Denise and her blog

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.

Predicting the stages of menstruation

When I was at the University of Greenwich running a degree in Complementary Therapies, I was fortunate to conduct some fascinating research.

My favourite project focused on using reflexology points on the feet to predict stages of the menstrual cycle.

By palpating areas of the feet corresponding to the pituitary gland, ovaries, fallopian tube, and uterus, it’s possible to determine which ovary is active, where the woman is in her cycle, and estimate the onset of her next period.

I’ve taken this research into our Reflex Zone Therapy courses for midwives, teaching how these techniques can be adapted to predict the onset of labour.
While we can’t pinpoint the exact time (it won’t be “4pm Friday”!), we can estimate whether it’s a matter of days or weeks.

It’s evidence-based, incredibly practical—and yes, a little fun!

Schumann Resonance Explained

Work by the scientist, Winifred Otto Schumann in the 1950s revealed that the earth’s energy vibrates at a particular energetic frequency and that the energetic level of humans (and animals) in optimum health is exactly the same as that of the earth. This is measured as 7.83 Hz. Any compromised wellbeing alters the energy frequency measurement, leading to ill health or disease. Other sources of energy (heat) can adversely affect wellbeing, also potentially leading to ill health. Electrical equipment such as TVs, mobile ‘phones, X-rays, microwaves, medical monitors such as CTG machines and more can interfere with the optimum 7.83 Hz energy of an individual. Stress hormones act as a vibrational heat source to agitate the brain (“hot tempered”) and blood (increased risk of clumping of platelets).
Adverse energies can also arise from changes in geopathic stress – volcanoes, earthquakes and global warming – leading to issues such as sick building syndrome and adversely affecting human and animal health.

During complementary therapy, the practitioner acts as a conduit to channel positive energy to aid a return to homeostatic balance – which is why it is vital that therapists are in good health when they are treating clients. This applies whether the therapy is manual, as with massage or reflexology, psychological, for example, Hypnotherapy, or energetic such as homeopathy or reiki. Midwives providing massage or aromatherapy in labour should not be stressed, busy or tired since their increasing negative energy levels can be transmitted to the birthing person, potentially adding to any negative energies arising from equipment, stress levels, noise, movement and light. This is why a quiet, secluded birthing environment is so important for both mother and baby.

The Importance of Touch

How many of you touch women in labour with a caring, nurturing touch? 

As midwives, we know how powerful our hands can be.  

Did you know there’s evidence showing that massage can significantly reduce stress hormones during labour?  

And when stress hormones decrease, birth hormones can do their job more effectively – a win for both mum and baby. 

Let’s not forget, massage and oils have been trusted in childbirth for centuries.  

This isn’t just a “nice-to-have”; it’s a practice grounded in history and science. 

A joyful and Peaceful December

As we step into December and the festive season begins, I wanted to take a moment to reflect on the incredible work midwives do every single day.

This time of year is a reminder of the powerful support we provide to expectant parents and the lasting impact we have on their journey into parenthood.

Whether you're looking to enhance your skills, connect with other midwives, or find moments of calm amidst the holiday hustle, I’m here to support you every step of the way.

Exciting resources and courses are coming in the new year - keep an eye out!

Let’s make this month count and step into 2025 with renewed confidence and knowledge. 🌟

Wishing you a joyful and peaceful December! 🎄

Self-Care For Midwives

There is so much pressure on midwives and the maternity services and midwives are all but burned out. Some are able to leave the NHS and find better job satisfaction and a better work-life balance by working in their own private practice, either as an independent midwife offering full pregnancy, birth and postnatal services, or focusing on antenatal and postnatal care and add-on services such as complementary therapies, lactation support and other aspects of the midwife’s role. However, many or forced to remain in the NHS, usually due to financial and family considerations. And, it must be said, there are some who enjoy their work and remain committed to NHS midwifery despite the difficulties,

However, continuing stress and pressure will eventually take its toll on both the mental and physical wellbeing of midwives.  It is, therefore, crucial to learn how to look after ourselves, both as individuals and as a professional group. You know what they say in the safety briefing on airplanes – “please fix your own oxygen mask before helping others”. It’s the same in healthcare, especially given the current state of midwifery. Midwives rarely manage to take breaks for lunch, a drink or even to go to the toilet. The work is physically and emotionally demanding, the shifts are inappropriately long, and many midwives stay way beyond their shifts to be there for the parents in their care. Families, social life and downtime suffer because midwives are too tired or unavailable. Yes, the “health” service does little to care for its staff and midwives are leaving their posts in droves, sometimes leaving healthcare altogether. It is long overdue to say the time has come to look after the profession and ourselves. Many midwives are too burned out to even have the energy to eat healthily, too strung up to rest and sleep well, and have little time or energy to exercise and get out into the fresh air.

This year, when we welcomed our new students to the Diploma in Midwifery Complementary Therapies and our Certificate programmes in individual therapies, we gave everyone a goody bag which was aimed at looking after themselves. The goody bags contained a reusable water bottle, a stress colouring book and set of crayons, a bar of organic vegan chocolate and a w roller ball with relaxing oils. We also included a link to a free online self-hypnosis relaxation session. In addition to our study days, regular webinars and tutorials, we have now introduced a regular monthly online hypnosis relaxation session, led by my colleague Laura who is the programme leader for our Certificate in Midwifery Clinical Hypnosis. Any of our students and Licensed Consultants (midwives in private practice) can attend as part of their membership of our Expectancy Community. They are well attended, and midwives tell us they value the opportunity to take time out for themselves.

Boundaries Of Midwifery Practice

I attended a fascinating workshop at the Normal Birth Conference in Hong Kong. Two American midwives presented a workshop on managing occipito-posterior (OP) position. They taught a manual manoeuvre that involved internally manipulating the fetal head into a more favourable anterior position. Essentially this is similar to the manoeuvre undertaken by an obstetrician when using forceps. 

Apparently, there is a high incidence of OP position in the units where these two midwives worked and the use of this technique by midwives had reduced Caesarean rates. However, since there is also a 90% epidural rate, it is hardly surprising that the incidence of OP position in second stage is high - the pelvic floor relaxes and fails to provide the resistance needed to aid rotation of the fetal head. Some delegates challenged why the epidural rate was not addressed but culturally, in a very high-tech medicalized system, epidural is - allegedly - what women want.

The discussion that ensued was about whether midwives in all countries represented would be permitted to use this manual rotation. In developing countries with poor access to medical care it could be a lifesaver for both mother and baby. However, in the UK, it is unlikely to be sanctioned by the NMC, when obstetric help is readily available. Two Irish midwives had the same reservations as those of us from the UK.

A Chinese Hong Kong midwife stressed that it would be almost physically impossible to perform the rotation as Chinese fingers are often short - this midwife told us she even has difficulty in reaching a posterior cervix during vaginal exam. The rotation technique requires the midwife's hand to be inserted fully into the vagina in order to reach round the fetal head.

 This workshop caused me to reflect on the boundaries of midwifery practice in different countries around the world. In developed countries we have the luxury of being able to attend to the psycho-social aspects of pregnancy, birth and early parenthood - although I believe this is increasingly at the expense of midwives fully understanding and applying the biological aspects to practice (more of that In another blog post). In developing countries, failure to recognise deviations from physiological progress can be fatal, and there is less focus on the social and mental health aspects of childbearing. 

 Back in the UK, it is interesting to see how many midwives are moving into fertility care (often, it appears, to enable them to leave the NHS). Whilst the WHO definition of the midwifery role encompasses fertility health and preconception care, it is not a standard element of midwifery practice in the UK. Similarly, miscarriage and abortion care is defined as within the remit of midwifery although it more commonly comes under gynaecology in the UK.

 At Expectancy, we have expanded the boundaries of practice of our "endorsed by Expectancy" midwives in private practice to enable them to offer services to women from the preconception period to the end of the first year following birth (subject to training and insurance). Many of our Licensed Consultants now provide fertility health consultations, Caesarean scar therapy and ongoing care and complementary therapies beyond the early postnatal period. They are not permitted to provide infertility care nor can they take on new clients who are more than eight weeks postnatal - they must work within the UK boundaries of midwifery practice. Since very few of our team are providing independent birth services, it is unlikely they will be in a position to have to make a decision about using the manual manoeuvre to turn a baby in the OP position to anterior. In any case they would be far more likely to have addressed this earlier with biomechanics and Rebozo.

Commitment to Learning: A Rant About Education!

Why is it that so many student midwives and nurses seem to want to do the basic minimum of study simply so they can pass the exam or scrape through to qualification? This is a growing problem,  not just in healthcare professions and not just in the UK. However it is extremely worrying that those entering midwifery and nursing seem not to appreciate that they will be responsible for people's lives. My partner, a university lecturer in anatomy and physiology, is constantly asked by nursing students "what do we have to learn for the exam?" who then seem surprised when he says " everything! " 

I wonder how comfortable these students would be if one of their relatives was in hospital being cared for by doctors, nurses or midwives with only half the knowledge relating to their particular condition. Any profession has a deep theoretical basis to support practice, including knowledge and understanding that may not be "needed" for everyday practice but may be essential at some point in the future to saving someone's life.

There also seems to be an undercurrent of student midwives struggling with the theory and developing the practical skills of the profession. Look - I know that things in the NHS are dire. I know there is unacceptable bullying especially towards students. I know we have large numbers of students with major personal or family health or social issues. But I'm sorry to say - if you can't stand the heat, get out of the kitchen. I know also that many readers will vilify me for this comment but - whether we like it or not - this is the current culture into which students are entering and we need them to be strong enough to challenge that culture and to help initiate change. We also need a profession - one that is currently threatened from all sides - that can continue to maintain its individuality. If we don't have expert midwives with comprehensive knowledge and refined skills, we are in danger of losing the profession or just becoming obstetric nurses.

Another issue is the expectation that once having learned something as a CPD activity, midwives can cascade their training to others - and often by using their own course notes and copyrighted teaching materials from their initial course. This is a real problem since we know that learners only retain around 60% of what they study, so cascade training causes a natural dilution when they pass it on to others who then only retain 60% of what they are taught. Yet not only clinical. midwives but also their managers condone this approach to learning - perhaps because it is quicker and cheaper to train up a group with sub-standard education than to pay for everyone to receive the training provided by quality educators. This occurs when managers don't appreciate the depth required for safe practice - and is a continuing issue when I go to NHS trusts to teach aromatherapy to midwives.

And then there are those who think they can have access to learning materials free of charge. I recently saw a post on another Facebook page where a friend of mine had been to a legal study day and someone asked if there were any slides or handouts - my friend's reply was "only if you've paid for it!"  Both she and I are freelance lecturers whose livelihood depends on the income from our training. You wouldn't go into a shop and not expect to pay for goods you want  - so is this attitude because education is not valued or respected?  Again, it's not only in the healthcare professions that this occurs, it seems to be a general issue, maybe because so much information is available free of charge via the internet. Copyrighted materials are not respected, yet people don't realise that these materials are protected by the law -  basically they're stealing someone else's work.

That brings me on to AI. So many students are now using artificial intelligence to write their assignments that university lecturers are having to do the same and then put the AI-produced work through TurnItIn which checks for plagiarism. Only in this way can they check students" work to see if they've used AI.

So .... back to my original rant about commitment to learning. If you want midwives, nurses and other professionals who know only half what they need to know in order to practise safely, then let them be told the exam questions so they know what they need to revise. Let them use AI for their essays so they can achieve a good. Degree based on someone else"a work.. Let's send one person on a course who can then use their limited new knowledge to train up everyone else. Let's undermine the quality of learning in general by making everything free and accessible to anyone who wants to steal the work of others by infringing copyright law. And - let's face it - you can buy a PhD in the USA so why don't we just do that as well.?

Rant over!! 

International Labour and Birth Research Conference in Hong Kong

What an incredible experience I had at the International Labour and Birth Research Conference in Hong Kong!

From reconnecting with familiar faces to meeting inspiring new colleagues, it was a whirlwind three days packed with insightful lectures and hands-on workshops.

I explored everything from the latest in birth technology to innovative techniques for supporting fetal positioning—and, of course, I had my own workshops on complementary therapies for postdates pregnancies.
The conference was beautifully organised, with speakers exceptionally well looked after.

To top it off, I enjoyed a fabulous 13-course Chinese banquet for the conference dinner last Tuesday!

Thank you to everyone who made it such a memorable event. Here's to bringing these insights back home and continuing my journey in supporting physiological birth!