Here Denise reflects on changing times in the pregnancy and birth arena and considers how stressful life is now compared to 40 years ago.
When I was first a midwife in the mid-1970s women either became pregnant or they didn't, but everyone accepted that nature would take its course. There were very few tests for fetal abnormalities, no electronic monitoring in labour and limited vaccinations for infants. If women worked, they took maternity leave from around 32 weeks of pregnancy and often chose to be full time parents, not returning to work until several years later. Midwives had time to spend with women at all stages, with frequent antenatal appointments. Home births were still quite common but even in hospital there was continued one to one care in labour. And the midwife provided welcome daily postnatal visits to the home for at least ten days after the birth.
In today's world, couples often leave it "physiologically late" to start a family, then are so stressed that conception takes longer than they want, or not at all. Pregnancy is stressful while women strive to continue working until the last moment, and to cope with "unexpected" - but completely normal - discomforts of pregnancy symptoms. Labour is "managed" either by the couple or by professionals instead of being helped to follow its natural course. New parents, who have generally given birth in hospital, have no time to recover from interventionist care before being thrown into the stressful world of attempting to be a "perfect parent".
Society expects perfection but nature isn't perfect and sometimes it lets us down. Extra social and medical choices are welcome but too much choice brings uncertainty - and uncertainty brings more stress. Stress increases hormones that interfere with conception, pregnancy and labour, recovery from birth and establishment of lactation.
The internet - and particularly social media - exacerbates expectant parent's distress, with childbirth tales, either of perfection or disaster. From the posts I'm currently seeing, there is a definite "them and us" attitude amongst a proportion of the pregnant public, spreading fear that midwives and doctors are ogres to be avoided at all costs, who will "make" parents accept care against their will and who are uncaring and unkind.
This saddens me greatly, to think that we've lost the respect of the people for whom we care. It saddens me, too, to see posts from students and newly qualified midwives who are so disillusioned with the maternity services that they feel they can no longer work in them. Yet these are the very people we need to take forward, to develop and improve the maternity services we offer. Recognising the problem is part of the solution, but we need motivated midwives to work on achieving the solution.
As long as I've been a midwife, there have been battles in the field of pregnancy and birth: midwives versus obstetricians, natural versus interventionist birth, parents versus professionals. But we're all there for the same reason: fundamentally, to continue the human race. Let's stop the fighting and start working together to improve services for expectant parents. Let's start respecting one another for the amazing work we do - respecting women's bodies for their ability to conceive, grow, birth and nurture babies.A nd respecting professionals who are, after all, there to help families, to ensure a safe and satisfying passage through the journey that is pregnancy, birth and parenthood.
Today, Denise expresses her continued concern about the continuing misuse of complementary therapies and and reinforces the need for both complementary and conventional health practitioners work within their professional boundaries. She says:
I continue to see some extremely alarming social media comments and suggestions on the use of complementary therapies. Some of the posts recently have included:
There are several issues with these posts. First is the lack of understanding of the general public about the risks, as well as the benefits of therapies, notably aromatherapy oils. This is a continuing problem and experienced therapy practitioners, as well as conventional healthcare professionals, need to keep putting the message out there to the public.
Secondly, nurses (or midwives) who enthusiastically condone the use of complementary therapies or natural remedies without any knowledge or understanding of the potential dangers, are putting their patients in jeopardy, and risking mistakes that could lead to loss of their professional registration. This is particularly significant when people are seriously ill, since the therapies could complicate the medical condition or interact with drugs.
And thirdly, the credibility of professional therapy practitioners is seriously undermined by a few individuals who seek to overstep their boundaries. I have worked with many reputable practitioners of reflexology and other therapies who specialise in working with people with diagnosed conditions, especially cancer patients or expectant parents. They have undertaken additional training and understand how to apply their experience of using the therapy to the physiology and pathology of the person’s condition.
We are delighted to announce that Denise has received the advance copies of her new book, Using Natural Remedies Safely in Pregnancy and Childbirth, to be published by Singing Dragon in mid-March 2021.
If you would like to win a signed copy of the book, please firstname.lastname@example.org with the answer to the question below, your email address and your name as you would like it in the book if you win. The draw will be made on Friday 12th February.
Here’s the question: If an expectant parent wishes to take raspberry leaf to facilitate labour, when should it be commenced?
a) 37-38 weeks’ gestation
b) 30-32 weeks’ gestation
c) 40-41week’s gestation
Denise has been extremely busy since the new year preparing for all the online teaching. We've already had one course this year on aromatherapy in midwifery, with rave reviews, one midwife emailing us afterwards to say it's the best course she's done in a long time. Over the next two weeks, Denise has courses for midwives and therapists in China and Japan, as well as upcoming webinars and a post dates pregnancy course.
It's been an interesting time, moving to teaching online but there are certainly benefits. Rather than being constrained by the size of an actual room, we've been able to give more midwives and birth workers the opportunity to study with us, with some overseas groups having up to 200 students. We run our study days in real time with three 2-hour sessions (and breaks between), from 9am to 4pm. This can be quite intensive so we break the day up with group work and time to chat socially. Students receive everything in advance so they have all the course materials. For the aromatherapy and post dates pregnancy courses, midwives receive a set of aromatherapy oils to use during the care planning sessions, and those on our acupuncture course receive a set of needles, a mini sharps bin and a practice pad (better than sticking needles in an orange which is now we practised to give injections!). I seem to spend my time packaging up parcels and getting them shipped off. We're also getting more students from overseas, with midwives joining us from Malta, Cyprus, Italy, Austria, Qatar and Slovenia. This has led us to offer the option to study our Certificate in Midwifery Complementary Therapies completely online, with ten study days, optional extra webinars, "open house" sessions and tutorials, taken over an academic year.
Join our online webinars on complementary therapies for pregnancy and childbirth
Date - Saturday 23rd January 2021 10:00 - 11:00 hours
Subject - Introduction to reflexology in midwifery practice with Denise Tiran, author of Reflexology for Pregnancy and Childbirth
Introduction to the principles of reflexology, the different types of reflexology used around the world and the benefits of using reflex zone therapy, the style taught by Expectancy, in midwifery practice. Suitable for midwives and students
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Pineapple has long been held as a symbol of fertility and is also often used to trigger labour contractions in women who are overdue. Pineapple core contains a chemical called bromelain which has been shown to have anti-inflammatory properties and possibly also some anti-cancer effects. When fertility issues are linked to internal scar tissue, perhaps caused by infection or previous surgery, it is thought that bromelain may reduce the inflammation and aid conception. It is also thought to have certain anti-coagulant (blood thinning) effects which is why it is thought to aid blood flow to the uterus. To date there is no pure research on the potential for bromelain to aid fertility and most of the information available on the subject appears to be based on a 2012 Indian paper which was a review of much older research.
However, for those who want to harness the fresh, bright image of pineapple as an aid to conception, there is no real problem unless you are allergic to pineapple or to latex or experience tingling in the mouth when eating pineapple (which may be the start of a more significant allergy). The main source of bromelain is in the fresh raw core of the pineapple, and it is destroyed by juicing, canning or cooking. Those taking prescribed aspirin or other blood thinning drugs prescribed to aid fertility should avoid eating large amounts of the core. Once pregnant, pineapple should be eaten only in moderation, avoiding the central fibrous core.
In the week before Christmas, Denise explores the medicinal uses of some of the popular Christmas spices and foods.
Cinnamon and cloves are both used extensively in cooking at this time of year and are safe in the small amounts used in cooking. Cinnamon is effective for various digestive conditions, but the essential oil is also used in some countries to stimulate labour at term, so should be avoided during pregnancy. This means that the oil should not be added to aromatherapy diffusers to fragrance the room if there is anyone in the family who is pregnant – or if there are cats or dogs in the house as it is toxic to animals. Clove is another popular spice, and the oil is sometimes used to treat toothache, but should be avoided in pregnancy. In some countries clove oil is used to ease the pain of teething in babies, but this can cause damage to the emerging teeth if the oil is rubbed into the baby’s mouth and gums. Like cinnamon, clove oil is also toxic to dogs and cats.
Many people like to add cranberry sauce to their Christmas dinner, but did you know that it can be used medicinally for urinary problems? Pregnant women are prone to urinary infections and cranberry juice can be a useful preventative – but it must be sugar free juice. A few people are allergic to cranberries, especially those who have asthma or who are allergic to aspirin and excessive consumption of the juice can cause irritation when passing urine.
Who doesn’t enjoy a few dates from those little wooden boxes at Christmas? However, whilst dried dates are suitable for pregnant women, fresh Medjool dates should be eaten in small amounts if you are pregnant. Research has shown that eating several large fresh dates every day in the last weeks of pregnancy can trigger labour contractions – but it’s best not to go mad on them at Christmas if you are not yet ready to give birth. Indeed, in some Middle Eastern countries dates are considered to be “forbidden fruits” in pregnancy.
Frankincenseevokes the sense of Christmas, perhaps more than any other spice. It is, however, a useful medicinal plant, being antiseptic and very good for colds and nasal congestion. The essential oil is a particularly useful one for stress and anxiety and is what Denise calls “the ultimate calmer”. It is especially effective for the transition stage of labour, just before the baby is ready to be born – just sniffing a couple of drops on a tissue calms you down (don’t put it in the birthing pool). If using it in a diffuser at home, just turn it on for 15-20 minutes – this is enough to fragrance the room for a good couple of hours and avoids overwhelming the air with the chemicals in the oil as it can cause headaches or nausea in some people.
When I was a student midwife in the late 1970s we offered parentcraft classes to all pregnant women and their husbands (I use the word advisedly). This meant that there was plenty of opportunity for students to observe midwives conducting classes and we then had to prepare and teach a class ourselves under supervision.
Classes started at around 34 weeks'gestation and we offered a.course of six sessions that usually included fetal development and dealing with"minor disorders" (rather late); one class on normal labour and one on complications (very scary), one on pain relief when the anaesthetist would come and talk about pethidine and Entonox (the dads liked this one and would often go off to the pub with the doctor afterwards!), a session on baby care in which we demonstrated baby baths and a session on infant feeding in which we covered breast feeding and demonstrated how to make up bottle feeds.
Most classes were offered in the daytime, usually in the afternoons, and the lecture was followed by an hour of relaxation in which the expectant mums would lie on mats on the floor in long rows. They were encouraged to go through some basic breathing techniques for labour with muscle relaxation - this was called the modified Laura Mitchell technique and included some guided imagery to music, followed by a period of sleep (the original "hypnobirthing").
Some classes excluded husbands, to offer the choice of being in a women- only group, but there were no specialist classes for women with different needs. All women were addressed as "Mrs" - in my unit this followed a survey in the clinic in which we asked women what they wanted to be called - even the very few unmarried women wanted to be addressed as Mrs so they didn't stand out and risk married women's disapproval!)
There was no mention of natural remedies - indeed, I remember one of my first classes as a community midwife when a woman expecting her first baby was not only insisting on a homebirth but was intending to receive acupuncture from her acupuncturist husband - what a maverick!
Neither was there any mention of rushing to get into labour. Women - and doctors - understood that babies come when they're ready and induction was not the cloud hanging over women that it is today.
Some advice we gave back then would raise eyebrows today. For example, to stimulate lactation women were advised to eat a Mars bar every day (for the sugar) and drink a glass of Guinness (for its iron content).
At the end of each class the students would make the tea and all the women would sit around chatting whilst the midwife answered individual questions. The women really got to know one another and often made lifelong friends. It was all very civilised and student midwives learned a great deal, not only about delivering antenatal classes but also about women, their families and the psychosocial factors that impacted on their pregnancies and labours. Oh - and we also learned how to make a good cup of tea!
Today, in what is bound to be a controversial discussion, Denise comments on the numerous worrying posts on social media from aromatherapy and reflexology groups which have caused her to reflect on professionalism in the complementary therapy disciplines.
I see dozens of posts on social media about complementary therapies and have become increasingly concerned about their professional calibre. Blanket suggestions on using aromatherapy in pregnancy come with no warnings about precautions. Some posts advocate aromatherapy for babies and toddlers, yet it should never be used on or near newborns and rarely, if ever, for toddlers. I've also seen posts on aromatherapy for animals despite the fact that many of the oils can be toxic to household pets.
Even more worryingly, I frequently see pictures of client's feet in reflexology groups posing questions to members on what the possible "diagnosis" might be and asking for suggestions for treatment. No indication is given as to whether client consent has been obtained, and making a diagnosis is impossible without a history and full examination. That's without the fact that reflexologists are taught that they should not "diagnose".
Whilst there are many highly professional complementary therapy practitioners including many who have additional training to treat people with specific clinical conditions, such as cancer, multiple sclerosis and - of course - pregnancy, this sort of posting does the complementary therapy disciplines no favours in terms of credibility, both with the public and with colleagues who are registered healthcare professionalsOf course, you could argue that these ideas are on social - rather than professional -media which has hundreds of inappropriate and dangerous suggestions on all sorts of topics. However when inaccurate and potentially harmful advice is offered by so-called professional practitioners it causes me real.concern. I worry not only about the level of knowledge, understanding and experienc; of the individuals posting, but also, vicariously, about the impact on the wider disciplines of complementary therapies.
Having worked in midwifery complementary therapies for almost 40 years, I have been part of the movement to professionalise complementary and alternative medicine (CAM) that was particularly active in the 1990s when the then Foundation for Integrated Medicine, with the patronage of HRH Prince of Wales, campaigned for increased standards of education and research to facilitate greater integration of complementary therapies with conventional.medicine.
Since then CAM has lost much of its impetus although disciplines such as osteopathy and chiropractic are now firmly included, by law, in the allied health professions and acupuncture and medical herbalism are self-regulated and have high levels of training and professional Codes of Practice to monitor standards. Sadly, however I have to question whether aromatherapy and reflexology have slipped backwards into simply being relaxation therapies with no real professional or clinical credibility.
Denise is having a busy week in the office, preparing the prospectus for the new.academic year's courses. She is delighted, but not surprised, already to have received applications for our unique Diploma in Midwifery Complementary Therapies for next September from some very enthusiastic midwives, several of them wanting to combine this with our Licensed Consultancy scheme for private practice. However she questions why so.many.midwives in the last.few.years have been keen to explore the move into having their own businesses offering maternity services such as complementary therapies,. antenatal classes and breast feeding support. Denise says:
Midwives love caring for expectant parents but need also to care for themselves. Midwives are leaving the NHS in droves, newly qualified midwives are choosing not to practise and older midwives are retiring early - and it seems as if this is due, at least in part, to burnout. It may also be due to the insidious erosion of the midwife's role or the risk-averse, litigation-conscious, blame-throwing culture of the NHS.
Conversely, midwives are beginning to realise that the NHS doesn't own them and that they are entitled to use their considerable skills,.knowledge and.expertise to.provide women with what they want - services that are generally not available on the NHS. In the UK there is a grave misconception amongst midwives (and nurses) that they are trained by - and therefore solely for - the NHS but this simply isn't true. Qualification grants midwives a licence to practise midwifery anywhere and in whatever way they choose, subject to national law and professional regulations.
Further, there is a demand from expectant parents for services to be available that provide them with services that ease their progress through pregnancy and birth and transition to becoming a parent. These services are not available in the NHS largely because the maternity services are obstetric-led for the benefit of the majority of users. The maternity services remain focused on the biological (physical) wellbeing of pregnancy and, give less credence to the psychosocial elements.
Pregnancy is a stressful time, more so now than ever before. To be able to call upon a professional who can provide relaxation treatments such as massage or reflexology, antenatal advice and support or specialist services to ease backache, nausea or avoid induction of labour is very appealing to many during pregnancy, and expectant parents are often prepared to pay for them.
Our team of Expectancy-trained midwives working in private practice is growing and more and more women are discovering the benefits of having the support they can offer. This current academic year we had more midwives than ever before choosing to join us to train as Licensed Consultants so that they too can provide a range of complementary therapy services for expectant and new parents. Why don't you come and join us?
How Times Change
The Misuse of Complementary Therapies
A New Book On The Horizon!
Brave New World...online learning
January Webinar News
Pineapples and Fertility
Christmas Foods And Spices
How Antenatal Education Has Changed
Expectancy Licensed Consultancy Explained