What is an IM?
An Independent Midwife is a qualified and regulated autonomous practitioner that – as with all Midwives – is the expert lead practitioner in uncomplicated pregnancy, birth, and postnatal care. An independent Midwife must practice within the NMC code of conduct, providing research-based evidence and best practice at all times. They are responsible for ensuring their clients make informed decisions based on the best clinical evidence available. Typically, they work to the guidelines set out by the National Institute of Clinical Excellence – NICE – and can provide care at home or hospital depending on where the client wishes to birth.
Why do clients access an IM?
Clients that chose to opt-out of conventional Maternity care and book with an IM, typically do so because they want personalised, holistic maternity care that is not restricted by time constraints. They want to get to know the person that will support them to birth to their baby and enjoy the consistency of advice throughout their care. It is common for clients to have had a birth experience previously that they found disempowering or even traumatic. They tend to want to regain control of their birth experience and access an IM to journey with them through the pregnancy and birth as someone they trust and understands them and their wishes.
What is indemnity insurance and why do I need it?
In the UK legislation requires that ALL healthcare professionals hold professional indemnity insurance. Previous to this, many Midwives worked as self-employed IMs without insurance as it was not a legal requirement. Midwifery indemnity insurance can be accessed in two ways. One, through the commercial markets, just like a regular car and household insurances, or two, via an indemnity product that is owned by an organisation or group, just like the NHS clinical negligence scheme for trusts (CNST). For many years now, only one provider of insurance has been available to private midwives outside of the NHS, and this requires employment by the insurance providers. However, a new product is about to launch in the UK in May 2022, that facilitates a wonderful balance for Midwives working as self-employed IMs as they did before legislation changes, but with the reassurance for families that insurance for birth is provided.
So, a new insurance product is available, how do I access it and set up as an independent midwife?
Having worked as an Independent Midwife before requiring Indemnity insurance, and as a community Midwife, then Birth Centre manager, I knew what I needed to become an IM but not how to go about it.
Below is the process I went through to set up ‘My Independent Midwife Ltd’. While this process will look different to all Midwives based on their current work setup and preferences; this is how I went about becoming an independent Midwife.
1) Register yourself as self-employed with HMRC or as a limited company with Company’s House.
This took surprisingly long as I went down the limited company route. This can be done in 24hrs from around £12 but I chose to work with a company that completes this setup on your behalf for around £60 and makes the process smoother. If I did it
again, I would likely just do it myself after some research. Self-employment is much quicker.
2) Choose a name
Choose wisely as this is the company name you will hopefully be using until you eventually retire – So ensure it’s something that rolls off the tongue and makes sense. Also, ensure that no one else has taken that name on Company’s House or is using the associated website.
Also, It’s worth noting that company’s house will flag ‘sensitive words’. Sensitive words like ‘Midwife’ need permission from a registered authority, such as the NMC, before you can use them. This was quite easy but again slowed down the overall process.
3) Hand in your notice.
Depending on your banding, you will need to give your current employer between 8-12 weeks’ notice. It takes a minimum of 8 weeks to get set up so that you’re ready to begin care as an independent Midwife. I thought I could be ready in 2 weeks, but every step depended on the previous one being completed, so it took much longer than anticipated.
4) Register with an agency.
Agency work is a great way to have reliable, flexible work that can maintain your income while you transition over to your new role as an Independent Midwife. Having another source of income that you can work around training/antenatal appointments etc, allows your client base to grow slowly and steadily. Working in the units your client base may be accessing, increases your familiarity with local policies and makes transfers much smoother as you are a known professional.
I registered with Pulse Nursing and NHSP for flexible options. There are lots of agencies available throughout the UK, but I have found Pulse to be very supportive and popular with trusts. Please feel free to mention my name as a referral source!
5) Create a website
I hoped to do this myself via websites such as Wix or WordPress. I know a few professionals that have produced beautiful websites themselves this way. However, as a Birth Centre ward manager, I just couldn’t find the time to achieve this myself. Instead, I worked with DotGo to produce an amazing website. I had support from a content writer and website designer who did a beautiful job at turning my ramblings into a useable, flexible website to showcase our services.
6) Register with an indemnity insurance provider.
The RCN provides insurance cover included within their union membership fees for antenatal and postnatal care. So you get union membership, of which the RCN does have a Midwifery branch and antenatal/postnatal indemnity insurance for £8.20/mth in your first year and £16.40/mth after that. It’s worth noting that the discounted, joint RCM and RCN membership doesn’t include indemnity cover – You must sign up for full RCN membership.
For full antenatal, intrapartum and postnatal indemnity insurance, Zest Midwives are the quality and safety collaborative that governs, maintains and facilitates access to the insurance product. This is a flat cost of £350 per year, <£30/mth. This includes support in becoming an IM, your annual mandatory training and equipment calibration.
7) Get the gear!
After looking around, I went with Medisave for my one-off and repeat consumables needed for my care provision. I found that the costs were very reasonable and it was very easy to open an account with them.
I went with the Elite Bag for community care and the Elite respiratory emergency bag for birth – I’ve used both of these bags in a previous Midwifery life and they are both very smart, organised and hardwearing. There are many cheaper alternatives but this was something I did want to compromise on quality.
I also went for the top of the range Huntleigh waterproof doppler and a pinard naturally! Again, this is the most expensive doppler that Medisave sells but I have used these in the past also and found them to be excellent quality.
After discussing my needs, Medisave are now stocking all of the emergency drugs and routine medications offered in Midwifery in their online pharmacy. Order with them online, they will request evidence that you are a registered Midwife, sent that off and your good to go.
Most of our other equipment came from Amazon, such as our TENs machines, baby scales and aromatherapy oils.
8) Get social
Like it or lump it, Social media is necessary for any new business as a main source of marketing. LinkedIn does have fantastic online short courses in all kinds of marketing and generally everything to do with business. At the time of writing, they offer 30days of free access to their online learning platform. I signed up and worked as hard as I could to get through as much information as possible as working for yourself is a steep learning curve.
9) Last of all is working on your personal brand.
Do you have a niche? A speciality or special interest? Can you offer services such as complementary therapies to support your care?
Even the uniform you choose and the way you present yourself reflects your personal brand so make sure it’s professional but personable.
We chose to use uniforms from amazon – They are a traditional tunic style which is professional and practical as well as reflects well should you have to provide care in a hospital setting. However, they are slightly quirkier than most healthcare uniforms without appearing like a beauty therapist – Not that this is bad, but it’s not what we are.
Becoming an Independent Midwife improves professional autonomy, freedom and flexibility, largely in part to the significantly greater time you have available to support and empower the people you care for. Hopefully this information a demystified some of the stumbling blocks to moving into working in this way.
If you have any questions or issues that you think I need to cover, please comment below. If you have made the transition yourself, please share your story below with others and let’s help build this wonderful community of Independent Midwifery.
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