Denise and her blog


Dr Denise Tiran HonDUniv FRCM, is an international authority on midwifery complementary therapies.

Watch our video and read Denise's blog for all the latest on complementary therapies and maternity care.


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Testimonials and Compliments

Published : 20/07/2021

It’s great to receive compliments and testimonials!

‘I have really enjoyed studying the Diploma in Midwifery Complementary Therapies. Working alongside Denise has been a real privilege, she is a real inspiration and a transformational midwife. I feel focused and motivated to approach my new midwifery career after being guided, supported and skilled by Expectancy.’ Nicola Rai

‘Dr Denise Tiran is simply the most knowledgeable and experienced authority on the subject of midwifery complementary therapies, and I feel extremely privileged to have been a student with Expectancy.’ Alexis Stickland

‘A professional and academic course with lecturers who are also clinicians who share a passion for alternatives to NHS midwifery care.’ Becky Franklin

‘I have thoroughly enjoyed learning with Expectancy and being part of a like-minded community of midwives to be able to develop myself to offer better support for women.’ Charlotte Williams

‘The Diploma is a holistic course aimed at offering women naturally safe options for both their own and their infants’ wellbeing.’ Nicki Hennighan



Watch Out For Your Pets

Published : 12/07/2021

Denise saw a question from someone planning a home birth about whether she could have her cat and dog with her. The family also wanted to use an aromatherapy difuser during the first stage. But did you know that aromatherapy oils can be toxic to cats and dogs? If an animal inhales the aromas, or if oil comes into contact with the skin, or if the animal ingests the oil (such as licking it off the skin or drinking spilled oil from the floor) it can cause serious side effects. Cats are particularly badly affected because they lack an enzyme needed to metabolise the oils, so the oils can cause liver problems or cause death. Birds, fish and reptiles can also be badly affected. Denise once had a midwife on one of her courses who had been told by the vet that oils would affect her pet iguana! The most significant oils include tea tree, eucalyptus, cinnamon, ylang ylang, peppermint, citrus oils and others. Don't use diffusers in the areas where your animals go - it could be fatal.



Homeopathic Remedies

Published : 09/07/2021

Did you know that homeopathic remedies, such as arnica, are chemically very fragile and can be inactivated by strong aromas from essential oils, moxa sticks, Deep Heat and Vicks vapour rub? Expectant parents using homeopathic remedies during pregnancy should also avoid drinking coffee, using mint flavoured toothpaste and chewing mint gum. Homeopathic remedies should not be stored near aromatherapy oils, microwave ovens or mobile 'phones. Birthing parents wanting to take homeopathic remedies during labour should not use aromatherapy.



Course Update

Published : 02/07/2021

It's day 2 of our latest postdates pregancy online course today for an NHS trust, and Denise will be talking about natural remedies before Amanda takes over to teach the acupressure. Denise says: 

It's worrying when I hear midwives advising parents to try a whole range of natural remedies to start labour, without giving them any advice about how to use them, and without having assessed whether it is appropriate for the individual. All herbal remedies - such as raspberry leaf, clary sage, evening primrose, castor oil - have their benefits but they also have risks if taken inappropriately. Importantly, they should not be combined - this is likely to cause more problems with labour, not fewer. Searching some Facebook pages this morning, I see women are using up to four times the recommended dose of some remedies - such as evening primrose oil - either because they've been given the wrong information or because they've not been given enough information. 

Midwives, doulas, antenatal teachers and other birth workers must offer comprehensive advice to enable parents to make informed choices about natural remedies. This includes information on:

  • What the remedy is 
  • How it works
  • Correct dosage
  • Method of administration
  • Frequency and duration of use
  • When not to take it
  • Possible side effects
  • Success rates based on evidence where possible.
  • Recording in the notes the information that is given 

And if professionals cannot give this information they should refrain from advising on the remedies. Continuing to do so without adequate knowledge and understanding is as risky as coercing women into induction when their bodies are not ready - and can equally lead to a cascade of intervention. Giving incorrect or incomplete information jeopardises not only the wellbeing of mother and baby but also the registration of the midwife if their advice leads to complications.

 



The "Negativity" Of Safety Information On Complementary Therapies

Published : 28/06/2021

I was concerned this week to have a midwife on one of our online postdates pregnancy courses repeatedly challenge what she perceived as the "negativity" of the session on the risks of self-help natural remedies used by women to start labour (raspberry leaf, clary sage,  pineapple, castor oil etc). We were discussing the possible complications  of these popular remedies and when not to use them - such as in conjunction with medical induction of labour. The issue was not that she had raised the point but that she did not seem to understand the need for midwives to know about the risks in order to advise parents appropriately.

Of even more concern was that this midwife was a manager, yet all she wanted from the course was a "how to do it" on using aromatherapy and acupressure for postdates pregnancy. This is what, in academic terms, is called level 4 thinking, or being a "knowledgeable doer" without the underpinning theoretical understanding that comes with level 6 learning and evidence-based practice. This attitude is particularly prevalent when it comes to learning about complementary therapies in midwifery and reinforces the incorrect and dangerous belief that "natural" equals "safe". It is not enough for midwives only to learn how to mix and administer oils or use pressure points to stimulate contractions. It is vital to appreciate the safety aspects of what we do - even more so perhaps when it comes to complementary therapies as opposed to other aspects of practice. If something has the power to do good, it also has the power to do harm when not used appropriately. We need to know about the risks, both for our own practice and to ensure the advice we give to parents is correct, comprehensive, balanced and evidence-based, so that they can make informed decisions about whether or not to use the remedies and therapies.

Complementary therapies are often denigrated as not being sufficiently evidence-based or not fitting with conventional maternity care options. There is some truth in this although I would not have been teaching the subject to midwives for all these years of I didn't feel we could overcome that and promote the therapies as adding beneficial elements to the care of expectant and birthing parents. However, whilst even midwifery managers remain ignorant of the need to balance the benefits of complentary therapies with some understanding of the risks, we are not going to validate the subject as worthy of being part of standard midwifery practice and safe care of parents. We also risk parents' and babies' wellbeing by not knowing where to draw the line between enjoying the therapies and enjoying them so much that we cause harm. 

I have written before about compassionate care and the Human Factors issues in relation to complementary therapies. It is not compassionate or caring to use complementary therapies in a "doing" way without understanding the risks of inappropriate use. Midwives need to get past the "niceness" of introducing complementary therapies into their care and start appreciating the balanced and caring approach that an understanding of possible contraindications, precautions, side effects and complications if therapies are not used correctly.

That midwifery manager needs to re-evaluate her managerial responsibilities to staff for whom she is responsible and for parents in her care to ensure midwives are able to offer complementary therapies safely in her unit.



Has Hypnobirthing Had Its Day?

Published : 21/06/2021

Here Denise explores some of the issues of teaching  birth preparation for expectant parents via the original  "hypnobirthing" method.She says: 

I recently read a Facebook post from a midwife questioning whether "hypnobirthing" could contribute to birth trauma rather than reducing it.  I have to agree with her that the emphasis on expecting birth to be pain-free is not helpful to those in labour who actually DO feel pain despite having learned "hypnobirthing". The essential  intense, repetitive, increasingly powerful muscular contractions of the uterus aid the birth process, and like any exercise, everyone experiences it in different ways. Labour is a biological process that, whilst being natural, is a rite of passage for women that CAN be painful - and has been since time immemorial. 

What contributes to birth being perceived as more painful than it might be is the psychosocial impact of western society, the medicalisation of childbirth  and the  contemporary emphasis on "doing it right". "Pain" is a dirty word in "hypnobirthing" classes which sometimes focus so much on imbuing a sense of denial of pain that it can be a real shock when labour is found not to be quite what the parents expected. This can lead to emotional trauma that may have long term consequences including mental ill health, poor bonding with the baby and fear of embarking on another pregnancy.

Further, "hypnobirthing" can place a barrier between mothers and midwives that is unhelpful and unnecessary. Midwives are there to work in partnership with parents, to be their advocates and to guide them through a life event that can make them feel out of control, especially in hospital. Parents enter labour already viewing the midwife as "the  enemy", which increases their stress and further contributes to perceiving  birth as painful. Some "hypnobirthing" teachers are so anti-establishment that they increase parents' fear of the birth process and the (lack of) care they may receive from midwives. 

Birth preparation classes started in the 1950s when Grantly Dick-Read introduced his "birth without fear" principles - and those of "hypnobirthing" are very similar. I have every support for these principles. I taught them myself as a community midwife in the 1980s, long before Mongan coined the now-trendy name of "hypnobirthing" - which is something of a misnomer since it is not actually hypnosis. 

Other companies have come along more recently with "new" approaches to birth preparation - but they are all the same under the skin. They provide information and advice, suggestions for physical and mental preparation for birth and parenthood and, in groups, an opportunity to meet other expectant parents. Unfortunately, the demise of much NHS provision of antenatal classes has meant midwives are more and more excluded from birth preparation - which has given these companies inroads into teaching commercially-labelled systems. 

There is nothing inherently wrong with any of these systems but let's be honest about what it is we're trying to do - to help expectant parents. Let's stop being divisive, with "hypnobirthing" teachers implying that they have all the answers to a failing NHS maternity service which no longer has time to address the fears and anxieties of its "customers".

Many midwives are moving away from the inflexibility of the original "hypnobirthing" method, adapting the basic principles to be more individualised, and dismissing the notion that birth can always be pain free. We should be honest about birth and help parents to learn strategies to cope with the pain, not to imagine that there will be none. Pain in labour is NOT a negative issue - it is the way we deal with it that is negative. We need to look closely at the long term adverse impact of unrealistic ideas and consider ways that enable parents to embrace birth and to feel a sense of achievement of having coped with whatever happens, whether it is painful or not. 

 



Seaweed For Postdates Pregnancy?

Published : 15/06/2021

Did you know that seaweed was previously used as a means of dilating the cervix in postdates pregnancy? Laminaria is an algae from seaweed, also known as kelp or kombu. It wastraditionally used to facilitate labour, and remains popular in the USA.


Laminaria has the ability to form a viscous gel in water, and laminaria "tents" are inserted intra-cervically to absorb ambient moisture, gradually swelling to 1 cm diameter over 4-6 hours. This may be due to the presence of a foreign body in the cervix initiating prostaglandin release, or possibly due to a high content of arachidonic acid, a prostaglandin precursor.

However, it can cause pelvic cramping and cervical bleeding and has been associated with fetal hypoxia and intrauterine death. Also, the “tents” can fragment and be retained in the cervical or vaginal canal, causing cervical wall rupture and infection. 

Reearch on laminaria shows it is not significantly effective although it may reduce the need for medical induction. The new NICE guideline on induction of labour states that there is insufficient evidence to support its use in postdates pregnancy.



Ten Tips For Midwives Looking For Complementary Therapy Courses

Published : 12/06/2021

The number of midwives - and NHS trusts - considering complementary therapy training is at an all-time high.

The interest in incorporating aromatherapy, acupuncture, reflexology, hypnosis and moxibustion into midwifery care appears to be a direct consequence of the out-of-control medical management of pregnancy and birth. 

But how do you know whether the complementary therapy courses you find are adequate and appropriate for midwives? It's certainly not necessary to be fully qualified in a therapy - and to be honest it's a bit of a waste of time and money to learn how to use aromatherapy, acupuncture or other therapies for non-pregnant women, for men, the elderly or people with cancer. On the other hand, remember that each therapy is a professional discipline in its own right, and midwives cannot expect to know everything after a short introductory course. More importantly, midwives must set the use of complementary therapies in the context of midwifery practice, the NHS and the laws and directives that govern our practice as midwives.

So here's our top ten tips to choosing an appropriate course so you can include complementary therapies in your midwifery care: 

1) Is the course accredited by the Royal College of Midwives or other relevant organisation such as the Federation of Antenatal Educators? (It does not have to be accredited by the therapy's regulatory body)

2) Are the teachers experienced midwives, fully qualified in the therapy, with teaching qualifications that provide them with insurance to teach the therapy? (check where, and with whom, they themselves trained)

3) Do the teachers have at least five years' experience of practising the therapy in midwifery, including having implemented the therapy into an NHS setting, as well as at least five years' experience of teaching the therapy to midwives? 

4) Is the course taught and assessed at academic level 6 so you understand how to apply principles of the therapy to midwifery practice? (This is very different from an academic level 4 course that just teaches you skills without ensuring understanding)

5) Does the course include the relevant physiology and other sciences (eg chemistry, anatomy, neurology) to aid your understanding of the therapy, especially in pregnancy and birth?

6) Will you learn enough about the safety - contraindications, precautions, side effects, complications and institutional Health and Safety regulations - to give you the confidence to practise the therapy safely?

7) How much attention is given during the course to the Nursing and Midwifery Council Code, other relevant midwifery documents such as medicines management, and the process of  change management to help you implement the therapy appropriately?

8) Is there an emphasis on evidence-based practice - do the teachers have experience of researching complementary therapies in relation to pregnancy and birth?

9) What requirements and provisions are there for continuing professional development in the use of the therapy in midwifery, in accordance with the NMC Code?

10) If you want to offer the therapy in private practice, does the course accreditation provide you with the option to obtain appropriate personal professional indemnity insurance? (This is different from the RCM's medical malpractice insurance)



The Dangers Of Passing It On

Published : 06/06/2021

Today, Denise was asked by a midwife who had completed Expectancy’s aromatherapy training, if it’s acceptable to give a telephone consultation to another midwife, not trained in aromatherapy, to enable the non-trained midwife to blend and administer aromatherapy to a birthing person. Denise says: 

The answer, I’m afraid, is a resounding “NO”. Midwives need to think about this in the same way as medicines management, their Nursing and Midwifery Council registration and the trust’s vicarious liability insurance. Midwives would not provide a ‘phone consultation to a midwife about a birthing woman she has not met, then prescribe drugs and allow another midwife to dispense and administer them – and the same applies to aromatherapy oils. If you are actually on-site you could do a face to face consultation with the mother,  prescribe and blend the oils, leaving a non-trained midwife, student or support worker to administer them under your direction. You cannot be on the community (off-site) or off duty (invalidates your right to vicarious liability insurance) – you must be accessible in case the mother has an adverse reaction so you can deal with it. YOU are accountable for the use of aromatherapy oils (chemicals in the workplace, classified under Health and Safety regulations). If the non-trained midwife makes a mistake, it is YOUR NMC registration that may be in jeopardy as well as theirs. Midwives who are not  trained in aromatherapy are NOT permitted to choose (prescribe) or blend (dispense) the oils. The best thing is for those midwives not yet trained to use just carrier oil and provide basic massage, although they must be trained sufficiently to understand any contraindications and precautions and how to record the massage treatment in the notes.



When Will Nice Stop Categorising All Complementary Therapies As “Non-Pharmacological”?

Published : 01/06/2021

Denise continues to challenge NICE on its inaccuracies when it comes to complementary and alternative medicine. She says:

Having recently seen the revised NICE guideline on induction of labour, currently out for national consultation, I was disappointed - but not surprised - to see a paltry single paragraph on the use of more natural methods to aid labour onset. Basically their stance is that there is insufficient evidence to support the use of almost all complementary therapies (CTs) although they singularly fail to include aromatherapy, one of the most commonly-used methods of encourage contractions, despite a growing body of randomised controlled trials to support its use. 

Further, NICE erroneously refers to CTs as “non-pharmacological”. The term “pharmacological” refers to the uses, effects and modes of action of drugs and other chemical substances. Manual therapies such as reflexology and massage, energy-based modalities including acupuncture and homeopathy, and psychological therapies such as clinical hypnosis ARE non-pharmacological as they have different mechanisms of action. However, ALL herbal medicines and aromatherapy oils act in exactly the same way as medicines, being absorbed, distributed, metabolised and excreted, and are, therefore, definitely “pharmacological”. They can interact with drugs and other herbal remedies, and can have serious toxic effects in some cases.

Not only is NICE wrong, but this continued use of terminology that belittles the clinical power of complementary modalities, that do not fit with the politically powerful medical profession’s dominance, is potentially unsafe. Until the medical and allied professions, including midwives, nurses, paramedics, physiotherapists etc, understand the risks of herbal medicines and essential oils when used inappropriately, we will continue to encounter real clinical issues. For example, overuse of raspberry leaf tea has a dose-dependent effect that  prolongs rather than shortens pregnancy, and excessive use of clary sage oil in labour can cause cessation of contractions rather than facilitating them.

For more information see Denise’s book, Using Natural Remedies Safely in Pregnancy and Childbirth (2021).



Essential Oil Responsibilities

Published : 25/05/2021

WHO IS RESPONSIBLE FOR PROVIDING ESSENTIAL OILS WHEN MIDWIVES OFFER AROMATHERAPY FOR BIRTH? Denise was very concerned today to hear from a midwife working in a trust in which aromatherapy is offered in the birth centre, but whose community midwives apparently have to purchase their own oils if providing aromatherapy for home births. She says:

Midwives are permitted to use aromatherapy in their practice if they have had adequate training and keep updated, have the trust’s permission and local clinical guidelines – this means they are protected by the trust’s vicarious liability insurance. Chemical substances in the workplace  – including aromatherapy oils - are regulated by the Health and Safety at Work Act and Control of Substances Hazardous to Health regulations. Aromatherapy oils must also be used in accordance with the same principles as medicines and must be of good enough quality for safe clinical practice. It is the trust’s responsibility to supply the oils and to ensure they are purchased from a reputable supplier, that expiry dates and batch number are centrally recorded and that there is a system in place to monitor midwives’ practice and record any adverse effects on parents, babies, visitors or staff.

Midwives’ attending home births must remember that the home setting is their place of work and that all the regulations relevant to the birth centre or maternity unit also apply in the community. The oils must be the same brand as those used in the hospital, the individual oils must be included in the trust aromatherapy guideline and midwives must also comply with requirements for safe storage. Asking individual midwives to provide their own oils is not only unethical, it is potentially unsafe. It is akin to asking midwives to purchase their own paracetamol rather than dispensing the trust’s approved brand of the drug.

Compare this situation to a trust in which midwives visiting parents at home are required to request that no one in the home smokes for at least two hours prior to the  visit, since the home becomes the midwife’s workplace. The midwives asked me if the same should apply to the use of aromatherapy in the home, especially when parents often use oils to aid contractions during home birth, which may be dangerous for midwives in early pregnancy. In principle, the same cautions should apply to aromatherapy oils as to cigarette smoking. I would far rather the midwives were ultra-cautious like this, than irresponsibly maverick as in the first trust.  



The Business Of Maternity Care

Published : 21/05/2021

Midwives studying our Diploma and preparing for private practice through our Licensed Consultancy scheme had a great "finance" webinar last night with the wonderful Joanne Bell from  Bell's Accountants in southeast London. We discussed starting up in business and what expenses you can claim, dealing with HMRC, completing self-assessment returns, VAT and Corporation tax and much more. 

If you're thinking of moving into private practice, there's so much to learn. On our business training module we include everything you need to know about starting and growing your business, advertising and marketing, legal and professional aspects including avoiding conflicts of interest for midwives continuing to work in the NHS and much more. It's a whole new world when you step outside the comparative safety of the NHS to become self employed!



Complementary Therapies

Published : 19/05/2021

Now the lockdown is being lifted it seems that midwives are keen to get back to working in ways that enhance care. We've been inundated with enquiries for training in maternity units and birth centres, with requests for everything from aromatherapy and postdates pregnancy to hypnosis and acupuncture. Denise comments:

The interest in using complementary therapies for labour and birth is at an all-time high. It's as if the plug has been pulled on the pandemic and midwives are desperate to provide holistic care for expectant parents so that their birthing experiences are memorable for all the right reasons. 

Complementary therapies offer so many ways to help, not just for relaxation, but for pain relief and aiding progress, for dealing with all those symptoms of pregnancy and sometimes for treating problems that occur. When used appropriately and cautiously, complementary therapies can make the difference between a home or hospital birth or between a physiological or medically managed birth.

However, whilst the NHS website and NICE guidelines are right to advise caution, their reliance on evidence to support the use of CTs - and consequent advice to parents to use them as.little as possible is missing the point. Expectant parents ARE using CTs, they want them to be available for birth and are prepared to pay for therapies during pregnancy. 

This means that midwives have a duty to know more about CTs and natural remedies so they can advise parents about using them safely. Yet the revised 2020 education standards for.midwifery from the Nursing and Midwifery Council have removed any overt mention of CTs to be included in pre-registration midwifery programmes. 

From a national, regulatory perspective CTs continue to be marginalised and disregarded. From the parents' perspective, this is something they want, sometimes without understanding the possible risks of misuse - so midwives have a duty to help. Conversely, we only have to look at the number of maternity units wanting to offer CTs to see that grass-roots midwives are trying to respond to the demand. Isn't it about time the NHS accepted this and took steps to accommodate the public's desire to use CTs whilst still advising caution?




15th May 2021- Today is International Hyperemesis Awareness Day

Published : 15/05/2021

Whilst around 5% of expectant parents experience excessive nausea and vomiting in pregnancy, with dehydration and weight loss, even more suffer mild to moderate sickness which does not normally require medical attention or hospital admission. Many women cope with mild symptoms but it is those caught in the middle, with ongoing vomiting and constant nausea who may need support which is not readily available. Midwives and GPs are ill equipped to help them and often make inappropriate suggestions such as the ubiquitous advice to “try ginger biscuits”, which is neither universally appropriate nor safe. Therapeutic doses of fresh root ginger (about 1gm daily) may help some but should be avoided by those with any bleeding or who are taking anticoagulant drugs such as heparin, enoxaparin or even preventative aspirin. Travel sickness bands may help – these are based on an acupuncture point on the inner wrist. Or try the Morningwell™ app which uses sound pulsations that bounce on the balancing centre in the ear to reduce nausea. Even more effective is acupuncture or homeopathy from a qualified practitioner. Aromatherapy oils are not always effective and may make symptoms worse if the nausea is exacerbated by smells.



Reflex Zone Therapy

Published : 10/05/2021

Denise and Amanda were teaching our popular online course on complementary therapies for post dates pregnancy this weekend. Reflexology can be useful to start labour, but there are some concerns about inappropriate treatments. Denise says: 

Many practitioners believe that contractions can be stimulated by massaging the area of the foot that represents the reflex area for the uterus - on the inner heel. However this is incorrect and potentially dangerous as overzealous stimulation of these areas may lead to placental separation. Labour contractions need oxytocin from the pituitary gland to activate the uterus, so it is more appropriate to work on the reflex zones for the pituitary gland - on the big toes. 
However, my research over many years suggests that the pituitary gland reflex zone is not where many practitioners traditionally position it. I place the pituitary reflex zone on the outer side of the big toes, nearest to the second toe. I also found that the reflex zone on the right foot reflects the anterior pituitary gland while that on the left corresponds to the posterior pituitary gland. 
Further, this relocation was confirmed in my research on using reflex points to detect stages of the menstrual cycle. It is possible to use these points to work out which ovary is active, estimate where in the cycle the woman is, and then to predict the next menstrual period. This process can then be applied to pregnant women, to predict the imminence of the onset of labour.



Misleading advice

Published : 08/05/2021


Denise was contacted today by a midwife concerned to see an Instagram post from a US midwife who advocated placing an opened bottle of essential oil to the nose of a newborn to calm the baby (and to promote a particular brand of oils).  Here is Denise’s reply: 

Newborn babies should not be exposed to - and especially not treated with - essential oils for five very significant physiological reasons: 1) the skin is very sensitive and dermal contact may cause severe skin irritation 2) the aroma masks the baby's ability to use their sense of smell to recognise their mother 3) all essential oils are metabolised via the liver and the neonatal liver is immature – inhaling oil chemicals could risk increased jaundice, possibly even kernicterus 4) the neonate has an immature blood brain barrier - inhaling oils causes rapid, potentially toxic absorption to the brain, risking jitteriness 5) all essential oils are antibacterial - neonatal exposure to oil vapours could interfere with the  maturation of immune system, which could lead to a lifelong difficulty in fighting infection



Homeopathy is not a placebo effect

Published : 03/05/2021


In this interesting video, academics, researchers and medics discuss homeopathy and the presumed  "placebo" effect. 

Denise comments: Homeopathy is a little-understood complementary modality that can be useful in pregnancy and birth. Highly diluted and agitated (shaken) substances release energetic potential to treat "like with like". If a substance is completely inert, it will have no effects at all - but this is not the case with homeopathy. Remember, if something has the power to do good, it also has the potential to do harm when not used correctly. Excessive or inappropriate homeopathic use can trigger the symptoms the remedy aims to treat. Homeopathic arnica, can be useful to reduce perineal trauma and bruising after birth, but excessive use may trigger a reverse effect, leading to systemic bruising. This is NOT a placebo effect. For more on homeopathy and herbal remedies, see Denise's book Using Natural Remedies Safely in Pregnancy and Childbirth (2021).



Hyperpolarisation

Published : 12/04/2021

Did you know that using too much clary sage aromatherapy oil to aid labour contractions can have the opposite and actually stop labour? Here, Denise discusses the growing incidence of hyperpolarisation arising from misuse of clary sage oil in labour. 

Clary sage is one of the most misused aromatherapy oils for labour. There is no doubt that it can aid the onset of labour when a woman is overdue. It may also help to accelerate the latent phase, encouraging contractions to become well established. However, both parents and professionals are over-using clary sage to the extent that I now receive reports on a regular basis of situations where labour has slowed down or even stopped despite the use of clary sage. Clary sage oil should be considered to be aromatherapy’s  equivalent of oxytocin and should only be used when there is a justification to use it to aid contractions; it is, of course, completely contraindicated until term pregnancy (37 weeks).

Prolonged use, excessive doses or continual environmental diffusion of clary sage oil can, in the first instance, cause excessively strong uterine contractions, possibly leading to fetal distress. However, continuing to use clary sage oil, administered either by inhalation or via the skin, may eventually cause a situation in which contractions slow down and eventually stop. This is a condition called hyperpolarisation, an effect that can occur with any pharmacological agent, including drugs, herbal remedies and aromatherapy essential oils. When a drug / oil is commenced, it triggers an action potential of the neurons in the relevant organ to make the body receptive to the substance  (this process is called depolarisation). In the case of clary sage oil, it stimulates an action potential to encourage the uterine muscles to contract. Eventually, a stage of optimum effect is reached, after which the oil becomes less effective (repolarisation). Ultimately, a state of hyperpolarisation is reached, in which the clary sage oil will start to have the opposite effect, namely relaxing the uterine muscles and interfering with the progress of physiological labour.

To prevent clary sage oil causing hyperpolarisation and leading to reduced or no contractions, midwives should:

  • Use clary sage in doses of no more than 3% to aid onset of labour
  • Avoid using clary sage once contractions have become well established
  • Avoid diffusion of clary sage (and other oils) in labour to prevent over-saturation of the atmosphere
  • Never use clary sage for the duration of a labour
  • Only use clary sage, in a 2% dose, to encourage labour that has slowed down if all other causes have been excluded (hypoglycaemia, full bladder, ketosis, obstructed labour, pain etc)
  • Be alert to the possibility that clary sage, if over-used, can have the opposite to the desired effect on contractions
  • Never use clary sage oil with drugs intended to facilitate labour



The Future of Midwives

Published : 04/04/2021

Many midwives will not be surprised to read a recent article in the the Independent on the possible departure of thousands of midwives from the NHS. Whilst the pandemic has exacerbated the pressures, it has really only brought to the fore a dissatisfaction that was already simmering amongst midwives. Midwives want to provide care for families in the way they were trained to care - holistic, individualised safe and empathetic care that provides choices for parents. Midwives also need choices - about how, where and when they work. 
NHS maternity services do not provide choices, for expectant parents or for midwives. They are designed to provide medical treatment for the majority, in effect to number crunch within the budget. And the result is dissatisfied parents and dissatisfied, exhausted and angry midwives. Yes, there are some wonderful initiatives in some areas where midwives try to return to nurturing pregnant and birthing women. However in the greater scheme things these are just papering over the cracks of the NHS. All the dimmed lights, aromatherapy oils and gentle music in the world will not solve the fundamental problems of working in the current NHS with inadequate staffing and poor resources.


On the other hand, midwives who have taken the step to work independently have control over their working lives. They can work in a way that suits them and enables them to offer that holistic, individualized, safe and empathetic care for families. Yes, they may not earn as much as they did in the NHS but job satisfaction far outweighs the issue of salary. Some midwives offer full antenatal, birth and postnatal care under one of the organisations through which they can obtain insurance. Others provide pregnancy and postnatal care, including antenatal classes, lactation support, complementary therapies and other maternity related services.


Solving the problems of the NHS maternity services is extremely complex and is not related purely to financial and organisational issues. Any effective solution will require an attitudinal change from government, management, employees and by those who use the services.The NHS comes into its own when dealing with high risk situations,  emergencies and end of life situations. Maternity services for the majority do not fit into these categories - pregnancy and birth are generally not high risk or emergency situations and, thankfully, rarely have to deal with end of life issues.


Perhaps one of the options is to adopt the system used in some other countries where birth services and basic antenatal monitoring are provided within the standard maternity services and all other care is offered by midwives and other professionals working independently? That does not necessarily have to mean "privately" as in paid-for by service users, but could involve midwives working in independent practices and contracting their services to the NHS. In that way, services could become responsive to demand and both parents and midwives would have increased satisfaction.


One thing is certain - unless something is done, and done soon, there will be no midwives left in the NHS - and those who remain will become increasingly burned out, putting their own health at risk. This does not bode well for those families having babies, nor for the profession of midwifery.

 



Aromas Are Chemicals 

Published : 03/04/2021


Here is an extract from  an article published by the Complementary Medical Association. Although it relates to chemicals in the home, this includes fragrances such as perfumes and aromatic candles. Although essential oils are not mentioned by name, the same principles also apply to the diffusion of essential oils in the home. The key is to use aromatherapy diffusers in the home for no more than 15-20 minutes at a time and to keep babies, children, ill people and animals away from the aromas.

Chemicals in the Kitchen

The development of chemicals in the last hundred or so years that would serve to help us be cleaner, live more efficiently and generally ‘improve’ our lives has had a devastating effect upon our immune systems. It is estimated that anyone living in a “Westernised” environment encounters up to 2,100,000 man-made chemical exposures every day. The truth is that we simply don’t know what most of these chemicals do – and they have never been researched in combination. We are sitting on the top of a ticking time-bomb – and only time will really tell us about the true effects of synthetic chemicals.

The potential dangers of these chemical exposures are worrying – to say the least – as they are associated with numerous health issues, including cancers, obesity, hormone disruption, dementias and much more. These toxic chemicals also accelerate ageing and are associated with many of the health concerns that we associate with ageing.

In this article we’ll look at just a few of the harmful chemicals in your kitchen – and ways that you can avoid them – or find substitutes that really work.

Antibacterial Soap

Many commercially available ‘antibacterial’ soaps (and toothpastes) on the market boast that they contain the antimicrobial chemical ‘triclosan’. This chemical is believed to disrupt thyroid function and hormone levels in people; and furthermore, when it goes down your drain and eventually mixes with wastewater, it has been shown to cause sex changes in aquatic life.

Even more worrying is that overuse of this and other antibacterial chemicals is promoting the growth of bacteria that are increasingly becoming immune to antibiotics and other anti-bacterial substances.

Better alternative: Good old-fashioned soap and warm water kills just as many germs as the chemical soaps. If you have to use a hand sanitizer, choose and alcohol based product that doesn’t contain triclosan, triclocarban or any other synthetic substances described as anti-bacterial or anti-microbial.

Synthetic Fragrances

The chemical compounds that we are most often exposed to in our kitchens are fragrances. These surface in in soaps laundry detergents, fabric softeners, dryer sheets, cleaning supplies, disinfectants and outside the kitchen they are founding abundance in air fresheners, deodorisers, shampoos, hair sprays, gels, lotions, sunscreens, perfumes, powders, and scented candles. Fragrances are a group of chemicals that are well worth the time and effort to avoid. The words “fragrance” or “parfum” on product labels can act as an euphemism for hundreds of harmful chemicals that are known to be carcinogens, endocrine disrupters, and reproductive toxicants, even at low levels.

Better alternative: Freshen the air with better ventilation and by setting out a saucer of bicarbonate of soda. You also can place a bowl of white vinegar in a room to dispel a stale smell. I often spritz my environment with a small spray bottle containing water and a few drops of my favourite essential oils. 

Harsh Cleaning Products

It is really quite scary that we inadvertently contaminate our air when we use harsh chemicals—some of which are known to cause cancer—to “clean” our homes? Ammonia can trigger asthma attacks, and harsh oven cleaners and drain openers can cause respiratory damage or burn the skin anyone who comes into contact with them – and these chemicals are even more dangerous to children – who have much lower body mass than adults.

Better alternative: Take any synthetic cleaner with an ingredient list that reads like a chemistry textbook to your local recycling centre – they’ll know how to dispose of these chemicals properly – don’t pour them down the drain as they end up in our water supply! (Check those products which boast ‘natural ingredients’ as there are a great many synthetic products out there which try to promote their ‘green’ credentials by adding a few natural products to a synthetic chemical soup – and there’s very little labeling legislation in place to stop this grossly misleading practice.)



Informed Consent

Published : 31/03/2021

Here, Denise discusses whether midwives provide enough information to enable expectant parents to give informed consent for complementary therapies.

Informed consent is the process of agreeing to, or declining, a course of action in healthcare, based on a clear appreciation of the benefits, risks, implication and consequences of the treatment. Where possible, the information given should be based on contemporary research, as well as local directives and national and international laws. Whilst the Nursing and Midwifery Council and medical laws require midwives to obtain informed consent for all treatment options throughout pregnancy and birth, the process is often not done well, even for major interventions such as induction of labour or Caesarean section.

When it comes to complementary therapies such as aromatherapy, reflexology, acupuncture or hypnotherapy, midwives frequently allow their enthusiasm for the benefits to overshadow any real discussion of possible risks. Indeed, some midwives do not themselves possess adequate knowledge of the therapy to be able to provide all but very basic information. In fairness, it should also be recognised that expectant parents are usually so keen to take advantage of what they see as purely "relaxation therapies" that they may disregard any need to appreciate the opposite side of the debate.

However, since complementary therapies are not part of mainstream midwifery practice (or education), it is almost more important to ensure that fully informed consent has been obtained than for other standard components of midwifery care. In the event of any untoward consequences of complementary therapy use, midwives must be sure that parents have been given and understand this information, together with opportunities to ask questions and seek clarification. The information should be given verbally and in writing prior to any complementary therapy interventions.

Midwives introducing the option of a complementary therapy as part of pregnancy and birth care must provide parents with the following information in order that fully informed consent can be given:

  • What the therapy is
  • How it works ( mechanism of action)
  • How it can benefit the pregnant or birthing woman at this time
  • Reasons for use
  • How likely it is to be successful in relieving symptoms / condition
  • How it is used (what to expect during treatment)with
  • Method of administration
  • Contraindications and precautions (assessment of individual)
  • Possible expected (normal) healing reactions to therapy
  • Possible unexpected side effects from appropriate use
  • Possible complications from inappropriate use (self administration)
  • Risks of possible interaction with medication or other treatments
  • What to report after treatment (with contact details)
  • Explanation about any research - and its overall calibre
  • Statement that NICE guidelines do not support the use of  complementary therapies in pregnancy and birth as it is generally poorly researched


If you're a midwife using complementary therapies in your practice, are YOU informed enough to be able to offer this information in sufficient detail when discussing complementary therapies with clients? 


For more details of Expectancy's courses that prepare midwives to provide this information, contact us on info@expectancy.co.uk

 



The Debate on Cascade Training of Complementary Therapies

Published : 26/03/2021

Here, Denise discusses the controversial issue of "cascade training" of complementary therapies and asks why midwifery managers feel it is acceptable. She says:

During our online course this week, on aromatherapy and acupressure for post dates pregnancy, a midwife asked about cascade training, the practice of returning to base to teach other midwives how to use the therapy the students have just learned. This is a common question that causes me great concern. It usually originates from managers who see it as a cheap way to get all the midwives trained up to use the therapy (most commonly aromatherapy but also reflexology or acupuncture). 

There are several reasons why cascade training is completely inappropriate when it comes to complementary therapies: 

Each therapy is a professional discipline in its own right, which takes at least a year (for aromatherapy) or up to four years (for acupuncture) to become fully qualified. Midwives would not sanction someone taking a few days or weeks of midwifery training and then being allowed not only to practise but also to teach it. Indeed, there is great concern amongst complementary therapy educational and regulatory organisations about the way in which other professionals such as midwives, nurses or physiotherapists, "cherry pick" a few aspects of a therapy discipline without deeper understanding of the scientific basis and the legal requirements underpinning its practice. Those who teach midwives to use complementary therapies in their practice must first be fully trained in the therapy, have consolidated their own learning, have extensive experience of using it in midwifery practice and be qualified and insured to teach it. 

"Training" to be able to carry out practical skills of a therapy is one thing but becoming sufficiently educated to understand the implications of safe practice and to be able to minimise the risks is entirely different - this is the difference between academic level 4 and level 6 study, or between "doing" and "understanding". It is evidenced that people only retain 60% of what they first learn so there is a natural dilution when that 60% is passed on to others who then also only retain 60% of what they have been taught.  Further, midwives must be able to apply the principles of the therapy to its practice within maternity care. Midwives who undertake post-registration courses such as Examination of the Newborn are not permitted to return to practice and immediately start teaching other midwives up to a level of competence - so why do midwifery managers presume this is permissible when it comes to complementary therapies?

The truth is that most midwifery managers have absolutely no understanding of the issues relevant to complementary therapy - not only its practice but the health and safety, legal, ethical and regulatory issues relevant to safe practice. Permitting midwives who have only studied a few days of a therapy then to train others could put everyone in a very invidious position. It risks the safety of parents and babies and the registration of midwives using the therapy and of those teaching it. It also risks the registration of midwifery managers who have unwittingly assumed that those teaching the therapy know enough to ensure safe accountable practice of those they train. 

Midwifery managers have a responsibility to ensure that what is included in the care provided by their employees is safe and appropriate. They must take account of institutional issues and adhere to the law - this is a direct requirement under the NMC Code (2018). Managers have a legal duty to comply with the Health and Safety at Work Act, regulations such as Control of Substances Hazardous to Health regulations and medicines management requirements. Midwives are insured to practise complementary therapies under NHS vicarious liability insurance on condition that they have managerial permission - but managers must understand what their staff are doing before giving that permission.

The truth is also, perhaps, that midwifery managers want to respond to the trend to include complementary therapies in their care provision so that expectant parents will want to book for their birth centre or maternity unit. They also want to introduce new initiatives as cheaply as possible in the cash-strapped NHS - but this risks cutting corners which, in the long term, may be counter-productive to the intention of  complementary therapies - and detrimental to the wellbeing of all concerned.

Much is written about "compassionate care" and the introduction of complementary therapies is seen as being an element of this. However, compassionate care also means safe care - not cheap care, not ill-informed care and certainly not illegal care. Before midwifery managers approve cascade training of complementary therapies for their staff, they need to think about the consequences.

All of Expectancy's courses set complementary therapies firmly in the context of midwifery practice and focus on safety, professional accountability an evidence-based care. Contact us now if you would like courses for your unit, online or face to face -  info@expectancy.co.uk



Denise's Latest Book

Published : 22/03/2021


I’ve been publishing on maternity complementary therapies for many years but the huge increase in popularity of natural remedies, including aromatherapy oils, herbs and homeopathic remedies led me to write this latest book. Expectant parents frequently ask midwives, doctors, doulas and antenatal teachers about the use of remedies such as raspberry leaf tea, and for remedies such as castor oil and evening primrose to start labour. The massive rise in popularity of aromatherapy in pregnancy and birth also means that parents often ask about essential oils, or want to bring them into the birth centre for use in labour. This can sometimes put the midwife or doctor in a difficult position because they may know very little about the oils and which are safe or not.  

There is a huge amount of information – and mis-information - available online, but it presents a confusing minefield for both parents and professionals. The subject is not included in conventional medical or midwifery education, yet increasingly, maternity care providers need to know about the popular remedies and how to advise pregnant, labouring or newly birthed parents. Safety and accountability are the principles that underpin all that I teach in my Expectancy courses on complementary therapies for midwives but there is still the misconception that “natural” means “safe”. This just simply is not true. Anything that has the power to act therapeutically can also cause harm if used inappropriately. The issue is intensified when remedies such as herbal medicines are used alongside prescribed drugs.  

This book aims to provide a ready reference for health professionals in both the maternity and obstetric fields as well as complementary therapy practitioners who may be working with pregnant clients. It aims to provide enough information to advise parents about the safety, or otherwise, of particular remedies, when working in the clinical situation.  



Thought For The Day...Clinical Hypnosis

Published : 15/03/2021

Clinical hypnosis involves deep relaxation to create a state of focused attention similar to daydreaming. This increased the person’s suggestibility so that positive cues can be used to help deal with issues such as fear of childbirth, stopping smoking in pregnancy or needle phobia.



A Few Words On Reflexology

Published : 10/03/2021

There are many different styles of reflexology. It is not simply foot massage but involves precise pressure point work all over the feet, and the location of organ points may vary according to the style being used. When reflexology is used for labour care, all midwives must use the same style and the same locations of points. This is particularly important when locating the reflex zone for the pituitary gland, the most significant point used in midwifery.




Thought For The Day

Published : 05/03/2021

Many pregnant women thinking about having acupuncture to treat sickness, backache or other symptoms, imagine that it will be painful. Although acupuncture does involve the insertion of fine needles into precise points around the body, it is not usually felt as more than a tiny pin prick, sometimes not at all. In fact, it is common to experience a buzz of energy as the needle reaches the correct spot – and acupuncture treatment has been shown to reduce stress hormones and increase feel good factors, so it can be quite relaxing.



How Times Change

Published : 28/02/2021

Here Denise reflects on changing times in the pregnancy and birth arena and considers how stressful life is now compared to 40 years ago.

She says:


When I was first a midwife in the mid-1970s women either became pregnant or they didn't, but everyone accepted that nature would take its course. There were very few tests for fetal abnormalities, no electronic monitoring in labour and limited vaccinations for infants. If women worked, they took maternity leave from around 32 weeks of pregnancy and often chose to be full time parents, not returning to work until several years later. Midwives had time to spend with women at all stages, with frequent antenatal appointments. Home births were still quite common but even in hospital there was continued one to one care in labour. And the midwife provided welcome daily postnatal visits to the home for at least ten days after the birth. 


In today's world, couples often leave it "physiologically late" to start a family, then are so stressed that conception takes longer than they want, or not at all. Pregnancy is stressful while women strive to continue working until the last moment, and to cope with "unexpected" - but completely normal - discomforts of pregnancy symptoms. Labour is "managed" either by the couple or by professionals instead of being helped to follow its natural course. New parents, who have generally given birth in hospital, have no time to recover from interventionist care before being thrown into the stressful world of attempting to be a "perfect parent".


Society expects perfection but nature isn't perfect and sometimes it lets us down. Extra social and medical choices are welcome but too much choice brings uncertainty - and uncertainty brings more stress. Stress increases hormones that interfere with conception, pregnancy and labour, recovery from birth and establishment of lactation.


The internet - and particularly social media - exacerbates expectant parent's distress, with childbirth tales, either of perfection or disaster. From the posts I'm currently seeing, there is a definite "them and us" attitude amongst a proportion of the pregnant public, spreading fear that midwives and doctors are ogres to be avoided at all costs, who will "make" parents accept care against their will and who are uncaring and unkind. 
This saddens me greatly, to think that we've lost the respect of the people for whom we care. It saddens me, too, to see posts from students and newly qualified midwives who are so disillusioned with the maternity services that they feel they can no longer work in them. Yet these are the very people we need to take forward, to develop and improve the maternity services we offer. Recognising the problem is part of the solution, but we need motivated midwives to work on achieving the solution.


As long as I've been a midwife, there have been battles in the field of pregnancy and birth: midwives versus obstetricians, natural versus interventionist birth, parents versus professionals. But we're all there for the same reason: fundamentally, to continue the human race. Let's stop the fighting and start working together to improve services for expectant parents. Let's start respecting one another for the amazing work we do - respecting women's bodies for their ability to conceive, grow, birth and nurture babies.A nd respecting professionals who are, after all, there to help families, to ensure a safe and satisfying passage through the journey that is pregnancy, birth and parenthood.



The Misuse of Complementary Therapies

Published : 14/02/2021

 

Today, Denise expresses her continued concern about the continuing misuse of complementary therapies and and reinforces the need for both complementary and conventional health practitioners work within their professional boundaries. She says: 

 

I continue to see some extremely alarming social media comments and suggestions on the use of complementary therapies. Some of the posts recently have included:

 

  • A woman whose husband is in intensive care being ventilated for Covid, whose nurses agreed that it was acceptable for her to bring in an essential oil diffuser to “ease his breathing”. This is one of the most worrying incidents I have seen. Whist diffusion of specific oils may aid respiration for people recovering from Covid at home, the very fact that this man is in ITU means that he needs specialist medical and nursing care and aromatherapy is completely contraindicated at this time. Further, it is frankly irresponsible of the nursing staff to agree to this: obviously they have no understanding of the dangers of diffusing oils in an area where people are in life-threatening conditions and how they may affect, not only this man, but other patients in the unit.
     
  • Various reflexology “professional” groups with numerous questions asking whether reflexology can “heal” particular medical conditions or  what reflexology treatment should be done to treat specific medical conditions. These questions are usually followed by numerous helpful suggestions from therapists who obviously do not understand the pathology of the conditions being discussed and do not appreciate their professional boundaries. Some of the conditions mentioned are so serious that the reflexologist should not be treating them at all yet there appear to be no posts urging caution, just total amateurish enthusiasm. In any case, reflexologists are not permitted to treat medical conditions unless they have undertaken extra training, are insured and preferably also communicate with the relevant medical doctor.
     
  • Reflexologists posting pictures of feet and asking what various changes mean, for example, lines, bulges or cracks on the feet. I have discussed this before and it worries me that these people make sweeping statements and  giving supposed “diagnoses” without any knowledge of the person’s history, symptoms or other factors that need to be taken into account when treating clients.
     
  • Certain essential oil companies advocating that oils can be taken by mouth as medicines. Again, this irresponsible publicly-available information is extremely dangerous and risks causing serious adverse effects, especially when used as an alternative to essential medical care. Oral  administration is not part of aromatherapy practice and should only be advised by medical practitioners who have been trained to use essential oils as medicines.  
     

There are several issues with these posts. First is the lack of understanding of the general public about the risks, as well as the benefits of therapies, notably aromatherapy oils. This is a continuing problem and experienced therapy practitioners, as well as conventional healthcare professionals, need to keep putting the message out there to the public.

 

Secondly, nurses (or midwives) who enthusiastically condone the use of complementary therapies or natural remedies without any knowledge or understanding of the potential dangers, are putting their patients in jeopardy, and risking mistakes that could lead to loss of their professional registration. This is particularly significant when people are seriously ill, since the therapies could complicate the medical condition or interact with drugs.

 

And thirdly, the credibility of professional therapy practitioners is seriously undermined by a few individuals who seek to overstep their boundaries. I have worked with many reputable practitioners of reflexology and other therapies who specialise in working with people with diagnosed conditions, especially cancer patients or expectant parents. They have undertaken additional training and understand how to apply their experience of using the therapy to the physiology and pathology of the person’s condition. 

 



A New Book On The Horizon!

Published : 30/01/2021

We are delighted to announce that Denise has received the advance copies of her new book, Using Natural Remedies Safely in Pregnancy and Childbirth, to be published by Singing Dragon in mid-March 2021.

If you would like to win a signed copy of the book, please emailinfo@expectancy.co.uk with the answer to the question below, your email address and your name as you would like it in the book if you win. The draw will be made on Friday 12th February.

Here’s the question: If an expectant parent wishes to take  raspberry leaf to facilitate labour, when should it be commenced?

a) 37-38 weeks’ gestation

b) 30-32 weeks’ gestation

c) 40-41week’s gestation



Brave New World...online learning

Published : 25/01/2021

Denise has been extremely busy since the new year preparing for all the online teaching. We've already had one course this year on aromatherapy in midwifery, with rave reviews, one midwife emailing us afterwards to say it's the best course she's done in a long time. Over the next two weeks, Denise has courses for midwives and therapists in China and Japan, as well as upcoming webinars and a post dates pregnancy course.

Denise says:


It's been an interesting time, moving to teaching online but there are certainly benefits. Rather than being constrained by the size of an actual  room, we've been able to give more midwives and birth workers the opportunity to study with us, with some overseas groups having up to 200 students. We run our study days in real time with three 2-hour sessions (and breaks between), from 9am to 4pm. This can be quite intensive so we break the day up with group work and time to chat socially. Students receive everything in advance so they have all the course materials. For the aromatherapy and post dates pregnancy courses, midwives receive a set of aromatherapy oils to use during the care planning sessions, and those on our acupuncture course receive a set of needles, a mini sharps bin and a practice pad (better than sticking needles in an orange which is now we practised to give injections!). I seem to spend my time packaging up parcels and getting them shipped off. We're also getting more students from overseas, with midwives joining us from Malta, Cyprus, Italy, Austria, Qatar and Slovenia. This has led us to offer the option to study our Certificate in Midwifery Complementary Therapies completely online, with ten study days, optional extra webinars, "open house" sessions and tutorials, taken over an academic year.



January Webinar News

Published : 15/01/2021

Join our online webinars on complementary therapies for pregnancy and childbirth 



Date - Saturday 23rd January 2021  10:00 - 11:00 hours

Subject - Introduction to reflexology in midwifery practice with Denise Tiran, author of Reflexology for Pregnancy and Childbirth

 





Introduction to the principles of reflexology, the different types of reflexology used around the world and the benefits of using reflex zone therapy, the style taught by Expectancy, in midwifery practice. Suitable for midwives and students

·      All webinars cost £20 – or book any two for £36.

·      Book via info@expectancy.co.uk

·      Full payment is required by direct bank transfer before we send the access link for your chosen webinar

·      Certificate of attendance emailed to you after the webinar

 



Pineapples and Fertility

Published : 04/01/2021

Pineapple has long been held as a symbol of fertility and is also often used to trigger labour contractions in women who are overdue. Pineapple core contains a chemical called bromelain which has been shown to have anti-inflammatory properties and possibly also some anti-cancer effects. When fertility issues are linked to internal scar tissue, perhaps caused by infection or previous surgery, it is thought that bromelain may reduce the inflammation and aid conception. It is also thought to have certain anti-coagulant (blood thinning) effects which is why it is thought to aid blood flow to the uterus. To date there is no pure research on the potential for bromelain to aid fertility and most of the information available on the subject appears to be based on a 2012 Indian paper which was a review of much older research.

However, for those who want to harness the fresh, bright image of pineapple as an aid to conception, there is no real problem unless you are allergic to pineapple or to latex or experience tingling in the mouth when eating pineapple (which may be the start of a more significant allergy). The main source of bromelain is in the fresh raw core of the pineapple, and it is destroyed by juicing, canning or cooking. Those taking prescribed aspirin or other blood thinning drugs prescribed to aid fertility should avoid eating large amounts of the core. Once pregnant, pineapple should be eaten only in moderation, avoiding the central fibrous core.



Christmas Foods And Spices

Published : 24/12/2020

In the week before Christmas, Denise explores the medicinal uses of some of the popular Christmas spices and foods.

Cinnamon and cloves are both used extensively in cooking at this time of year and are safe in the small amounts used in cooking. Cinnamon is effective for various digestive conditions, but the essential oil is also used in some countries to stimulate labour at term, so should be avoided during pregnancy. This means that the oil should not be added to aromatherapy diffusers to fragrance the room if there is anyone in the family who is pregnant – or if there are cats or dogs in the house as it is toxic to animals. Clove is another popular spice, and the oil is sometimes used to treat toothache, but should be avoided in pregnancy. In some countries clove oil is used to ease the pain of teething in babies, but this can cause damage to the emerging teeth if the oil is rubbed into the baby’s mouth and gums. Like cinnamon, clove oil is also toxic to dogs and cats.

Many people like to add cranberry sauce to their Christmas dinner, but did you know that it can be used medicinally for urinary problems? Pregnant women are prone to urinary infections and cranberry juice can be a useful preventative – but it must be sugar free juice. A few people are allergic to cranberries, especially those who have asthma or who are allergic to aspirin and excessive consumption of the juice can cause irritation when passing urine.

Who doesn’t enjoy a few dates from those little wooden boxes at Christmas? However, whilst dried dates are suitable for pregnant women, fresh Medjool dates should be eaten in small amounts if you are pregnant. Research has shown that eating several large fresh dates every day in the last weeks of pregnancy can trigger labour contractions – but it’s best not to go mad on them at Christmas if you are not yet ready to give birth. Indeed, in some Middle Eastern countries dates are considered to be “forbidden fruits” in pregnancy. 

Frankincenseevokes the sense of Christmas, perhaps more than any other spice. It is, however, a useful medicinal plant, being antiseptic and very good for colds and nasal congestion. The essential oil is a particularly useful one for stress and anxiety and is what Denise calls “the ultimate calmer”. It is especially effective for the transition stage of labour, just before the baby is ready to be born – just sniffing a couple of drops on a tissue calms you down (don’t put it in the birthing pool). If using it in a diffuser at home, just turn it on for 15-20 minutes – this is enough to fragrance the room for a good couple of hours and avoids overwhelming the air with the chemicals in the oil as it can cause headaches or nausea in some people.



How Antenatal Education Has Changed

Published : 08/12/2020

When I was a student midwife in the late 1970s we offered parentcraft classes to all pregnant women and their husbands (I use the word advisedly). This meant that there was plenty of opportunity for students to observe midwives conducting classes and we then had to prepare and teach a class ourselves under supervision.

Classes started at around 34 weeks'gestation and we offered a.course of six sessions that usually included fetal development and dealing with"minor disorders" (rather late); one class on normal labour and one on complications (very scary), one on pain relief when the anaesthetist would come and talk about pethidine and Entonox (the dads liked this one and would often go off to the pub with the doctor afterwards!), a session on baby care in which we demonstrated baby baths and a session on infant feeding in which we covered breast feeding and demonstrated how to make up bottle feeds.

Most classes were offered in the daytime, usually in the afternoons, and the lecture was followed by an hour of relaxation in which the expectant mums would lie on mats on the floor in long rows. They were encouraged to go through some basic breathing techniques for labour with muscle relaxation - this was called the modified Laura Mitchell technique and included some guided imagery to music, followed by a period of sleep (the original "hypnobirthing").

Some classes excluded husbands, to offer the choice of being in a women- only group, but there were no specialist classes for women with different needs. All women were addressed as "Mrs" - in my unit this followed a survey in the clinic in which we asked women what they wanted to be called - even the very few unmarried women wanted to be addressed as Mrs so they didn't stand out and risk married women's disapproval!)

There was no mention of natural remedies - indeed, I remember one of my first classes as a community midwife when a woman expecting her first baby was not only insisting on a homebirth but was intending to receive acupuncture from her acupuncturist husband - what a maverick!

Neither was there any mention of rushing to get into labour. Women - and doctors - understood that babies come when they're ready and induction was not the cloud hanging over women that it is today.

Some advice we gave back then would raise eyebrows today. For example, to stimulate lactation women were advised to eat a Mars bar every day (for the sugar) and drink a glass of Guinness (for its iron content). 

At the end of each class the students would make the tea and all the women would sit around chatting whilst the midwife answered individual questions. The women really got to know one another and often made lifelong friends. It was all very civilised and student midwives learned a great deal, not only about delivering antenatal classes but also about women, their families and the psychosocial factors that impacted on their pregnancies and labours. Oh - and we also learned how to make a good cup of tea!

 



Being Professional

Published : 29/11/2020

Today, in what is bound to be a controversial discussion, Denise comments on the numerous worrying posts on social media from aromatherapy and reflexology groups which have caused her to reflect on professionalism in the complementary therapy disciplines.

She says:

I see dozens of posts on social media about complementary therapies and have become increasingly concerned about their professional calibre. Blanket suggestions on using aromatherapy in pregnancy come with no warnings about precautions. Some posts advocate aromatherapy for babies and toddlers, yet it should never be used on or near newborns and rarely, if ever, for toddlers. I've also seen posts on aromatherapy for animals despite the fact that many of the oils can be toxic to household pets.

Even more worryingly, I frequently see pictures of client's feet in reflexology groups posing questions to members on what the possible "diagnosis" might be and asking for suggestions for treatment. No indication is given as to whether client consent has been obtained, and making a diagnosis is impossible without a history and full examination. That's without the fact that reflexologists are taught that they should not "diagnose".

Whilst there are many highly professional complementary therapy practitioners including many who have additional training to treat people with specific clinical conditions, such as cancer, multiple sclerosis and - of course - pregnancy, this sort of posting does the complementary therapy disciplines no favours in terms of credibility, both with the public and with colleagues who are registered healthcare professionalsOf course, you could argue that these ideas are on social - rather than professional -media which has hundreds of inappropriate and dangerous suggestions on all sorts of topics. However when inaccurate and potentially harmful advice is offered by so-called professional practitioners it causes me real.concern. I worry not only about the level of knowledge, understanding and experienc; of the individuals posting, but also, vicariously, about the impact on the wider disciplines of complementary therapies.

Having worked in midwifery complementary therapies for almost 40 years, I have been part of the movement to professionalise complementary and alternative medicine (CAM) that was particularly active in the 1990s when the then Foundation for Integrated Medicine, with the patronage of HRH Prince of Wales, campaigned for increased standards of education and research to facilitate greater integration of complementary therapies with conventional.medicine.

Since then CAM has lost much of its impetus although disciplines such as osteopathy and chiropractic are now firmly included, by law, in the allied health professions and acupuncture and medical herbalism are self-regulated and have high levels of training and professional Codes of Practice to monitor standards. Sadly, however I have to question whether aromatherapy and reflexology have slipped backwards into simply being relaxation therapies with no real professional or clinical credibility.



Previous articles

Testimonials and Compliments

Watch Out For Your Pets

Homeopathic Remedies

Course Update

The "Negativity" Of Safety Information On Complementary Therapies

Has Hypnobirthing Had Its Day?

Seaweed For Postdates Pregnancy?

Ten Tips For Midwives Looking For Complementary Therapy Courses

The Dangers Of Passing It On

When Will Nice Stop Categorising All Complementary Therapies As “Non-Pharmacological”?