Aromatherapy For Low Risk Women in Pregnancy Labour and Postnatally UHL Obstetric Guideline

Aromatherapy for Low Risk Women in Pregnancy
Labour and Postnatally UHL Obstetric Guideline

C1/2019
1. Introduction and Who Guideline applies to
This Guideline is designed to give guidance and support to Midwives to provide appropriate
and optimal care for women, who choose to employ the use of aromatherapy in the
antenatal, labour and postnatal period.
RCM positon statement for Complementary therapies and natural remedies

All Midwives at the point of registration, should have a basic understanding of the benefits
and risks of complementary therapies and natural remedies, even though they may not be
directly involved in administering or advising on them.
Complementary and natural remedies should be treated with the same caution and degree
of expertise as any other clinical intervention. They should be used in conjunction with
conventional midwifery and obstetric care and not viewed by mothers or midwives as a
replacement for adequate monitoring and care by appropriately qualified maternity
professional.
It is appropriate for midwives to gain competence in new skills, in accordance with NMC
requirements, so that they can offer women a wider range of choices during maternity care.
However, they must take care not to overstep the boundaries of professional accountability.
Midwives who are using these therapies in their practice should have gained the necessary
knowledge and skills through recognised training programmes.
The administration of complementary therapies and/ or provision of advice on their use must
be in the best interests of the mother and baby and midwives must be able to justify their use
in terms of currently available evidence. (MNC 2013)
Definition
Aromatherapy is an element of herbal medicine in which highly concentrated essential oils
from plants are extracted by steam distillation, cold expression, carbon dioxide or solvent
extraction to be used for therapeutic purposes. The chemical constituents of the oils work
pharmacologically, acting physiologically on different organs in the body and psychologically
via the limbic system in the brain. (Tiran 2018)
Evidence
Some women find the use of aromatherapy during labour beneficial as highlighted in Burns
et al (2000) original study found. Women described having increased satisfaction with their
labour, more control of their bodies and better psychological outcomes.
Aromatherapy for Low Risk Women in Pregnancy Labour and Postnatally UHL Obstetric Guideline
Page 1 of 17
V1 Approved by Maternity Governance Group on 20.2.19 Trust Ref: C1/2019 Next Review: August 2021
NB: Paper copies of this document may not be most recent version. The definitive version is in the Policy and Guidelines
Library
Aromatherapy and massage intrapartum service impact on use of analgesia and
anaesthesia in women in labour; a retrospective case note analysis. Journal of Alternative
and Complementary Medicine, Vol 18, No10 Dhany A, Mitchell T, Foy, C (2012)
2. Guideline Standards and Procedures
Recommendations
Accountabilities and responsibilities
1. Midwife Therapist qualified to minimum Diploma standard in recognised Aromatherapy
course as Lead Practitioner.
2. Midwives to attend approved UHL Aromatherapy course to provide Aromatherapy
services.
3. All women assessed for suitability.
4. Contraindications and Precautions.
5. Essential Oils Safety
6. Responding to adverse reactions.
7. Infection Prevention.
8. Safe storage of oils.
9. Disposal of unused oils.
10. Required documentation.
Recommendation 1
Midwife Lead Therapists should be qualified to a minimum Diploma standard in recognised

Aromatherapy course as Lead Practitioners.
 A minimum of 2 trained Aromatherapists should be trained to a recognised

Diploma standard. A register of current therapists with evidence of the
registration/qualification and which organisation allied to must be maintained.
 Lead therapists must adhere to the policy and provide evidence of method of
application, safety and audit service.
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Recommendation 2
Midwives should attend approved UHL Aromatherapy course to provide Aromatherapy

services.
Midwives should provide aromatherapy services following LCAT assessment.
 Midwives should administer aromatherapy treatments only after they have attended a
UHL approved Aromatherapy course and successfully completed LCAT assessment,
performed by Registered Midwife, LCAT assessor with full Aromatherapy Diploma.
 Each Practitioner is accountable for their own practice, competency and registration
with appropriate regulatory body (NMC,2008).
 Registrants must have successfully undertaken training and be competent to practise
the administration of complementary and alternative therapies (NMC, 2010).
 A Midwife is accountable by understanding and working within locally agreed
guidelines. The Midwife is also responsible for maintaining and developing that
competence through continuous Midwifery education (NMC,2004)
Recommendation 3
All women should be assessed for suitability.
 Women who have given informed verbal consent, subject to availability.

 Use interpreter services if language difficulties are apparent.
 Women 37/40 +
 Normal singleton pregnancy.
 Normally situated placenta.
 Women in the latent phase, early or established labour.
 Women eligible for care in Midwife led setting in Birth Centres or home.
 Postnatal women with no medical or obstetric complications.
 Blood pressure within normal limits (Diastolic 90mm Hg or below)
 No contraindicated medical or obstetric conditions.
 Normal fetus with no intrauterine growth restriction.
 Postnatal low risk women.
Recommendation 4
Contraindications and Precautions.
 Absolutely contraindicated for Epileptic women and midwives.

 Major cardiac, hepatic or other significant disease.
 Known allergies to essential oils
 If a woman has multiple allergies use, grape seed oil as a massage medium only.
 Insulin dependent Diabetic or unstable gestational diabetes.
 Severe Asthma or Respiratory condition.
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 Pathological Anaemia or Haematological disorder.
 Thromboembolic or coagulation disorder, DVT, mothers of Anticoagulant therapy.
 Infectious conditions, unexplained Pyrexia.
 Multiple Pregnancies.
 Transverse, oblique or unstable lie.
 Current APH, Placenta Praevia.
 Hypertension with diastolic above 90 mm Hg, mothers with fulminating PET.
 Women with threated Pre-term labour.
 Within the first 60 minutes following induction/acceleration of labour.
 In new complications of labour stop current treatment and reassess essential oil use.
If in doubt use grapeseed oil only.
 Air the room prior to new admission.
 No Vaporisers to be used.
Recommendation 5
Essential Oils Safety
 Check for known Allergies.

 Full consultation between woman and practitioner who will administer the first
treatment.
 Not to be used in the birth pool (can be used in the bath if not expected to deliver in
the bath. Can be used postnatally in the bath.
 No oral use.
 No use of vaporisers.
 Avoid massage over varicosities, broken skin or suspected DVT.
 Any Pregnant staff to avoid exposure to Clary Sage, Jasmine and Rose, or personal
preference, or meet any of the named exclusion criteria.
 An hour should pass before putting women with a compromised medical / obstetric
history into a room recently vacated by a woman using clary sage
 Do not use oils near the neonate.
 Do not use near pets at a home birth.
 See Appendix 1.
Recommendation 6
Responding to adverse reactions.
 Air the room, open windows if possible, to facilitate evaporation of essential oils, they
evaporate extremely quickly.
 Expose skin to air to encourage evaporation of essential oil.
 Wash off any oils on the skin with warm soapy water.
 Remove any oils used in any medium from the room.
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 If skin irritation is severe a cold compress with water only should be used. Document
in the notes, discuss with woman and inform medics.
 Technically, if you can still smell the aromas there are still chemicals in the air.
 Follow UHL Anaphylaxis guidelines.
 If a member of staff has a reaction to oils this needs to be documented and an
awareness not to use this oil if the member of staff is present (the member of staff
needs to communicate this to the team)
 Record on audit form.
Recommendation 7
Infection Prevention.
 Routine universal precautions (Aprons) Gloves not required.

 5 steps, hand hygiene prior to preparation and administration of Aromatherapy oils
and following.
 Prior to epidural please wash backs with warm soapy water, if aromatherapy oils
have been used on back.
 Adhere to Expiry dates.
 Do not use oils on broken or irritated skin.
 Wash reusable bowls with warm soapy water, rinse and dry.
Recommendation 8
Safe storage of oils.
 Unopened bottles of carrier and essential oils to be stored in a locked cupboard.

 Opened bottles of essential oils to be stored in a locked fridge in designated areas.
 Keep bottles upright in storage container.
 Open carrier oil to be kept in locked cupboard.
Recommendation 9
Disposal of unused oils.
 Safe disposal of any pre-blended oil left over in clinical waste bin following emptying
of any oils into paper hand towels.
 Glass bottles to be disposed in brown paper bags for recycling.
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Recommendation 10
Required Documentation
The Midwife must maintain accurate, comprehensive, contemporaneous records on the use
of aromatherapy, including any advice given in the course of treatment.
 Document maternal consent to aromatherapy treatment.
 Indication for and justification of the selected essential oils and base oils used.
 Blend used to include percentage and number of drops of essential oils and base oil
used.
 Method of administration: if applied via massage, type of massage and areas of
body, duration and frequency of treatment.
 Aftercare advice given and on-going evaluation.
3. Education and Training
 Midwives must administer aromatherapy treatments only after they have attended a
UHL approved Aromatherapy course and successfully completed LCAT assessment.
 Each Practitioner is accountable for their own practice, competency and registration
with appropriate regulatory body (NMC,2008).
 Registrants must have successfully undertaken training and be competent to practise
the administration of complementary and alternative therapies (NMC, 2010).
 A Midwife is accountable by understanding and working within locally agreed
guidelines. The Midwife is also responsible for maintaining and developing that
competence through continuous Midwifery education (NMC,2004)
4. Monitoring Compliance
What will be
How will compliance Reporting
measured to monitor Monitoring Lead Frequency
be monitored arrangements
compliance
Safe use of Register of Lead Annual Database
Aromatherapy oils Aromatherapy Aromatherapists
and compliance with Midwife Practitioners
guidelines
Effectiveness of Aromatherapy Audit Lead For each Clinical
Therapy form Aromatherapists client Governance
episode
Patient safety – Aromatherapy Audit Lead For each Obstetrician/
monitoring and form Aromatherapists client Anaesthetist
reporting adverse episode
effects.
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5. Supporting References
Tiran (2018)
Burns et al (2000)
Dhany A, Mitchell T, Foy C. (2012
6. Key Words
List of words, phrases that may be used by staff searching for the Guidelines on PAGL.
Aromatherapy Lead
Essential oils
Contraindications
Blends
Responding to adverse reactions
CONTACT AND REVIEW DETAILS

Guideline Lead (Name and Title) F Cox Executive Lead C Fox
Details of Changes made during review:

New document
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Appendix 1
Guide to dosages in Aromatherapy Administration The following is a guide to the

number of drops of essential oil to be added to the carrier oil to ensure correct
dosages.
Grapeseed is the recommended carrier oil for midwifery practice. The number of
drops is the total, irrespective of how many essential oils are used. Generally, a
maximum of 3 essential oils should be used in any 1 blend.
Dosages should be as follows:
 Pregnancy = 1 or max 1.5%
 Labour and postnatal = 2%
 An exception to the rule is for induction of labour in post-dates pregnancy, by
midwives only = 3%
Percentage Number of drops to be added per:-

blend
5mls of 10mls of 15mls of 20mls of
required
carrier oil carrier oil carrier oil carrier oil
1% 1 2 3 4
1.5% x 3 x 6
2% 2 4 6 8
3% 3 6 9 12
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Essential Oils for Use in UHL
Name of Oil Blends with Physiological effects of Application to Contraindications
constituents Midwifery Practice Precautions
Bergamot Black pepper, Chamomile, Antiseptic; Antibacterial; Pregnancy Avoid exposure of skin to
(Citrus Clary Sage and all other antiviral; antifungal; Relaxation, calming, nausea direct sunlight for 2 hours:
Aurantium/Bergamia stated UHL oils analgesic; anticoagulant Labour avoid in women allergic to
(mild);antidepressant; Analgesia relief of spasm, citrus fruit.
anti-spasmodic; digestive; uplifting, nausea
hypotensive; sedative Postnatal
Stress, anxiety, nausea
Black Pepper Bergamot, Chamomile, Analgesic; Antibacterial; Pregnancy Mild phototoxicity

(Piper Nigrum) Clary sage, Frankincense, antifungal; Gastric stimulant. Muscular Pain, oedema, Use sparingly –
geranium, grapefruit, rose constipation, heartburn, strong aroma.
ylang ylang, orange, Indigestion
lavender Labour
1st stage analgesia
Postnatal
Constipation, analgesia
Chamomile Roman Bergamot, clary sage, frank, Antibacterial; antiviral; Pregnancy Avoid until after
(Chamaemelum geranium, rose antifungal; analgesic, Constipation, Indigestion, third trimester,
Nobile/Anthemis Jasmine, lavender, neroli, anti-inflammatory, Insomnia, leg cramps possible uterotonic effect
Nobilis ylang ylang, Orange, pepper antispasmodic. Labour (use in small doses)
Mint Stress, anxiety, tension, Skin irritant if
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NB: Paper copies of this document may not be most recent version. The definitive version is in the Policy and Guidelines Library
analgesia used neat.
Postnatal
Constipation.
Clary Sage Bergamot, Frankincense, Antibacterial; antiviral; Pregnancy Hypertonic uterine action,
(Salvia Sclarea) geranium, rose, jasmine, analgesic; Nil do not use until term fetal distress, do not use in
lavender, neroli, ylang ylang, emmenagoguic, Labour well-established labour, not
Orange, black, pepper, uteronic, sedative, Induction, to be used for retained
grapefruit. Anti-depressant Acceleration, retained products of conception.
Placenta, Pain relief, anxiety,
fear.
Postnatal
Sinus congestion, “blues”
depression
Cypress Bergamot, Chamomile, Antibacterial; antifungal; anti- Pregnancy Caution Hypertensive

(Cupressus Clary sage, Frankincense, Spasmodic, calming, Oedema, Carpal tunnel, Women, possible skin
Sempervirans) geranium, rose, Jasmine, Diuretic, phlebotonic, leg cramps, relaxing/calm, sensitation,
lavender, neroli, ylang ylang, expectorant. Haemorrhoids Avoid neat application.
Orange, grapefruit Labour
Analgesia, Oedema,
Stimulating.
Postnatal
Oedema, Carpal tunnel,
leg cramps, relaxing/calm,
sinus relief
Frankincense Bergamot, Black Antiseptic, Antibacterial, Pregnancy Asthmatics, adverse to
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(Boswellia Cateri/ Pepper, Chamomile, antifungal, Antiviral, Colds, flu, Sinus congestion, strong odours
Olibanum) Clary sage, geranium, rose decongestant, Relaxation & Balancing of
Jasmine, lavender, neroli, Expectorant, calming Emotions.
ylang ylang, Orange, yet mentally stimulating Labour
grapefruit, Peppermint. Analgesia, Anxiety/tension
Excellent for transition.
Postnatal
Depression/ p/n blues
Geranium Bergamot, Black Pepper, Antibacterial, antifungal, Pregnancy Caution with

(Pelargonium Cypress, geranium, rose Uplifting, calming, Relaxation, Relieving anxiety, Hypertensive
Graveolens) Jasmine, lavender, neroli, Analgesic, astringent, Varicosities in compress, women due to
ylang ylang, Orange, Reduces nervous oedema astringent effect
grapefruit, Peppermint agitation, wound healing, Labour
possibly diuretic Pain Relief, Calming,
Reducing fear
Postnatal
Wound healing,
Postnatal “blues”, oedema
Grapefruit Bergamot, black pepper, Antibacterial, antiseptic, Pregnancy Avoid if mother has citrus
(Citrus X Paradisi) Chamomile, Clary sage, antifungal, antiviral, Stress, anxiety Depression, fruit allergy
rose, Cypress, Frankincense, Analgesic, Nausea & Vomiting, Pica,
Geranium, Jasmine, Anti-inflammatory, tonic, Constipation, Headaches,
Lavender, Neroli, hypotensive, calming, Colds/Flu
Orange, peppermint, tea possibly diuretic, improves Labour
tree, ylang ylang lymphatic flow, Relief of fear/Anxiety
immune stimulant Postnatal
Anti-infective, Emotional
Calming, Uplifting
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Jasmine Bergamot, Chamomile, Possibly Pregnancy Pregnancy, unknown effect
(Jasminum Officinale) Clary sage, rose, emmenagoguic due to From 37/40 Calming, on fetus, aroma may be
Frankincense, ketone content – do not use Relaxation nauseating, may induce
Geranium, Grapefruit, until term, Labour narcosis
Jasmine, Lavender, Neroli, antispasmodic, analgesic, Reduce anxiety, Pain relief,
Orange, ylang ylang stimulating, antifungal, Enhance uterine action,
antiviral, antibacterial Induction and Acceleration of
Labour, retained placenta
Postnatal
Afterpains – With care avoid
if retained products,
depression
Lavendar Bergamot, black pepper, Antibacterial, analgesic Pregnancy Slight risk of skin
(Lavedula Angustifo- Chamomile, Clary sage, Relaxing, sedative, Stress, anxiety Irritation, avoid
Lia/Officinalis cypress, Frankincense, Hypotensive, muscle Relaxation, In mothers with
Geranium, Grapefruit, Relaxant, antispasmodic, Insomnia, hypertension, Havfever, asthma, caution if
Jasmine, Neroli, Anti-inflammatory, Colds, sinus, Congestion, supine –postural
Orange rose, tea tree, ylang Carminative, expectorant Backache, Constipation hypotension with epidural
ylang Labour Sedative effect on staff.
Pain Relief,
Anxiety, fear,
enhance uterine action,
Retained placenta
Postnatal
Wound healing
Reduce inflammation
Neroli (Citrus Bergamot, black pepper, Antibacterial, antiviral, Pregnancy None known
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Aurantum: Neroli Chamomile, Sedative, anti-spasmodic Anxiety, fear, depression, But caution in
Bigarde) Clary sage, cypress general relaxation, nausea, Women with hayfever &
Frankincense, constipation and diarrhoea, Asthma triggered by flower
Geranium, cramps, insomnia pollen
Grapefruit, Lavender, Labour Citrus fruit allergy
Jasmine, Generally uplifting
Orange, peppermint, rose, Reduces anxiety,
tea tree, ylang ylang Relieves nausea, indirectly
aids pain relief
Postnatal
Prevention of P/N
“blues” depression
Orange Sweet Bergamot, black pepper, Analgesic, relaxing, Pregnancy Avoid if sensitive to citrus
(Citrus Sinensis) Chamomile, Clary sage, Antibacterial, antifungal Uplifting, relaxing, fruit,
cypress Frankincense, May aid smooth muscle Fatigue, insomnia, Possibility of skin irritation
Geranium, Grapefruit, contraction Skin irritation, oedema, especially in strong sunlight
Jasmine, Lavender, Neroli, stress, anxiety, fear,
peppermint, rose tea tree, Constipation
ylang Labour
ylang Mood enhancing, Reduces
fear & tension, slight
analgesic
Postnatal
recovery from birth,
relaxation Constipation,
P/N “blues”
Peppermint Bergamot, Chamomile, Anti-emetic, Pregnancy Avoid with cardiac

(Mentha Piperata) cypress Antibacterial, antifungal Nausea/vomiting compromise,
Frankincense, Analgesic, decongestant Heartburn, Avoid in epileptics, skin
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Geranium, Grapefruit, Anti-inflammatory Indigestion, Irritation if used neat
Jasmine, Lavender, Constipation, Hepatotoxic in large doses
Neroli, orange, rose, tea Muscular aches
tree, ylang ylang & pains, headaches, skin
Irritation, stress,
Anxiety
Labour
Pain relief, nausea may
facilitate uterine action
Postnatal
Constipation,
Recovery from birth, uplifting,
pain relief
Rose Bergamot, black pepper, Antebacterial, antifungal Pregnancy Avoid until 34/40
(Rosa Damanscena Chamomile, clary sage, Analgesic, vasoconstrictive, Relaxation, Relieving anxiety, Slight emmenagoguic
or Centifolia) cypress, Geranium, Astringent, immunostimulant, fear, tension, pain relief, action
Grapefruit, Jasmine, digestive, relaxing constipation
Lavender, Neroli, orange, Labour
Peppermint, rose, tea tree, Pain relief, anxiety
ylang ylang Fear, tension,
Uplifting & calming
Postnatal
P/N “blues” depression,
stress
Recovery from birth, eczema
Tea Tree Bergamot, cypress, Strongly antibacterial, Pregnancy Do not use in Labour.
(Melaleuca Geranium, Grapefruit, antifungal, antiviral, Vaginal thrush, Dermatitis is possible with
Alterniflolia) Jasmine, Lavender, Neroli, Antimicrobial, antiseptic Colds & Flu, Suprapubic neat or prolonged use on
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orange, Peppermint, rose, Anti-inflammatory, compresses for relief of skin
ylang ylang Immunostimulant, cystitis & UTI
Decongestant, Labour
May be anti-hypertensive Nil
effect (Lahlou et al Postnatal
2000) Prevention or Treatment of
perineal or abdominal wound
Infection
Ylang Ylang Bergamot, black pepper, Antidepressant, Sedative, Pregnancy Aroma may be overpowering
(Cananga Odorata) chamomile, Clary sage, antiseptic, antibacterial, Relaxation, stress, fear,
cypress, Geranium, antifungal, hypotensive anxiety, mild hypotension/
Grapefruit, Jasmine, Pre-eclampsia
Lavender, Neroli, orange, Labour
Peppermint, rose, Tea tree Pain relief, anxiety, stress
Postnatal
P/N “blues” depression
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Appendix 1a
Summary of Essential Oil Properties
Relaxing/Calming Sedating
Bergamot, Cypress, Lavender, Rose Chamomile, Lavender
Chamomile, Frankincense, Neroli, Ylang Ylang Ylang
ylang
Stimulating Emmenagoguic
Black pepper (circulation) Clary Sage (avoid until term)
Cypress (circulation, astringent) Jasmine (avoid until term)
Frankincense ( respiratory) Rose (avoid until 3rd trimester)
Orange, Bergamot, Grapefruit (gastro-
Intestinal) Avoid Tea tree in labour may relax
Tea tree (anti-infective) smooth muscle
Uplifting Hypotensive
Bergamot, Grapefruit, Neroli, Orange, Clary sage
Rose, Lavender
Geranium (may have opposite Ylang ylang
Effect in some women)
Antispasmodic Laxative
Bergamot Black pepper
Black pepper Bergamot
Clary sage Orange
Lavender Grapefruit
Jasmine
Analgesic Hypertension
Black pepper Geranium
Clary sage
Lavender
Appendix 2
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Aromatherapy Audit Form
Name:
DOB:
Hosp No:
Date: _____________________
Blend 1 Blend 2 Blend 3

Time of
Administration
Indications for use
Oil(s) used
Percentage Blend
Type and amount

of carrier oil
Method of
Administration e.g.
Massage/inhalation
Mothers perception
of effectiveness
(score 1-5 with 1
being effect -5
extremely effective
and comments
Any adverse
effects?
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Aromatherapy for Low Risk Women in Pregnancy

Labour and Postnatally UHL Obstetric Guideline

1. Introduction and Who Guideline applies to

RCM positon statement for Complementary therapies and natural remedies

2. Guideline Standards and Procedures

Midwife Lead Therapists should be qualified to a minimum Diploma standard in recognised

 A minimum of 2 trained Aromatherapists should be trained to a recognised

Midwives should attend approved UHL Aromatherapy course to provide Aromatherapy

All women should be assessed for suitability.

 Women who have given informed verbal consent, subject to availability.

Contraindications and Precautions.

 Absolutely contraindicated for Epileptic women and midwives.

Essential Oils Safety

 Check for known Allergies.

Responding to adverse reactions.

 Routine universal precautions (Aprons) Gloves not required.

Safe storage of oils.

 Unopened bottles of carrier and essential oils to be stored in a locked cupboard.

Disposal of unused oils.

3. Education and Training

CONTACT AND REVIEW DETAILS

Details of Changes made during review:

Guide to dosages in Aromatherapy Administration The following is a guide to the

Percentage Number of drops to be added per:-

Black Pepper Bergamot, Chamomile, Analgesic; Antibacterial; Pregnancy Mild phototoxicity

Cypress Bergamot, Chamomile, Antibacterial; antifungal; anti- Pregnancy Caution Hypertensive

Frankincense Bergamot, Black Antiseptic, Antibacterial, Pregnancy Asthmatics, adverse to

Geranium Bergamot, Black Pepper, Antibacterial, antifungal, Pregnancy Caution with

Peppermint Bergamot, Chamomile, Anti-emetic, Pregnancy Avoid with cardiac

Summary of Essential Oil Properties

Blend 1 Blend 2 Blend 3

Indications for use

Type and amount

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