Denise and her blog

Safe Storage Of Essential Oils In Midwifery Units 

Yet again, the thorny question of storage of essential oils in NHS settings has raised it head. When I teach our aromatherapy courses for NHS midwives, I am often challenged by managers and even pharmacists on my guidelines for storage of oils. I’m sorry to say that this arises from lack of knowledge and understanding of how aromatherapy oils work and how the principles of use must be applied to their use within the institutional settings of maternity units and birth centres, and within the parameters of midwifery practice. 

In my courses, I teach that unopened bottles of essential oils should be stored in a locked cool, dark cupboard. More importantly, all opened bottles (when the seal has been broken) should be stored in a locked refrigerator, separate from the drugs ‘fridge. 

The need to store opened bottles of essential oils in a fridge is a requirement of the aromatherapy organisations and is related to more rapid deterioration of chemicals within the oils when stored in a warm place. Previously, it was thought that only citrus oils such as grapefruit, orange, mandarni etc, should be kept in the fridge as they are known to deteriorate more quickly than most other oils. Deteriorated oils oxidise and chemicals originally in the oils change into other chemicals which can cause toxicities and effects such as allergic reactions. 

The use of essential oils in the NHS MUST be along the same principles of Medicines Management, event though they are not eligible for inclusion in the BNF. They should be treated as drugs both in terms of administration and storage. This requires all medicines to be stored safely ie locked away. Midwives administering oils are also bound by the NMC Code in respect of having adequate knowledge, understanding and practice principles when using aromatherapy.  

The storage of all chemicals in insitutional settings such as the NHS is regulated under COSHH 2002. COSHH requires all staff to take steps to minimise risks associated with chemicals in the workplace, whether cleaning products, medicines or other substances and includes “vapours” such as essential oils.  

The issue of the refrigerator being separate from the drugs fridge is my regulation for added safety in light of the scrutiny of midwifery aromatherapy by CQC and Ockenden review teams. There is no evidence that storing the oils in the drugs fridge does affect the drugs, but neither is there any eviidence that they do not. If ever there was a court case involving aormatherapy use, it would be imposssible to state categorically that the oils did not have an effect on the drugs. Essential oil bottles, even when firmly closed, emit aromas (ie chemicals) once the seal has been broken, so this rule is sensible additional secruity to protect women receiving the oils, women requiring drugs if they have been stored alongside essential oils, other women and other staff who may be exposed to aromatherapy vapours within the unit AND the midwives using either oils OR medicines that have been stored with them.

So, in summary, storing oils in a locked refrigerator, separate from a drugs fridge, is based on the application of knowledge and understanding to midwifery (and pharmaceutical) practice including:

• chemistry of oils and aromas
• medicines management principles
• COSHH regulations
• NMC Code for midwives using aromatherapy oils and those who administer drugs
• ethics – understanding all of the above suggests that midwives must take steps to use aromatherapy and essential oils as cautiously as possible

What Is A Midwife?

It is interesting to see the increasing number of midwives leaving the NHS (even though the fact doesn't seem to free up posts for those who want to stay - but that's a discussion for another day). Midwifery attrition has turned from a trickle to a deluge which seems unstoppable. 

Some who leave are making conscious decisions to move on with their careers or have personal or family issues which dictate a move. Many more appear simply to be deserting the sinking ship of the NHS,  with hopes of finding something better elsewhere. 

There is a trend for these midwives to consider how else they could use their midwifery degrees and experiences. However, this may be done more with a sense of desperation than with any real forethought or understanding that moving from midwifery may entail further training.

The role of the midwife encompasses direct clinical care, research and education. Clinical care ranges from the preconception period to one year after birth. Whilst there are many commonalities and shared skills with other professions, a midwifery qualification does not automatically enable you to move into other professions without further training. I frequently see questions on social media from midwives considering leaving midwifery about whether they can get a job in health visiting or school nursing. Health visiting is a separate profession, albeit strongly linked with midwifery, School nursing is a specialism within the nursing profession, not midwifery. Even other aspects of midwifery such as abortion care, becoming a research midwife or moving into pre- and post-registration midwifery education require further learning and acquisition of new skills. 

I remember during my PGCEA course in preparation for teaching, we had to debate whether midwifery was a profession. In the 1980s we still valued midwifery as a profession with its own body of knowledge and specific skills not shared with other professions or jobs. Unfortunately, we seem to have lost respect for midwifery as a profession - and to many, it IS just a job. The erosion of midwifery, aspects of which are increasingly being taken over by obstetricians or maternity support workers, seems to be leading to an inevitable demise of the profession, despite being one of the oldest in the world.

Induction of labour is the hot topic in maternity care right now.

Rates are sky-high, and with them comes the cascade of intervention we’re all working so hard to avoid.

That’s exactly why I wrote my latest book:

Complementary Therapies for Post-Dates Pregnancy (published late 2023).

It’s written for professionals, but there’s plenty in there for expectant parents too - especially those hoping to avoid medical induction.

When researching the book, I found over 100 traditional methods from around the world for starting labour. Some were evidence-based, like reflexology or acupuncture. Others… less so. (Let’s just say, I won’t be recommending baboon urine or elephant dung - though I did come across them!)

The point is: there’s a huge appetite for natural ways to get labour started. But not every method is safe or appropriate for every person. Often, less is more - and timing, context, and caution matter deeply.  

Whether you’re a midwife, doula, or educator, this book is designed to give you evidence-based, balanced guidance on working with physiology - not overriding it.

Women’s Bodies Are Designed To Give Birth

That’s the one truth I wish every student midwife carried with them from day one.  

Too often, student midwives enter a system where physiological birth is rarely seen - where intervention is the norm, not the exception. And without even realising it, they’re enculturated into a model that assumes the body needs rescuing.

But what if midwifery education started from a different place?

From a foundational belief that the pregnant body is not broken. That birth doesn’t need to be managed, but supported. That we are there to work with physiology, not override it.  

If we grounded our teaching in that truth, we’d raise a generation of midwives who trust the body - and know how to hold space for it to do what it was made to do.

Midwives: did you see physiological birth as a student? How did it shape the way you practise now?

A few words about lavender essential oil

If I had to pick just one essential oil to take to a desert island... it might have to be lavender.
Common lavender – lavandula angustifolia – is a midwife’s best friend. It's deeply relaxing, great for pain relief, and even has antimicrobial properties. I’ve found it incredibly helpful in both pregnancy and labour.
BUT not all lavender oils are created equal! Some types contain chemical compounds that aren’t safe for pregnancy, so it’s really important we stick to common lavender – the safest and most appropriate for use during pregnancy, birth, and beyond.
This kind of detail is exactly why I love what we do at Expectancy. It’s about blending knowledge with safety, and giving us the confidence to use complementary therapies in practice.

Mastering the Business of midwifery

Using Natural Remedies Safely in Pregnancy and Childbirth

Herbs, Homeopathy & Rescue Remedy - are the women you care for asking about natural remedies?

I’ve always had a strong interest in natural approaches to pregnancy, birth, and the early postnatal period.

I’m not alone - up to 80–90% of expectant parents in some areas turn to herbal remedies, especially things like raspberry leaf tea for birth prep or ginger for nausea.

However not everything natural is safe. For example, St John’s Wort can interact dangerously with prescribed antidepressants and shouldn’t be used in pregnancy.

That’s why I wrote this book - a kind of A–Z guide to natural remedies. It covers:

✅ Herbal remedies
✅ Homeopathy
✅ Bach flower remedies (yes, including Rescue Remedy)
✅ Traditional approaches from around the world.

It’s a quick reference tool for midwives, birth workers, or anyone who wants to give balanced, evidence-informed advice to the women they support.
Because when they ask - we need to know.

Impact Of Aromatherapy Oils On Midwives

Safety for midwives using aromatherapy in practice.

Let’s talk about your safety when using aromatherapy in practice.

A midwife recently asked me if prolonged exposure to clary sage during a long labour could have triggered unexpected bleeding - despite her having a contraceptive implant.  

While we can’t say for certain, it is possible.

Clary sage is powerful. I’ve heard of it causing heavy menstrual bleeding in midwives - and even threatened miscarriage in early pregnancy.

And it’s not the only one to watch:
Lavender, geranium, rose = potential hay fever & asthma triggers
Ylang ylang, clary sage = dizziness & fainting
Citrus oils = skin reactions (especially in those sensitive to citrus)

We’re so focused on supporting women with aromatherapy, but let’s not forget to protect ourselves too. The NMC Code reminds us: care and caution apply to everyone in the room - staff included.

Nausea in Pregnancy

Midwives, let’s talk nausea in pregnancy…

There’s nothing quite like that relentless, queasy feeling - and as someone who battled it for 20 weeks, I really get how miserable it can be.

One simple, effective tool I often recommend? Acupressure wristbands - originally made for travel sickness, but incredibly helpful in pregnancy too.

They work by pressing on a specific acupuncture point (three finger-widths up from the wrist crease).  
Pop them on before getting out of bed, and they can make a real difference. And when those waves of nausea hit later in the day, a little extra pressure on the button with your thumb can help ease the symptoms.

Research backs it up - they're low-cost, drug-free, and can be a game-changer for those struggling with nausea (even more than vomiting itself).

Simple, safe, and well worth sharing with your clients.

Feedback

At Expectancy, we pride ourselves on offering training that truly makes a difference to midwives’ practice.

We’re so grateful for the feedback from those who tell us how much they value the depth of knowledge, professionalism, focus on safety and the supportive environment our team brings to every course.

Our aim is simple: to deliver learning that inspires confidence, encourages thoughtful discussion, and helps midwives feel empowered to offer even better care.

Thank you for trusting us to be part of your professional journey - it’s a privilege to support such passionate and dedicated midwives.

Let’s talk about feet

Let’s talk about feet… and how they might just hold the key to supporting pregnancy and birth.

Reflex zone therapy (RZT) on the feet isn’t just a relaxing treatment - it’s a powerful complementary technique grounded in traditional reflexology, but taken a step further.

By working specific zones on the feet, we can help stimulate the body’s own healing responses, support balance in the nervous system, and ease common pregnancy discomforts like nausea, back pain, and anxiety.

At Expectancy, we teach midwives how to use RZT as part of holistic maternity care - whether it’s preparing for labour, supporting emotional wellbeing, or simply helping someone feel more connected to their body.

Because sometimes, the smallest touches can make the biggest difference.

Think clary sage is the best oil to speed up labour?

Think clary sage is the best oil to speed up labour? Think again.

This little bottle might look harmless - and many pregnant women have heard that clary sage can help kickstart labour. And yes, it can stimulate the uterus... but only when used correctly.

As a midwife, you need to know when not to use it just as much as when you can.

✨ Too early? May cause preterm labour – don’t use it before 37 weeks
✨ Too much? It might delay labour instead of getting it started
✨ Used for too long? It could actually cause excessive contractions and fetal distress or eventually stop contractions

Aromatherapy is powerful - but it’s also nuanced. If you’re recommending oils or supporting clients who want to use them, make sure you’ve got the knowledge to do it safely and effectively.

Are You A Procrastinator When It Comes To Revalidation?

How do you keep up to date with your practice? What contributes to your CPD requirements for NMC revalidation? What’s the difference between participatory learning and non-participatory CPD? And how do you decide if a CPD course is suitable?  

All midwives are required by the Nursing and Midwifery Council (NMC) to revalidate every three years in order to remain on the register of practising midwives. They must show evidence of at least 35 hours of continuing professional development (CPD), of which 20 hours must be “participatory”, the rest can be self-guided or “non-participatory”. However, it’s vital to plan your CPD and keep ahead of the game – leaving it until the last minute can be an unnecessary headache and may mean you don’t get your documents to the NMC in time.  

Attending courses or conferences is perhaps the easiest way to demonstrate participatory learning, but these need to be midwifery-specific or have a direct relevance to midwifery practice. Skills updating, mandatory training, RCM i-learn courses - anything from study days to full Masters or PhD studies - contribute to your CPD hours. However, it can be difficult to decide on the calibre and relevance of some potentially suitable CPD activities and the NMC leaves it up to individuals to decide. Midwives erroneously believe that courses must be “accredited” or have the approval of the regulatory body. This is not actually true. Accreditation is a sort of kitemark but, in midwifery, does not always guarantee that a course is suitable for clinical practice, even if it can be used as CPD.   

I am often asked if our courses are accredited by the Royal College of Midwives, yet many midwives do not realise that the RCM no longer approves external courses. Expectancy’s courses were originally university-accredited at a time before degree-level pre-registration education was required. This meant that some midwives were “topping up” from a Diploma of Higher Education to a degree, and our Diploma was accredited for 60 points at academic level 6 to contribute to their top-ups.

Over time, it became unnecessary – and expensive for us and our students - to have university approval, so we sought professional accreditation from the Royal College of Midwives, which continued until 2020. Since then, our courses have been approved by the Federation of Antenatal Educators, essentially as this enables midwives wanting to offer complementary therapies in private practice to obtain professional indemnity insurance. I would advise you to avoid any course falsely claiming to be “RCM accredited” as it shows that the course providers are not up to date, which may indicate out of date course content. This includes specifically some maternity aromatherapy courses that may teach you skills, but which do not include the professional, legal and institutional aspects that are essential to using oils in midwifery practice.

And what about the issue of achieving 450 “practice” hours every three years? “practice” does not have to be clinical practice. Your 450 hours could include teaching, management, receiving or assisting others with clinical supervision. Involvement in research studies, clinical audits or implementing new initiatives are all relevant. Offering private birth preparation, “hypnobirthing” or complementary therapies are direct clinical practice hours – you don’t only have to count your NHS hours. 

Even your own pregnancy experiences can all be classified as CPD learning and possibly practice hours if used in the right way. One of the midwives on our Diploma in Midwifery Complementary Therapies had an extremely distressing personal experience with her fourth baby, because of the way she was treated by midwives and obstetricians trying to dissuade her from having a home birth. She discussed this with me, recorded the hours spent in discussions with care providers and wrote an excellent reflection on her experience, demonstrating what she had learned that she could take back into her own clinical practice – and we used this towards her revalidation.

Finally, here are some tips to help you with your revalidation requirements:

• get organised - don’t leave it until three weeks before your revalidation is due for renewal to remember all the CPD activities you’ve completed in the last three years or to find you don’t have enough “practice hours”
• store any certificates you have – many course providers do not maintain records for more than two years, to comply with GDPR requirements, or may charge a fee for a duplicate certificate 
• keep an ongoing record and store notes and reflections as you go along
• be creative with what you can use towards your 450 “practice hours” – if your personal circumstances mean you are not currently circumstances mean you’ve not been in clinical practice, consider what else may be relevant
• and remember - it’s important to view CPD activities as learning experiences to enhance your practice, rather than as a chore

Did you know that not all reflexology is the same?

There are several different styles of reflexology, where pressure points, commonly on the feet, but sometimes on the hands, face, or even the back relate to different body parts.   

While most are familiar with general reflexology, which focuses on reducing stress hormones and restoring balance, I practice something special called Reflex Zone Therapy.  

This technique, developed by a German midwife in the late 20th century, is much more targeted and can address specific issues like predicting the onset of labour or treating back pain, sciatica, and nausea. It’s intensive, fascinating, and incredibly rewarding for those who want to apply it in midwifery practice.  

Our Certificate in Reflex Zone Therapy (clinical reflexology) starts this September in London. It’s a 10-day programme across the academic year, offering plenty of hands-on practice and in-depth learning about the foot maps. There are additional webinars, tutorials and other online events to supplement your learning. Accredited for NHS and private practice.

Do You Know The Scope Of Your Role As A Midwife?

Midwives frequently question on social media whether they are “allowed” to do certain things within their registration. Can I work outside the NHS? Can I work part-time in the NHS and part-time in private practice? Can I have more than one job? Can I work overseas? The answer to all these questions is a resounding YES!

Qualifying as a midwife provides you with a UK licence from the Nursing and Midwifery Council that enables you to practise anywhere in the world, subject to local and national requirements. You can work in any environment where midwives are required, whether in the NHS or other state-funded healthcare system or in private / independent practice. The World Health Organisation defines the role of the midwife from preconception care to the end of the first year following the birth of the baby, and even though UK midwifery has traditionally focused less on the pre-pregnancy period or that after eight weeks postnatal, the world of midwifery is your oyster.

There are, however, quite a few misconceptions amongst midwives about the definition of a “practising midwife” and what you are allowed to do (and not allowed to do) within the role. It is worth noting that some supposed parameters are not set by the NMC but by local NHS trusts. 

For example, there is no requirement for you to undertake a preceptorship in the NHS – this is an advisable period of consolidation focused on preparing you to work within the NHS. However, the focus on interventionist maternity care does not adequately prepare you if you wish to work in independent practice. 

Similarly, you are not required to rotate around all areas of a maternity service – although it is advisable to consolidate your learning and may help you decide if there is an area of midwifery in which you would like to specialise. But let’s face it, rotation is a managerial strategy to ensure staffing around all areas of the service in the NHS - the movement of midwives from “less essential” postnatal or community care to cover labour ward being a common occurrence. 

I am also often asked by midwives enquiring about our complementary therapy courses whether they need to be a practising midwife, but sometimes they misinterpret this as meaning “ in clinical practice”. The role of the midwife is diverse, from hands-on care of expectant, birthing and newly birthed parents and their babies, to midwifery education, research, publication and many other aspects related to the definition of a midwife. I am a practising midwife – but my “practice” is teaching. We require midwives on our courses to be currently registered with the NMC (and hence a “practising midwife”) even though they are not working in clinical practice or even in the NHS. We offer confirmer services so they can maintain their “practice” hours and to help them navigate the confusing world of revalidation. 

Midwifery is a profession with many specialisms within it. However, there is inadequate preparation for professional progression if you wish to specialise. Indeed, to be cynical, it is not in the interests of NHS management to encourage individuals unless their specialist interests align with contemporary issues – and fit the budget. Complementary therapies is an example of how short-sighted managers can be: rather than seeing the value in providing nurturing care for women and the potential to reduce intervention by helping women to feel less stressed, there is a negative approach to the cost of training, the time required to implement and practice complementary therapies and the misunderstanding of the evidence base for this specialism.

Further, pre-registration midwifery training prepares students almost exclusively for NHS practice and there is rarely, if any, acknowledgement of working outside the system. This is problematic on several levels.

First, students are currently being trained to be obstetric nurses in the NHS. They are not observing or gaining practice in caring for parents having physiological pregnancies – and many are extremely fearful of caring for a woman who wishes to have a physiological birth. A community midwife reported to me that a student’s response to a woman birthing in the all-fours position at a home birth was that she “had never realised that babies could be born if the mother was in that position”. And as for caring for those who wish to birth “outside guidelines” – the fear factor for students and newly qualified NHS midwives is very strong. But whose guidelines are these anyway? Certainly not the parents’. They are NHS guidelines designed to avoid the risk of litigation from expectant parents choosing to direct their own experiences, those who decline treatment approved by NICE or that which is reportedly less well evidenced than standard care. 

Secondly, pre-registration education virtually never acknowledges that a midwifery qualification should prepare you for the option of working in private practice. It is predicated on the misconception that you are training for the NHS (and many midwives believe this). 

Thirdly, there is a continuing mismatch between what is taught in the classroom and what is seen or practised in reality. Education is focused on the ideal, retaining the traditional expansive role of autonomous midwifery at its heart. Yet this is not what students witness or are allowed to practise in the clinical areas. This results in students becoming frustrated that what they learn in theory is not applied in practice, leaving them unable to develop the confidence to  be  self-reliant in their profession (and I don’t just mean independent midwifery here, but being confident and assertive enough within the NHS environment.

Conversely, there seems to be an increasing number of midwives desperate to leave the profession (or maybe NHS midwifery) who are looking towards other professions. It concerns me that midwives think they can move directly into fertility nursing, health visiting, school nursing or paramedic work. Yet, whilst there is some overlap between the skills (and possibly knowledge) required, each of these roles is part of a different profession. As a profession, we would not permit nurses or paramedics to make a direct transition into midwifery without some further training, so why do midwives think they can move across without learning more?

It is sad that many midwives do not understand the full scope of a midwife’s role, in the UK or elsewhere. Midwifery is a wonderful profession with many many ways in which you can work with people planning a pregnancy and progressing through pregnancy, birth and the postnatal period, as well an enabling midwives to feel fulfilled in their work. And you can take the leap if you really want to. There are many experienced independent midwives who would be happy to discuss the move to private practice, there are ways of developing a specialism that aligns with your own interests and philosophy and there are numerous opportunities to work autonomously for the benefit of both parents and midwives.