Pregnancy and childbirth

12 Pregnancy and childbirth

Ethical, legal and safety aspects in pregnancy

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.

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.

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 and abortifacients

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).

Aromatherapy and massage during pregnancy

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.

Case Study 12.1 Massage throughout pregnancy treatments

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).

Common problems in pregnancy

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.

Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Pregnancy and childbirth
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