Denise and her blog


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

Watch our video and read Denise's blog for all the latest on complementary therapies and maternity care.


Find us on Facebook

Connect on LinkedIn

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.

 



Aromas Are Chemicals 

Published : 03/04/2021


Here is an extract from  an article published by the Complementary Medical Association. Although it relates to chemicals in the home, this includes fragrances such as perfumes and aromatic candles. Although essential oils are not mentioned by name, the same principles also apply to the diffusion of essential oils in the home. The key is to use aromatherapy diffusers in the home for no more than 15-20 minutes at a time and to keep babies, children, ill people and animals away from the aromas.

Chemicals in the Kitchen

The development of chemicals in the last hundred or so years that would serve to help us be cleaner, live more efficiently and generally ‘improve’ our lives has had a devastating effect upon our immune systems. It is estimated that anyone living in a “Westernised” environment encounters up to 2,100,000 man-made chemical exposures every day. The truth is that we simply don’t know what most of these chemicals do – and they have never been researched in combination. We are sitting on the top of a ticking time-bomb – and only time will really tell us about the true effects of synthetic chemicals.

The potential dangers of these chemical exposures are worrying – to say the least – as they are associated with numerous health issues, including cancers, obesity, hormone disruption, dementias and much more. These toxic chemicals also accelerate ageing and are associated with many of the health concerns that we associate with ageing.

In this article we’ll look at just a few of the harmful chemicals in your kitchen – and ways that you can avoid them – or find substitutes that really work.

Antibacterial Soap

Many commercially available ‘antibacterial’ soaps (and toothpastes) on the market boast that they contain the antimicrobial chemical ‘triclosan’. This chemical is believed to disrupt thyroid function and hormone levels in people; and furthermore, when it goes down your drain and eventually mixes with wastewater, it has been shown to cause sex changes in aquatic life.

Even more worrying is that overuse of this and other antibacterial chemicals is promoting the growth of bacteria that are increasingly becoming immune to antibiotics and other anti-bacterial substances.

Better alternative: Good old-fashioned soap and warm water kills just as many germs as the chemical soaps. If you have to use a hand sanitizer, choose and alcohol based product that doesn’t contain triclosan, triclocarban or any other synthetic substances described as anti-bacterial or anti-microbial.

Synthetic Fragrances

The chemical compounds that we are most often exposed to in our kitchens are fragrances. These surface in in soaps laundry detergents, fabric softeners, dryer sheets, cleaning supplies, disinfectants and outside the kitchen they are founding abundance in air fresheners, deodorisers, shampoos, hair sprays, gels, lotions, sunscreens, perfumes, powders, and scented candles. Fragrances are a group of chemicals that are well worth the time and effort to avoid. The words “fragrance” or “parfum” on product labels can act as an euphemism for hundreds of harmful chemicals that are known to be carcinogens, endocrine disrupters, and reproductive toxicants, even at low levels.

Better alternative: Freshen the air with better ventilation and by setting out a saucer of bicarbonate of soda. You also can place a bowl of white vinegar in a room to dispel a stale smell. I often spritz my environment with a small spray bottle containing water and a few drops of my favourite essential oils. 

Harsh Cleaning Products

It is really quite scary that we inadvertently contaminate our air when we use harsh chemicals—some of which are known to cause cancer—to “clean” our homes? Ammonia can trigger asthma attacks, and harsh oven cleaners and drain openers can cause respiratory damage or burn the skin anyone who comes into contact with them – and these chemicals are even more dangerous to children – who have much lower body mass than adults.

Better alternative: Take any synthetic cleaner with an ingredient list that reads like a chemistry textbook to your local recycling centre – they’ll know how to dispose of these chemicals properly – don’t pour them down the drain as they end up in our water supply! (Check those products which boast ‘natural ingredients’ as there are a great many synthetic products out there which try to promote their ‘green’ credentials by adding a few natural products to a synthetic chemical soup – and there’s very little labeling legislation in place to stop this grossly misleading practice.)



Informed Consent

Published : 31/03/2021

Here, Denise discusses whether midwives provide enough information to enable expectant parents to give informed consent for complementary therapies.

Informed consent is the process of agreeing to, or declining, a course of action in healthcare, based on a clear appreciation of the benefits, risks, implication and consequences of the treatment. Where possible, the information given should be based on contemporary research, as well as local directives and national and international laws. Whilst the Nursing and Midwifery Council and medical laws require midwives to obtain informed consent for all treatment options throughout pregnancy and birth, the process is often not done well, even for major interventions such as induction of labour or Caesarean section.

When it comes to complementary therapies such as aromatherapy, reflexology, acupuncture or hypnotherapy, midwives frequently allow their enthusiasm for the benefits to overshadow any real discussion of possible risks. Indeed, some midwives do not themselves possess adequate knowledge of the therapy to be able to provide all but very basic information. In fairness, it should also be recognised that expectant parents are usually so keen to take advantage of what they see as purely "relaxation therapies" that they may disregard any need to appreciate the opposite side of the debate.

However, since complementary therapies are not part of mainstream midwifery practice (or education), it is almost more important to ensure that fully informed consent has been obtained than for other standard components of midwifery care. In the event of any untoward consequences of complementary therapy use, midwives must be sure that parents have been given and understand this information, together with opportunities to ask questions and seek clarification. The information should be given verbally and in writing prior to any complementary therapy interventions.

Midwives introducing the option of a complementary therapy as part of pregnancy and birth care must provide parents with the following information in order that fully informed consent can be given:

  • What the therapy is
  • How it works ( mechanism of action)
  • How it can benefit the pregnant or birthing woman at this time
  • Reasons for use
  • How likely it is to be successful in relieving symptoms / condition
  • How it is used (what to expect during treatment)with
  • Method of administration
  • Contraindications and precautions (assessment of individual)
  • Possible expected (normal) healing reactions to therapy
  • Possible unexpected side effects from appropriate use
  • Possible complications from inappropriate use (self administration)
  • Risks of possible interaction with medication or other treatments
  • What to report after treatment (with contact details)
  • Explanation about any research - and its overall calibre
  • Statement that NICE guidelines do not support the use of  complementary therapies in pregnancy and birth as it is generally poorly researched


If you're a midwife using complementary therapies in your practice, are YOU informed enough to be able to offer this information in sufficient detail when discussing complementary therapies with clients? 


For more details of Expectancy's courses that prepare midwives to provide this information, contact us on info@expectancy.co.uk

 



The Debate on Cascade Training of Complementary Therapies

Published : 26/03/2021

Here, Denise discusses the controversial issue of "cascade training" of complementary therapies and asks why midwifery managers feel it is acceptable. She says:

During our online course this week, on aromatherapy and acupressure for post dates pregnancy, a midwife asked about cascade training, the practice of returning to base to teach other midwives how to use the therapy the students have just learned. This is a common question that causes me great concern. It usually originates from managers who see it as a cheap way to get all the midwives trained up to use the therapy (most commonly aromatherapy but also reflexology or acupuncture). 

There are several reasons why cascade training is completely inappropriate when it comes to complementary therapies: 

Each therapy is a professional discipline in its own right, which takes at least a year (for aromatherapy) or up to four years (for acupuncture) to become fully qualified. Midwives would not sanction someone taking a few days or weeks of midwifery training and then being allowed not only to practise but also to teach it. Indeed, there is great concern amongst complementary therapy educational and regulatory organisations about the way in which other professionals such as midwives, nurses or physiotherapists, "cherry pick" a few aspects of a therapy discipline without deeper understanding of the scientific basis and the legal requirements underpinning its practice. Those who teach midwives to use complementary therapies in their practice must first be fully trained in the therapy, have consolidated their own learning, have extensive experience of using it in midwifery practice and be qualified and insured to teach it. 

"Training" to be able to carry out practical skills of a therapy is one thing but becoming sufficiently educated to understand the implications of safe practice and to be able to minimise the risks is entirely different - this is the difference between academic level 4 and level 6 study, or between "doing" and "understanding". It is evidenced that people only retain 60% of what they first learn so there is a natural dilution when that 60% is passed on to others who then also only retain 60% of what they have been taught.  Further, midwives must be able to apply the principles of the therapy to its practice within maternity care. Midwives who undertake post-registration courses such as Examination of the Newborn are not permitted to return to practice and immediately start teaching other midwives up to a level of competence - so why do midwifery managers presume this is permissible when it comes to complementary therapies?

The truth is that most midwifery managers have absolutely no understanding of the issues relevant to complementary therapy - not only its practice but the health and safety, legal, ethical and regulatory issues relevant to safe practice. Permitting midwives who have only studied a few days of a therapy then to train others could put everyone in a very invidious position. It risks the safety of parents and babies and the registration of midwives using the therapy and of those teaching it. It also risks the registration of midwifery managers who have unwittingly assumed that those teaching the therapy know enough to ensure safe accountable practice of those they train. 

Midwifery managers have a responsibility to ensure that what is included in the care provided by their employees is safe and appropriate. They must take account of institutional issues and adhere to the law - this is a direct requirement under the NMC Code (2018). Managers have a legal duty to comply with the Health and Safety at Work Act, regulations such as Control of Substances Hazardous to Health regulations and medicines management requirements. Midwives are insured to practise complementary therapies under NHS vicarious liability insurance on condition that they have managerial permission - but managers must understand what their staff are doing before giving that permission.

The truth is also, perhaps, that midwifery managers want to respond to the trend to include complementary therapies in their care provision so that expectant parents will want to book for their birth centre or maternity unit. They also want to introduce new initiatives as cheaply as possible in the cash-strapped NHS - but this risks cutting corners which, in the long term, may be counter-productive to the intention of  complementary therapies - and detrimental to the wellbeing of all concerned.

Much is written about "compassionate care" and the introduction of complementary therapies is seen as being an element of this. However, compassionate care also means safe care - not cheap care, not ill-informed care and certainly not illegal care. Before midwifery managers approve cascade training of complementary therapies for their staff, they need to think about the consequences.

All of Expectancy's courses set complementary therapies firmly in the context of midwifery practice and focus on safety, professional accountability an evidence-based care. Contact us now if you would like courses for your unit, online or face to face -  info@expectancy.co.uk



Denise's Latest Book

Published : 22/03/2021


I’ve been publishing on maternity complementary therapies for many years but the huge increase in popularity of natural remedies, including aromatherapy oils, herbs and homeopathic remedies led me to write this latest book. Expectant parents frequently ask midwives, doctors, doulas and antenatal teachers about the use of remedies such as raspberry leaf tea, and for remedies such as castor oil and evening primrose to start labour. The massive rise in popularity of aromatherapy in pregnancy and birth also means that parents often ask about essential oils, or want to bring them into the birth centre for use in labour. This can sometimes put the midwife or doctor in a difficult position because they may know very little about the oils and which are safe or not.  

There is a huge amount of information – and mis-information - available online, but it presents a confusing minefield for both parents and professionals. The subject is not included in conventional medical or midwifery education, yet increasingly, maternity care providers need to know about the popular remedies and how to advise pregnant, labouring or newly birthed parents. Safety and accountability are the principles that underpin all that I teach in my Expectancy courses on complementary therapies for midwives but there is still the misconception that “natural” means “safe”. This just simply is not true. Anything that has the power to act therapeutically can also cause harm if used inappropriately. The issue is intensified when remedies such as herbal medicines are used alongside prescribed drugs.  

This book aims to provide a ready reference for health professionals in both the maternity and obstetric fields as well as complementary therapy practitioners who may be working with pregnant clients. It aims to provide enough information to advise parents about the safety, or otherwise, of particular remedies, when working in the clinical situation.  



Previous articles

Hyperpolarisation

The Future of Midwives

Aromas Are Chemicals 

Informed Consent

The Debate on Cascade Training of Complementary Therapies

Denise's Latest Book

Thought For The Day...Clinical Hypnosis

A Few Words On Reflexology

Thought For The Day

How Times Change