ABOUT

An independent midwife is a self employed health care professional that is qualified to attend women in all aspects of their childbearing journey. Generally she is not attached to any hospital or birth center and has her own indemnity insurance. 

Time, choice and continuity of carer. Hiring an independent midwife allows you to have unrushed appointments where you can discuss all your concerns and truly make an informed choice about your care. Having the same midwife throughout your pregnancy is a luxury that very few experience on the NHS. NHS midwives are tide down by the protocols of the institution they work for, however independent midwives follow the latest evidence and your preferences. 

An NHS midwife works for the NHS, a private midwife works for a company called Private Midwives, an independent midwife works for herself (and her clients), a doula cannot legally give clinical care, and a birth keeper is usually an ex-midwife that still supports women to birth their babies (but cannot give clinical care). 

SERVICES

High quality evidence has shown that for low risk women giving birth at home is as safe as doing it in hospital. Being in a known environment helps release oxytocin and this helps with optimal birth progress. Having a known midwife is another factor that will aid birth physiology. 

Usually we will try to transfer to hospital before an actual emergency, for instance if there are deviations from normal. However, there will generally be two highly trained midwives at the birth that are competent at dealing with emergencies. The paramedics can also assist and even your birth partner can call an ambulance.

Evidence shows that most women transfer to the hospital from a home birth due to slow progress or for pain relief. It is always your choice whether to transfer or not. 

At hospital I will act similarly to a doula by giving you emotional support and helping you make your own decisions. I will not be doing any clinical care (such as vaginal examinations, taking your observations, giving you injections, etc.) as you will be under the care of the NHS. I am not insured to work in the hospital but I am cover by my own insurance so I will not simply stand idle and let the NHS midwives perform unsafe care. I can act in an emergency and I can give clinical care in exemptions.

Absolutely! Should you need it. If you sustain a tear that involves your back passage then we will have to transfer in. This is rare, around 3%.

Unfortunately no. One of the most important parts of preparing for the birth is getting to know the midwife that will attend. Most midwives ask a minimum of 3 to 5 antenatal appointments for the relationship to build. 

The latest is 28 weeks but can be as late as 34 weeks if the missing appointments can be concentrated in a shorter time frame. 

PRICING

Generally midwives in England charge between £6500 and £8000 for a full package of care depending on the area and extra services provided. These packages usually start in the first trimester and cover until one to two months postnatal. Cheaper packages starting at around £4500-£5000 have a reduced number of appointments that are not always ideal if the pregnancy is complex. Bare in mind that you are having someone available to you for 9 months and around 5 weeks of those the midwife is on call for your birth meaning she will drop everything to come to you. These prices also factor in for expenses such as indemnity insurance which at present is around £1500 per client. Mileage is also included and most midwives travel around 1 hour for each appointment at the client´s home. The majority of midwives only opt to take in 2 clients that are due to give birth each month and sometimes the second client spot is taken by being on call for another midwife. This is so there is less chances of clients giving birth on the same day. So, you are paying for much more than a midwife. You are paying for exclusive access to her services and knowledge, plus all the equipment, drugs and various insurances you need. And, remember, you get two midwives at the birth for safety. 

Independent self-employed midwives make per hour similarly to any other professional. I generally advertise an hourly rate of £80, however this gets reduced to £60/h when booking some home birth packages. On busy months we might have 20 to 40 appointments. Generally independent midwives make similar amounts of money compared to NHS midwives but they get better work life balance and more flexibility with their time. It is not a profession that can make you rich as there is a limit of clients one can book per month.

You will be refunded the unused care as reflected on the contract given to you when you pay your deposit.

I am afraid that is not an option at the moment but you can ask your bank for a loan to be paid over a long period of time.

Hello! My name is Irene Vine and I am an independent midwife  covering Suffolk, Essex, Cambridge and East London. I provide full antenatal, postnatal and birth care including homebirths and outside of guidelines care. I am passionate about supporting women achieve a birth experience where they feel empowered, heard and understood. If you would like to experience the best possible care with unrushed appointments and a private midwife who is always at the other end of the phone, give me a call! I cover most cities and villages in East Anglia, such as Chelmsford, Colchester, Ipswich, Cambridge, Harlow, London or Southend.

Resources For Fetal Heart Monitoring

1.When did we start monitoring babies in labour?

For more high quality evidence around fetal monitoring please visit Kirsten website here, an obstetrician with a PHD in CTGs. https://birthsmalltalk.com/

In this post she discusses intermittent auscultation: https://birthsmalltalk.com/2023/08/23/what-is-intermittent-auscultation/

Hear her talk about the lack of evidence behind CTGs in this podcast: https://open.spotify.com/episode/1eXZY973Oxbs1ducavpSAk?si=872f8c4077be4ba5

Post on the history of fetal heart monitoring: https://birthsmalltalk.com/2023/08/09/listening-to-the-fetus-the-history-of-fetal-heart-rate-monitoring/

Cochrane review comparing CTG to intermittent ausculation (CTG increases interventions
): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006066.pub3/full

Does CTG use improve outcomes for high risk women? https://birthsmalltalk.com/2024/10/16/the-story-behind-our-paper/

2. How should we use intermittent auscultation in labour?

These are the NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

Midwife researcher and lecturer Rachel Reed has a brilliant article and podcast about this where she unpicks the evidence around the recommendations for intermittent auscultation protocols here https://www.rachelreed.website/blog/listening-to-baby-during-labour

and podcast here: https://open.spotify.com/episode/3sJeIR3xUOr20EBRGilHxl?si=818537594dd04457

The WHO recommendations for intrapartum care: https://iris.who.int/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1

3. How does intermittent auscultation detect fetal distress?

For more on normal and abnormal heart rate monitoring watch this explanatory video: https://www.youtube.com/watch?v=Ni48bbtiZgs

4. What happens if there are concerns with the fetal heart rate at a homebirth?

NICE guidelines for fetal monitoring in labour: https://www.nice.org.uk/guidance/ng229/chapter/Recommendations

5.What is better for fetal monitoring in labour: a Doppler or a Pinard/fetoscope?

To read about the research and the experiences of midwives using a fetoscope/pinard antenatally and in labour check these links out.

Short facebook comments compiled in this magazine here: https://www.midwiferytoday.com/mt-articles/wisdom-of-the-midwives-issue-131/

Midwives perceptions of fetoscope vrs Doppler Tanzania https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1736-y

Midwives experiences of Pinard use Norway https://www.sciencedirect.com/science/article/pii/S0266613822000407

Defense of fetoscope article by American midwives

https://hearthandhomemidwifery.com/blog/fetoscope-a-tool-of-the-midwifery-trade#:~:text=Fetoscope%20uses%20go%20beyond%20just,birthing%20person%20and%20the%20baby.

A Cochrane review that compares Doppler and Pinard use in low income countries: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008680.pub2/full

For a compilation of research that compares the use of Doppler to Pinard check this link: https://www.cochranelibrary.com/content?templateType=related&urlTitle=%2Fcentral%2Fdoi%2F10.1002%2Fcentral%2FCN-01110791&doi=10.1002%2Fcentral%2FCN-01110791&p_p_id=scolariscontentdisplay_WAR_scolariscontentdisplay&_scolariscontentdisplay_WAR_scolariscontentdisplay_action=related-content&p_p_lifecycle=0&p_p_mode=view&type=central&contentLanguage=

6. What if you decline some or all fetal auscultations?

Is fetal monitoring essential?: https://birthsmalltalk.com/2024/11/06/myth-busting-3-fetal-monitoring-is-essential/

7. What to bear in mind about intermittent auscultation in labour?

Examples of womens experiences of fetal auscultation in labour: https://www.sciencedirect.com/science/article/pii/S1871519224002658#bib14