Denise and her blog

Transitioning Role From Midwife To Grandmother

My son, Adam and his fiancee, Ninka, are expecting their first baby – or should I say, babies – as they ‘ve found out it is twins! (Ninka is a twin). Until now, I have not been mentally ready to become a grandmother, but it is an exciting time and a new chapter in all our lives. I find myself swaying between the potential joys of grandmothering and the professional concerns as a midwife, although friends tell me it’s the best thing in the world. Their GP warned them that Johannesburg has one of the highest Caesarean rates in the world at 90% in the private sector – with twins, I would think that narrows it down to possibly 99.9%! Thankfully, they have been able to register with a midwife-led birth centre with visiting obstetricians, and currently the fact that it is twins does not seem to be a barrier to continuing their care there. It is a little alarming though to hear Adam and many of his contemporaries say that they don’t mind if they have a Caesarean – almost as if it is a normal expectation of having a baby. More on this later.

Midwifery, Aromatherapy and Natural Birth Under Attack Again

A recent article in The Skeptic (June 2026) has yet again seen fit to lambast midwives, midwifery care, “natural” birth and – of particular interest to me – aromatherapy use by midwives. Granted, this was published online prior to the Ockenden and Amos reports, but is simply more of the same rhetoric against midwives and against women who desire a physiological birth.

I do wish these journalists would get their facts right. Quite frankly, Michael Marshall does not know what he is talking about. He is one of a growing number of journalists and campaigners determined to undermine the maternity services and physiological birth and all that goes with it. He slates water injections for analgesia in labour, incorrectly assuming there is no evidence base, moxibustion for breech presentation (a Chinese technique which he cannot get his head around), homeopathy (there is anecdotal evidence, but I might concede on that one) and – of course – aromatherapy – of which he has absolutely no understanding whatsoever.

Marshall states that “this” (presumably complementary medicine) is an area “in which (he) has a degree of experience” – yes, mainly in demonising centuries-old modalities and being instrumental in the political agenda to have them removed from public accessibility.  He twists facts to suit the political narrative and is ignorant of the evidence that supports these strategies. He states that there is no clear mechanism of action of aromatherapy, despite it having been proven to have a pharmacological mechanism – which is known to have both positive and negative impacts on human physiology. Either it does something or it doesn’t, but if it doesn’t, then how can it have negative effects? Aromatherapy is not simply “nice smells” and a bit of massage: it is a powerful chemical modality, and essential oils continue to be researched by the pharmaceutical companies as potential sources of new drugs.

Apparently, his Freedom of Information request to discover the prevalence of aromatherapy use by NHS midwives uncovered some questionable practices by enthusiastic but ill-informed midwives (about which I have written previously). He quotes NHS expenditure on aromatherapy as anything up to, in one trust, a totally unrealistic £30,000 – even if we account for training, this is at least three times the standard cost (and if the trust has quoted that, there is something inherently wrong). It costs no more than £1,000 a year to provide a midwifery aromatherapy service for women undergoing physiological labour – less than half the cost of a Caesarean section. If we add in around £7,000 to train 24 midwives, and factor that in across three years, plus £3,000 for oils, we are looking at a total of £10,000 or an annual cost of around £3300 – NOT £30,000! So, you only have to save two Caesareans, and the service has paid for itself.

Marshall quotes NICE guidelines as stating that aromatherapy should only be used if women request it, but NICE is part of the same establishment political agenda as Marshall supports. In any case, the NICE publications are guidelines, not directives or legally binding. Heaven forfend that a trust decides to offer an option to women that, allegedly, has no evidence to support it – when there are plenty of obstetric initiatives introduced into maternity services that have little or no evidence to support them. From his FOI request, he has uncovered some practices which, if correct, I would deem inappropriate (such as using midwives using oils for non-pregnancy related conditions such as coughs and colds, which are not part of midwifery aromatherapy) or frankly, unsafe (eg some quoted uses of oils which should be used with care, especially clary sage which should be discontinued once labour is well established and never used with Syntocinon). 

And let’s face it, we are looking at CARE here, in a broken maternity service, where compassion and individualisation has currently left the building. Marshall gives no credence to the use of simple complementary strategies such as massage (part of aromatherapy for which there is considerable evidence) on the physiology of labour and birth. There is plenty of research to show the reduction in cortisol and adrenaline and the corresponding increase in oxytocin and endorphins – and if only he focused on that aspect rather than vilifying something of which he quite obviously has no knowledge, things would be a great deal better.

Marshall is one of those sceptics whose views are based on … absolutely nothing …. except prejudice, misogynistic, anti-physiological opinion. He is, of course, entitled to his opinion but should take care as to how he expresses it. Instead, his frankly dangerous and unfounded lack of factual integrity is counterproductive to the whole intention to improve maternity services. He uses language intended to ridicule claims for the effectiveness and safety of aromatherapy and divert attention away from the things that matter in today’s maternity care. So, he should stop taking on subjects about which he is ignorant and start supporting the changes needed in maternity care to make it a service acceptable to those who use it and those who work in it.  

https://www.skeptic.org.uk/2026/06/aromatherapy-the-nhs-maternity-crisis-and-the-obsession-with-natural-birth/

About Midwifery

What do I love about midwifery? I love what it was when I first started midwifery in the late 70s – totally individualised care, with your own midwife, very little intervention, very few Caesareans – and these were only in extreme circumstances. Midwives were left to care for women without medical oversight. Women stayed in hospital for up to seven days after a “normal” birth and for between ten and fourteen days after Caesarean (right up to the mid-1980s). I remember in one south London unit where I was a midwifery tutor, women who had been in for nine days were encouraged to go out for a meal with their husband and leave the care of the babies to the midwives in the nursery, so they had time on their own before going home the next day. Home births were common although there were increasing hospital births as the 1970s progressed, in line with the Peel Report of 1970. Postnatal care was the envy of the world and when I was a community midwife, we visited on the evening of the day women left hospital, then twice daily for three days, then daily up to ten days then, if necessary weekly up to 28 days. This is probably the aspect that has saddened me most in my career although the massive intervention rate now is – in my opinion – reprehensible, costly, counterproductive to physiology and potentially the beginning of the end for midwifery as I have known it.

What do I love about midwifery teaching? I have actually spent almost all my career in midwifery education, becoming an obstetric tutor in 1980 for student nurses completing their four-week maternity placement, before I went on to take the postgraduate certificate in education to become a bona fide tutor at Greenwich and Bexley school of midwifery (later part of the University of Greenwich). I love seeing student midwives blossom into qualified practitioners and try to impart to them my love of midwifery and my inherent belief that women’s bodies are their own and that they should be able to choose what they want (not told). I love seeing those new midwives thrive and blossom into fantastic caring practitioners, with some going on to make a name for themselves in their chosen specialist fields of the profession.

And what do I hate about midwifery education? I have an absolute despair over the lack of anatomy and physiology knowledge and understanding that underpins safe practice and may make the difference between life and death. The fact that basic aspects - such as biomechanics and relaxation now branded as “hypnobirthing” - were removed from pre-registration education and are now lauded as something special for those interested in post-registration training is very sad and, actually, deplorable.

Personally, having been trained the traditional way of learning “on the job”, I am still not convinced, even quarter of a century later, that midwifery (or nursing) needs to be a graduate programme. Having a degree may encourage critical thinking in some but does not necessarily ensure that graduates have the basic skills to care for women in pregnancy, birth and postnatally, especially with the fight for physiological births and the . changed definition of “normal birth” by the NMC to enable students to achieve their 40 births (or less in some cases). Indeed, with all due respect, some graduates think they are superior simply because they have a degree and the sense of entitlement seen amongst a minority of students simply because they are paying for their course, detracts from the true meaning of a caring profession. Indeed, the universities are complicit in contributing to the current state of the maternity services, with their commercial desire to achieve full cohorts and their somewhat questionable determination to attain the highest number of first-class degrees, often by “dumbing down” on pass marks.

When I was first a lecturer, we had our own set of students, to whom we taught almost the whole syllabus of the training programme. Groups were small (between 8-10 students) and tutors often worked with them in clinical practice – and we maintained our own practice skills. We got to know them and were able to help those struggling. We marked all their written work and saw how some were better able to apply theory to practice than others. And occasionally, we recognised when a student was not really suited to midwifery and could advise them accordingly. Students were expected to work in all clinical areas across the full 24 spectrum of care (there were none with ADHD or other issues that might excuse them from night duty, leaving others to fill the gaps). 

Perhaps what I hate most about contemporary midwifery education is the wastage – students leaving mid-course because it is too taxing, or fabulous students unable to find jobs on qualifying. It is a waste for them, in time and money, a waste for universities and educators, a waste for the maternity services and a waste for parents who could have been cared for by a committed, enthusiastic and caring midwife. 

And I hate the notion that, having been seconded for placements during training in NHS maternity services, there is an embedded misconception that the NHS owns them. It does not, there is no obligation to work in the NHS or complete a preceptorship (which I have said before is a management strategy to ensure appropriate staffing in all areas of the maternity services). However, this is rarely, if ever, addressed in midwifery education. There needs to be more coverage of the whole professional career of midwifery, not just training to staff an overburdened service.

Quality Of Education In Midwifery Complementary Therapies

As many of you know, I have spent over 40 years practising, teaching, researching and writing about the use of complementary therapies in midwifery, with 22 of those years in my own business offering university-level education and training for midwives. I have always stood by my philosophy, on which I gained my reputation, having an absolute focus on safety, professional accountability and evidence-based practice. CTs are so much more than simply relaxation – although we should not dismiss the power of relieving stress and anxiety and the consequent physiological impact on reducing cortisol and increasing oxytocin and endorphins. Different therapies offer options for dealing with the various symptoms of pregnancy, easing pain and aiding progress in labour and helping women recover from the birth and adapt to parenthood.

I like to think I may, over the years, have influenced midwives, obstetricians, birth workers and parents to see the value of complementary therapies (CTs) for pregnancy, birth and the early postnatal period. I was fortunate to work in the university sector for many years, which contributed to making CTs education an academic, research focused discipline in midwifery, whilst my own clinical experience, treating almost 6000 women with CTs, has hopefully grounded the practice of CTs in a women-focused, individualised way. I am proud to have been a pioneer in midwifery CTs since the early 1980s, and have seen many midwives gain the enthusiasm, skills and knowledge to use CTs in their own practice and to spread the word to others. Expectancy is unique, worldwide in providing a wide range of courses on many different therapies and offering academic programmes of study, together with business training for midwives wanting to work in private practice.

Why then, does it worry me to see others offering training in CTs for midwives and birth workers? This is absolutely not about commercial competition at all, this is a concern, from a professional and academic perspective, about the quality of the training, the experience of those teaching and the potential dilution of professional quality that could compromise safe practice. Many midwives who have trained in a therapy can pass on their skills to others, but it is the underpinning academic knowledge and awareness of how CTs fit into contemporary midwifery / maternity care that is so important. We are seeing a plethora of courses set up by midwives with an interest in imparting the value of their therapies to others in the birth field - and some are of very good calibre - but others lack the depth that midwives and birth workers need in order to practise safely.

CTs still incite scepticism and antagonism amongst some of our colleagues, and I have been vilified by some well-known figures in the anti-natural-childbirth lobby. Now, more than ever, the quality of post-registration midwifery education in CTs needs to be faultless. Those who practise must be able to advocate for their therapies. They can do this by demonstrating very sound knowledge based on application of theory to practice and to pregnancy and birth physiology. It is not acceptable to learn skills at academic level 4; there must be level 6 critical understanding of anatomy and physiopathology, chemistry and pharmacology, safe parameters of practice, health and safety laws, the issue pertinent to using CTs not just in physiologically normal pregnancy and birth, but also the use of those therapies within maternity units and birth centres. Those using CTs in maternity care must be able to justify their use (for midwives, in line with national definitions and regulations for practice), must have an appreciation of the good – and the not so good – research findings, and an understanding of local, regional, national and international laws pertaining to CTs and to maternity care.

It concerns me that midwifery managers, keen to reduce interventions and return to physiological birth, rush to introduce therapies such as aromatherapy with little thought of the wider professional and safety issues or the institutional regulations. There is, as with other courses, an unrealistic and unprofessional belief that funding one midwife to attend a CTs course who can then teach everyone else to use that therapy is good use of monies. It is not. This is an accident waiting to happen. We know that learners only retain around 60% of what they are taught. Cascade training means a further dilution of learning and understanding, risking poor practice which can lead to iatrogenic complications, especially in the dynamic episode that is labour and birth. Midwifery managers fail to apprecaite that they also need to understand the safety issues in order to monitor the practice of those midwives actually providing the therapies to women – yet very few trusts in which I have taught have encouraged managers to attend the courses. Those few notable trusts who have included at least one manager on the student list generally do much better in implementing CTs into midwifery care than those who do not.

Whilst, of course, I would love midwives to consider learning with Expectancy, there may be reasons why they actively elect to join courses provided by other organisations or individuals.  Their decision making may be made on convenience, duration, course fees, word of mouth, a preference for a non-assessed course or other factors. So what should you look for in a course that you may be considering? How do you know if the course is credible and appropriate for your needs? And what do yu get from joining an Expectancy course that you may not find elsewhere?

All of Expectancy’s study days, short courses and longer programmes are:

• totally applied directly to midwifery, with an emphasis on safety, professional accountability and evidence-based practice
• taught by senior midwifery lecturers who are fully qualified in the therapies they teach, with extensive experience of implementing and researching CTs in the NHS ornuniversity sector, and who have qualifications and insurance to teach others
• a balance between in-person practice and online theory, which encourages critical thinking and provides midwives with the knowledge and skills to advocate for and justify their use of CTs
• taught and, for longer academic programmes assessed, at academic level 6-7 and accredited by FEDANT so that midwives wanting to work in private practice can obtain indemnity insurance cover 
• acknowledged by senior national midwifery authorities as robust, professional, appropriate and safe for midwifery practice in the NHS and private practice
• renowned, worldwide as the longest-standing internationally-available midwifery pre- and post-registration education in the specialism of CTs, with the widest range of courses across a number of complementary modalities  

If you’d like to join us, we’re now recruiting for the 2026-27 academic year.

Why don’t you request a prospectus contact info@expectancy.co.uk and see what takes your fancy?

We’d love to hear from you.

Safe Maternity Care

Many women ask whether ginger is safe and effective for pregnancy sickness.

While ginger is one of the most commonly used natural remedies for nausea and vomiting, it is important that women receive balanced, information before using any complementary therapy.

As midwives, our role is not simply to recommend or discourage a therapy. It is to help women understand the potential benefits, limitations and considerations so they can make informed decisions.

Natural does not automatically mean safe, and comprehensive knowledge, understanding and an ability to apply theory to practice should always guide our advice.

Safe maternity care starts with informed conversations.

The Publication Of The Ockenden Report

The publication of the Ockenden report into systemic failings in Nottingham is sobering reading. My thoughts go out to those families affected by poor care, institutional issues and serious errors.

However, I fear that the wider effects of this damning report will be to cause a knee-jerk reaction that will exacerbate the fundamental factors that have, at least in part, contributed to the problems in Nottingham and elsewhere.

Above all, in my opinion, is the fact that modern society has lost sight of pregnancy and birth as normal physiological events that women's bodies are designed to achieve. Birth has been medicalised beyond all recognition of what women's bodies have been doing for millennia.. 

In almost 50 years of practising and teaching midwifery, I have seen maternity care ravaged by a paternalistic, risk averse, litigation conscious system that seeks to control birth - and women - not only in the UK, but across the world.

Yes, there are multiple complex, intertwining and possibly irrevocable factors that have led us to where we are now - and a solution to the innate problems of the maternity services is not easy. 

We have an ageing maternity population with much more complex medical issues, women becoming pregnant due to medical advancements, who would never have been able to have children 50 years ago. We have an almost untenable increase in demand for maternity care in a completely overloaded NHS, simply unable to cope. 

Poor staffing is compounded by lack of money to pay for more midwives, whilst conversely midwives are leaving the profession retiring early, changing direction and escaping the toxic, blame-throwing culture of the NHS. Universities are complicit in the issues, commercially recruiting students to a degree for which there are insufficient clinical placements - and no jobs at the end.

The Nursing and Midwifery Council has dumbed down the clinical requirements for midwifery training, changing the definition of "normal" birth to fit the falling numbers of completely physiological births available to students, rather than standing up to the medical establishment and demanding that students are legally required to conduct 40 entirely physiological births. This is akin to the suggestion made recently that we need more operating theatres to accommodate the rising Caesarean levels - instead of looking at how to reduce operative births

We have the contemporary agenda that focuses on BAME women's greater morbidity in childbirth, extending services for non-biological women who are pregnant and adapting to the needs of multicultural immigrants. I fervently believe that ALL maternity service users should be treated as individuals, whatever their colour, creed, religion, sexual preferences, ability, level of education or anything else. We should not single out specific groups as being more vulnerable than others. To do so risks omitting or disadvantaging others. ALL PREGNANCIES MATTER.

Student midwives are taught to attend to the needs of individuals, but they need time to be able to do this well. This requires more staff to accommodate the needs of ALL expectant and birthing parents. Increased staffing requires increased job availability, which is not currently sufficiently funded, leaving newly qualified midwives with nowhere to go.

I could go on, but it is impossible to unwind all the contributing factors that have accumulated over decades. Sadly, however, I fear things are only going to get worse, even if only temporarily. I fear intervention will become more intense in a futile attempt to reduce the issues that have led to increased mortality and morbidity. We will have an even more punitive approach to human errors, a higher managerial backlash to try to shore up a failing, completely inadequate NHS and an even more interventionist approach to pregnancy and childbirth to avoid further deaths.

So what are the answers? It is impossible for one person to address this question and it is not my intention to do so here. However, I would like to see an expansion of midwifery services outside the NHS, with greater options for expectant parents. This means educating students that the NHS is not their only option. A designated career pathway for midwives wishing to work privately is necessary with parameters that allow flexibility and choice whilst protecting parents and professionals.

A return to the fledgling idea of a maternity "passport" with which parents had a say in how their allocated budget could be used, might be a starting point. More education and information for people before and in early pregnancy to outline their options could help. 

And, perhaps, most importantly of all, we need an acknowledgement that childbirth is not a medical condition for most women and that unnecessary, potentially harmful intervention must stop.

More from Denise at the 34th ICM Congress in Lisbon

The 34th ICM Congress in Lisbon has been both thought-provoking and inspiring.

The theme, One Million More Midwives, has highlighted some of the greatest challenges facing our profession globally, and the impact these challenges have on women, babies and families.

Whilst we face significant issues in the UK and other developed countries around intervention, maternity care and the status of midwives, it is humbling to hear the experiences of colleagues working in lower-income countries where access to safe maternity care remains a daily challenge.

Perhaps the most sobering thought is that, somewhere in the world, a woman may die in pregnancy or childbirth in the time it takes to read this post. In some cases, her baby may die too.

These are not just statistics. They are mothers, babies, families and communities.

The One Million More Midwives campaign recognises that investing in midwives is one of the most effective ways to improve outcomes for women and babies worldwide.

Please join me in supporting the campaign and advocating for a stronger midwifery workforce across the globe.

ICM Congress in Lisbon

A wonderful start to the 34th Triennial Congress of the International Confederation of Midwives with a fantastic opening ceremony. The theme this year is ‘One Million More Midwives’.

One of the things I enjoy most about attending international midwifery events is the opportunity to reconnect with friends and colleagues from around the world, whilst also meeting new people who share a passion for improving care for women and families.

It's always inspiring to hear different perspectives, exchange ideas and learn from one another.

Looking forward to the rest of the conference and the conversations still to come.

Birth Preparation

Birth preparation is about far more than packing a hospital bag.

For many women, preparation also means reducing fear, understanding physiology and feeling supported in the decisions they make during pregnancy and birth.

Simple approaches such as relaxation, massage, breathing techniques and appropriate complementary therapies can all help support confidence and calm during the transition to parenthood.

As midwives, we have an important role not only in clinical care, but in helping women feel informed, reassured and empowered throughout the process.

About Birth

Birth is not just physical. It is hormonal, emotional and environmental too.

When women feel calm, supported and safe, the body is better able to produce the hormones that help labour progress physiologically.

This is why environment, communication, reassurance and supportive care matter so much within maternity services.

Complementary approaches such as massage, relaxation and reflexology help reduce stress hormones such as cortisol and support the body’s natural processes by increasing oxyocin and the “feel good” chemicals, endorphins and encephalins.

Thinking Critically

One of the greatest strengths a midwife can have is the confidence to think critically.

Not every trend is evidence-based. Not every intervention is necessary. And not every complementary therapy is automatically safe simply because it is described as “natural”.

Modern midwifery requires a balance of knowledge, clinical judgement and professional accountability.

That means understanding physiology, evaluating research, recognising contraindications and supporting women to make informed decisions about their care.

This is why education matters far beyond qualification. Because the more knowledge we develop, the more confidently and safely we can practise.

We are currently recruiting for our Diploma and Certificate programmes in Midwifery Complementary Therapies, starting 1st October, designed specifically for midwives who want to expand their knowledge safely, professionally and evidence-informed.

Have We Lost Sight Of Physiological Birth?

As a midwife for almost 50 years and having worked as a community midwife in the 1980s, I’ve attended many successful physiological births, at home and in midwife-led birthing units. It is therefore extremely sad to see how much birth has been medicalised in the last 20-30 years. With induction of labour and Caesarean section reaching catastrophically high rates, we now have a generation of midwives and obstetricians with little experience of physiological birth – and little knowledge of normal anatomy and physiology either. There is no trust in a woman’s body to become pregnant, to carry the baby and to give birth without the need for intervention – but let’s face it, it’s what women’s bodies are designed to do. Women and families are also indoctrinated into a system that induces fear that they cannot possibly manage birth without the “expertise” of a midwife - who dutifully agrees to medical intervention at the earliest possible stage.  

The very fact of these unacceptably high intervention rates reduces confidence and competence in student and newly qualified midwives who hardly witness truly physiological birth. Birth should commence spontaneously when the baby is ready to be born, latent phase may take several days, established first stage should proceed without issue and culminate in the birth of a live, healthy, undamaged baby and mother, then expulsion of the placenta and control of haemorrhage occurring spontaneously if left to nature. Very few students witness labours that are left alone - most births are followed by active management of the third stage at the very least. Students are so hell bent on achieving their required 40 “normal” births that they become as mechanised as their more senior colleagues, without any understanding of how physiological birth can be facilitated. I heard of one third-year student accompanying an experienced midwife for a home birth in which the mother chose to birth on all fours, saying “I never realised that babies could be born like that”.  

Added to this, midwives are scared to step outside the “institutional model” in case they are seen as a maverick or disciplined for not toeing the institutional line. They are constrained by litigation-conscious guidelines and are not always able to advocate for women who wish to “birth outside guidance” – and what a ridiculously punitive phrase to describe someone who wants to retain control over their own birthing experience – how dare they?!! Flor Cruz, an insightful American doula, states that “human females have been giving birth long before industrialised obstetrics turned birth into a liability-management business model”. It is so true that birth has become a commodity, a business to be managed efficiently, cost-effectively and with as rapid a turnover as possible. Also we play homage to the so-called evidence-based approach – but only if the research fits the medical model. Woe-betide anyone who quotes evidence to support home birth.

And, despite its best efforts, midwifery pre-registration education no longer adequately prepares students to work within the international definition of midwifery set out by the World Health Organisation and International Confederation of Midwives. Indeed, the NMC standards for education are now so focused on psychosocial aspects of pregnancy and birth that it seems to have lost sight of the need to instil in students exactly what physiological birth actually is. Perhaps the proposed addition of EDI training should also include assertiveness training to aid midwives in challenging the status quo to accommodate the minority of “difficult patients” who want what they want? More importantly, pre-reg programmes should return to providing students with in-depth education on anatomy and physiology – rather than giving them workbooks for self-guided study. I am appalled when teaching qualified midwives that they are unable to apply the principles of A&P to the practise of midwifery – yet this is what constitutes safe practice, especially in labour. 

The removal from midwifery training of aspects which are now seen as optional post-registration professional development is appalling. Biomechanics should not be something added on after qualifying, nor should delivery of antenatal education be seen as something that is a postgraduate skill. I’ve written on numerous occasions of the need for the subject of natural remedies to be included in pre-reg education, particularly the use of herbal remedies such as raspberry leaf, castor oil, clary sage, inappropriate use of ginger for sickness and so much more. As regular readers will know, I do not believe that midwives, at the point of registration, should necessarily be able to practise manual complementary therapies, but lack of knowledge on commonly used natural remedies is leading to unnecessary iatrogenic problems that go unrecognised but which could easily be resolved. On the other hand, including simple elements of complementary therapy such as the use of massage during labour could reduce fear and anxiety, normalising the balance of oxytocin, endorphins and encephalins with stress hormones such as cortisol and adrenaline – this alone could contribute to more physiological progress.

And as for preceptorship – don’t get me started! Preceptorship does not facilitate consolidation of learning and experience for individual midwives. it does not provide a foundation to encourage career development. Preceptorship is an NHS management strategy to ensure that all members of the workforce are capable of working in all clinical areas. I certainly believe that newly qualified midwives should consolidate their learning but not at the expense of their own career to equip an outmoded national health service. In any case, there are, as we know, no jobs available - I recently heard of one trust offering six months preceptorship followed by six months on a zero-hours contract, but a first class honours NQM was told she didn’t have the right credentials. Other NQMs are desperate to secure jobs but may wait two years for one, by which time their knowledge and skills are at risk of being lost, further compounding the lack of understanding of physiological birth.

We all know the NHS maternity services have reached crisis point. The system is broken, almost to the point of no return. Although this is a multifactorial issue that is not easily resolved, there is no awareness amongst managers at all levels of the criminal expense of contemporary interventionist, medicalised, paternalistic, litigation conscious obstetric management and midwifery “care”. We are not caring for student and newly qualified midwives helping them to gain confidence in physiological birth. We are not caring for an over-pressurised staff, that results in huge and increasing attrition, leaving junior colleagues without more experienced support. We are not caring for expectant and birthing parents.  

We need a return to understanding that physiological birth is, for the majority, the way babies should be born. This will protect the human biome, the psychosocial aspects of family life, the profession of midwifery and the costs, staffing and reputation of the maternity services. Bring back physiological birth before it is lost forever!

The Humble Pineapple

Can pineapple help prepare the cervix for labour? New research suggests it may play a role.

I have explored a recent study from Nigeria looking at pineapple consumption in late pregnancy and its possible impact on labour progress.

But as always, evidence needs context. Allergies, diabetes, IBS and other contraindications matter just as much as the headline result.

Because in maternity care, safe advice is never just about what might help and exploring the evidence in favour. It is also about knowing when caution is needed too.

🎥 Watch for a balanced look at the research and what professionals should keep in mind.

Reference: Elendu C et al 2026 The impact of pineapple consumption on cervical ripening and labor outcomes: A Nationwide Retrospective Cohort Study among pregnant women in Nigeria. Medicine (Baltimore) 105(16):e48335

Expanding Midwifery Knowlege

Midwives are expected to know more than ever before.  

Clinical care. Emotional support. Complex decision-making.  

At the same time, women are asking more about complementary approaches to care. But this is not consistently covered in training.  

This creates a gap between what is expected in practice and what midwives feel confident advising on.  

Closing that gap is not optional. It is essential for safe, modern care.

Developing confidence in this area is possible with the right training and support.

Denise Takes Time Out To Recharge

Sometimes the best way to move forward is to step away for a while.

I have recently spent almost three weeks in southern Africa, a part of the world I have loved for many years and always find deeply restorative.

My journey began in Namibia, where I spent time writing my memoirs in the mornings and heading out on afternoon game drives. From leopard tracking to walking tours to see protected rhinos in their natural habitat, it was the perfect balance of focus and perspective.

I then travelled to South Africa to spend time with my son and family, continuing to work on my book in the mornings before enjoying family time and reconnecting with loved ones.

We often talk about supporting the wellbeing of others, but restoring our own energy matters too.

For me, southern Africa has always been a place to reset, reflect and return with renewed clarity.

Global Warming, Pregnancy And Midwifery 

I was fascinated recently to see that the effects of extreme heat were debated at the International Maternal and Newborn Health conference in Nairobi, which included representation from WHO, ICM, UNICEF and other international organisations. Global warming is becoming a critical issue in relation to women’s, babies’ and children’s health, and to the work of midwives around the world.

It is well evidenced that Schumann resonance – the electromagnetic energy of the earth – has increased from around 7.83 Hz to over 8.2 Hz in recent years, and that this rising heat is becoming critical to health and wellbeing. The effect of this heat on human (and animal) health and wellbeing has been discussed for some decades,  and attributed to the huge rise in population 9including people living longer) and the ever-increasing use of technology and electromagnetic forces, transportation and industrialisation, excessive use of chemicals in the atmosphere (in processed foods, in fragrances, cleaning products), uncontrolled viruses such as Covid – and much more. The issue of “electrosmog” from increased use of mobile ‘phones, radio frequencies, electricity, microwaves, ultrasound and more adversely affects sleep patterns, energy levels and mental wellbeing. Stress, which is a source of heat, increases brain vibrations, leading to agitation, anger (becoming “hot tempered”) and increased cortisol and adrenaline, causing hormonal imbalances, whilst the rise of ADHD and dementia in modern society is one of the longer term impacts of global warming.

In reproductive health, increased energetic impulses adversely affect fertility and conception, raising the risk of genetic mutations (heat affects the speed of cell division and mitotic division). Later in pregnancy, excess heat can lead to gestational complications - hypertension, diabetes, preterm labour, stillbirth – and to issues such as ovum implantation, potentially leading to placenta praevia, antepartum haemorrhage and more. Crucially, the abhorrent use of often unnecessary intervention in childbirth is a major source of negative energy for parents, babies and professionals – from CTG monitoring to brightly lit rooms, to increased use of induction, epidural and Caesarean births, with all the technology surrounding this terminal medical management of birth.  For newborn babies, there is an impact on temperature regulation, maturation of the immune system and neurological development.

For midwives, exposure to constant heat in the maternity unit causes dehydration, extreme tiredness and a reduced ability to “think straight” – with the risk of poor decision making. Constantly raised cortisol affects midwives’ mood and cerebral balance, leading to agitated midwives who become short-tempered and who lose their ability to be compassionate. Over time, these issues lead to occupational burnout and, in the long-term, major health issues for midwives – and of course other healthcare professionals. In midwifery education, whilst technology has its place in aiding learning, constant exposure to digitalised equipment, mobile ‘phones, virtual learning resources and – since Covid – online learning, all contribute to additional exposure to heat. 

Clinical midwifery – and antenatal and intrapartum care – have changed out of all recognition since I was first a midwife. There is so much reliance on technology, and consequent loss of basic observation, listening, smelling and other skills that, when well refined, were just as reliable in detecting complications – and midwives were taught how to resolve or manage those complications well before the arrival of medical help. Midwifery “care” – despite good intentions – is no longer as caring as it once was because the “system” does not allow us to care. Caring is a skill which balances the midwife’s brain, reducing cortisol and raising oxytocin, in the same way as it aids physiological progress in the women for whom we care. Addressing the clinical – and learning - environments to minimise sources of heat which adversely affect women, babies and their caregivers is crucial, particularly as some aspects of global warming are outside our direct control.

How do you think you can contribute to reducing heat sources in your workplace?

Expectancy is Worldwide!

Did you know that Expectancy is unique, worldwide, in providing university-level professional and academic courses specifically for midwives on the safe use of complementary therapies in pregnancy, birth and the postnatal period? Expectancy has been offering complementary therapy courses for almost 22 years, in the UK and overseas. I’ve helped NHS midwives to implement aromatherapy, clinical reflexology and moxibustion for breech presentation. I’ve encouraged several hundred midwives to train in both complementary therapies and business studies so they can start their own private practices. And I’ve had the great pleasure of travelling to many countries around the world, including Japan, Hong Kong, Taiwan, China, Iceland, Spain, Norway, Canada and elsewhere, to train midwives in various therapies. I’m immensely proud of the midwives who join our Expectancy Community and who follow their dreams of providing the best possible care to their clients.

A Place For Complementary Therapies

One of the most important principles behind everything I teach at Expectancy is safety and professional accountability.

Complementary therapies in midwifery can sometimes attract scepticism, particularly when they are associated with discussions around physiological or “natural” birth.

That’s why our programmes place such a strong emphasis on evidence-based practice, safety frameworks and professional debate.

Midwives need to be able to explain why they are using a therapy, understand the safety considerations, and practise within the professional boundaries set out in the Nursing and Midwifery Council Code.

This allows midwives to confidently discuss their practice with colleagues, managers and parents - grounded in professional accountability and the best evidence available.

Complementary therapies should never sit outside professional practice.

They should sit within it.

What About Midwives Who Choose To Work Outside Mainstream Midwifery?

I had a great time recently at the Royal College of Midwives’ education and research conference in London. It was good to meet up with friends and colleagues and to debate current issues around midwifery and maternity care. As you might expect, there was a lot of discussion about the ongoing investigations into maternity service problems, and of course, everyone had their views on possible solutions. There were several presentations on equity, diversity and inclusivity and several on the increasing use of artificial intelligence in midwifery education. There was also much talk of the difficulties facing students trying to achieve their required 40 physiological births and, of course, the ongoing problem of intervention in childbirth.

However, it was disappointing to see that the RCM and all the speakers focused only on NHS clinical midwifery or research and on education provided by universities. There was no acknowledgement at all of the growing number of registered midwives choosing to work outside “the system” – independent midwives offering full birth services, midwifery educators providing specialist post-registration training, midwives in private practice offering antenatal education, complementary therapies, tongue tie division and other maternity-related services, midwives working for charities such as BPAS, or for companies that design digital programmes for maternity care or midwives engaged by private companies to undertake research or very senior midwives with national and international reputations offering consultancy services. 

This lack of recognition that midwives can work in many ways in diverse settings is disrespectful to those of us who are self-employed. There is no apparent appreciation that being a registered midwife entitles you to work anywhere in any setting in any field of midwifery as defined by the WHO and ICM, from preconception care and fertility through pregnancy, birth and the postnatal period up to one year after birth. It is as if those who work outside mainstream clinical or educational organisations are “persona non grata” and disregarded in favour of the majority. Is this not a form of discrimination in its own right?

I raised this point on at least two occasions during the conference, including in sessions at which there were several midwifery educators or clinicians who have retired from the university sector or NHS and who are now working in a freelance consultancy capacity. There is an inherent undercurrent of dismissal of those who leave the NHS or higher education systems (even when some of those have given years of service and reached retirement age but who choose to continue working). It is almost as if our treacherous behaviour somehow undermines the value of the NHS or HEIs and that by doing so, we come up lacking credibility. (I remember, over twenty years ago when I left the university to set up Expectancy, a colleague from another university implying that I could not possibly be as good a lecturer as before now I had dared to go it alone.)

Then of course, there is the small matter of freelance midwives actually charging for our services. Chatting with colleagues about the various investigations currently in the news, one fairly senior midwife commented on the apparent hefty fees one authority was “raking in” –  it was not actually a large amount that was quoted - but to an NHS midwife on a salary it obviously seemed like a small fortune. Yet, do NHS midwives work for nothing? Do they offer their services pro bono? Absolutely not – even though they may work plenty of hours of unpaid overtime. It seems, however, that actually having to charge for your services (rather than being paid a salary) is not de rigeur, not in keeping with the philosophy of our free-at-the-point-of-access healthcare system. 

Whilst I completely understand that there are other priorities at present, including Ockenden reviews, the Amos report, ever-increasing intervention rates in childbirth, lack of resources, including staff and a dwindling (retiring) workforce, no jobs for newly qualified midwives and more, it is imperative that our colleagues and the organisations that affect our profession  recognises that the way midwives choose to work is changing – and the way expectant parents want to receive care is also changing and they are prepared to pay for services they cannot find in the NHS. Let’s have a shout out for all those wonderful midwives who are working incredibly hard outside the system – in clinical midwifery, in education and in other areas in which being a registered midwife is a requirement.

Working with The Midwives at Liverpool Woman's NHS Foundation Trust

I’ve just returned from a wonderful few days in Liverpool working with the midwives at Liverpool Women's NHS Foundation Trust.

This was my second visit to provide Expectancy’s 3-day course on Aromatherapy and Acupressure for Postdates Pregnancy, helping midwives expand a specialist clinic designed to support women preparing for birth and potentially reduce the need for induction.

It was fantastic to see such enthusiasm from the 20 midwives attending the training.  

Over the three days we explored:

• Safe use of aromatherapy at term and during labour
• Massage techniques for labour support
• Reflex zone therapy and its diagnostic insights
• Acupressure points to support cervical ripening and labour onset

But the highlight for me was visiting the birth preparation clinic in the midwife-led unit and seeing how the service is being delivered in practice.

The clinic is proving hugely popular, and early audit findings suggest that more women are going into labour spontaneously and requiring fewer interventions.

Most importantly, the midwives are delivering the service with a strong foundation in safety and professional criteria, exactly as we teach on the course.

It was a pleasure to spend time with such a dedicated team and to see the impact they are already having for the women they support.

And now… time to pack my bags for Yorkshire for the next course.

How Things Have Changed In Midwifery

I’ve been a midwife for almost 50 years, starting in the mid-70s at a time when it was all very “Call the Midwife”. We didn’t talk about “physiological birth” or “intervention” – women just got on with being pregnant and giving birth, then adapting to motherhood. Here are a few of the things that have changed in the last 50 years (and how I miss some, but not all of them!)

• The midwife was truly the expert in pregnancy, birth and postnatal care of mother and baby. Once, as a community midwife rushing to a home birth, I arrived to find the GP literally holding the baby’s head in the vagina and stating “I was waiting for you, Sister”!
• Midwives were respected pillars of the community and women always deferred to their advice (they did what they were told!)
• Almost all midwives had trained as nurses and then took additional training – I was in the last group of the one-year post-nursing students
• Students always got their required numbers of normal births; observing the required number of complicated births was more difficult  
• Doctors were absolutely only called in when progress deviated from normal, which was hardly ever; and GPs were much more actively involved in maternity care, as they knew all their patients and cared for the whole family  
• It was quite common for midwives to deliver breech babies, rarely was the obstetrician called

• Women either got pregnant – or they didn’t – there was no fertility treatment (and still variable availability of family planning / contraception services)
• The process of becoming pregnant was never discussed – what happened before reporting to antenatal clinic was in “another life”
• All expectant mothers were called “Mrs” – surveys showed this was their preference, as unmarried women didn’t want to be identified
• Most women didn’t work so could prepare for birth, relax and focus on their new baby without getting completely over-tired; other women in the community always helped out
• Antenatal education (parentcraft) classes involved lectures followed by relaxation sessions (the original “hypnobirthing”); there was usually only one class for fathers, often led by the (male) obstetrician, after which the men would all go down to the pub 

• There were very few inductions, even fewer Caesareans, no CTG monitors (they started to be used in the late 70s, very sparingly).
• Men had only recently started to be welcomed into the birth room; most paced the floors outside the room or went outside to smoke (and patients were still allowed to smoke  in the wards!) 
• We had three types of inhalational analgesia – Entonox, Trilene and another (I can’t remember the name as it was just becoming obsolete when I started); pethidine was only used if absolutely necessary - and there were virtually no epidurals
• Routine enemas and vulval shaving was normal;  episiotomy was only used as a last resort – and was often done as a midline incision, not mediolateral
• Community midwives conducted home births on their own, with the woman in left lateral position and her upper leg balanced over the midwife’s shoulder; if problems arose, we called out the “flying squad”

• Breastfeeding was the norm; stilboestrol was often given to dry up the milk of mothers who didn’t want to breastfeed (rare) or whose babies had died; stilboestrol was banned some years later as it was found to be carcinogenic
• There were no disposable nappies, we used terry towelling, put to soak in Milton after use and then washed in the twin tub washing machine and wrung out by a mangle at the top of the machine 
• Postnatal visits by midwives were done twice a day up to day 3, daily up to day 10, then weekly until 28 days, or longer if the cord had not separated and the umbilicus healed; women waited for the midwife and would not have dared to take the baby out before 10 days!
• The health visitor took over care at 28 days and mothers were encouraged to go to the baby clinic weekly for weighing the baby, feeding, baby care and immunisation advice; the clinic was a place for women to meet and chat, have a cup of tea and get their vitamins
• Most women cared fulltime for their children until at least school age, usually longer; women rarely returned to work after birth, especially as they often got pregnant again quite quickly 
• Postnatal depression was not heard of, or at least never discussed – you just got on with caring for the baby, cooking food, cleaning and putting up with your lot

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

It might sound unrelated - but it isn’t.

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

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

Sometimes the smallest details are part of the safest practice.

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

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

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

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

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

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

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

FAQs

Will this help me support parents more effectively?

That’s always the starting point.

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

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

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

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

Safety and Storage of Essential Oils

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

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

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

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

Aromatherapy can be incredibly supportive when used well.

Complementary Therapies Aren’t About “doing more ”

Complementary therapies aren’t about “doing more.”

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

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

That’s exactly where complementary therapies fit.

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

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

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

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

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

The Reflexology Relaxation Point

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

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

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

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

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

The Benefits Of Using Complementary Therapies In Pregnancy

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

Complementary therapies are often dismissed as “just relaxation.”

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

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

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

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

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

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

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