Denise and her blog

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

Would you ever think to ask about pets when discussing essential oils? 🐾

It might sound unrelated - but it isn’t.

Cats lack the enzyme needed to metabolise essential oils safely, which means aromatherapy oils should not be used around them at all - even in litter trays.

As midwives using or teaching complementary therapies, safety doesn’t stop at pregnancy. It extends into the whole home environment.

Sometimes the smallest details are part of the safest practice.

Praise for Liverpool Women’s Hospital’s Pre-Birth and Postdates Pregnancy Service

I’ve just spent a fabulous few days in Liverpool with the midwives from the Women’s Hospital. This was my second trip to provide Expectancy’s 3-day course on Aromatherapy and Acupressure for Postdates Pregnancy. The first group of midwives have established a specialist clinic for women to help them prepare for birth and hopefully to reduce the need for induction of labour. It was now time to train up some more midwives to expand the service, which is extremely popular amongst both the mothers and the midwives. Once again, I was welcomed with open arms, by 20 excited and enthusiastic colleagues. Having thoroughly enjoyed the course I taught in 2024, it was lovely to return and also to see many of the midwives I had met before.

Despite the first day being held in a rather small pre-fabricated building, with a temperature roaming from freezing to boiling, we had fun. Midwives were impressed by the benefits of using aromatherapy for women at term, both before and during labour, and stunned by the safety issues they needed to consider when using essential oils. After a very intensive morning of theory, we had a lovely afternoon practising foot and hand massage and the group was fascinated by my introduction to reflex zone therapy (clinical reflexology) and its diagnostic potential for predicting stages of the menstrual cycle and onset of labour. On day 2, we explored how aromatherapy can help to relieve physiological symptoms in late pregnancy, labour and the early postnatal period, and the midwives had to “submit” to the pleasures of seated back massage for labour (they were warned not to tell the managers who might have thought they were just having a good time!) On day 3, we included the specific acupuncture points which have been shown to be effective (with thumb and finger pressure) for aiding descent of the fetus, cervical ripening and onset and establishment of contractions. Then we put it altogether and practised the full postdates pregnancy treatment in the afternoon. I was incredibly well looked after and was invited to join some of the midwives for drinks and an early supper on the final day of the course. Special thanks go to Gemma, who organised the course, Jayne, who made sure I was well supplied with coffee and Mia and her friends for the invite to Duke’s Place Market.

On the fourth day, I had the pleasure of attending the birth preparation clinic in the midwife-led unit, where it was wonderful to see how well the team had set up and were running the service. It was also a useful experience to add to my own CPD for NMC revalidation. Unfortunately, the MLU was closed to birthing women on that morning, but the clinic was still going ahead – and huge thanks to Courtney for allowing me to shadow her. We actually had a lovely morning despite a few issues arising. The first lady was from Somalia and spoke only a few words of English, so Courtney used Language Link for live translation – but unfortunately technology was against us as it kept being lost and we had to wait for the service to be resumed. This meant that the first appointment took much longer than normal, but eventually Courtney was able to conclude the acupressure treatment with a lovely foot massage for the lady. The second lady, having her third baby, had actually been an aromatherapist herself so it took a lot less time to explain what was being offered and to select a pleasant and clinically effective aromatic blend. It was also easier to show her the acupressure points around the body, which she was encouraged to continue practising at home. Both ladies were given the remainder of their individualised oil blends to take away, with instructions on how to use it at home.

The clinic is hugely popular and there is now a need to consider ways to expand the service,, especially with rising induction rates across the trust. We discussed that it was important to publicise it as a pre-birth preparation appointment rather than a complementary therapy clinic, which – from personal experience – often leads to a stampede from expectant parents wanting to enjoy a massage. There are specified criteria for eligibility to attend the clinic, and audit is showing that more women commence labour spontaneously and need less intervention, which can be a huge cost saving. The midwives’ attention to the safety criteria taught on the courses means that they have a solid foundation on which to build the service, whilst still offering something to help avoid the need for women booked for MLU births to have to transfer to delivery suite.

It was a fabulous week and the midwives at Liverpool Women’s Hospital should be rightly proud of what they have achieved so far. I hope to be invited again to further their training in using complementary therapies to aid physiological pregnancy and birth. 

And now it’s time to get ready to trek off to Yorkshire for the next course ……

FAQs

Will this help me support parents more effectively?

That’s always the starting point.

Everything we teach is designed to enhance midwifery care - not replace it, and not overcomplicate it. Complementary therapies, when used appropriately, can support physiology, reduce stress responses and give parents a greater sense of calm, control and confidence across pregnancy, labour and the postnatal period.

For midwives, this means having additional, safe tools you can draw on when anxiety is high, labour isn’t progressing as expected, or parents simply need more support than words alone can offer. It’s about understanding when a technique is helpful, when it isn’t, and how to use it responsibly within your professional role.

We place just as much emphasis on clinical reasoning, contraindications and governance as we do on practical skills. That way, what you’re offering feels aligned with evidence, policy and good midwifery practice - not separate from it.

If you’re looking to support parents in a way that feels calm, grounded and physiologically informed, our programmes are designed with exactly that in mind.

Safety and Storage of Essential Oils

Essential oils can be a wonderful support in pregnancy, labour and postnatally - but they’re not just “nice smells.”

Here, I talk about the safety and storage of essential oils, whether you’re using them in an NHS setting, private practice, or at home. Each oil contains hundreds of chemical constituents and works pharmacologically - meaning how they’re stored, inhaled and used really matters.

Poor storage can lead to degradation, increasing the risk of irritation or side effects. And because inhaled oils circulate through the body (including the placenta), we need to treat them with the same respect as medicines.

I also touch on protecting yourself as a midwife - being mindful of exposure, only using oils you tolerate well, and understanding why disliking an aroma is important clinical information, not something to push through.

Aromatherapy can be incredibly supportive when used well.

Complementary Therapies Aren’t About “doing more ”

Complementary therapies aren’t about “doing more.”

They’re about supporting what the body already knows how to do.

In midwifery practice, we spend a lot of time supporting physiology - reducing unnecessary stress, protecting hormonal pathways, and creating conditions where labour and recovery can unfold as normally as possible.

That’s exactly where complementary therapies fit.

When used appropriately, approaches such as reflexology, aromatherapy and hypnosis can help lower stress responses, encourage relaxation, and support the neuro-hormonal processes that underpin pregnancy, labour and the postnatal period.

They don’t replace clinical skills - they sit alongside them, offering additional, gentle ways to support parents when anxiety is high or progress feels difficult.

At Expectancy, we focus on safe, evidence-informed use. That means understanding not just how to use a technique, but when, why and for whom it’s appropriate - including contraindications, professional accountability and scope of practice.

Our aim is simple: to equip midwives with tools that feel clinically sound, ethically grounded and genuinely useful in real-world practice.

Because sometimes the most effective support isn’t another intervention - it’s creating the right conditions for physiology to work as it’s meant to.

The Reflexology Relaxation Point

One of the simplest techniques we teach on our complementary therapy programmes is the reflexology relaxation point.

It’s gentle, it’s non-invasive, and it doesn’t require oils, equipment or a clinical guideline - just calm, intentional touch.

On our courses,  I show how this unique reflexology point can be used on the hands to support relaxation in many situations: during labour (even in transition), before procedures like blood tests, when someone has received difficult news, or simply when anxiety is high.

There’s no pressure involved - just light contact and slow, steady movement. Sometimes it takes a minute or two, but that small pause can make a real difference to how someone feels and how well they’re able to cope.

It’s a reminder that supportive touch is still a powerful clinical skill - and often the simplest techniques are the most effective.

The Benefits Of Using Complementary Therapies In Pregnancy

What are the benefits of using complementary therapies in pregnancy, labour and postnatally?

Complementary therapies are often dismissed as “just relaxation.”

But relaxation, at its most basic level, is a powerful clinical tool.

When we use approaches such as reflexology, massage, aromatherapy or acupuncture carefully and safely, we see a measurable reduction in stress hormones like cortisol. As cortisol reduces, oxytocin, endorphins and enkephalins increase - creating the hormonal environment that supports physiological pregnancy and birth.

When physiology is supported, the likelihood of intervention can reduce.

That means fewer inductions, fewer epidurals, and fewer caesareans - all of which can have a significant impact on parents’ experiences and longer-term outcomes.

Used appropriately, complementary therapies don’t sit outside midwifery practice - they enhance it.

They support physiological birth, improve parental satisfaction, and often restore midwives’ own sense of professional fulfilment in the care they’re able to offer.

This is why education, safety and scope matter so much.

What Is Happening In Midwifery?

Midwifery appears to be at a crossroads, both in the UK and elsewhere. Practice and education are both under attack, largely from paternalistic factions wanting to control childbirth and the profession of midwifery. Childbirth has become the pariah of healthcare, causing immense stress for expectant and birthing parents, leading midwives to leave the NHS and even the profession, and the government to have knee-jerk reactions in terms of national reviews and even the suggestion of a minister for maternity care.  

As a midwife of almost 50 years, I have seen maternity care and midwifery practice change from something akin to the “Call the Midwife” era (I started in the mid-1970s), to the deplorable state we find ourselves in today. We have had numerous reviews over those years, from the 1970 Peel Report advocating hospital birth, to the three Maternity Care in Action reports in the 80s, Changing Childbirth in the 90s, to a string or reports, investigations and attempts to improve maternity care in the 2000s. But what ARE the current problems and how can some of the issues be resolved – or, indeed, can they?

First, in my opinion, is a catastrophic and almost total loss of any understanding – amongst midwives, obstetricians and the public - that pregnancy and birth are physiological life events that simply require careful observation and, in a few cases, when progress deviates from the anticipated norm, medical support. There is also a significant lack of understanding by the government, NHS, obstetricians and even some midwives, of the wide role of the midwife, as defined by the World Health Organisation, which focuses on working with women from the preconception period, through pregnancy, birth and the postnatal period up to one year following birth of the baby.   

The denial of “normality” has led to increased medicalisation of birth with premature and unwarranted “cascades of intervention” and excessively high induction (up to 60% in at least one unit known to me) and Caesarean rates that have overtaken spontaneous vaginal births. This is coupled with a deplorably coercive and paternalistic approach to maternity care “options” for expectant and birthing parents, largely driven by a fear of litigation if no action is taken, and the obstetric culture of wanting to “do something”, with controlled management, as in other medical specialties. Expectant parents are “advised” that intervention is necessary to protect them and their babies, with insufficient information given to aid them in making informed decisions about their births. Some parents are so anxious about their maternity experiences at the hands of the NHS, that they choose home birth, independent midwives or even unassisted birth.

Added to the internal issues around medicalisation are the demands from the anti-natural childbirth lobby, which have arisen from various investigations into baby loss. It is, of course, very sad when any baby, or mother, dies in childbirth, but we should be careful to put this in perspective. Whilst perinatal loss and maternal mortality statistics could be a great deal better, the majority of women have – or at least could have, if left to physiology – a perfectly normal pregnancy and a spontaneous vaginal birth. It is often the intervention that adds to the “abnormality” which then leads to further medicalisation. Any national review is only likely to add to the intervention in a “just in case” approach.

On the other hand, we now have many more women with increasingly complex pathological, psychological and social needs, who require obstetric and often general medical treatment, leading to increased staffing requirements, clinical costs and bed occupancy. Whilst the birth rate has fallen slightly, there are additional demands on the maternity services, with medical advances enabling women who would otherwise not have been able to conceive and reproduce, as well as people newly arrived in the UK who may present with issues that have not hitherto been familiar to NHS staff.

We now have a shortage of midwifery staff, with many experienced midwives near retirement age and many more leaving the NHS due to burnout. This is well documented by a press hungry to highlight the problems of the maternity services, leading to a poor perception of midwifery that can affect recruitment, It is not that midwives want to stop caring for expectant and birthing parents, but that they can no longer tolerate long hours and unpaid overtime, lack of gratitude and incessant demands on their energy that leave many unable even to find time to go to the toilet or have a drink, let alone take the statutorily required breaks in their working days.

Midwifery education must also take some of the blame for the current issues in the maternity services. There is a “bums on seats” approach by universities accepting students, coupled with lecturing staff redundancies, leading to lack of support for student midwives who are then unable to cope with the rigours of midwifery theoretical learning and clinical practice. Students are required to pay exorbitant fees for education that may still not provide them with jobs and preceptorships at the end of their pre-registration period. I am sceptical about preceptorships which, in the NHS are a management strategy to ensure that all midwives are capable of working in all clinical areas to fill staffing gaps. However, for newly qualified midwives (NQMs), it is certainly advisable to consolidate their learning, yet there appear to be fewer and fewer opportunities to do so immediately after qualifying. The gap between obtaining registration and actually starting clinical work often leads to loss of momentum, with some NQMs never practising. 

All these factors discussed so far have resulted in a deplorable lack of experience of physiological birth for student and NQMs who are then fearful of caring for parents wanting a more natural birth because they do not understand it in practical terms. This only perpetuates and strengthens the argument for intervention. Further, there is little career development support to enable midwives to specialise in a specific area of midwifery, coupled with a “dumbing down” of expertise by employing more support workers. 

There is also, in both education and practice, a culture implying that students are being trained for the NHS, with an overall political refusal to accept midwifery as a profession which enables midwives to work in any setting, anywhere, both NHS and privately, at home and overseas, subject to local requirements. Further, there remains difficulty in obtaining professional indemnity insurance cover for those who wish to work in a self-employed capacity, although some steps have been taken in more recent years to address this.

Further, there is a totally unacceptable culture of bullying within NHS maternity services, both midwifery and medical, from management and between clinical colleagues, with an element of multi-professional tensions adding to the problem.  The overall attitude within the maternity services is punitive and threatening, with staff afraid to speak out – it is easier to fit with the system than to be seen as a maverick. All of this leads to high sickness and absence rates, resignations and significant mental health issues for individuals concerned. 

And so, we get to finance, which the government seems to think is one of the primary issues. Perhaps there is a shortage of funding for maternity services, but more likely it is the inappropriate allocation of resources and the need to fund interventionist practice which impacts on maternity, anaesthetic and paediatric services, as well as bed capacity and other services eg domestic and portering. Yes, we could do with more money in the NHS generally, but it is not the sole answer.

Throwing money at the issue of the maternity services is not going to solve the problems. Neither will yet another government sponsored review, which already adds political bias, be the answer, nor the appointment of a Minister for Maternity Services.    

Evidence-Informed Education In Complementary Therapies

Every day, midwives hold an extraordinary position of trust.

Women come to you not only for clinical expertise, but for reassurance, interpretation, and guidance - especially when they’re exploring complementary or natural approaches alongside conventional care.

That’s why I believe so strongly that midwives deserve robust, evidence-informed education in complementary therapies.

Not to replace clinical practice - but to enhance it.

To help you answer questions with confidence.
To support women safely, ethically and within your scope.

At Expectancy, everything we teach is grounded in midwifery values: safety, professionalism, critical thinking and woman-centred care.

Happy New Year !!

The start of a new year often brings a moment to pause and reflect on where we are - and where we’d like to grow.

For many midwives, that growth comes from deepening knowledge, building confidence, and finding new ways to support women with care that is both evidence-informed and compassionate.  

Complementary therapies can play a valuable role in that journey when they’re integrated safely and professionally.

If you’re considering developing your skills this year - whether for your clinical role or for a future private practice - I’d love to support you in exploring what’s possible.  

A new year can be the beginning of a very rewarding next chapter.

Reflections

I’ve been reflecting on our first practical weekend of the Acupuncture course back in October, taught by our lovely Amanda.  

It’s always such a memorable point in the programme - that moment when midwives begin actually placing needles for the first time!

There’s usually a mix of excitement and a little apprehension, which is completely natural. But the group handled it brilliantly, supporting one another as they developed their confidence and technique.

Acupuncture is a wonderfully effective tool in maternity care, and watching midwives lean into new skills with such enthusiasm is one of the joys of teaching. 💜

The Parlous State Of The UK Maternity Services – Is Midwifery Education To Blame?

Sunday 9^th November 2025 was a sad day for midwifery education in the UK with the publication in the Sunday Times of an article blaming universities offering pre-registration training of promoting an irresponsible  “normal birth ideology”, apparently at the expense of safety for mothers and babies. Only a couple of weeks ago, the media bombarded us with the risks of home birth, following a case in which both mother and baby died. And now, the likes of Wes Streeting, Jeremy Hunt and of course James Titcombe, have waded in to the debate, taking the angle that midwives’ training programmes are to blame. This week, using the emotive case of a mother whose baby died at 42 weeks’ gestation, allegedly because she was not advised to have an induction for postdates pregnancy, the anti-natural-childbirth lobby has yet again found an excuse to launch another attack on midwifery, maternity care – and now – on midwifery education.

It is obvious that those determined to disparage midwifery and everything it stands for have no knowledge of childbirth as a normal bio-psycho-social life event nor of the dangers of the astronomical rates of intervention we are currently facing, across many westernised countries including not only the UK, but Australia, the USA and many European countries. There is no understanding of the World Health Organisation’s and International Confederation of Midwives’ definitions of midwifery and what constitutes midwifery practice, nor of their commitment to midwives as specialists in physiological birth. There is no comprehension of the role of the regulator (Nursing and Midwifery Council) in maintaining the international essential competencies for midwifery as promoters of physiological birth. And there is no empathy in failing to acknowledge parental emotions, desires or needs in this natural process of having a baby. Midwifery educator peers have been vilified (again) for daring to organise the annual Normal Birth conference, with the media – and those influencing the media – casting aspersions that this perpetuates the “ideology of normal birth at all costs”. Universities offering midwifery programmes have now come under fire for allowing this apparent dogma to thrive, with critics claiming that students are not being taught safe practice.

These critics – the policy makers, the politicians and influencers previously affected personally by birth related mortality or morbidity – have catastrophically failed to appreciate the multifactorial issues facing the maternity services,  the midwifery and obstetric professions, midwifery education and all the other issues impacting on the dire situation we now face. We have a paternalistic antenatal and birth system that sees birth as a medical issue to be managed – and managed within the constraints of finances, staffing and bed space. We have an ever-increasing population with more women with complex pregnancies, often requiring intervention to achieve a safe birth.  We have a maternity care system rife with bullying – of staff and consumers. We have a profession that is scared to step outside guidelines to support women safely and appropriately. We have such a focus on evidence-based practice that we are at risk of losing all common sense when it comes to birth.  

There is an ageing midwifery workforce with many senior and experienced midwives retiring, sometimes taking early retirement to escape the deplorable maternity service environment. Conversely, we have students entering midwifery education with fewer prospects of jobs at the end because of an under-funded and inappropriately pathologised system. Crucially, students are not witnessing physiological birth in practice, nor are they observing experienced midwives prepared to advocate for normal birth out of fear of being accused of whistle blowing in an increasingly punitive system. Indeed, in defence of obstetricians, medical staff are also not seeing enough physiological labour and birth to be certain of their own boundaries, leading them to take a “just in case” approach, often intervening before it becomes necessary. Lack of experience, as a student or newly qualified midwife, of birth as a normal life event means that midwives  are encultured into the medicalisation of birth, with many never developing the confidence to care for women in physiological labour nor the competence to recognise when labour deviates from normal progress and requires referral to obstetricians who specialise in “abnormal” labour.

Universities could be accused of being partly to blame for inappropriate education of midwives, but not in respect of evangelically promoting a normal birth “ideology”. Universities are businesses and need “bums on seats” to make their programmes cost effective. Shared learning has become standard in many higher education institutions – and not primarily because some shared learning is valuable, but because it saves money, time and rooming needs. My personal bugbear is the lack of anatomy and physiology that is now taught in midwifery pre-registration programmes (and sometimes not at all) – yet a deeper applied knowledge of A&P can save lives, both babies’ and mothers’. Midwifery educators are bound to comply with the international standards for midwifery, the UK standards for pre-registration education and to instil in students and qualified midwives the confidence in achieving and upholding the principles of midwifery practice, knowledge, understanding and progress.

Indeed, this whole debacle -accusing midwives and educators of promoting an “ideology of birth as normal at all costs” - smacks of yet another way in which the profession and expectant and birthing parents can be influenced. We have increasing numbers of parents petrified – not of giving birth, but of the maternity services in which they give birth. We have midwives who are terrorised by the ever-present threat of litigation. We have midwifery managers who have the constant sword of Damocles in respect of saving money whilst avoiding litigation hanging over them. We have a disjointed maternity service that is so embedded in the contemporary culture of fear, that no one is able to tie everything together for the good of all concerned.

It is time for midwives to fight – for our profession, our education system and most of all, for the women and babies in our care. We need to address the huge problems of an NHS that is no longer fit for purpose, especially in maternity care. We need to challenge the educational programmes for student midwives to ensure they can develop the confidence and competence to practise safely whilst addressing the full bio-psycho-social needs of people in their care. We need to challenge government to analyse the myriad issues faced by the maternity services – not in yet more service reviews, nor in simply throwing money at the system, but by changing the mindset of everyone to accept that childbirth – in the main – IS a normal life event. We need a better balance between spontaneous onset and progress of birth versus inappropriate or sometimes necessary intervention. And we need educational systems that ensure that both midwives and obstetricians can work together to provide the full spectrum of care that is effective, safe, cost effective, evidence-based where necessary and fit for purpose.

The media creates fear because fear keeps the population under control. And – make no mistake – this fear is male-driven. By this, I don’t mean only those biological men who are currently active in the debate, but our whole patriarchal society that puts women in a subservient position, something that has always been the case in relation to childbirth. And there, perhaps, lies the crux of the problem. We are not going to win the battle and be able to advocate for the midwifery profession and for childbearing women until we address the culture of childbirth more generally. The profession of midwifery is largely a female-dominated one, whereas traditionally obstetrics has been male-dominated. Even though that has changed, with far greater numbers of female obstetricians, they too have trained and practised in an autocratic medical system that persists to this day.

All that this current media scrutiny will achieve is to accelerate the climate of fear around childbirth, giving parents fewer choices and, in some cases, driving parents away from professional help, which may in itself lead to a whole raft of other problems.  Whatever the media states, pregnancy and birth ARE normal physiological life events and midwifery is the profession best placed to help in that process.

What Should You Learn on a Midwifery Aromatherapy Course? 

Expectancy has been running aromatherapy courses for Midwives for 21 years. I have been teaching aromatherapy for over 40 years, including as part of a BA Honours degree at the University of Greenwich.  My Masters degree focused on the safety of aromatherapy in pregnancy and birth. 

You might find another course, cheaper, better publicised and looking like it's more fun but is it really what you need rather than what you want? Compassionate care is about safe care, so aromatherapy always need to be safe before it's effective. 

The issue for midwives is not about the lovely aromas and a bit of massage. It's about using some aspects of aromatherapy as a specific clinical tool to enhance midwifery care. Furthermore, it's about fitting aromatherapy into the parameters of midwifery practice outlined in the NMC Code, especially since aromatherapy is not a standard part of midwifery practice. It's an additional tool that can be a fabulous complement to midwifery care but it needs to fit in the context of your midwifery registration. 

So, what should an aromatherapy course for midwives cover?

• What is aromatherapy?
• Chemistry of essential oils
• Benefits AND risks of essential oils in pregnancy and birth
• Indications, contradictions and precautions to aromatherapy in pregnancy and birth
• Pharmacology and pharmacokinetics
• Legal aspects of using oils in midwifery and in maternity units and birth centres 
• Professional issues for midwives providing aromatherapy, in the maternity unit, birth centre of home setting
• Health and safety aspects of using oils in the workplace 
• Dealing with complications - and how to minimise the risks
• Professional autonomy when using essential oils 
• Protecting yourself as well as others 
• The practice of aromatherapy - scientific modes of blending, methods of administration - note that this comes after the professional, scientific and safety aspects  have been covered

In Support of Home Birth

I am desperately sorry for the family of the mother and baby who died following a home birth recently. I am also sympathetic towards the midwife and other staff involved in this situation who did their best in difficult circumstances. Whilst it is not my place to comment on the precise details of this case, it seems that the family decided to birth “outside of (NHS) guidance” and allegedly, repeatedly declined to accept advice for transfer to hospital for medical care. 

However, the media has taken it upon itself to castigate the family for its decisions, an unkind reaction for a devastated family, and has concluded that it was the family’s choice of home birth that was “wrong”, sparking yet another furious debate about the risks home birth. In particular, the family’s previous experiences of the maternity services seem to have influenced their choices for the birth of their second child at home.

Having a baby is a normal life event. Women’s bodies are designed to be pregnant and give birth. I had my son, Adam, at home, at the age of 34 - a 24-hour labour and a forceps birth; he weighed 4.3kg. However, the obstetrician and the two midwives who cared for me were friends. They knew me well enough to know that if things started to deviate from physiological progress, I would accept their decisions. And I knew them well enough to know that if they advised transfer to hospital, it was the right decision. We trusted each other and we worked in partnership with one another.

I trained as a midwife in the middle 1970s, only a few years after the Peel report advocated hospital birth for all women, yet we were still emotionally committed to birth at home. As students we learned to recognise when labour progress was deviating from normal and we knew what to do about it. We used techniques which have now been given fancy names (such as “hypnobirthing” and “biomechanics”) – these were a standard part of midwifery practice. We grew to know the families and saw them frequently for both antenatal care and “parentcraft” classes, which served as both an educational opportunity and a social meeting place. As a community midwife, we usually attended births on our own, without mobile ‘phones for added communication with colleagues or satnavs to find our way in the middle of the night.

Home birth is safe – and often safer than having a baby in today’s NHS with its “institutional ticking clock” and the belief that things should progress at a pre-defined pace based on nothing more than management needs for bed space and saving money. This family – and many others - are victims of a disempowering system which made them afraid to have their baby in a maternity unit and who decided that their home, surrounded by their family, was the natural place to give birth. 

Nowhere, in what I have read about this case, has there been any real media acknowledgement of the underlying issues within the NHS which may have contributed to the family’s choices. Issues include coercive (bullying) behaviour from doctors and midwives for a woman to adhere to a particular course of action, staff shortages leading to harassed care providers, the paternalistic and litigation conscious approach to childbirth, the lack of experience of “normal” (physiological) birth amongst more recently qualified midwives and doctors and a blurring of the lines between what is normal and what is not.  

It is time for parents, professionals and the maternity services to reclaim childbirth as a normal human bio-psycho-social event. The public needs to regain its trust in the maternity services and those who care for expectant and birthing women. 

The Power of Essential Oils

When I first started working with essential oils in practice, I knew they could be powerful - but I didn’t realise just how powerful.

A single essential oil can contain over 300 naturally occurring chemicals, each one with its own therapeutic properties.

Some are calming.
Some reduce blood pressure.
Some can actually stimulate contractions.

In midwifery, that’s not just interesting - it’s essential knowledge.

Because when used with confidence and the right training, aromatherapy can genuinely support women through:

🌿 Early labour
🌿 Pain relief
🌿 Nausea
🌿 Anxiety
…and more.

But it’s not something to dabble in lightly. The wrong oil, at the wrong time, can do harm.

That’s why we teach it clinically - so midwives can use aromatherapy safely, professionally, and with real skill.

Worldwide Midwifery Friendships

One of the best parts of my recent trip to Hong Kong? The people.  

It was such a joy to reconnect with colleagues like Elce, Head of the School of Midwifery, and Jessie from the Chinese University of Hong Kong and to share a lunch of wonderful dim sum and laughter, and really inspiring conversation with a wider group of midwives and educators.

There’s something special about sitting around a table with midwives from across the world - different systems, different pressures, but the same passion for physiology, compassion, and safe, woman-centred care.

More soon about the teaching side of the trip, but for now, I’m simply feeling thankful for midwifery friendships that stretch across continents.

Ginger in pregnancy

Ginger in pregnancy?

It’s not always the answer.
Ginger is often suggested for morning sickness - but it’s not right for everyone.
Here’s when ginger might not be safe in pregnancy:
🚫 If there's heartburn (ginger can make it worse)
🚫 If taking blood thinners like aspirin (it can affect clotting)
🚫 If diabetic (ginger may lower blood sugar)
🚫 If there are liver or bowel conditions (ginger can irritate digestion)
And no, ginger biscuits don’t count as a treatment!
Natural doesn’t always mean safe.
That’s why midwives need the right knowledge to give good advice.