Denise and her blog


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

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Vaginal and Caesarean Births…Some Advice

Published : 21/10/2021

Denise is often asked by midwives about whether women wanting a vaginal birth after a previous Caesarean section (VBAC) can use complementary therapies and natural remedies to start labour. Obviously these women are desperate to avoid another Caesarean and often try everything they can find to help. Of course, having a nice relaxing massage or reflexology treatment can be good - it reduces the stress hormone, cortisol, and encourages an increase in oxytocin so labour is more likely to start naturally. Hypnotherapy can also help, by encouraging the expectant mum to focus on the positives of the impending birth rather than on the negative feelings about the past Caesarean.

However just because they're natural doesn't necessarily make self-administered natural remedies safe. This applied to all pregnant women but it's a particular risk when those wanting a VBAC start trying every remedy they've heard of - and often all together. More is definitely not better - indeed, using lots of remedies may confuse physiology so much that it actually increases the risk of complications, leading to the need for another Caesarean.

Maternity professionals - midwives, doulas, doctors - and therapists treating pregnant women should advise those trying for a VBAC to: 

* have regular relaxation treatments from a suitably qualified therapist who is insured for maternity work

* avoid self-administering castor oil, raspberry leaf tea, clary sage oil, evening primrose oil and other herbal remedies - and NEVER EVER to take them all at the same time

* inform their midwife or doctor about any complementary therapies they've had, and especially any herbal remedies they've taken or aromatherapy oils they've used.



Aromatherapy Oils Are Not To Be Played With

Published : 19/10/2021

Here, Denise discusses an issue that arose on a recent aromatherapy course in which a midwife reacted adversely to the oils.

During our  aromatherapy course for midwives this weekend, one student had a significant reaction to the essential oils, which we finally identified as being caused by frankincense. The student had already told me she suffered with eosinophilic asthma and I had urged her to be cautious but explained that some reactions cannot be anticipated or attributed to specific oils.

As the midwives were deciding on their preferred blends for the practical massage session, this midwife began to experience tightening in her throat and the beginnings of symptoms indicative of an asthma attack. Fortunately, she was able to move to another room and the oils she and her partner had chosen did not seem to affect her so she was able to engage in the practical work.

I have had several other midwives experiencing adverse reactions to oils during courses, some of which have been quite severe. Different oils have been involved including geranium, rose, clary sage, sweet orange, lavender and now frankincense. Indeed, I have witnessed a far greater number of midwives having negative effects from oils in the last five years than in all the years of teaching aromatherapy before that. Another midwife had such a serious reaction to simply sniffing clary sage from the bottle that we thought we would have to take her to A&E (she declined the offer and eventually the effects wore off). Other symptoms have included midwives being violently sick (from geranium) or developing an acute migraine-like headache (after using chamomile). One midwife reacted so badly to the use, by another midwife, of rose hand cream that she had to go home – she later informed us that she was allergic to roses.

I know of several maternity units where midwives with allergies to citrus fruits are unable to use oils such as orange, grapefruit, neroli or other citrus oils. Another unit has not one, but two members of staff severely allergic to lavender, one having been seriously affected when a mother brought her own lavender oil into the birth centre.

I cannot stress enough that midwives must take care when using aromatherapy in their practice, offering it to birthing parents or using it around other staff. The adverse effects can be unpredictable, severe and long-lasting. It is unethical, unsafe and unprofessional to assume that all people exposed to the oils in a birth centre either like the aromas or can tolerate the chemical effects. Get to know your oils and their benefits and possible adverse effects!



Why is Complementary Medicine not Included?

Published : 12/10/2021

Denise is in Portsmouth again this week, teaching aromatherapy and acupressure for postdates pregnancy. Having had a good first day,  the course is having to decamp on Tuesday to another hospital due to lack of room availability. The group was due to use a church hall but a last minute change was required when the church rescinded its booking, claiming that aromatherapy and massage did not fit with its religious ideals. Here, Denise reflects on the attitudes towards complementary therapies.

What a shame that we were unable to use the church hall for the second day of our course due to a possible conflict between religious views and what is sometimes still seen as "new age" therapies. Complementary medicine still has to fight its cause on many fronts. Scientists accuse CTs of being poorly evidenced. Purists feel that "alternatives" have no place in conventional healthcare; obstetricians claim they can interfere with medical interventions (true to a certain extent but they may also avoid the need for medical intervention). Managers sometimes reject them because , they say, there is not enough time to use them. Others claim they are dangerous, illogical or are an element of fringe medicine (or witchcraft).

In almost 40 years of practising, teaching, researching and writing about complementary therapies, I have encountered many views and much opposition. People are, of course, entitled to their views, although it is sad that some are based on lack of knowledge and understanding of what CTs are about, how they work and how they can be used beneficially to enhance maternity care. 

We hear a lot, today, about different lifestyles, perspectives and views on everything from sexuality to religion to disability to politics. Everywhere there are pleas for greater inclusivity. Why then does complementary medicine continue to be sidelined by the conventional healthcare and scientific communities? Is it not time that complementary medicine was brought in from the cold and considered equally alongside other forms of medicine and healthcare?



What’s Happened to Midwifery?

Published : 11/10/2021

I've seen many posts on social media about the deplorable state of midwifery and the maternity services in Britain but I've also seen similar posts from French midwives where midwifery is possibly even more.medicalised.than in the UK. Midwifery is in crisis in the western world - I would say we are seeing the death of midwifery as we know it unless radical action is taken now.

Blame is heaped on the current government yet this situation has been evolving for decades. It's not the fault of one government or one political party. One government can't cure the problems of fifty year's worth of intervention, control and pathologising of childbirth. 

Poor pay is also sometimes raised - but you don't go into midwifery or nursing for the money (that argument is for another day but it's not just the UK that pays its nurses and.midwives poorly). No amount of pay increases will bring more people into midwifery training  or stop the deluge of departures from those already working in the system.

I believe the problem lies in the culture and attitudes of the system. Midwives are mainly women and although many obstetricians are now female, they too work in a male dominated, paternalistic - and I would say, sometimes misogynistic - culture and often become part of the problem. Historically women have been moulded into "bodies that have vaginas" (as the recent Lancet referred to) and childbirth has become just another medical problem.

I heard only yesterday of a midwife committing suicide, possibly partly as a result of extreme bullying at work by her colleagues and managers. Bullying is rife in the NHS and possibly worst in midwifery - contributing to midwives leaving the profession for a better work-life balance and as.a.way to protect their own mental wellbeing.

Pressures on the maternity services have risen exponentially with increased population and increased complex needs of those using the services - obesity, diabetes, mental health issues and so on. More users bring higher demands and need more resources - including staff. Yet this means that those with complex needs take priority and those whose pregnancies and births are "normal" are left to get on with it - so they feel dissatisfied. More complex needs mean more emphasis on pathology to the extent that we all begin to see childbirth as a pathological condition.

The problems of midwifery are multifactorial and not easily rectiified. My preference would be to return to a community-based profession with individualised continuity of care and carer -but it's not going to happen easily. I believe midwives should adopt the independent midwifery model but this will be difficult in the NHS which exists for the majority and not for the individual. I feel that unless we do something soon, midwives will become obstetric nurses during birth, antenatal care will focus on the biological and not the psychosocial aspects and postnatal care -well, will there be any at all? 

I don't know what the answer is because the situation is so complicated but unless we act soon as a united profession we won't have anything to fight for. Long live midwifery.



Aromatherapy in Midwifery Practice

Published : 06/10/2021

If you’re wanting to implement aromatherapy into your midwifery practice, what do you need to learn? Here Denise shares a checklist for midwives and doulas preparing to use aromatherapy for labour care. The list can also be applied to the postgraduate study by aromatherapists wanting to specialise in maternity work.

  • Anatomy and physiology of the skin, the sense of touch, olfaction, respiration
  • Pharmacology and pharmacokinetics of essential oils. mechanism of action
  • Basic chemical concepts, specific chemistry of essential and carrier oils
  • Therapeutic properties of essential oils 
  • Methods of administration appropriate to us within labour care settings 
  • Methods of blending
  • Indications, contraindications and precautions to use of aromatherapy in pregnancy, labour and postnatal period
  • Recognition of healing reactions, adverse reactions, overdose and inappropriate use
  • Health and safety at work, control of substances hazardous to health regulations
  • Evidence-base for aromatherapy 
  • Keeping up to date with contemporary changes in aromatherapy practice
  • Evaluation and audit of midwifery aromatherapy service
  • Change management and the process of implementation of aromatherapy in midwifery practice

 



A Word About Essential Oils

Published : 02/10/2021

Essential oils are not a panacea for everything! 

Denise comments on continuing concerns about the overuse of aroma therapy oils.

Can you use lavender oil to lower blood pressure if an expectant parent has developed pre-eclampsia?

Is it OK to use tea tree (known to relax.smooth muscle) to stop a threatened preterm labour?

How about treating a skin reaction to one essential oil with another to stop the irritation?

The answer is a resounding NO!

When aromatherapy is used in pregnancy and birth, it should be supportive and can be very relaxing, uplifting, wound healing or immune boosting. However once progress.deviates from the norm, aromatherapy should be DISCONTINUED.

It is neither medically appropriate not professionally expedient for midwives and doulas to attempt to rectify medical complications with aromatherapy oils - sometimes DRUGS are needed! And it is not good.practice to attempt to reverse the effects of one oil or blend with another. If a woman has a reaction to an oil or a single chemical in an oil, she may react adversely to other oils containing the same chemical. CAUTION always when using essential oils in pregnancy and birth. Enjoy them but don't abuse them!



Osteopathy and Chiropractic

Published : 27/09/2021

Osteopathy and chiropractic offer probably the most dynamic treatment options for expectant parents with lower or upper back pain, pelvic girdle pain or any other musculoskeletal problems in pregnancy such as carpal tunnel syndrome and shoulder girdle pain. 

A follow-up study of 115 women who received chiropractic for back pain in pregnancy indicated a 52% improvement after one treatment, with steadily increasing rates of improvement with longer courses of treatment, particularly when continued postnatally for up to a year (PetersonMühlemannHumphreys 2014). 

In countries such as Canada, where chiropractic is accepted as being complementary to conventional healthcare, expectant parents with musculoskeletal symptoms can receive care which is genuinely shared between the obstetrician and the chiropractor.

In the UK, osteopathy and chiropractic are highly regarded allied health professions, with all practitioners statutorily registered under the General Osteopaths Council or General Chiropractic Council. Hensel, Buchanan, Brown et al (2015) set up the Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects (PROMOTE) study to evaluate the efficacy of osteopathic techniques for musculoskeletal pain in late pregnancy.

400 expectant parents were randomly allocated to receive standard care, osteopathy with standard care or placebo ultrasound treatment with standard care. Both osteopathy and the placebo treatment achieved some improvement in symptoms reported by participants although osteopathy was significantly more effective.

This was one of the largest trials ever conducted on the effectiveness of osteopathic manipulations in pregnancy, although it was interesting to note a high attrition rate, stated as being due to missed appointments and the onset of labour before 40 weeks’ gestation in some women.

As with much other complementary medicine research, the need to use a standardised treatment regime rather than individually-tailored clinically-relevant programmes of treatment may have affected the ultimate efficacy of treatment.



Black and Blue Cohosh Explained

Published : 25/09/2021

Some women take herbal remedies to trigger labour, including either black cohosh or blue cohosh.

Black cohosh is thought to have hormonal effects, menstrual and uterine-stimulating effects, but there is little reliable information available on the safety or effectiveness. When taken orally, it can cause gastrointestinal disturbance headache, dizziness, breast tenderness and skin irritation.Women with a history of hepatic or renal disease, epilepsy or vaginal bleeding in pregnancy should be advised to avoid black cohosh.

Blue cohosh is now known to cause significant adverse effects including reports of severe poisoning and life-threatening toxicity in the baby, including stroke, acute myocardial infarction, congestive heart failure, multiple organ injury and neonatal shock and should not be used in pregnancy or for birth.

NB It is essential to differentiate between black cohosh (Cimicifuga racemosa) and blue cohosh (Caulophyllum thalictroides) to avoid confusion and inappropriate administration. It is also important to differentiate between the herbal (pharmacological) and homeopathic (energetic) use of these plants





The Science of Aromatherapy Oils

Published : 24/09/2021

Aromatherapy oils are like Victoria sponge cakes! Whether you buy your cake from one supermarket chain or another, or from a local artisan bakery, the basic ingredients are much the same. Some cakes may contain more sugar, extra cream, fewer eggs or different flavoured jam than others, so the taste of the end product is affected by the proportion of these primary ingredients.

Essential oils, in principle, are much the same. They all contain the same groups and sub-groups of chemical ingredients, but in widely different proportions. When you examine a list of the "top ten" chemicals in each oil, it's these that give the oil its distinctive aroma and its primary effects  - such as being relaxing or stimulating, analgesic or anti-infective and so on. With almost 300 chemicals in each oil, some are found in such minute traces that their physiological effects are negligible. 

In pregnancy, we're concerned with avoiding those oils with high levels of specific chemicals particularly, ketones, which may be toxic to the fetus or cause uterine contractions or other maternal complications. Essential oils with only a trace of these chemicals will be much safer than those with significantly higher levels. Conversely, oils with high proportions of ketones should be avoided in pregnancy until term - oils such as jasmine, clary sage, rose or cinnamon.



Why are Good Midwives Being Driven Away?

Published : 16/09/2021

Have midwives lost the ability to use their common sense because they're caught up in a system that requires ticks in boxes and a "just in case" approach? Why can't the system enable midwives to watch and wait instead of intervening prematurely in what is, after all, a physiological process for both mother and baby?


A friend recently had a lovely son but the pregnancy, birth and first few days were not all.plain sailing. Nothing was wrong medically although the system pathologised.every small.deviation from "normal" and caused extreme anxiety for the parents. The baby was breech at 35 weeks - but ECV was performed instead of waiting to see if he turned - or discussing the option of a breech birth if he didn't. Labour started spontaneously with a very long latent phase - but, surprise, surprise, duration of "established" labour was measured from hospital admission, with mutterings (threats) to intervene if "nothing happened" within a set timeframe. As it happened labour did (of course) progress to the extent that the mum started requesting an epidural - which was arranged immediately instead of spending time supporting her through each contraction and building up her confidence in her body's ability to birth naturally. It was only because the unit was busy that saved her from the possible cascade that goes with epidural - the anaesthetist was unavailable so she laboured, largely on her own with just her partner present, and eventually gave birth to a healthy son. In the postnatal ward, someone saw fit to tell the mum that - on day 1 - she didn't have enough milk and gave her a bottle of milk for the baby. What?!! And then someone decided the baby had not passed urine and mum and baby were kept in hospital until he did - 48 hours later. I can almost guarantee that he will have passed urine in the early hours and that it was missed -but the parents were subjected to.more anxiety (with no explanations) instead of "allowing" them home and having the community midwife visit to check everything was OK.

These are minor incidents in clinical terms but accumulatively worrying for the parents and marred their overall enjoyment of having their first baby. This is also not an isolated case. Midwives are so fearful of losing their registration that they comply with requirements to fit every individual into a system that favours the institution and not each parent. They are so fixated on ticking charts designed to reduce the risk of omission that they forget to think outside the box - and end up missing important cues anyway (this has been proven in research). Lack of understanding of anatomy and physiology and the paternalistic desire of the system to see pathological problems before normality causes more anxiety for parents who are naturally already in need of a confidence boost.

Midwives have lost the ability to be intuitive about pregnancy, birth and the early days of parenthood. This is the fault of pre-registration education which now has so.much content there is hardly any time to learn - and understand - the basics before going on to complications (which, let's face it, are almost more commonly seen than so-called normality these days). It's the fault of a medicalised, paternalistic, risk-averse, litigation-conscious system that exists for the majority and not for the individual. It's the fault of a midwifery profession that has such a culture of bullying - of both staff and parents - that.compassionate midwives are leaving the profession, adding to staff shortages and compounding the whole sitiation. It's the fault of managers who are trying to balance the rotas and budgets whilst also thinking about CQC inspections and national.ratings.And it's the fault of all of us for being complicit in letting it happen. 



Pineapple Fritters Anyone?

Published : 13/09/2021

Expectant parents often start eating pineapple as a way of avoiding induction of labour. Pineapple (and to a lesser extent, mango and papaya) contains bromelain, a chemical that affects smooth muscle which is thought to aid uterine contractions. The bromelain is in the central core of the pineapple so it's no good eating tinned pineapple rings. In fact, cooking destroys the bromelain, so pineapple fritters are no good either, nor is drinking pineapple juice. It needs to be fresh, raw pineapple. However, some people are allergic to pineapple and eating large quantities can even lead to anaphylactic shock.



The Caring Role of a Midwife

Published : 05/09/2021

What an incredibly moving and brave article in this month's @MIDIRS by Iris Snowdon on her personal experience of such severe burnout that she walked out of the job she loved - being a midwife. It is a harrowing - but ultimately uplifting - acount of her gradual slide into the deepest depths of despair to her healing journey to a new life. How sad that such a caring and devoted midwife should suffer as a result of complete overload and lack of sympathy from many of her colleagues. 

However, Iris is not alone. Many of the midwives who study with Expectancy report similar experiences and some of those have taken the brave step to leave the NHS and do something different. I have met midwives at all levels, from Heads of Midwifery to newly qualified midwives, who have felt unable to continue working in a culture that is unsupportive, ungrateful, bullying and blame-throwing.

A desire to continue caring for expectant parents seems common to all, but often those midwives who have to pay the bills are forced either to stay where they are and put up with the situation or to find another job outside midwifery. Increasingly, midwives are working for themselves, offering maternity- related services such as antenatal classes, complementary therapies, lactation support, birth trauma resolution or tongue-tie division, even though this may mean less income. 

It is disturbing, when the NHS is so short of midwives, that it  actually isn't really about the money, but about wanting a better work-life balance and about wanting to with families in a caring compassionate way - the way that midwifery care should be. 



About Herbal Teas

Published : 28/08/2021

We often think herbal teas are just pleasant drinks but some are not safe in pregnancy or need to be used with caution

All herbal remedies including teas contain chemicals that act like drugs.

Although chamomile tea can aid sleep, drinking too much can have the opposite effect and over-stimulate the brain.

Peppermint tea can be good for nausea but is a cardiac stimulant and if drunk to excess, can cause palpitations, so should be avoided by anyone with a heart problem.

Raspberry leaf is good for birth preparation but should be avoided by women with a uterine scar from a previous Caesarean.

See Denise's latest book, Using Natural Remedies Safely in Pregnancy and Birth for more information.




The Need for education on Complementary Therapies

Published : 26/08/2021

New Australian research by Mollart et al 2021 again advocates the need for education on “complementary therapies” to be added to midwifery programmes. Here, Denise comments on the implications of the research:
 
I am pleased to see an abstract of the latest research by Mollart and colleagues, due to be published in November in the Complementary Therapies in Clinical Practice journal, on the education of midwives on complementary therapies. The results are unsurprising, revealing that just over 50% of midwives have had some “training” in CTs, ranging from being self-taught up to diploma level, primarily in aromatherapy, massage, reflexology and acupressure. The recommendation that evidence-based education needs to be included in pre-registration midwifery education is spot-on but requires some clarification.
 
First, we need to look at the calibre of the training in CTs that is provided for midwives and students. Student midwives are preparing to practise midwifery not complementary therapies. While they need a basic understanding of the main CTs and natural remedies used by expectant and birthing parents, they do not need, at the point of registration, to be able to practise the therapies or incorporate them into their care of parents. Pre-registration education should provide students with an overview of the commonly-used therapies including – crucially – safety issues. This is particularly pertinent to aromatherapy and natural remedies which are often self-administered, sometimes unsafely. Midwives should be able to answer parents’ questions on safe use of the therapies, rather than be competent in the skills of providing the therapies.
 
Post-registration midwifery education should offer interested midwives the opportunity to undertake higher level training in therapies of their choice. There is a difference between skills “training” and academic education. Courses for midwives MUST be midwifery-specific and taught at least at academic level 6 so that midwives not only develop skills but also acquire deep knowledge and understanding, with an appreciation of the available evidence, safety issues and the parameters within which they can practise. There are many courses available to midwives that provide only level 4 training – usually based on enjoying a day of massage or blending of aromatherapy oils or learning specific acupressure of reflexology points to treat specific situations in labour. 
 
In addition, it is not appropriate for midwives to train fully in a therapy and then undertake to implement that therapy in midwifery practice, without help to apply the principles of the therapy to maternity care. The use of CTs must be set in the context of the institutional area of practice – the birth centre, main obstetric unit or parents’ own homes. Midwives must appreciate how therapies are regulated within their midwifery practice – by medicines management, health and safety laws and by local, national and international regulations. The use of CTs must also be set in the context of the healthcare services, relevance to the service rather than to individuals, equity of service provision so that as many as possible can benefit from the therapies, evidence-based practice and the need to minimise risk and potential litigation.
 
Having taught CTs to midwives for almost 40 years, I am, of course, keen that the subject should be included in midwifery education. However, I am concerned – and have written frequently on the subject – that the enjoyment of using CTs often overrides the professional requirements to practise CTs safely. CTs education for midwives should be provided by midwives who are fully qualified in the relevant therapy and experienced in using it within midwifery practice and education. Lecturers should be qualified to teach adult learners and qualified and insured to teach the theory and practice of each therapy. Cascade training is NOT appropriate – students only to retain around 60% of what they learn, so midwives who have themselves only just learned a therapy and then attempt to teach others risk a natural dilution of content and understanding as their learners only retain 60% of what they have provided. Before we can include the subject in the midwifery curricula, we need to concentrate on educating midwifery lecturers and senior clinicians and researchers in order to develop and maintain appropriate standards of safe practice.
 
We must also remember that the field of “complementary therapies” encompasses many different professional disciplines. Complementary medicine practitioners are increasingly well trained, sometimes to degree level. Their professional bodies have codes of conduct, continuing professional development requirements and disciplinary procedures to maintain standards and safety in the same way as midwifery and nursing. Midwives need to appreciate that lack of knowledge and understanding potentially puts parents and babies, as well as colleagues, managers and their own midwifery registration at risk.



The Alexander Technique

Published : 25/08/2021

The Alexander technique may benefit expectant mothers with low back pain, sciatica and symphysis pubis discomfort. The Alexander technique aims to teach the woman how to move and use her body mindfully, correcting habitual postures, movements, coordination and balance, as well as patterns of accumulated tension which interfere with the innate ability to move easily and efficiently.  Daily activities, - sitting, lying, standing, walking, lifting and other physical activities - become easier by using the body in a more efficient manner, with less risk of pain and discomfort. The Alexander technique is energising because the client learns how to move with less energy expenditure, thus promoting an enhanced sense of wellbeing. Unfortunately, although the Alexander technique is popular amongst actors to assist optimal positioning for voice projection (it was devised by an actor), its use as a general complementary therapy has declined in recent years and it may be difficult for expectant mothers to access a local teacher of the discipline.



Breech Presentation

Published : 21/08/2021

If you’re asked by expectant parents about moxibustion for breech presentation, how do you know if it is appropriate or safe for them? The contraindications to moxibustion are the same as for external cephalic version plus hypertension and respiratory conditions such as asthma. These last two reasons are because the heat of the moxa sticks can temporarily increase the blood pressure and the smoke from the burning sticks can cause respiratory irritation.



Oils and Allergies

Published : 18/08/2021

Are you allergic to any essential oils? Denise has been allergic to geranium for many years, and is now becoming increasingly intolerant to rose oil.Even a brief exposure to geranium when teaching aromatherapy can cause nausea, and prolonged exposure leads to headaches.Geranium and rose share some of the same chemicals which is why rose is also starting to cause symptoms. Other common oils that can trigger allergic reactions include citrus oils - orange, grapefruit, mandarin etc. Denise has also had midwives react adversely to different oils in class - including one midwife who simply took a quick sniff from a bottle of clary sage and had a major respiratory attack. If you have a reaction to inhaling oil vapours it is vitally important not to continue being exposed to that oil as eventually it can cause anaphylactic shock.We'd be interested to know if you have had any adverse reactions to oils.



The Benefits of Frankincense Oil

Published : 17/08/2021

Frankincense oil is "the ultimate calmer" and a quick sniff of a single drop on a tissue can be very effective for women in the transition phase of labour. The power of frankincense calms the woman and helps her through that last short period before the birth. It's also useful for helping those who are frightened of having blood taken.



Reflexology-a few words

Published : 03/08/2021

Reflexology is NOT the same as foot massage

When reading research studies on reflexology in labour, it's important to clarify what treatment is being given.

There are several studies that claim to reduce labour pain and duration with reflexology, but most studies use basic foot massage and not reflex points on the feet. It's OK in a clinical sense - foot massage can be a wonderful aid to labour care - but there is very little research using specific reflex points to stimulate contractions or reduce pain.

On the other hand, reflex zone therapy, the style of reflexology taught by Expectancy, can be very effective for postdates pregnancy, latent phase, stalled labour and retained placenta.



Moxibustion

Published : 30/07/2021

How many expectant parents with a breech baby have asked you about moxibustion? This Chinese technique, performed from 34 weeks of pregnancy, is around 68% successful in turning a breech to head-down. But there are certain women who shouldn't try moxibustion. If an ECV is contraindicated, then so is moxibustion. Also, high blood pressure - because the heat of the moxa sticks can raise the BP slightly; and asthma or other respiratory condition - because the smoke from the burning moxa sticks can increase symptoms.



All About Ginger

Published : 27/07/2021

Ginger biscuits are NOT the answer to pregnancy sickness! There's not enough ginger in a biscuit to have any therapeutic effect - and the sugar content causes peaks and troughs of blood sugar that can make sickness worse. Ginger tea, made from half a teaspoon of grated root gjnger, may be better but it's not appropriate or safe for everyone. Ginger contains chemicals that thin the blood so should not be used by expectant parents on anticoagulants including aspirin and clexane, or by anyone with a threatened miscarriage.



Testimonials and Compliments

Published : 20/07/2021

It’s great to receive compliments and testimonials!

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

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

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

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

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



Watch Out For Your Pets

Published : 12/07/2021

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



Homeopathic Remedies

Published : 09/07/2021

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



Course Update

Published : 02/07/2021

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

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

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

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

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

 



The "Negativity" Of Safety Information On Complementary Therapies

Published : 28/06/2021

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

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

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

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

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



Has Hypnobirthing Had Its Day?

Published : 21/06/2021

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

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

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

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

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

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

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

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

 



Seaweed For Postdates Pregnancy?

Published : 15/06/2021

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


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

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

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



Ten Tips For Midwives Looking For Complementary Therapy Courses

Published : 12/06/2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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



The Dangers Of Passing It On

Published : 06/06/2021

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

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



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

Published : 01/06/2021

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

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

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

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

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



Essential Oil Responsibilities

Published : 25/05/2021

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

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

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

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



The Business Of Maternity Care

Published : 21/05/2021

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

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



Complementary Therapies

Published : 19/05/2021

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

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

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

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

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

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




15th May 2021- Today is International Hyperemesis Awareness Day

Published : 15/05/2021

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



Reflex Zone Therapy

Published : 10/05/2021

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

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



Misleading advice

Published : 08/05/2021


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

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



Homeopathy is not a placebo effect

Published : 03/05/2021


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

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



Hyperpolarisation

Published : 12/04/2021

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

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

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

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

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



The Future of Midwives

Published : 04/04/2021

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


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


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


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


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

 



Previous articles

Vaginal and Caesarean Births…Some Advice

Aromatherapy Oils Are Not To Be Played With

Why is Complementary Medicine not Included?

What’s Happened to Midwifery?

Aromatherapy in Midwifery Practice

A Word About Essential Oils

Osteopathy and Chiropractic

Black and Blue Cohosh Explained

The Science of Aromatherapy Oils

Why are Good Midwives Being Driven Away?