Currently there is no public indemnity insurance available to independent midwives (IMs), which means I am personally liable for any negligence claim made against me. (Midwives employed by the NHS are covered through their Trust’s insurance scheme.)
The Royal College of Midwives (RCM) provided insurance to its independent members until 1993, when the cover was withdrawn as annual premiums began to increase. Since then and until March 2002, a small number of IMs remained insured, paying premiums of around £20,000 annually, the cost of which they passed on to their clients. For most IMs though, the payment of such large premiums was simply untenable with operating a business and charging a realistic price for services and so they continued to practise, without insurance.
Since 1993, the Independent Midwives Association have searched for an alternative and more realistically priced source of insurance, but in March 2002, because of an insurance crisis worldwide, all public indemnity insurance for self employed midwives and some doctors was withdrawn.
Premiums are so expensive because: a) obstetrics is the most litigious area of medicine and b) compensation payouts within obstetrics are the largest within health care, because of the nature of most claims. Unfortunately, midwifery premiums are calculated on the same basis as private obstetricians, even though the midwifery remit and approach within maternity care is very different.
Evidence shows that many people sue hospitals because they received inadequate communication / explanation from caregivers, their care was impersonal and / or procedures were carried out without properly informed consent. Often, patients want a full explanation and an apology for what happened, not necessarily financial compensation. Unfortunately the medical profession often “closes ranks” after a tragedy believing that an apology is an admission of responsibility. This actually makes patients more inclined to sue, as the only available option to seek redress.
My aim is to build a close and trusting relationships with my clients, based on good communication and information exchange and respect for my clients’ rights to make their own choices and decisions about the care they want and receive. I trust that this partnership approach to care will help protect against the types of scenario above.
Should you decide that our care has been negligent in any way, you would need to take us to court to prove this. Should you be able to prove negligence on our part, any compensation offered would be based on our individual worth i.e. the value of our home and earnings. You would probably be advised against pursuing this, since the amounts involved would be relatively small and legal experts may be reluctant to award you much because of the effect on our families. However, if negligence was to be proved, we would also receive disciplinary action via our professional regulatory bodies and if necessary, be struck off the midwifery register.
Within the NHS, cases rarely get to court, because Trusts often settle before this, to save the heavy costs of a legal case. Therefore, it is hard to evaluate how easy it is to actually prove negligence in any case.
You need to think carefully how you would feel, should the outcome of your pregnancy not be as you desired. Unfortunately unexpected tragedies do occur and in most cases, no one is to blame. Even if you felt there was no negligence in the care given by your independent midwives, you might be advised to pursue a negligence case, as currently, it’s the only way to obtain compensation to help you care for a child with special needs. Realistically, for the reasons already given, this is unlikely to be successful, or to result in the amounts of compensation / settlement obtainable from the NHS.
Midwives are required to document carefully everything they say and do; because of the insurance situation, IMs are usually extra careful. We expect to always be conscientious and responsible practitioners and perhaps are particularly vigilant in our practice, because we are (without wishing to be dramatic) ‘laying our lives on the line’ every time we work. However, we choose to work this way because our whole philosophy and attitude to care is based on our belief that our role is to offer well informed, up to date and honest midwifery expertise and advice, to enable and support you in making your own informed choices about care for yourself and baby; and that any decisions affecting your care are made jointly and with consent. Working in this way, should also help protect against negligent practice on our part.
For more information about IMs and insurance, please ask us or contact the Independent Midwives Association at www.independentmidwives.org.uk
R Schwencke RM
S Harley RM