How I work: common questions
How do you differ from an NHS midwife?
''An independent midwife is a midwife who has chosen to work outside the NHS in order to maximise to the fullest extent the skills, knowledge and autonomy that her expert role allows.''(EO-H)
I carry a mostly self-referred, mixed-risk client caseload. My clinical work takes place in the privacy of my clients' homes. Home is the place where we rest and recuperate after interacting with the world - where we get to re-group with our nearest and dearest. It's the place where we can truly be ourselves without having to question what others will think of us. It's therefore the perfect place to get to know each other in a way that prioritises mutual trust, active listening, discussion and information exchange. My approach is unhurried and non-clock watching.
After months of antenatal care, when labour finally begins, the established sense of safety and familiarity will have imprinted the birthing experience in ways that are clearly beneficial to all concerned. There begins the postnatal experience, an incredible journey where women and their partners exchange a known self in a known world, for an unknown self in an unknown world .
The NMC (Nursing and Midwifery Council) stipulate approximately seventy non-negotiable rules and standards that constitute our Code of Conduct to which I formally renew my commitment annually. Working in the way I have described means that I can fully adhere to the Code and reflexively respond to the needs of the mother-baby dyad and the unique needs of the family as a whole, without the adage of budget-led, insurance-driven policies and guidelines.
My approach is deontological as opposed to utilitarian. As a midwife and a trainee psychotherapist (Family / Systemic), I regard clients as being unique individuals with unique needs, who have unique outcomes. When I think of a client, I think of her in relation to her baby, her partner and other children they may have. I welcome as much of the partner's involvement as possible. Furthermore, I'm always happy to meet any other family members, i.e. parents, siblings and other relevant people such as best friends, neighbours, and so on.
Do your clients only have homebirths?
No, but most do. Clients choose to give birth where they feel most comfortable. If you're interested in homebirth, then you probably already have a good idea of it's benefits. However my aim is not to persuade you to choose homebirth or for that matter a hospital birth. Whatever thoughts and feelings you have about where and how you would like to give birth, my aim is to listen carefully and respond with information to stimulate further discussion. It is important you feel supported and empowered to make informed decisions in relation to all of your options.
What medical benefits are there to having an independent midwife?
Research shows that having the support of your chosen midwife for your birth means you have increased likelihood of achieving the birth you want. Benefits include lower rates of caesarean section and other forms of intervention - for example, medical induction, vacuum and forceps births. Choosing your midwife and having continuity of care is also associated with better breastfeeding rates and lower rates of post-natal depression.
Can you tell me about autonomy and informed choice?
It is a woman’s inalienable right to birth her baby where she chooses and it's a midwife's duty to ensure that the woman has been provided with the best evidence regarding her choices. A midwife or doctor cannot decide whether a woman can or cannot have a homebirth. It is her choice alone. A midwife is responsible for making all necessary arrangements to safely attend a client in the place of her choice.
The Nursing and Midwifery Council (NMC) offers guidance for midwives about homebirth stating that midwives should support diversity of women's informed choice. They add that if there is a problem in doing so, midwives must enhance their skills in appropriate ways to meet the needs of the public. Furthermore the NMC suggest that the lack of a homebirth service affects women just as much as denying them a hospital birth service.
Conclusions to recent UK homebirth studies brought forth the statement: "The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support homebirth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications as it confers considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with long-term implications for her health and that of her baby."
Can I change my mind or is my decision about place of birth ''set in stone''?
It may be a relief to know that the any decision you make antenatally regarding place of birth are not set in stone. Making plans around birth during the antenatal period is intrinsic to the psychological process of exploring barriers that may influence your ability to labour, free from anxiety. However I inform clients antenatally that even as labour progresses, preferences can change. For example, planned waterbirths may be abandoned in preference to giving birth in the conservatory with the smell of geraniums or a considered hospital birth may end up seeming completely ludicrous when it becomes obvious that home is the only place to be.
During labour should you need or wish to transfer to hospital, I will swiftly organise this. In hospital I will continue to provide continuity of care by building a positive relationship with the NHS clinicians. I will act as your advocate birth-attendant to help you feel positive in the clinical setting. Without an honorary hospital contract I cannot care for you clinically, but can enhance the your levels of by ensuring your birth wishes are known by the NHS staff and adhered to as much as possible.
I am very comfortable in hospitals (having recently finished a positive 3 month, full time stint in a NW London Hospital). Hospital birth is sometimes the best for a mother and her baby and fortunately we live in a country where our already wonderful obstetric care is forever improving.
What are your favourite things about being an independent midwife?
(in no particular order)
How do you differ from an NHS midwife?
''An independent midwife is a midwife who has chosen to work outside the NHS in order to maximise to the fullest extent the skills, knowledge and autonomy that her expert role allows.''(EO-H)
I carry a mostly self-referred, mixed-risk client caseload. My clinical work takes place in the privacy of my clients' homes. Home is the place where we rest and recuperate after interacting with the world - where we get to re-group with our nearest and dearest. It's the place where we can truly be ourselves without having to question what others will think of us. It's therefore the perfect place to get to know each other in a way that prioritises mutual trust, active listening, discussion and information exchange. My approach is unhurried and non-clock watching.
After months of antenatal care, when labour finally begins, the established sense of safety and familiarity will have imprinted the birthing experience in ways that are clearly beneficial to all concerned. There begins the postnatal experience, an incredible journey where women and their partners exchange a known self in a known world, for an unknown self in an unknown world .
The NMC (Nursing and Midwifery Council) stipulate approximately seventy non-negotiable rules and standards that constitute our Code of Conduct to which I formally renew my commitment annually. Working in the way I have described means that I can fully adhere to the Code and reflexively respond to the needs of the mother-baby dyad and the unique needs of the family as a whole, without the adage of budget-led, insurance-driven policies and guidelines.
My approach is deontological as opposed to utilitarian. As a midwife and a trainee psychotherapist (Family / Systemic), I regard clients as being unique individuals with unique needs, who have unique outcomes. When I think of a client, I think of her in relation to her baby, her partner and other children they may have. I welcome as much of the partner's involvement as possible. Furthermore, I'm always happy to meet any other family members, i.e. parents, siblings and other relevant people such as best friends, neighbours, and so on.
Do your clients only have homebirths?
No, but most do. Clients choose to give birth where they feel most comfortable. If you're interested in homebirth, then you probably already have a good idea of it's benefits. However my aim is not to persuade you to choose homebirth or for that matter a hospital birth. Whatever thoughts and feelings you have about where and how you would like to give birth, my aim is to listen carefully and respond with information to stimulate further discussion. It is important you feel supported and empowered to make informed decisions in relation to all of your options.
What medical benefits are there to having an independent midwife?
Research shows that having the support of your chosen midwife for your birth means you have increased likelihood of achieving the birth you want. Benefits include lower rates of caesarean section and other forms of intervention - for example, medical induction, vacuum and forceps births. Choosing your midwife and having continuity of care is also associated with better breastfeeding rates and lower rates of post-natal depression.
Can you tell me about autonomy and informed choice?
It is a woman’s inalienable right to birth her baby where she chooses and it's a midwife's duty to ensure that the woman has been provided with the best evidence regarding her choices. A midwife or doctor cannot decide whether a woman can or cannot have a homebirth. It is her choice alone. A midwife is responsible for making all necessary arrangements to safely attend a client in the place of her choice.
The Nursing and Midwifery Council (NMC) offers guidance for midwives about homebirth stating that midwives should support diversity of women's informed choice. They add that if there is a problem in doing so, midwives must enhance their skills in appropriate ways to meet the needs of the public. Furthermore the NMC suggest that the lack of a homebirth service affects women just as much as denying them a hospital birth service.
Conclusions to recent UK homebirth studies brought forth the statement: "The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support homebirth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications as it confers considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with long-term implications for her health and that of her baby."
Can I change my mind or is my decision about place of birth ''set in stone''?
It may be a relief to know that the any decision you make antenatally regarding place of birth are not set in stone. Making plans around birth during the antenatal period is intrinsic to the psychological process of exploring barriers that may influence your ability to labour, free from anxiety. However I inform clients antenatally that even as labour progresses, preferences can change. For example, planned waterbirths may be abandoned in preference to giving birth in the conservatory with the smell of geraniums or a considered hospital birth may end up seeming completely ludicrous when it becomes obvious that home is the only place to be.
During labour should you need or wish to transfer to hospital, I will swiftly organise this. In hospital I will continue to provide continuity of care by building a positive relationship with the NHS clinicians. I will act as your advocate birth-attendant to help you feel positive in the clinical setting. Without an honorary hospital contract I cannot care for you clinically, but can enhance the your levels of by ensuring your birth wishes are known by the NHS staff and adhered to as much as possible.
I am very comfortable in hospitals (having recently finished a positive 3 month, full time stint in a NW London Hospital). Hospital birth is sometimes the best for a mother and her baby and fortunately we live in a country where our already wonderful obstetric care is forever improving.
What are your favourite things about being an independent midwife?
(in no particular order)
- Working in a professional field that fully engages my personal ethics and values
- Providing continuity of care to my clients
- Getting to know my clients and their families very well indeed
- The high degree of mutual autonomy (client-midwife)
- Noticing how families develop and positively change as an effect of the childbearing process
- Facilitating babies to enter into the world as safely as possible and welcoming them warmly
- The social and geographical variety that my work allows
- Drinking herb tea or fine coffee, while having very interesting discussions; and playing with my favourite animals