Rethinking Maternity Care - The Doula Difference

Thirty-one years a ago, I gave birth to a beautiful baby girl, Abbie. My pregnancy wasn’t entirely without complications, but I felt safe, secure, and confident that I had the best possible care within the NHS.

Birth Coach Jo Hewson

Fast forward three decades, and maternity services are at breaking point. Last week the Health Secretary, Wes Streeting, announced a rapid review of maternity safety. He also announced he will be chairing a National Maternity and Neonatal Task Force, bringing together experts, staff and campaigners across maternity and neonatal services in England.

By coincidence, last week I also had the pleasure of meeting Jo Hewson, a birth coach (doula), whom one of my patients has been seeing. I was fascinated by the idea of a doula and Jo generously gave her time to meet me for coffee to explain what she does and answer my questions.

1. Why did you become a birth coach/doula?

After a difficult time with the birth of my own daughter, I decided to become a midwife so I could make changes from within the service. During the final year of my midwifery degree from the University of York, on one particularly harrowing shift, I realised that I was doing little more than keeping my patients alive. With the incredible amount of medical care that I was having to give, there just wasn't time for anything else. At that moment, I decided to leave so I could offer more support to women to fill these gaps that I knew I couldn't fill as a midwife. I achieved my degree, but decided not to register as a midwife to ensure I wasn't restricted in the care that I give.

2. Can you define a Birth Coach / Doula?

A birth coach, or doula, offers physical and emotional well-being support and guidance during pregnancy, birth and the postnatal period.

3. Can anyone become a Doula?

Yes, the role of a doula is unregulated in the UK, so in theory, anyone can become one. However, many people choose to complete a course through organisations like Doula UK. My clinical background as a midwife gives me a unique perspective and the ability to fully understand the medical side of things whilst offering compassion and advocacy to prospective parents. However because the role isn't yet regulated, understandably, many people are sceptical about the legitimacy of workers within this field.

5. What services do you offer?

I offer a range of services, including hypnobirthing, massage, aromatherapy, birth preparation and advocacy. Unlike many other birth practitioners, I take a 'picknmix' approach so that you can choose what works for you rather than having to buy a whole package. It makes it affordable and achievable to get bespoke support for you and your family to increase your chances of having positive experiences of birth.

4. When should someone contact you?

There’s a different answer to that for everyone. I work with some people to prepare them for being pregnant and helping them get into the right mindset. For others, being present at the birth, advocating for the woman and supporting her and her partner is what’s needed. I tailor support to each family depending on their unique needs and circumstances.

6. Do you find any conflicts with the NHS when you’re supporting births?

I know many of the staff in Harrogate and I keep my foot in the door by doing a few shifts as a Support Worker each month. I don't think the importance of having extra support outside of the NHS is understood yet but hopefully things will change with that. There are gaps, everyone knows that. That's why there is now a national investigation team working on maternity services. I believe communication with private support services in each area could significantly improve things. A lot of the time families don't know what is available in their area. My dream is for the many amazing services in our area to be recognised by the NHS so that we can all work together with women and families at the heart.

Wes Streeting is due to announce the results of his review by Christmas. For parents and the overstretched staff working in maternity services, those findings can’t come soon enough. In the meantime, it’s reassuring to know there are dedicated professionals like Jo providing compassionate, personalised support throughout pregnancy and birth.

Denise’s story - Reflux left me desperate

Denise’s Story

I discovered Jane a couple of years ago on a recommendation.

I had suffered with chronic reflux for a number of years, which was consuming my life 24/7 and had left me feeling desperate.

Having undergone tests previously, my GP determined there was no underlying issue and had prescribed me with reflux medication which I disliked taking daily. I also took over the counter indigestion remedies, all of which provided minimal relief from my symptoms.

“changes over the coming weeks were profound”

— Denise

Following my first very thorough assessment and initial treatment with Jane I responded to treatment and the changes over the coming weeks were profound. Having experienced a life long sluggish bowel, I came to realise that when the reflux was acute it corresponded to my bowel being especially slow and how interlinked the digestive system is, but also interlinked with tension. Initially it was important to see Jane every week to give her the opportunity to unpick how stagnant I had become. 

“I have not taken any reflux medication for over 18 months”

— Denise

Jane has also provided a brilliant sounding board on eating habits, I’ve always loved dry textured food and I realised this has definitely been a contributor to my issues. Through our conversations I have changed habits to support my digestive system.

I have not taken any reflux medication for over 18 months. Having gained such a positive result with my reflux, Jane has also helped me with the effects of post-menopause both physically and emotionally and I see her on a regular basis, as she is my No.1 go to person.

Jane is very professional, extremely calming and competent, I trust her and wouldn’t hesitate to recommend her to anyone. She has truly changed my life for the better.

Jane’s comments

 Western Medicine had confirmed that Denise didn’t have any issues that would lead to serious concerns for her health in the future. But still, left without a solution, the quality of her life was significantly impacted.

“One of the great strengths of Chinese Medicine is the ability to treat issues that don’t fit into a western diagnostic process”

— jane

One of the great strengths of Chinese Medicine is the ability to treat issues that don’t fit into a western diagnostic process – those issues where you’re told everything is fine when it clearly isn’t. Using a process that looks at you holistically, there’s no need for a Western Medical diagnosis for treatment.

 Let’s look at the fundamental concept of Qi in Chinese Medicine. It has different meanings for different people. From my perspective, it often simply describes how things work. The Qi of the digestive system has a general downward movement- we take food in at one end and it comes out of the other. But rather than working like a well-oiled engine, taking in fuel, digesting it, and excreting the remains, Denise’s digestive system had been stuck .  She said she was stagnant and she was right. This stagnation meant that the whole functioning of the whole digestive was impaired and the blockage in the downward flow meant that the stuck Qi, having nowhere else to go, moved upwards leading to reflux. Acupuncture helped to get things moving in the right direction again, and the addition of food with a higher level of liquid helped to oil the wheels of the digestive system.

Does Acupuncture Work? Let's Talk About Evidence Based Healthcare

Fifty-five year old Andy came to came to see me with chronic back pain. He’d tried a few other treatments without success. Now, with the tough physical challenge of a sailing race looming, he desperately needed help.

Could acupuncture help him?

It’s one of the questions I’m most often asked …… “will acupuncture work for me and my problem?”.

And it’s understandable. No-one wants to waste their hard-earned cash on an ineffective treatment. In answer, I usually give an indication of the likelihood of acupuncture helping someone. But I also add that I can’t guarantee it - and nor can any other practitioner. Here’s why…..

I know I get good results in clinic, but I often think the question is really “ is there evidence for acupuncture and my problem?” . To answer, firstly we need to look at what evidence-based medicine IS. This blog dives into the principles of evidence-based medicine and the challenges of research. In my next blog we’ll talk about where acupuncture fits into this picture.

What is Evidence Based Medicine?

Western medicine can often seem to be all about “the science” or evidence-based medicine, a concept developed by Canadian epidemiologist David Sackett.

Back in 1981 he and his colleagues at McMaster University began publishing a series of articles in the Canadian Medical Journal advising physicians how to appraise medical literature. But an evidence-based medicine approach doesn’t rely solely on research. Sackett also advocated using the physician’s expertise, considering the individual needs of the patient, and the patient’s wishes.

Challenges in Evidence-Based Medicine 

Once Sackett had given us a starting point for evidence-based medicine, you’d think it would be easy to understand what “works” But no, the research aspect of evidence-based medicine is a minefield.

Firstly, there needs to be a hypothesis – an assumption that can be tested to see if it’s true or not.

Secondly, you need to test that hypothesis. There are many different ways to research a treatment; case studies, cohort studies, randomised controlled trials (RCT’s), systematic reviews, and many more. These studies are not all equal - some are far more rigorous than others. A randomised controlled trial (RCT) is considered the “gold standard” of research.

Thirdly you need money. A condition affecting a big chunk of the population is likely to attract more research funding than a rare illness. Decent trials cost money, lots of it. And the better-quality trials like RCT’s cost more. Because these trials are so expensive it makes sense to make sure that someone will benefit from doing them (if the hypothesis is right!), whether in terms of prestige or financial gain. This could explain the dominance of pharmaceuticals in medicine nowadays.  

AND THEN once you’ve for the money, you must find a big enough chunk of similar folk to test your hypothesis on. Only then can you say the result was due to the treatment, not chance.

 The big question – will it work for you?

Let’s imagine that, like Andy, you’ve hurt your back. Your neighbour tells you that she saw someone who helped her. It’s always good to have a personal recommendation, so you make an appointment.

But will it work for you? The reality is you don’t know. One person’s experience carries little weight in scientific terms.

Let’s add more people, perhaps everyone in the town with back pain, and do a proper study. That will give us more information. It might be that 50% improve with treatment.

“Evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice
”

— David Sackett

But will it work for you? You still don’t know, you might in the portion of people the treatment is successful for, you might not. And something else might work better in any case.

Let’s make it a bit trickier. We’ll add in some comparisons, like a placebo or another treatment. That other treatment might be whatever is on offer now, often known as ‘standard care’. We might find that 60% of people in the new treatment group see an improvement- but so do 45% in the standard care group, and 30% of the folk in the placebo group. Again, you don’t know which camp you would fall into.

The downsides

We’ve started to see some of the issues with research. The huge amount of expense and time required for good quality research such as randomised controlled trials means that only a fraction of the options available to you could be “evidence based”. And even then, evidence-based treatments take time to filter into common usage – usually about 17 years, according to the British Medical Journal.

And, as American astronomer Carl Sagan put it, “Absence of Evidence is not Evidence of Absence” . A lack of research for a treatment doesn’t mean it’s not effective. It could be that the evidence isn’t there because researchers don’t see a benefit from doing the research. Remember though, that if something has been tested and found wanting, that could be a different matter.

“Absence of Evidence is not evidence of absence”

— Carl Sagan

Also remember, researchers need to ask the right question (the hypothesis) and test it on the right group of people. It’s not unusual to find studies with conflicting results because researchers have chosen to test a different group of people, or asked the question in a slightly different way.

The existence of an evidence base can give you some confidence to make an informed decision, based on the likelihood of a positive impact against any potential side effects, but finding a definite answer is a tricky business.

The U.K position - N.I.C.E

In April 1999 The National Institute for Clinical Excellence was created to create consistent guidelines and end “postcode rationing “across the U.K. Now known as the National Institute for Health and Care Excellence (NICE) , they continue to provide standard guidance for treatment of a range of conditions. This guidance is given in relation to the evidence base and to cost. But it rarely takes into account the expertise of the physician or the individual patient, as David Sackett suggested.

“We use the best available evidence to develop guidance to improve health and social care”

— National Institute for Health & Care Excellence

Limitations of NICE Guidelines

Sadly, NICE hasn’t stopped the postcode lottery as each area manages its own funds. As an example, treatment offered to people struggling with fertility varies across the country. As I write this, NICE recommend 3 cycles of IVF for women struggling to conceive, but only one cycle is offered in Harrogate and the rest of North Yorkshire.

 Where does that leave you?

Western science is a wondrous thing. The experimental approach means that new ideas are tested, and many a life has been saved by interventions developed following scientific studies. Studies also help organisations such as The National Centre For Care and Excellence (NICE) to decide what treatments to recommend when there are a myriad of options available and budgets are tight, but they can’t promise every treatment will work for everyone. Nor can they factor in the skill of the person treating you,  or your individual wishes, the two strands of David Sackett’s model of ‘Evidence Based Medicine’ that are so often forgotten. Remember too, that not every treatment is tested for every condition.

Did acupuncture help Andy? Yes! His pain started to decrease after his first treatment. Six sessions later, he was pain free, and looking forward to his epic sailing challenge.

Does that mean I can promise to help you, as I have helped Andy and many others? No, I can never promise a result as everyone is unique. But I can promise that if I think a different treatment would be better for you, I’ll tell you. I can promise that I’ll give you an honest opinion of the likelihood of success based on my clinical experience, and I can promise that I’ll give you the best treatment possible for you, based on my experience and the experience of other acupuncturists over the last two thousand years.

Your Chinese Medicine Diagnosis

Imagine a healthcare system that has been used for over 2,000 years—one that sees not just your symptoms, but the whole you. This is the essence of Chinese medicine.

Traditional Chinese Medicine (TCM) offers a holistic approach to health. It doesn't rely on lab tests or imaging, as Western medicine does. Instead, TCM uses ancient diagnostic methods like questioning, observation, and palpation to uncover the root causes of imbalances in the body. This approach doesn’t just look at physical symptoms but also considers your emotional, mental, and spiritual well-being, offering a truly comprehensive view of health.

What is a Chinese Medicine Diagnosis?

In Traditional Chinese Medicine (TCM), diagnosis revolves around understanding the functional roles of internal organs, the intricate network of channels that connect these organs to the body’s exterior AND to one another, and the “fundamental substances” that sustain them. These substances—Qi, Blood, and Jing—play a vital role in ensuring the organs operate in harmony, supporting overall health and balance.

Why is a TCM Diagnosis Different?

One of the first things many people share with me is their Western medical diagnosis. While this can be helpful, it’s not essential in TCM. This system views health and illness through a different lens.

Rather than identifying a specific disease, TCM seeks to uncover patterns of disharmony—underlying imbalances that lead to symptoms. That disharmony may manifest in one or more organs, fundamental substances may be off kilter, or both organs and fundamental substances may be involved.

The organ system

Organs are understood not just anatomically but functionally; for example, the Heart in TCM is far more than the muscular pump we think of in the West. It encompasses emotional well-being, memory, sleep and even fertility, as emotional disturbances can affect the balance of hormones.

Fundamental substances

Qi, Blood, and Jing – the “three treasures”

What is Qi?  Ask one hundred Chinese Medicine practitioners and you could get one hundred different answers! The translation can be as basic as “energy”. To me, Qi is a concept that explains how well the body is functioning. For example, if your Lung Qi is strong, you will breathe easily, if your Heart Qi is robust that important muscle is beating regularly, and you are emotionally stable.

The concept of Blood is similar to the Western understanding; a vehicle to move nutrients and oxygen around the body. TCM also sees Blood as a vehicle to house the mind. The quality of Blood is very much determined by the quality of the food we eat, and the connection between blood and the mind isn’t completely at odds with Western thinking. There is now a growing understanding of the connections between mental health and diet.

And Jing? Think of your constitution. Some lucky souls are born with a super strong constitution and seem to be able to withstand anything life throws at them, , whereas others are hit by everything that comes along. We can’t change what we’re born with, but most of us can look after our reserves of Jing with good lifestyle choices.

When things go wrong

Imagine your body as a house. The walls create a barrier between the interior and exterior protecting you from the environment. Inside, you have systems in place to make sure the atmosphere is just right; not too hot or cold, not too dry or damp. But if the heating system isn’t working well, the house can become icy or overheat, the atmosphere may become too dry or damp can breach the boundaries. And if the windows cannot withstand the elements, wind will whip through the house.

Natural metaphors such as Damp, Heat, Dryness, and Wind, help us understand how your body functions in TCM terms.

These terms may seem abstract, but they are grounded in a structured diagnostic process. And it’s not too hard to see how they came about. Before there was any understanding of bacteria and viruses, infections were seen as an invasion of Wind. And the resulting raised temperature of an infection can clearly be seen as excess Heat in the body.

“Ancient Chinese medicine had no knowledge of bacteria or viruses and acute respiratory were considered to be due to an invasion of ‘Wind’ or other climatic factors”

— Giovanni Maciocia

What to expect during your session

Your first session in TCM might surprise you with its depth. It’s all about getting to know you, your body, and your life. The process typically includes:

• Pulse Diagnosis The pulse is a treasure trove of information in TCM, far beyond just heart rate and rhythm.

 I’ll feel the pulse in three positions on each wrist and at three depths in each position. Each position corresponds to an organ and provides insights into your Qi (energy), Blood, and the health of your organs.

• Questioning: We’ll have a chat about your lifestyle, medical history, sleep, diet, digestion, emotions, and more. If you have pain, I’ll want to know when it occurs, how it feels, and what makes it better or worse.

• Tongue Examination

The tongue reflects the state of your internal organs. Its colour, shape, coating, and moisture level give clues about your overall health. Remember those climatic factors such as Damp and Dryness – they can be seen quite clearly on the tongue. If you’re brave enough to ask to examine your friends’ tongues, you’ll begin to see how different they are – you may notice how ‘dried out’ one looks, or a thick greasy coat on another showing Damp in the body.

• Palpation: Palpating acupuncture channels can uncover more information about your body’s imbalances. Channels may also seem an abstract concept, but these are real places linking the exterior of the body to the interior, with many connections between them. Channels spread throughout the body, but are usually easy to locate on the limbs, in the spaces between muscle and bone.

What am I looking for? The texture of the skin, how firm the channel is, and if there are any lumps and bumps along the way. They all help me to work out what’s going on.

“Tong bing yi zhi, Yi bing tong zhi,”

— Different Diseases, One Treatment; Same Disease, Different Treatments

Different Diseases, One treatment, Same Disease, Different Treatments

This classic saying in Chinese medicine, “Tong bing yi zhi, Yi bing tong zhi,” captures its essence.

Two people with the same Western diagnosis, for example migraines, may receive entirely different treatments because their underlying patterns differ. Conversely, two people with completely different issues might benefit from similar treatments if their patterns of disharmony are the same.

Let’s look at some examples. It’s  winter time as I write this, we’ll look at a couple of simple cough scenarios !

 1.        John has a dry tickly cough, feels thirsty, and has a hoarse voice.

He doesn’t have a temperature or any other signs of illness. John is suffering from “Lung dryness” caused by spending too much time in overheated and dry environments, such as his office and the pubs and clubs he’s gone to for Christmas parties.

  2.        Sarah also has a cough. She can’t stand the cold, she has an itchy throat, she’s breathless, has a blocked nose and her head and body aches. Sarah has an Invasion of the Lungs by Wind-Cold!

 In this case, Wind means a pathogen such as a virus or bacteria has entered the body – when Chinese Medicine was developed over 2,000 years ago, there was no knowledge of such things.

Likewise that migraine may show up as a Liver issue, or it could have more to do with the function of the Stomach. There may be some Heat or there could be Damp, or even Damp’s uglier relative, Phlegm. The possibilities are almost endless, so we need to look for and treat the underlying cause of the migraine -  “same disease, different treatments “

And the “Different Diseases, One Treatment “ side of the equation?  Let’s take Damp as an example. Damp can be caused by exposure to Damp environments or by eating a Damp-forming diet (lots of wheat, dairy, and sugar!). It can show up as a feeling of heaviness in the limbs, a fuzzy head, or it might affect the stools or urination. Either way, the treatment is likely to involve fortifying the body’s warming systems to clear the Damp, much as you would do in a damp house.

A Treatment Tailored to You

After gathering all this information and making your diagnosis, I’ll develop a treatment plan that’s unique to you. This includes selecting acupuncture points on specific channels to address the root cause of your imbalance. Everything—needle placement, depth, and technique—is carefully chosen to suit your needs.

Your acupuncture treatment plan evolves as your body responds, reflecting a dynamic and personalised approach to healing.

Helping Yourself Heal

Healing is often a collaborative effort. Alongside acupuncture, I may recommend lifestyle or dietary adjustments to support your recovery. This could include:

• Eating or avoiding certain foods to support your recovery.

• Incorporating relaxation techniques to reduce stress.

• Trying gentle movement practices like Qi Gong, or yogic breathing techniques, to enhance your treatment.

These small changes, combined with regular acupuncture, can make a big difference in restoring harmony to your body and mind.

If you're ready to explore a personalised treatment plan, I’m here to help guide you on your journey toward balance and well-being..