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.  

https://www.skeptic.org.uk/2026/06/aromatherapy-the-nhs-maternity-crisis-and-the-obsession-with-natural-birth/

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.

Quality Of Education In Midwifery Complementary Therapies

As many of you know, I have spent over 40 years practising, teaching, researching and writing about the use of complementary therapies in midwifery, with 22 of those years in my own business offering university-level education and training for midwives. I have always stood by my philosophy, on which I gained my reputation, having an absolute focus on safety, professional accountability and evidence-based practice. CTs are so much more than simply relaxation – although we should not dismiss the power of relieving stress and anxiety and the consequent physiological impact on reducing cortisol and increasing oxytocin and endorphins. Different therapies offer options for dealing with the various symptoms of pregnancy, easing pain and aiding progress in labour and helping women recover from the birth and adapt to parenthood.

I like to think I may, over the years, have influenced midwives, obstetricians, birth workers and parents to see the value of complementary therapies (CTs) for pregnancy, birth and the early postnatal period. I was fortunate to work in the university sector for many years, which contributed to making CTs education an academic, research focused discipline in midwifery, whilst my own clinical experience, treating almost 6000 women with CTs, has hopefully grounded the practice of CTs in a women-focused, individualised way. I am proud to have been a pioneer in midwifery CTs since the early 1980s, and have seen many midwives gain the enthusiasm, skills and knowledge to use CTs in their own practice and to spread the word to others. Expectancy is unique, worldwide in providing a wide range of courses on many different therapies and offering academic programmes of study, together with business training for midwives wanting to work in private practice.

Why then, does it worry me to see others offering training in CTs for midwives and birth workers? This is absolutely not about commercial competition at all, this is a concern, from a professional and academic perspective, about the quality of the training, the experience of those teaching and the potential dilution of professional quality that could compromise safe practice. Many midwives who have trained in a therapy can pass on their skills to others, but it is the underpinning academic knowledge and awareness of how CTs fit into contemporary midwifery / maternity care that is so important. We are seeing a plethora of courses set up by midwives with an interest in imparting the value of their therapies to others in the birth field - and some are of very good calibre - but others lack the depth that midwives and birth workers need in order to practise safely.

CTs still incite scepticism and antagonism amongst some of our colleagues, and I have been vilified by some well-known figures in the anti-natural-childbirth lobby. Now, more than ever, the quality of post-registration midwifery education in CTs needs to be faultless. Those who practise must be able to advocate for their therapies. They can do this by demonstrating very sound knowledge based on application of theory to practice and to pregnancy and birth physiology. It is not acceptable to learn skills at academic level 4; there must be level 6 critical understanding of anatomy and physiopathology, chemistry and pharmacology, safe parameters of practice, health and safety laws, the issue pertinent to using CTs not just in physiologically normal pregnancy and birth, but also the use of those therapies within maternity units and birth centres. Those using CTs in maternity care must be able to justify their use (for midwives, in line with national definitions and regulations for practice), must have an appreciation of the good – and the not so good – research findings, and an understanding of local, regional, national and international laws pertaining to CTs and to maternity care.

It concerns me that midwifery managers, keen to reduce interventions and return to physiological birth, rush to introduce therapies such as aromatherapy with little thought of the wider professional and safety issues or the institutional regulations. There is, as with other courses, an unrealistic and unprofessional belief that funding one midwife to attend a CTs course who can then teach everyone else to use that therapy is good use of monies. It is not. This is an accident waiting to happen. We know that learners only retain around 60% of what they are taught. Cascade training means a further dilution of learning and understanding, risking poor practice which can lead to iatrogenic complications, especially in the dynamic episode that is labour and birth. Midwifery managers fail to apprecaite that they also need to understand the safety issues in order to monitor the practice of those midwives actually providing the therapies to women – yet very few trusts in which I have taught have encouraged managers to attend the courses. Those few notable trusts who have included at least one manager on the student list generally do much better in implementing CTs into midwifery care than those who do not.

Whilst, of course, I would love midwives to consider learning with Expectancy, there may be reasons why they actively elect to join courses provided by other organisations or individuals.  Their decision making may be made on convenience, duration, course fees, word of mouth, a preference for a non-assessed course or other factors. So what should you look for in a course that you may be considering? How do you know if the course is credible and appropriate for your needs? And what do yu get from joining an Expectancy course that you may not find elsewhere?

All of Expectancy’s study days, short courses and longer programmes are:

• totally applied directly to midwifery, with an emphasis on safety, professional accountability and evidence-based practice
• taught by senior midwifery lecturers who are fully qualified in the therapies they teach, with extensive experience of implementing and researching CTs in the NHS ornuniversity sector, and who have qualifications and insurance to teach others
• a balance between in-person practice and online theory, which encourages critical thinking and provides midwives with the knowledge and skills to advocate for and justify their use of CTs
• taught and, for longer academic programmes assessed, at academic level 6-7 and accredited by FEDANT so that midwives wanting to work in private practice can obtain indemnity insurance cover 
• acknowledged by senior national midwifery authorities as robust, professional, appropriate and safe for midwifery practice in the NHS and private practice
• renowned, worldwide as the longest-standing internationally-available midwifery pre- and post-registration education in the specialism of CTs, with the widest range of courses across a number of complementary modalities  

If you’d like to join us, we’re now recruiting for the 2026-27 academic year.

Why don’t you request a prospectus contact info@expectancy.co.uk and see what takes your fancy?

We’d love to hear from you.

Safe Maternity Care

Many women ask whether ginger is safe and effective for pregnancy sickness.

While ginger is one of the most commonly used natural remedies for nausea and vomiting, it is important that women receive balanced, information before using any complementary therapy.

As midwives, our role is not simply to recommend or discourage a therapy. It is to help women understand the potential benefits, limitations and considerations so they can make informed decisions.

Natural does not automatically mean safe, and comprehensive knowledge, understanding and an ability to apply theory to practice should always guide our advice.

Safe maternity care starts with informed conversations.

The Publication Of The Ockenden Report

The publication of the Ockenden report into systemic failings in Nottingham is sobering reading. My thoughts go out to those families affected by poor care, institutional issues and serious errors.

However, I fear that the wider effects of this damning report will be to cause a knee-jerk reaction that will exacerbate the fundamental factors that have, at least in part, contributed to the problems in Nottingham and elsewhere.

Above all, in my opinion, is the fact that modern society has lost sight of pregnancy and birth as normal physiological events that women's bodies are designed to achieve. Birth has been medicalised beyond all recognition of what women's bodies have been doing for millennia.. 

In almost 50 years of practising and teaching midwifery, I have seen maternity care ravaged by a paternalistic, risk averse, litigation conscious system that seeks to control birth - and women - not only in the UK, but across the world.

Yes, there are multiple complex, intertwining and possibly irrevocable factors that have led us to where we are now - and a solution to the innate problems of the maternity services is not easy. 

We have an ageing maternity population with much more complex medical issues, women becoming pregnant due to medical advancements, who would never have been able to have children 50 years ago. We have an almost untenable increase in demand for maternity care in a completely overloaded NHS, simply unable to cope. 

Poor staffing is compounded by lack of money to pay for more midwives, whilst conversely midwives are leaving the profession retiring early, changing direction and escaping the toxic, blame-throwing culture of the NHS. Universities are complicit in the issues, commercially recruiting students to a degree for which there are insufficient clinical placements - and no jobs at the end.

The Nursing and Midwifery Council has dumbed down the clinical requirements for midwifery training, changing the definition of "normal" birth to fit the falling numbers of completely physiological births available to students, rather than standing up to the medical establishment and demanding that students are legally required to conduct 40 entirely physiological births. This is akin to the suggestion made recently that we need more operating theatres to accommodate the rising Caesarean levels - instead of looking at how to reduce operative births

We have the contemporary agenda that focuses on BAME women's greater morbidity in childbirth, extending services for non-biological women who are pregnant and adapting to the needs of multicultural immigrants. I fervently believe that ALL maternity service users should be treated as individuals, whatever their colour, creed, religion, sexual preferences, ability, level of education or anything else. We should not single out specific groups as being more vulnerable than others. To do so risks omitting or disadvantaging others. ALL PREGNANCIES MATTER.

Student midwives are taught to attend to the needs of individuals, but they need time to be able to do this well. This requires more staff to accommodate the needs of ALL expectant and birthing parents. Increased staffing requires increased job availability, which is not currently sufficiently funded, leaving newly qualified midwives with nowhere to go.

I could go on, but it is impossible to unwind all the contributing factors that have accumulated over decades. Sadly, however, I fear things are only going to get worse, even if only temporarily. I fear intervention will become more intense in a futile attempt to reduce the issues that have led to increased mortality and morbidity. We will have an even more punitive approach to human errors, a higher managerial backlash to try to shore up a failing, completely inadequate NHS and an even more interventionist approach to pregnancy and childbirth to avoid further deaths.

So what are the answers? It is impossible for one person to address this question and it is not my intention to do so here. However, I would like to see an expansion of midwifery services outside the NHS, with greater options for expectant parents. This means educating students that the NHS is not their only option. A designated career pathway for midwives wishing to work privately is necessary with parameters that allow flexibility and choice whilst protecting parents and professionals.

A return to the fledgling idea of a maternity "passport" with which parents had a say in how their allocated budget could be used, might be a starting point. More education and information for people before and in early pregnancy to outline their options could help. 

And, perhaps, most importantly of all, we need an acknowledgement that childbirth is not a medical condition for most women and that unnecessary, potentially harmful intervention must stop.

More from Denise at the 34th ICM Congress in Lisbon

The 34th ICM Congress in Lisbon has been both thought-provoking and inspiring.

The theme, One Million More Midwives, has highlighted some of the greatest challenges facing our profession globally, and the impact these challenges have on women, babies and families.

Whilst we face significant issues in the UK and other developed countries around intervention, maternity care and the status of midwives, it is humbling to hear the experiences of colleagues working in lower-income countries where access to safe maternity care remains a daily challenge.

Perhaps the most sobering thought is that, somewhere in the world, a woman may die in pregnancy or childbirth in the time it takes to read this post. In some cases, her baby may die too.

These are not just statistics. They are mothers, babies, families and communities.

The One Million More Midwives campaign recognises that investing in midwives is one of the most effective ways to improve outcomes for women and babies worldwide.

Please join me in supporting the campaign and advocating for a stronger midwifery workforce across the globe.

ICM Congress in Lisbon

A wonderful start to the 34th Triennial Congress of the International Confederation of Midwives with a fantastic opening ceremony. The theme this year is ‘One Million More Midwives’.

One of the things I enjoy most about attending international midwifery events is the opportunity to reconnect with friends and colleagues from around the world, whilst also meeting new people who share a passion for improving care for women and families.

It's always inspiring to hear different perspectives, exchange ideas and learn from one another.

Looking forward to the rest of the conference and the conversations still to come.

Birth Preparation

Birth preparation is about far more than packing a hospital bag.

For many women, preparation also means reducing fear, understanding physiology and feeling supported in the decisions they make during pregnancy and birth.

Simple approaches such as relaxation, massage, breathing techniques and appropriate complementary therapies can all help support confidence and calm during the transition to parenthood.

As midwives, we have an important role not only in clinical care, but in helping women feel informed, reassured and empowered throughout the process.

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