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Aromatherapy in childbirth: An effective

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Article in British Journal of Midwifery · October 2000

DOI: 10.12968/bjom.2000.8.10.8065

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 RESEARCH
Aromatherapy in childbirth:
An effective approach to care
By Ethel E Burns, Caroline Blamey and Andrew J Lloyd
I
n recent years there has been an
undisputed rise in interest among the
public and health professionals in the
use of complementary therapies
(Trevelyan, 1998).
Aromatherapy has been cited as the most
popular complementary therapy by mid-
wives (NHS Confederation, 1997). Despite
this trend, there is little available evidence
on the use of aromatherapy in midwifery
practice, apart from two studies which
explored the effect of lavender oil on pain
in labour and perineal pain postpartum,
(Reed and Norfolk, 1993; Dale and
Cornwell, 1994).
The present study evolved over an 8-year
period (1990–98) involving over 8000 moth-
ers and builds on an exploratory 6-month
sample of 585 mothers from the same study
centre (Burns and Blamey, 1994).
Research design
This was an evaluative study of a cohort of
mothers who all used aromatherapy dur-
ing childbirth. Mothers admitted in labour
to delivery suite between 1990–8 were
offered the option of aromatherapy.
Informed consent preceded any aro-
matherapy administration. Following dis-
cussion with her midwife, each mother
was individually assessed and the essential
oil(s) chosen, together with the mode of
application to suit her requirements.
Administration of oils was largely directed
according to the guidelines which were
drawn up with the assistance of a consul-
tant aromatherapist (Blamey and Burns,
1993). Any mother, irrespective of their
obstetric history or current risk factors,
was eligible for aromatherapy, with the
following exceptions:
 Lavender oil was avoided by mothers with
asthma-related hay fever. This followed
anecdotal feedback from midwives of
mothers with asthma-related hay fever
BRITISH JOURNAL OF MIDWIFERY, OCTOBER 2000, VOL 8, NO 10
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ABSTRACT
This article discusses findings from a large evaluative study on the use
of aromatherapy in childbirth (Burns et al, 1999). The sample involved
8058 mothers and took place on the delivery suite of a busy teaching
unit. A primary objective was to examine whether aromatherapy could
facilitate maternal coping mechanisms during labour by improving
mothers’ sense of wellbeing, reducing anxiety and fear and influencing
the perception of pain. Mothers consistently rated the administration of
aromatherapy positively. Aromatherapy was found to be an inexpensive
choice for mothers. Only 100 mothers reported minor side-effects
associated with essential oil administration. This study provides a
valuable insight into the potential for the use of a aromatherapy in
midwifery practice.
reporting headache, sickness and/or nau-
Ethel E Burns PGDip DPSM
sea after lavender administration.
RM is a Research Associate
 Mothers with multiple allergies only Midwife and Andrew J Lloyd
used chamomile. Chamomile has a high DPhil is a Senior Research
degree of esters in its molecular make- Fellow at the Oxford Centre
up and these are known for their calm- for Health Care Research and
ing, anti-inflammatory and anti-spas-
Development, Oxford Brookes
University; and Caroline
modic action (Franchomme lecture, Blamey MISPA RM is a
1990; Lawless, 1996; Price and Price, Midwife Aromatherapist at
1999). The authors were aware of the the Oxford Radcliffe NHS
need for absolute safety when introduc- Hospital Trust.
ing a new care option. Therefore,
This article was accepted for
although other essential oils were poten- publication on 31 August
tially safe to use with highly sensitized 2000
women, chamomile was deemed to be
the safest for use during the study.
 Peppermint, eucalyptus and clary sage
were not used in the birthing pool.
Peppermint and eucalyptus both
increase topical blood circulation which
is perceived by the recipient as cooling
on the skin (Price and Price, 1999). It
was a concern that, potentially, these
may have the effect of inducing a prema-
ture gasp in babies born underwater. In
the study centre, clary sage was used to
augment contractions. However, for
mothers who were not progressing in
labour, it was felt more appropriate that
mothers should leave the pool.
639
 RESEARCH

 Pregnant midwives avoided using pep- onset (spontaneous or induced), broad-

permint or clary sage. Peppermint and ened the range of the study.
clary sage have chemical constituents
which may induce menstruation and are Administration and modes of application
therefore best avoided in pregnancy Table 1 details the ten essential oils used in
(Lawless, 1996; Davis, 1993; Tiran, 1996). the study alongside the rationale for their
The availability of aromatherapy to use based upon their presumptive quali-
mothers, whatever their parity or labour ties (Lawless, 1996; Sapsford, 1993; Burns
and Blamey, 1994). Essential oils were
usually applied individually to simplify the
Table 1 Essential oils used in the study and rationale for use evaluation. Sweet almond oil was used as a
carrier oil.
Modes of aromatherapy application
Latin name Botanical Rationale for
included:
Essential oil Country of origin source use in labour
 Footbath
Lavender Lavandula Lamiaceae For anxiety, tension, stress,  Birthing pool
Angustifolium relaxation, headaches
 Droplet on forehead or palm
France and after perineal suturing
 Massage
Frankincense Boswellia Carteri Burseraceae For high anxiety,  Taper or drop on pillow or clothing
Olibanum Somalia hyper ventilation, hysteria
 Compress
Clar y Sage Salvia Sclarea Lamiaceae For assisting contractions  Inhalation via bowl
Russia to enhance labour  Perineal lavage.
Peppermint Mentha Piperita Lamiaceae For nausea and vomiting, In 1997, author CB qualified as an aro-
China headaches, pyrexia matherapist and adopted the supervisory
Lemon Citrus Limonum Rutaceae For upper respirator y tract and educator role for midwives.
Argentina infections, to enhance mood
Data collection and analysis
Mandarin Citrus Reticulata Rutaceae For relaxation,
Argentina to enhance mood Prospective information was collected on
the following variables:
Rose Absolute Rosa Centifolia Rosaceae For depression, anxiety
 Reason(s) for administration
Morocco or bereavement,
to enhance labour  Mode(s) of application
 Stage of labour administered
Jasmine Jasminum Jasminaceae For depression or anxiety,
 Maternal parity
Grandiflorum to assist labour, to help
Morocco expel placentae  Onset of labour
 Type of pain relief before and after
Eucalyptus Eucalyptus Globulus Myr taceae For nasal congestion,
administration
China pain relief
 Type of delivery and any associated
Roman Chamaemelum Nobile Asteraceae For mothers with multiple side-effects.
Chamomile Chile allergies, ezcema, anxiety,
Mothers’ and midwives’ ratings of effective-
and after perineal suturing
ness (on Likert scales) were also recorded
in a revised questionnaire which was intro-
duced in 1993. Therefore this data was
Table 2. Maternal effectiveness ratings of peppermint oil by available for 48% of mothers overall.
stage of labour Data was entered onto a database and
subsequently analysed, using a statistical
Stage of labour Helpful Equivocal Not helpful  programme (SPSS). The data was analysed
Latent 54 (54%) 25 (25%) 20 (20%) 17.2† to test whether the use of aromatherapy
Established 151 (50%) 105 (34%) 49 (16%) 47.4†
could assist maternal coping mechanisms
in labour by alleviating anxiety, fear, pain;
Transition 12 (75%) 3 (19%) 1 (6%) 12.9† nausea and/or vomiting and enhance the
2nd and 3rd stage 11 (42%) 9 (34%) 6 (23%) 1.5 mother’s sense of wellbeing. Information
Total 228 (51%) 142 (32%) 76 (17%) was also analysed on mothers with dys-
functional labour who had aromatherapy
* The 2 test was used to determine whether the pattern of responses as helpful, equivocal or not helpful
to improve their contractions. Mothers’
occurred by chance (i.e. equal propor tions in each column) † P<0.01
effectiveness ratings by stage of labour

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 (Table 2) and by reasons associated with whereas only 13% of mothers and
maternal wellbeing (Table 3) were com- 12% of midwives rated it as
pared using a  analysis. unhelpful. Aromatherapy was an
inexpensive option costing less
than £800 in 1997, when it was
Results used by 1592 mothers.
Use of essential oils
Between 1990–98, aromatherapy became Aromatherapy to ease nausea
an increasingly popular choice among and/or vomiting
mothers in the unit during labour. During A total of 14% (n = 1104) mothers
the years of the study a total of 8058 used peppermint oil to alleviate
women used aromatherapy during child- nausea and/or vomiting. Table 2
birth. A broad range of mothers used aro- indicates that most mothers found
matherapy with a significant rise in uptake it ‘helpful’ with only 17% rating it
among both primigravidae and multigravi- as ‘unhelpful’. Statistical analysis
dae whose labour was induced. The study of women in the latent and estab-
sample consisted of 60% primigravidae. lished phases of labour revealed
Mothers mostly used aromatherapy in that significantly more women
established labour (60%), or in the latent reported peppermint as helpful
phase (29%). The remainder had aro- than equivocal or unhelpful.
matherapy in the operating theatre or
immediately following delivery. Aromatherapy to enhance
The highest proportion of mothers used maternal wellbeing
aromatherapy to reduce anxiety and/or fear Aromatherapy was used by 7%
60% (n = 4853) and a further 7% (n = 537) (n = 579) of mothers for a cluster
used it to alleviate pain. Aromatherapy was of reasons categorized as wellbe-
used to augment contractions by 523 moth- ing. Table 3 details maternal effectiveness
ers, when clinical staff considered that the ratings by the reasons for administration.
labour progress was slow. The majority of Again, most mothers rated aromatherapy
these mothers, 86% (n = 451), used clary as ‘helpful’ when given to enhance their
sage. It is difficult to quantify the augmen- sense of wellbeing.
tation effect of clary sage directly. However, Mothers rated oils as ‘helpful’ significant-
it is interesting to note that of the multi- ly more frequently when administered to
gravidae in spontaneous labour who ‘uplift spirits’, for ‘blocked nose/sinusitis/
received clary sage, 70% did not subse- cold’ and when given at ‘mother’s request’.
quently require intravenous oxytocin. Reasons in ‘other’ included feelings of
Aromatherapy was not found to be harm- fearfulness of the new environment, tearful-
ful. Out of a total of 8058 mothers, less than ness, fatigue, pruritis, grief. The three
1% (n = 100) reported associated symptoms essential oils most used to improve mater-
which were normally very minor. These nal wellbeing were eucalyptus 34%
included: nausea/vomiting (n = 60);
rash/itching (n = 15); hay fever/watery eyes Table 3. Maternal effectiveness ratings for oils used for wellbeing
(n = 3). There were nine reports of precipitate by reason for administration
labour following aromatherapy administra-
Reasons n Helpful Equivocal Not helpful 2
tion. It is important to note that none of the
nine reports of rapid labour resulted in a Blocked nose,
compromised mother or baby. Nausea and sinusitis/cold 208 53% 35% 12% 21.9*
vomiting is a common feature of many Uplift spirits 202 48% 35% 17% 11.1*
labours and so it is difficult to attribute this to Mother’s request 71 53% 39% 8% 11.2*
the essential oils with any certainty. As with
any other treatment, midwives should inform Refresh 67 51% 29% 20% 5.5
mothers of the possible side-effects of aro- Other 31 71% 29% 0% –
matherapy.
Total 579 53% 34% 13%
Both mothers and midwives most com-
* P<0.01
monly rated aromatherapy as helpful (50%),

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 RESEARCH

(n = 194), lemon 19% (111) and mandarin fear and pain in different health-care set-
17% (99). Oxydes in eucalyptus provide a tings (Stevenson, 1994; Dunn et al 1995).
decongestant action, and terpenes alleviate
Lavender oil contains linalool to be
pain (Tiran, 1996). Lactones in lemon oil
one of many aromatherapy eye, inhaled
can uplift mood (Manley, 1993). Both lemon (inhaled). After filling out the pretest
and mandarin also possess aldehydes which questionnaire, the respondent was given
can be calming (Tiran, 1996). lavender aromatherapy intervention
dropped by five drops with 30 ml of air
Aromatherapy to reduce anxiety, fear evaporated for 15 minutes for the patient
and pain to breathe. Then done posttest. After 60
Anxiety and fear are key elements of the minutes, 90 minutes or 8-9 cervical
pain cycle. A total of 68% (5390) of the discharge is done second posttest. The
mothers used aromatherapy to reduce their positive impact of aromatherapy to
anxiety, fear or pain. Table 4 shows the decrease the level of hatred will be more
rates of pharmacological pain relief before pronounced if given directly (inhalation)
and after the administration of aromathera- the distance between the furnace or
py for anxiety/fear/pain and the types of vapolizer with the patient 30 cm, because
delivery, by parity and labour onset. The it has a direct relationship with the brain
practice of aromatherapy tended to precede that produce aromatherapy effect.
the use of pharmacological forms of pain
relief. The spontaneous vaginal delivery Discussion
rate was higher in all four groups than that
The study suggests that aromatherapy has
of the study centre (Burns et al, 1999). It is
the potential to assist mothers in childbirth.
interesting to note that 14% (n = 750) of the
Despite initiatives introduced to improve
mothers used aromatherapy alone, 37%
maternal choice for care during labour,
(n = 281) of whom were primigravidae in
choices available to mothers giving birth in
spontaneous labour. The two predominant
hospital delivery suites in the UK remain
essential oils used to reduce anxiety, fear
limited (District Audit, 1997).
and pain were lavender, 53% (n = 2847) and
The dominant features within delivery
frankincense, 31% (n = 1677). These oils
rooms remain the mechanical bed, monitor
have calming and analgesic properties
and resuscitaire, even though there may be
which have been shown to reduce anxiety,
pleasant wallpaper and curtains. The first
recourse to assist mothers with the pain of
Table 4. Uptake of pain relief and type of delivery for aromatherapy labour still tends to be the administration of
administered for anxiety/ fear/pain, by parity and labour onset pharmacological pain relief. Options such
as a floor mattress or a beanbag are some-
Primigravidae Multigravidae times provided but not necessarily on view.
Spontaneous Induced Spontaneous Induced
Many units have a birthing pool facility but
(n=2070) (n=933) (n=1186) (n=650)
the promotion of this option varies.
Epidural-before 1% 3% 1.3% 2% Mothers wishing to use complementary
Epidural-after 35% 56% 14% 27% therapies are often discouraged or asked to
assume total responsibility. At the same
Entonox-before 35% 22% 30% 17%
time, midwives are expected to extend their
Entonox-after 62% 55% 62% 59% knowledge base of complementary thera-
Pethidine-before 1.4% 1.5% 0.4% 0.3% pies in order to offer greater choice (UKCC,
1998). Aromatherapy is one complementary
Pethidine-after 4% 4% 1% 3%
therapy that can facilitate a mother’s ability
Spontaneous bir th 67% 54% 91% 86% to mobilise and adopt different positions
Vaginal operative during labour, maximising her control and
deliver y 27% 32% 5% 10% coping mechanisms, thereby reducing anxi-
Vaginal breech 1% <1% 1% 2% ety. The influence on mood and behaviour
of olfactory stimulation has been studied
Emergency
(Warren and Warrenburg, 1993; Martin
Caesarean section 6% 14% 3% 4%
1996).

642 BRITISH JOURNAL OF MIDWIFERY, OCTOBER 2000, VOL 8, NO 10

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 Conclusion
Although exciting, the findings of this study
require greater scrutiny in the form of fur-
ther research. It is extremely difficult to con-
trol the effects of confounding factors in this
type of evaluative study. The authors are
planning to take this work forward by testing
specific ideas with the use of randomized
controlled trials, incorporating both qualita-
tive and quantitative methods.
There is a need for greater rigour in the
research of complementary therapies in the
UK. For this to happen, there needs to be a
commitment to allocate funding as a priori-
ty (Worth, 1999). It is hoped that traditional
sources such as the Medical Research
Council and other similar bodies, will rec-
ognize the importance of supporting multi-
centre research collaboration. BJM
Acknowledgements
The authors wish to thank all the mothers and
midwives who participated in this study. The
authors are also grateful to Dr Steve Ersser, Dr
Alex Smarason, Ms Lin Barnetson and Mrs
Christine Sapsford for their support and advice
and Purple Flame Aromatherapy for the
generous donation of essential oils in the first
year of the study.
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KEY POINTS
 Aromatherapy can assist maternal coping mechanisms by reducing anxiety,
fear and pain; feelings of nausea and enhancing general wellbeing.
 This example of integrated midwifery practice widens the scope for future
research.
 Aromatherapy offers mothers another choice in childbir th.
 Aromatherapy is a tool that can assist midwives to gain greater
confidence in being with woman.
643