Sarah Fitzsimmons
Independent Midwife, Independent Midwifery Coach and Midwife Birth Advocate www.myindependentmidwife.co.uk
@midwiveshub @myindependentmidwifeltd
Summary
An independent midwife (IM) is a qualified and registered midwife who works independently, providing antenatal, birth, and postnatal care. As self-employed professionals, they maintain small caseloads, allowing families to build a trusting relationship with the same midwife throughout their care. IMs focus on holistic health, with appointments typically lasting 1-2 hours in the client’s home. Independent midwives coordinate with the NHS, allowing clients to access all NHS maternity care while receiving personalized care from their chosen IM. IMs work under professional indemnity insurance to ensure legal practice. Independent midwifery embodies this continuity of care model. The latest data suggests that families with independent midwives have high rates of vaginal and home births, with a low emergency caesarean section rate. However, there are limitations, as IMs generally cannot provide clinical care in a hospital setting, and their services come with a financial cost, typically ranging from £1500 to £8000. A real-life story highlights the positive impact of independent midwifery on mental health and the overall birthing experience. The individual found empowerment, support, and a personalized approach, leading to a positive birth experience and improved well-being.
What is an independent midwife?
An independent midwife (IM) is a fully qualified, registered Midwife that families book to provide some or all of their antenatal, birth and postnatal care. As self-employed, they have small caseloads and abundant time to spend with the families they support. An IM provides continuity of carer. Continuity of carer means having the same midwife throughout all the elements of care you choose to book them for. This allows you to build a professional, trusting relationship with your midwife. Typically, appointments are 1-2 hours long, conducted in your home, with a holistic focus on your physical, mental and emotional health.
If you work with an independent midwife, you are also entitled to access all of your NHS maternity care. Your IM will be a care coordinator, liaising with NHS services on your behalf, attending any scans or appointments you wish them to, and updating your local trust on any significant changes to your or your baby’s wellbeing. Some families choose not to engage with NHS services routinely, and your IM will work within your preferred boundaries.
Independent midwives work under professional indemnity insurance. This insurance must be provided to each gestational parent individually, and your IM is responsible for arranging this for you on your behalf. It is illegal for any midwife to practice without indemnity insurance.
Each independent midwife has their own specialism; for those providing birth support, this is typically expertise in physiological labour and birth – for this reason, many families choose an independent midwife to support them through home birth. However, an independent midwife can prepare and support you in various ways through all modes of birth.
Some independent midwives specialise in antenatal and postnatal support, induction of labour, planned caesareans, infant feeding and many more areas. Some independent midwives have niche skills such as breech or twin birth. Therefore, discussing your specific health circumstances with your independent midwife to ensure their skill set complements your individual health circumstances is important.
The Evidence around Continuity of Carer and the impact of Independent Midwifery
Continuity of carer occurs when a family is cared for by a very small number of midwives – typically between 1 to 6 – who know the women and family and can provide continuity throughout the pregnancy, birth and postnatally.
A review of over 17,000 women receiving continuity of carer1 demonstrated that they were less likely to:
- Have a pre-term birth
- Have a stillbirth
- Be induced
- Require an epidural
- Have an episiotomy
- Have an instrumental birth
- Have a cot death
Equally, safety is not just about whether their baby lives or dies; safety for childbearing women and their partners and families also means emotional, psychological, and social safety. This holistic sense of safety is what they receive through continuity of care2
Continuity improves safety, clinical outcomes, as well as a better experience overall3
Independent Midwifery is a pure continuity of care model, with one midwife providing almost all of your midwifery care and support needs.
The latest data4 demonstrates that families who have an independent midwife at their birth have a:
- Vaginal birth rate of 93%
- Homebirth rate of 70%
- Emergency c/s birth rate of 3%
Limitations of an Independent Midwife
- There are two main limitations to Independent Midwifery care:
- An Independent Midwife, generally, cannot provide clinical care in a hospital setting as the trust does not employ them. Occasionally, IMs may have an honorary contract with individual trusts that facilitates clinical care, but on the whole, the role of an IM in a hospital remains that of a birth partner, advocate and advisor throughout your care in a hospital.
- Working with an Independent Midwife has a financial cost. As an individual family contracts IMs, families pay the IM for their time, expertise, experience, knowledge, time on-call and access to them throughout their pregnancy and postnatal period.
How much does an Independent Midwife cost?
Full care, including antenatal, birth and postnatal care, typically costs between £7000-£8000. Many IMs offer smaller care package options beginning from £1500 upwards.
Real-life story: Reflections on care from an independent midwife
“I really struggled after the birth of my first; not only did I feel completely ignored and lost during the birth, but my mental health plummeted for weeks afterwards, so much so that, when I found out I was pregnant again, I refused to talk about the birth and had a complete mental block. When at my 28-week NHS appointment, I was told my notes had been lost, and despite showing symptoms of a severe water infection, I couldn’t be seen again until I was 36 weeks, I knew I had to take matters into my own hands – in stepped the independent midwife. Two days later, I sat at home with my independent midwife and finally felt listened to and like someone understood. Over the next few appointments, I went from dreading the birth to genuinely feeling excited and empowered. Even when things became more complex with my GBS positive result, my midwife jumped into action to give me every possible option and to make sure the birth was going to be exactly on my terms and how I wanted. I felt informed, supported and listened to throughout. When it finally came to it, Arthur’s birth was incredible. Everything I could have hoped for and more; it was such an amazing experience, and that is wholly down to my IM. I wish I had found them when I was pregnant with George. I’ve sat here three days post-partum feeling the happiest I’ve ever felt with a lovely settled baby and haven’t had to set foot in a hospital. Even Mike turned to me this morning and said, “ahh, so this is what it is supposed to be like?” You can’t put a price on your mental health, but these guys have done so much more than that. They’ve given me confidence in my instincts, and I’ve made good friends along the way. Mike and I feel Arthur has completed our family, but should that ever change and we get pregnant again, an independent midwife is the first person I am calling”.
Links to other resources
Books
Books Podcasts
PodcastsThe Better Birth Podcast | Independent Midwifery with Debs Neiger
The Neurodivergent Birth Podcast | An Independent Midwife’s Perspective with Sarah Fitzsimmons
Articles
ArticlesAll4Maternity ‘Independent Midwifery is back!’ by Sarah Fitzsimmons
Why Choose an Independent Midwife?
Social Media
Social Media@midwiveshub
@myindependentmidwifeltd
Websites
WebsitesReferences
Please use the latest/most notable references for this topic. Use AMA numerical referencing. Guide at end.
- Yao A. Distribution of blood between infant and placenta after birth. The Lancet. 1969;294(7626):871-873. doi:10.1016/s0140-6736(69)92328-9
- WHO. Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants. World Health Organization. https://www.who.int/elena/titles/cord_clamping/en/. Published 2014. Accessed April 5, 2020.
- McDonald S, Middleton P, Dowswell T, Morris P. Effect of the timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews. 2013. doi:10.1002/14651858.cd004074.pub3
