Denise and her blog

Would you ever think to ask about pets when discussing essential oils? 🐾

It might sound unrelated - but it isn’t.

Cats lack the enzyme needed to metabolise essential oils safely, which means aromatherapy oils should not be used around them at all - even in litter trays.

As midwives using or teaching complementary therapies, safety doesn’t stop at pregnancy. It extends into the whole home environment.

Sometimes the smallest details are part of the safest practice.

Praise for Liverpool Women’s Hospital’s Pre-Birth and Postdates Pregnancy Service

I’ve just spent a fabulous few days in Liverpool with the midwives from the Women’s Hospital. This was my second trip to provide Expectancy’s 3-day course on Aromatherapy and Acupressure for Postdates Pregnancy. The first group of midwives have established a specialist clinic for women to help them prepare for birth and hopefully to reduce the need for induction of labour. It was now time to train up some more midwives to expand the service, which is extremely popular amongst both the mothers and the midwives. Once again, I was welcomed with open arms, by 20 excited and enthusiastic colleagues. Having thoroughly enjoyed the course I taught in 2024, it was lovely to return and also to see many of the midwives I had met before.

Despite the first day being held in a rather small pre-fabricated building, with a temperature roaming from freezing to boiling, we had fun. Midwives were impressed by the benefits of using aromatherapy for women at term, both before and during labour, and stunned by the safety issues they needed to consider when using essential oils. After a very intensive morning of theory, we had a lovely afternoon practising foot and hand massage and the group was fascinated by my introduction to reflex zone therapy (clinical reflexology) and its diagnostic potential for predicting stages of the menstrual cycle and onset of labour. On day 2, we explored how aromatherapy can help to relieve physiological symptoms in late pregnancy, labour and the early postnatal period, and the midwives had to “submit” to the pleasures of seated back massage for labour (they were warned not to tell the managers who might have thought they were just having a good time!) On day 3, we included the specific acupuncture points which have been shown to be effective (with thumb and finger pressure) for aiding descent of the fetus, cervical ripening and onset and establishment of contractions. Then we put it altogether and practised the full postdates pregnancy treatment in the afternoon. I was incredibly well looked after and was invited to join some of the midwives for drinks and an early supper on the final day of the course. Special thanks go to Gemma, who organised the course, Jayne, who made sure I was well supplied with coffee and Mia and her friends for the invite to Duke’s Place Market.

On the fourth day, I had the pleasure of attending the birth preparation clinic in the midwife-led unit, where it was wonderful to see how well the team had set up and were running the service. It was also a useful experience to add to my own CPD for NMC revalidation. Unfortunately, the MLU was closed to birthing women on that morning, but the clinic was still going ahead – and huge thanks to Courtney for allowing me to shadow her. We actually had a lovely morning despite a few issues arising. The first lady was from Somalia and spoke only a few words of English, so Courtney used Language Link for live translation – but unfortunately technology was against us as it kept being lost and we had to wait for the service to be resumed. This meant that the first appointment took much longer than normal, but eventually Courtney was able to conclude the acupressure treatment with a lovely foot massage for the lady. The second lady, having her third baby, had actually been an aromatherapist herself so it took a lot less time to explain what was being offered and to select a pleasant and clinically effective aromatic blend. It was also easier to show her the acupressure points around the body, which she was encouraged to continue practising at home. Both ladies were given the remainder of their individualised oil blends to take away, with instructions on how to use it at home.

The clinic is hugely popular and there is now a need to consider ways to expand the service,, especially with rising induction rates across the trust. We discussed that it was important to publicise it as a pre-birth preparation appointment rather than a complementary therapy clinic, which – from personal experience – often leads to a stampede from expectant parents wanting to enjoy a massage. There are specified criteria for eligibility to attend the clinic, and audit is showing that more women commence labour spontaneously and need less intervention, which can be a huge cost saving. The midwives’ attention to the safety criteria taught on the courses means that they have a solid foundation on which to build the service, whilst still offering something to help avoid the need for women booked for MLU births to have to transfer to delivery suite.

It was a fabulous week and the midwives at Liverpool Women’s Hospital should be rightly proud of what they have achieved so far. I hope to be invited again to further their training in using complementary therapies to aid physiological pregnancy and birth. 

And now it’s time to get ready to trek off to Yorkshire for the next course ……

FAQs

Will this help me support parents more effectively?

That’s always the starting point.

Everything we teach is designed to enhance midwifery care - not replace it, and not overcomplicate it. Complementary therapies, when used appropriately, can support physiology, reduce stress responses and give parents a greater sense of calm, control and confidence across pregnancy, labour and the postnatal period.

For midwives, this means having additional, safe tools you can draw on when anxiety is high, labour isn’t progressing as expected, or parents simply need more support than words alone can offer. It’s about understanding when a technique is helpful, when it isn’t, and how to use it responsibly within your professional role.

We place just as much emphasis on clinical reasoning, contraindications and governance as we do on practical skills. That way, what you’re offering feels aligned with evidence, policy and good midwifery practice - not separate from it.

If you’re looking to support parents in a way that feels calm, grounded and physiologically informed, our programmes are designed with exactly that in mind.

Safety and Storage of Essential Oils

Essential oils can be a wonderful support in pregnancy, labour and postnatally - but they’re not just “nice smells.”

Here, I talk about the safety and storage of essential oils, whether you’re using them in an NHS setting, private practice, or at home. Each oil contains hundreds of chemical constituents and works pharmacologically - meaning how they’re stored, inhaled and used really matters.

Poor storage can lead to degradation, increasing the risk of irritation or side effects. And because inhaled oils circulate through the body (including the placenta), we need to treat them with the same respect as medicines.

I also touch on protecting yourself as a midwife - being mindful of exposure, only using oils you tolerate well, and understanding why disliking an aroma is important clinical information, not something to push through.

Aromatherapy can be incredibly supportive when used well.

Complementary Therapies Aren’t About “doing more ”

Complementary therapies aren’t about “doing more.”

They’re about supporting what the body already knows how to do.

In midwifery practice, we spend a lot of time supporting physiology - reducing unnecessary stress, protecting hormonal pathways, and creating conditions where labour and recovery can unfold as normally as possible.

That’s exactly where complementary therapies fit.

When used appropriately, approaches such as reflexology, aromatherapy and hypnosis can help lower stress responses, encourage relaxation, and support the neuro-hormonal processes that underpin pregnancy, labour and the postnatal period.

They don’t replace clinical skills - they sit alongside them, offering additional, gentle ways to support parents when anxiety is high or progress feels difficult.

At Expectancy, we focus on safe, evidence-informed use. That means understanding not just how to use a technique, but when, why and for whom it’s appropriate - including contraindications, professional accountability and scope of practice.

Our aim is simple: to equip midwives with tools that feel clinically sound, ethically grounded and genuinely useful in real-world practice.

Because sometimes the most effective support isn’t another intervention - it’s creating the right conditions for physiology to work as it’s meant to.

The Reflexology Relaxation Point

One of the simplest techniques we teach on our complementary therapy programmes is the reflexology relaxation point.

It’s gentle, it’s non-invasive, and it doesn’t require oils, equipment or a clinical guideline - just calm, intentional touch.

On our courses,  I show how this unique reflexology point can be used on the hands to support relaxation in many situations: during labour (even in transition), before procedures like blood tests, when someone has received difficult news, or simply when anxiety is high.

There’s no pressure involved - just light contact and slow, steady movement. Sometimes it takes a minute or two, but that small pause can make a real difference to how someone feels and how well they’re able to cope.

It’s a reminder that supportive touch is still a powerful clinical skill - and often the simplest techniques are the most effective.

The Benefits Of Using Complementary Therapies In Pregnancy

What are the benefits of using complementary therapies in pregnancy, labour and postnatally?

Complementary therapies are often dismissed as “just relaxation.”

But relaxation, at its most basic level, is a powerful clinical tool.

When we use approaches such as reflexology, massage, aromatherapy or acupuncture carefully and safely, we see a measurable reduction in stress hormones like cortisol. As cortisol reduces, oxytocin, endorphins and enkephalins increase - creating the hormonal environment that supports physiological pregnancy and birth.

When physiology is supported, the likelihood of intervention can reduce.

That means fewer inductions, fewer epidurals, and fewer caesareans - all of which can have a significant impact on parents’ experiences and longer-term outcomes.

Used appropriately, complementary therapies don’t sit outside midwifery practice - they enhance it.

They support physiological birth, improve parental satisfaction, and often restore midwives’ own sense of professional fulfilment in the care they’re able to offer.

This is why education, safety and scope matter so much.

What Is Happening In Midwifery?

Midwifery appears to be at a crossroads, both in the UK and elsewhere. Practice and education are both under attack, largely from paternalistic factions wanting to control childbirth and the profession of midwifery. Childbirth has become the pariah of healthcare, causing immense stress for expectant and birthing parents, leading midwives to leave the NHS and even the profession, and the government to have knee-jerk reactions in terms of national reviews and even the suggestion of a minister for maternity care.  

As a midwife of almost 50 years, I have seen maternity care and midwifery practice change from something akin to the “Call the Midwife” era (I started in the mid-1970s), to the deplorable state we find ourselves in today. We have had numerous reviews over those years, from the 1970 Peel Report advocating hospital birth, to the three Maternity Care in Action reports in the 80s, Changing Childbirth in the 90s, to a string or reports, investigations and attempts to improve maternity care in the 2000s. But what ARE the current problems and how can some of the issues be resolved – or, indeed, can they?

First, in my opinion, is a catastrophic and almost total loss of any understanding – amongst midwives, obstetricians and the public - that pregnancy and birth are physiological life events that simply require careful observation and, in a few cases, when progress deviates from the anticipated norm, medical support. There is also a significant lack of understanding by the government, NHS, obstetricians and even some midwives, of the wide role of the midwife, as defined by the World Health Organisation, which focuses on working with women from the preconception period, through pregnancy, birth and the postnatal period up to one year following birth of the baby.   

The denial of “normality” has led to increased medicalisation of birth with premature and unwarranted “cascades of intervention” and excessively high induction (up to 60% in at least one unit known to me) and Caesarean rates that have overtaken spontaneous vaginal births. This is coupled with a deplorably coercive and paternalistic approach to maternity care “options” for expectant and birthing parents, largely driven by a fear of litigation if no action is taken, and the obstetric culture of wanting to “do something”, with controlled management, as in other medical specialties. Expectant parents are “advised” that intervention is necessary to protect them and their babies, with insufficient information given to aid them in making informed decisions about their births. Some parents are so anxious about their maternity experiences at the hands of the NHS, that they choose home birth, independent midwives or even unassisted birth.

Added to the internal issues around medicalisation are the demands from the anti-natural childbirth lobby, which have arisen from various investigations into baby loss. It is, of course, very sad when any baby, or mother, dies in childbirth, but we should be careful to put this in perspective. Whilst perinatal loss and maternal mortality statistics could be a great deal better, the majority of women have – or at least could have, if left to physiology – a perfectly normal pregnancy and a spontaneous vaginal birth. It is often the intervention that adds to the “abnormality” which then leads to further medicalisation. Any national review is only likely to add to the intervention in a “just in case” approach.

On the other hand, we now have many more women with increasingly complex pathological, psychological and social needs, who require obstetric and often general medical treatment, leading to increased staffing requirements, clinical costs and bed occupancy. Whilst the birth rate has fallen slightly, there are additional demands on the maternity services, with medical advances enabling women who would otherwise not have been able to conceive and reproduce, as well as people newly arrived in the UK who may present with issues that have not hitherto been familiar to NHS staff.

We now have a shortage of midwifery staff, with many experienced midwives near retirement age and many more leaving the NHS due to burnout. This is well documented by a press hungry to highlight the problems of the maternity services, leading to a poor perception of midwifery that can affect recruitment, It is not that midwives want to stop caring for expectant and birthing parents, but that they can no longer tolerate long hours and unpaid overtime, lack of gratitude and incessant demands on their energy that leave many unable even to find time to go to the toilet or have a drink, let alone take the statutorily required breaks in their working days.

Midwifery education must also take some of the blame for the current issues in the maternity services. There is a “bums on seats” approach by universities accepting students, coupled with lecturing staff redundancies, leading to lack of support for student midwives who are then unable to cope with the rigours of midwifery theoretical learning and clinical practice. Students are required to pay exorbitant fees for education that may still not provide them with jobs and preceptorships at the end of their pre-registration period. I am sceptical about preceptorships which, in the NHS are a management strategy to ensure that all midwives are capable of working in all clinical areas to fill staffing gaps. However, for newly qualified midwives (NQMs), it is certainly advisable to consolidate their learning, yet there appear to be fewer and fewer opportunities to do so immediately after qualifying. The gap between obtaining registration and actually starting clinical work often leads to loss of momentum, with some NQMs never practising. 

All these factors discussed so far have resulted in a deplorable lack of experience of physiological birth for student and NQMs who are then fearful of caring for parents wanting a more natural birth because they do not understand it in practical terms. This only perpetuates and strengthens the argument for intervention. Further, there is little career development support to enable midwives to specialise in a specific area of midwifery, coupled with a “dumbing down” of expertise by employing more support workers. 

There is also, in both education and practice, a culture implying that students are being trained for the NHS, with an overall political refusal to accept midwifery as a profession which enables midwives to work in any setting, anywhere, both NHS and privately, at home and overseas, subject to local requirements. Further, there remains difficulty in obtaining professional indemnity insurance cover for those who wish to work in a self-employed capacity, although some steps have been taken in more recent years to address this.

Further, there is a totally unacceptable culture of bullying within NHS maternity services, both midwifery and medical, from management and between clinical colleagues, with an element of multi-professional tensions adding to the problem.  The overall attitude within the maternity services is punitive and threatening, with staff afraid to speak out – it is easier to fit with the system than to be seen as a maverick. All of this leads to high sickness and absence rates, resignations and significant mental health issues for individuals concerned. 

And so, we get to finance, which the government seems to think is one of the primary issues. Perhaps there is a shortage of funding for maternity services, but more likely it is the inappropriate allocation of resources and the need to fund interventionist practice which impacts on maternity, anaesthetic and paediatric services, as well as bed capacity and other services eg domestic and portering. Yes, we could do with more money in the NHS generally, but it is not the sole answer.

Throwing money at the issue of the maternity services is not going to solve the problems. Neither will yet another government sponsored review, which already adds political bias, be the answer, nor the appointment of a Minister for Maternity Services.    

Evidence-Informed Education In Complementary Therapies

Every day, midwives hold an extraordinary position of trust.

Women come to you not only for clinical expertise, but for reassurance, interpretation, and guidance - especially when they’re exploring complementary or natural approaches alongside conventional care.

That’s why I believe so strongly that midwives deserve robust, evidence-informed education in complementary therapies.

Not to replace clinical practice - but to enhance it.

To help you answer questions with confidence.
To support women safely, ethically and within your scope.

At Expectancy, everything we teach is grounded in midwifery values: safety, professionalism, critical thinking and woman-centred care.

Happy New Year !!

The start of a new year often brings a moment to pause and reflect on where we are - and where we’d like to grow.

For many midwives, that growth comes from deepening knowledge, building confidence, and finding new ways to support women with care that is both evidence-informed and compassionate.  

Complementary therapies can play a valuable role in that journey when they’re integrated safely and professionally.

If you’re considering developing your skills this year - whether for your clinical role or for a future private practice - I’d love to support you in exploring what’s possible.  

A new year can be the beginning of a very rewarding next chapter.

Reflections

I’ve been reflecting on our first practical weekend of the Acupuncture course back in October, taught by our lovely Amanda.  

It’s always such a memorable point in the programme - that moment when midwives begin actually placing needles for the first time!

There’s usually a mix of excitement and a little apprehension, which is completely natural. But the group handled it brilliantly, supporting one another as they developed their confidence and technique.

Acupuncture is a wonderfully effective tool in maternity care, and watching midwives lean into new skills with such enthusiasm is one of the joys of teaching. 💜