Denise and her blog

Published : 12/06/2024

Safe Use Of Natural Remedies In Pregnancy: Guidelines For Maternity Professionals


The use of natural remedies is at an all-time high, especially in pregnancy. Women are advised not to take drugs unnecessarily, yet many do not appreciate the potential risks of inappropriate self-administration of herbal and other remedies. Natural remedies (NRs) have, of course, been used for centuries and were traditionally a significant part of midwifery care until around the 17th century when the emerging medical and pharmaceutical professions took control of healthcare. We know that, today, around 80% of expectant parents resort to complementary therapies and particularly to self-medication with NRs, perhaps as a means of recapturing some of that control of pregnancy and birth that has been lost in the mists of time. Herbal medicines, including many traditional and folk remedies, act in exactly the same way as drugs (and can interfere with them). They are not regulated in the same way as drugs and are relatively easy to access in health stores.   

Midwives, doulas and doctors may be asked for information or advise on herbal remedies such as raspberry leaf tea for birth preparation, clary sage and other aromatherapy oils for use in labour or to avoid an induction or, occasionally on homeopathic medicines such as arnica for perineal bruising. However, this is not a subject that is taught within pre-registration training for midwives and obstetricians, despite the increasing use by the public. Whilst herbal medicine is a self-regulated profession in its own right with graduate level training of at least three years, the issue for birth professionals is not those women who consult medical herbal practitioners but those who wish to use remedies and oils at home, sometimes without adequate knowledge to use them safely.

Many people, including conventionally trained healthcare professionals, believe that because these remedies are “natural” they are also safe – but this is not the case. Anything that has the power to do good also has the potential to do harm if not used appropriately. No remedy is suitable for every expectant, labouring or newly-birthed woman – and many are not suitable at all.

So how can maternity professionals advise expectant parents? Here are some guidelines to help you:


  • All NRs should be treated with the same respect as that given to pharmaceutical drugs.
  • No remedy should be used routinely for prolonged periods of time and NEVER as a replacement for proven medical treatment, especially in the event of an emergency.
  • Women should be advised to avoid ALL NRs before and during pregnancy, labour and breastfeeding unless under the supervision of an appropriately qualified, insured professional.
  • Women should be asked at their first antenatal appointment to reveal if they are using any NRs and their answers recorded in the maternity notes.
  • Women should be advised to seek professional advice on NRs and not to rely on information obtained from the Internet, social and other media or friends and family.
  • Women should be informed that not all NRs are approved, regulated or evidence based. NRs obtained from the Internet may be falsely labelled, contaminated with chemical impurities or contain banned or toxic ingredients.
  • Women should be informed about the possible risks of taking pharmacologically active herbal remedies or using aromatherapy essential oils, including adverse effects such as allergies and interactions with other NRs, prescribed medications or foods.
  • Advise women against combining several different NRs / complementary therapies: take only one remedy at a time, particularly at term when women may seek to expedite labour.
  • Aromatherapy essential oils should not be applied to the skin neat; they should not be taken orally, rectally or used in or around the vaginal opening; keep away from eyes. Avoid using oils in the birthing pool.
  • Pregnant maternity professionals and birthing companions should avoid exposure to (inhalation of)  essential oils intended to promote uterine contractions during labour eg clary sage, jasmine.
  • NRs should be avoided / discontinued in the event of any medical, obstetric or fetal pathology, either pre-existing, gestationally-induced or occurring incidentally during pregnancy, labour or postnatally.
  • Maternity professionals should consider the possibility that deviations from normal progress in pregnancy or labour may be linked to undisclosed use of NRs.
  • Women admitted to the antenatal ward have, by definition, pathological complications requiring medical attention; they must be asked directly if they are self-administering NRs.
  • Women should be advised to discontinue all pharmacologically active NRs (herbal and traditional medicines) at least two weeks prior to elective surgery or dental extraction to reduce the risk of excessive bleeding.


Published : 11/06/2024

Why is it that “money” is a dirty word in the NHS?

Recently, I was teaching aromatherapy and acupressure to midwives at a large London hospital. In the course evaluation, I was accused of being too commercial because I was providing information on my textbooks (offered for sale as a learning resource) and on other courses they could take with Expectancy (in response to direct questions from a few midwives). This was not only distressing but blatantly unfair as I am always conscious of not being overly “sales-y”. This was a group that had been funded by the NHS trust to attend the course – and who were also able to attend it in their work time – so there was no obligation to appreciate the financial element of having the course.

Why is it that “money” is a dirty word in the NHS? Did the midwives think the course was provided free of charge? Did they not recognise that the training not only cost the fees that were paid to Expectancy by the trust but also that the clinical hours “lost” to training had to be replaced with other midwives? Further, did they think I was providing it from a misplaced sense of altruism? Midwives do not seem to understand that everything costs money – and that they are paid for the services they provide in the form of a salary. Just because no money physically changes hands at the point of providing the service does not mean our “customers” (expectant parents) are not paying for it. Healthcare costs the UK over £180 billion a year and is funded largely through taxes - so working people pay for the NHS, including care for those who do not pay tax. However, ask any midwife how much it costs for a spontaneous vaginal birth, a Caesarean, a urine specimen pot or an epidural and no one can tell you – a factor that contributes to huge wastage since employees do not have to take personal responsibility for equipment, medicines and other tools used in client care, unlike in the private sector.

Midwives who choose to go into private practice, whether as independent midwives providing full birth services or in a self-employed capacity offering services such as pregnancy complementary therapies, antenatal classes or tongue-tie division, are often castigated by colleagues because they dare to charge their clients. Yet there are services provided in the private sector that are not available on the NHS – and which some expectant and birthing parents choose to access and to pay for.  Similarly, increasing numbers of midwives are choosing to work outside the NHS – perhaps because they want a better work-life balance or are committed to offering services less accessible in the NHS. This is, as I have said before, about choices.

Prospective clients know that there will be a charge, should they choose to access private services – and it is not a problem for them. If they don’t want to pay it, they don’t become clients. If they become clients, they are happy to pay. Midwives who choose to work for themselves usually find it really difficult to price their services and to ask clients for the money – but they need to tackle this issue if they are going to be successful. If a midwife goes to the hairdresser, she expects to pay the going rate – so why is it so difficult to ask to be paid for the services offered? Obstetricians who work in private practice have no such qualms – although in fairness, they usually have an administrator who actually invoices their clients, effectively removing doctors from actually asking for the money. It would, however, be well worth any midwife considering private practice to have a chat with an obstetrician about this aspect before they set up their business.

Charging a realistic price for services can make the difference for a self-employed midwife between success and failure. Being aware of exactly what it is they are charging for is the first step on this difficult road. Prices are based on costs of training, setting up the business, costs of the actual service equipment and other aspects that have to be factored in – insurances, unpaid holidays of sick leave, legal and accountancy services and much more. On my business training days, we discuss “money” a lot and try to work out realistic pricing strategies so that clients feel they are receiving value for money without being fleeced, and midwives feel appropriately remunerated to fund their lifestyle without the guilt of over-charging. It’s a fine balance, but one that has to be confronted. If you’re considering starting your own business – come and find out how to “get over ” the charging-for-services  hurdle!

 


Published : 10/06/2024

It’s Aromatherapy Awareness Week!

I strongly believe in the power of holistic care for expectant parents and maternity service professionals.

As a midwife, staying updated with the latest advancements in aromatherapy and other complementary therapies is essential.

We recommend updating your aromatherapy knowledge every two years to ensure you provide the best care possible.

Tips for practitioners:

🌸 Start with basic essential oils like lavender and sweet orange for relaxation.

🌸 Integrate aromatherapy into birth care to create a calming environment.

🌸 Stay informed about the latest research on aromatherapy benefits and risks.

Learn new knowledge and skills on our Expectancy Certificate in Midwifery Aromatherapy.


Published : 25/05/2024

Making The Move To Starting Your Own Maternity-Related Business

So … you have decided to set up your own business … but where do you start? It’s vital to research what you want to do and how you want to do it. Don’t be tempted to rush ahead with enthusiasm as this may cause you to make mistakes (which can be costly – professionally, financially, or even legally) or you may find you have to “unpick” something you initiated too early. I have mentored many midwives who become so excited about branching out on their own that they forge ahead with ideas that are only partly thought-through, often with disastrous consequences (I’ve also done it myself in the early days!). Make sure you are deciding on private practice for the right reasons – are you moving towards something better or running away from an untenable situation? 

Once you’ve decided that you really do want to set up your own practice - and having looked honestly at your reasons for doing so - you now need to start by making some concrete plans. Decide on the specific services you wish to provide and consider how you would like to provide them. Take time to think about things, leaving it for a while and going back with fresh eyes once you have had time to consolidate your ideas. Try to identify exactly what you wish to offer – if you don’t know, then neither will your potential clients understand what you are offering. It’s also counter-productive to include too many different elements at the start of your new venture and you need to be flexible enough so that other services can be added later.

When I set up Expectancy, I made the mistake of trying to be all things to all my potential customers. I wanted to offer clinical services to pregnant women, as well as professional courses. Not only did I want to provide education for midwives, but also for doulas, antenatal teachers and therapists. This meant that I was trying to spread myself and my colleagues (and my limited advertising budget) across at least four different markets. Indeed, my adverts were completely unclear because we had tried to have a “one size fits all” leaflet – which just did not work. Everyone was confused – including the team. It was only later that I made the decision to focus solely on offering professional courses preparing the students to provide their own clinical services that it started to make sense. When I finally decided to concentrate entirely on marketing courses and business services for midwives there was a consequent substantial growth in income. If I’d taken time and explored specifically what I wanted to do, I may have achieved success more quickly and more productively. You can’t start everything at once, and your business will develop as you grow.

Discuss your thoughts and plans with your family, your colleagues and, if possible, talk about your ideas with potential users of your services. Is there a market in your area for what you want to offer, and will women pay for it? You will need to be aware of what’s available to women via your local NHS services. For example, if you’ve decided to offer postnatal care and lactation services, be sure that you know how much - or how little – of this is provided by the local maternity services. Similarly, it would be difficult, both in business and professional terms, to offer a service for women who want to avoid induction of labour by accessing complementary therapies if your local maternity unit had already implemented a postdates pregnancy clinic. Perhaps you could start earlier than 40 weeks’ gestation and offer a pre-birth preparation package instead? Research the competition and look at ways in which you may be able to offer something different or better. Which service providers in your area are successful, or more successful than others? Do they have a particular focus on how they market (sell) their services? Are there other midwives or doulas in your area already offering what you are considering?

Taken from Denise’s book The Business of Maternity Care, a guide for midwives and doulas setting up in private practice (Tiran 2019)


Published : 13/05/2024

What Is A Practising Midwife?

Why is it that many midwives believe - incorrectly - that those who are not working in NHS clinical midwifery are not practising midwives? 

 I recently saw a Facebook question asking who had left midwifery and wanting to know what they were doing now. Almost half of respondents actually stated that they had "left" midwifery - yet they were still registered for NHS bank work or had roles that required a midwifery (or nursing) registration, such as safeguarding. There were one or two ex-midwives now working as doulas (in which case they are required to lapse their midwifery registration), but the majority were practising midwives by virtue of still being on the NMC register, even if they were not employed by the NHS.

This disrespect for midwives not working in NHS clinical practice extends across the whole profession. At the recent RCM annual conference, I overheard a midwife joking about a colleague having "gone over to the dark side" ie, into midwifery teaching. When I left the university sector, where I had worked as a midwifery lecturer, to set up Expectancy, I had colleagues wishing me well "on my retirement" - despite the fact I was about to embark on a journey on which I would work harder than ever before. There was even one who implied that I could not possibly be as good a lecturer now I was about to go freelance as I had been the previous week when I had been employed.

Even at the highest levels, there are often comments made about the number of midwives who have "left" the profession. And yes, midwives are leaving the NHS in droves, but they have not all rescinded their midwifery licence to practise. Some move into independent midwifery, whilst others set up their own businesses providing maternity complementary therapies, antenatal education, lactation support or tongue-tied division. Leaving the NHS to work in a self-employed capacity is seen as traitorous by many, and the notion of actually charging for their services is the ultimate treachery. This is despite the fact that these same midwives do not work for nothing in the NHS - they receive a salary.

When I teach business studies to the midwives who join Expectancy to start their own businesses, we spend some time discussing their personal attitudes to becoming self-employed and to physically charging for the work they do. There are some who never quite overcome what I call "the NHS mentality" - and who consequently only achieve a "hobby business" that they enjoy and that gives them some pin money for a few extras in their lives. But there is a growing number of midwives who embrace this new challenge wholeheartedly and who become successful as "endorsed by Expectancy" business owners.

The nature of maternity care is changing and pregnant women are increasingly prepared to pay for what they want. We talk a lot in midwifery about giving women choices - but what about the midwives? Don't they deserve to be able to make choices about the way they work? A qualification in midwifery prepares you to practise midwifery anywhere in the world (subject to local national requirements) and in any setting in which pregnant, birthing or new parents require our support. This includes teaching and private practice. The NHS doesn't own you and charging for your professional midwifery services is not the heinous crime some would infer.

Let's learn to respect ALL our midwifery colleagues wherever and however they choose to work. The term "practising midwife" refers to anyone with a midwifery qualification who - in the UK - is currently registered with the Nursing and Midwifery Council.


Published : 04/05/2024

The Power of Reflexology: Predicting Stages of the Menstrual Cycle

Reflexology is a popular relaxation therapy and often used as a therapeutic technique to ease physiological discomforts of pregnancy and the postnatal period. “Reflexology” is not a single complementary therapy, but a generic term for a wide variety of different modalities. The principle of all types of reflex therapy is that one small area of the body (usually the feet) represents a “map” of the whole, with all parts of the body reflected in that defined area. Almost all styles of reflex therapy focus primarily on using the two feet to represent the “map” or chart of the whole, with every part of the body identifiable on one or both feet, although the precise location of different organs varies considerably between different styles of reflex therapy. The application of manual pressure to specific points aims to induce a sense of relaxation, relieve pain, reduce stress and, with some modalities, to treat specific clinical conditions. By working on these precise points on the feet, impulses are thought to be directed to the various organs, having a physiological effect on that distal part of the body to which the foot point relates.

Most forms of reflexology currently used in the UK, USA and southern Europe are based on modified versions of early 20th century charts. In the 1950’s, a German midwife, Hanne Marquardt, refined reflexology into a dynamic clinical tool for treating various clinical conditions. The Marquardt style of reflex zone therapy (more recently renamed as “reflexotherapy”) is notably different from generic reflexology, with a different “map” of the feet, different terminology, different therapeutic techniques and different pressures. It is commonly used by midwives in Germany, Switzerland, Austria and Scandinavia. RZT is the basis of my personal style of practice which I have taught to many midwives around the world and Expectancy is the only UK organisation offering RZT courses specifically for midwives.  

RZT can be useful from the preconception period to the end of the postnatal period. Regular reflexology treatments allow women to take time for themselves; the accumulative physical and emotional effects assist in preparing them for the birth through a proven reduction in stress levels which automatically increases oxytocin levels. When physical discomforts occur during pregnancy, specific techniques can be used to reduce symptoms such as sickness, backache and sciatica, carpal tunnel syndrome, constipation and oedema. Receiving regular RZT in the final weeks of pregnancy may contribute to spontaneous labour onset, reduced duration of the first stage and greater parental satisfaction.  During labour, it can reduce anxiety, pain and duration of the first stage. 

Many reflexologists claim to be able to “read” the feet and there is growing evidence to suggest a correlation between reflexology points and physiology as well as actual, impending or previous pathology. From my work whilst at the University of Greenwich, I found I was able to identify stages of the menstrual cycle in non-pregnant women, using the foot reflex zones for the reproductive tract and the pituitary gland (a different location from most styles of reflexology, defined by my own research). It is possible to identify in non-pregnant woman with average 28-day menstrual cycles whether they are in the follicular or luteal stage of their cycles, which ovary is active and then to predict the date of onset of the next menstrual period. My results showed a 65-70% success rate and I have since taught midwives on my courses how to do this assessment.  I also adapted the technique to enable an estimation of the onset of labour based on palpation of the two reflex zones for the pituitary gland. Accumulated experience over many years suggests that the pituitary reflex point on the right foot is tender throughout pregnancy, inferring that it is consistent with ongoing anterior pituitary activity. However, the pituitary point on the left foot becomes increasingly tender as term approaches, potentially reflecting the changes in hormonal activity as pregnancy hormones decline and labour hormones increase in readiness for the birth. When the pituitary zone on the woman’s left foot is more tender than (or at least equal to) that on the right, this suggests that labour is imminent, albeit based on a subjective assessment by the woman on the severity of tenderness. The pituitary gland reflex zones are fundamental to midwifery practice of RZT and the primary points to be stimulated for facilitating labour onset. In addition to using this point for postdates pregnancy or to avoid early term induction. It is also useful for encouraging progress in the latent phase of labour, as well as for stalled first stage, retained placenta and, postnatally for lactation, all of which rely on the production of oxytocin. 

If you would like to learn how to use RZT in midwifery, including estimating stages of the menstrual cycle and onset of labour, contactinfo@expectancy.co.uk for details of our Certificate in Midwifery Reflex Zone Therapy commencing 28th September 2024.


Published : 02/05/2024

Aromatherapy in Fife

I can hardly believe that April is almost over. Time has flown by so quickly!

One of my highlights was leading the aromatherapy and acupressure course for postdate pregnancy in Fife, Scotland.

It was wonderful visiting the midwives who are eager to embrace the nurturing aspects of midwifery and to establish a service for women seeking alternatives to induction for being overdue. They are committed to promoting natural birthing processes and reducing medical interventions at the unit.

Twelve enthusiastic midwives are now dedicated to this new initiative!

A special thanks to Louise Hepburn and the group for their warm hospitality. 


Published : 01/05/2024

What has happened to childbirth?

When I teach our postdate pregnancy courses, midwives tell me that term labour is considered to be “overdue” if it has not started spontaneously by 41 weeks and five days gestation or – if you’re lucky – by 42 weeks.

Why are obstetricians – and increasingly, many midwives - so frightened of physiological birth that they feel the need to manage it as a pathological medical condition?  

Why is there such an obstetric dependence on measuring time limits or other numerical markers? Induction rates and other interventions have sky-rocketed, with some units having a 60% induction rate.

There is so much reliance on watching the clock that we are producing midwives who have rarely witnessed an entirely physiological birth. I talk more about the “Institutional Ticking Clock’ in my  blog post.

You can read it here - https://pulse.ly/ukzr1isgag (Photo: Mateus Campos-felipe via Unsplash)


Published : 16/04/2024

Denise looks back

On my first trip to teach obstetricians in Hong Kong in 2001, I visited a typical Chinese medicine clinic, which was a fascinating experience.

Acupuncture was sometimes used as the primary treatment for a condition, sometimes with herbs or massage, and sometimes the patient was referred to the "bone-setter", who appeared to be a sort of Chinese osteopath.

However, on this trip, my medical peers, trained in the West, had mixed feelings, especially witnessing the informal atmosphere of the clinic and unconventional methods of prescribing herbs.

Yet, years later, I've seen Traditional Chinese Medicine (TCM) evolve into a blend of tradition and modernity in clinics across Hong Kong, China, and Taiwan - bustling, professional, and as popular as ever.

With nearly 66,000 hospitals and 19,000 clinics dedicated to Chinese medicine in China by 2019, and an increasing amount of research evidence, it's clear: TCM's impact is profound and growing.


Published : 14/04/2024

Raspberry Leaf – Not A Way To Start Labour

Did you know that raspberry leaf tea (or tablets), one of the most popular herbal remedies used by pregnant women, should not be used to trigger labour contractions? Whilst almost 60% of pregnant women in the western world may be self-administering raspberry leaf, it is of concern that over 50% of midwives, doulas and antenatal educators may be advising women (incorrectly) to take it as a means of avoiding.

The active ingredient is primarily fragarine, which works on smooth muscle and aids cervical ripening. Taking raspberry leaf in the third trimester has been shown to reduce the likelihood of pregnancy going beyond term and may lead to a shorter first stage. Another ingredient, quercetin, is thought to have vasodilatory effects, both on the systemic circulation and the respiratory tract (it is sometimes used for asthma), as well as on other systems containing smooth muscle such as the gastrointestinal tract. Women desperate to avoid induction who start drinking copious amounts of the tea or taking excessive numbers of tablets are more likely to overstimulate the uterus, leading to hypertonic uterine action and fetal distress.

Raspberry leaf should generally be avoided in the first and second trimesters unless prescribed by a qualified medical herbalist, who may use it to prevent or treat threatened miscarriage. However, women should not be advised to wait until 37 weeks’ gestation before commencing it as it is a preparation for birth, toning the muscles of the uterus in readiness for labour. It should be started in the third trimester - one cup of the tea daily, increase gradually to two, then to three a day over three-week period. Overdose has been shown potentially to prolong pregnancy and the duration of the first stage of labour, probably due to the quercetin. The tea can be drunk in labour until well established and in the early postnatal period to aid uterine recovery. Indeed, raspberry leaf should not be discontinued suddenly – the amount should be reduced slowly over two or three weeks to avoid sudden relaxation of the uterus, leading to haemorrhage.

However, when it comes to commercially prepared raspberry leaf tablets or capsules, information via the internet is inconsistent, with advice to take between one and four tablets, with strengths between 35mg to 750mg per tablet. Some sites advise commencing from 30 weeks’ gestation until birth, daily or twice daily, plus, somewhat confusingly, a product marketed as 750mg tablets (no specified daily amount), “suitable for use after the third trimester of pregnancy and beyond birth”. However, the general advice for the capsules seems to be to take between one and two 750 mg tablets daily (approximately equivalent to one to two cups of the tea made from fresh leaves) from about 30-32 weeks’ gestation for the remainder of the pregnancy. Since these are not regulated under medicines law, no medicinal claims can be made, nor are the manufacturers required to provide any further safety advice beyond that required for nutritional supplements in general. As with many products, the “get out” clause on some products may simply state “do not take in pregnancy”, whereas those purporting its value in pregnancy generally do not include any precautions beyond the suggested gestation for commencing the remedy. Many years ago, there was a raspberry leaf product labelled “do not take until two hours before labour” – although I am not sure how you would know when that was!

There are certain expectant parents for whom it is not appropriate, including anyone with medical or obstetric complications, those requiring elective Caesarean for specific indications and – crucially – those with a scar on the uterus from a recent Caesarean (within the last 2-3 years). This latter is a difficult one because so many women wanting a vaginal birth after Caesarean try anything and everything to avoid another operative birth.  Raspberry leaf should not be taken in combination with oxytocic drugs or natural remedies with similar effects such as clary sage aromatherapy oil, castor oil or evening primrose oil which may be used to start labour, nor if there is any smooth muscle condition such as irritable bowel syndrome or hypertension. It appears to have some anticoagulant action so should not be used if a woman is on anticoagulants or other drugs including aspirin and enoxaparin. It can sometimes cause excessively strong Braxton Hicks contractions, in which case it should be reduced – but not stopped suddenly. 


Published : 08/04/2024

The Institutional Ticking Clock: Have We Lost Sight Of What Is Normal?

When does a physiological labour become pathological? When I teach our postdates pregnancy courses, midwives tell me that term labour is considered to be “overdue” if it has not started spontaneously by 41 weeks and five days’ gestation, or – if you’re lucky – by 42 weeks. If you’re unlucky, then the cut-off might be 41 weeks and 2 days. There are also those women who are recommended to have labour induced even before their estimated due date for various medical, obstetric or social indications, occasionally justifiable but frequently questionable, such as high BMI or even – until challenged vociferously – ethnic origin.  Further we have the issue of the definition of “latent phase” of labour, in which any woman whose labour has not become “established” within a certain time limit (variable) is advised to have intervention such as artificial membrane rupture or oxytocic drugs to accelerate the process. Similarly, a “prolonged” third stage is defined as one in which the placenta has not spontaneously separated and been expelled, usually around an hour after the birth of the baby. The concept of a vaginal breech birth or twin delivery is alien to most midwives even though there may be no deviations from physiological progress.

 

What has happened to childbirth? Why are obstetricians – and increasingly, many midwives - so frightened of physiological birth that they feel the need to manage it as a pathological medical condition? Why is there such an obstetric dependence on measuring time limits or other numerical markers? There is, in fact, a difference between the parameters defined by the NHS and those who work outside it. Women who choose home birth, especially with an independent midwife, or those who wish to freebirth, do not rely on these time constraints and labour progresses at its own rate. As a community midwife in the 1980s, I knew of several women whose pregnancies lasted 43 weeks, those who had latent phases of 48 hours or longer and others who had third stages lasting up to four hours (myself included in this latter case, with a first stage of 24 hours at home). Even in the 1990s, an obstetric colleague was happy for some women to wait up to 44 weeks before being advised to have an induction of labour – because he trusted in the ability of a woman’s body to do its own work. 

 

Induction rates and other interventions have sky-rocketed, with some units having a 60% induction rate. This includes one large tertiary unit with 8000 births a year, in which women are coerced into induction for often-unspecified reasons, then has 20-25 women per day who have delayed inductions due to lack of bed space (despite having had the fear of God put into them by forceful doctors or midwives). This is clinical negligence in the extreme, yet the professional governing bodies, the scrutineers such as the Care Quality Commission, and NICE which sets practice guidelines, do not appear to recognise nor acknowledge this, nor do they express any concern for the very real possibility of the cascade of intervention leading to Caesarean section or risks of fetal or maternal morbidity and even mortality. 

 

There is so much reliance on watching the clock, that we are producing midwives who have rarely witnessed a completely physiological birth – and students who are now permitted to record as “normal” a birth in which they may have cared for a woman for the first stage and helped her to birth her baby, but who have had to step aside because a manual removal of placenta is required. If this was not allowed, they would likely never meet their 40 required “normal” births. But these are NOT normal, indeed, neither is a labour in which the third stage is actively managed with drugs to expedite the separation of the placenta, although this has become standard practice. As educators, we are producing midwives who are basically obstetric nurses, who lack the knowledge, understanding and experience to facilitate physiological birth, and the “dumbing down” of educational requirements is complicit in this. Clinicians are putting babies’ and women’s lives at risk, and managers and budget holders are basing decision making on financial and institutional factors rather than clinical factors.  

 

The simple answer is that maternity professionals are scared. In an overworked, blame-throwing, litigation-conscious autocratic and paternalistic maternity service, midwives and obstetricians do “the job”. At the risk of criticism, I would almost – but perhaps not quite yet – say that many midwives are no longer autonomous birth professionals, able to assess progress in pregnancy and birth, to facilitate a woman’s body and mind to grow and birth a baby, to encourage her to make her own decisions based on being given comprehensive information to make an informed choice and to have the confidence to deal with a situation when things do start to go awry.

 

This leads expectant and birthing parents to be scared – but they may not be aware that what they are scared of is not pregnancy and birth. They are scared of the system which attempts to manage them for its own benefits. Yes, we have a totally overburdened workload, we have far more women with complex pregnancies than ever before and a pregnant population that expects a “service” that is individualised and gives them what they want. But those who are assertive enough to express their wishes, especially if those wishes go against NICE guidance and unit policies, are often labelled as “difficult patients” or are told that there are not enough facilities to “allow” them their rights, for example having a home birth on the NHS. Those who do not baulk against the system and who unquestioningly accept what is provided often have unsatisfying experiences which can have a lifelong impact on their relationships with their babies and partners.

 

For all expectant parents, pregnancy and birth has become a battleground that causes immense stresses – the very fact that interferes with the fine balance between stress hormones and birth hormones. Lip service is paid by professionals to relaxing pregnant women and to providing information to answer their myriad questions, despite evidence indicating that these can facilitate physiological birth. Some maternity units provide complementary therapies during first stage labour (primarily aromatherapy) but so much more could be achieved by offering more during pregnancy. We have also largely lost the provision of antenatal education within the NHS, although the increasing number of options for those families who wish to pay for classes is admirable and offers a much-needed service. However, despite this, women mostly give birth in NHS services where the “institutional ticking clock” interferes with parents’ choices – and even with the actions of the most well-intentioned midwives. Let us learn to stand back and facilitate birth from the sidelines for those who progress is within physiological – not institutional – norms.

 


Published : 04/04/2024

Forty Years In The Making! Denise Celebrates A Milestone In Her Career

April 4th marks 40 years since I started teaching midwives. I qualified as a nurse and midwife in the 1970s. After a short time on the labour ward back at St Bartholomew’s Hospital in London,  I was accepted as a “district” midwife in Surrey, which I loved. In 1984 I decided on a change of direction and went into midwifery teaching, starting as an clinical tutor at the Middlesex Hospital in Goodge Street, London (which closed in 2005). Here, I was responsible for the 4-week maternity secondment that all student nurses were required to take, so I had a new group of students every four weeks. I had a little classroom and worked alongside the students in the clinical areas – with a labour ward that had only three rooms.

 

About 18 months later, I moved to the British Hospital for Mothers and Babies (BHMB) in Woolwich, southeast London, where I stayed until going to Surrey University to complete the postgraduate education certificate. BHMB was a wonderful place to work, a tiny, personalised, Christian hospital, where even in 1980s, prayers were still said on the wards every morning. I suppose it was what would be classed as a large birth centre now. We did have an operating theatre, but unfortunately, we didn’t have an anaesthetist or obstetrician onsite. For any emergencies and for the very few elective Caesareans (always scheduled for Fridays), the medical team would come from the Brook Hospital about two miles away. We didn’t have CTG machines or epidurals and students really learned to use all their senses to assess women’s progress in labour. Ultrasound scans were not routine – and not available at BHMB – and we were sometimes faced with sad consequences, such as a baby born with anencephaly (a serious neural tube defect) who died shortly after birth. One of the downsides of these rare occurrences was that everyone was encouraged to go and see the baby and his abnormality – in the sluice. Baby loss was not dealt with as compassionately in the 80s as it is now.

 

Following my time away at the university, I returned to teaching, but BHMB had closed in one of the early rationalisations of the maternity services, so I was sent to Queen Mary’s Hospital at Sidcup (now also closed). It was here that my interest in complementary therapies started and where I was able to develop it as a specialist field in midwifery. Having undertaken a massage course in 1984, I returned to Queen Mary’s and started to teach massage and touch for labour care. I went on to train in reflex zone therapy (a German clinical style of reflexology) and aromatherapy. In 1990, the Greenwich and Bexley schools of midwifery and nursing were incorporated into what became the University of Greenwich and we transferred from being employed by the NHS to become university staff. The benefit of being part of the academic institution was the opportunities to develop areas of interest and expertise and I was able to develop, first, a post-registration module for midwives and nurses on complementary therapies, which evolved into one of the few BSc (Hons) degrees in complementary therapies, which I managed for 14 years. During this time, I also studied other therapies including acupressure and moxibustion, herbal medicine, homeopathy and Bach flower remedies.

 

As part of this work, I established a complementary therapies antenatal teaching clinic at the hospital, where student midwives and those on the degree programme could observe and gain experience in working with pregnant women receiving different therapies. This wasn’t simply a relaxation clinic but offered alternative options for women with problems such as sickness, backache, fear of labour, postdates pregnancy and more. Over a ten-year period (1994-2004), I was privileged to treat almost 6000 women and gained immense experience of combining therapies for different conditions. However, as with any large institution, I eventually became burned out with the university bureaucracy and the changes occurring in the NHS. I was aware of the huge increase in interest amongst the general public in the use of “alternative” or complementary medicine and had been active in some of the national initiatives including the Prince of Wales’s Foundation for Integrated Health. I also knew that midwives in particular were frequently asked about natural options but were unsure where to learn more; conversely, expectant parents wanted to explore these options but didn’t know where to find credible practitioners.

 

I decided to leave the university and set up Expectancy in 2004 to offer academic and professional complementary therapy courses for midwives and birth workers, as well as for therapists wanting to specialise in working with pregnant women. This was, by far, the scariest thing I have ever done, and a real change from being a highly paid principal lecturer in the university sector to having to charge for services and build up from nothing, working in the commercial sector. As far as I know, Expectancy is the only  company in the world offering a unique range of courses on midwifery complementary therapies and has gained a reputation for high calibre university level education that focuses on safety and professional accountability when midwives use complementary therapies in their care of expectant and birthing parents.  I am proud to say that Expectancy celebrates its 20th anniversary on September 4th 2024 – watch this space for more about that later in the year.

 


Previous articles

Safe Use Of Natural Remedies In Pregnancy: Guidelines For Maternity Professionals

Why is it that “money” is a dirty word in the NHS?

It’s Aromatherapy Awareness Week!

Making The Move To Starting Your Own Maternity-Related Business

What Is A Practising Midwife?

The Power of Reflexology: Predicting Stages of the Menstrual Cycle

Aromatherapy in Fife

What has happened to childbirth?

Denise looks back

Raspberry Leaf – Not A Way To Start Labour