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.
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).
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.
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!
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?
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.
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.
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
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).
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:
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.
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.
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.
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.)
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:
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 firstname.lastname@example.org
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 - email@example.com
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.
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.
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.
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.
Here Denise reflects on changing times in the pregnancy and birth arena and considers how stressful life is now compared to 40 years ago.
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.
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:
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.
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 firstname.lastname@example.org 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
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.
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.
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
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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.
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.
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!
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.
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.
Denise is having a busy week in the office, preparing the prospectus for the new.academic year's courses. She is delighted, but not surprised, already to have received applications for our unique Diploma in Midwifery Complementary Therapies for next September from some very enthusiastic midwives, several of them wanting to combine this with our Licensed Consultancy scheme for private practice. However she questions why so.many.midwives in the last.few.years have been keen to explore the move into having their own businesses offering maternity services such as complementary therapies,. antenatal classes and breast feeding support. Denise says:
Midwives love caring for expectant parents but need also to care for themselves. Midwives are leaving the NHS in droves, newly qualified midwives are choosing not to practise and older midwives are retiring early - and it seems as if this is due, at least in part, to burnout. It may also be due to the insidious erosion of the midwife's role or the risk-averse, litigation-conscious, blame-throwing culture of the NHS.
Conversely, midwives are beginning to realise that the NHS doesn't own them and that they are entitled to use their considerable skills,.knowledge and.expertise to.provide women with what they want - services that are generally not available on the NHS. In the UK there is a grave misconception amongst midwives (and nurses) that they are trained by - and therefore solely for - the NHS but this simply isn't true. Qualification grants midwives a licence to practise midwifery anywhere and in whatever way they choose, subject to national law and professional regulations.
Further, there is a demand from expectant parents for services to be available that provide them with services that ease their progress through pregnancy and birth and transition to becoming a parent. These services are not available in the NHS largely because the maternity services are obstetric-led for the benefit of the majority of users. The maternity services remain focused on the biological (physical) wellbeing of pregnancy and, give less credence to the psychosocial elements.
Pregnancy is a stressful time, more so now than ever before. To be able to call upon a professional who can provide relaxation treatments such as massage or reflexology, antenatal advice and support or specialist services to ease backache, nausea or avoid induction of labour is very appealing to many during pregnancy, and expectant parents are often prepared to pay for them.
Our team of Expectancy-trained midwives working in private practice is growing and more and more women are discovering the benefits of having the support they can offer. This current academic year we had more midwives than ever before choosing to join us to train as Licensed Consultants so that they too can provide a range of complementary therapy services for expectant and new parents. Why don't you come and join us?
Denise was delighted to receive a ‘phone call this week from an old friend, Fiona. Denise, who developed and managed the BSc (Hons) degree in complementary therapies at the University of Greenwich, and Fiona, who was a health visitor, were lecturers in complementary therapies in the 1990s and early 2000s and were both instrumental in promoting the practice of complementary therapies within their respective professions. As is the way when you have not heard from someone for a while, they fell to reminiscing about the “good old days”. Denise left the University of Greenwich in December 2004 to set up Expectancy and Fiona reminded her of those early forays into freelance work.
Denise had arranged her very first private aromatherapy course for midwives and had booked a room in a small local hotel to run the course for eight weeks on a Tuesday evening from 5-8 pm. Nearing the day, she was worried that only four midwives had booked on the course and she asked Fiona if she should cancel it – to which Fiona replied “absolutely not!”. In order to boost numbers to a viable group, Denise then offered the course at a knock-down price to some of her midwifery friends, asking them to act as a pilot, so in the end there were eight midwives who attended.
The course was not without a few issues. The hotel room overlooked the car park and the windows did not have curtains wide enough to close – so when the midwives were due to do the practical work, including back massage for labour, they had to tape all their coats over the windows to stop hotel residents coming in from the car park from looking into the room. Another problem was that all the midwives had rushed to the hotel ready to start the course at the end of an already tiring day of clinical work. Denise had originally requested teas and coffees to be available – but the midwives were so hungry and tired on that first day that she ordered chips to be brought in with the drinks. This became the routine every week and it was great fun studying aromatherapy whilst munching on hot chips with salt and vinegar – but Denise does admit that it meant she made no profit at all from that first course! Thankfully, things have improved and although she no longer provides chips with the courses, midwives still keep coming and Denise has now taught complementary therapies such as aromatherapy to over 3000 midwives since starting her business in 2004. Fiona was obviously right then!
The use of complementary therapies (CTs) by expectant parents is at an all-time high – but are they actually safe? Today, Dr Denise Tiran considers the minefield around the advice available to those expecting a baby who wish to use therapies such as aromatherapy, acupuncture, reflexology and herbal medicine. She says:
The advice pages on www.NHS.org.uk take a cautious approach to CTs, stating that there is generally insufficient research evidence to support their use during pregnancy, yet making blanket statements for the apparent safety of massage, aromatherapy and (incorrectly) ginger for pregnancy sickness. The National Institute for Health and Care Excellence (NICE) goes further by actively discouraging women from using modalities that, they suggest, are inadequately researched. Similarly, Cochrane systematic reviews, whilst being somewhat more sympathetic, also consider the inadequacy of research on the safety of CTs for pregnancy and birth. Unfortunately, these national guidelines fail to acknowledge the huge number of expectant parents seeking support from professional therapists or – more worryingly – self-administering natural remedies. CTs such as massage, aromatherapy, and reflexology are commonly used for relaxation; acupuncture and hypnotherapy are accessed for the treatment of specific physical and emotional symptoms. Natural remedies (NRs), including aromatherapy oils, herbal medicines and homeopathic remedies, are increasingly being used at home to prepare for and encourage the onset of labour.
The issue of research evidence is almost irrelevant if CTs and NRs continue to be used by expectant parents (and by those attempting to conceive). Certainly, the amount of evidence available is limited and largely explores the effectiveness of different CTs – it is impossible to conduct formal research into the safety of different types of CTs. So how should maternity professionals advise expectant parents about CTs and NRs? It is a difficult balancing act for midwives, doctors, doulas and others providing care for the pregnant population. Simply advising against CTs and NRs risks people using them surreptitiously without informing their maternity care providers. Avoiding the subject altogether similarly risks people taking remedies or receiving CTs which may be inappropriate at that time and potentially harmful. Lack of knowledge amongst health professionals risks them giving inaccurate or – more often - incomplete information which may equally compromise maternal, fetal or pregnancy wellbeing. Conversely, advocating the benefits of CTs and NRs without adequate and specific knowledge, may lead to side effects and complication from inappropriate use.
Suggested guidelines for maternity professionals and complementary therapy practitioners working with expectant parents:
We are delighted to announce that our very own Denise Tiran, CEO and Education Director for Expectancy, has been awarded an honorary doctorate by the University of Greenwich for her pioneering work in developing “complementary therapies” as a specialist area of practice, education, research and publication in midwifery. Her award was conferred at a graduation ceremony held mostly online on 27th October, but Denise was able to visit the University and receive her award in person from the Vice Chancellor (socially distanced, of course).
Denise, who also received a Fellowship from the Royal College of Midwives in 2018, says;
I am so proud to receive this honour from the University of Greenwich where I spent many happy years as a midwifery lecturer and had the opportunity to develop the UK’s first practice-based BSc (honours) degree in complementary therapies. I feel the award acknowledges the area of complementary therapies as a specific discipline and aids the credibility of a subject that still has many sceptics. This award is not only for me; it is for all those midwives who are interested in complementary therapies, all those I have taught, both in the University and, since 2004, via my own company, Expectancy, around the world. Most of all, it is for my son, Adam, who makes it all worthwhile – looking forward to celebrating with friends and family when circumstances allow us to be together again.
Denise reflects on changing childbirth since she first became a midwife over 40 years ago.
When I was first a midwife, women became pregnant spontaneously, if they were lucky - there was no fertility treatment available for those who could not conceive. The maternity benefits system allowed those who worked to start maternity leave at around 32 week's gestation without financial penalties so they could test and prepare for the birth and parenthood.
Pregnancy was accepted as a set of physiological symptoms and women coped with the sickness, backache and swollen ankles. Labour started when it started and lasted as long as it took.....
There were no scans in pregnancy and no monitors in labour - midwives and doctors used their five senses to monitor progress and wellbeing of mother and baby. There were no epidurals for pain relief - but midwives had time to be "with woman" and provide physical and emotional support.
Caesareans were rarely carried out and only for life threatening emergencies. Mostly women stayed at home to care for their babies and the local community provided support for new families.
Today, couples often leave it late to start a family whilst they develop their careers. When they decide it's time, they expect to get pregnant immediately but are often too stressed out by daily living for the body to do its work.
Once pregnant, women expect to sail through the next nine months and become frustrated when their bodies let them down and they experience the natural aches and pains of pregnancy. They expect (or need) to work almost up to the estimated due date, stop work, go into labour spontaneously and give birth in precisely the way they have planned, whether it is completely naturally or with all the technological interventions available - and feel disappointed and let down when labour doesn't go along with their plans. Parents assume their babies will feed regularly and sleep contentedly between feeds so they can continue with their normal (pre-baby) lives, including returning to work within a few weeks.
Many people planing pregnancy are not well-enough nourished today, despite the plethora of foods available. Environmental pollution adds to the imbalance of healthy chemicals in the body, affecting fertility, as does the negative energy from technology - mobile phones, computers and more. Posture is adversely affected from too much sitting in cars or at work and not enough walking. the incidence of breech pregnancy is higher because the ergonomics of our bodies has changed and women are not on their hands and knees scrubbing the kitchen floor as they did in the 1970s - the ultimate optimal fetal positioning.
Added to this is all the social stress - the negativity in the world, politics, pandemics and a social expectation that you must have a perfect pregnancy (what ever that is) and be seen to be a perfect parent. No wonder pregnancy, birth and parenthood is so stressful.
It concerns me when I see posts from pregnant women on social media trying to find answers to questions that cannot always be answered. Maternity professionals need to encourage expectant parents to chill and take it as it comes a little more. Of course there are some with very real physical, mental or social problems but for those whose pregnancies are progressing well, enjoy it and don't let it get you down. Go with the flow and don't expect too much. Consider all those aches and pains as good signs that your body is doing its work well. And look forward to the birth as "the end of the beginning".
A few words from Denise about Expectancy’s essential oils supplier, Absolute Aromas
I have known David Tomlinson, owner and managing director of Absolute Aromas for over 25 years, having met him at one of the annual complementary medicine shows that used to be held every year in Earls’ Court. He and his wife, Kay, are lovely and very knowledgeable about essential oils. Their company has grown considerably since I first met them and they are now based in Alton in Hampshire.
The essential oils are of very high quality and I have used them ever since I met David. We use them on the Expectancy courses (although I always make the point I am not on commission!).
Midwives who have completed our courses can also purchase the specially compiled Expectancy kits for maternity aromatherapy – there is a full set of the 16 essential oils we teach on the courses, together with some carrier oil, a mixing glass and stirrer in a wipe-clean carry case, with space for more oils.
More recently, as a result of changes to our courses due to Covid, we have been teaching our aromatherapy courses online and each midwife who attends receives a mini kit with twelve of the 16 oils we teach, in a lovely wooden presentation box.
Today is World Mental Health Day so here, Denise considers some of the complementary therapies and natural remedies which may – or may not be of help.
Most people know that some new mothers can experience postnatal depression, but depression during pregnancy is becoming much better recognised. Antenatal depression may occur in women with a tendency to depression, anxiety or severe stress when not pregnant, or may arise as a result of the hormonal, physical, social and occupational changes brought about by pregnancy. It can be severe, partly because is it not always diagnosed early enough, or because women do not always feel able to talk about it to their midwives or doctors. There are several ways of reducing the severity of antenatal depression, including trying to reduce stress and stressful situations, eating well and having moderate amounts of exercise. Avoiding stimulants such as caffeine, alcohol and nicotine is wise advice in pregnancy anyway, but will also reduce the impact on antenatal depression. Yoga, Pilates, swimming, tai chi and other gentle exercise can all help, especially in a designated antenatal class, in which the opportunity to talk to others can also be helpful. Relaxation therapies such as massage, reflexology, and aromatherapy can be helpful, as can mindfulness training or hypnotherapy from a qualified practitioner. Acupuncture has also been shown to reduce stress hormone levels such as cortisol and to increase feel-good factors including endorphins and encephalins. Expectant mothers, however, should be discouraged from stopping or reducing their current antidepressant medication without medical support and must be advised not to take the herbal remedy St John’s wort, which is not considered safe in pregnancy.
St John’s wort (SJW) is a herbal remedy also known as hypericum (its Latin name is Hypericum perforatum). It is often taken orally for mild to moderate depression and mood disturbance, but can also be useful for polycystic ovary syndrome, menopausal symptoms, seasonal affective disorder and other conditions. However, SJW is not a suitable alternative to antidepressants. Although the evidence is inconclusive, there is some suggestion that it may have adverse effects on the developing baby. Similarly, in breastfeeding, it should be avoided because the baby may be at greater risk of lethargy and drowsiness, as well as intestinal colic
SJW can cause a variety of adverse effects in patients, even those who are taking it appropriately. These include insomnia, restlessness, anxiety, panic attacks, irritability, dizziness, headaches and skin rashes. More serious effects include low blood sugar, high blood pressure , raised thyroid stimulating hormone and sensitivity to sunlight (this latter effect meaning that anyone also using aromatherapy oils should use citrus oils such as orange, bergamot, grapefruit and lime oils cautiously. Significantly, SJW should not be substituted for the selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline, citalopram, seroxat or fluoxetine, because its mechanism of action is similar. Women will need to withdraw gradually from SSRIs and the same applies to SJW; they should certainly not be taken together as major adverse effects such as SSRI syndrome can develop in which the person experiences suicidal thoughts and mania.
SJW can also interact with various other medications especially when taken in excessive or prolonged amounts. In addition to SSRIs, SJW can interact with the contraceptive Pill, anticoagulants, immune system suppressants, iron supplements and many other drugs used in cancer care and transplant surgery. It should also be avoided if taking other herbal remedies, notably L-tryptophan, an essential amino acid used to increase serotonin levels in depressive conditions, and red yeast, sometimes used to lower cholesterol.
SJW cream can be used topically to treat bruising and aid wound healing but the herbal remedy should not be confused with the homeopathic version which is much safer since it does not act pharmacologically. SJW cream is however safe enough to use during pregnancy and breastfeeding in small amounts. In non-pregnant women, SJW should be avoided when having fertility treatment and should not be taken with the Pill as it may reduce its contraceptive effects.
As a midwifery lecturer, I have been teaching complementary therapies for over 30 years and have long held that they must be set in the context of the culture in which they are used. Where a culture combines mainstream health care with ancient local or regional medicine systems including the use of indigenous plants and techniques, the population has a far greater appreciation of the clinical effects of treatment, both positive and negative. For example, in China, Hong Kong, Taiwan and other Far Eastern countries traditional Chinese medicine is integrated into the healthcare facilities available to the public and medical students are taught about both systems. Similarly, in India there has traditionally been cross-referral of patients between orthodox and complementary practitioners, and further legal changes to integrate the two systems more comprehensively have been made in recent years. Guidelines for the registration of traditional African medicine were published by the World Health Organisation some years ago to facilitate greater integration into the healthcare provision across the continent, particularly in sub-Saharan Africa. In South America, countries vary in respect of acceptance and regulation of traditional medicine, but some such as Brazil have introduced legislation to ensure consistency of standards and to preserve local traditions Indeed, the World Health Organisation has accepted a wide range of traditional medical modalities into its global compendium. In the Western world, things are rather different. Complementary – or alternative – medicine does not have the respect of mainstream medicine. This may be partly due to the prevailing medical system and the status of the medical professions. The political standing of doctors is considerable in some developed countries. One only has to look at the power of the British Medical Association to appreciate the influence of doctors on healthcare policy. Scientists frequently demean complementary medicine as not being sufficiently evidence-based – largely because it is difficult to undertake randomised controlled trials when using modalities that need, by their very definition, to be individualised to the person. The pharmaceutical companies also exert immense financial pressure on governments, and there is an underlying emphasis on the benefits of drugs to treat disease. In addition, the focus of medical practice is on the suppression of symptoms rather than on finding the cause of disease; there is still poor appreciation of the impact of lifestyle factors such as diet and stress on illness. Added to this is the short-term healthcare policy-making of governments in which the controlling political party may no longer be in power to witness the impact of any long term health promotion initiatives. Furthermore, populations differ widely between cultures in which people generally defer to authority compared to westernised democracies in which individuals can make their own decisions about whether to accept medical advice and treatment or to find their own alternatives. It could be argued that the rise in the use of complementary and alternative medicine is a rebellion against paternalistic orthodox medicine. The Internet too has added to the potential “knowledge-base” of healthcare consumers, although it must be acknowledged that information is not always accurate, comprehensive and balanced and may, on occasion, be downright dangerous. There is also a misplaced notion in the west that “more is better”. Nowhere do we see this more than amongst the pregnant population. Women in westernised countries want to take control of their childbearing experience; they search the Internet for solutions to the discomforts of pregnancy and notably take it on themselves to interfere in the normal process of going into labour, arguably the most common reason for pregnant women to resort to natural remedies and complementary therapies. Added to this is the ill-informed advice given by healthcare professionals about natural methods, in an attempt to be seen as mothers’ advocates. Only today, I saw on Facebook a proudly displayed post from a UK birth centre actively encouraging women to eat dates to promote labour onset. This is not, in itself a bad suggestion, but incomplete advice put out by an organisation deemed to be the “authority” for women using the service can risk some women experiencing negative effects which may go unrecognised by staff who are not in possession of the full facts. Also, there was no advice to restrict the use of natural remedies that may interact with other complementary practices or with conventional medical induction of labour. This, then, is the nub of the argument: in the developed countries there are so many options for dealing with various health conditions, ranging from highly sophisticated contemporary medical treatments for specific problems to well-known and popular complementary therapies to the fringe alternatives (commonly used by desperate cancer patients seeking solutions), that people are unaware of the issues that may occur when they are combined. It is well known that herbal remedies, which act pharmacologically, carry a significant risk of interaction with other pharmacological agents, including both prescribed and recreational drugs and other natural remedies (See my forthcoming book on Using Natural Remedies Safely in Pregnancy and Childbirth, due to be published March 2021). Having spent almost my entire career practising, researching, writing about, teaching and promoting the use of complementary therapies in pregnancy and childbirth, I would be doing a disservice to everyone to suggest that their use should now be limited. However it is vital that midwives, doctors, doulas, antenatal teachers and other maternity professionals, as well as people attempting to conceive, and those in the antenatal, labour and postpartum periods, understand that these “alternatives” are powerful and may be either beneficial or hazardous. I always say, if something has the power to do good, it also has the power to do harm if not used appropriately. As with any medicinal product, natural remedies and complementary therapies MUST be adapted to the individual, used correctly, in the smallest “dose” needed to achieve a positive effect. Professionals must understand the reasons for use and those people who should not use a particular remedy or therapy; they must understand the way in which the therapy works, and be alert to side effects and adverse reactions – and know how to deal with them. Their use of alternatives must be set in the context of the culture in which they are working – and in developed countries that usually means the national healthcare services. In the UK, the NHS works for the good of the majority rather than the interests of individuals; it is focused on using evidence-based practices and dismissing those without “proof” of both effectiveness and safety. The NHS is litigation conscious and policy is largely directed towards the “just in case” scenario, utilising routine practices in an attempt to show that everything has been done correctly – just in case there is a legal case arising from possible malpractice or other factors. Whilst we may not like the culture in which NHS employees work, that is the prevailing situation and any alternative options must be used or offered with this in mind.
Eating curry is one of many so-called “old wives’ tales” about starting labour. To my knowledge, there is no research to prove this but it is thought to work because the hot spices stimulate the gut which may have an indirect effect on the nearby nerves and muscles of the uterus, thus triggering contractions. Diarrhoea and loose stools can be a sign of impending labour but are natural responses to the changes already occurring in the body in readiness for labour. Other popular natural ways of getting yourself into labour include pineapple (the core contains a chemical which can cause contraction of uterine muscle) and dates, which have been shown in a couple of studies to have some effect on contractions. Dates contain fatty acids that help in the production of prostaglandins, as well as other chemicals which may contribute to smooth muscle contraction. Aubergine and tomatoes with parmesan is a popular Italian recipe that is also though to contribute to labour onset, but its success is more likely to be due to the herbs used in the recipe - basil and oregano should be used with caution during pregnancy as they are known, in large quantities to cause threatened miscarriage. So – in honour of national curry week, perhaps the best curry recipe to trigger labour would be one with aubergine, tomatoes, pineapple and dates in it! However, my advice is to take care with all natural ways of starting labour and just to let your body do its own work – after all that’s what you’re designed for.
Did you know there are many different styles of reflexology? The word “reflexology” refers to the use of one small part of the body as a “map” of the whole. Normally reflexology is performed on the feet, with every part of the body being reflected on one of both feet, but the therapy can also be done via the hands, ears, tongue, face or even the back.
The style that Denise and her team teach for midwives and doulas is the German style of clinical reflex zone therapy (RZT) devised by the German midwife, Hanne Marquardt.
RZT fits very well with midwifery because it can be used both as a relaxation treatment but also for more specific conditions such as pregnancy sickness, backache, sciatica, carpal tunnel syndrome and to stimulate the onset of labour. It is good for pain relief in labour and can help with retained placenta. Postnatally, RZT can aid recovery from birth, stimulate lactation and boost the immune system.
Other types of reflexology range from the very gentle light touch reflexology, combining traditional reflexology with healing energy techniques, to vertical reflexology, which starts by applying pressure to the weight-bearing tops of the feet or hands, followed by a conventional treatment. Eastern styles include Chinese Five Element reflexology and Taiwanese Rwo Schur, which uses an extremely intense pressure. Most generic reflexologists use the Ingham method, which incorporates more massage-type techniques rather than just pressure point treatments
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