The use of essential oils in maternity care
Pregnancy is a special moment in a woman’s life that can be supported by massage and aromatherapy.
Aromatherapy provides stress and anxiety reducing benefits from preconception, through the antenatal period and into the postnatal period offering immense support and benefit to the mother in terms of promoting a healthy pregnancy and a healthy child.
Reducing stress, relieving aches and discomforts, easing up anxiety, fears and negative emotions and reducing the impact of ‘baby blues’ or preventing depression in post-natal care are some of the benefits.
Aromatherapy provides us with natural remedies for morning sickness and other pregnancy discomforts such as swollen legs and feet, constipation, hemorrhoids, breast problems, c-section scar and it is remarkable in preparing your body for birth with perineum massage oils and in healing the area after delivery.
This article goes on to discuss:
How can essential oils assist you in pregnancy?
Preconception and antenatal care
Are essential oils safe?
How to use essential oils safely in pregnancy
Pregnancy and postnatal symptoms and essential oil suggestions
How can essential oils assist you in pregnancy?
Aromatherapy excels in the domain of stress management and this is a main role of aromatherapy in maternity care. Reducing the mother’s anxiety levels will also have a positive impact on the baby. For reduction of anxiety and mood enhancement, inhalation of low doses of essential oils is the most effective method. The saying “less is more” applies here especially considering that the sense of smell during pregnancy becomes more acute. Sometimes it is enough to sniff the oil from a bottle or a nasal sniffer blend (which your aromatherapist can make for you) or only use 0.5/1% in a body oil (3/6 drops of essential oils in 30ml of vegetable oil).
PRECONCEPTION and ANTENATAL
Stress and anxiety reduction are fundamental in preconception as they are established factors for some women who have difficulty conceiving. The inclusion of stress management techniques such as aromatherapy (along with other lifestyle and nutrition measures) are increasing in preconception care, advice and support to optimize the chances of conception (Williams 2005). I find it beautiful that the ideal essential oils to use in preconception are those derived from plants that produce their volatiles primarily for the purpose of sexual reproduction! These essential oils are especially the floral ones such as Rose, Ylang Ylang, Jasmine, Neroli and lavender. Important to note that these essential oils are also some of the best choices for anxiety and stress management.
A pregnant woman goes through significant physiological and hormonal changes coupled with anticipation, fear and concern for the baby’s health. These factors often lead to peaks of anxiety at different stages in pregnancy and can be made worse by sleep disturbance and fatigue. The support that aromatherapy gives goes beyond providing pleasant smells; by helping reduce maternal stress it contributes to promoting positive health of both mother and child (Bastard & Tiran 2006).
Are essential oils safe?
There is a fair amount of confusion surrounding the debate about essential safety during pregnancy. Up to date, there have been no reported cases of serious problems arising from the use of essential oils in pregnancy (such as premature labour, spontaneous abortion, fetal abnormality, etc.) (Harris, R., Yates, S., 2010, p.219). Nowadays there is plenty of evidence that essential oils penetrate the body so a degree of caution is necessary, however, the risk of serious harm occurring to mother or baby from the appropriate application of essential oils is considered negligible (Harris, R., Yates, S., 2010, p.219), especially with the skin and inhalation route. Until more data is available it is wise to stay on the side of caution (Tiran, D., 2000). And especially it is prudent to avoid essential oils which are potentially dangerous throughout pregnancy.
This concern is perfectly justified as essential oils are so easily available to everyone but with so little knowledge about the safety of this powerful substances and the respectful use of them. I would also like to bring the attention to the fact that essential oils are today found in so many products used in the house for cleaning and for toiletry and body care, including shampoos, shower gels, deodorants, creams, make up and the list goes on. Many of these products are not natural and the chemicals in them, including synthetic fragrances are probably a bigger concern than a safe dosage of the right essential oil used appropriately.
Many therapists avoid the use of essential oils during the first trimester more as a safeguard against uncertainty and doubt concerning responsibility if a woman was to miscarry during that period than as a protection against fetal malformation or potential abortifacient risk. (Harris, R., Yates, S., 2010, p.220). Of course awareness of the changes that occur during pregnancy and respect for the developing fetus are basic but fundamental starting points.
How to use essential oils safely in pregnancy?
Of course, as a professional aromatherapist I do recommend that you consult an aromatherapist that can guide and support you in this choice but below I am listing the main important points to consider to stay in the safe side:
1. AMOUNT/DOSAGE LOW, USUALLY HALF THAT OF A NON-PREGNANT WOMAN OR LESS.
Toxicity with essential oils is very much dose dependent in general use. Of course during pregnancy it is advisable that we keep at a very low dosage (0.5-1% for general body work and 2-5% for acute, localized problems) diluted in a carrier oil or cream. Each % is a drop per 5ml carrier oil, so 1%=1 drop per 5ml, 2%=2drops per 5ml etc. This is also a good idea considering that during pregnancy our senses are highlighted and we are much more sensitive to smells.
2. SELECTION OF ESSENTIAL OILS WITH LOW RISK OF TOXICITY:
It is important to know the chemistry and the possible hazards of essential oils before administration, so that we can avoid oils containing phenols, ketones and phenylpropanoids which carry a greater risk. Some oils (especially containing ketones) have abortifacient and emmenagogic properties (they bring on menstruation stimulating bleeding) and therefore could cause miscarriage. Although there is no evidence that these essential oils have emmenagogic effect in pregnancy, the subject is still debatable. Oils such as Clary sage, rose, cypress, lavender, marjoram, peppermint have been labelled as emmenagogue but there is no evidence that they are abortifacient in the amounts used in aromatherapy. Therefore, the overall risk from essential oils is very small (Tisserand & Balacs, 1995, p.110).
Essential oils to avoid altogether in pregnancy are not very common oils but some of the most known are Spanish sage, Hyssop, Ho leaf, Camphor, Parsley leaf, Savin, Birch, Cassia, Cinnamon bark, Clove, Basil, Mustard, Origanum, Pennyroyal, Rue, Pine (dwarf), Savory (summer), Tansy, Thuja, Vanilla, Wintergreen, Wormwood (Tisserand, R., Balacs, T., 1995, p.111); (Tiran, D., 2000, p45).
Oils to use with caution throughout pregnancy (due to suspect toxicity – or toxic suspect components) are Lavandula stoechas, Lavender cotton, Rue, Perilla, Tree Moss. Please note that there are many species of lavender, the safe one to use is Lavandula angustifolia, True lavender or High altitude) (Tisserand, R., Balacs, T., 1995, p.111). Be cautious with oils which have been shown to be emmenagogic or stimulate uterine action (very useful in labour) such as fennel, clary sage, jasmine, nutmeg and large quantities of lavender (Ostad et al 2001; Burns et al 2000).
(Tisserand, R., Balacs, T., 1995, p111; Bowles, 2003; Williams, 2005; Tiran, 2001 p38;)
3. THE ROUTE OF ADMINISTRATION. LIMIT THOSE TO EXTERNAL AND INHALATION.
Skin application and inhalation of essential oils is safer than the oral, vaginal or rectal route in terms of toxicity. Of course, it is unusual to use essential oils through these routes unless prescribed by a medical practitioner. Reports of toxicity have been recorded due to ingestion of essential oils in pregnancy, affecting both mother and fetus. (Harris, R., Yates, S., 2010).
PREGNANCY AND POSTPARTUM SYMPTOMS & ESSENTIAL OILS SUGGESTIONS
Aromatherapy can help the mother to physically adapt to the changes in her body and help her to manage symptoms that arise with it.
The suggested essential oils below are for inhalation (in a burner, aromatherapy diffuser or few drops in a tissue) or skin application (never use neat, always dilute in a vegetable oil of your choice). When essential oils are used on the skin dilute them in a vegetable oil.
Vegetable oils and hydrolats (flower waters, produced with the essential oil extraction) are in many cases sufficient to help reduce some of the symptoms especially those skins related such as stretch marks, itching and skin dryness, or soothing cracked nipples, reducing breast engorgement, preparing the perineum with perineum massage and accelerating tissue repair following surgical intervention.
● Altered body image – Rose, Jasmine, Patchouli, Neroli, Ylang Ylang, Geranium
● Fatigue – Ginger, Spike Lavender, Cardamon, Coriander, Rosemary
● Stress, anxiety, mood swings - Rose, Ylang Ylang, Jasmine, Neroli, Bergamot, and lavender, Citrus oils are very uplifting. Use bergamot and grapefruit with caution as it is photosensitive. Photosensitivity in pregnancy increases as a result of the oestrogen-precursor, melanocytic hormone and could potentially be exacerbated by inappropriate use of bergapten-rich oils.
● Back pain, sciatica and hip pain – Add oils in your bath for pain relief: lavender, Ginger, mandarin and relaxing ylang ylang, petitgrain and neroli. Marjoram for muscular pain, lemongrass and rosemary may help with sciatica (do not use rosemary if you have high blood pressure). St John’s Wort infused oil is also good for nerve pain.
● Headaches and dizziness – one drop each of lavender and peppermint and rub them into the temples. Chamomile also can help
● Stretch marks – Vegetable oils such as Rosehip oil, vitamin E, almond oil, shea butter, argan oil, wheatgerm oil, Neroli and mandarin essential oils.
● Skin changes, itchy skin – Lavender, chamomile. Useful vegetable oils are Nigella sativa, Calendula, Argan, Rosehip, Almond and Jojoba.
● Sleep problems – lavender and chamomile, Ylang Ylang extremely relaxing if you are very stressed. Suggestion: use four drops in 5ml/1tsp of carrier oil.
● Swollen ankles and Leg cramps - One drop each of Cypress, Juniper berry, geranium, rosemary or patchouli, rest your feet in a foot bath or blend in a lotion.
● Varicose veins -cypress, juniper berry, lemon
● Sinus congestion – tea tree, eucalyptus, lavender, frankincense, manuka, myrtle, niaouli can ease congestion and also fight infection (colds and cough). Use in steam inhalation, or put two drops in a tissue or in a diffuser.
● Nausea and vomiting - Nausea in the early weeks can be relieved by small doses of chamomile, citrus oils such as lemon, orange, mandarin, lime and grapefruit are very refreshing too. Peppermint, Spearmint and ginger are also effective but keep doses very low as their smell can be overpowering. Bergamot is an appetite regulator.
● Hemorrhoids – Cypress, Frankincense, Lemon, patchouli, clary sage
● Carpal tunnel syndrome – Cypress and Juniper berry (do not use Juniper if you have kidney problems. There is a dispute about Juniper berry safety, please use with caution and read more below (essential oils to use with caution).
● Heartburn and indigestion – Try four drops of lemon, orange or neroli and one drop of oil of black pepper in 5ml/1tsp of carrier oil and massage to the chest and upper back or put in the bath (Tiran D., 2001, p.95). Coriander also good and citrus oils for constipation. While for diarrhea Neroli, petitgrain and sandalwood can be helpful.
● Thrush – can affect mums- to- be in the later weeks - tea tree, palmarosa, geranium, sandalwood, bergamot, chamomile (use as a wash).
● Breast tenderness. Breast massage with vegetable oils. Specific essential oils can help in producing milk for breastfeeding: aniseed caraway, dill, fennel, basil and lemongrass. Of course, rinse off before putting the baby to the breast. Herbal infusions or alcohol free tinctures of the same herbs (including fenugreek) are also very effective.
● Hypertension (raised blood pressure) – A good deal of research has been conducted which shows that several essential oils can have an effect on blood pressure: lavender, lemon, marjoram, Melissa, chamomile, ylang ylang; neroli and rosewood have been shown to lower blood pressure and increase relaxation. Lavender and neroli are particularly effective. On the other hand, essential oils of rosemary, fennel, hyssop and sage raise blood pressure (Tiran D., 2001, p.134).
● Hypotension (low blood pressure)- This may occur in the mid-trimester. Use caution when using hypotensive oils such as Ylang Ylang, lavender, chamomile. Use Rosemary, fennel, hyssop to raise blood pressure.
As a general rule, keep essential oils to very low doses and make sure you only use what you know is safe and select the most appropriate oil. The consultation of a professional aromatherapist is recommended especially in the first trimester so that you are on the safe side and you use the appropriate oils. Essential oils are powerful substances, very effective when used respectfully and appropriately but be aware that some of them are contraindicated in pregnancy, thought to potentially cause miscarriage (in the first weeks) or have an anti-implantation effect although there is no evidence or cases reported.
There are safe oils to use in pregnancy (in small doses) including: citrus oils (grapefruit, lime, lemon, mandarin, bergamot (be careful especially with the latest and lime as they are photosensitive, never use if you are exposed to the sun), neroli as well as ylang ylang, ginger, and chamomile.
Always try to purchase your oils from a reputable supplier who can guarantee their authenticity and purity. Avoid using them neat unless you have been specifically advised to do so as some oils contain chemicals which can irritate the skin. Dilute them in a vegetable oil reach and skin nourishing, cold pressed and organic, chose from almond oil, rosehip, avocado, grapeseed, argan.
Bastard, J., Tiran, D., 2006. Aromatherapy and massage for antenatal anxiety: its effect on the fetus. Complement. Ther. Clin. Pract. 12(1), 48-54
Bowles, J. E. (2003) The Chemistry of Aromatherapeutic Oils. Australia: Allen and Unwin
Burns E, Blamey C, Ersser SJ et al 2000 The use of aromatherapy in intrapartum midwifery practice: an observational study Compl Ther Nurs Midwifery 6(1):33-44
Clark A. R., M. Lin, M. Tawhai, R. Saghian, J. L. James, Multiscale modelling of the feto–placental vasculature
Published 20 February 2015.DOI: 10.1098/rsfs.2014.0078
(Harris, R.), Yates, S., 2010. Pregnancy and childbirth, Elsevier Churchill Livingstone
Gunn JW 1921 The action of the “emmenagogue” oils on the human uterus. The journal of Pharmacology and Experimental Therapeutics 16:485-489
Ostad SN, Soodi M, Shariffzadeh M et al 2001 The effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicity study J Ethnopharmacol, 76(3):299-304
Pages et al., 1996. Sabinyl acetate the main component of Juniperus Sabina L’Herit essential oil responsible for anti-implantation effect. Phytother. Res. 10 (7), 438-440.
The Merck Manual of Diagnosis and Therapy.(1999)17th edition, USA: Merck and Co. Inc
Tiran, D., In Essence Vol.6 No.2 Autumn 2007, p. 10
Tiran, D., 2000, Clinical Aromatherapy for pregnancy and childbirth, Elsevier Churchill Livingstone
Tiran,D., 2001, Natural remedies for morning sickness and other pregnancy problems, Quadrille publishing Ltd
Tisserand, R., Balacs, T., (1995) Essential oil safety. A guide for health professionals. New York: Elsevier Churchill Livingstone, p.111
Williams, W., (2005), Preconception care and aromatherapy in pregnancy, International Journal of Clinical Aromatherapy, Vol 2, Issue 1