Denise and her blog

Castor Oil: Back in the spotlight

When I first started my midwifery training, Castor oil was a common herbal remedy to encourage labour onset. It fell out of fashion for a while, but now it's become popular again.

Some research suggests that drinking 30ml of Castor oil in one dose might help trigger labour, but it's important not to overdo it.

In reality, Castor oil is more likely to cause diarrhoea than stimulate effective uterine contractions.  

Well, I suppose that could still help get things moving. 😅  

But here's the thing: Castor oil isn't safe for everyone, and we should steer clear of chewing Castor seeds. These seeds contain ricin, a highly toxic substance, so that's something we don't want any pregnant women doing in the mistaken belief it'll help with labour.  

So, while Castor oil might be a tool in your toolbox, remember moderation is key and always approach cautiously.  

The Changing Face Of Maternity Complementary Therapies 

Having recently celebrated 50 years since starting my career, I have been reflecting on how thinking around the subject of “complementary therapies” has changed since I first pioneered the specialism in midwifery in the early 1980s. When I started becoming interested in this vast subject area and applying it to midwifery practice, research, education and publication, it was still very much considered “alternative” or “fringe medicine” – and many colleagues gave the impression they thought I was the resident witch.  Since my student days in the 1970s, I had been an advocate for physiological birth and women’s empowerment, joining the Association of Radical Midwives, going on “natural birth” campaign marches and fervently supporting home birth. Bear in mind that, since the Peel report of 1970, this was now a time when hospital birth had become well entrenched in the NHS. Gone were the days of birth as a family event, largely occurring at home with midwifery support and little medical intervention. In came a changed style of maternity care with new technology, new interventions and new attitudes. As we progressed into the 1990s and 2000s, the maternity services became more paternalistic, more punitive and more litigation conscious.

Despite, or perhaps because of this, there emerged a huge public interest for more natural ways of dealing with health issues, not just in maternity care. The then Prince of Wales supported holistic approaches to care and set up the Foundation for Integrated Health, from which several specialist complementary health clinics evolved. Various universities started to offer undergraduate degrees in complementary medicine. I was in the right place at the right time in this respect, having trained in several therapies and then being given the opportunity in 1992 to develop the first practice-based BSc(Hons) in Complementary Therapies at the University of Greenwich. As part of this work, I established a unique midwifery clinic offering complementary therapies for women with pregnancy discomforts, using a combined approach of standard care with a range of different modalities. With increased medicalisation of birth, professional interest in complementary therapies also grew, partly in response to demand from expectant parents. At that time, the subject was not included in pre-registration education, yet service users were asking questions, seeking alternatives and expressing a desire to pay for them by consulting independent practitioners. Conversely, the complementary therapy professions were beginning to evolve beyond generic practice to provide training and insurance for those who wished to specialise in working with particular client groups, including cancer patients and pregnant women.

The first decade of the 21^st century was possibly the heyday of complementary medicine, with complementary methods now a firm option for healthcare amongst the general public. When I left the university to set up Expectancy in 2004 to provide training in the subject especially for midwives, various NHS trusts were starting to consider how they could incorporate this “new” element of care into the maternity services. I spent much of my time up to 2020 running around the UK delivering in-house courses for midwives and travelling overseas to teach in maternity units, universities and colleges, notably in the Far East. Even now, Expectancy remains unique, worldwide, in providing this specialist midwifery education with an academic emphasis on theory and practice similar to degree level studies. By 2019, there were dozens of UK maternity units offering aromatherapy for labour, some including moxibustion education in their breech clinics and a few providing acupuncture clinics for dealing with a range of antenatal and postnatal issues. 

Then came the pandemic when, at a stroke, maternity complementary therapies were, understandably, almost universally discontinued. Disappointingly, many services have not been re-established, with lack of staffing, funding and the need for updating being cited as the main reasons. The situation has been exacerbated in the last three years by concerns over reported issues arising when midwives seek to replace – rather than enhance – conventional midwifery care with complementary therapies, or delay seeking obstetric support when intrapartum progress deviates from the physiological norm. On the other hand, there is a slight resurgence in NHS interest from trusts where intervention rates are so high that it has been acknowledged that “something” has to be done to reduce high costs, not just in financial terms but in legal costs and human costs too. This latter is particularly pertinent in terms of physical and emotional trauma experienced by women subjected to gross intervention and in the flight of dissatisfied midwives from the NHS. Unfortunately, there persists the notion, not entirely accurate, that complementary therapies are primarily used for relaxation and stress relief (surely an indication for using them now, given the immense stresses and mental health issues experienced by pregnant, birthing and postnatal mothers?) Even after over 40 years of flying the flag for midwifery complementary medicine, it continues to be regarded with scepticism by many in the health services and there is little enthusiasm for introducing apparently time-consuming treatments that are seen as expensive, inequitable and poorly evidenced luxuries.

However, a new breed of midwives is emerging, with many so dissatisfied with working in the blame-and-bullying culture of the NHS that they are choosing to take their first steps towards offering maternity-related services in private practice. There are many expectant parents who are prepared to pay for services that they cannot obtain on the NHS – and midwives are tapping into this demand. There is a growth in the numbers of independent midwives, many now able to offer full birth services once again, others offering enhanced antenatal care and education, or specialist services such as tongue tie division, repeat newborn examinations, Caesarean scar therapy and of course complementary therapies. The tide is turning and there are increasing numbers of midwives wanting to make that leap into the commercial world of healthcare – both for the benefit of potential clients and for their own work-life balance and peace of mind.

Going into business – leaving the relative security of a regular income and perceived professional and clinical support of the NHS – can be daunting and there is a lot to learn. “Business studies” is a whole new ball game, but essential if you want to make a success of your private practice and want to avoid making costly mistakes – financial, professional and even legal mistakes.  If you are interested in making the move to private practice, Expectancy offers a Licensed Consultancy scheme (similar to a franchise) for midwives wanting to offer complementary therapies in their own businesses, and a brand-new Certificate in Midwifery Business Studies for other midwives who do not necessarily wish to study complementary therapies. See www.expectancy.co.uk or contact me on info@expectancy.co.uk for more information.

Happy International Women’s Day! 💜

As midwives, we have the privilege of supporting, empowering, and advocating for women at one of the most transformative moments of their lives.

Today is a celebration of the strength, resilience, and compassion that women bring to the world - and as midwives, we see that every single day.

Let’s continue to lift each other up, champion women’s health, and push for better support and recognition for the incredible work we do.

Here’s to all the women we care for, the women we work alongside, and the women who inspire us!

A Reunion To Remember.

What a special day it was, coming together to celebrate 50 years in midwifery!

Meeting at St Bartholomew’s Hospital, we reminisced over coffee, explored the changes since our last reunion, and of course, took our traditional photo by the fountain (thankfully, the weather was on our side!).

The day wouldn’t have been complete without a lovely lunch down the road, filled with laughter, memories, and stories from decades of dedication to nursing and midwifery..

A heartfelt thank you to everyone who came – it was a joy to reconnect and reflect on the journey we’ve shared. Here’s to the next reunion! 💜

THE START OF MY CAREER 

Monday February 17^th 1975 was the beginning of my career, and the start of my nurse training at St Bartholomew’s Hospital in the City of London. A group of 38 of us entered Preliminary training School (PTS), an eight-week period of classroom learning before being let loose on the wards. We were almost all in our late teens or early twenties and unmarried (although one girl was 25 and – horror of horrors – divorced!) It was the first time away from home for many of us and out tutors acted in loco parentis. Great excitement ensued as we were given our uniforms and taught how to make up our caps from a starched square of thick white cotton. We had our hair length assessed and if it was on our collars, we were required to tie it up under the cap. Skirt length of our uniform dresses was actually measured and had to sit on the knee when standing straight. Any ladders in our black stockings meant we had to change them to ensure we looked professional. We even had our nail length and the amount of make up (discouraged) examined. No perfume was allowed at all as it could adversely affect some patients. Those first few weeks were exhausting, somewhat frightening but entirely exhilarating as we prepared to go out into practice for the first time. We received lectures from our tutors and some medical consultants, clinical skills were taught by the clinical tutors who would accompany us to the wards later, and we also had sessions on looking after ourselves. The Nursing Officer for Obstetrics and Gynaecology came to talk to us about “family planning”, her advice being “the best form of contraception, girls, is NO!” We also had sessions from local groups such as historians and one of the City of London’s ancient Livery companies. Those eight weeks provided us with a wonderful foundation of professionalism and basic knowledge that would stand us in good stead for the rest of our careers.

Midwifery Reflex Zone Therapy

What if a simple technique could help support pregnancy, ease labour, and promote postnatal recovery?

When I first started studying reflexology, my son was just nine months old, and I was still breastfeeding him morning and night.  

During my training in reflex zone therapy, a more clinical and targeted approach to reflexology, I experienced something incredible - my milk supply suddenly surged, just like the boost mothers get a few days after birth.

That was my lightbulb moment! If this therapy could have such a powerful effect on me, what could it do for other mothers?

Since then, I’ve used reflex zone therapy to support expectant, birthing, and postnatal mothers - helping with pregnancy symptoms, encouraging labour, easing pain, and promoting postnatal recovery.  

It’s not just a foot massage or a relaxation technique; it’s a method that triggers the body’s self-healing ability.

Midwives play a key role in facilitating this process, supporting the body’s natural responses rather than just treating symptoms.  

That’s exactly what we explore in depth in our Certificate in Midwifery Reflex Zone Therapy programme.

Postdate Pregnancies

Medical induction isn’t the only approach for postdate pregnancies - let’s talk about natural alternatives!

When I wrote my book on complementary therapies for postdate pregnancies, I wanted to give midwives practical, evidence-based tools to support women facing induction.

So often, women are told their only option is medical intervention - but what if we could offer safe, natural alternatives to help encourage labour?  

Reflexology, aromatherapy, acupuncture, and other techniques have been shown to promote relaxation, reduce stress hormones, and even stimulate oxytocin production - all of which can support the body’s natural readiness for birth.

This book isn’t about replacing medical care, but rather empowering midwives with additional skills to give women more choice in their birth journey.

Have you explored complementary therapies in your midwifery practice?

A Cause For Concern – Aromatherapy In Theatre

I recently acted as a confirmer for a midwife about to revalidate, who told me that she had witnessed another midwife using aromatherapy in theatre for a woman undergoing elective Caesarean under spinal anaesthetic. Apparently, the woman became nauseous during the surgery – so the midwife took from the pocket of her theatre scrubs a small bottle of peppermint oil and encouraged the woman to sniff it to ease the nausea.  However, this is negligent on so many accounts:

• my student told me there were no clinical guidelines in the unit for the use of aromatherapy
• she was unsure if the midwife had received midwifery aromatherapy training – but presumably not if she felt it acceptable to use essential oils in theatre
• there was, apparently, no prior communication with the anaesthetist or obstetrician which should have occurred when any pharmacologically active substance was to be used
• there was no assessment of the mother in terms of whether or not essential oils in general and peppermint oil in particular were acceptable for the individual
• no informed consent was obtained from the woman, the bottle was simply offered for her to inhale the peppermint vapours
• the use of any essential oils in theatre or the anaesthetic room is completely contraindicated, an environment in which rapid changes in patient physiology can occur
• indeed, peppermint oil can be a cardiac stimulant in some people, so its use in a situation in which the woman’s vital signs may change rapidly was completely inappropriate
• there was no acknowledgement of the possible risks, albeit minimal, to mother, baby and staff present in the theatre
• the quality of the essential oil, whether it was within use-by dates, the dosage and the specific type of peppermint oil was unknown – some types of peppermint are contraindicated in pregnancy
• no documentation was undertaken about the use of the peppermint oil, presumably because it was not perceived as a form of medication
• the midwife was working entirely outside the parameters of the NMC Code

The revalidating midwife and I discussed her responsibilities under the “escalating concerns” clause of the NMC Code, and she agreed to try to tackle the problem once she was back in the unit.

What issues have you witnessed or experienced in relation to aromatherapy use in the maternity unit or birth centre?

Is NHS Midwifery Becoming Obstetric Nursing? 

There have been plenty of social media posts from midwives and doulas about the parlous state of maternity care in the westernised world. There is an increasing backlash against the catastrophic medicalisation of birth from almost entirely unnecessary and potentially harmful interventions imposed on women, especially around labour onset and progress. Induction rates in some tertiary UK units are as high as 60% (personal communications) whilst UK Caesarean rate reached an average of 42% in 2024, with some units having even higher rates. Indeed, even Elon Musk has commented that Caesareans lead to babies with “bigger brains” although what he may have meant was “bigger heads” due to avoidance of the moulding that occurs in spontaneous vaginal birth. Whether or not he feels that having a larger head is a positive or negative matter is unclear, but it is unbelievable that he should deign to comment on something about which he knows nothing. Parameters of “safe” practice are now being changed negatively, including the “safe” gestation parameters for term, resulting in earlier inductions, or the cutoff point for diagnosing diabetes in pregnancy, leading to stress in women who are told they are “diabetic” yet who would not have been diagnosed as such previously.

More importantly, midwifery practice is changing – in my opinion, not for the better. Students are not witnessing physiological birth and newly qualified midwives lack the confidence (and, I would argue, the competence) to work with women in physiologically normal labour. Midwives are frightened by the perceived “risk” of childbirth and also by the implicit threat of disciplinary action for not following local or national guidelines or by the risk of litigation if they do something “wrong”. This is not helped by the redefinition of “normal” birth that now allows students to count towards their required 40 “normal” births those in which they may not have personally managed the entire labour experience, for example, not managing placental expulsion. It seems that the main reason for this change in the regulations relates to the diminishing rates of physiological birth. Further, the NMC now permits increased hours of simulated practice rather than direct clinical contact with women and babies, presumably because of a shortage of placements for students. Whilst certain clinical skills can be learned in simulation laboratories, there is no replacement for direct clinical contact with service users, all of whom have different responses to procedures, treatments and the whole childbearing experience. 

Midwives’ knowledge of anatomy and physiology is deplorable, sometimes to the point of being potentially negligent in clinical practice. This is compounded by the reduction in, and methods of teaching anatomy and physiology to students, presumably to accommodate the extra psycho-social elements of contemporary midwifery practice. This lack of knowledge means that midwives may be unable to detect changing physiopathology early enough to raise concerns, especially in labour, something that is only going to worsen as more and more women are coerced – indeed, emotionally blackmailed – into interventions, notably inductions, with the high risk of a cascade of intervention leading to Caesarean. Universities are reducing the required teaching hours of A&P and the pass marks for assignments, with to my knowledge, some students being given three, four or even five attempts to pass an exam or assignment. It is very saddening to see social media comments by student midwives agonising over the theoretical difficulties of midwifery pre-registration education, many – perhaps most – finding A&P and related subjects such as pharmacology “too hard”. This is extremely worrying – would you want a relative (or yourself) to be cared for by a doctor, midwife or nurse who only knows half of what they need to know because they deemed it “too hard” to learn? If someone wishes to become a healthcare professional – with the emphasis on the word “professional” - then potential midwives need to realise that pre-registration education IS hard and requires an absolute commitment to all elements required to carry out the role.

NHS midwives have completely lost their autonomy and now appear to work almost entirely under the direction of local and national clinical guidelines, including the debatable NICE guidelines, medical instructions and managerial financial, time and staffing constraints. Essentially, they have become obstetric nurses. Much of the work of midwives within maternity units is now more akin to surgical nursing care and administrative duties than the holistic bio-psycho-social focus of traditional midwifery care. I despair of what I see and hear about NHS midwifery (and state-run maternity services in other developed countries). Care of families going through the maternity services is not compassionate and is certainly not physiological, suggesting that it is also not safe. I have very grave concerns for when the time comes for my son and his partner to start their own family and would actively advise them not to have NHS care over which they have no control – what a sad indictment for someone who has been a committed midwife and midwifery lecturer for almost 50 years. 

I support entirely those midwives who choose to work independently, however, difficult that may be in terms of fighting the system, obtaining insurance and other trials that come with being self-employed. Perhaps it is time to re-evaluate completely the way in which maternity care is provided in the UK. Increasing numbers of midwives are choosing to work outside the “system” although most no longer provide birth services but focus on enhancing pregnancy and postnatal care with services not generally provided by the NHS, such as individualised preparation for birth, complementary therapies, traditional postnatal care over the first month of the babies’ lives and more. Does this mean that the NHS will provide services in which doctors and nurses manage births, with medicalisation becoming all the more the conventional way of having a baby, leaving midwives to provide psycho-social care during pregnancy and after the birth?  

Moxibustion

When a woman has a breech presentation, she’s often eager to avoid an external cephalic version (ECV) or a caesarean section if the baby doesn’t turn.
That’s where moxibustion can be a game-changer!
This simple, inexpensive therapy can be taught to parents, empowering them to do the treatment themselves.
Starting around 34 weeks of pregnancy, it involves using a stick of burning herbs (I know, it sounds unusual!) as a heat source applied to an acupuncture point on the little toe.
This gentle heat helps relax the uterus, increases baby’s movements, and has a success rate of around 68% for turning a breech baby to head-first.
Couples are encouraged to do the treatment twice a day for 5–7 days, which makes it both practical and effective.