21st-century midwifery: NHS community midwifery models

AIMS Journal, Summer 2004, Vol 16 No 2

Annie Francis and Brenda van der Kooy report on a new model of midwifery care, fully supported by AIMS, from the Independent Midwives Association (IMA)

Many AIMS members will have experienced the difficulties involved in trying to get the kind of care they want for themselves and their babies. A large proportion of the complaints referred to AIMS come from women trying to arrange for true continuity of care either in hospital or at home, a home birth or a water birth.

The Independent Midwives Association (IMA) has developed a new model of midwifery care that would be responsive to these needs. Now under consideration by the Department of Health, our suggestion is that this new model should sit alongside the current provision, and be available to any midwife interested in working in this way and to any woman who would like to have genuine continuity of care.

The concept is easy. When a woman gets pregnant, she has direct access to a list of midwives local to her. She meets one or two and chooses the one she feels most comfortable with. That midwife then enters into a contract with the NHS, which pays on a set-fee-per-case basis.

This is the beginning of a relationship between the midwife and the woman which can develop over the months of pregnancy and provide a firm foundation for an equal partnership based on trust. This, as the research shows, makes for good outcomes and positive experiences for everyone involved. And it isn't just about home births-the midwife would have full access to NHS facilities so that her client could choose the place and type of birth that most suits her needs.

One of the major problems facing the provision of maternity services today is the shortage of midwives. Despite many initiatives to improve recruitment and retention within the midwifery profession, the crisis is deepening.

A new approach is needed and we believe our community midwifery model-if made available to those women who want it, no matter where they live or what socioeconomic class they come from-would be good for mothers and babies as well as good for midwives.

To read about our proposal in more detail, visit the IMA website: www.independentmidwives.org.uk and go to the 'latest news' box on the home page. There is also an online survey that we are asking the general public to complete to enable us to provide evidence that there is a demand for this type of service.

Please help us to make this a reality. Write to your local MP, and send copies of your letter to the Minister responsible for maternity services (Dr Stephen Ladyman, Parliamentary Under-Secretary of State, Department of Health, Richmond House, Whitehall, London SW1A 2NS) and to the Chief Executive of your NHS Trust. Tell them that you would like this option to be made available in your area.

Spread the word to as many people as you can, whoever they are. As a community, we should all have a vested interest in a maternity service that genuinely meets the needs of all women who use it, including the next generation.