Denise and her blog

What Is Happening In Midwifery?

Midwifery appears to be at a crossroads, both in the UK and elsewhere. Practice and education are both under attack, largely from paternalistic factions wanting to control childbirth and the profession of midwifery. Childbirth has become the pariah of healthcare, causing immense stress for expectant and birthing parents, leading midwives to leave the NHS and even the profession, and the government to have knee-jerk reactions in terms of national reviews and even the suggestion of a minister for maternity care.  

As a midwife of almost 50 years, I have seen maternity care and midwifery practice change from something akin to the “Call the Midwife” era (I started in the mid-1970s), to the deplorable state we find ourselves in today. We have had numerous reviews over those years, from the 1970 Peel Report advocating hospital birth, to the three Maternity Care in Action reports in the 80s, Changing Childbirth in the 90s, to a string or reports, investigations and attempts to improve maternity care in the 2000s. But what ARE the current problems and how can some of the issues be resolved – or, indeed, can they?

First, in my opinion, is a catastrophic and almost total loss of any understanding – amongst midwives, obstetricians and the public - that pregnancy and birth are physiological life events that simply require careful observation and, in a few cases, when progress deviates from the anticipated norm, medical support. There is also a significant lack of understanding by the government, NHS, obstetricians and even some midwives, of the wide role of the midwife, as defined by the World Health Organisation, which focuses on working with women from the preconception period, through pregnancy, birth and the postnatal period up to one year following birth of the baby.   

The denial of “normality” has led to increased medicalisation of birth with premature and unwarranted “cascades of intervention” and excessively high induction (up to 60% in at least one unit known to me) and Caesarean rates that have overtaken spontaneous vaginal births. This is coupled with a deplorably coercive and paternalistic approach to maternity care “options” for expectant and birthing parents, largely driven by a fear of litigation if no action is taken, and the obstetric culture of wanting to “do something”, with controlled management, as in other medical specialties. Expectant parents are “advised” that intervention is necessary to protect them and their babies, with insufficient information given to aid them in making informed decisions about their births. Some parents are so anxious about their maternity experiences at the hands of the NHS, that they choose home birth, independent midwives or even unassisted birth.

Added to the internal issues around medicalisation are the demands from the anti-natural childbirth lobby, which have arisen from various investigations into baby loss. It is, of course, very sad when any baby, or mother, dies in childbirth, but we should be careful to put this in perspective. Whilst perinatal loss and maternal mortality statistics could be a great deal better, the majority of women have – or at least could have, if left to physiology – a perfectly normal pregnancy and a spontaneous vaginal birth. It is often the intervention that adds to the “abnormality” which then leads to further medicalisation. Any national review is only likely to add to the intervention in a “just in case” approach.

On the other hand, we now have many more women with increasingly complex pathological, psychological and social needs, who require obstetric and often general medical treatment, leading to increased staffing requirements, clinical costs and bed occupancy. Whilst the birth rate has fallen slightly, there are additional demands on the maternity services, with medical advances enabling women who would otherwise not have been able to conceive and reproduce, as well as people newly arrived in the UK who may present with issues that have not hitherto been familiar to NHS staff.

We now have a shortage of midwifery staff, with many experienced midwives near retirement age and many more leaving the NHS due to burnout. This is well documented by a press hungry to highlight the problems of the maternity services, leading to a poor perception of midwifery that can affect recruitment, It is not that midwives want to stop caring for expectant and birthing parents, but that they can no longer tolerate long hours and unpaid overtime, lack of gratitude and incessant demands on their energy that leave many unable even to find time to go to the toilet or have a drink, let alone take the statutorily required breaks in their working days.

Midwifery education must also take some of the blame for the current issues in the maternity services. There is a “bums on seats” approach by universities accepting students, coupled with lecturing staff redundancies, leading to lack of support for student midwives who are then unable to cope with the rigours of midwifery theoretical learning and clinical practice. Students are required to pay exorbitant fees for education that may still not provide them with jobs and preceptorships at the end of their pre-registration period. I am sceptical about preceptorships which, in the NHS are a management strategy to ensure that all midwives are capable of working in all clinical areas to fill staffing gaps. However, for newly qualified midwives (NQMs), it is certainly advisable to consolidate their learning, yet there appear to be fewer and fewer opportunities to do so immediately after qualifying. The gap between obtaining registration and actually starting clinical work often leads to loss of momentum, with some NQMs never practising. 

All these factors discussed so far have resulted in a deplorable lack of experience of physiological birth for student and NQMs who are then fearful of caring for parents wanting a more natural birth because they do not understand it in practical terms. This only perpetuates and strengthens the argument for intervention. Further, there is little career development support to enable midwives to specialise in a specific area of midwifery, coupled with a “dumbing down” of expertise by employing more support workers. 

There is also, in both education and practice, a culture implying that students are being trained for the NHS, with an overall political refusal to accept midwifery as a profession which enables midwives to work in any setting, anywhere, both NHS and privately, at home and overseas, subject to local requirements. Further, there remains difficulty in obtaining professional indemnity insurance cover for those who wish to work in a self-employed capacity, although some steps have been taken in more recent years to address this.

Further, there is a totally unacceptable culture of bullying within NHS maternity services, both midwifery and medical, from management and between clinical colleagues, with an element of multi-professional tensions adding to the problem.  The overall attitude within the maternity services is punitive and threatening, with staff afraid to speak out – it is easier to fit with the system than to be seen as a maverick. All of this leads to high sickness and absence rates, resignations and significant mental health issues for individuals concerned. 

And so, we get to finance, which the government seems to think is one of the primary issues. Perhaps there is a shortage of funding for maternity services, but more likely it is the inappropriate allocation of resources and the need to fund interventionist practice which impacts on maternity, anaesthetic and paediatric services, as well as bed capacity and other services eg domestic and portering. Yes, we could do with more money in the NHS generally, but it is not the sole answer.

Throwing money at the issue of the maternity services is not going to solve the problems. Neither will yet another government sponsored review, which already adds political bias, be the answer, nor the appointment of a Minister for Maternity Services.    

Evidence-Informed Education In Complementary Therapies

Every day, midwives hold an extraordinary position of trust.

Women come to you not only for clinical expertise, but for reassurance, interpretation, and guidance - especially when they’re exploring complementary or natural approaches alongside conventional care.

That’s why I believe so strongly that midwives deserve robust, evidence-informed education in complementary therapies.

Not to replace clinical practice - but to enhance it.

To help you answer questions with confidence.
To support women safely, ethically and within your scope.

At Expectancy, everything we teach is grounded in midwifery values: safety, professionalism, critical thinking and woman-centred care.

Happy New Year !!

The start of a new year often brings a moment to pause and reflect on where we are - and where we’d like to grow.

For many midwives, that growth comes from deepening knowledge, building confidence, and finding new ways to support women with care that is both evidence-informed and compassionate.  

Complementary therapies can play a valuable role in that journey when they’re integrated safely and professionally.

If you’re considering developing your skills this year - whether for your clinical role or for a future private practice - I’d love to support you in exploring what’s possible.  

A new year can be the beginning of a very rewarding next chapter.

Reflections

I’ve been reflecting on our first practical weekend of the Acupuncture course back in October, taught by our lovely Amanda.  

It’s always such a memorable point in the programme - that moment when midwives begin actually placing needles for the first time!

There’s usually a mix of excitement and a little apprehension, which is completely natural. But the group handled it brilliantly, supporting one another as they developed their confidence and technique.

Acupuncture is a wonderfully effective tool in maternity care, and watching midwives lean into new skills with such enthusiasm is one of the joys of teaching. 💜

The Parlous State Of The UK Maternity Services – Is Midwifery Education To Blame?

Sunday 9^th November 2025 was a sad day for midwifery education in the UK with the publication in the Sunday Times of an article blaming universities offering pre-registration training of promoting an irresponsible  “normal birth ideology”, apparently at the expense of safety for mothers and babies. Only a couple of weeks ago, the media bombarded us with the risks of home birth, following a case in which both mother and baby died. And now, the likes of Wes Streeting, Jeremy Hunt and of course James Titcombe, have waded in to the debate, taking the angle that midwives’ training programmes are to blame. This week, using the emotive case of a mother whose baby died at 42 weeks’ gestation, allegedly because she was not advised to have an induction for postdates pregnancy, the anti-natural-childbirth lobby has yet again found an excuse to launch another attack on midwifery, maternity care – and now – on midwifery education.

It is obvious that those determined to disparage midwifery and everything it stands for have no knowledge of childbirth as a normal bio-psycho-social life event nor of the dangers of the astronomical rates of intervention we are currently facing, across many westernised countries including not only the UK, but Australia, the USA and many European countries. There is no understanding of the World Health Organisation’s and International Confederation of Midwives’ definitions of midwifery and what constitutes midwifery practice, nor of their commitment to midwives as specialists in physiological birth. There is no comprehension of the role of the regulator (Nursing and Midwifery Council) in maintaining the international essential competencies for midwifery as promoters of physiological birth. And there is no empathy in failing to acknowledge parental emotions, desires or needs in this natural process of having a baby. Midwifery educator peers have been vilified (again) for daring to organise the annual Normal Birth conference, with the media – and those influencing the media – casting aspersions that this perpetuates the “ideology of normal birth at all costs”. Universities offering midwifery programmes have now come under fire for allowing this apparent dogma to thrive, with critics claiming that students are not being taught safe practice.

These critics – the policy makers, the politicians and influencers previously affected personally by birth related mortality or morbidity – have catastrophically failed to appreciate the multifactorial issues facing the maternity services,  the midwifery and obstetric professions, midwifery education and all the other issues impacting on the dire situation we now face. We have a paternalistic antenatal and birth system that sees birth as a medical issue to be managed – and managed within the constraints of finances, staffing and bed space. We have an ever-increasing population with more women with complex pregnancies, often requiring intervention to achieve a safe birth.  We have a maternity care system rife with bullying – of staff and consumers. We have a profession that is scared to step outside guidelines to support women safely and appropriately. We have such a focus on evidence-based practice that we are at risk of losing all common sense when it comes to birth.  

There is an ageing midwifery workforce with many senior and experienced midwives retiring, sometimes taking early retirement to escape the deplorable maternity service environment. Conversely, we have students entering midwifery education with fewer prospects of jobs at the end because of an under-funded and inappropriately pathologised system. Crucially, students are not witnessing physiological birth in practice, nor are they observing experienced midwives prepared to advocate for normal birth out of fear of being accused of whistle blowing in an increasingly punitive system. Indeed, in defence of obstetricians, medical staff are also not seeing enough physiological labour and birth to be certain of their own boundaries, leading them to take a “just in case” approach, often intervening before it becomes necessary. Lack of experience, as a student or newly qualified midwife, of birth as a normal life event means that midwives  are encultured into the medicalisation of birth, with many never developing the confidence to care for women in physiological labour nor the competence to recognise when labour deviates from normal progress and requires referral to obstetricians who specialise in “abnormal” labour.

Universities could be accused of being partly to blame for inappropriate education of midwives, but not in respect of evangelically promoting a normal birth “ideology”. Universities are businesses and need “bums on seats” to make their programmes cost effective. Shared learning has become standard in many higher education institutions – and not primarily because some shared learning is valuable, but because it saves money, time and rooming needs. My personal bugbear is the lack of anatomy and physiology that is now taught in midwifery pre-registration programmes (and sometimes not at all) – yet a deeper applied knowledge of A&P can save lives, both babies’ and mothers’. Midwifery educators are bound to comply with the international standards for midwifery, the UK standards for pre-registration education and to instil in students and qualified midwives the confidence in achieving and upholding the principles of midwifery practice, knowledge, understanding and progress.

Indeed, this whole debacle -accusing midwives and educators of promoting an “ideology of birth as normal at all costs” - smacks of yet another way in which the profession and expectant and birthing parents can be influenced. We have increasing numbers of parents petrified – not of giving birth, but of the maternity services in which they give birth. We have midwives who are terrorised by the ever-present threat of litigation. We have midwifery managers who have the constant sword of Damocles in respect of saving money whilst avoiding litigation hanging over them. We have a disjointed maternity service that is so embedded in the contemporary culture of fear, that no one is able to tie everything together for the good of all concerned.

It is time for midwives to fight – for our profession, our education system and most of all, for the women and babies in our care. We need to address the huge problems of an NHS that is no longer fit for purpose, especially in maternity care. We need to challenge the educational programmes for student midwives to ensure they can develop the confidence and competence to practise safely whilst addressing the full bio-psycho-social needs of people in their care. We need to challenge government to analyse the myriad issues faced by the maternity services – not in yet more service reviews, nor in simply throwing money at the system, but by changing the mindset of everyone to accept that childbirth – in the main – IS a normal life event. We need a better balance between spontaneous onset and progress of birth versus inappropriate or sometimes necessary intervention. And we need educational systems that ensure that both midwives and obstetricians can work together to provide the full spectrum of care that is effective, safe, cost effective, evidence-based where necessary and fit for purpose.

The media creates fear because fear keeps the population under control. And – make no mistake – this fear is male-driven. By this, I don’t mean only those biological men who are currently active in the debate, but our whole patriarchal society that puts women in a subservient position, something that has always been the case in relation to childbirth. And there, perhaps, lies the crux of the problem. We are not going to win the battle and be able to advocate for the midwifery profession and for childbearing women until we address the culture of childbirth more generally. The profession of midwifery is largely a female-dominated one, whereas traditionally obstetrics has been male-dominated. Even though that has changed, with far greater numbers of female obstetricians, they too have trained and practised in an autocratic medical system that persists to this day.

All that this current media scrutiny will achieve is to accelerate the climate of fear around childbirth, giving parents fewer choices and, in some cases, driving parents away from professional help, which may in itself lead to a whole raft of other problems.  Whatever the media states, pregnancy and birth ARE normal physiological life events and midwifery is the profession best placed to help in that process.

What Should You Learn on a Midwifery Aromatherapy Course? 

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

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

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

So, what should an aromatherapy course for midwives cover?

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

In Support of Home Birth

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

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

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

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

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

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

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

The Power of Essential Oils

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

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

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

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

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

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

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

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

Worldwide Midwifery Friendships

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

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

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

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

Ginger in pregnancy

Ginger in pregnancy?

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

Midwives - Adapting To Change

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

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

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

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

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

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

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

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

What Does Is Mean To Study With Expectancy?

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

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

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

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

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

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

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

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

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

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

Contact us NOW to join us.

A little note from me

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

It’s about belief.

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

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

Expectancy isn’t just about learning a new therapy.

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

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

The Identity of a Midwife

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

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

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

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

Past the Due Date

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

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

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

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

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

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

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

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

Indemnity Insurance In Private Practice: What Midwives Need To Know

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

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

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

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

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

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

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




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

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

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

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

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

ASK ABOUT OUR EXCITING NEW CERTIFICATE IN MIDWIFERY BUSINESS STUDIES.

Another end to a successful Expectancy academic year

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

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

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

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

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

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

STOP USING CLARY SAGE OIL IN LABOUR!

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

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

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

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

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

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

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

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

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

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

Our Annual Licensed Consultants Day in London

A fabulous day recently spent with some truly inspiring midwives!

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

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

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

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

Essential Oil Chemisty

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

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

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

A few can even help with pain.

But here’s the key:

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

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

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

It’s essential knowledge for safe practice.

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

The Northern Maternity & Midwifery Festival 8th July 2025

What a brilliant day in Manchester yesterday!

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

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

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

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

Until next time, Manchester 👋

Using Natural Remedies Safely in Pregnancy and Childbirth

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

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

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

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

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

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

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

Book Available via this website.

Expectancy Monthly Newsletter

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

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

Each month, I’ll be sharing:

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

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

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

https://expectancy.myflodesk.com/zintmx8av2

Safe Storage Of Essential Oils In Midwifery Units 

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

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

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

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

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

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

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

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

What Is A Midwife?

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

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

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

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

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

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

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

That’s exactly why I wrote my latest book:

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

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

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

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

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

Women’s Bodies Are Designed To Give Birth

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

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

But what if midwifery education started from a different place?

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

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

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

A few words about lavender essential oil

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

Mastering the Business of midwifery

Using Natural Remedies Safely in Pregnancy and Childbirth

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

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

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

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

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

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

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

Impact Of Aromatherapy Oils On Midwives

Safety for midwives using aromatherapy in practice.

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

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

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

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

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

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

Nausea in Pregnancy

Midwives, let’s talk nausea in pregnancy…

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

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

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

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

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

Feedback

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

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

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

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

Let’s talk about feet

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

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

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

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

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

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

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

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

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

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

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

Are You A Procrastinator When It Comes To Revalidation?

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

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

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

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

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

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

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

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

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

Did you know that not all reflexology is the same?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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