Midwives are ideally placed to anticipate and to recognise any changes that may lead to complications and additional care needs. When such situations arise, the midwife is responsible for recognising these and for immediate response, management, and escalation, involving, collaborating with and referring to interdisciplinary and multiagency colleagues. In such circumstances, the midwife has specific responsibility for continuity and coordination of care, providing ongoing midwifery care as part of the multidisciplinary team, and acting as an advocate to ensure that care always focuses on the needs, views, preferences, and decisions of the woman and the needs of the newborn infant’
There is a very good argument to suggest that having Midwives in a large industrialised system actually prevents them in having the freedom to exercise their full role and potential as defined in legislative statute
‘Putting expectant mothers in hospital at set times for consultant appointments, clinics and induction of labour, gives the hospital system control over them, rather than allowing for the healthy physiological process itself to be in control.’(Margaret Jowitt 2018)
Far from increasing risk, I would argue that enabling Midwives who choose to practice in a self-employed capacity outside of the NHS system and then being able to refer directly for targeted specialist care as, when and if needed, will significantly improve both psychological and physical safety outcomes for women and families in their care.