Denise and her blog
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 .
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!
Previous articles
Today is Expectancy’s 20th Birthday! 🎉
Pass The Baton - Where Is The Next Generation Of Leaders In The Specialism Of Midwifery Complementary Therapy?
Our Woman In Tokyo
Safe Care Cannot - And Should Not - Be Done On The Cheap
Guest Blog : Annual Networking Day
Why I Love Reflex Zone Therapy
Annual Networking Day
My Favourite Aromatherapy Oils
The Conveyor Belt Of Childbirth
Best Foot Forward: Teaching Reflexology In Hong Kong
