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February 24, 2016

National Maternity Review: Q&A with Jacqui Tomkins

The NHS England commissioned National Maternity Review has published its recommendations as to how maternity services should change over the next five years.   Independent midwife and IMUK Chair Jacqui Tomkins explains what they could mean for independent midwives and the women they care for.


There’s been a predictably mixed reaction to the recommendations of the review. Based on your own conversations with birthing women, is this what they’ve been asking for?

I think this is good news for women who are looking for some level of control over their care provider within the healthcare system. It’s important that women who want to choose have the ability to do so whilst being supported by skilled healthcare professionals and the infrastructure itself. Independent midwives care for a lot of women who don’t feel they’ve been given choices or that there wasn’t the infrastructure to support them as a result, many of them describe their experience as traumatic. I’d echo the thoughts of Birthrights who’ve pointed out that many of today’s recommendations are rights women should already enjoy. Women should already be choosing where to give birth for instance, based on long-standing Department of Health policy.

“It could be that this kind of access would require independent midwives to work in a completely different way to the way in which they work now”.

The review states that independent midwifery could be included as part of a wider range of providers a woman will be able to choose from. Is that the case?

We define an independent midwife as being a self-employed midwife and in terms of our own self-employed members it is too early to say whether or not it will be possible for women to access their care under the proposed scheme.   It could be that this kind of access would require independent midwives to work in a completely different way to the way in which they work now (the report states for example  that accredited practitioners would need to be similarly set up to GP practices, which is currently not the case). There are also issues around governance and guidelines which are highly complex in relation to independent midwifery. We are sought out by women because as we already offer the kind of care being recommended in the report and because our members prioritise the evidence in combination with individualised care.  It is a priority for us and the women we care for to continue to work in this way. It’s possible that some of our members would seek the NHS accreditation they’d need to be included as an option in the scheme but it’s complex.  In the meantime we are working to create a fund for women meeting certain criteria to access our care when costs make it prohibitive.

“We’ve been supporting women with complex circumstances to make choices for a long time now. Continuity of carer and an individualised approach are vital for these women in particular. It is our great hope that these women will have a voice in this process”.

Many women cared for by independent midwives would be given a ’high-risk’ label within an NHS setting. How do today’s recommendations work for women with more complex circumstances?

The report states that “NHS England will work with CCGs to work out how best women with complex pregnancies can be supported to make choices”. It isn’t clear whether or not women labelled ‘high-risk’ by the system will be eligible for the pilots that will happen this year. We’ve been supporting women with complex circumstances to make choices for a long time now. Continuity of carer and an individualised approach are vital for these women in particular. It is our great hope that these women will have a voice in this process and we’re available to support the review in any way that we can with our own experience of care.

“The majority of our clients are coming to us because of a previous traumatic experience and/or are requiring specialist skills that the NHS cannot provide. That still may be the case with the maternity voucher scheme.”

Why are the recommendations so key for ‘high risk’ women?
If women with more complex circumstances could access continuity of carer in particular, we’d see a decline in the rate of C-section and managed births, together with their associated risks. How women (and these women in particular) are cared for during their pregnancy, labour and beyond affects birthing outcomes. The evidence shows continuity of carer is the safest care and it brings a level of trust, understanding and knowledge that just isn’t possible within a fragmented system. The emotional support and trust and one to one relationship brings is crucial for maternity care to be optimum. Choice and safety are completely intertwined here and in many other cases.

“Supporting a woman through her pregnancy, labour and beyond with clinical excellence and emotional understanding, this level of care saves lives.  If we can achieve continuity of carer for all women with this scheme then we’ll have taken a huge step forward.”

Is there any concern that the voucher scheme will impact on the viability of independent midwifery businesses if they are not included as an option within the proposed scheme?
I don’t think this will impact on our caseload. The majority of our clients are coming to us because of a previous traumatic experience and/or are requiring specialist skills that the NHS cannot provide. That still may be the case with the maternity voucher scheme.

 

In your view, where will the review have most impact?
If we can achieve continuity of carer for all women with this scheme then we’ll have taken a huge step forward.  Supporting a woman through her pregnancy, labour and beyond with clinical excellence and emotional understanding, this level of care saves lives.

The NHS England commissioned National Maternity Review has published its recommendations as to how maternity services should change over the next five years.   Independent midwife and IMUK Chair Jacqui Tomkins explains what they could mean for independent midwives and the women they care for. There’s been a predictably mixed reaction to the recommendations of the […]

 
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