NHS Borders clinical guidelines
Clinical Aromatherapy is the use of essential oils for therapeutic outcomes, which can be measurable, such as nausea, stress and pain. Essential oil components of plants are extracted by steam distillation, cold expression, and carbon dioxide or solvent extraction. These essential oils are highly concentrated, with the chemical constituents have therapeutic properties. Although the chemical constituents of the essential oils work pharmacologically, it is also viewed as a holistic form of complementary medicine, with the oils having psychological and emotional effects. Aromatherapy research has focused on exactly what makes the oils work – the chemicals, the physiological or psychological effects of the aromas, the method of administration, particularly massage. The Best Start (Scottish Government 2017) recommends that health boards provide options for pain relief including aromatherapy, to optimise normal birth processes.
Aromatherapy Guideline for Midwifery Practice
Objectives
To enable registered midwives who have received the appropriate training from a Clinical Education Midwife, with additional training in Aromatherapy and massage, to safely administer nominated aromatherapy oils to women in labour. Increased demand for midwives to support the use of complementary therapies is widely accepted (Royal College of Midwives 2014). It is important for midwives to understand the reasons why women are seeking to use complementary therapies in order to provide a service, especially if it enhances and normalises the birth experience (Mitchell and Williams 2006). It is important for midwives to consider the training and education options to strengthen the credibility of an aromatherapy service and to support its implementation in the NHS (Mitchell and Williams 2006).
Scope
Aromatherapy is the administration of essential oils, extracted from plants, which can be administered by topical application via massage, inhalation or dispersed in water. It promotes relaxation, whilst relieving stress, anxiety and tension, pain and nausea. The chemical constituents of the essential oils work pharmacologically but aromatherapy is also considered to be a holistic form of complementary medicine which works due to the combination of the chemical constituents, the way it is administered and the effect of the aromas on the limbic system which affects mood. Research suggests that women want to be empowered, to take control and to explore choices. Many women have used complementary therapies before conception, while others seek non-pharmacological for treatment of physiological discomforts in pregnancy.
- Aids relaxation and well-being
- Eases physical discomforts of pregnancy
- Aids pain relief in labour
- Facilitates uterine action
- Shortens length of labour
- Odour has a direct pathway to the limbic part of the brain, in particular to the amygdala that governs fear (Buckle 2007)
It is vital for midwives to be able to apply the theoretical principles of aromatherapy and the clinical skills they have trained in, to the physiology of pregnancy and birth in the context of approved midwifery practice (Tiran 2007). It is challenging to generate evidence from randomised controlled trials for interventions with complementary therapies such as aromatherapy or massage (Baston and Wray 2013, Finlayson 2013).
Aromatherapy and massage have been proven to be beneficial in labour to facilitate normal birth, reducing the need for pharmacological or surgical intervention as well as enhancing maternal satisfaction and increasing midwives job satisfaction which affected staff retention and recruitment (Burns et al 1999).
Results from the above study of 8058 women demonstrated that:
- The uptake of epidural anaesthesia was significantly less for women who used aromatherapy, regardless of parity and labour onset.
- There was an association with a reduction in the use of systemic opioids when aromatherapy was used.
- Less than 1% of women reported any side effects following the use of aromatherapy.
- Primips reported a reduction in pain following aromatherapy, overall length of labour was shorter, no difference in assisted births or LSCS, no difference in use of epidurals, SVDs or augmentation (2011).
Additionally, women expressed feelings of empowerment and feeling supported when using aromatherapy. (Burns et al, 2000. Allright et al, 2003) Aromatherapy aims to enhance women’s overall birth experience by increasing choice, a recommendation made by The Best Start (Scottish Government 2017) and by promoting normality and reducing intervention. Aromatherapy therefore has the potential to be a safe, effective and cost effective option for women. To be able to provide choice, midwives need to understand what is available and how to access information and evidence and to have confidence in the choices offered (Baston and Wray 2013). The choice of complementary therapies can be combined to produce an environment of calm and relaxation that enables women to labour effectively and enhances a holistic approach to pain management in labour, which increases the available options to women (Pollard 2008, Mitchell and Williams 2006, Buckle et al 2014, Wray and Baston 2012). Women choose complementary therapies to help reduce intensity of pain and to improve experiences of labour (Jones et al 2012, Smith et al 2018).
The Nursing and Midwifery Council (NMC) allows midwives to use complementary therapies in their practice when they have been “adequately and appropriately” trained to do so. Each midwife is accountable for her or his own practice and must be able to justify any actions (Tiran and Mack, 2000). The Midwives’ Rules and Standards (NMC 2015) allow Midwives to use aromatherapy oils and to massage clients, but only with informed consent. Midwives using or advising on aromatherapy must adhere to the Nursing and Midwifery Council Code (NMC 2015). Midwives must be adequately and appropriately trained to use aromatherapy, and maintain continuing professional development (NMC 2015). Training should include both the benefits and the risks of aromatherapy in pregnancy, birth and the puerperium, including the science and research evidence underpinning it and the application of aromatherapy principles to midwifery practice (Tiran 2016).
Accountable practitioners need to use evidence and research about aromatherapy to inform practice (Tiran & Price 2007, IFPA 2013). Administration of complementary therapies and/or provision of advice on their use must be in the best interests of the mother and baby. Midwives must be able to justify their use in terms of currently available evidence (NMC 2014). Every midwife wishing to use essential oils in practice does not need to be a fully qualified aromatherapist in order to use specific essential oils; they are simply extending their normal role in helping women in labour (Tiran and Mack, 2000). In order to advise on use of Aromatherapy and administer Aromatherapy to women accessing our services, Midwives and Maternity Care Assistants need to attend the NHS Borders training day and read the Midwives’ Handbook and complete 5 case studies.
The Nursing and Midwifery Council facilitates the use of aromatherapy and massage providing that midwives:
- “complete the necessary training before carrying out a new role (NMC 2015, 13.5).”
- “make sure that any information or advice given is evidenced based, including information relating to using any healthcare products or services (NMC 2015, 6.1.)”
- “maintain the knowledge and skills you need for safe effective practise (NMC 2015, 6.2.)”
- “make sure that you get properly informed consent and document it before carrying out any action (NMC 2015, 4.2).”
- “keep clear and accurate records (NMC 2015, 10.)”
- “make sure that you have an appropriate indemnity arrangement in place relevant to your scope of practice (NMC 2015, 12.1)”.
Midwives wishing to use aromatherapy and massage during their practise whilst employed by NHS Borders must:
- Be adequately and appropriately trained and must be able to apply the principles of aromatherapy and massage to their midwifery practise and demonstrate competence
- Endeavour to remain up to date with current evidence, and be able to evidence this as part of revalidation, if they are working with essential oils and massage in practice.
- Base their aromatherapy practise on sound principles, available knowledge and skills and where possible contemporary evidence or authoritative debate.
- Documentation including: assessment of suitability, consent, rational for treatment, treatment given and evaluation of treatment given.
- Use aromatherapy within the parameters of these instructions to ensure cover by NHS Borders vicarious indemnity insurance cover
- Maternity care assistants may administer massage with essential oils on the responsibility of an aromatherapy trained midwife who has dispensed the relevant blend of oils to be used.
Appropriate training will be provided by an accredited Aromatherapy In Practice course. The education programme is a three-step process
| Step 1 | Midwives must complete a NHS Borders/ RCM accredited Aromatherapy in Practice Course. |
| Step 2 | Midwives will attend an Aromatherapy oil workshop session in their clinical area |
| Step 3 | Midwives undertake a period of supervised practice and competency assessment in which they are asked to evaluate and document their care of a minimum 5 cases in which essential oils have been used for women. The midwife mentor provides written feedback on each form. Through this documentation, the midwife mentor determines whether midwives are using essential oils appropriately |
| Step 4 | Complete an Aromatherapy practical update session every 3 years. |
A live register of midwives and maternity care assistants who have attended aromatherapy training in NHS Borders is recorded
- Midwives offering aromatherapy should document that they have discussed its use with the woman on Maternity Badger.
- The discussion should include information about the essential oils that have been chosen, the reasons for use and contraindications
- Verbal consent is sufficient. Midwives should respect, support and document a person’s right to accept or refuse treatment. (NMC, 2015, 2.5)
- Women should be provided with sufficient knowledge to make an informed decision about the use of aromatherapy (NMC 2015).
- Verbal consent is sufficient, but must be documented in the midwifery notes.
- Women should be made aware that the decision to use or not use oils does not affect their subsequent care.
- Midwives are required to document the consent and indication discussion, together with rationale in the Midwifery notes. Discussion should include information about the essential oil(s) and the reason for application.
Midwives must maintain contemporaneous records on the use of aromatherapy according to The Code (2019) and recorded on Maternity Badger. Women receiving aromatherapy should be identified in the report to the next shift. In the unlikely event of a serious reaction to aromatherapy, an Incident Report should be completed as part of the risk management process.
The use of aromatherapy oils will be at the discretion of the midwife providing care, with compassionate consideration given to other ward inpatients. In hospital antenatal wards ideally, induction of labour with use of aromatherapy will take place within a side room. Midwives will use their professional judgement and evidence is administering aromatherapy to antenatal inpatients. Aromatherapy can only be administered by a Midwife or Maternity Care Assistant who has undergone NHS Borders training and completed 5 case studies and is deemed competent by a Midwife competent in the use of Aromatherapy.
- Epilepsy - people with epilepsy or the risk of seizure should stay away from stimulating essential oils such as: eucalyptus
- High Blood Pressure - avoid oils that will increase circulation and adrenaline: peppermint, eucalyptus.
- Low Blood Pressure (diastolic <60)– avoid hypotensive oils or oils that are overly sedating clary sage, ylang ylang, and lavender (Escent 2019).
- Post Partum Haemorrhage/ VTE on thromboprophylaxis- Bergamot is an anti-coagulant
- Women with IDDM and GDM- avoid use of peppermint and Jasmine oil as it is high in ketones.
- Women in the antenatal period – except for hyper emesis.
- Pre-existing medical condition: Cardiac, renal or hepatic disease
- Pathological anaemia or any thrombo-embolic or coagulation disorder
- Infectious condition or unexplained pyrexia- Sepsis
- Severe asthma or other major respiratory condition
- Current Antepartum Haemorrhage
- Placenta praevia
- Allergies or sensitivities to aromatherapy
- Long term medication e.g. anti-hypertensive’s, anti- coagulants.
- Epidural in situ – avoid hypotensive oils – lavender and clary sage.
- Mild asthma – avoid essential oils from flowers if mother suffers hay fever or asthma triggered by pollen.
- VBAC or previous uterine surgery– do not use uterine stimulating oils.
- Do not use uterine stimulating oils when using oxytocin or for 30 mins after Artificial Rupture of Membranes or 1 hour after administration of medicine for Induction of Labour (Burns et al 1999).
- Do not use uterine stimulating oils when: Pre-term Labour, Multiple Pregnancy, Transvers/ Unstable Lie
- Avoid clary sage if mother has excessive lochia or retained products of conception
- Broken/open/weeping skin
- Skin allergies
- Infected or sore skin conditions
- No massage on burns, even sunburn
- No massage on inflamed/ bruised areas, undiagnosed lumps and bumps
- Unhealed fractures or other acute injuries (wounds)
- Any history of haemorrhage
- No abdominal massage with previous Caesarean section or history of manual removal of placenta or an anterior placenta
- Pyrexia, illness or infection
- Varicose veins and history of deep vein thrombosis (Kimber 2002, Chang 2002)
- Do not take essential oils internally
- Essential oils should not be directly used undiluted onto the skin (except Frankincense, Peppermint and Lavender)
- Keep essential oils away from naked flames, they are highly flammable
- Keep essential oils away from children and babies
- All essential oils must be labelled
The Royal College of Midwives Position statement suggests that complementary therapies should be treated with the same degree of caution and expertise as other clinical interventions (RCM 2014). Education, training and assessment of midwives competence to use aromatherapy safely is essential. This education should include possible side effects and contraindications. (Tiran 2004, Tiran 2006, Burns et al 1999.). The pharmacological interactions between essential oils used for pregnancy and childbirth appear safe, especially in the dilution and applications advocated (Tisserand and Balacs 1999). Prolonged use (i.e. over a period of three or more months) will not be an issue so dermal sensitivities are unlikely to be a problem.
- A maximum of 3 different essential oils should be used in any one blend. With one exception: Jasmine or Clary Sage can be used for a retained placenta with normal blood loss.
- Essential oil profiles; a list of oils, uses, cautions and methods of application will be available in the aromatherapy cupboard or in the treatment room in clinical areas for competent midwives to use as reference. (Tiran 2004) (See Essential Oil Profiles)
- Do not top-up footbaths/baths use a freshly filled one.
- Do not use aromatherapy treatments in rapid succession. The effect of the treatment should be observed and the aroma be allowed to dissipate before another treatment is offered (Tiran 2014).
Effects on the Fetus
Avoid in the first trimester because some essential oils are emmenagogic. The placenta is a barrier to molecules but small molecules with molecular weights below 1000 are able to cross the placenta. Aromatherapy oils have molecular weighs of 250. However, crossing the placenta doesn’t mean toxicity- it depends on the constituents of the oils, plasma concentration of the compound and the safe dosage, quantities and duration of the oil are factors (Price & Price 2012, Tiran 2004, Tisserand and Balacs 1999). The immaturity of the fetal liver means that it is unable to metabolise compounds into more toxic ones (unlike adults) thus giving the fetus a degree of protection from any potentially harmful constituents in some essential oils. (Tiran 2004). The concentration of oils used, which will be for a short period of time, will not allow development of high plasma concentrations in the fetus.
Implications for Staff
Tisserand and Balacs (1999) suggest that important indicators of toxicity of essential oils are found through dosage levels, frequency of use and method of administration. They continue that massage using essential oils is very unlikely to result in toxicity to staff as the amount of oil used is so small and the absorption rate into the blood stream is low. Midwives will administer oils infrequently and not usually for long periods of time so absorption into the blood stream will be minimal. The risk of toxicity from inhalation of essential oils is very low even though the rate and depth of breathing influence the speed of absorption of essential oils into the blood stream. (Tisserand and Balacs, 1999). In the Oxford Study (Burns et al, 1999) found that 24 caregivers (0.3% in the 8 year study of 8058 women) reported adverse associated symptoms whilst attending women in labour: 19 complained of headache , 3 suffered nausea, 2 suffered watery eyes.
Midwives who have a natural tendency to skin or olfactory sensitivities should be cautious when using essential oils initially until they have assessed their personal response to each of the oils. (Tisserand and Balacs, 1999).
Pregnant Staff
There is no evidence to suggest that the essential oils are abortifacient or teratogenic when used appropriately (Tiran, 2014). Caution is recommended for midwives who are pregnant or who think that they are pregnant when using essential oils and uterine stimulating oils are definitely contraindicated for pregnant midwives. Adequate communication of the use of aromatherapy by the use of signs on doors and informing co-ordinators should be implemented to allow members of the healthcare team to avoid aromatherapy if they require.
Minimising the risk of sensitivities to midwives and maternity care assistants
There are a variety of sensitivities: skin irritation, mucous membrane irritation, contact sensitisation (Price & Price 2012). Possible sensitivities:
- Irritant contact dermatitis (ICD) caused by wet work, chemicals, and physical and biological agents;
- Allergic contact dermatitis (ACD) caused by sensitising chemicals; and,
- Occupational contact urticaria (OCU) caused by proteins in food or latex (Health and Safety Executive 2019 a)
- Neat essential oils should not be used directly on the skin.
- Avoid contact of essential oils with sensitive areas such as nose, eyes and face.
- Gloves can be used when blending, mixing and agitating.
- Mix oils on a flat surface in the room that they are to be used. Take the aromatherapy box into the room.
- Wash hands thoroughly after massaging and/or essential oil treatments.
- Do not store blended oils after use (Price & Price 2012).
Minimising risk of massage to midwives and maternity care assistants
Body massage may be defined as a series of non invasive manual techniques that affect one or more structures of the body; muscles, joints, skin, fatty tissue, fasciae, blood and lymphatic vessels, in order to release pain, reduce swelling, enhance mobility of joints and alleviate emotional and mental tension. Midwives providing massage need to be aware of the risk of musculoskeletal injury, and ensure they are using correct postures for manual handling. MSK injury includes: pain in the low back, neck, shoulders, wrists and thumbs (Health and Safety Executive 2009).
Adverse reaction may affect anyone coming into contact with essential oils
Skin
Wash skin with un perfumed soap to remove oil and expose skin to air to encourage evaporation of the oil
Eyes
If undiluted essential oil is accidentally splashed into the eyes: Flush the eyes with clean warm water, saline eye wash
Other
- Remove person suffering adverse reaction from oil source, or oil source from vicinity of person. Consider the birth partners in the room and sensitisation or allergies
- Ventilate the room if possible to facilitate evaporation.
- For any accident or adverse reaction with oils, complete a Datix form detailing incident and persons involved.
- In the unlikely event of a severe reaction follow the Anaphylaxis Guideline.
Ordering
Order from a reputable supplier with aromatherapy oils for clinical use with evidence of purity and small dark, glass bottles, with a dropper in the neck avoid oxidation . Safety data, expiry date and batch number should be on the bottle (Tiran 2000, Tiran 2016).
Storage
Degradation comes about from three main ways: oxygen, heat, and light.
- Oxygen that gets into the bottle and reacts with some of the constituents is called oxidation. This oxidation can affect the therapeutic properties of the essential oil, as well as render it more hazardous. The biggest hazard is increased risk for sensitization.
- Heat causes the more volatile constituents to evaporate more quickly. CO2 extracts are more prone to damage from heat than steam-distilled essential oils.
- Light Ultraviolet light promotes free radicals. Dark amber colored bottles are best at keeping UV light out (Price & Price 2012, Clarke 2008).
Shelf life is determined by the chemical composition of the essential oils, some of which oxidize or evaporate more quickly than others. The date of opening should be recorded on the bottle cap. Essential oil bottles should be correctly labelled with the date of opening and /or expiry date. It is recommended that clinical midwives who open the oil take responsibility for this.
- Essential oils which contain a lot of monoterpenes or oxides have the shortest shelf life, of approximately 6 months -1 year (Citrus oils: Mandarin, Grapefruit, Lemon, Eucalyptus). Ideally citrus oils should be refrigerated.
- Most All Other Essential Oils 2-3 Years(oils that contain a higher percentage of aldehydes, monoterpenols, esters, ethers, phenols or ketones.) (Frankincense, Lavender, Rose)
- Essential oils which contain a lot of phenols may last 3 years (Bergamot, Jasmine)
- Essential oils which contain ketones, monoterpenols, and/or esters have a shelf life of 4-5 years. (Peppermint, Ylang Ylang, Geranium, Chamomile, Clary Sage).
- The potentially longest-lasting essential oils contain lots of sesquiterpenes and sesquiterpenols which can last up to 6 years (Petitgrain)
- Grapeseed carrier oil should be replaced every 6-9 months (Tisserand 2016, Tiran, 2016, Tisserand & Young 2013, Price & Price 2012, Clarke 2008, Jacobson 2019).
The Classification, Labelling and Packaging of Chemicals Regulations (Government 2015) requires chemicals to be labelled correctly and packaged to; prevent escape of the chemical, not be adversely affected by the chemical, be strong enough to withstand normal handling and if the package has a replaceable closure this must continue to prevent escape even after repeated use (Health and Safety Executive 2019 b).
Disposal
Control of Substances Hazardous to Health Regulations (COSHH, 2002)
- Essential oils are flammable liquids.
- Essential oils should be stored in a sealed box in a locked cupboard (hospital)
- Waste diluted oils can be disposed of down the sink for footbaths, compresses and bowls of water.
- Waste oils mixed with carrier oil should be disposed of by wiping out the pot with a hand towel and disposing in a yellow bag.
- Equipment used for mixing, blending and treatment should be washed with soap and warm water and then be dried thoroughly.
- Expired, undiluted essential oils should be disposed of in the original bottle in the clinical waste.
Preventing exposure to harmful substances usually means a combination of some of the following controls:
- Keep the workplace well ventilated.
- Use good work techniques that avoid or minimise contact with harmful substances and minimise leaks and spills.
- Practice good hand care – remove contamination promptly, wash hands properly, dry thoroughly and moisturise regularly.
- For some tasks, you may also need to provide personal protective equipment like protective gloves, aprons and eye protection (Health and Safety Executive 2019 c).
- Chemicals, like other types of waste, can be harmful to human health or to the environment, either immediately or over an extended period of time. Chemical waste, needs to be disposed of safely (Health and Safety Executive 2019 d).
| Massage |
1 drop of essential oil in 5mls grapeseed oil (1%) 2 drops of essential oil in 10 mls grapeseed oil (1% concentration) 3 drops of essential oil in 15 mls grapeseed oil (1 % concentration) 4 drops of essential oil in 20 mls grapeseed oil (1%) 5 drops of essential oil in 25 mls grapeseed oil (1%) |
Essential Oil Profiles summary table. Detailed information can be located in the Essential Oils Aromatherapy Profiles document (2019)
| ESSENTIAL OIL |
INDICATION FOR USE |
CONTRA-INDICATIONS |
| BERGAMOT | Relaxation, reduction of anxiety, calming, reduces blood pressure, uplifting | Photo-sensitive. Caution in third trimester and early postnatal when clotting factors change - has anticoagulant effect |
| CHAMOMILE | Anxiety, tension, stress, headaches, insomnia, backache, nasal congestion, maternal pyrexia. | May be irritant if used neat and in large doses. |
| CLARY SAGE | Assist contractions, establish labour, backache. | Avoid use in women who have had previous uterine surgery. Not recommended for the birthing pool. Avoid if mother has excessive lochia or retained products of conception |
| EUCALYPTUS | To refresh and revitalise, backache, nasal congestion, maternal pyrexia. | Do not use in the birthing pool. Do not use in conjunction with homeopathic remedies. |
| FRANKINCENCE | Anxiety, tension, hyperventilating, hysteria, insomnia. | Avoid in asthmatic women. |
| GERANIUM | Relaxation, relieve anxiety and fear, calming, pain relief, wound healing, oedema. | Caution with hypertensive women due to astringent effect. |
| GRAPEFRUIT | Hypertension, nausea, analgesia, to uplift mood. | Avoid in women allergic to citrus fruit. |
| JASMINE | Reduce anxiety, stress, enhance uterine activity, induction of labour, retained placenta, analgesia. | Not to be used in threatened premature labour or women who have had previous uterine surgery. Not to be used in the pool |
| LAVENDER | Anxiety, tension , stress, insomnia for relaxation, headaches (not for women with multiple allergies or hay fever/ asthma) swollen perineum. | Avoid in women with hay fever or asthma triggered by pollen. Caution with hypotensive women. Can have sedative effect. |
| LEMON | Refresh and revitalise, nasal congestion. | Caution as this oil is phototoxic and may increase skin sensitivity to ultraviolet light causing accelerated burning. |
| MANDARIN | Anxiety, tension, stress, insomnia, refresh, to calm contractions | None reported. |
| PEPPERMINT | Nausea and/or vomiting, headache, maternal pyrexia, refresh, revitalise. | Not to be used in the pool. Avoid in women with cardiac compromise. Avoid in women with epilepsy and Diabetes. Inactive homeopathic remedies. May cause an irritation if used neat and in large doses. |
| PETIGRAIN | Relaxant, eases anxiety, nervous tension, panic, hypotensive, calming, eases transition and restlessness. | None reported |
| ROSE | To assist contractions, lift mood, calming, sedative, relieves stress | Not to be used in threatened premature labour or women who have had previous uterine surgery. Not to be used in the pool. |
| YLANG YLANG | Hypertension, stress, tachycardia, low mood, depression. | Avoid prolonged use – aroma may be overpowering. |
Methods of use of aromatherapy table
| Method | Dilution and Administration |
| Footbath | 4 drops of essential oil(s) mixed well in half a bowl of warm water. |
| Birthing pool | Mix 6-8 drops of essential oil(s) with 10 mls milk (full fat preferred) to disperse the oil in water evenly. Add to water and agitate well. Essential oil(s) may be used in pool whether the membranes are intact or ruptured. |
| One undiluted drop on forehead | For peppermint only to help prevent nausea and vomiting by affecting the vomiting centre of the brain very quickly. Although cooling, some women may experience a burning sensation instead. (Headaches/migraine may be alleviated by a drop on each temple of either peppermint or lavender). Ensure drop is in the centre of forehead, not too near the eyes |
| One undiluted drop on palm | For Frankincense only The mother is encouraged to inhale the scent from her palm. |
| Massage | 20mls of grapeseed carrier oil mixed with a total of 4 drops of essential oil(s). Blend a maximum of 3 essential oils together. Recommended for backache, anxiety, insomnia and relieving pruritis. Feet, legs, arms, back, shoulders, and lower abdomen may all be massaged. |
| Taper or drop on pillow | A drop on a strip of absorbent card or cotton wool can be used for any essential oil. |
| Compress | Fill half a bowl of water (1 litre), float flannel, add 4 drops and wring out flannel. Apply to area and cover with small towel to increase skin absorption. Re-wet flannel when required or when it has reached maternal body temperature. |
| Mood lamp diffuser | All labour ward rooms have a mood lamp which can also diffuse aromatherapy. Fill with 100ml water and add 6 drops of essential oils. Use for up to 60 minutes with a rest period where the diffuser is turned off for the same amount of time. Intermittent use more effective. |
| Perineal lavage | For chamomile and lavender only. After suturing, add 3 drops of essential oil(s) to a litre sterile jug. Fill jug with warm water. Pour over perineum, with mother over a bedpan. |
| Perineal pack | Soak a sanitary pad in either iced water or warm water infused with 4 drops of aromatherapy oil |