Denise and her blog

What Should You Learn on a Midwifery Aromatherapy Course? 

Expectancy has been running aromatherapy courses for Midwives for 21 years. I have been teaching aromatherapy for over 40 years, including as part of a BA Honours degree at the University of Greenwich.  My Masters degree focused on the safety of aromatherapy in pregnancy and birth. 

You might find another course, cheaper, better publicised and looking like it's more fun but is it really what you need rather than what you want? Compassionate care is about safe care, so aromatherapy always need to be safe before it's effective. 

The issue for midwives is not about the lovely aromas and a bit of massage. It's about using some aspects of aromatherapy as a specific clinical tool to enhance midwifery care. Furthermore, it's about fitting aromatherapy into the parameters of midwifery practice outlined in the NMC Code, especially since aromatherapy is not a standard part of midwifery practice. It's an additional tool that can be a fabulous complement to midwifery care but it needs to fit in the context of your midwifery registration. 

So, what should an aromatherapy course for midwives cover?

• What is aromatherapy?
• Chemistry of essential oils
• Benefits AND risks of essential oils in pregnancy and birth
• Indications, contradictions and precautions to aromatherapy in pregnancy and birth
• Pharmacology and pharmacokinetics
• Legal aspects of using oils in midwifery and in maternity units and birth centres 
• Professional issues for midwives providing aromatherapy, in the maternity unit, birth centre of home setting
• Health and safety aspects of using oils in the workplace 
• Dealing with complications - and how to minimise the risks
• Professional autonomy when using essential oils 
• Protecting yourself as well as others 
• The practice of aromatherapy - scientific modes of blending, methods of administration - note that this comes after the professional, scientific and safety aspects  have been covered

In Support of Home Birth

I am desperately sorry for the family of the mother and baby who died following a home birth recently. I am also sympathetic towards the midwife and other staff involved in this situation who did their best in difficult circumstances. Whilst it is not my place to comment on the precise details of this case, it seems that the family decided to birth “outside of (NHS) guidance” and allegedly, repeatedly declined to accept advice for transfer to hospital for medical care. 

However, the media has taken it upon itself to castigate the family for its decisions, an unkind reaction for a devastated family, and has concluded that it was the family’s choice of home birth that was “wrong”, sparking yet another furious debate about the risks home birth. In particular, the family’s previous experiences of the maternity services seem to have influenced their choices for the birth of their second child at home.

Having a baby is a normal life event. Women’s bodies are designed to be pregnant and give birth. I had my son, Adam, at home, at the age of 34 - a 24-hour labour and a forceps birth; he weighed 4.3kg. However, the obstetrician and the two midwives who cared for me were friends. They knew me well enough to know that if things started to deviate from physiological progress, I would accept their decisions. And I knew them well enough to know that if they advised transfer to hospital, it was the right decision. We trusted each other and we worked in partnership with one another.

I trained as a midwife in the middle 1970s, only a few years after the Peel report advocated hospital birth for all women, yet we were still emotionally committed to birth at home. As students we learned to recognise when labour progress was deviating from normal and we knew what to do about it. We used techniques which have now been given fancy names (such as “hypnobirthing” and “biomechanics”) – these were a standard part of midwifery practice. We grew to know the families and saw them frequently for both antenatal care and “parentcraft” classes, which served as both an educational opportunity and a social meeting place. As a community midwife, we usually attended births on our own, without mobile ‘phones for added communication with colleagues or satnavs to find our way in the middle of the night.

Home birth is safe – and often safer than having a baby in today’s NHS with its “institutional ticking clock” and the belief that things should progress at a pre-defined pace based on nothing more than management needs for bed space and saving money. This family – and many others - are victims of a disempowering system which made them afraid to have their baby in a maternity unit and who decided that their home, surrounded by their family, was the natural place to give birth. 

Nowhere, in what I have read about this case, has there been any real media acknowledgement of the underlying issues within the NHS which may have contributed to the family’s choices. Issues include coercive (bullying) behaviour from doctors and midwives for a woman to adhere to a particular course of action, staff shortages leading to harassed care providers, the paternalistic and litigation conscious approach to childbirth, the lack of experience of “normal” (physiological) birth amongst more recently qualified midwives and doctors and a blurring of the lines between what is normal and what is not.  

It is time for parents, professionals and the maternity services to reclaim childbirth as a normal human bio-psycho-social event. The public needs to regain its trust in the maternity services and those who care for expectant and birthing women. 

The Power of Essential Oils

When I first started working with essential oils in practice, I knew they could be powerful - but I didn’t realise just how powerful.

A single essential oil can contain over 300 naturally occurring chemicals, each one with its own therapeutic properties.

Some are calming.
Some reduce blood pressure.
Some can actually stimulate contractions.

In midwifery, that’s not just interesting - it’s essential knowledge.

Because when used with confidence and the right training, aromatherapy can genuinely support women through:

🌿 Early labour
🌿 Pain relief
🌿 Nausea
🌿 Anxiety
…and more.

But it’s not something to dabble in lightly. The wrong oil, at the wrong time, can do harm.

That’s why we teach it clinically - so midwives can use aromatherapy safely, professionally, and with real skill.

Worldwide Midwifery Friendships

One of the best parts of my recent trip to Hong Kong? The people.  

It was such a joy to reconnect with colleagues like Elce, Head of the School of Midwifery, and Jessie from the Chinese University of Hong Kong and to share a lunch of wonderful dim sum and laughter, and really inspiring conversation with a wider group of midwives and educators.

There’s something special about sitting around a table with midwives from across the world - different systems, different pressures, but the same passion for physiology, compassion, and safe, woman-centred care.

More soon about the teaching side of the trip, but for now, I’m simply feeling thankful for midwifery friendships that stretch across continents.

Ginger in pregnancy

Ginger in pregnancy?

It’s not always the answer.
Ginger is often suggested for morning sickness - but it’s not right for everyone.
Here’s when ginger might not be safe in pregnancy:
🚫 If there's heartburn (ginger can make it worse)
🚫 If taking blood thinners like aspirin (it can affect clotting)
🚫 If diabetic (ginger may lower blood sugar)
🚫 If there are liver or bowel conditions (ginger can irritate digestion)
And no, ginger biscuits don’t count as a treatment!
Natural doesn’t always mean safe.
That’s why midwives need the right knowledge to give good advice.

Midwives - Adapting To Change

Well, here I am, stuck in my hotel room in Hong Kong. I was due to start teaching the midwives reflex zone therapy this morning, but we're in the middle of a typhoon and everyone's been advised to stay home. It's one of those situations you can't anticipate, but one requiring adaptation and flexibility so I'm rearranging the week's course programme to account for the lost time today.

Midwives are very good at adapting to changing situations in clinical practice, especially during labour when progress deviates from its anticipated course. It's part of what we do, especially when labour is such a dynamic event changing all the time.

But are we as good at adapting to the changing face of maternity care? Change - especially within organisations - brings uncertainty, anxiety, sometimes anger - and sometimes, eventually - hope. And there is no doubt that maternity care is changing - in the way it is delivered, in response to parents' more complex clinical needs and emotional demands and as a result of increasing pathologising of childbirth across the world.

The question is - do midwives want to remain an inherent part of the problem, or become a driver for the solution? Frustration, irritation, taking out our feelings on others or simply withdrawing from the problem is not going to solve it. We have to act. Without Emmeline Pankhurst there would have been no votes for women. Surely, midwives owe it to expectant and birthing parents to fight the issues we are currently experiencing in maternity care?

Some midwives are addressing the issues - influential midwifery professors, researchers, educators and clinicians. But grassroots midwives have the power to influence change too. YOU can challenge the 21st century status quo, the introduction of new initiatives imposed for spurious reasons, budget limitations or defensive practice.

We know - absolutely - that physiological pregnancy and birth is - and should be - the norm. It is what women's bodies are designed to do. Yet midwives are complicit in supporting intervention because they are caught up in the paternalistic medical model, brought about by litigation-conscious government guidelines that control, inhibit choice and imply punitive action if not followed.

So, what can you do to be an agent for change in the maternity care systems around the (westernised) world?

• Be prepared to put your head above the parapet - challenge local and national decisions that affect maternity care, don't be afraid to speak out. Join activist groups campaigning for improvements in maternity care. Challenge NICE guidelines, RCTs that direct care in one (usually medical) direction or local clinical guidelines introduced in a knee-jerk reaction to a one-off situation elsewhere.
• Know your anatomy and physiology - thoroughly - so that you're informed enough to challenge clinical decisions and advocate for the parents in your care. This is fundamental to understanding physiological pregnancy and birth and knowing how deal with untoward events. Poor knowledge, understanding and application of A&P is, in my opinion, one of the main reasons why midwives have almost become obstetric nurses who cannot - or care not - challenge intervention.
• Consider alternative ways of working including full independent midwifery including birth services (contact Zest) or private practice offering antenatal and postnatal care (contact Expectancy). You are NOT tied to the NHS, your NMC licence to practise allows you to work where, when and how you wish, subject to the parameters of the Code.
• Don't think that colleagues who choose to leave the NHS to work in private midwifery practice are leaving the sinking ship. YOU have that choice too. If you prefer to continue in the NHS, do it with a clear remit to aid the changes that are needed - not just those imposed on the maternity services after yet another government think-tank.
• And finally - don't give up. Together, midwives CAN be agents for change, channelling their frustration and dissatisfaction with the current state of the maternity services into demands for a better one. Let's do it!

What Does Is Mean To Study With Expectancy?

I often receive enquiries from midwives who are really keen to add complementary therapies (CTs) to their toolbox of skills, but who expect to learn everything in two or three days. I've even had midwifery managers ask for a single study day for their midwives to learn three therapies!

I always try to help midwives and managers understand that this isn't possible because each therapy is a professional discipline in its own right. They may not be statutorily regulated like midwifery, but the primary CTs professions are rightfully protective of their individuality and their professional autonomy and integrity.

Some therapies such as acupuncture or herbal medicine take up to four years to learn. Most supportive therapies, such as aromatherapy, reflexology or hypnotherapy take a minimum of a year. There is a huge amount of theory as well as practical skills to learn, with assignments and case studies to be completed.

Add in the need to apply the principles of each therapy specifically to midwifery practice, particularly in the institutional setting of a maternity unit or birth centre, and there's even more to learn.

Expectancy's courses are taught and assessed at academic level 6-7, equivalent to the third year of a degree. We have an external examiner who ensures we're working at a level similar to that in universities. There's also a lot of practice to be done at home between study days, as well as reading around the subject.

We use a variety of teaching methods and don't spoon feed you! We encourage you to reflect and to engage in group work to aid your learning. We discuss complementary therapy issues that have arisen in your midwifery practice and focus on applying them to the NMC Code, such as safety of yourself as well as others or the need to escalate concerns.

Our philosophy has an absolute focus on safety and professional accountability, something we reiterate on every study day (ad nauseum, some might say!) However, it's important to acknowledge that CTs are still looked at with scepticism by some people, and it's vital that midwives learning about them acknowledge their boundaries of practice and are able to justify their actions when challenged.

So, if you're interested in joining us to learn how to use CTs in your midwifery practice, either in the NHS, or privately, here's what you can expect:

• Learn from midwifery educators fully qualified in the therapies they teach, with extensive experience of implementing and using them in midwifery practice, both in the NHS, and in private practice
• Join an established training organisation that is unique, worldwide, in offering professional academic courses, with a 21-year history of renowned training specifically for midwives
• Be prepared to study in-depth theory and skills directly applied to safe practice in pregnancy, birth and the postnatal period, whilst also reviewing, refining and adding to your midwifery knowledge, skills and attitude
• A fun learning environment in which you'll not only give treatments but also receive them yourself - often with positive effects on your own physical and emotional wellbeing
• Remember - our courses are first and foremost MIDWIFERY programmes intended to enhance your midwifery care of expectant and birthing parents
• And you'll gain a huge sense of achievement when you complete your programme, knowing that all the effort was worthwhile, setting you up as a midwife who's not only effective but also safe.

We're now finalising our applications for midwives joining our September Diploma in Midwifery CTs, and our Certificate programmes in midwifery aromatherapy, acupuncture, reflexology and clinical hypnosis. 

Contact us NOW to join us.

A little note from me

If you’ve trained with us - or even just followed us for a while - you’ll know that Expectancy is about more than qualifications or course content.

It’s about belief.

I’ve spent decades as a midwife, educator, and author - but more than anything, I believe in you.

I believe in midwives as skilled, compassionate professionals.
I believe in holistic care that respects the whole person.
And I believe we all deserve the confidence and autonomy to practise in ways that feel aligned with our values - even when the system makes that hard.

Expectancy isn’t just about learning a new therapy.

It’s about reconnecting with the midwife you wanted to be when you first started.

If that’s something you’ve been craving - I’d love to welcome you into our community.

The Identity of a Midwife

Midwifery isn’t just a job - it’s an identity.

But sometimes, we need to take the uniform off and remember who we are outside of the role.

Finding time to rest, to laugh, to be with people who aren’t asking you for your opinion on raspberry leaf tea - it matters more than we often admit.

Whether it’s a quiet coffee with a friend, a walk that doesn’t involve answering your phone, or just switching off the midwife brain for a night… you deserve that space.
Midwives give so much. You don’t need to earn rest, or prove you need it.
You just need to take it.
This is your gentle reminder to connect - with others, and with yourself.

Past the Due Date

“I’ll try anything to get things going!”

That’s often what I hear from expectant parents once they go past their due date.

And I understand the frustration - but not all natural remedies are safe, and more doesn’t always mean better.

From reflexology to acupuncture, homeopathy to aromatherapy, there are complementary therapies that may gently support the body as it prepares for labour.  

But it’s all about the right approach, at the right time, and for the right person.

When I researched for my book on post-dates pregnancy, I came across over 100 methods from around the world - some helpful, some questionable, and some downright dangerous or weird (elephant dung, anyone? I don’t recommend it).

✨ The key is knowing what’s safe, appropriate, and rooted in physiology - not panic.

That’s what we teach at Expectancy: how to use complementary therapies professionally to support the body - not override it.

Indemnity Insurance In Private Practice: What Midwives Need To Know

I’ve recently seen a lot of questions about insurance for midwives wanting to move into private practice and it can be very confusing to work out what you need. As you know, it’s a legal requirement, and mandatory under the NMC Code, to have personal professional indemnity insurance (PII). In today’s litigation-conscious world, compensation claims in the NHS have reached an all-time high, with £2.8 billion paid out in 2023-24, of which maternity cases accounted for an astonishing 57%. 

When you work for the NHS, you are covered by its vicarious liability insurance (similar to medical malpractice cover). In cases of possible clinical negligence, the NHS protects its employees (and the organisation) for approved work undertaken on its behalf. If you engage in practices that have not been approved (such as using aromatherapy oils without ratified guidelines), your right to vicarious liability cover may be removed and you would therefore not be covered for any midwifery practice in the trust. Vicarious liability cover does not apply to independent midwives attending women in hospital unless they have a specific (usually honorary) trust contract. You must also have personal PII, a requirement of NMC revalidation.

Medical malpractice insuranceprotects you from claims arising due to your errors, omissions or negligence, including misdiagnosis, medication mistakes, surgical errors (eg episiotomy) etc, plus injury or property damage. However, compensation claims are usually based on an “occurrence” basis – it does not matter when the claim is made (and, under the 1976 Congenital Disabilities Act, obstetric claims can be made up to 25 years after the event) – it is the insurance cover in force at the time of the incident that is relevant. The RCM provides medical malpractice insurance for high-risk labour care but does not offer professional indemnity when working outside the NHS except for “occasional” unpaid episodes such as caring for a friend in labour or helping someone in an emergency.

Personal professional indemnity insurance covers you for errors or omissions in your practice, including advice given to parents, and safeguards you to a certain extent against professional negligence. As with medical malpractice insurance, legal costs for court cases are covered, but the amount may be considerably less than with medical malpractice cover and there are usually further restrictions imposed as part of the cover. PII covers only those compensation claims involving economic losses. If a claim is made against you alleging that your negligence caused physical injury or property damage, PII would not cover you – you need medical malpractice cover for personal injury and public liability cover for property. The RCN provides professional indemnity insurance for full members (see below).

Public liability insurance – PL insurance protects the premises and property in which you work. It will cover you for damage to people’s property (such as spilling aromatherapy oils on someone’s precious rug) as well as injury related to the premises (eg a client injured from falling over a loose step). It is advisable but not mandatory

In private practice, there are several options for professional indemnity cover, depending on the services you provide:

• Royal College of Nursing – you must be a full RCN member to take advantage of its indemnity insurance cover for self-employment, which will also be applicable if you continue working in the NHS (not joint membership combined with RCM). It will, however, cover you for private antenatal and postnatal care, most complementary therapies provided within midwifery services (with a few restrictions) and other services, dependent on your training and CPD. It covers your clinical practice if you are a sole trader orindividually if you have set up a limited company. RCN PII will not cover your business liabilities, including public liability(see below) and cyber protection. Other exclusions include incisions (eg frenulotomy, episiotomy), stand-alone lactation consultancy, massage (unless you have a recognised massage qualification eg Expectancy’s Diploma in Midwifery Complementary Therapies or our Certificate in Midwifery Aromatherapy), homeopathic prescribing, ultrasound scanning or for manufacture or distribution of products (eg selling aromatherapy oils for a MLM company).




SIGNIFICANTLY, RCN PII WILL NOT COVER YOU FOR RETROSPECTIVE CASES whilst a member of the RCM or other union. It is this issue that can be confusing for midwives considering the switch from RCM to RCN and you should clarify the implications of transferring. It is wise to maintain RCM medical malpractice cover for retrospective cases, especially if you have cared for parents who experienced traumatic births, potentially causing maternal injury or who gave birth to babies with possible birth-related injuries. Approximate cost per year £200, and eligible for tax relief – so add it to your self-assessment tax return.

• ZEST - Zest Midwives has arrangements with insurers to provide Healthcare Professional Liability Insurance exclusively for midwives who are ZEST registrants.‍ This covers full independent midwifery practice, including intrapartum care, plus complementary therapies and some other services. Cover is provided for “bodily or mental injury, illness, disease or death of any client caused by negligence, error or omission committed by an independent midwife”. If offering birth services, you pay a premium relating to each birth (currently around £1500), a cost which needs to added to the parents’ fees. Unless you intend to offer birth services, you may prefer RCN indemnity insurance.

• FEDANT – Expectancy’s Diploma and Certificate programmes are accredited by the Federation of Antenatal Educators (FEDANT), membership of which entitles you obtain PII from Balens’ block insurance scheme, for complementary therapies and antenatal and postnatal education. It does not cover you for midwifery care (except parent education). The policy includes professional Indemnity, limited medical malpractice cover, limited public liability and product Liability. FEDANT registration currently costs from £58 a year and insurance is from £47 annually UK or €105 for Ireland; there is a 50% loading for Expectancy’s Certificate in Midwifery Acupuncture. If you do not intend to offer more specific midwifery care / engage in midwifery practice, FEDANT insurance may be sufficient to cover your complementary therapy services.  If you have trained in aspects such as frenulotomy, you will need specialist insurance cover and should discuss this with the relevant training organisation.

• For further information see Tiran 2019 The Business of Maternity Care and www.gov.uk/starting-a-business information. We are now recruiting for our Certificate in Midwifery Business Studies commencing in September.

JOIN OUR UNIQUE COMPLEMENTARY THERAPY COURSES FOR MIDWIVES, UK AND WORLDWIDE

ASK ABOUT OUR EXCITING NEW CERTIFICATE IN MIDWIFERY BUSINESS STUDIES.

Another end to a successful Expectancy academic year

What a lovely way to wrap up the academic year! 🎉

This was the final day for our amazing group of midwives completing the Diploma in Midwifery Complementary Therapies - and we made it a celebration.

✨ A fun quiz (yes, with prizes!)
🧠 Thoughtful group work
🥗 A shared lunch
🌱 And some rich discussion about what’s next…

Most of these brilliant midwives are planning to move into private practice, offering safe, professional complementary therapies to support pregnancy, birth and beyond.

I’m so proud of what they’ve achieved - and excited to see the different ways they’ll carry this work forward into the world.

Here’s to new beginnings, new practices, and midwifery care that honours both evidence and intuition.

STOP USING CLARY SAGE OIL IN LABOUR!

Midwives and doulas have come to think that clary sage is THE aromatherapy oil for labour.

Think of clary sage as "nature's Syntocinon". It's a powerful oil that can be effective for encouraging contractions (when it's appropriate to do so) but can complicate a labour that is progressing well. 

You wouldn't use Syntocinon in well-established labour - so don't use clary sage. It can cause excessively strong contractions, incoordinate uterine action and fetal distress. 

Prolonged use can eventually cause contractions to slow down and even stop through the pharmacological process of hyperpolarisation.

Pregnant staff or visitors should not inhale clary sage vapours as it may cause miscarriage or preterm labour.

It should NEVER be used in a diffuser during labour even in a home birth as continuous use can cause drowsiness (in the partner, baby and midwife as well as the mother)

And don't forget - ALL aromatherapy should be discontinued by the start of the second stage to avoid exposing the baby to oil vapours.

And clary sage should NOT be used for retained placenta, especially if the placenta is partially or fully separated as it can cause cervical constriction, and lead to torrential haemorrhage. 

If you are trained to use selected aromatherapy oils in labour there are plenty of others you can use to aid relaxation and relieve pain - lavender, frankincense, rose or orange oils are all very effective and smell great.

Know your facts before using aromatherapy - and stop using clary sage!

Our Annual Licensed Consultants Day in London

A fabulous day recently spent with some truly inspiring midwives!

Our annual Licensed Consultants’ networking day brought together midwives from across the country - some already offering maternity-focused complementary therapy services, others just about to begin their journey.

It’s always such a joy to spend time with this group: thoughtful, skilled, and committed to making maternity care more holistic, respectful, and woman-centred.

Whether they’re supporting families with aromatherapy, acupuncture, reflexology, or clinical hypnosis, each midwife brings their own unique approach - and I’m so proud to be part of their next chapter.

Here’s to another year of safe, professional, and heart-led complementary therapy in midwifery practice!

Essential Oil Chemisty

Did you know that every essential oil contains up to 300 different chemicals?

Each one in a unique blend - and each with its own physiological effect.

Some are calming.
Some are stimulating.
Some lower blood pressure.
Others raise it.

A few can even help with pain.

But here’s the key:

👉 Not all essential oils are safe to use in pregnancy or birth.

This is what makes aromatherapy so fascinating, but also why it needs to be used with real understanding and caution in midwifery.

Knowing which oils are safe - and which are not - isn’t just nice to know.

It’s essential knowledge for safe practice.

🌿 If you're curious about deepening your understanding of aromatherapy in maternity care, Expectancy’s training has you covered.

The Northern Maternity & Midwifery Festival 8th July 2025

What a brilliant day in Manchester yesterday!

The Northern Maternity & Midwifery Festival never disappoints - so many inspiring conversations, thoughtful questions, and passionate midwives all in one place. 💛

Thank you to everyone who stopped by to chat, shared their stories, or asked about how complementary therapies can fit safely and professionally into midwifery care.

There’s such a hunger for change in our profession - real, grounded, holistic care that supports everyone in the system.

If you picked up one of our leaflets, joined the mailing list, or left wanting to know more about our training - please do reach out. I’d love to keep the conversation going.

Until next time, Manchester 👋

Using Natural Remedies Safely in Pregnancy and Childbirth

Are the people you care for asking about ginger for nausea, raspberry leaf for labour prep - or maybe Rescue Remedy for anxiety?

You’re not imagining it. In some areas, up to 80–90% of expectant families explore natural remedies during pregnancy.

I’ve always been fascinated by these approaches - from herbs to homeopathy - and how they can sit alongside midwifery care. But we have to remember: natural doesn’t always mean safe.

Take St John’s Wort, for example. It’s often used for low mood but can dangerously interact with antidepressants - and it’s not suitable in pregnancy.

That’s exactly why I wrote this book - an A–Z style guide for midwives, doulas, and birth workers. It covers:

✅ Common herbal remedies
✅ Homeopathic approaches
✅ Bach flower remedies
✅ Global traditional practices

It’s there to help you feel confident offering informed, balanced advice - because when questions come (and they will), it’s so important we’re ready with safe, sensible answers.

Book Available via this website.

Expectancy Monthly Newsletter

I’m really excited to share this... We’re launching the Expectancy monthly newsletter! 🎉

It’s designed for midwives, doulas, birth workers, and anyone interested in exploring maternity complementary therapies through a professional lens.

Each month, I’ll be sharing:

🌿 Evidence-based insights
🧠 Clinical reflections
📚 Course updates
🛠️ Practical tools you can use straight away

If you're curious about how therapies like aromatherapy, hypnosis, acupuncture or reflexology fit into maternity care (ethically, safely, and effectively) - this is for you.

Follow the link below to sign up and be the first to receive it.

https://expectancy.myflodesk.com/zintmx8av2

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.