12 Pregnancy and childbirth
Aromatherapy and massage on expectant mothers have proved to be effective throughout their pregnancy, especially where some allopathic medications are contraindicated because of possible adverse effects on the fetus. Aromatherapy can offer a gentler means of achieving optimum wellbeing during the antenatal period and labour, as essential oils can help combat many of the physical and emotional symptoms. This chapter seeks to advise the professional in their safe and effective use, while stressing that aromatherapy is not an alternative to the orthodox care of a pregnant woman, but a complementary aid.
Aromatherapy during pregnancy and childbirth has gained enormous popularity in the last decade; many midwives were already using it at the turn of the century (Ager 2002, Reed & Norfolk 1993), as it blends in easily with the one-to-one situation of labour and delivery care and enables both midwives and aromatherapists to provide more holistic care.
Aromatherapy offers a wonderful means of helping women to cope with the physiological symptoms of pregnancy and early parenthood and to ease discomfort and pain in labour.
However, UK law states that only a midwife or doctor can take sole responsibility for the care of an expectant or labouring mother, except in an emergency. Treatment with essential oils is complementary to normal antenatal, intrapartum or postnatal care, from confirmation of conception until 28 days after delivery, when the legal period of midwifery care comes to an end.
Only aromatherapists with specialized training in the changing anatomy and physiology of pregnant women should administer essential oils, always liaising with the maternity care team. On the other hand, it is not appropriate for midwives to advise women on the use of aromatherapy unless they have undertaken accredited training, to ensure that the information and care given is accurate, safe and up-to-date (NMC 2002a, b). A cooperative team of experienced professional midwives and aromatherapists can enhance the wellbeing of the mother and add to her overall pleasure and sense of achievement. Protocols may be devised not only to ensure best midwifery practice but also to include the protection of mothers and midwives. Although not actually a safety issue, cigarettes and alcohol are best avoided during pregnancy.
Aromatherapists should be well insured for their work, and nurse-aromatherapists should have personal professional indemnity insurance cover in addition to their nursing insurance, which does not cover them for essential oil use. If permission to use aromatherapy within their midwifery practice has been obtained from the employing authority, the Trust’s liability insurance cover will usually apply. Midwives having a private aromatherapy practice should notify the Local Supervising Authority if intending to use essential oils on a pregnant client.
Most women keep their pregnancy notes with them and have access to midwife or consultant comments. The Congenital Disabilities Act 1976 says that notes must be kept for a period of 25 years after the baby is born, in case of any legal claims for error at birth. With this in mind, it would be prudent for a therapist also to keep their consultation and follow-up notes for this same period, giving the expectant mother a copy to keep with her maternity notes.
There is little scientific evidence for or against the safety of essential oils in pregnancy, as it is impossible and unethical to conduct randomized controlled studies on pregnant women; most available evidence comes from anecdotal and empirical knowledge accumulated by practitioners. Antenatal application of a limited number of essential oils is assumed to be safe, based on anecdotal evidence from years of use by pregnant women, currently available knowledge, and the increasing number of research findings (these have been carried out on animals, however, and so are not necessarily relevant to humans). Lists of essential oils contraindicated in pregnancy differ from one authority to the next, emphasizing the need for continual training to ensure that therapists are practising according to current information, whether based on experience or research.
It is standard practice for aromatherapist-midwives or aromatherapists administering essential oils to pregnant and labouring women to use only those that are considered to be safe. They should apply both knowledge of essential oil chemistry and common sense to the physiology and potential pathological complications of pregnancy.
Some aromatherapists, who have taken only a short course or one not recognized by a leading aromatherapy organization, feel they should not treat pregnant women: considering their lack of knowledge and experience, such people should not even be calling themselves aromatherapists (O’Hara 2002).
Although some aromatherapists prefer not to use essential oils with emmenagogic or abortive properties on pregnant women, there is only real danger if these oils are used in excess (i.e. 5–10 mL) and/or internally, neither of which a proficient aromatherapist would do. During the first 3 months of pregnancy the developing child is particularly sensitive to chemicals, and remains vulnerable throughout. There is good evidence that different fetal systems are sensitive to different chemicals at specific times (Tisserand & Balacs 1995 p. 110).
Where oils have been reported to cause spontaneous abortion, it has been as a result of ingesting quantities more than 20 times the amount that would normally be used – even in therapeutic aromatherapy, when maternal hepato- or renal toxicity is a far more likely primary outcome (Balacs 1992). Essential oils considered to be abortifacient (such as pennyroyal) are not used during pregnancy (see Ch. 3 Pt II and Appendices B2 and B3 on the CD-ROM).
An emmenagogue is a substance that promotes and regulates menstruation, and it is therefore understandable that oils with this property are usually avoided until the end of the first trimester once a woman realizes she is pregnant. Although essential oils with emmenagogic properties are used extensively in aromatherapy for conditions such as polycystic ovaries, dysmenorrhoea, amenorrhea and PMT, such oils should be avoided during pregnancy. There is no conclusive evidence that essential oils can cause a miscarriage, but women experiencing such a loss may look to the oils as a reason and may blame their aromatherapy treatment for their loss, even though the overall risk from essential oils is very small indeed.
Certain individual constituents, e.g. ketones, are claimed to stimulate uterine contractions, although this may depend on the isomer present in the particular oil; it may be wise to refrain from using oils containing ketones, particularly for women with a history of preterm labour. On the other hand, ketones can be useful at the end of pregnancy as they stimulate contractions and so reduce the time spent in labour.
An abortifacient is a substance which can provoke an abortion (Collin 1993 p. 2). It is necessarily powerful as it has to fight nature, not help it. Essential oils known to be abortifacient should not normally be used in general practice – savin, tansy, juniper and pennyroyal have all been considered abortifacient. However, work using the isolated human uterus shows that the essential oils of these plants have no direct action on uterine muscles (Gunn 1921). There appears to be no clear evidence that any essential oils present an abortifacient risk, as far as external use in aromatherapy is concerned (Tisserand & Balacs 1995 p. 112).
Most abortion cases reported have been due to oral ingestion of a large quantity of an essential oil. Rather than advising oils for different stages of pregnancy, the wisest course is to avoid potentially hazardous oils throughout.
Although photosensitizing oils are not a major problem in aromatherapy because possible ill effects are ineffective within 2 hours of administration (see Ch. 3), pregnant women should take extra care as they have an increased production of melanocytic hormone, which may make them more prone to being affected if the minimum waiting period of 2 hours is not observed before going into direct sunlight. Citrus oils, expressed or distilled, contain furanocoumarins, which trigger phototoxicity (Naganuma et al. 1985). Women who develop chloasma (the butterfly-shaped facial pigmentation of pregnancy) have higher circulating levels of melanocytic hormone and should not apply such oils on parts of the body most likely to be exposed to the sun. However, citrus essences and essential oils are otherwise considered relatively safe during pregnancy (see also Ch. 3 Pt II).
The selection of essential oils can only be made in conjunction with the mother, following assessment of her condition at the time of the treatment. The oils suggested below are given as a general guide. Aromatherapy used to relieve specific physiological disorders in pregnancy offers mothers, midwives and aromatherapists additional tools to treat the unwanted symptoms which can present during the 9 months, as well as making the birth itself much easier. Most methods of use can be employed, although oral use (see Ch. 9) is the most effective way of treating digestive disorders, should the mother request it: it should not be used for any other problem. Not enough schools teach this aspect, so it is best used on the prescription of an aromatologist working with a medical practitioner. Regular antenatal aromatherapy, whether by massage, inhalation or self-application, is a pleasant way of enhancing the mother’s wellbeing by aiding relaxation, sleep, and easing physiological discomforts.
Massage during pregnancy reduces stress hormones such as cortisol and may contribute to a lower incidence of antenatal, intranatal and postpartum complications (Field et al. 1999), as well as being invaluable for treating oedematous ankles, constipation, backache and headaches etc.
See Ch. 8 for help in positioning a woman advanced in pregnancy for massage, in order to avoid supine hypotension, especially in later pregnancy, and to prevent discomfort.
Case Study 12.1 Massage throughout pregnancy treatments
Ms E, age 38 – pregnant with non-identical twins (her first baby had died at 11 months old 7 years previously).
Recent diagnosis of gestational diabetes – under control. A history of polycystic ovaries was diagnosed in her early 20s, she experienced bad PMT, mood swings and had a 45-day cycle. She is emotionally tender over losing her first baby and is feeling tired, often aching.
(1% blend in sweet almond oil used for all treatments)
Aim: to help Mrs E to feel relaxed, more confident about pregnancy and help dispel feelings of fear. Full body massage was given and the following oils selected:
• Citrus sinensis – calming, sedative, aids sleep
• Santalum album – cardiotonic, general tonic
• Citrus aurantium var. amara flos – calming, neurotonic, aids sleep
The same blend of essential oils given in a lotion to apply on shoulders each night.
2nd treatment – 3 weeks later – Mrs E had been sleeping better
Assessment: her sacroiliac area was painful and she was congested, with excess mucus.
Aim: To decongest system and relieve muscular aches and pains
• Boswellia carteri – analgesic, anticatarrhal, anti-inflammatory, energizing, expectorant, immunostimulant
• Pelargonium graveolens – analgesic, anti-inflammatory, relaxant
• Myrtus communis – anticatarrhal, expectorant, decongestant
The same blend was given for local application morning and night at home.
Having frequent Braxton–Hicks contractions; was told not to overdo it, to drink more water and to rest. Mrs E was not sleeping well again, this time because it was difficult to get comfortable; her feet were swollen and tight. Heartburn was a regular occurrence. Scan showed twins gaining weight, so no worries. The oils selected were:
• Chamaemelum nobile [Roman chamomile] – calming, sedative (aids sleep), carminative, digestive
• Citrus paradisi [grapefruit] – digestive (indigestion), diuretic
• Citrus limon [lemon] – calming, carminative, digestive, diuretic (oedema)
• Lavandula angustifolia [lavender] – balancing, calming, cardiotonic, carminative
The blend was given for home application twice a day
Last treatment – before caesarean section booked for 2 weeks’ time
Babies have dropped so heartburn has eased. Mrs E excited but nervous. Has had medication altered to combat insulin dropping sharply after meal times. Feeling fed up and very tired!
Firm sacral massage on a woman with a history of preterm labour must be avoided, as inadvertent stimulation of the acupuncture points in the intravertebral foramen may trigger uterine contractions. Additionally, there are certain points on the feet that should be avoided, for example massage of the area between the heel and the inner ankle is contraindicated in early pregnancy as this is the reflexology zone for the uterus (Price 1999 p. 55).
A 1% dilution is recommended during all stages of pregnancy – for application, compresses and baths; it is advisable not to use the oils neat during this time, except in an emergency, such as a burn. As a woman’s sense of smell can change dramatically during pregnancy (see morning sickness and Box 12.1), always involve the client in the choice of oils and blends. It would perhaps be prudent to use a seed oil such as sunflower or grapeseed in case the client has a nut allergy.
Box 12.1 Taste and smell in pregnancy
A report by Nordin et al. (2004) showed that abnormal taste and smell was reported by 76% of 187 pregnant women tested, typically believed to be caused by their pregnancy. Increased smell sensitivity was common during the early stages of pregnancy (67%), occasionally accompanied by qualitative smell distortions (17%) and phantom smells (14%). Smell abnormalities occurred less in the later periods of pregnancy and were virtually absent postpartum. Abnormal taste sensitivity was fairly commonly reported (26%), often described as an increase in bitter and a decrease in salt taste. The authors conclude that pregnancy smell and taste disorders relate to fetal protection mechanisms to avoid poisons and increase salt levels for the expanded fluid levels.
Blood pressure is monitored closely in pregnancy and is checked at each antenatal visit – some women may suffer from hypertension throughout their pregnancy. If pre-eclampsia (a serious condition involving oedema, high blood pressure and protein in the urine (Collin 1993 p. 278)) is present, or if the mother-to-be is already on medication for high blood pressure, the authors do not advocate the use of aromatherapy; however, elevated blood pressure in the parameters of what is considered normal can be treated effectively with massage using hypotensive essential oils. Those reputed to lower blood pressure include: Cananga odorata [ylang ylang], Citrus aurantium var. amara (flos) [neroli], Citrus limon [lemon], Lavandula angustifolia [lavender] and Melissa officinalis [melissa].
Digestive disorders such as constipation, diarrhoea and indigestion, even if not directly connected with pregnancy, are likely to occur at some stage (see Table 4.6, which gives essential oils for all types of digestive disorder.
As massage is not appropriate for digestive problems, they are most easily relieved by taking essential oils orally – but only when prescribed by an aromatologist! Using 3 drops maximum in total, 1 drop each of two or three of the oils below should be blended with a little honey, followed by a teaspoonful of boiling water; the cup should then be half-filled with cold water; 10–15 drops each of two or more of the oils can be put into a dropper bottle for easy use.
Alternatively, should internal use not be considered advisable, 15 drops of the blended essential oils should be added to 50 mL lotion for self-application. Aromatherapists familiar with Swiss reflex treatment (see Ch. 8) can massage the whole area of the arches of the soles of the feet with the relevant oils, in a clockwise direction, to stimulate the digestive system reflex zones, especially those of the large intestine.
The hormonal action of progesterone relaxes the digestive system, which can result in the slowing down of peristalsis. It is often made worse by high doses of iron supplements to alleviate anaemia symptoms. A diet rich in fruit and vegetables and at least 2 litres of water a day will assist defecation. Essential oils which can help constipation include Citrus aurantium var. amara per. [bitter orange], Citrus reticulata [mandarin], Piper nigrum [black pepper], Rosmarinus officinalis [rosemary] and Zingiber officinale [ginger]. Coriandrum sativum [coriander seed] and Elettaria cardamomum [cardamon] aid a sluggish digestion, which may in turn aid constipation.
Clockwise massage over the abdomen can bring relief, but would have to be very light to be comfortable in later pregnancy (see above).
Diarrhoea can be helped by the following oils (see also Table 4.6): Citrus limon [lemon], Cupressus sempervirens [cypress], Melaleuca viridiflora [niaouli] and Pelargonium graveolens [geranium].
Heartburn can be relieved by inhalation, ingestion or applying a blend of oils in a carrier firmly on to the chest area. Suggested oils are Carum carvi [caraway], Citrus aurantium var. amara fol. [petitgrain], Citrus aurantium var. amara per. [bitter orange], Citrus limon [lemon], Citrus reticulata [mandarin], Mentha x piperita [peppermint] and Origanum majorana [marjoram].
Although very different, these two conditions have been grouped together as they can be alleviated using the same essential oils. Haemorrhoids, which are sometimes protruding, often occur in pregnancy due to weight gain and/or a sluggish digestion. The changing levels of oestrogen and progesterone cause the smooth muscles of the body to soften, leading to changes in the digestive and circulatory systems, when the increase in blood volume sometimes results in varicose veins.
The client needs to reduce the amount of time spent standing and the legs should be elevated for 10 minutes every hour – or, if there is another child, for half an hour twice a day, when the child is resting or while reading a story. Exercising the feet several times a day is also beneficial.
When treating haemorrhoids, aloe vera gel makes a good base for the essential oils, which can be self-administered. Spending 10 minutes in a sitz bath with essential oils (blended first in a little honey and hot water or an emulsifier) is also useful, as is a compress. There is a wide choice of phlebotonic oils, some of which are also astringent, such as Cupressus sempervirens [cypress]; two or three oils together always gives an enhanced result.
Phlebotonic essential oils which help to relieve haemorrhoids and varicose veins are: Citrus aurantium var. amara flos. [neroli], Citrus limon [lemon] Citrus paradisi [grapefruit], Cupressus sempervirens [cypress], Pelargonium graveolens [geranium], Helichrysum angustifolium [everlasting], Melaleuca alternifolia [tea tree], Melaleuca leucadendron [cajuput], Melaleuca viridiflora [niaouli], Nardostachys jatamansi [spikenard] and Pogostemon patchouli [patchouli].
When treating varicose veins there are rules to follow for massage or self-application: this must always start above the affected vein in order to help clear the blood from this area up towards the heart, before encouraging the upward flow of blood from below – direct pressure over the vein itself must be avoided.
Some women suffer from headaches in early pregnancy, sometimes due to increased blood flow leading to vasodilatation; nausea can also bring on a headache, as can stress when pregnancy nears termination and as the breasts become heavier. If severe headaches are reported in the final trimester and are accompanied by oedema and sickness, this may be an indication of hypertension or pre-eclampsia. If so, it should be reported to the midwife or consultant.
Several methods of using decongestant and relaxing essential oils can be employed to relieve headaches:
Inhalation – tipping the bottle against a finger, then rubbing this on the forehead, behind the ears or at the hairline of the back of the neck is an effective and easy method. Mentha x piperita [peppermint] has been shown to be effective (Göbel et al. 1994).
Massage – head, back of neck and shoulders with essential oils in a carrier.
Compress – a small compress on the places mentioned above can be a helpful addition to inhalation.
Essential oils effective for headaches are Chamaemelum nobile [Roman chamomile] (antispasmodic, sedative), Eucalyptus smithii [gully gum] (decongestant), Lavandula angustifolia [lavender] (calming, sedative), Mentha x piperita [peppermint] (analgesic, decongestant) and Rosmarinus officinale [rosemary] (analgesic, decongestant).
Nausea and vomiting are two of the earliest symptoms of pregnancy, the degree differing from woman to woman. Some sail though pregnancy without any concerns, but approximately 50% are adversely affected, resulting in time off work, feelings of despondency, and in severe cases the need for medical intervention. The medical term for this degree of severity is hyperemesis gravidarum; it affects less than 3% of women, requiring hospital admission and intravenous fluid replacement.
Studies have shown that women who have morning sickness tend to have healthier and easier pregnancies, with lower rates of miscarriages and stillbirths, than women who have nausea-free pregnancies (Flaxman & Sherman 2000). It is not fully understood why morning sickness occurs, but there is a change in a woman’s sense of smell, which pregnancy is known to heighten; feelings of nausea will exaggerate this (see Box 12.1).
The best method to combat nausea is to place 2–3 drops of the favoured oil on a tissue or cotton wool ball and inhale deeply three times. A light massage can also help, as can a bath containing 6–8 drops – swished well before entering.
Melissa officinalis [lemon balm] and Matricaria recutita [German chamomile] are especially effective for morning sickness.
Other digestive oils which help to combat nausea and morning sickness include Citrus limon (lemon), Mentha x piperita (peppermint), Mentha spicata (spearmint) and Zingiber officinale (ginger).
Ginger tea may also be helpful, as the whole herb has been shown to be statistically significant in its effectiveness in trials on expectant mothers (Bartram 1995 p.198–199).
Case Study 12.2 Morning sickness
Lesley suffered from nausea and sickness from very early stages of pregnancy and was offered orthodox medication in the form of antacids by her GP. These helped for only a few minutes before the feeling returned, and she was often sick afterwards. When I talked to Lesley, I found that she had a very sensitive sense of smell and so it was necessary to find aromatherapy treatments that worked but were not overly invasive in aroma.
The following essential oils and hydrolats were chosen:
• Citrus aurantium amara fol [petitgrain] – uplifting, refreshing, digestive
• Coriandrum sativum [coriander] – digestive, anti-nausea, stomach relaxant
• Santalum austrocaledonicum [sandalwood] – digestive, heartburn, sedative
• Mentha x piperita [peppermint] hydrolat – digestive, antispasmodic
Petitgrain, coriander and sandalwood were blended 1% in two different bases, first, at 5%, in a heavy massage cream that was applied to the soles of Lesley’s feet during a Swiss reflex treatment that her husband was going to carry on at home. After the treatment she was given a peppermint hydrolat drink.
Second, for home use, a white lotion, at 1%, was given to Lesley to apply to her solar plexus and chest as many times a day as she needed (recommended up to four times). This was to calm the stomach area and also to give a slight ongoing aroma during the day.
Finally, it was suggested that Lesley used 10 mL of peppermint hydrolat in a glass of warm water to drink 20 minutes before taking food – and if she felt sick, with a maximum of five drinks a day.
Lesley began to improve during the first treatment, and particularly so when she took the hydrolat drink before leaving the couch to return home. Lesley reported that although she did still feel slightly nauseous during the next few days, she was able to control it and keep it minimal. She much preferred the natural approach and continued to improve. After the first 10 days of treatment the nausea had gone, although Lesley continued using the same blends throughout the pregnancy as she found they relaxed and comforted her.
As the fetus grows the mother’s body changes, causing postural changes that lead to muscular aches and pains. Often expectant mothers will have increased lumbar lordosis due to their increasing size and change in centre of gravity, which may lead to lower back pain and sometimes sciatic pain from trapped nerves. Sciatica is difficult to treat, although many have benefited from applying a lotion (50 mL containing 3 drops each of the following analgesic or/and anti-inflammatory oils) which is known to relieve muscular aches and pains: Chamaemelum nobile [Roman chamomile], Mentha x piperita [peppermint], Myristica fragrans [nutmeg], Ocimum basilicum [basil], Pelargonium graveolens [geranium], Piper nigrum [black pepper], Zingiber officinalis [ginger].
The same oils can be used also in a bath (6–8 drops) or in a compress.
Massage of the head, neck, shoulders, arms, hands and upper back can be helpful: back massage in particular is both psychologically and physically relaxing by altering the sense and perception of pain, thus bringing relief. (See Ch. 8 for massage positioning during pregnancy).
Analgesic and anti-inflammatory oils which help to relieve muscular aches and pains include: Chamaemelum nobile [Roman chamomile], Boswellia carteri [frankincense], Elettaria cardamomum [cardamom], Matricaria recutita [German chamomile], Origanum majorana [sweet marjoram], Piper cubeba, [cubeb] and Zingiber officinale [ginger].
This is when the symphysis pubis, the cartilage that joins the two sections of the pubic bone, separates slightly from the bone owing to increased levels of the hormone relaxin, resulting in mild to severe pain. Some women describe the experience as their ‘pelvis coming apart’. Pain is felt on making certain movements, such as turning in bed, climbing stairs etc. The pain radiates anywhere from the pubis, into the groin, the inner side of the thighs, the hips and into the buttocks.
A client who is experiencing this condition may be unable to get on and off the couch for treatment (she should be advised to keep her thighs together rather than moving first one leg then the other, as this would exacerbate the diastasis (Tiran 2005). Essential oils with analgesic properties can be used effectively in local application (see Muscular aches and pains above).
Oedema in pregnancy, particularly of the feet and ankles, results from weight gain and the general slowing down of the blood circulation. It can be worse in hot weather or if the client has spent a long time on her feet. If sudden or extreme it should be reported to the midwife or consultant, as it may be an early sign of hypertension and in severe cases pre-eclampsia (see Headaches above).
Massage is known to relieve fluid retention in the legs and ankles, particularly if performed with long, upward strokes, always moving away from the ankle. The condition can also be helped by raising the legs, taking regular gentle exercise and keeping up fluid intake. Essential oils with diuretic properties are useful and can be applied in treatment (should be offered for local application between treatments).
Diuretic essential oils which can reduce oedema include Angelica archangelica [angelica root], Citrus paradisi [grapefruit], Cupressus sempervirens [cypress], Citrus limon [lemon], Cedrus atlantica [Atlas cedarwood] and Juniperus communis fruct. [juniper berry].
Various skin changes may occur in pregnancy, such as the appearance of acne, dry or sweaty skin, stretch marks or even changes to moles, freckles and birth marks (the latter due to an increase in the production of melanin). Local application at home can bring relief to many skin complaints.
Extreme chloasma (darkened pigmentation to the face) can make a woman feel self-conscious. Citrus limon [lemon] undiluted is reputed to help such a condition; essential oils having euphoric, antidepressant or sedative properties may also be of help: Citrus aurantium var. amara flos [neroli], Pelargonium graveolens [geranium], Rosa damascena [rose otto].
Acne or oily skin: this may be hormonal and often leads to distress, in which case the essential oils above may be of benefit. A diet without fatty foods combined with the use of antiseptic, anti-infectious, anti-inflammatory and/or astringent oils such as the following can help to clear the skin: Cedrus atlantica [Atlas cedarwood], Citrus aurantium var. amara fol. [petitgrain], Citrus limon [lemon], Eucalyptus radiata [narrow-leaved peppermint], Melaleuca alternifolia [tea tree], Myrtus communis [myrtle], Juniperus communis ram. [juniper branch], Pelargonium graveolens [geranium], Pogostemon patchouli [patchouli].
Itchy skin: many women suffer skin irritation (often on the abdomen) during pregnancy. Severe itchy skin in the third trimester may indicate obstetric cholestasis; this is not common but is due to a build-up of bile acids in the bloodstream and must be reported to the primary carer. Oils for irritated skin include: Angelica archangelica rad. [angelica root], Chamaemelum nobile [Roman chamomile], Mentha x piperita [peppermint].
Stretch marks: women always fear they will develop stretch marks; although genetics can play a role in determining whether a woman will develop them, regular use of essential oils is a great preventative. Ethnicity is also a factor, women with darker skin being less likely to get stretch marks than those with fairer skin. Stretch marks are caused by a loss of elasticity in the deeper layers of the skin and the following cicatrizant, skin-softening, cytophylactic essential oils (32 drops in total) in 25% macerated carrot oil and 75% almond oil have been proved by the editor to be successful with all clients who used the blend twice a day from the fourth month: Boswellia carteri [frankincense], Cymbopogon citratus [lemongrass], Lavandula angustifolia [lavender], Pogostemon patchouli [patchouli].
Fiona, a model, was expecting her first baby. She was in her fourth month and was very concerned about possible stretch marks – this was her biggest worry!
Both carrier and the first four essential oils were chosen for their emollient, cicatrizant (scar reducing) and/or skin softening properties, the oil mix being as follows:
• 75 mL sweet almond oil – emollient (dry skin)
• 25 mL macerated carrot oil – cicatrizant, emollient
• 8 drops each of Boswellia carteri [frankincense], Lavandula angustifolia [lavender] and Pogostemon patchouli [patchouli]
• 8 drops Cymbopogon citratus [lemongrass] – chosen for its refreshing and toning properties
Fiona was told that she must apply the oil every night and every morning without fail if she wanted a good result, and to increase the area covered as her tummy increased in size, including the tops of her thighs during the last month.
Owing to increased hormone levels, pregnant women are prone to a range of emotional symptoms such as tearfulness, anger, elation and depression. A study carried out by Field et al. (1999) concluded that massage given during pregnancy reduces anxiety by reducing cortisol (a stress hormone) and may contribute to a lower incidence of antenatal, intranatal and postpartum complications.
Society has changed dramatically; family members are not always close, leaving some women feeling isolated and anxious. Textbooks and the media present a rosy view of the experience to come, but many women feel a loss of their identity, are fearful of a change in their financial situation and have very little knowledge or experience of being around newborn infants. Aromatherapy and massage at this time can alleviate some of the anxieties and concerns that women go through in the lead-up to labour. Symptoms presented at treatment may be insomnia, mood swings or general fear of the unknown.
Essential oils which may help emotional symptoms are: Mood swings: Balancing essential oils and those which are uplifting and calming are a good choice: Citrus aurantium var. amara fol. [petitgrain], Citrus aurantium var. amara [bitter orange], Citrus reticulata [mandarin] Commiphora myrrha [myrrh] Lavandula angustifolia [lavender], Lavandula x intermedia [lavandin], Pelargonium graveolens [geranium], Santalum album [sandalwood].
Oils can also be chosen for the properties below:
Euphoric: Citrus aurantium var. amara (flos) [neroli], Cedrus atlanticus [Atlas cedarwood], Rosa damascena [rose otto].
Antidepressant: Citrus aurantium var. amara (flos) [neroli], Citrus bergamia [bergamot], Citrus sinensis [sweet orange], Citrus reticulata [mandarin], Citrus aurantium var. amara (fol) [petitgrain] Pelargonium graveolens [geranium], Rosa damascena [rose otto], Santalum album [sandalwood].
Refreshing/stimulating: Citrus limon [lemon], Citrus paradise [grapefruit], Citrus bergamia [bergamot], Boswellia carteri [frankincense].
Grounding/strengthening: Boswellia carteri [frankincense], Cedrus atlantica [Atlas cedarwood], Cedrus deodar [Deodar], Santalum album [sandalwood], Zingiber cassumunar [plai].
Sedative/calming: Lavandula angustifolia [lavender], Nardostachys jatamansi [spikenard], Origanum majorana [marjoram], Vetiveria zizanioides [vetiver].
Only about a quarter of all conceptions culminate in the birth of a live child – obvious recognized miscarriages occur in approx 15% of all pregnancies. These statistics do not lessen the blow to the individual, but show how common miscarriages are.
• A pregnancy that ends spontaneously before the 28th week of pregnancy is termed a miscarriage or a spontaneous abortion.
• Stillbirth is the term used if a baby is born dead any time after the 28th week of pregnancy up to full term.
• Neonatal death is when the baby dies in the first 4 weeks of life.
These occurrences affect the mother and father in many ways and counselling is often offered. A client suffering any of the above may return to the aromatherapist for help to cope with the loss. Essential oils for grief and loss include: Citrus aurantium var. amara (fol) [petitgrain], Citrus aurantium var. amara (flos) [neroli], Cupressus sempervirens [cypress], Melissa officinalis [melissa], Nardostachys jatamansi [spikenard] and Rosa damascena [rose otto].
Massage at this time is most effective, but whether or not the treatment should include an abdominal massage depends on the client’s individual feelings about touch on this area – a gentle placing of hands could bring some sense of comfort.
Towards the end of pregnancy, during the last 6 weeks, essential oils can be used to prepare the uterus for labour. Adding 3 drops of Rosa damascena [rose otto] to the stretch mark mix helps the uterus to gain tone and strength.
Aromatherapy can be used to reduce the perineal trauma and discomfort that may result from childbirth. Perineal management is becoming part of the midwife’s role; it is not uncommon for women to experience some extent of perineal trauma in childbirth, especially those having their first baby, a trial having been carried out in 2000 (Labrecque et al. 2000). To help prepare the perineal muscles to expand, the mother-to-be can moisten two fingers with her stretch mark oil mix and place them inside the vulva to stretch the space by moving the fingers in a circular fashion; this should be done every day. Having an intact perineum and preventing tears and other damage saves the midwife from having to suture the perineum after the birth.(see Table 12.1).
Table 12.1 Essential oils to help with labour
| Essential oil | Properties |
|---|---|
| Boswellia carteri [frankincense] | Circulatory stimulant, respiratory tonic, helpful for anxiety and nervous tension |
| Chamaemelum nobile [Roman chamomile] | Analgesic, antispasmodic, helpful for anxiety, shock and nervousness |
| Chamomilla recutita [German chamomile] | Analgesic, helpful for anxiety, fear and tension |
| Citrus aurantium var. amara (flos) [neroli] | Antispasmodic, helpful for anxiety, exhaustion, stress and shock |
| Citrus limon [lemon] | Refreshing, cleansing, helpful for anxiety and dark moods |
| Citrus sinensis [sweet orange] | Hypotensive, antispasmodic, helpful for anxiety, depression and has the ability to ‘bring sunshine to a situation’ |
| Commiphora myrrha [myrrh] | Uterine tonic, emotionally warming |
| Cymbopogen martinii [palmarosa] | Tonic, cooling and refreshing – helpful for a summer labour |
Also during the last 6 weeks uterotonic essential oils such as aniseed and fennel are useful in order to facilitate delivery (Franchomme & Penoel 2001 p. 382, 416). Drinking sage tea during this time is also helpful; Bernadet (1983 p. 120) recommends a tea made with sage leaves, but an alternative is to make a tea by putting two drops of Salvia officinalis [sage] essential oil on a tea bag (preferably tannin free) and adding hot water.
As soon as the first signs of labour appear, the client’s partner can apply the following blend to her back, in between contractions; the feet can also be massaged with the same blend: Chamaemelum nobile [Roman chamomile], Citrus reticulata [mandarin] and Santalum album [sandalwood] in a carrier oil.
A ‘must’ in the labour ward is a ball of cotton wool with several drops of Salvia sclarea [clary sage]; this should be kept in the palm of the hand and really deep breaths taken from it each time a contraction begins – the relaxing benefits are enormous.
A woman hoping to labour in a birthing pool will not be allowed to use essential oils in the water during the second stage because of the risk of the baby ingesting them, but a blend may be used in a bath prior to this, which is an effective way to reduce pain and worry. Most labours involve a certain degree of pain, and if the client wishes to take those essential oils into the labour suite it would be prudent to include some with analgesic properties.
Box 12.2 Lavender baths during labour (Reed & Norfolk 1993)
This trial was carried out by Reed and Norfolk (1993), with the support of the Director of Midwifery Services at Ipswich Hospital – using her practical procedures.
19 primigravidae and 19 multigravidae clients took part in a trial to determine whether pain relief and relaxation could be achieved without adverse side effects, using 5 drops of lavender (unspecified) in the bath.
The good Apgar scores would suggest that 5 drops of lavender in baths present no risks to the baby.
Although it was not possible to assess whether or not labour was shortened by the lavender baths, labour in some clients appeared to progress very rapidly. Progress was better in those clients who:
If the therapist has permission to attend, blends can be administered at the client’s request. Some women prefer to use the oils themselves and/or ask their birthing partner to administer them; either way, they can be of benefit.
Massage and touch can be very soothing for labouring women, and firm deep pressure is often requested by the women over the sacrum area, while lying on their side. Massage to certain areas may be restricted because of medical interventions, e.g. an epidural, or the fact that the woman may be supine on the bed.
Citrus oils are light and fresh and are beneficial in the labour suite, an effective method being to inhale the chosen oil or oils from a tissue or cotton wool ball as above. Essential oil burners with a naked flame are not allowed in hospitals for obvious reasons, and an electric vaporizer must be checked by the hospital electrician. For essential oils and their properties useful for labour see Table 12.1.
With the birth of a baby many physical and emotional changes can occur and aromatherapy can be of help.
As soon as possible after the birth, women who have suffered perineal tears may benefit from a sitz bath containing Lavandula angustifolia [lavender] and Cupressus sempervirens [cypress] to assist healing. Even without tearing the perineal and vulval areas will be bruised and stretched. Application can be repeated twice a day until healing has taken place (see Case Study 12.4). The blend will also benefit if haemorrhoids are present, when again they should be used in a sitz bath. Parents and babies are assisted in the early days of parenthood by midwives, GPs and health visitors, with various tests and aftercare advice being given. At about 6 weeks postpartum mother and infant have a postnatal check, which includes physical examination and a chance to air any concerns.
Case Study 12.4 Postnatal treatment after stitches
Ms K (33) had a long, slow first labour. The baby presented occipitoposterior (spine to spine) and pethidine was given, with eventual assisted delivery using episiotomy and ventouse. Stitches were administered.
The treatment was by self-administered essential oils.
On postpartum day 2 Mrs K used the following essential oils in a sitz bath twice a day to assist healing from the episiotomy:
• 2 drops of Lavandula angustifolia – analgesic, antibacterial, anti-inflammatory, cicatrizant
• 2 drops of Cupressus sempervirens [cypress] – antibacterial, anti-infectious, phlebotonic
She continued to do this for approximately 5 days, after which she had one sitz bath daily until day 10.
When essential oils are used for breast care whilst breastfeeding, they should only be applied immediately after feeding – never just before; this gives the oils time to be thoroughly absorbed, leaving none for the baby to ingest at feeding time.
Infection of the breast tissue is usually compounded by tiredness and the infant not latching on to the nipple efficiently; symptoms include tenderness, redness and occasionally lumpiness. Over 50% of mothers who have mastitis experience ‘flu-like’ symptoms, and if the mother is given a course of antibiotics, this may affect the composition of the milk. A compress using essential oils can be helpful alongside the orthodox treatment. The signs are often a tingly feeling in the breast and acute discomfort on feeding. Anti-inflammatory essential oils can be used as a preventative and applied via a compress at the initial sign of inflammation or infection.
The following oils can be applied as a blend alongside antibiotics to help the healing process:Lavandula angustifolia [lavender], Pelargonium graveolens [geranium], Chamaemelum nobile [Roman chamomile].
A woman’s ability to produce enough milk for her infant may be hindered by stress levels, her state of tiredness and her dietary intake. Assurance and the application of lactogenic essential oils can be beneficial. The safest essential oil to increase milk flow is: Foeniculum vulgare var. dulce [fennel].
Stimulating the pituitary gland reflex by massaging the centre of each big toe with Swiss reflex cream containing fennel oil could also be of help.
It was once thought that Jasminum grandiflorum [jasmine] (an absolute, not an essential oil) acted as a galactogogue until evidence showed the reverse – it actually works as a suppressant (Shrivastav et al. 1988).
As the uterus is returning to its original size, cramp can sometimes be felt in the lower abdomen; although breastfeeding encourages the uterus to shrink, the cramps are often stronger while the baby is at the breast. A blend containing the analgesic and antispasmodic essential oils below applied to the lower abdomen can help reduce the pain: Zingiber cassumunar [plai] – used traditionally in Thailand for many generations, massaged into the mother’s abdomen directly after the birth Matricaria recutita [German chamomile] Eucalyptus citriodora [lemon-scented gum].
Aromatherapy can offer valuable postnatal support to women who live at a distance from their immediate family and who feel isolated with the arrival of the baby. To encourage confidence and give support, the following essential oils have been chosen, as they are balancing, energizing, relaxing, tonic or/and uplifting: Boswellia carteri [frankincense], Citrus aurantium var. amara [neroli], Citrus bergamia [bergamot], Cananga odorata [ylang ylang], Ocimum basilicum [basil], Pelargonium graveolens [geranium], Origanum majorana [sweet marjoram], Rosa damascena [rose otto], Thymus vulgaris ct. geraniol, ct. linalool [sweet thyme].
After giving birth, approximately eight out of ten new mothers experience ‘baby blues’, which are different from postnatal depression. They usually occur 3–4 days after the birth, when the colostrum (the thin, yellow fluid that the mammary glands secrete before the normal breast milk) is changing to normal breast milk. There is a huge swing in hormone levels at this time and women may feel tearful, anxious or mildly depressed. Fortunately this usually lasts a few days only.
Postnatal depression may affect around one in every ten women and is much more serious. It usually occurs during the first 6 months, but can occur at any time during the first year. It generates a deep feeling of hopelessness and inability to perform even the simplest task, leaving women exhausted, angry and bewildered. It is only when they are obviously unable to cope that medical intervention occurs. The use of essential oils to treat depression is well known, and aromatherapists have a selection of euphoric, antidepressant, strengthening and uplifting oils to draw upon: Boswellia carteri [frankincense], Cananga odorata var. genuina [ylang ylang], Citrus aurantium var. amara [neroli] (aids fatigue, sleep and nervous system imbalance), Citrus bergamia [bergamot], Citrus paradisi [grapefruit] (relieves exhaustion), Origanum majorana, Pelargonium graveolens [geranium] (also relaxing, relieving anxiety and nervous fatigue), Rosa damascena [rose otto], Thymus vulgaris ct. geraniol, ct. linalool [sweet thyme] (also uterotonic).
According to Field (1995), massage has been shown to have a variety of very positive effects on both full-term and preterm babies. Many societies use massage daily as part of a baby’s routine, and the addition of essential oils can enhance this if used correctly. A blend of 0.25% is recommended for infants up to 1 year old, increasing to 0.5% for those between 1 and 2, after which a 1% blend is suitable.
Among the mild essential oils suitable for babies – and the favourites – are: Chamaemelum nobile [Roman chamomile] and Lavandula angustifolia [lavender]
as they can be used for a variety of infant complaints. Other oils may be added to help the following complaints:
Colic, fever or raised temperature, insomnia, nappy rash and undue crying (stress): Citrus sinensis per. [sweet orange] can be added for colic and insomnia.
Santalum album [sandalwood] is a helpful addition for undue crying and nappy rash. Coughs/colds can be helped by two effective anti-infectious and expectorant oils:
Eucalyptus smithii [gully gum] and Myrtus communis [myrtle].
Cradle cap is a type of seborrhoeic eczema and can be a worrying problem in small babies. A mild shampoo (very little!) should be used on the baby’s scalp and hair then rinsed off thoroughly. It is easier to treat successfully as soon as the scaling is noticed. One drop each of the following essential oils should be blended into 10 mL grapeseed oil and massaged gently into the scalp at night after washing the hair. Leave overnight – the scales should be rubbed off gently the next morning while re-washing the baby’s hair (Price & Price 2005 p. 96–97).
Cedrus atlantica [cedarwood], Pogostemon patchouli [patchouli], Santalum album [sandalwood].
Aromatherapy can be used safely to benefit and enhance a woman’s health and wellbeing during the whole of her pregnancy and her early days as a mother. The transition from adult to parent is huge. In a society that often undervalues the importance of parenthood, massage and the application of essential oils can bring confidence, care and support to women and their partners at this critical and wonderful time.
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