Insurance

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.

Keeping records

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.

Safety issues

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).

Emmenagogues

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.

Abortifacients

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.

A note on photosensitivity

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).

Choice of oils and methods of use

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.

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).

Essential oil use

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.

Blood pressure

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

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.

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