Repeatedly, doulas discuss whether or not it’s in their scope of practice to recommend or use essential oils and aromatherapy. While that is a part of the discussion, it really isn’t the central issue. What we need to recognize is an underlying philosophical difference between doulas. The core issue is whether it the doula’s role to DO more to moms or just to BE present with her as the labor unfolds. In the DO camp, people say they want to have more tools in their birth bag. When a few simple sniffs can help with nausea, mood, or even help a woman to urinate, that is a good thing. There are so many other interventions happening with the labor, using oils can help to counter them and bring the labor back into balance – or at least make the laboring mother feel better.
The BE group tends to feel that mothers have enough people trying to alter the course of her labor. These doulas feel their strength is in the support they bring and the use of comfort measures to alleviate discomfort, not to change what is happening in the labor or what mother is feeling. Being “present with” and supporting the mother 100% means not seeing her or her labor as a problem that needs to be fixed. Doulas are usually the only ones who are not trying to will things to be different than what they are. In a postpartum context, these issues are still present. Is it our support that makes a difference or is it the tools we bring to help with post birth discomforts? There is also a baby to consider, whose system may react differently than expected to scents and oils.
The BE-la vs. DO-la* debate isn’t new, but it reflects one of the philosophical differences between doulas. I don’t think either of these approaches is wrong, but each leads us in a different direction. As a community we haven’t formally acknowledged these two approaches. The essential oils issue brings them to the forefront, and offers an effective way to frame this discussion. If you’re a DO-la, using essential oils and/or aromatherapy makes sense.
The second issue with essential oils and aromatherapy is more practical. Is there a potential for harm when they are used? The answer is clearly “yes”. People can get burned and have unexpected adverse reactions (headache, migraine, nausea, allergic reactions, skin sensitization, phototoxicity, etc). For example, the desired result of calming a mother by using lavender can have the unintended effect of lessening contraction strength and frequency. However, often these reactions are not common enough to discourage them from being sold to unwary doulas, who see themselves as trying to help mothers. If you haven’t had an adverse reaction yourself, it’s hard to imagine that someone else might.
Essential oils are drugs. They are processed products that are used with the intention of altering what is already occurring. They smell nice, have fun names, and are easily available. You can buy them at parties! But that does not mean they are benign. Rather they are potent substances deserving of respect and care. Many hospitals need to chart their use in labor. For these reasons, using essential oils as an untrained doula should be avoided. Some would say that is enough reason for doulas to always leave them alone.
One of the core tenets for almost any doula is that the mother should be free to make her own choices, and the doula’s role is to fully support her in those choices. Including essential oils and/or aromatherapy as part of one’s practice could certainly be one of those choices, if you know what you’re doing. It just seems so simple to pair a scent with a relaxation exercise during pregnancy to condition the mother to relax when smelling the same scent in early or active labor. However if you want to use this powerful tool, you need to take full responsibility for it. To me that means going over all the risks of using essential oil therapy as well as the benefits, and having your client acknowledge that in writing.
The risks to the mother if the doula isn’t fully informed are great. They are not “safe” and any web site that makes that claim is wrong. According to one doula, you can be liable for prosecution if there is a negative consequence, depending on how your state’s legislation is written. She suggests that the way to protect yourself and your client is to pair with a certified aromatherapist and have them make the recommendations. The doula follows through on what the mother wants to do based on the consultation. The risks to our profession are even higher. Doulas are in a tentative position in many communities, and a black mark against one doula causing harm to a mother can easily spread. I don’t want to be alarmist, but our position is precarious in some communities. I often think that newer doulas are not considering how their actions affect everyone else. We live in a global world now. This means you have a responsibility to other doulas and our profession once you begin to use the title of “doula”.
These days there’s really no excuse for not getting educated by completing a high quality course and engaging in ongoing discussions with others who use oils dermally and as aromatherapy. Birth Arts International offers a self paced course specifically for doulas. (If you know of others, please put them in the comments section.) As with all things, if the course is being offered by someone who is also selling you a specific brand of products, sales may be their primary motivator. You may not receive objective information or even the breadth of experience you’d like in an instructor about their use during pregnancy, labor, and postpartum.
Some certifying doula organizations prohibit the use of essential oils or aromatherapy, taking the stance that they are drugs. Others advocate that doulas interested in this therapy take formal education or certification so they can be used properly and follow an aromatherapy standard of practice. Others have no opinion on the matter.  This confuses the average doula who just wants to help mothers. The better we understand what the debate is really about – philosophically, educationally, and professionally, the better we can support each other to find our own right actions.
Note: In the interest of full disclosure, I have used essential oils on several occasions, most notably on my dog when he was dying of untreatable cancer. I would don gloves and a facial mask twice a day and apply the oils in several places on his body. The veterinarian, oil consultant, and I are all convinced that their application made him more comfortable, stimulating his appetite, minimizing his discomfort, and lengthening his life. Second, my body does not respond positively to essential oils. There are very few that do not irritate my skin or cause other unpleasant symptoms, including migraine headaches. However I have close friends and midwives who have been using them in their professional practices with people and animals for a long time. All of them have taken educational courses to gain the knowledge to use them appropriately and safely. Because of these experiences, I have a healthy respect for the power of essential oils.
 At my last count, there were 26 certifying organizations in the U.S. alone, so I’m not going into detail. Feel free to put your group’s stance in the comments section.
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