Career advice

Life as an independent midwife

The risks involved in being a self-employed midwife outweigh the rewards, according to those who have taken the plunge

For midwives who want to offer greater continuity in the care they provide, one option is to become an independent midwife. Being able to support a woman throughout pregnancy and birth is the main reason they choose to join this small band of professionals, believed to number fewer than 200 in the UK.

Jacqui Tomkins, chair of Independent Midwives UK (IMUK) and partner at the London Birth Practice, left the NHS 15 years ago because she found that she was not able to offer the kind of care she wanted to. ‘Continuity of care is important to me,’ says Ms Tomkins, who works with four other midwives at her practice. ‘I want to know the women I look after, build a relationship and see them through the entire pregnancy, birth and up to six weeks after. It’s like becoming a part of their family.’

Independent midwives are usually self-employed and paid directly by the women they care for

Picture credit: Alamy

Most independent midwives are self-employed, although some are employed by private companies and others have set up social enterprises. Some work for the NHS part-time and independently the rest of the time.

Independent midwives are paid directly by the women they care for and are generally chosen by those who want home births. Women may also be drawn to their service for specialist skills, such as vaginal breech birth and twins. However, Ms Tomkins says, independent midwives can also support women who want to give birth in hospital and offer support during labour, although they cannot be the named midwife in charge of the birth.

The average charge is about £4,000, which includes care during pregnancy, labour and up to six weeks post-birth. Midwives can earn up to £60,000 a year, or much less, depending on their caseload.

While midwives can choose to become an independent straight from their midwifery degree, and no extra training or exams are necessary, some experience can be useful.

Royal College of Midwives head of education and learning Carmel Lloyd says: ‘The majority of midwives spend a year or two on a maternity unit to get a bit more confidence and experience and become familiar with how maternity units work. For those working as an independent, most births will be at home, but some will need to be transferred to hospital, so it is good that independent midwives know how systems work.’

There are challenges when it comes to working independently. Good links are needed with other local independent midwives to provide cover when they are away or on holiday, which can be difficult in rural areas. Ms Lloyd says independent midwives tend to be mainly found around London and the home counties – there are only one or two in Wales and Scotland.

Careful planning is needed by midwives to manage their caseload, as they are generally on call.

All self-employed midwives must have indemnity insurance to practise. Changes in 2014, driven by a reform to a EU directive, caused major concern about the future of independent midwifery because there was no such insurance available at that time. Almost 80 full members of IMUK now have access to an insurance provider who will provide the level of cover needed.

It can also be difficult for women with their own young children, Ms Tomkins says. ‘You may miss something important in your family’s life occasionally and you must have a supportive family. If your partner or children are going to be traumatised by you being unavailable for chunks of time or issues with childcare, then you cannot do it. You need a support network around you.’

Independent midwives offer continuity of care to pregnant women.

They can choose and manage their workload by deciding how many women to take on their caseload.

£4,000 is the average charge for a using an independent midwife.

The earnings of an independent midwife can be up to £60,000 per year.

Income can be less reliable than for NHS employed staff and independent midwives must pay for expensive indemnity insurance.

The Royal College of Midwives reports that maternity services in the UK are overstretched. The college says that 2,600 extra full-time midwives are needed in England.

There are increasing numbers of complicated births due to higher numbers of obese pregnant women, multiple births and older first-time mothers.

‘I love the freedom and working as an autonomous clinician’

– Elsie Gayle

Elsie Gayle left the NHS after feeling that the maternity system was failing pregnant women, particularly those who are not white. She now works as an independent midwife in the West Midlands, and has a zero hours contract with a private birthing centre to support women through labour.

‘I love my work – the freedom, the excitement, the miracle, working fully to midwifery rules and code of practice as an autonomous clinician, and helping women,’ she says. ‘But I have had to find other means of supporting myself. We are in a period of austerity so it is hard for women to pay.'

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