Denise and her blog
Transitioning Role From Midwife To Grandmother
My son, Adam and his fiancee, Ninka, are expecting their first baby – or should I say, babies – as they ‘ve found out it is twins! (Ninka is a twin). Until now, I have not been mentally ready to become a grandmother, but it is an exciting time and a new chapter in all our lives. I find myself swaying between the potential joys of grandmothering and the professional concerns as a midwife, although friends tell me it’s the best thing in the world. Their GP warned them that Johannesburg has one of the highest Caesarean rates in the world at 90% in the private sector – with twins, I would think that narrows it down to possibly 99.9%! Thankfully, they have been able to register with a midwife-led birth centre with visiting obstetricians, and currently the fact that it is twins does not seem to be a barrier to continuing their care there. It is a little alarming though to hear Adam and many of his contemporaries say that they don’t mind if they have a Caesarean – almost as if it is a normal expectation of having a baby. More on this later.
Midwifery, Aromatherapy and Natural Birth Under Attack Again
A recent article in The Skeptic (June 2026) has yet again seen fit to lambast midwives, midwifery care, “natural” birth and – of particular interest to me – aromatherapy use by midwives. Granted, this was published online prior to the Ockenden and Amos reports, but is simply more of the same rhetoric against midwives and against women who desire a physiological birth.
I do wish these journalists would get their facts right. Quite frankly, Michael Marshall does not know what he is talking about. He is one of a growing number of journalists and campaigners determined to undermine the maternity services and physiological birth and all that goes with it. He slates water injections for analgesia in labour, incorrectly assuming there is no evidence base, moxibustion for breech presentation (a Chinese technique which he cannot get his head around), homeopathy (there is anecdotal evidence, but I might concede on that one) and – of course – aromatherapy – of which he has absolutely no understanding whatsoever.
Marshall states that “this” (presumably complementary medicine) is an area “in which (he) has a degree of experience” – yes, mainly in demonising centuries-old modalities and being instrumental in the political agenda to have them removed from public accessibility. He twists facts to suit the political narrative and is ignorant of the evidence that supports these strategies. He states that there is no clear mechanism of action of aromatherapy, despite it having been proven to have a pharmacological mechanism – which is known to have both positive and negative impacts on human physiology. Either it does something or it doesn’t, but if it doesn’t, then how can it have negative effects? Aromatherapy is not simply “nice smells” and a bit of massage: it is a powerful chemical modality, and essential oils continue to be researched by the pharmaceutical companies as potential sources of new drugs.
Apparently, his Freedom of Information request to discover the prevalence of aromatherapy use by NHS midwives uncovered some questionable practices by enthusiastic but ill-informed midwives (about which I have written previously). He quotes NHS expenditure on aromatherapy as anything up to, in one trust, a totally unrealistic £30,000 – even if we account for training, this is at least three times the standard cost (and if the trust has quoted that, there is something inherently wrong). It costs no more than £1,000 a year to provide a midwifery aromatherapy service for women undergoing physiological labour – less than half the cost of a Caesarean section. If we add in around £7,000 to train 24 midwives, and factor that in across three years, plus £3,000 for oils, we are looking at a total of £10,000 or an annual cost of around £3300 – NOT £30,000! So, you only have to save two Caesareans, and the service has paid for itself.
Marshall quotes NICE guidelines as stating that aromatherapy should only be used if women request it, but NICE is part of the same establishment political agenda as Marshall supports. In any case, the NICE publications are guidelines, not directives or legally binding. Heaven forfend that a trust decides to offer an option to women that, allegedly, has no evidence to support it – when there are plenty of obstetric initiatives introduced into maternity services that have little or no evidence to support them. From his FOI request, he has uncovered some practices which, if correct, I would deem inappropriate (such as using midwives using oils for non-pregnancy related conditions such as coughs and colds, which are not part of midwifery aromatherapy) or frankly, unsafe (eg some quoted uses of oils which should be used with care, especially clary sage which should be discontinued once labour is well established and never used with Syntocinon).
And let’s face it, we are looking at CARE here, in a broken maternity service, where compassion and individualisation has currently left the building. Marshall gives no credence to the use of simple complementary strategies such as massage (part of aromatherapy for which there is considerable evidence) on the physiology of labour and birth. There is plenty of research to show the reduction in cortisol and adrenaline and the corresponding increase in oxytocin and endorphins – and if only he focused on that aspect rather than vilifying something of which he quite obviously has no knowledge, things would be a great deal better.
Marshall is one of those sceptics whose views are based on … absolutely nothing …. except prejudice, misogynistic, anti-physiological opinion. He is, of course, entitled to his opinion but should take care as to how he expresses it. Instead, his frankly dangerous and unfounded lack of factual integrity is counterproductive to the whole intention to improve maternity services. He uses language intended to ridicule claims for the effectiveness and safety of aromatherapy and divert attention away from the things that matter in today’s maternity care. So, he should stop taking on subjects about which he is ignorant and start supporting the changes needed in maternity care to make it a service acceptable to those who use it and those who work in it.
About Midwifery
What do I love about midwifery? I love what it was when I first started midwifery in the late 70s – totally individualised care, with your own midwife, very little intervention, very few Caesareans – and these were only in extreme circumstances. Midwives were left to care for women without medical oversight. Women stayed in hospital for up to seven days after a “normal” birth and for between ten and fourteen days after Caesarean (right up to the mid-1980s). I remember in one south London unit where I was a midwifery tutor, women who had been in for nine days were encouraged to go out for a meal with their husband and leave the care of the babies to the midwives in the nursery, so they had time on their own before going home the next day. Home births were common although there were increasing hospital births as the 1970s progressed, in line with the Peel Report of 1970. Postnatal care was the envy of the world and when I was a community midwife, we visited on the evening of the day women left hospital, then twice daily for three days, then daily up to ten days then, if necessary weekly up to 28 days. This is probably the aspect that has saddened me most in my career although the massive intervention rate now is – in my opinion – reprehensible, costly, counterproductive to physiology and potentially the beginning of the end for midwifery as I have known it.
What do I love about midwifery teaching? I have actually spent almost all my career in midwifery education, becoming an obstetric tutor in 1980 for student nurses completing their four-week maternity placement, before I went on to take the postgraduate certificate in education to become a bona fide tutor at Greenwich and Bexley school of midwifery (later part of the University of Greenwich). I love seeing student midwives blossom into qualified practitioners and try to impart to them my love of midwifery and my inherent belief that women’s bodies are their own and that they should be able to choose what they want (not told). I love seeing those new midwives thrive and blossom into fantastic caring practitioners, with some going on to make a name for themselves in their chosen specialist fields of the profession.
And what do I hate about midwifery education? I have an absolute despair over the lack of anatomy and physiology knowledge and understanding that underpins safe practice and may make the difference between life and death. The fact that basic aspects - such as biomechanics and relaxation now branded as “hypnobirthing” - were removed from pre-registration education and are now lauded as something special for those interested in post-registration training is very sad and, actually, deplorable.
Personally, having been trained the traditional way of learning “on the job”, I am still not convinced, even quarter of a century later, that midwifery (or nursing) needs to be a graduate programme. Having a degree may encourage critical thinking in some but does not necessarily ensure that graduates have the basic skills to care for women in pregnancy, birth and postnatally, especially with the fight for physiological births and the . changed definition of “normal birth” by the NMC to enable students to achieve their 40 births (or less in some cases). Indeed, with all due respect, some graduates think they are superior simply because they have a degree and the sense of entitlement seen amongst a minority of students simply because they are paying for their course, detracts from the true meaning of a caring profession. Indeed, the universities are complicit in contributing to the current state of the maternity services, with their commercial desire to achieve full cohorts and their somewhat questionable determination to attain the highest number of first-class degrees, often by “dumbing down” on pass marks.
When I was first a lecturer, we had our own set of students, to whom we taught almost the whole syllabus of the training programme. Groups were small (between 8-10 students) and tutors often worked with them in clinical practice – and we maintained our own practice skills. We got to know them and were able to help those struggling. We marked all their written work and saw how some were better able to apply theory to practice than others. And occasionally, we recognised when a student was not really suited to midwifery and could advise them accordingly. Students were expected to work in all clinical areas across the full 24 spectrum of care (there were none with ADHD or other issues that might excuse them from night duty, leaving others to fill the gaps).
Perhaps what I hate most about contemporary midwifery education is the wastage – students leaving mid-course because it is too taxing, or fabulous students unable to find jobs on qualifying. It is a waste for them, in time and money, a waste for universities and educators, a waste for the maternity services and a waste for parents who could have been cared for by a committed, enthusiastic and caring midwife.
And I hate the notion that, having been seconded for placements during training in NHS maternity services, there is an embedded misconception that the NHS owns them. It does not, there is no obligation to work in the NHS or complete a preceptorship (which I have said before is a management strategy to ensure appropriate staffing in all areas of the maternity services). However, this is rarely, if ever, addressed in midwifery education. There needs to be more coverage of the whole professional career of midwifery, not just training to staff an overburdened service.
Previous articles
Transitioning Role From Midwife To Grandmother
Midwifery, Aromatherapy and Natural Birth Under Attack Again
About Midwifery
Quality Of Education In Midwifery Complementary Therapies
Safe Maternity Care
The Publication Of The Ockenden Report
More from Denise at the 34th ICM Congress in Lisbon
ICM Congress in Lisbon
Birth Preparation
About Birth
