The Essential (Oil) Dilemma

Apr 30, 2015 by

EOflowerphotoRepeatedly, 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).[1]  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. [2] 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. 

 

*Thank you to Gena Kirby and Lesley Everest who introduced me to this phrase.

[1] http://www.agoraindex.org/Frag_Dem/eosafety.html

https://www.naha.org/explore-aromatherapy/safety/

[2] 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.

 

As always, if you like what you read, please subscribe!  The link is over there on the right ——–>

 

28 Comments

  1. Thanks so much for this post. I used to be in the camp that said we should get to use oils and I looked for all the “loopholes” available for me to use them as a doula. I do purchase oils through a network marketing company for myself and people buy them for me and for a while, I included this service as a part of my doula practice, citing my education from the MLM as credible. I now am so much more conservative and know that not only is skewed information from an MLM not adequate as aromatherapy training, but I really don’t feel that using these as a doula without formal training is appropriate. Knowledge comes with maturity and experience!

  2. Amy Gilliland

    Here is a column by an aromatherapist blogger on the long term and sometimes irreversible negative effects on internal organs when essential oils are added to your drinking water. It surprised me that it could be so much worse than I thought, yet people don’t realize the practice can be harmful.

    http://www.thebarefootdragonfly.com/why-essential-oils-are-not-water-flavoring-agents/

    The author, Amy Kreydin, is a Board Certified Reflexologist and Clinically-trained Aromatherapist, in private practice since 2004.

  3. Alyse Erbele

    I appreciate seeing the deeper issue.
    I like Emily’s statement, “I am a BE-la, but I always bring my DO-la bag.”

    I see my bag as tools for the mom to ask for instead of me using.

    My frustration is that frequently the people who are trained through a MLM refuse to hear that there are risks to using EOs.

    I had a quick reaction when a careprovider who used a diffuser and had spilled on their hands and then touched my face. I said that I was concerned if patients didn’t know and came into the office, and their reasoning for not worrying about patients telling was that it was diffused, not used undiluted.

    I had to carefully explain that since I had reacted, I could be sensitized to it being used in the air.

    I am alarmed that EOs are the first thing people turn to.

    • Alyse

      I assumed that everyone know that MLMs are multi-level marketing sales, such as Pampered Chef or Tupperware.

  4. I also teach an Aromatherapy course for Birthworkers as well through Sacred Scent which is a sister program of Sacred pregnancy. The next course will May 13th , 2015. https://www.facebook.com/sacredscent…….and http://www.sacredlivingmovement.com/#!spring-with-divinity/c1u57. I am an Certified Aromatherapist, Herbalist, Labor and Postpartum Doula, MPA, Certified Childbirth Educator and Scheduled to sit for the IBCLE 2016.

    Here are links to my other business websites: https://www.facebook.com/peacefulheartherbals
    https://www.facebook.com/ZenandTeas

  5. Melinda Delisle-Clark

    Thank you for a poignant and thoughtful post! IMHO, even if one is trained in the use of essential oils, applying them to the skin when there is the potential for harmful effects is unwise. Because the active nature of the oils is absorbed so quickly, this eliminates the ability to be able to remove the oil and its effects if a negative reaction occurs. I believe that this also applies to diffusers. Isn’t one of the biggest objections to Cytotec (other than labor induction being a risky off-label use) the fact that the pill can not be removed if a mother develops bad complications in response to it? I do not recommend specific essential oils in my childbirth classes. I do recommend that any of my students who want to use essential oils or other, more innocuous, scents during labor do their research, and only use them applied to a tissue or cotton ball that can be bagged or removed in the event of a negative reaction.

    • Penny

      This is exactly why Demetria Clark in her course talks about Aroma-Assault and making sure the blend can be removed.

  6. JudyC

    This is an excellent article. From my experience as a midwife: I had two women labouring at the same time in a hospital, both wanting to birth in water and only one bath. The first women birthed and we moved her out while other staff cleaned the bath and filled it for the next. One decided the room needed a pretty smell and put a little lemon oil somewhere but the second woman hated it and it made her feel unwell. We got rid of it pretty fast. No harm done but an example of an inappropriate use. For the record they both had their lovely waterbirths 1hr and 19 minutes apart and became friends through shared experience.

  7. Pen

    Thank you. I am in the Birth Arts International Aromatherapy course and it is really challenging and amazing course. It is really cool to learn the science behind why these oils work. Thank you for sharing about aromatherapy and birth work. With so many unsafe practices going around it is good to know a source for safe ones.

  8. Amy Gilliland

    Thank you all for your comments! Lesley Everest, Ashley Lovell and Emily Clark pointed out that in our responsiveness to the mother and her labor, we may sometimes be BE-la’s and sometimes be DO-la’s. I agree that at a particular labor that’s true. But I also feel that each doula has a philosophical orientation to The Work, and it may change over time. As I said in the essay, I don’t have judgment about either one – they’re both acceptable. I was reminded of the lyrics in Frank Sinatra’s famous song Strangers In The Night, “Do Be Do Be Do, Be Do Be Do Be, Do Be Do”.

    • Emily Clark, CD(DONA), CPD(CBI), CLC

      I am always so appreciative of your posts, Amy. Not only do they always start a really fascinating dialogue among such esteemed colleagues, but they always push me to examine my practices and beliefs. It’s invaluable, thank you!

  9. I offer my clients pre-mixed massage oils made with EOs, but they are mixed specifically for labor and birth, by an RN and aromatherapist. I had not thought that I should get them to sign a release, or get a thorough description of benefits and risks for them. How eye-opening for me! I always encourage them to ask for benefits and risks, and I did not do the same! Thanks for this powerful reminder. I also think what we do is different for each client (the do vs. be philosophy), and I’m not sure that many people would hire us if we only stated that we are “be-las”. A doula is an intervention, even if she just stands there, so really we are just talking about different styles, and to be successful in a small market, we have to be willing to adjust our styles to suit the client.

  10. Love this!! Thank you for articulating this subject so well!

  11. Even with certification in aromatherapy, EOs can be problematic. I never “recommend” oils, as that would suggest I am promoting the use of oils. We do discuss them, however. Many women have a very strong, favourable connection to scent feel amazing supported by an oil which soothes or uplifts them. And others don’t. That is easily verifyable before birth. I talk about the tools I can potentially use to support in labour, and see what the responses are. If they are good, I suggest research and then choice.

    I don’t know if there are two clesr trajectories doulas follow, the DOs and the BEs. Certainly one may have a tendancy towards the other, but it may not be as black and white. I think of myself as a responsive doula. I BE, birthed BEs…until I am guided to support her system so change can happen. EOs should not necessarily be seen in the allopathic, prescriptive, doing model (though it can be used as such) For those who love lavender, an alterative herb (which tends to shape shift into the energy needed in the moment), providing a drop on a tissue, which can be easily flushed, can create a deep relaxation response. That is not do-ing, it is kind of more UN-doing. It can weave a sense of deep nurturing and safety in some people. It is this presence of calm in scent form (instead of doula BEing) form which allows Body/mind to feel into its relaxation. In doing so, things can reboot and positive hormonal/emotional responses can arise and promote healing. My use of EOs are for emotional support. If a physiological response arises, nice.

  12. There is a lot of discussion about essential oils and I appreciated your comparison between two types of doulas. I would also add that there are also those for whom culture plays a part in their use of essential oils, teas or of flowers, leaves, or roots during the birthing year. So it may not necessarily be a matter not choosing to simply “be” with the birthing mother… It may mean that the “being” means something slightly different for them. Overall, however, I agree that individuals should be educated about the potency of these elements when added to the birthing environment, because all over the world, people still use variations of plants as drugs (as you stated) and they can greatly influence pregnancy, childbirth, and postpartum.

    • Amy Gilliland

      That is an important issue to bring up, and I’m glad that you did. Emily Clark’s comment about sometimes you’re one or the other depending on what mom wants or how her labor unfolds is also relevant. But I would imagine that part of one’s cultural training is also when to use xxx or when not to, so you’d get the education in an informal way. It’s the understanding of all the possibilities and communicating that to your clients that is my main point.

  13. Patty Brennan

    How about empowering the mother so that, if she wants to use essential oils at her birth, SHE is the one to bring them and choose?

  14. Emily Clark, CD(DONA), CPD(CBI), CLC

    My two cents: I would heartily agree that EOs should be handled with great care, by an educated doula and a fully informed client. They ARE interventions. But so is doing an abdominal release, giving a massage, guided relaxation, using hot and cold packs, using a rebozo, and encouraging a client to do a miles circuit instead of staying in bed. These are all comfort measures that are done to support our clients but also to change what she is feeling. Rarely are doulas also licensed massage therapists, craniosacral therapists, chiropractors, hypnotherapists, or Certified Rebozo Practioners (although can we make that a thing? Gena?). There have certainly been births where I am a BE-la, and it is a wondrous, valuable thing, to simply be present. But I would guess that even if we have a BE-la philosophy, most of us end up a DO-la in some capacity at births. Lavender can slow down labor, so can a warm bath. Certain essential oils applied to skin can cause allergic reaction or contact burns, so can an improperly applied ice or hot pack. A doula should be aware if a client has a sensitivity to an oil before using it, just like she should be aware if the client had a health problem that would make it dangerous to do certain positioning. I would agree that we should be concerned with how doulas are presenting themselves in hospital settings, but I would guess more doulas get the stink-eye for supporting a woman into a hands and knees position than for diffusing lavender and grapefruit in the room. I think we should focus on helping doulas gain better professional and ethical conduct, and encourage more comprehensive training within basic doula workshops in areas like rebozo technique, aromatherapy, and massage (and breastfeeding!). Continuing to limit the scope of practice and warn of impending liability makes certification less desirable for doulas that would like to utilize these techniques, which means our profession continues to fracture.

    • Amy Gilliland

      I agree with you Emily except your point about certification. I think this issue has little to do with the certification decision. Your examples rely on the doula’s awareness that whatever strategy they are using could go either way. My point is that doulas wanting to use to essential oils with clients are usually unaware of these unintended consequences because they don’t have enough education.

      • Emily Clark

        You have done the research on the pros and cons of certification, so I will defer to your expertise in that area! I think the scope of practice conversation, as it pertains to tools and techniques, is one I get more fired up about. In the end, we want the same thing- more awareness. So I want a “Learn More!” sign, and not “Beware!” Because if we are going to be hanging “Beware!” signs, we are going to have to hang them on everything we do. I find that the more knowledgeable and comfortable I become with certain techniques, the more conservative and measured I am in using them. I am a BE-la, but I always bring my DO-la bag.
        As always, thank you for taking on the important topics. It helps me tremendously.

        • Amy Gilliland

          Since I don’t use essential oils, I think the best analogy I can make is with hypnotherapy. I’ve taken 40 hours of instruction (including 16 hours from Phyllis Klaus), as well as used many techniques myself. They work! I have used them with clients to lower their blood pressure, reduce anxiety, and to get baby to turn into a more optimal position for labor. However, its mucking around in someone’s consciousness, which I do not take lightly. The best hypnotherapy is self-hynosis. In fact, some would say all of it is self-hypnosis. So I do give a very complete disclosure, stating exactly what we’ll do, and that it might not get the desired results. I prefer to have another adult present who the mother feels safe with and to tape record the session. To me, this is prudent protection for me and reassuring for the mother. I love this tool but don’t use it often.
          So I agree with you, Emily, and don’t want doulas to be wandering around feeling “I can’t”. Instead, I would prefer doulas to be empowered by extending their education and to choose to offer their DO-la tools judiciously.

    • Jolene Simpson, CHD (DONA trailed)

      Very well stated, Emily. I agree with all your comments.

  15. Thank you so much for writing so succintly about the role of the doula and essential oils. EOs are powerful natural medicines that can help and hurt. I believe fully that one must be a trained aromatherapist (not a MLM rep with sales training that is presented as thorough) in order to recommend and administer EOs. And then you are doing that as an aromatherapist and NOT as a doula. Thank you, thank you!

  16. Amy Gilliland

    DONA International’s stance is that essential oils and aromatherapy are not forbidden, however the doula needs to get extra education, training and/or certification in their use. That way the doula is informed about the pros and cons of using them, and can discuss it with her client beforehand.

Trackbacks/Pingbacks

  1. Wednesday Wrap Up May 6 | Andrea Lythgoe Doula Salt Lake City Utah - […] Gilliland has written an excellent article on The Essential Oil Dilemma – I am very much on the side…

Let me know what you're thinking

%d bloggers like this: