Denise and her blog


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

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Old Books For New:

Published : 19/05/2022

Denise has been seeing a lot of posts on Social media recently from students offering their used midwifery textbooks for sale at the end of their training. Here she explores the issues around academic reading and keeping up to date.

It’s that time of year when students are coming towards the end of their three year pre-registration midwifery programmes – and when those about to start midwifery training excitedly start preparing. Part of this preparation is thinking about which textbooks to buy. The two traditional UK midwifery texts are Myles’ Textbook for Midwifery and Mayes’ Midwifery, to both of which I have contributed chapters on complementary therapies on many occasions over the various editions. Another staple is Bailliere’s Midwives’ Dictionary, which I have edited every three years since 1997 and have just finished the 14th edition (Tiran, Redford 2022). However, there is such huge diversity within the modern midwifery profession, including obstetrics, physiology, psychology, sociology, research methods, obstetric emergencies and many contemporary issues, that there is a dizzying selection of textbooks, some of which cost up to £50 or more.

It is therefore understandable that students who have purchased their own copies may want to sell them on to incoming students. However, I am concerned that some books posted for sale on social media are extremely old and have been replaced with more recent editions. I recently saw a copy of the 11th edition of the Bailliere’s Midwives’ Dictionary (2009) for sale at £10, only marginally less than the latest edition which contains many new terms and more socially acceptable definitions. Another student was selling a 2011 copy of Obstetrics by Ten Teachers, despite it having been updated six years later. Some of the books are so old that they could be kept as historical texts - and prove  very interesting to compare practice years ago with how it has evolved today. 

However, whilst some books remain useful for new learners, many become out of date quickly. Remember that a newly published book is often already 18 months old or more by the time it is available for sale, since the writing of it and the publication process take considerable time. My advice to incoming student midwives (despite being an author wanting you to buy my books!)  is just to buy one recent comprehensive textbook (either Myles’ or Mayes’) and the dictionary – and then wait to see what is available in the university library. You may develop an interest in a specific aspect of midwifery such as breast feeding, genital mutilation, genetics or complementary therapies, in which case you can look for the most recent academic textbooks on those specialisms.  You could consider sharing books with a group of colleagues to enable you all to access both general midwifery and specialist texts. You could ask for Christmas or birthday presents for those you feel you would like to own. You may find cheaper versions of some books as digital copies. Bear in mind that many of the books you purchase for your own course will be out of date by the time you qualify and may not, therefore, be suitable for students coming along after you.

Books are wonderful, especially when you own a pristine hard copy, but it is essential to keep up to date. Not only could you lose assignment marks by referring to an old edition, it could also mean you are not up to date in your practice. 

If you are lucky enough to own a previous edition, especially one that is more than 20 years old, keep it for posterity, but make sure your theory and practice are based on the most up to date editions.



Borage Explained

Published : 09/05/2022

The beautiful blue flowers are sometimes added to cocktails. More importantly, borage contains significantly more gamma linolenic acids, one of the primary therapeutic constituents, than evening primrose oil.

Both EPO and borage are traditional remedies to start labour although evidence for effectiveness is limited.

Care should be taken with borage as it can cause liver toxicity in some.











Z is for ZuSanLi

Published : 08/05/2022

Z is for ZuSanLi, an acupuncture point also called Stomach 36. It is situated about four finger-widths below the bottom edge of the kneecap, between the two bones of the lower leg. In pregnancy it can relieve nausea, constipation, carpal tunnel syndrome, anxiety and aid birth preparation. It is useful for aiding progress in labour and postnatal recovery. Stomach 36 is one of the 15 points taught on Expectancy’s Certificate in Midwifery Acupuncture programme – we are now recruiting for September.








Y is for ylang ylang

Published : 07/05/2022

Y is for ylang ylang, (Cananga odorata), a wonderfully relaxing essential oil that is safe to use in pregnancy and birth. It can have strong sedative effects so should not be used for too long, and midwives caring for parents in labour who wish to use it should take regular breaks and keep hydrated to ensure they are alert enough to make clinical decisions (and drive).

It is very good for postnatal blues but caution is urged if there is a history of diagnosed clinical depression, as the effects can be so deep that the emotions can almost be pushed inwards, compounding the problem. The aroma is deep and floral but can be heavy and cloying for some people so use in small doses and for short periods of time.

In the home, ylang ylang should not be used near neonates, elderly relatives or animals (it is toxic to cats and dogs).




X is for X-rays

Published : 27/04/2022

X is for X-rays – one of the sources of energy that can inactivate homeopathic remedies. Since homeopathic medicines are chemically  very fragile, they can be easily inactivated by X-rays, mobile ‘phones, televisions and microwaves. Never store your homeopathic arnica and other remedies near electrical sources in the home – and take care when passing through the airport if you have homeopathic jetlag remedies with you.

 






W is for witch haze

Published : 26/04/2022

W is for witch hazel, a common herbal remedy used for perineal healing after birth. However, witch hazel should not be used on an inflamed or infected wound. It can be useful for haemorrhoids after birth as it has an astringent effect, causing vasoconstriction, although the research evidence is poor. Witch hazel should not be taken orally.

 





V is for Vitex agnus castus

Published : 25/04/2022

V is for Vitex agnus castus  - This herbal remedy, also called chaste berry, is a popular remedy for menopausal problems and is also used for infertility treatments. However, it should not be self-administered orally in the preconception period, pregnancy and when breast feeding, unless on the advice of a qualified medical herbalist. There is some suggestion that the plant hormones may compromise implantation of the embryo in early pregnancy. These also increase dopamine activity which blocks the production of prolactin, so  it may affect lactation. Topical use of the cream appears safe.


 



Adjust Your Own Oxygen Mask Before Helping Others

Published : 24/04/2022

Denise has been in Glasgow this week for various meetings. Flying from Heathrow, she reflected on the pre-flight safety briefing, including what to do in the event of reduced oxygen in the cabin, and related this to our work as midwives providing care for expectant and birthing parents. She says:

Midwives work incredibly hard in difficult circumstances, with inadequate staffing and long hours, often without time for a break, even a drink or visit to the toilet. Yet how can we expect to care for families if we are not fit, healthy and refreshed ourselves? Midwives become dehydrated, ketotic and exhausted which leaves them in no fit state to care for people. Put this in the context of the institution for which they work, with its dependence on risk avoidance and the pressures of an immensely  punitive culture, and the stress on midwives and other maternity care providers is immense..It is hardly surprising that midwives are leaving the NHS in droves.

Isn't it about time we started looking after ourselves first? We need to praise and thank the midwifery workforce, not bully them into being a mechanistic corporate set of hands blindly doing the job. We.need to facilitate midwives and support workers to give mindful care that not only helps service users but also leaves service providers feeling fulfilled and valued.

One NHS trust has recently asked me to provide a series of half day relaxation events for its staff, to thank them for their efforts and to give them something back to show that they are, indeed, valued. Engaging in some rostered "me time", with relaxation to music, massage and time to chat over a cup of tea and cake can do wonders to boost morale. Offering a metaphorical "oxygen mask" goes some.way towards helping midwives and support workers feel appreciated and to revitalise them so they are in a better state to provide quality and caring support to parents and babies.



The Business Of Midwifery 

Published : 19/04/2022

Denise recently interviewed a midwife for our Diploma who had just completed a Master's in Business Administration (MBA). Discussion turned to some of the issues plaguing the NHS and her insight into midwives’ lack of knowledge of the business of maternity care. Denise reflects on her conversation:  

Midwives seem to have little concept of how the NHS works or how much everything costs. 

For example, the difference in cost between a spontaneous vaginal birth and a Caesarean section is around £2000; an epidural costs at least £850; even the comparative pennies needed for a urine sample bottle or a pack of gauze swabs add up to a  multibillion pound NHS.

A trial was done some years ago in a London surgical ward in which the prices of NHS equipment were listed on cupboard doors. Increased awareness of the nurses led to more mindful use, less wastage and considerable cost savings. I find it fascinating when teaching business studies to the midwives preparing to set up their own private practices via  our Licensed Consultancy scheme to hear their views on money - costs, pricing and savings. One midwife recently told me she would be charging just £35 for an hour's complementary therapy treatment in her private practice. This was way below the average price of a pregnancy massage in her area. Further, she had not considered the money she had already spent to get to the point of starting her business - training and experience, NMC registration and revalidation, insurances, equipment and the  costs of starting and running her business. She was, in effect, giving her services free of charge - and actually paying to provide them. It is interesting that independent midwives do not have the same reticence talking about their fees as midwives working solely in the NHS.

Asking people to pay for their services is not a problem. Indeed, it is the only way an independent midwife is paid. NHS midwives do not give their time free of charge – so why is there such a negative feeling about asking expectant parents - who have consciously chosen a private option – to pay the fees for services provided? No one would expect to go to the hairdresser or massage therapist without paying for their expert services – so why do we have a mindset that finds talking about  “money” distasteful?. I believe that midwifery and all healthcare pre-registration programmes should include a mandatory module on the business of  healthcare.

If NHS staff understood how much everything costs, there would be less wastage and savings would contribute to a more balanced use of NHS limited budgets. For midwives going into private practice, it would be wise to study business matters before commencing to avoid costly mistakes – professional and legal as well as financial.

A greater understanding of the business of maternity care would contribute to a more successful business. 



Previous articles

Old Books For New:

Borage Explained

Z is for ZuSanLi

Y is for ylang ylang

X is for X-rays

W is for witch haze

V is for Vitex agnus castus

Adjust Your Own Oxygen Mask Before Helping Others

The Business Of Midwifery 

U is for Uterus