Denise and her blog

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.

Did you know?  

When I was writing my book on complementary therapies for post-date pregnancy, I discovered over 100 different ways that expectant parents try to start labour naturally.   

And it’s not just in the Western world - women across the globe are seeking out remedies, from pineapple and dates to more unusual ones like elephant dung and baboon urine in parts of Africa (though, I wouldn’t recommend those!).  

While it’s natural for women to want to meet their baby as soon as possible, my advice is this: don’t mix too many remedies at once. Trying everything together can confuse the body’s natural rhythms and may even slow things down.  

If you’re supporting women in starting labour or avoiding induction, encourage them to try one remedy at a time, give it a moment to work, and then move to the next if needed.  

Castor Oil: Back in the spotlight

When I first started my midwifery training, Castor oil was a common herbal remedy to encourage labour onset. It fell out of fashion for a while, but now it's become popular again.

Some research suggests that drinking 30ml of Castor oil in one dose might help trigger labour, but it's important not to overdo it.

In reality, Castor oil is more likely to cause diarrhoea than stimulate effective uterine contractions.  

Well, I suppose that could still help get things moving. 😅  

But here's the thing: Castor oil isn't safe for everyone, and we should steer clear of chewing Castor seeds. These seeds contain ricin, a highly toxic substance, so that's something we don't want any pregnant women doing in the mistaken belief it'll help with labour.  

So, while Castor oil might be a tool in your toolbox, remember moderation is key and always approach cautiously.  

The Changing Face Of Maternity Complementary Therapies 

Having recently celebrated 50 years since starting my career, I have been reflecting on how thinking around the subject of “complementary therapies” has changed since I first pioneered the specialism in midwifery in the early 1980s. When I started becoming interested in this vast subject area and applying it to midwifery practice, research, education and publication, it was still very much considered “alternative” or “fringe medicine” – and many colleagues gave the impression they thought I was the resident witch.  Since my student days in the 1970s, I had been an advocate for physiological birth and women’s empowerment, joining the Association of Radical Midwives, going on “natural birth” campaign marches and fervently supporting home birth. Bear in mind that, since the Peel report of 1970, this was now a time when hospital birth had become well entrenched in the NHS. Gone were the days of birth as a family event, largely occurring at home with midwifery support and little medical intervention. In came a changed style of maternity care with new technology, new interventions and new attitudes. As we progressed into the 1990s and 2000s, the maternity services became more paternalistic, more punitive and more litigation conscious.

Despite, or perhaps because of this, there emerged a huge public interest for more natural ways of dealing with health issues, not just in maternity care. The then Prince of Wales supported holistic approaches to care and set up the Foundation for Integrated Health, from which several specialist complementary health clinics evolved. Various universities started to offer undergraduate degrees in complementary medicine. I was in the right place at the right time in this respect, having trained in several therapies and then being given the opportunity in 1992 to develop the first practice-based BSc(Hons) in Complementary Therapies at the University of Greenwich. As part of this work, I established a unique midwifery clinic offering complementary therapies for women with pregnancy discomforts, using a combined approach of standard care with a range of different modalities. With increased medicalisation of birth, professional interest in complementary therapies also grew, partly in response to demand from expectant parents. At that time, the subject was not included in pre-registration education, yet service users were asking questions, seeking alternatives and expressing a desire to pay for them by consulting independent practitioners. Conversely, the complementary therapy professions were beginning to evolve beyond generic practice to provide training and insurance for those who wished to specialise in working with particular client groups, including cancer patients and pregnant women.

The first decade of the 21^st century was possibly the heyday of complementary medicine, with complementary methods now a firm option for healthcare amongst the general public. When I left the university to set up Expectancy in 2004 to provide training in the subject especially for midwives, various NHS trusts were starting to consider how they could incorporate this “new” element of care into the maternity services. I spent much of my time up to 2020 running around the UK delivering in-house courses for midwives and travelling overseas to teach in maternity units, universities and colleges, notably in the Far East. Even now, Expectancy remains unique, worldwide, in providing this specialist midwifery education with an academic emphasis on theory and practice similar to degree level studies. By 2019, there were dozens of UK maternity units offering aromatherapy for labour, some including moxibustion education in their breech clinics and a few providing acupuncture clinics for dealing with a range of antenatal and postnatal issues. 

Then came the pandemic when, at a stroke, maternity complementary therapies were, understandably, almost universally discontinued. Disappointingly, many services have not been re-established, with lack of staffing, funding and the need for updating being cited as the main reasons. The situation has been exacerbated in the last three years by concerns over reported issues arising when midwives seek to replace – rather than enhance – conventional midwifery care with complementary therapies, or delay seeking obstetric support when intrapartum progress deviates from the physiological norm. On the other hand, there is a slight resurgence in NHS interest from trusts where intervention rates are so high that it has been acknowledged that “something” has to be done to reduce high costs, not just in financial terms but in legal costs and human costs too. This latter is particularly pertinent in terms of physical and emotional trauma experienced by women subjected to gross intervention and in the flight of dissatisfied midwives from the NHS. Unfortunately, there persists the notion, not entirely accurate, that complementary therapies are primarily used for relaxation and stress relief (surely an indication for using them now, given the immense stresses and mental health issues experienced by pregnant, birthing and postnatal mothers?) Even after over 40 years of flying the flag for midwifery complementary medicine, it continues to be regarded with scepticism by many in the health services and there is little enthusiasm for introducing apparently time-consuming treatments that are seen as expensive, inequitable and poorly evidenced luxuries.

However, a new breed of midwives is emerging, with many so dissatisfied with working in the blame-and-bullying culture of the NHS that they are choosing to take their first steps towards offering maternity-related services in private practice. There are many expectant parents who are prepared to pay for services that they cannot obtain on the NHS – and midwives are tapping into this demand. There is a growth in the numbers of independent midwives, many now able to offer full birth services once again, others offering enhanced antenatal care and education, or specialist services such as tongue tie division, repeat newborn examinations, Caesarean scar therapy and of course complementary therapies. The tide is turning and there are increasing numbers of midwives wanting to make that leap into the commercial world of healthcare – both for the benefit of potential clients and for their own work-life balance and peace of mind.

Going into business – leaving the relative security of a regular income and perceived professional and clinical support of the NHS – can be daunting and there is a lot to learn. “Business studies” is a whole new ball game, but essential if you want to make a success of your private practice and want to avoid making costly mistakes – financial, professional and even legal mistakes.  If you are interested in making the move to private practice, Expectancy offers a Licensed Consultancy scheme (similar to a franchise) for midwives wanting to offer complementary therapies in their own businesses, and a brand-new Certificate in Midwifery Business Studies for other midwives who do not necessarily wish to study complementary therapies. See www.expectancy.co.uk or contact me on info@expectancy.co.uk for more information.

Happy International Women’s Day! 💜

As midwives, we have the privilege of supporting, empowering, and advocating for women at one of the most transformative moments of their lives.

Today is a celebration of the strength, resilience, and compassion that women bring to the world - and as midwives, we see that every single day.

Let’s continue to lift each other up, champion women’s health, and push for better support and recognition for the incredible work we do.

Here’s to all the women we care for, the women we work alongside, and the women who inspire us!

A Reunion To Remember.

What a special day it was, coming together to celebrate 50 years in midwifery!

Meeting at St Bartholomew’s Hospital, we reminisced over coffee, explored the changes since our last reunion, and of course, took our traditional photo by the fountain (thankfully, the weather was on our side!).

The day wouldn’t have been complete without a lovely lunch down the road, filled with laughter, memories, and stories from decades of dedication to nursing and midwifery..

A heartfelt thank you to everyone who came – it was a joy to reconnect and reflect on the journey we’ve shared. Here’s to the next reunion! 💜

THE START OF MY CAREER 

Monday February 17^th 1975 was the beginning of my career, and the start of my nurse training at St Bartholomew’s Hospital in the City of London. A group of 38 of us entered Preliminary training School (PTS), an eight-week period of classroom learning before being let loose on the wards. We were almost all in our late teens or early twenties and unmarried (although one girl was 25 and – horror of horrors – divorced!) It was the first time away from home for many of us and out tutors acted in loco parentis. Great excitement ensued as we were given our uniforms and taught how to make up our caps from a starched square of thick white cotton. We had our hair length assessed and if it was on our collars, we were required to tie it up under the cap. Skirt length of our uniform dresses was actually measured and had to sit on the knee when standing straight. Any ladders in our black stockings meant we had to change them to ensure we looked professional. We even had our nail length and the amount of make up (discouraged) examined. No perfume was allowed at all as it could adversely affect some patients. Those first few weeks were exhausting, somewhat frightening but entirely exhilarating as we prepared to go out into practice for the first time. We received lectures from our tutors and some medical consultants, clinical skills were taught by the clinical tutors who would accompany us to the wards later, and we also had sessions on looking after ourselves. The Nursing Officer for Obstetrics and Gynaecology came to talk to us about “family planning”, her advice being “the best form of contraception, girls, is NO!” We also had sessions from local groups such as historians and one of the City of London’s ancient Livery companies. Those eight weeks provided us with a wonderful foundation of professionalism and basic knowledge that would stand us in good stead for the rest of our careers.

Midwifery Reflex Zone Therapy

What if a simple technique could help support pregnancy, ease labour, and promote postnatal recovery?

When I first started studying reflexology, my son was just nine months old, and I was still breastfeeding him morning and night.  

During my training in reflex zone therapy, a more clinical and targeted approach to reflexology, I experienced something incredible - my milk supply suddenly surged, just like the boost mothers get a few days after birth.

That was my lightbulb moment! If this therapy could have such a powerful effect on me, what could it do for other mothers?

Since then, I’ve used reflex zone therapy to support expectant, birthing, and postnatal mothers - helping with pregnancy symptoms, encouraging labour, easing pain, and promoting postnatal recovery.  

It’s not just a foot massage or a relaxation technique; it’s a method that triggers the body’s self-healing ability.

Midwives play a key role in facilitating this process, supporting the body’s natural responses rather than just treating symptoms.  

That’s exactly what we explore in depth in our Certificate in Midwifery Reflex Zone Therapy programme.

Postdate Pregnancies

Medical induction isn’t the only approach for postdate pregnancies - let’s talk about natural alternatives!

When I wrote my book on complementary therapies for postdate pregnancies, I wanted to give midwives practical, evidence-based tools to support women facing induction.

So often, women are told their only option is medical intervention - but what if we could offer safe, natural alternatives to help encourage labour?  

Reflexology, aromatherapy, acupuncture, and other techniques have been shown to promote relaxation, reduce stress hormones, and even stimulate oxytocin production - all of which can support the body’s natural readiness for birth.

This book isn’t about replacing medical care, but rather empowering midwives with additional skills to give women more choice in their birth journey.

Have you explored complementary therapies in your midwifery practice?

A Cause For Concern – Aromatherapy In Theatre

I recently acted as a confirmer for a midwife about to revalidate, who told me that she had witnessed another midwife using aromatherapy in theatre for a woman undergoing elective Caesarean under spinal anaesthetic. Apparently, the woman became nauseous during the surgery – so the midwife took from the pocket of her theatre scrubs a small bottle of peppermint oil and encouraged the woman to sniff it to ease the nausea.  However, this is negligent on so many accounts:

• my student told me there were no clinical guidelines in the unit for the use of aromatherapy
• she was unsure if the midwife had received midwifery aromatherapy training – but presumably not if she felt it acceptable to use essential oils in theatre
• there was, apparently, no prior communication with the anaesthetist or obstetrician which should have occurred when any pharmacologically active substance was to be used
• there was no assessment of the mother in terms of whether or not essential oils in general and peppermint oil in particular were acceptable for the individual
• no informed consent was obtained from the woman, the bottle was simply offered for her to inhale the peppermint vapours
• the use of any essential oils in theatre or the anaesthetic room is completely contraindicated, an environment in which rapid changes in patient physiology can occur
• indeed, peppermint oil can be a cardiac stimulant in some people, so its use in a situation in which the woman’s vital signs may change rapidly was completely inappropriate
• there was no acknowledgement of the possible risks, albeit minimal, to mother, baby and staff present in the theatre
• the quality of the essential oil, whether it was within use-by dates, the dosage and the specific type of peppermint oil was unknown – some types of peppermint are contraindicated in pregnancy
• no documentation was undertaken about the use of the peppermint oil, presumably because it was not perceived as a form of medication
• the midwife was working entirely outside the parameters of the NMC Code

The revalidating midwife and I discussed her responsibilities under the “escalating concerns” clause of the NMC Code, and she agreed to try to tackle the problem once she was back in the unit.

What issues have you witnessed or experienced in relation to aromatherapy use in the maternity unit or birth centre?

Is NHS Midwifery Becoming Obstetric Nursing? 

There have been plenty of social media posts from midwives and doulas about the parlous state of maternity care in the westernised world. There is an increasing backlash against the catastrophic medicalisation of birth from almost entirely unnecessary and potentially harmful interventions imposed on women, especially around labour onset and progress. Induction rates in some tertiary UK units are as high as 60% (personal communications) whilst UK Caesarean rate reached an average of 42% in 2024, with some units having even higher rates. Indeed, even Elon Musk has commented that Caesareans lead to babies with “bigger brains” although what he may have meant was “bigger heads” due to avoidance of the moulding that occurs in spontaneous vaginal birth. Whether or not he feels that having a larger head is a positive or negative matter is unclear, but it is unbelievable that he should deign to comment on something about which he knows nothing. Parameters of “safe” practice are now being changed negatively, including the “safe” gestation parameters for term, resulting in earlier inductions, or the cutoff point for diagnosing diabetes in pregnancy, leading to stress in women who are told they are “diabetic” yet who would not have been diagnosed as such previously.

More importantly, midwifery practice is changing – in my opinion, not for the better. Students are not witnessing physiological birth and newly qualified midwives lack the confidence (and, I would argue, the competence) to work with women in physiologically normal labour. Midwives are frightened by the perceived “risk” of childbirth and also by the implicit threat of disciplinary action for not following local or national guidelines or by the risk of litigation if they do something “wrong”. This is not helped by the redefinition of “normal” birth that now allows students to count towards their required 40 “normal” births those in which they may not have personally managed the entire labour experience, for example, not managing placental expulsion. It seems that the main reason for this change in the regulations relates to the diminishing rates of physiological birth. Further, the NMC now permits increased hours of simulated practice rather than direct clinical contact with women and babies, presumably because of a shortage of placements for students. Whilst certain clinical skills can be learned in simulation laboratories, there is no replacement for direct clinical contact with service users, all of whom have different responses to procedures, treatments and the whole childbearing experience. 

Midwives’ knowledge of anatomy and physiology is deplorable, sometimes to the point of being potentially negligent in clinical practice. This is compounded by the reduction in, and methods of teaching anatomy and physiology to students, presumably to accommodate the extra psycho-social elements of contemporary midwifery practice. This lack of knowledge means that midwives may be unable to detect changing physiopathology early enough to raise concerns, especially in labour, something that is only going to worsen as more and more women are coerced – indeed, emotionally blackmailed – into interventions, notably inductions, with the high risk of a cascade of intervention leading to Caesarean. Universities are reducing the required teaching hours of A&P and the pass marks for assignments, with to my knowledge, some students being given three, four or even five attempts to pass an exam or assignment. It is very saddening to see social media comments by student midwives agonising over the theoretical difficulties of midwifery pre-registration education, many – perhaps most – finding A&P and related subjects such as pharmacology “too hard”. This is extremely worrying – would you want a relative (or yourself) to be cared for by a doctor, midwife or nurse who only knows half of what they need to know because they deemed it “too hard” to learn? If someone wishes to become a healthcare professional – with the emphasis on the word “professional” - then potential midwives need to realise that pre-registration education IS hard and requires an absolute commitment to all elements required to carry out the role.

NHS midwives have completely lost their autonomy and now appear to work almost entirely under the direction of local and national clinical guidelines, including the debatable NICE guidelines, medical instructions and managerial financial, time and staffing constraints. Essentially, they have become obstetric nurses. Much of the work of midwives within maternity units is now more akin to surgical nursing care and administrative duties than the holistic bio-psycho-social focus of traditional midwifery care. I despair of what I see and hear about NHS midwifery (and state-run maternity services in other developed countries). Care of families going through the maternity services is not compassionate and is certainly not physiological, suggesting that it is also not safe. I have very grave concerns for when the time comes for my son and his partner to start their own family and would actively advise them not to have NHS care over which they have no control – what a sad indictment for someone who has been a committed midwife and midwifery lecturer for almost 50 years. 

I support entirely those midwives who choose to work independently, however, difficult that may be in terms of fighting the system, obtaining insurance and other trials that come with being self-employed. Perhaps it is time to re-evaluate completely the way in which maternity care is provided in the UK. Increasing numbers of midwives are choosing to work outside the “system” although most no longer provide birth services but focus on enhancing pregnancy and postnatal care with services not generally provided by the NHS, such as individualised preparation for birth, complementary therapies, traditional postnatal care over the first month of the babies’ lives and more. Does this mean that the NHS will provide services in which doctors and nurses manage births, with medicalisation becoming all the more the conventional way of having a baby, leaving midwives to provide psycho-social care during pregnancy and after the birth?  

Moxibustion

When a woman has a breech presentation, she’s often eager to avoid an external cephalic version (ECV) or a caesarean section if the baby doesn’t turn.
That’s where moxibustion can be a game-changer!
This simple, inexpensive therapy can be taught to parents, empowering them to do the treatment themselves.
Starting around 34 weeks of pregnancy, it involves using a stick of burning herbs (I know, it sounds unusual!) as a heat source applied to an acupuncture point on the little toe.
This gentle heat helps relax the uterus, increases baby’s movements, and has a success rate of around 68% for turning a breech baby to head-first.
Couples are encouraged to do the treatment twice a day for 5–7 days, which makes it both practical and effective.

Predicting the stages of menstruation

When I was at the University of Greenwich running a degree in Complementary Therapies, I was fortunate to conduct some fascinating research.

My favourite project focused on using reflexology points on the feet to predict stages of the menstrual cycle.

By palpating areas of the feet corresponding to the pituitary gland, ovaries, fallopian tube, and uterus, it’s possible to determine which ovary is active, where the woman is in her cycle, and estimate the onset of her next period.

I’ve taken this research into our Reflex Zone Therapy courses for midwives, teaching how these techniques can be adapted to predict the onset of labour.
While we can’t pinpoint the exact time (it won’t be “4pm Friday”!), we can estimate whether it’s a matter of days or weeks.

It’s evidence-based, incredibly practical—and yes, a little fun!

Schumann Resonance Explained

Work by the scientist, Winifred Otto Schumann in the 1950s revealed that the earth’s energy vibrates at a particular energetic frequency and that the energetic level of humans (and animals) in optimum health is exactly the same as that of the earth. This is measured as 7.83 Hz. Any compromised wellbeing alters the energy frequency measurement, leading to ill health or disease. Other sources of energy (heat) can adversely affect wellbeing, also potentially leading to ill health. Electrical equipment such as TVs, mobile ‘phones, X-rays, microwaves, medical monitors such as CTG machines and more can interfere with the optimum 7.83 Hz energy of an individual. Stress hormones act as a vibrational heat source to agitate the brain (“hot tempered”) and blood (increased risk of clumping of platelets).
Adverse energies can also arise from changes in geopathic stress – volcanoes, earthquakes and global warming – leading to issues such as sick building syndrome and adversely affecting human and animal health.

During complementary therapy, the practitioner acts as a conduit to channel positive energy to aid a return to homeostatic balance – which is why it is vital that therapists are in good health when they are treating clients. This applies whether the therapy is manual, as with massage or reflexology, psychological, for example, Hypnotherapy, or energetic such as homeopathy or reiki. Midwives providing massage or aromatherapy in labour should not be stressed, busy or tired since their increasing negative energy levels can be transmitted to the birthing person, potentially adding to any negative energies arising from equipment, stress levels, noise, movement and light. This is why a quiet, secluded birthing environment is so important for both mother and baby.

The Importance of Touch

How many of you touch women in labour with a caring, nurturing touch? 

As midwives, we know how powerful our hands can be.  

Did you know there’s evidence showing that massage can significantly reduce stress hormones during labour?  

And when stress hormones decrease, birth hormones can do their job more effectively – a win for both mum and baby. 

Let’s not forget, massage and oils have been trusted in childbirth for centuries.  

This isn’t just a “nice-to-have”; it’s a practice grounded in history and science. 

A joyful and Peaceful December

As we step into December and the festive season begins, I wanted to take a moment to reflect on the incredible work midwives do every single day.

This time of year is a reminder of the powerful support we provide to expectant parents and the lasting impact we have on their journey into parenthood.

Whether you're looking to enhance your skills, connect with other midwives, or find moments of calm amidst the holiday hustle, I’m here to support you every step of the way.

Exciting resources and courses are coming in the new year - keep an eye out!

Let’s make this month count and step into 2025 with renewed confidence and knowledge. 🌟

Wishing you a joyful and peaceful December! 🎄

Self-Care For Midwives

There is so much pressure on midwives and the maternity services and midwives are all but burned out. Some are able to leave the NHS and find better job satisfaction and a better work-life balance by working in their own private practice, either as an independent midwife offering full pregnancy, birth and postnatal services, or focusing on antenatal and postnatal care and add-on services such as complementary therapies, lactation support and other aspects of the midwife’s role. However, many or forced to remain in the NHS, usually due to financial and family considerations. And, it must be said, there are some who enjoy their work and remain committed to NHS midwifery despite the difficulties,

However, continuing stress and pressure will eventually take its toll on both the mental and physical wellbeing of midwives.  It is, therefore, crucial to learn how to look after ourselves, both as individuals and as a professional group. You know what they say in the safety briefing on airplanes – “please fix your own oxygen mask before helping others”. It’s the same in healthcare, especially given the current state of midwifery. Midwives rarely manage to take breaks for lunch, a drink or even to go to the toilet. The work is physically and emotionally demanding, the shifts are inappropriately long, and many midwives stay way beyond their shifts to be there for the parents in their care. Families, social life and downtime suffer because midwives are too tired or unavailable. Yes, the “health” service does little to care for its staff and midwives are leaving their posts in droves, sometimes leaving healthcare altogether. It is long overdue to say the time has come to look after the profession and ourselves. Many midwives are too burned out to even have the energy to eat healthily, too strung up to rest and sleep well, and have little time or energy to exercise and get out into the fresh air.

This year, when we welcomed our new students to the Diploma in Midwifery Complementary Therapies and our Certificate programmes in individual therapies, we gave everyone a goody bag which was aimed at looking after themselves. The goody bags contained a reusable water bottle, a stress colouring book and set of crayons, a bar of organic vegan chocolate and a w roller ball with relaxing oils. We also included a link to a free online self-hypnosis relaxation session. In addition to our study days, regular webinars and tutorials, we have now introduced a regular monthly online hypnosis relaxation session, led by my colleague Laura who is the programme leader for our Certificate in Midwifery Clinical Hypnosis. Any of our students and Licensed Consultants (midwives in private practice) can attend as part of their membership of our Expectancy Community. They are well attended, and midwives tell us they value the opportunity to take time out for themselves.

Boundaries Of Midwifery Practice

I attended a fascinating workshop at the Normal Birth Conference in Hong Kong. Two American midwives presented a workshop on managing occipito-posterior (OP) position. They taught a manual manoeuvre that involved internally manipulating the fetal head into a more favourable anterior position. Essentially this is similar to the manoeuvre undertaken by an obstetrician when using forceps. 

Apparently, there is a high incidence of OP position in the units where these two midwives worked and the use of this technique by midwives had reduced Caesarean rates. However, since there is also a 90% epidural rate, it is hardly surprising that the incidence of OP position in second stage is high - the pelvic floor relaxes and fails to provide the resistance needed to aid rotation of the fetal head. Some delegates challenged why the epidural rate was not addressed but culturally, in a very high-tech medicalized system, epidural is - allegedly - what women want.

The discussion that ensued was about whether midwives in all countries represented would be permitted to use this manual rotation. In developing countries with poor access to medical care it could be a lifesaver for both mother and baby. However, in the UK, it is unlikely to be sanctioned by the NMC, when obstetric help is readily available. Two Irish midwives had the same reservations as those of us from the UK.

A Chinese Hong Kong midwife stressed that it would be almost physically impossible to perform the rotation as Chinese fingers are often short - this midwife told us she even has difficulty in reaching a posterior cervix during vaginal exam. The rotation technique requires the midwife's hand to be inserted fully into the vagina in order to reach round the fetal head.

 This workshop caused me to reflect on the boundaries of midwifery practice in different countries around the world. In developed countries we have the luxury of being able to attend to the psycho-social aspects of pregnancy, birth and early parenthood - although I believe this is increasingly at the expense of midwives fully understanding and applying the biological aspects to practice (more of that In another blog post). In developing countries, failure to recognise deviations from physiological progress can be fatal, and there is less focus on the social and mental health aspects of childbearing. 

 Back in the UK, it is interesting to see how many midwives are moving into fertility care (often, it appears, to enable them to leave the NHS). Whilst the WHO definition of the midwifery role encompasses fertility health and preconception care, it is not a standard element of midwifery practice in the UK. Similarly, miscarriage and abortion care is defined as within the remit of midwifery although it more commonly comes under gynaecology in the UK.

 At Expectancy, we have expanded the boundaries of practice of our "endorsed by Expectancy" midwives in private practice to enable them to offer services to women from the preconception period to the end of the first year following birth (subject to training and insurance). Many of our Licensed Consultants now provide fertility health consultations, Caesarean scar therapy and ongoing care and complementary therapies beyond the early postnatal period. They are not permitted to provide infertility care nor can they take on new clients who are more than eight weeks postnatal - they must work within the UK boundaries of midwifery practice. Since very few of our team are providing independent birth services, it is unlikely they will be in a position to have to make a decision about using the manual manoeuvre to turn a baby in the OP position to anterior. In any case they would be far more likely to have addressed this earlier with biomechanics and Rebozo.

Commitment to Learning: A Rant About Education!

Why is it that so many student midwives and nurses seem to want to do the basic minimum of study simply so they can pass the exam or scrape through to qualification? This is a growing problem,  not just in healthcare professions and not just in the UK. However it is extremely worrying that those entering midwifery and nursing seem not to appreciate that they will be responsible for people's lives. My partner, a university lecturer in anatomy and physiology, is constantly asked by nursing students "what do we have to learn for the exam?" who then seem surprised when he says " everything! " 

I wonder how comfortable these students would be if one of their relatives was in hospital being cared for by doctors, nurses or midwives with only half the knowledge relating to their particular condition. Any profession has a deep theoretical basis to support practice, including knowledge and understanding that may not be "needed" for everyday practice but may be essential at some point in the future to saving someone's life.

There also seems to be an undercurrent of student midwives struggling with the theory and developing the practical skills of the profession. Look - I know that things in the NHS are dire. I know there is unacceptable bullying especially towards students. I know we have large numbers of students with major personal or family health or social issues. But I'm sorry to say - if you can't stand the heat, get out of the kitchen. I know also that many readers will vilify me for this comment but - whether we like it or not - this is the current culture into which students are entering and we need them to be strong enough to challenge that culture and to help initiate change. We also need a profession - one that is currently threatened from all sides - that can continue to maintain its individuality. If we don't have expert midwives with comprehensive knowledge and refined skills, we are in danger of losing the profession or just becoming obstetric nurses.

Another issue is the expectation that once having learned something as a CPD activity, midwives can cascade their training to others - and often by using their own course notes and copyrighted teaching materials from their initial course. This is a real problem since we know that learners only retain around 60% of what they study, so cascade training causes a natural dilution when they pass it on to others who then only retain 60% of what they are taught. Yet not only clinical. midwives but also their managers condone this approach to learning - perhaps because it is quicker and cheaper to train up a group with sub-standard education than to pay for everyone to receive the training provided by quality educators. This occurs when managers don't appreciate the depth required for safe practice - and is a continuing issue when I go to NHS trusts to teach aromatherapy to midwives.

And then there are those who think they can have access to learning materials free of charge. I recently saw a post on another Facebook page where a friend of mine had been to a legal study day and someone asked if there were any slides or handouts - my friend's reply was "only if you've paid for it!"  Both she and I are freelance lecturers whose livelihood depends on the income from our training. You wouldn't go into a shop and not expect to pay for goods you want  - so is this attitude because education is not valued or respected?  Again, it's not only in the healthcare professions that this occurs, it seems to be a general issue, maybe because so much information is available free of charge via the internet. Copyrighted materials are not respected, yet people don't realise that these materials are protected by the law -  basically they're stealing someone else's work.

That brings me on to AI. So many students are now using artificial intelligence to write their assignments that university lecturers are having to do the same and then put the AI-produced work through TurnItIn which checks for plagiarism. Only in this way can they check students" work to see if they've used AI.

So .... back to my original rant about commitment to learning. If you want midwives, nurses and other professionals who know only half what they need to know in order to practise safely, then let them be told the exam questions so they know what they need to revise. Let them use AI for their essays so they can achieve a good. Degree based on someone else"a work.. Let's send one person on a course who can then use their limited new knowledge to train up everyone else. Let's undermine the quality of learning in general by making everything free and accessible to anyone who wants to steal the work of others by infringing copyright law. And - let's face it - you can buy a PhD in the USA so why don't we just do that as well.?

Rant over!! 

International Labour and Birth Research Conference in Hong Kong

What an incredible experience I had at the International Labour and Birth Research Conference in Hong Kong!

From reconnecting with familiar faces to meeting inspiring new colleagues, it was a whirlwind three days packed with insightful lectures and hands-on workshops.

I explored everything from the latest in birth technology to innovative techniques for supporting fetal positioning—and, of course, I had my own workshops on complementary therapies for postdates pregnancies.
The conference was beautifully organised, with speakers exceptionally well looked after.

To top it off, I enjoyed a fabulous 13-course Chinese banquet for the conference dinner last Tuesday!

Thank you to everyone who made it such a memorable event. Here's to bringing these insights back home and continuing my journey in supporting physiological birth!

Diagnosis and Professionalism in Reflexology

I recently saw a Facebook post on a reflexologists’ page, in which an obviously inexperienced therapist was querying why expectant mothers should not lie flat on their backs at 39 weeks’ gestation. Whilst it is worrying that she did not understand and possibly had not undertaken specific training on working with pregnant clients, the responses from her colleagues were even more worrying. Many (although not all) did not seem to appreciate the impact of supine hypotension on maternal and fetal oxygenation, nor did they fully understand safe positioning to avoid not only resulting dizziness and fainting but also how to avoid excess strain on the spinal muscles and ligaments and the symphysis pubis. Another post, a few days earlier, - of a type which I see frequently – was the group’s attempt to make a diagnosis from a photograph of a client’s feet. There were some extremely worrying comments, with therapists jumping to conclusions about possible medical conditions which they had “recognised” from the picture, with no other history available. Even more concerning were the comments about how reflexologists might actually treat this person, based on their so-called diagnosis.

As a midwife for over 40 years, a clinical reflex zone therapist for 35 years and having treated almost 6000 pregnant clients, I am alarmed by the attitudes of these practitioners, which showed little knowledge and understanding of the physiology and possible pathology of the client in question. I have no doubt at all that it is possible to examine the feet visually and via palpation, as well as taking into account the reactions of the client in terms of areas of tenderness and pain in relevant reflex zones on the feet. I have, myself, often seen or felt variations on the foot reflex zones that indicate changes in physiology or impending pathology, and my main interest in the therapy is its diagnostic potential. For example, I have undertaken formal research whilst at the University of Greenwich in the 1990s, to show that it is possible to predict stages of the menstrual cycle from an examination of the feet zones relating to the pituitary gland, ovaries, fallopian tubes and uterus – I have around a 70-75% success rate in so doing. I teach this in my courses for midwives and lead on to teaching how they can estimate the onset of labour, using the same theories.

However, a clinical diagnosis is achieved from a complete assessment of the client, including taking a comprehensive medical (and obstetric) history, ascertaining the current signs and symptoms, then a visual examination and thorough palpatory examination of the feet. Having drawn some conclusions, it is then essential to understand the physiopathology behind the assumed condition and to work out whether or not reflexology is an appropriate treatment to reduce the severity of symptoms, rather than resolving the condition. More often than not, medical conditions are a contraindication, even for a statutorily regulated health profession, and certainly for a reflexologist who is not a clinician.   I am sure the injudicious attempt to work out what is happening and how reflexology may be able to help people with specific medical conditions arises from a compassionate but misplaced enthusiasm to help people.

If we want reflexology to be seen as a credible therapy with underpinning theory and evidence-based practice, practitioners MUST acknowledge the boundaries of their personal practice. These parameters may be different in different therapists due to their training and experience, but it is fundamental to professionalism to know when not to treat as much as it is essential to understand how to treat someone. This certainly applies to working with pregnant clients – and it is usually a post-registration training and qualification to be eligible to treat pregnant and newly-birthed women. For someone working with a client at 39 weeks of pregnancy and not to understand the most basic principle of positioning is obviously due to lack of, or poor, training and the fact that she was still about to treat the client is bordering on negligence. Further, I would assume that if she did not know this, she would certainly not be prepared to deal with any emergencies that might arise such as the woman having a rapid labour resulting in a precipitate birth whilst in the consulting room, or her waters breaking and the umbilical cord prolapsing.

Guidelines On Herbal Remedies In Pregnancy 

The term “natural remedies” refers to herbal remedies, herbal teas, aromatherapy essential oils, homeopathic medicines, plus traditional (indigenous) medicines, whether sourced from plants, minerals or animals.

• All natural remedies should be treated with the same respect as pharmaceutical drugs.

• “Natural” does not mean that all remedies are safe, or safe for everyone, particularly during pregnancy and childbirth.

• Natural remedies should not be used as a replacement for proven medical treatment, especially in the event of an emergency. 

• Expectancy parents should be advised to avoid ALL natural remedies, including aromatherapy oils, before and during pregnancy, labour and breastfeeding unless under the supervision of an appropriately qualified, insured professional.

• Women should be asked at their first antenatal appointment if they are using any remedies, especially herbal medicines and aromatherapy oils and again as they prepare for the birth, especially if they are desperate to avoid induction of labour. 

• Advise parents that not all remedies are approved, regulated or evidence based. Remedies obtained from the Internet may be falsely labelled, contaminated with chemical impurities or contain banned or toxic ingredients.

• Women should be informed about the possible risks of taking pharmacologically active remedies, including adverse effects such as allergies and interactions with prescribed medications, foods or other remedies.

• Advise women against combining several different NRs / complementary therapies: take only one remedy at a time, particularly at term when trying to avoid induction.

• Natural remedies are completely contraindicated for pregnant women with major hepatic, renal, cardiac and neurological conditions and cancers of any type, irrespective of whether they currently require pharmaceutical medications. 

• Anyone taking medically prescribed drugs, by whatever route of administration, should be strongly advised against using NRs at any time.

• Midwives should be alert to the possibility that deviations from physiological progress in pregnancy or labour may be linked with undisclosed use of natural remedies.

• Women admitted to the antenatal ward have, by definition, pathological complications requiring medical attention and should avoid self-administering all natural remedies. It is not appropriate for midwives and doulas to advocate natural remedies for these women or to use essential oils for aromatherapy in the antenatal ward area.

• Women should be advised to discontinue all pharmacologically active herbal and traditional medicines at least two weeks prior to elective surgery or dental extraction to reduce the risk of excessive bleeding. Anaesthetists and dental surgeons should check whether women have continued to use remedies immediately prior to surgery, many of which may have an adverse effect on blood clotting. 

• Medical, midwifery and health visitor pre-registration education and doula and antenatal teacher preparation should include an appropriate introduction to the safe use of natural remedies in pregnancy and childbirth that balances benefits and risks. 

• There is an urgent need for more research on natural remedy safety, although not all modalities can be studied using a randomised, controlled, blinded approach.

Midwives, did you know? 🌿

If a pregnant woman needs to change from her pre-pregnancy antidepressant, the popular alternative remedy, St. John's Wort may not be a safe alternative.

This herbal remedy works in a similar way to some antidepressants and can carry similar risks during pregnancy.

Always advise your clients to consult with their midwife or a qualified herbalist before considering St. John's Wort. (NB always midwife before doctor!!)

Keeping both mother and baby safe is always the top priority!

This week is World Reflexology Week!

Reflexology in pregnancy can offer a range of potential benefits for expectant mothers, including:

• Relief from pregnancy discomfort
• Stress reduction
• Preparation for labour
• Improved sleep

During my time at the University of Greenwich, I discovered that by using foot reflex zones linked to the reproductive tract and pituitary gland (based on my research), I could identify different stages of the menstrual cycle in non-pregnant women with a 65-70% success rate.
I've since taught midwives worldwide how to perform this assessment through my courses.

Complementary Therapies and The M25 

I frequently drive along the M25 motorway around London, particularly the stretch from southeast London to Heathrow.  As I drive, I’m struck by the analogy between drivers on these busy roads and midwives venturing into the field of complementary therapies (CTs).

Having been practising, teaching, researching and publishing on CTs for over 40 years, I consider myself an experienced “driver” of this aspect of midwifery care. I was in the right place at the right time to pioneer the subject as a midwifery specialism in the early 1980s. I’m well qualified in several therapies and practise safely; I recognize difficulties and can deal with them, or recognise when to withdraw temporarily. I understand where I can cut corners and when I need to `drive by the book' and I’m fully informed about the rules and regulations relating to practice, both in CTs and in midwifery.

But what about those midwives who are only just starting out on their CTs journey? In observing other road users on the M25, I can see that midwives are similar to many drivers – the plodders, the safety conscious, the sceptics and the mavericks.  

There are the “lorry drivers” who proceed slowly in the inside lane, struggling up the inclines and rarely able to overtake others, but eventually reaching their journey's end. This is similar to midwives who press on competently with their existing practice, but who are fearful of moving out of the `slow' lane to drive new initiatives. There is nothing wrong in this: we need midwives to deliver fundamental services in the same way as lorry drivers deliver goods around the country. Midwives who are “plodders” wanting to introduce CTs into practice, may take a long time to make it a reality, but are safe, reliable, conscientious practitioners. They’ve thought through all the issues, sought answers to numerous questions and eventually achieved their aims of enhancing care for women with CTs.  

Next come the safety conscious midwives, like mature, experienced drivers whose reactions may be slower but who painstakingly observe all the rules of the road. Their practice of CTs is based on adequate and appropriate preparation and adherence to the laws, regulations and guidelines dictating safe practice. These are by far the most professional when it comes to using CTs in midwifery practice, with a focus on both theoretical and practical training and an acknowledgement of prescribed boundaries, especially within the NHS. 

Conversely, there are those maverick lorry drivers who rampage along the motorway, tailgating other vehicles and – increasingly – breaking the law by moving into the outside lane in their time-restricted rush to get where they’re going. Similarly, drivers of fast sports or status cars - the typical exhibitionist “boy racers” - believe they can charge along with little regard for others, blaring their horns or flashing their lights to make their presence felt so that everyone else is forced to make way for them. This is a case of appearances being deceptive, of course, because these drivers may be no better (and are sometimes considerably worse) than the more cautious ones. They antagonise fellow road users and are a danger to themselves and others. 

Midwives who advocate the `racing car approach' to implementing CTs, often with a misplaced ideal of being the first or the best, are far more likely to make mistakes and cause safety issues that could result in a managerial knee-jerk response of abandoning the CTs services. There is more to it than looking good on the surface whilst vociferously forging ahead with ideas and ideals at the expense of colleagues who work more slowly but with more attention to detail. Implementing CTs into midwifery care will be far more effectively achieved by respectful, professional and reasoned dealings with colleagues than by riding roughshod over sceptics or those who are already working in their own professional `fast lanes' in different ways.

Likewise, the `white van syndrome' is also inappropriate. We have all had experience of the drivers of transit vans, often tradesmen, attempting to force us into slower lanes so they can get ahead. Increasingly too, there are those who disregard the rules: I’ve seen impatient white van drivers barging their way across several lanes to exit the motorway at the last possible minute. Many are so familiar with their route that they become complacent with the task of driving, preferring instead to monopolize and control the road and its users. 

Complacency is definitely an issue for midwives, especially those who have been using CTs for some time. They may think they are competent because they have refined their practical and manual skills, but this does not make their practice contemporary, nor is it necessarily safe or evidence based. As regular readers of my blogs will know, this is a group of midwives which concerns me greatly. Failing to keep up to date, arrogantly believing that they’re “experienced” and know what they’re doing, can only lead to safety incidents, some of which have come under national scrutiny in recent years. There is no place for those wanting to use CTs to demonstrate either complacency in their work or superiority over colleagues. There is always something to learn from others, most of all the need for good teamwork. Those who think they know it all will eventually make mistakes which may be fatal to themselves, their colleagues and even the people in their care.

There is also the novice motorway driver. In order to venture onto the motorways a full driving licence is required and drivers should preferably have some experience of driving on non-motorway roads. In the same way, midwives moving into the field of CTs must be qualified and experienced clinical midwives in order to add to their basic practice. It is daunting taking those first journeys into a new area, especially when others may appear competent and confident. Sympathetic drivers already on the motorway may slow down to enable newer ones to join the road, and this should also be the case when introducing CTs into midwifery care. Often those who are new to the road take time to learn and understand what they’re doing - and may sometimes remind more experienced `drivers' of some of the rules they have recently learned. 

The road itself often presents dangers and problems. The surface may be icy, blocked by debris or altered by new roadworks, and drivers need to negotiate their way around carefully. Possession of well-developed driving skills, knowing the rules and regulations and remaining alert to changes all contribute to achieving a safe journey. Midwives using CTs must be appropriately skilled, cognisant of relevant local, national and international rules and must take account of new developments in practice and policies in healthcare. 

There is one section of the M25 between the junctions of the M3 motorway and the M4/ Heathrow turn-off where mandatory variable speed limits are imposed at peak hours to regulate traffic flow. These can be likened to clinical guidelines on CTs in midwifery, which are used to protect the public (and practitioners) and avoid individuals becoming too independently autonomous at the expense of safety. It is occasionally necessary to slow down the pace of change in order to consolidate what has happened so far and prevent enthusiasts from racing forward inappropriately. Once the restrictions have passed it is perfectly acceptable to regain speed and press on.

So where do you fit in with all this? Are you continuing to be the plodding “lorry driver” or the newly licensed novice lacking in confidence? Do you want to be seen as a sports car or white van driver? Do you recognize the ups and downs of the road? Are you familiar with the rules and regulations? Will you reach your destination or fail at the first set of “roadworks”? Whatever category you fit into it is ultimately essential to appreciate that we all have a part to play in the greater journey we are taking together - with care, attention and integrity we will all achieve a safe and satisfying outcome and complementary therapies will hopefully become integral to midwifery care.

This blog post is adapted from a 2000 article I wrote for the Complementary Therapies in Clinical Practice journal. Unfortunately, things do not seem to have progressed very far in some respects. Whilst CTs are far more prevalent in maternity care and midwifery practice, we still have midwives who want to be sports car drivers and rush ahead without planning, or lorry drivers who break the rules. There are still midwifery managers who do not acknowledge the need for proper training and expect staff to teach others immediately after learning CTs themselves, despite the recognition that all other aspects of midwifery require consolidation and experience before passing on the mantle to others. And we still have midwives who fail to update because they believe themselves to be experienced, yet conveniently forget the NMC requirement to remain updated in all aspects of their work. 

Today is Expectancy’s 20th Birthday! 🎉

For two decades, we’ve proudly remained the only company worldwide dedicated to providing professional academic courses that teach midwives and birth workers how to integrate complementary therapies into their care.

From designing our unique programmes to launching the signature Licensed Consultancy, it’s been an incredible journey preparing midwives to build their own businesses in maternity complementary therapies.

Thank you all for your unwavering support—here’s to another twenty years! 🌟

Pass The Baton - Where Is The Next Generation Of Leaders In The Specialism Of Midwifery Complementary Therapy?

Whilst in Tokyo recently, I was invited to contribute to an aromatherapy forum discussion on changes in the profession. One question focused on how - indeed, whether - the aromatherapy world is preparing the next generation of authorities for the profession as it moves towards the 2030s. Those who have made a name in aromatherapy, such as Robert Tisserand, Gabriel Mojay and Kurt Schnaubelt - and my host was kind enough to include me in this group - are reaching an age when we will all soon be retiring and leaving day-to-day involvement in the discipline. Yet there is no name that shouts out to us about who might be one of the next generation of aromatherapy leaders.

This led me to thinking about the midwifery specialism of complementary therapies (CTs) and to whom I should hand over the baton when I retire (not that I intend to, yet!). Many midwives are interested in CTs but are not fully qualified in any therapy. It is important to acknowledge that the field of “complementary therapies” is not just about aromatherapy (the most commonly used therapy in pregnancy and maternity care) but requires training and a comprehensive academic knowledge of several other therapies. Whilst interest in a subject is a great starting point, developing an area of expertise requires dedication, a lengthy time commitment and a single-mindedness that is similarly applied to achieving a PhD. However, having a postgraduate qualification in a subject does not, in itself, make an expert in the overall subject matter. Within midwifery, becoming a specialism leader requires a combination of advanced clinical practice and academic involvement including teaching, research and publication. 

However, most midwives have not been in positions to enable them to gain wide clinical experience of using CTs in their practice. Yes, there are many several midwives who have introduced an aromatherapy or postdates pregnancy service and sustained their involvement in CTs, but most have other roles within the organisation and are unable to focus solely on CTs. Almost all of these midwives are not qualified teachers (as is required by the therapy regulatory bodies), nor have they engaged in the higher-level teaching of colleagues (and I don’t mean “cascade training” here).  There are a few senior academics in the UK and Australia who have engaged in research around midwifery CTs, but who do not necessarily have the direct clinical experience of working with CTs in pregnancy and birth. Additionally, whilst most of these have published their research, which provides a valuable contribution to the subject area, very few, if any, have added to the textbooks available on the subject. 

That “complementary therapies” is an established specialism within midwifery is still under debate, despite my having spent forty years developing it. Many still see CTs as an add-on to physiological birth care, but do not appreciate that there are many more facets to the specialism that should be incorporated into midwifery education, at least as a post-registration activity. I have long campaigned for pre-registration education to include a general introduction to the subject, but lack of educators with adequate knowledge and understanding of this vast subject area means that inclusion in the programme is patchy at best. Acquiring a working knowledge of CTs in midwifery is NOT just about learning some massage and throwing a few aromatherapy oils about. It requires an understanding of safety and safe practice, and an ability to apply the principles of the therapies to their use within midwifery practice and their self-administration by expectant and birthing parents.  

So which midwives are interested in developing the requisite skills, knowledge and attitudes to become the new leaders in midwifery CTs? Where are they – and importantly, how can we prepare them to continue CTs as a midwifery specialism and to develop it further? I have a few colleagues whom I would trust to take over my own work – but that is not the only issue here. We need new leaders who can sustain the subject of complementary therapies as a significant field within maternity care.

Our Woman In Tokyo

I've been coming to Tokyo since 2001, incredible to think that's almost a quarter of a century. Apart from the pandemic years, I've made the long journey at least I once, If not twice a year, and occasionally even three times.

I first met my colleague, Azusa, when I was still at the University of Greenwich, running the degree in complementary therapies and a maternity teaching clinic for students to experience working with pregnant women. Azusa was an aromatherapy teacher wanting to specialise in maternity work. She had read one of my early books which had been translated into Japanese and she had wanted to contact me for some time. However, apparently in awe of a published author and university lecturer, she felt she could not visit me until she had undertaken 1000 pregnancy aromatherapy treatments. It was not until some years later that I told her she had more practical experience than I had at that time!

She invited me to teach in Japan on a new maternity aromatherapy course she was planning, for therapists and midwives (and occasionally, obstetricians). My first journey to Japan was eventful. I flew KLM via Schipol and arrived in Tokyo to find my luggage had gone astray - it only turned up two days later (minus the gift I had brought for my colleague). I was only there for four days but went to try and buy some T-shirts and knickers - at a time when I had no knowledge of Japanese, and very few Japanese people spoke English. I also realised, with such tiny people, that a Japanese T-shirt would just about fit over one of my arms. Needless to say, I couldn't find one large enough and spent the next few days washing the clothes I stood up in and putting them on still damp in the mornings.

Azusa and I have been working together for so long now that we hardly need to question any translations (although to my shame, I can still only say about ten Japanese phrases). It wasn't like that at the beginning though and of course when something is translated it takes twice as long. Japanese midwifery is more similar to the UK system than the US system and there are "midwives' houses'" which are similar to UK birth centres. There is however a medical.dominance and the question I was asked most often was about the ubiquitous home birth situation in the UK. No one could understand how it was allowed and they had the typical medical fear that something might go wrong.

Aromatherapy and most other therapies except acupuncture had a low reputation at that time - and still do to a certain extent. Like the UK, aromatherapy was seen as beauty therapy based on the effects of massage alone. It is fascinating to know that Japan is now leading the way in research into the physiological effects of essential.oils - and contemporary evidence suggests that dermal application has very little impact due to poor absorption of the oil chemicals. There is now more emphasis on the olfactory effects on the autonomic nervous system,, along with western studies into the physiological effects of the chemicals.

I have seen considerable changes in Japanese life since I started visiting. The effect of an increasingly westernized diet and commercial availability of fast food has caused obesity and there has been an increase in domestic violence, thought to be due in part to greater unemployment. There is considerable affluence in the areas in which I have taught, but there is also deprivation in the more traditional parts of the country further away from Tokyo. On this trip, the yen is so badly affected by the pound that prices here have risen and it may not be cost effective for my colleague to invite me to teach in person next year. We will have to go back to online teaching as we did during the pandemic, with me working night shifts to accommodate the time change.

I find the thousands of people overwhelming in the city, and society extremely deferential to authority, and I wouldn't want to live here - give the peace and space of Namibia any time. However, the people are lovely - so kind, thoughtful and polite and always treating me like an honoured guest and addressing me as "professor" out of respect for my experience and knowledge. I love coming to Tokyo and hope I will be able to continue doing so for some time yet.

Safe Care Cannot - And Should Not - Be Done On The Cheap

This slogan refers to the Royal College of Midwives' campaign calling for better salaries for midwives, implying that better funding for recruitment and retention leads to safer care for mothers and babies.

However, this same principle also applies to the introduction of new practices, including complementary therapies. Any new initiative requires a financial and educational commitment to ensure safety.  I find it inconceivable that midwives want to introduce complementary therapies to facilitate physiological birth - yet they want to do so as cheaply and quickly as possible with no investment in training or professional development.

I was recently contacted by a birth centre manager interested in training 20 midwives in aromatherapy, acupressure, moxibustion for breech and reflexology - and wanted me to do this in a single study day! This is not an uncommon request, which is triggered by a laudable interest in and enthusiasm for complementary therapies, and a lack of understanding of what each therapy involves or how difficult they can be to learn the knowledge and skills effectively. This particular request involved four different therapies and professional disciplines requiring a minimum of ten days' training to prepare midwives to use the therapies effectively and safely.

Midwifery budget holders want to be seen to be introducing new initiatives to reduce intervention yet fail to recognise the need for comprehensive training of both the midwives who will practise the therapies and the managers who will monitor standards of practice. They have little appreciation of how complementary therapies need to fit into NHS care and the various laws and regulations relating to their use. 

Further, there is concern amongst complementary therapy educators and regulators about other professionals "cherry picking" aspects of therapies to add to their own professional disciplines. We would be horrified to think a therapist would want to study a few days of midwifery and then go out to practise - or even worse, to teach it to others, yet midwives and their managers sanction this very same concept when it comes to complementary therapies.

SAFETY in midwifery requires comprehensive theoretical as well as practical education so that midwives can apply the principles of each therapy to its practice in maternity care. It requires an understanding of how to minimise risk and how to practise cost effectively and equitably as well as safely and effectively and in line with available evidence.

Other experienced midwifery educators will attest to the general decline in students' desire to understand their practice (becoming a knowledgeable doer) and an increase in just becoming a "doer" without that underpinning knowledge. In today's fast paced world students want to "achieve" their certificates as quickly and cheaply as possible, especially as pre-registration students are generally "customers". 

However, when it comes to complementary therapies as a post-registration option, it is even more essential to be knowledgeable enough, not only to be able to justify their actions but also to counter the sceptics. Perhaps even more crucially, since midwifery complementary therapies have come under national scrutiny by the CQC and Ockenden review teams in some units, adequate education of an appropriately academic calibre is paramount to SAFE practice. 

In twenty years of Expectancy, I have always stuck to my absolute belief that safety, professional accountability and evidence-based practice are fundamental to the use of complementary therapies by midwives. This has often been at the expense of my business, but I steadfastly refuse to compromise my own principles to offer courses that do not adequately prepare midwives to practise complementary therapies SAFELY. I am always happy to offer a single introductory awareness study day to interested midwives and students - but the profession must understand that this, in no way, prepares midwives to practise the therapies. So - to quote the RCM - Safe care cannot - and should not - be done on the cheap, either in terms of cost or education.

Guest Blog : Annual Networking Day

I recently had the privilege of attending the Expectancy Annual Networking Day in London, for the “endorsed by Expectancy” midwives working in private practice .

The event was set up to network, share experiences and to explore successes and hurdles encountered with the daily running of their midwifery businesses. Some midwives are already in business and some are bravely starting up their own — I am sure this opportunity served as a valuable insight into setting off on the rewarding yet sometimes intimidating path of going it alone. Denise was there to offer sound business advice and encouragement, she must be very proud of her midwives — and rightly so! 

It was lovely to hear people talk about their reasons for having gone it alone, how they came to that decision, and how things are going for them now. It’s been a difficult time in the UK of late, but I really admired their determination to press on, adapt to changes and grow their businesses.

It was clear from the pulse in the room that the discussions were hugely beneficial for the fledgling midwifery entrepreneurs in attendance. The opportunity to explore business issues together and share information and advice was inspiring for all involved. Not to forget the camaraderie which was so vibrant and motivating. 

We all left feeling positive, full of inspiration and determined to keep flourishing. I salute these lovely and enthusiastic midwives — you are wonderful ambassadors of the Expectancy community! 

Why I Love Reflex Zone Therapy 

Having trained in aromatherapy and massage, I decided, for some unknown reason, to train in reflexology in 1989. Like many others, I naively thought reflexology was just foot massage – but I was in for a big shock. The course I started was not actually reflexology in the standard sense, but a very specific form of clinical reflex zone therapy, a German style devised by a former midwife. In the UK, the British School of Reflex Zone Therapy was headed up by a very formidable South African lady, also a former midwife, who knew her stuff and ruled us with a rod of iron – but how blessed we were to be taught by her.

Training at the end of 1989, my son was only nine months old at the time and I was still breastfeeding him. During the first weekend of the course, I realised I was producing much more milk than before I started the training. When I asked the tutor why this had happened, she explained that we had been practising the day before on the parts of the feet that reflect the endocrine system and that the student I was working with had slightly over-stimulated the reflex zones on my feet relating to the pituitary gland. These was my ah-ah moment and my lifelong fascination with reflex zone therapy was born.

Many midwives have heard me tell this story before, but this was only the beginning. I went on to develop and refine my skills and experience in reflex zone therapy and over the next fourteen years I treated almost 6000 pregnant women with a variety of symptoms and antenatal and postnatal issues. For a while, having experienced shocking pregnancy sickness myself, I specialised in treating women with nausea and vomiting and developed new theories about the causes of the issue and new reflex techniques to treat the problem. Sometimes, using something I call the “advanced technique” – a rather forceful toe-twisting manoeuvre - I could treat a woman in just ten minutes, reducing the severity of her symptoms almost immediately.  I learned ways to treat other symptoms such as backache, sciatica and pelvic girdle pain or carpal tunnel syndrome, with short dynamic, focused treatments, a necessity when my clinic at that time was NHS-based and a teaching clinic for my students at the University of Greenwich.

The focus of my work was less on relaxation therapy and more on resolving specific problems, although most women reported feeling much more relaxed even when the hands-on treatment was only fifteen or twenty minutes. Whether this was directly due to the manual treatment or the fact that women had an opportunity to talk to me and to have their symptoms validated, is debatable and was probably a combination of both. Everyone working with complementary therapies understand the power of holistic therapies and the importance of reducing stress hormones to enable an increase in feel-good hormones including endorphins and oxytocin, both so fundamental to progress in pregnancy and birth.

I was in an invaluable position, being a university lecturer, to undertake research on reflex zone therapy and other complementary therapies and to spend time writing for publication. Although my book, Reflexology for Pregnancy and Birth was published in 2010, the gist of it is still valid today, apart from the research component which is, of course, now quite old. As the years went by, I actually made some changes to parts of the map used in reflex zone therapy (which is different from those used in other forms of reflexology) and did some research into using the reflex points on the feet to predict stages of the menstrual cycle. I am over 70% successful in being able to detect whether a woman is in the first pre-ovulatory or later post-ovulatory stage of the cycle, to identify which is the active ovary of the month and to predict when the next menstrual period will commence, certainly to within a day or two.

This led on to becoming absolutely fascinated by what the feet can tell us. I have a friend in South Africa, Chris Stormer, who is a worldwide authority on reading the feet, who first introduced me to this element of the therapy (although her style is very different from mine). Chris takes a more spiritual approach to foot reading, almost an esoteric approach, whereas I am firmly focused on the anatomical and physiological aspects of detection from the feet. Many reflexologists are taught that they should not “diagnose” but this is largely to avoid those who are not conventional healthcare practitioners from making assumptions about what they see or feel on the feet. In my opinion, it is difficult to avoid making some form of diagnosis about wellbeing of the client, otherwise we would not be able to individualise the treatment to her specific needs. I have detected various medical issues via the feet and was once asked by an obstetrician if I would try to find a diagnosis because the medical staff had been unable to do so. I can often tell you which teeth need filling, whether you have had an appendicectomy or hysterectomy, or whether to advise someone to get their breasts checked for lumps.

This is what makes reflex zone therapy so amazing. It is not just a relaxation therapy, but a very powerful clinical tool, both to aid diagnosis and treatment. In midwifery, I have used RZT techniques to treat gastrointestinal, musculoskeletal and reproductive system issues. In pregnancy, RZT can be used to treat almost all physiological symptoms and to prevent some complications from becoming more severe. Later, it is invaluable for aiding the onset and progress of labour, easing contraction pain and dealing with retained placenta. Postnatally, it helps recovery from birth, eases complications from epidural or Caesarean labours and encourages lactation.

Later, when I set up Expectancy, now in its 20^th year, I started to teach reflex zone therapy to other midwives. Initially, I offered a short course of three days but soon realised not only was this not enough to gain practice and understanding of such a dynamic and complex therapy, it was also too much for midwives to receive repeated treatments from fellow students on three consecutive days. I changes the course to two 2-day blocks which was less stressful for the students’ physiology, but still didn’t give enough time to learn the theory and engage in the practice to feel entirely confident in using RZT in clinical practice. The course was finally expanded to a six-day course, one weekend per month, which gives time to practise in between study blocks and provides midwives with some fascinating insights into the power of reflex zone therapy.

Although I am experienced in practising and teaching several different therapies in midwifery practice, reflex zone therapy remains my favourite. I have practised, studied, researched and taught it now for 35 years and still love it – although the impact on my somewhat ageing hands is beginning to tell (repetitive strain). Although I could probably not now practise regularly on real clients, if I had to give up teaching it I would be very disappointed. I am still learning about German reflex zone therapy and other forms of reflexology and hope to be able to do so for many years to come.  

Annual Networking Day

Saturday 13th July saw the annual networking day for our Licensed Consultants – midwives who’ve completed their studies and are already in business as well as those just finalising their plans to start up a private maternity complementary therapies practice. We got together for a relaxed day of chatting about our businesses and meeting new midwives. We started with networking bingo where everyone had to talk to each other to find out interesting facts such as “I love rice pudding” or “I’ve changed jobs in the last year” , We went on to explore our successes and challenges from the past year as well as planning our goals for the coming year. We also enjoyed a lovely lunch from the local falafel shop.

My Favourite Aromatherapy Oils

My absolute favourite essential oil is lime – to me it smells like the old-fashioned Opal Fruit sweets (not Starburst!), you can even taste it in your mouth because the smell and taste senses are closely linked. Lime is a gentle oil and can be effective for sickness in pregnancy but also goes well with many other oils to balance some of the heavy aromas of oils such as black pepper or ylang ylang. Should be avoided by anyone allergic to citrus fruit such as oranges.

Ylang ylang is another firm favourite, which is surprising as it is quite a heavy floral aroma and something I don’t usually like. The oil comes from the flowers of an Indonesian tree. Ylang ylang is incredibly relaxing and can be sedative so useful for relaxation and aiding sleep. It is also claimed to be aphrodisiac, presumably because it is so relaxing.  It blends well with lighter oils such as lime, grapefruit and even cypress. In practice, my only precaution is to avoid it when working with women with postnatal depression – it is so deeply relaxing that it seems to push negative emotions deeper inside, whereas these women may benefit from more uplifting oils.

Spearmint is also a firm favourite. It has a lighter aroma than peppermint but is equally as effective for nausea and vomiting in pregnancy and during labour. Spearmint is a very uplifting oil and enhances the mood. It is a good oil to use for pain relief in labour and can be helpful for headaches (with the proviso that they are not a symptom of pre-eclampsia) and for respiratory congestion, coughs and colds.

My least favourite oil is geranium – indeed, after many years of using it when teaching,  I am now allergic to it, developing headaches and nausea and increasingly experiencing throat irritation when inhaling it. This is an important issue to take on board when using essential oils and I always discourage midwives learning aromatherapy from using oils which they dislike. This is due to certain smell receptors in the nose being aggravated by one or more chemicals in the oil – and repeated use will exacerbate this effect until eventually an allergy can occur. Having said that, many women like geranium and it is a useful oil for relaxation and aiding labour progress.

The Conveyor Belt Of Childbirth

OK, so now we have a new US research paper concluding that epidural in labour reduces maternal morbidity by 35% (Kearns at all, BMJ 2024). Of course, it's a team of anaesthetic and obstetric doctors which has completed the study, which gives it the political power to affect policy and to lead organisations such as NICE potentially to recommend epidural in labour as the optimal method of pain relief. If this happens, epidural will become even more of a routine than at present, with even more risk of needing other interventions in labour, likely leading to Caesarean section.

Intervention in birth is at an all-time high, to the extent that it affects service users, service planners and service costs. Women are either petrified that they will be coerced into unwanted and unwarranted induction or Caesarean, or conversely, they have lost all confidence in the ability of their bodies to give birth naturally. Midwives are fast losing their knowledge, skills and understanding of birth as a physiological process, and have certainly lost their confidence to enable women to labour spontaneously. Service managers and budget holders have completely lost sight of the fact that physiological birth is cheaper, more fulfilling for parents and staff and far less likely to lead to ultra-expensive litigation.

Having trained as a midwife in the middle 70s,. I've seen the battle for "normal" childbirth go round and round. In the 1980s we had the Maternity Care in Action reports, in the 90s it was Changing Childbirth and more recently we've had Better Births. Despite these initiatives, we are further away than ever from physiological childbirth and midwifery seems almost to be a dying profession. The incredibly vocal anti-natural childbirth lobby has inveigled itself into the debate too and is using the sad loss of many babies to add weight to the argument that medical management of birth is essential, a move guaranteed to increase unnecessary intervention.

Midwifery is no longer the autonomous ,champion of birth that it was 50 - or even 20 - years ago. Midwives in the NHS are bowed down by petty rules and regulations, too much paperwork and not enough time to care for parents. Childbirth is a conveyor belt of monumental proportions, In which all parties - parents, midwives, doctors, managers - are supposed to know their places in the system and behave accordingly to avoid breakdowns that might interfere with the complex mechanism of the maternity services. The more checks and balances we put in, the better that mechanism will run - supposedly - but at what cost?

Woe betide any maverick who challenges the system. They are subjected to coercion and emotional blackmail if they are service users, or to extreme bullying and unnecessary managerial processes if they are staff. This means that everyone either puts up and shuts up or leaves the system. Parents choose to employ independent midwives or Douglas or even to freebirth, while midwives and doctors leave their professions completely or risk alienating themselves by daring to work in private practice. 

I am not alone in despairing for the maternity services, for expectant and birthing parents and for the midwifery profession. I recently saw a post from another Facebook page, In which someone with a well-paid but unfulfilling job was considering training as a midwife and was asking midwives whether it was a good idea. Without exception, all the respondents said "don't do it" - a very sad indictment indeed for the profession. Yet if the current midwifery profession doesn't encourage new blood, the only thing that will change is the loss of midwifery as we know it and the further pathological approach to birth.

Best Foot Forward: Teaching Reflexology In Hong Kong 

I was so excited to be back in Hong Kong last week for the first time since before the pandemic. Travelling Business Class on BA, I was able to benefit from the new “pods” which provide an individual little area with a flat screen for films and, more importantly, a flat bed, so much more comfortable than the previous arrangement which required stepping over the next passenger’s feet to get out to the washroom during the night. I arrived on the Saturday afternoon, well refreshed, and was met by my lovely colleague Elce, head of the school of midwifery at the Prince of Wales Hospital. All week, I was so well looked after and treated as an honoured guest, being presented with a School of Midwifery teddy bear at the end of my stay – he had to be rather ignominiously shoved into an already full suitcase as I was leaving straight for the airport to come home.

In 2019, I had taught aromatherapy but this time I was asked to teach two 2-day introduction to reflexology courses for almost 60 midwives. This proved logistically challenging as the close supervision required to ensure students can accurately locate and palpate reflex points on the feet means that I usually only have about 12 in a group in the UK (and the course is six days, not just two). We also had some ongoing discussion before I left the UK about a suitable bed / couch on which I could demonstrate and how to position the midwives so they could comfortably work on their partners’ feet. For the first course, we had everyone working on mats on the floor although this was not particularly comfortable, so we arranged the second course with everyone working on chairs, which was much better. The midwives were fascinated by reflex zone therapy and learned a mini relaxation and some first aid points for treating women with backache, carpal tunnel syndrome, constipation, heartburn and, of course, pain relief in labour.

Midwifery practice in Hong Kong is very similar to UK midwifery, unlike in mainland China which is even more medicalised than the UK. Currently, the Beijing government is challenging midwifery numbers, claiming that there are too many midwives in Hong Kong. This is despite midwifery managers and educators stating that there is a shortage of midwives. The government has counted all those on the midwifery register but not accounted for those who have returned to nursing (midwifery is a post-registration qualification) or those who are not working at all at present. My colleague had a busy week of meetings to discuss this issue as it is likely to impact on student midwife numbers.

Back home, I had one day to recover and then it’s back to work with a vengeance as we come to the end of the current academic year and assignment marking and prepare for the new intake of midwives starting in September. Before that, I have my second trip of the year to teach aromatherapy in Tokyo and then I am back in Hong Kong in October to speak at the Normal Birth conference. Happy days!

Safe Use Of Natural Remedies In Pregnancy: Guidelines For Maternity Professionals

The use of natural remedies is at an all-time high, especially in pregnancy. Women are advised not to take drugs unnecessarily, yet many do not appreciate the potential risks of inappropriate self-administration of herbal and other remedies. Natural remedies (NRs) have, of course, been used for centuries and were traditionally a significant part of midwifery care until around the 17^th century when the emerging medical and pharmaceutical professions took control of healthcare. We know that, today, around 80% of expectant parents resort to complementary therapies and particularly to self-medication with NRs, perhaps as a means of recapturing some of that control of pregnancy and birth that has been lost in the mists of time. Herbal medicines, including many traditional and folk remedies, act in exactly the same way as drugs (and can interfere with them). They are not regulated in the same way as drugs and are relatively easy to access in health stores.   

Midwives, doulas and doctors may be asked for information or advise on herbal remedies such as raspberry leaf tea for birth preparation, clary sage and other aromatherapy oils for use in labour or to avoid an induction or, occasionally on homeopathic medicines such as arnica for perineal bruising. However, this is not a subject that is taught within pre-registration training for midwives and obstetricians, despite the increasing use by the public. Whilst herbal medicine is a self-regulated profession in its own right with graduate level training of at least three years, the issue for birth professionals is not those women who consult medical herbal practitioners but those who wish to use remedies and oils at home, sometimes without adequate knowledge to use them safely.

Many people, including conventionally trained healthcare professionals, believe that because these remedies are “natural” they are also safe – but this is not the case. Anything that has the power to do good also has the potential to do harm if not used appropriately. No remedy is suitable for every expectant, labouring or newly-birthed woman – and many are not suitable at all.

So how can maternity professionals advise expectant parents? Here are some guidelines to help you:

• All NRs should be treated with the same respect as that given to pharmaceutical drugs.

• No remedy should be used routinely for prolonged periods of time and NEVER as a replacement for proven medical treatment, especially in the event of an emergency.
• Women should be advised to avoid ALL NRs before and during pregnancy, labour and breastfeeding unless under the supervision of an appropriately qualified, insured professional.
• Women should be asked at their first antenatal appointment to reveal if they are using any NRs and their answers recorded in the maternity notes.
• Women should be advised to seek professional advice on NRs and not to rely on information obtained from the Internet, social and other media or friends and family.
• Women should be informed that not all NRs are approved, regulated or evidence based. NRs obtained from the Internet may be falsely labelled, contaminated with chemical impurities or contain banned or toxic ingredients.
• Women should be informed about the possible risks of taking pharmacologically active herbal remedies or using aromatherapy essential oils, including adverse effects such as allergies and interactions with other NRs, prescribed medications or foods.
• Advise women against combining several different NRs / complementary therapies: take only one remedy at a time, particularly at term when women may seek to expedite labour.

• Aromatherapy essential oils should not be applied to the skin neat; they should not be taken orally, rectally or used in or around the vaginal opening; keep away from eyes. Avoid using oils in the birthing pool.

• Pregnant maternity professionals and birthing companions should avoid exposure to (inhalation of)  essential oils intended to promote uterine contractions during labour eg clary sage, jasmine.
• NRs should be avoided / discontinued in the event of any medical, obstetric or fetal pathology, either pre-existing, gestationally-induced or occurring incidentally during pregnancy, labour or postnatally.
• Maternity professionals should consider the possibility that deviations from normal progress in pregnancy or labour may be linked to undisclosed use of NRs.
• Women admitted to the antenatal ward have, by definition, pathological complications requiring medical attention; they must be asked directly if they are self-administering NRs.
• Women should be advised to discontinue all pharmacologically active NRs (herbal and traditional medicines) at least two weeks prior to elective surgery or dental extraction to reduce the risk of excessive bleeding.

Why is it that “money” is a dirty word in the NHS?

Recently, I was teaching aromatherapy and acupressure to midwives at a large London hospital. In the course evaluation, I was accused of being too commercial because I was providing information on my textbooks (offered for sale as a learning resource) and on other courses they could take with Expectancy (in response to direct questions from a few midwives). This was not only distressing but blatantly unfair as I am always conscious of not being overly “sales-y”. This was a group that had been funded by the NHS trust to attend the course – and who were also able to attend it in their work time – so there was no obligation to appreciate the financial element of having the course.

Why is it that “money” is a dirty word in the NHS? Did the midwives think the course was provided free of charge? Did they not recognise that the training not only cost the fees that were paid to Expectancy by the trust but also that the clinical hours “lost” to training had to be replaced with other midwives? Further, did they think I was providing it from a misplaced sense of altruism? Midwives do not seem to understand that everything costs money – and that they are paid for the services they provide in the form of a salary. Just because no money physically changes hands at the point of providing the service does not mean our “customers” (expectant parents) are not paying for it. Healthcare costs the UK over £180 billion a year and is funded largely through taxes - so working people pay for the NHS, including care for those who do not pay tax. However, ask any midwife how much it costs for a spontaneous vaginal birth, a Caesarean, a urine specimen pot or an epidural and no one can tell you – a factor that contributes to huge wastage since employees do not have to take personal responsibility for equipment, medicines and other tools used in client care, unlike in the private sector.

Midwives who choose to go into private practice, whether as independent midwives providing full birth services or in a self-employed capacity offering services such as pregnancy complementary therapies, antenatal classes or tongue-tie division, are often castigated by colleagues because they dare to charge their clients. Yet there are services provided in the private sector that are not available on the NHS – and which some expectant and birthing parents choose to access and to pay for.  Similarly, increasing numbers of midwives are choosing to work outside the NHS – perhaps because they want a better work-life balance or are committed to offering services less accessible in the NHS. This is, as I have said before, about choices.

Prospective clients know that there will be a charge, should they choose to access private services – and it is not a problem for them. If they don’t want to pay it, they don’t become clients. If they become clients, they are happy to pay. Midwives who choose to work for themselves usually find it really difficult to price their services and to ask clients for the money – but they need to tackle this issue if they are going to be successful. If a midwife goes to the hairdresser, she expects to pay the going rate – so why is it so difficult to ask to be paid for the services offered? Obstetricians who work in private practice have no such qualms – although in fairness, they usually have an administrator who actually invoices their clients, effectively removing doctors from actually asking for the money. It would, however, be well worth any midwife considering private practice to have a chat with an obstetrician about this aspect before they set up their business.

Charging a realistic price for services can make the difference for a self-employed midwife between success and failure. Being aware of exactly what it is they are charging for is the first step on this difficult road. Prices are based on costs of training, setting up the business, costs of the actual service equipment and other aspects that have to be factored in – insurances, unpaid holidays of sick leave, legal and accountancy services and much more. On my business training days, we discuss “money” a lot and try to work out realistic pricing strategies so that clients feel they are receiving value for money without being fleeced, and midwives feel appropriately remunerated to fund their lifestyle without the guilt of over-charging. It’s a fine balance, but one that has to be confronted. If you’re considering starting your own business – come and find out how to “get over ” the charging-for-services  hurdle!

It’s Aromatherapy Awareness Week!

I strongly believe in the power of holistic care for expectant parents and maternity service professionals.

As a midwife, staying updated with the latest advancements in aromatherapy and other complementary therapies is essential.

We recommend updating your aromatherapy knowledge every two years to ensure you provide the best care possible.

Tips for practitioners:

🌸 Start with basic essential oils like lavender and sweet orange for relaxation.

🌸 Integrate aromatherapy into birth care to create a calming environment.

🌸 Stay informed about the latest research on aromatherapy benefits and risks.

Learn new knowledge and skills on our Expectancy Certificate in Midwifery Aromatherapy.

Making The Move To Starting Your Own Maternity-Related Business

So … you have decided to set up your own business … but where do you start? It’s vital to research what you want to do and how you want to do it. Don’t be tempted to rush ahead with enthusiasm as this may cause you to make mistakes (which can be costly – professionally, financially, or even legally) or you may find you have to “unpick” something you initiated too early. I have mentored many midwives who become so excited about branching out on their own that they forge ahead with ideas that are only partly thought-through, often with disastrous consequences (I’ve also done it myself in the early days!). Make sure you are deciding on private practice for the right reasons – are you moving towards something better or running away from an untenable situation? 

Once you’ve decided that you really do want to set up your own practice - and having looked honestly at your reasons for doing so - you now need to start by making some concrete plans. Decide on the specific services you wish to provide and consider how you would like to provide them. Take time to think about things, leaving it for a while and going back with fresh eyes once you have had time to consolidate your ideas. Try to identify exactly what you wish to offer – if you don’t know, then neither will your potential clients understand what you are offering. It’s also counter-productive to include too many different elements at the start of your new venture and you need to be flexible enough so that other services can be added later.

When I set up Expectancy, I made the mistake of trying to be all things to all my potential customers. I wanted to offer clinical services to pregnant women, as well as professional courses. Not only did I want to provide education for midwives, but also for doulas, antenatal teachers and therapists. This meant that I was trying to spread myself and my colleagues (and my limited advertising budget) across at least four different markets. Indeed, my adverts were completely unclear because we had tried to have a “one size fits all” leaflet – which just did not work. Everyone was confused – including the team. It was only later that I made the decision to focus solely on offering professional courses preparing the students to provide their own clinical services that it started to make sense. When I finally decided to concentrate entirely on marketing courses and business services for midwives there was a consequent substantial growth in income. If I’d taken time and explored specifically what I wanted to do, I may have achieved success more quickly and more productively. You can’t start everything at once, and your business will develop as you grow.

Discuss your thoughts and plans with your family, your colleagues and, if possible, talk about your ideas with potential users of your services. Is there a market in your area for what you want to offer, and will women pay for it? You will need to be aware of what’s available to women via your local NHS services. For example, if you’ve decided to offer postnatal care and lactation services, be sure that you know how much - or how little – of this is provided by the local maternity services. Similarly, it would be difficult, both in business and professional terms, to offer a service for women who want to avoid induction of labour by accessing complementary therapies if your local maternity unit had already implemented a postdates pregnancy clinic. Perhaps you could start earlier than 40 weeks’ gestation and offer a pre-birth preparation package instead? Research the competition and look at ways in which you may be able to offer something different or better. Which service providers in your area are successful, or more successful than others? Do they have a particular focus on how they market (sell) their services? Are there other midwives or doulas in your area already offering what you are considering?

Taken from Denise’s book The Business of Maternity Care, a guide for midwives and doulas setting up in private practice (Tiran 2019)