Denise and her blog

About Birth

Birth is not just physical. It is hormonal, emotional and environmental too.

When women feel calm, supported and safe, the body is better able to produce the hormones that help labour progress physiologically.

This is why environment, communication, reassurance and supportive care matter so much within maternity services.

Complementary approaches such as massage, relaxation and reflexology help reduce stress hormones such as cortisol and support the body’s natural processes by increasing oxyocin and the “feel good” chemicals, endorphins and encephalins.

Thinking Critically

One of the greatest strengths a midwife can have is the confidence to think critically.

Not every trend is evidence-based. Not every intervention is necessary. And not every complementary therapy is automatically safe simply because it is described as “natural”.

Modern midwifery requires a balance of knowledge, clinical judgement and professional accountability.

That means understanding physiology, evaluating research, recognising contraindications and supporting women to make informed decisions about their care.

This is why education matters far beyond qualification. Because the more knowledge we develop, the more confidently and safely we can practise.

We are currently recruiting for our Diploma and Certificate programmes in Midwifery Complementary Therapies, starting 1st October, designed specifically for midwives who want to expand their knowledge safely, professionally and evidence-informed.

Have We Lost Sight Of Physiological Birth?

As a midwife for almost 50 years and having worked as a community midwife in the 1980s, I’ve attended many successful physiological births, at home and in midwife-led birthing units. It is therefore extremely sad to see how much birth has been medicalised in the last 20-30 years. With induction of labour and Caesarean section reaching catastrophically high rates, we now have a generation of midwives and obstetricians with little experience of physiological birth – and little knowledge of normal anatomy and physiology either. There is no trust in a woman’s body to become pregnant, to carry the baby and to give birth without the need for intervention – but let’s face it, it’s what women’s bodies are designed to do. Women and families are also indoctrinated into a system that induces fear that they cannot possibly manage birth without the “expertise” of a midwife - who dutifully agrees to medical intervention at the earliest possible stage.  

The very fact of these unacceptably high intervention rates reduces confidence and competence in student and newly qualified midwives who hardly witness truly physiological birth. Birth should commence spontaneously when the baby is ready to be born, latent phase may take several days, established first stage should proceed without issue and culminate in the birth of a live, healthy, undamaged baby and mother, then expulsion of the placenta and control of haemorrhage occurring spontaneously if left to nature. Very few students witness labours that are left alone - most births are followed by active management of the third stage at the very least. Students are so hell bent on achieving their required 40 “normal” births that they become as mechanised as their more senior colleagues, without any understanding of how physiological birth can be facilitated. I heard of one third-year student accompanying an experienced midwife for a home birth in which the mother chose to birth on all fours, saying “I never realised that babies could be born like that”.  

Added to this, midwives are scared to step outside the “institutional model” in case they are seen as a maverick or disciplined for not toeing the institutional line. They are constrained by litigation-conscious guidelines and are not always able to advocate for women who wish to “birth outside guidance” – and what a ridiculously punitive phrase to describe someone who wants to retain control over their own birthing experience – how dare they?!! Flor Cruz, an insightful American doula, states that “human females have been giving birth long before industrialised obstetrics turned birth into a liability-management business model”. It is so true that birth has become a commodity, a business to be managed efficiently, cost-effectively and with as rapid a turnover as possible. Also we play homage to the so-called evidence-based approach – but only if the research fits the medical model. Woe-betide anyone who quotes evidence to support home birth.

And, despite its best efforts, midwifery pre-registration education no longer adequately prepares students to work within the international definition of midwifery set out by the World Health Organisation and International Confederation of Midwives. Indeed, the NMC standards for education are now so focused on psychosocial aspects of pregnancy and birth that it seems to have lost sight of the need to instil in students exactly what physiological birth actually is. Perhaps the proposed addition of EDI training should also include assertiveness training to aid midwives in challenging the status quo to accommodate the minority of “difficult patients” who want what they want? More importantly, pre-reg programmes should return to providing students with in-depth education on anatomy and physiology – rather than giving them workbooks for self-guided study. I am appalled when teaching qualified midwives that they are unable to apply the principles of A&P to the practise of midwifery – yet this is what constitutes safe practice, especially in labour. 

The removal from midwifery training of aspects which are now seen as optional post-registration professional development is appalling. Biomechanics should not be something added on after qualifying, nor should delivery of antenatal education be seen as something that is a postgraduate skill. I’ve written on numerous occasions of the need for the subject of natural remedies to be included in pre-reg education, particularly the use of herbal remedies such as raspberry leaf, castor oil, clary sage, inappropriate use of ginger for sickness and so much more. As regular readers will know, I do not believe that midwives, at the point of registration, should necessarily be able to practise manual complementary therapies, but lack of knowledge on commonly used natural remedies is leading to unnecessary iatrogenic problems that go unrecognised but which could easily be resolved. On the other hand, including simple elements of complementary therapy such as the use of massage during labour could reduce fear and anxiety, normalising the balance of oxytocin, endorphins and encephalins with stress hormones such as cortisol and adrenaline – this alone could contribute to more physiological progress.

And as for preceptorship – don’t get me started! Preceptorship does not facilitate consolidation of learning and experience for individual midwives. it does not provide a foundation to encourage career development. Preceptorship is an NHS management strategy to ensure that all members of the workforce are capable of working in all clinical areas. I certainly believe that newly qualified midwives should consolidate their learning but not at the expense of their own career to equip an outmoded national health service. In any case, there are, as we know, no jobs available - I recently heard of one trust offering six months preceptorship followed by six months on a zero-hours contract, but a first class honours NQM was told she didn’t have the right credentials. Other NQMs are desperate to secure jobs but may wait two years for one, by which time their knowledge and skills are at risk of being lost, further compounding the lack of understanding of physiological birth.

We all know the NHS maternity services have reached crisis point. The system is broken, almost to the point of no return. Although this is a multifactorial issue that is not easily resolved, there is no awareness amongst managers at all levels of the criminal expense of contemporary interventionist, medicalised, paternalistic, litigation conscious obstetric management and midwifery “care”. We are not caring for student and newly qualified midwives helping them to gain confidence in physiological birth. We are not caring for an over-pressurised staff, that results in huge and increasing attrition, leaving junior colleagues without more experienced support. We are not caring for expectant and birthing parents.  

We need a return to understanding that physiological birth is, for the majority, the way babies should be born. This will protect the human biome, the psychosocial aspects of family life, the profession of midwifery and the costs, staffing and reputation of the maternity services. Bring back physiological birth before it is lost forever!

The Humble Pineapple

Can pineapple help prepare the cervix for labour? New research suggests it may play a role.

I have explored a recent study from Nigeria looking at pineapple consumption in late pregnancy and its possible impact on labour progress.

But as always, evidence needs context. Allergies, diabetes, IBS and other contraindications matter just as much as the headline result.

Because in maternity care, safe advice is never just about what might help and exploring the evidence in favour. It is also about knowing when caution is needed too.

🎥 Watch for a balanced look at the research and what professionals should keep in mind.

Reference: Elendu C et al 2026 The impact of pineapple consumption on cervical ripening and labor outcomes: A Nationwide Retrospective Cohort Study among pregnant women in Nigeria. Medicine (Baltimore) 105(16):e48335

Expanding Midwifery Knowlege

Midwives are expected to know more than ever before.  

Clinical care. Emotional support. Complex decision-making.  

At the same time, women are asking more about complementary approaches to care. But this is not consistently covered in training.  

This creates a gap between what is expected in practice and what midwives feel confident advising on.  

Closing that gap is not optional. It is essential for safe, modern care.

Developing confidence in this area is possible with the right training and support.

Denise Takes Time Out To Recharge

Sometimes the best way to move forward is to step away for a while.

I have recently spent almost three weeks in southern Africa, a part of the world I have loved for many years and always find deeply restorative.

My journey began in Namibia, where I spent time writing my memoirs in the mornings and heading out on afternoon game drives. From leopard tracking to walking tours to see protected rhinos in their natural habitat, it was the perfect balance of focus and perspective.

I then travelled to South Africa to spend time with my son and family, continuing to work on my book in the mornings before enjoying family time and reconnecting with loved ones.

We often talk about supporting the wellbeing of others, but restoring our own energy matters too.

For me, southern Africa has always been a place to reset, reflect and return with renewed clarity.

Global Warming, Pregnancy And Midwifery 

I was fascinated recently to see that the effects of extreme heat were debated at the International Maternal and Newborn Health conference in Nairobi, which included representation from WHO, ICM, UNICEF and other international organisations. Global warming is becoming a critical issue in relation to women’s, babies’ and children’s health, and to the work of midwives around the world.

It is well evidenced that Schumann resonance – the electromagnetic energy of the earth – has increased from around 7.83 Hz to over 8.2 Hz in recent years, and that this rising heat is becoming critical to health and wellbeing. The effect of this heat on human (and animal) health and wellbeing has been discussed for some decades,  and attributed to the huge rise in population 9including people living longer) and the ever-increasing use of technology and electromagnetic forces, transportation and industrialisation, excessive use of chemicals in the atmosphere (in processed foods, in fragrances, cleaning products), uncontrolled viruses such as Covid – and much more. The issue of “electrosmog” from increased use of mobile ‘phones, radio frequencies, electricity, microwaves, ultrasound and more adversely affects sleep patterns, energy levels and mental wellbeing. Stress, which is a source of heat, increases brain vibrations, leading to agitation, anger (becoming “hot tempered”) and increased cortisol and adrenaline, causing hormonal imbalances, whilst the rise of ADHD and dementia in modern society is one of the longer term impacts of global warming.

In reproductive health, increased energetic impulses adversely affect fertility and conception, raising the risk of genetic mutations (heat affects the speed of cell division and mitotic division). Later in pregnancy, excess heat can lead to gestational complications - hypertension, diabetes, preterm labour, stillbirth – and to issues such as ovum implantation, potentially leading to placenta praevia, antepartum haemorrhage and more. Crucially, the abhorrent use of often unnecessary intervention in childbirth is a major source of negative energy for parents, babies and professionals – from CTG monitoring to brightly lit rooms, to increased use of induction, epidural and Caesarean births, with all the technology surrounding this terminal medical management of birth.  For newborn babies, there is an impact on temperature regulation, maturation of the immune system and neurological development.

For midwives, exposure to constant heat in the maternity unit causes dehydration, extreme tiredness and a reduced ability to “think straight” – with the risk of poor decision making. Constantly raised cortisol affects midwives’ mood and cerebral balance, leading to agitated midwives who become short-tempered and who lose their ability to be compassionate. Over time, these issues lead to occupational burnout and, in the long-term, major health issues for midwives – and of course other healthcare professionals. In midwifery education, whilst technology has its place in aiding learning, constant exposure to digitalised equipment, mobile ‘phones, virtual learning resources and – since Covid – online learning, all contribute to additional exposure to heat. 

Clinical midwifery – and antenatal and intrapartum care – have changed out of all recognition since I was first a midwife. There is so much reliance on technology, and consequent loss of basic observation, listening, smelling and other skills that, when well refined, were just as reliable in detecting complications – and midwives were taught how to resolve or manage those complications well before the arrival of medical help. Midwifery “care” – despite good intentions – is no longer as caring as it once was because the “system” does not allow us to care. Caring is a skill which balances the midwife’s brain, reducing cortisol and raising oxytocin, in the same way as it aids physiological progress in the women for whom we care. Addressing the clinical – and learning - environments to minimise sources of heat which adversely affect women, babies and their caregivers is crucial, particularly as some aspects of global warming are outside our direct control.

How do you think you can contribute to reducing heat sources in your workplace?

Expectancy is Worldwide!

Did you know that Expectancy is unique, worldwide, in providing university-level professional and academic courses specifically for midwives on the safe use of complementary therapies in pregnancy, birth and the postnatal period? Expectancy has been offering complementary therapy courses for almost 22 years, in the UK and overseas. I’ve helped NHS midwives to implement aromatherapy, clinical reflexology and moxibustion for breech presentation. I’ve encouraged several hundred midwives to train in both complementary therapies and business studies so they can start their own private practices. And I’ve had the great pleasure of travelling to many countries around the world, including Japan, Hong Kong, Taiwan, China, Iceland, Spain, Norway, Canada and elsewhere, to train midwives in various therapies. I’m immensely proud of the midwives who join our Expectancy Community and who follow their dreams of providing the best possible care to their clients.

A Place For Complementary Therapies

One of the most important principles behind everything I teach at Expectancy is safety and professional accountability.

Complementary therapies in midwifery can sometimes attract scepticism, particularly when they are associated with discussions around physiological or “natural” birth.

That’s why our programmes place such a strong emphasis on evidence-based practice, safety frameworks and professional debate.

Midwives need to be able to explain why they are using a therapy, understand the safety considerations, and practise within the professional boundaries set out in the Nursing and Midwifery Council Code.

This allows midwives to confidently discuss their practice with colleagues, managers and parents - grounded in professional accountability and the best evidence available.

Complementary therapies should never sit outside professional practice.

They should sit within it.

What About Midwives Who Choose To Work Outside Mainstream Midwifery?

I had a great time recently at the Royal College of Midwives’ education and research conference in London. It was good to meet up with friends and colleagues and to debate current issues around midwifery and maternity care. As you might expect, there was a lot of discussion about the ongoing investigations into maternity service problems, and of course, everyone had their views on possible solutions. There were several presentations on equity, diversity and inclusivity and several on the increasing use of artificial intelligence in midwifery education. There was also much talk of the difficulties facing students trying to achieve their required 40 physiological births and, of course, the ongoing problem of intervention in childbirth.

However, it was disappointing to see that the RCM and all the speakers focused only on NHS clinical midwifery or research and on education provided by universities. There was no acknowledgement at all of the growing number of registered midwives choosing to work outside “the system” – independent midwives offering full birth services, midwifery educators providing specialist post-registration training, midwives in private practice offering antenatal education, complementary therapies, tongue tie division and other maternity-related services, midwives working for charities such as BPAS, or for companies that design digital programmes for maternity care or midwives engaged by private companies to undertake research or very senior midwives with national and international reputations offering consultancy services. 

This lack of recognition that midwives can work in many ways in diverse settings is disrespectful to those of us who are self-employed. There is no apparent appreciation that being a registered midwife entitles you to work anywhere in any setting in any field of midwifery as defined by the WHO and ICM, from preconception care and fertility through pregnancy, birth and the postnatal period up to one year after birth. It is as if those who work outside mainstream clinical or educational organisations are “persona non grata” and disregarded in favour of the majority. Is this not a form of discrimination in its own right?

I raised this point on at least two occasions during the conference, including in sessions at which there were several midwifery educators or clinicians who have retired from the university sector or NHS and who are now working in a freelance consultancy capacity. There is an inherent undercurrent of dismissal of those who leave the NHS or higher education systems (even when some of those have given years of service and reached retirement age but who choose to continue working). It is almost as if our treacherous behaviour somehow undermines the value of the NHS or HEIs and that by doing so, we come up lacking credibility. (I remember, over twenty years ago when I left the university to set up Expectancy, a colleague from another university implying that I could not possibly be as good a lecturer as before now I had dared to go it alone.)

Then of course, there is the small matter of freelance midwives actually charging for our services. Chatting with colleagues about the various investigations currently in the news, one fairly senior midwife commented on the apparent hefty fees one authority was “raking in” –  it was not actually a large amount that was quoted - but to an NHS midwife on a salary it obviously seemed like a small fortune. Yet, do NHS midwives work for nothing? Do they offer their services pro bono? Absolutely not – even though they may work plenty of hours of unpaid overtime. It seems, however, that actually having to charge for your services (rather than being paid a salary) is not de rigeur, not in keeping with the philosophy of our free-at-the-point-of-access healthcare system. 

Whilst I completely understand that there are other priorities at present, including Ockenden reviews, the Amos report, ever-increasing intervention rates in childbirth, lack of resources, including staff and a dwindling (retiring) workforce, no jobs for newly qualified midwives and more, it is imperative that our colleagues and the organisations that affect our profession  recognises that the way midwives choose to work is changing – and the way expectant parents want to receive care is also changing and they are prepared to pay for services they cannot find in the NHS. Let’s have a shout out for all those wonderful midwives who are working incredibly hard outside the system – in clinical midwifery, in education and in other areas in which being a registered midwife is a requirement.

Working with The Midwives at Liverpool Woman's NHS Foundation Trust

I’ve just returned from a wonderful few days in Liverpool working with the midwives at Liverpool Women's NHS Foundation Trust.

This was my second visit to provide Expectancy’s 3-day course on Aromatherapy and Acupressure for Postdates Pregnancy, helping midwives expand a specialist clinic designed to support women preparing for birth and potentially reduce the need for induction.

It was fantastic to see such enthusiasm from the 20 midwives attending the training.  

Over the three days we explored:

• Safe use of aromatherapy at term and during labour
• Massage techniques for labour support
• Reflex zone therapy and its diagnostic insights
• Acupressure points to support cervical ripening and labour onset

But the highlight for me was visiting the birth preparation clinic in the midwife-led unit and seeing how the service is being delivered in practice.

The clinic is proving hugely popular, and early audit findings suggest that more women are going into labour spontaneously and requiring fewer interventions.

Most importantly, the midwives are delivering the service with a strong foundation in safety and professional criteria, exactly as we teach on the course.

It was a pleasure to spend time with such a dedicated team and to see the impact they are already having for the women they support.

And now… time to pack my bags for Yorkshire for the next course.

How Things Have Changed In Midwifery

I’ve been a midwife for almost 50 years, starting in the mid-70s at a time when it was all very “Call the Midwife”. We didn’t talk about “physiological birth” or “intervention” – women just got on with being pregnant and giving birth, then adapting to motherhood. Here are a few of the things that have changed in the last 50 years (and how I miss some, but not all of them!)

• The midwife was truly the expert in pregnancy, birth and postnatal care of mother and baby. Once, as a community midwife rushing to a home birth, I arrived to find the GP literally holding the baby’s head in the vagina and stating “I was waiting for you, Sister”!
• Midwives were respected pillars of the community and women always deferred to their advice (they did what they were told!)
• Almost all midwives had trained as nurses and then took additional training – I was in the last group of the one-year post-nursing students
• Students always got their required numbers of normal births; observing the required number of complicated births was more difficult  
• Doctors were absolutely only called in when progress deviated from normal, which was hardly ever; and GPs were much more actively involved in maternity care, as they knew all their patients and cared for the whole family  
• It was quite common for midwives to deliver breech babies, rarely was the obstetrician called

• Women either got pregnant – or they didn’t – there was no fertility treatment (and still variable availability of family planning / contraception services)
• The process of becoming pregnant was never discussed – what happened before reporting to antenatal clinic was in “another life”
• All expectant mothers were called “Mrs” – surveys showed this was their preference, as unmarried women didn’t want to be identified
• Most women didn’t work so could prepare for birth, relax and focus on their new baby without getting completely over-tired; other women in the community always helped out
• Antenatal education (parentcraft) classes involved lectures followed by relaxation sessions (the original “hypnobirthing”); there was usually only one class for fathers, often led by the (male) obstetrician, after which the men would all go down to the pub 

• There were very few inductions, even fewer Caesareans, no CTG monitors (they started to be used in the late 70s, very sparingly).
• Men had only recently started to be welcomed into the birth room; most paced the floors outside the room or went outside to smoke (and patients were still allowed to smoke  in the wards!) 
• We had three types of inhalational analgesia – Entonox, Trilene and another (I can’t remember the name as it was just becoming obsolete when I started); pethidine was only used if absolutely necessary - and there were virtually no epidurals
• Routine enemas and vulval shaving was normal;  episiotomy was only used as a last resort – and was often done as a midline incision, not mediolateral
• Community midwives conducted home births on their own, with the woman in left lateral position and her upper leg balanced over the midwife’s shoulder; if problems arose, we called out the “flying squad”

• Breastfeeding was the norm; stilboestrol was often given to dry up the milk of mothers who didn’t want to breastfeed (rare) or whose babies had died; stilboestrol was banned some years later as it was found to be carcinogenic
• There were no disposable nappies, we used terry towelling, put to soak in Milton after use and then washed in the twin tub washing machine and wrung out by a mangle at the top of the machine 
• Postnatal visits by midwives were done twice a day up to day 3, daily up to day 10, then weekly until 28 days, or longer if the cord had not separated and the umbilicus healed; women waited for the midwife and would not have dared to take the baby out before 10 days!
• The health visitor took over care at 28 days and mothers were encouraged to go to the baby clinic weekly for weighing the baby, feeding, baby care and immunisation advice; the clinic was a place for women to meet and chat, have a cup of tea and get their vitamins
• Most women cared fulltime for their children until at least school age, usually longer; women rarely returned to work after birth, especially as they often got pregnant again quite quickly 
• Postnatal depression was not heard of, or at least never discussed – you just got on with caring for the baby, cooking food, cleaning and putting up with your lot