Essential oils can be administered in water, such as in the bath or a foot bath, or applied locally as a compress. Contact with the skin causes the oils to absorb down the hair shafts into the circulation. In addition, the heat of the water and the steam encourages greater absorption via the respiratory tract, making baths or foot baths an especially beneficial means of administering the oils.
Essential oils should not be added to the water neat – although they are not actually oily in consistency, they do float on the surface of the water. If the woman came into contact with the oils as she immersed herself in the bath water, she would have neat essential oil on her skin, which could cause contact dermatitis, if susceptible. The ‘dose’ for essential oils in water is not calculated in percentages as with massage blends. Between 4 and 6 drops of essential oil in total (maximum three oils) can be added, preferably as the water is running into the bath so that the agitation will facilitate the spread of the essential oils throughout the water. For a bath, the neat essential oils should be mixed into a few millilitres of carrier oil (e.g. grapeseed oil). Milk can also be used but it must be full-fat (not semi-skimmed or skimmed) as the essential oils are dispersed through the fatty globules. If a foot bath is to be given, a large bowl is filled with water (hot to touch or cold as required)
and 2–3 drops of essential oil can be added. A carrier oil is not necessary in this case, as the oils can be dispersed by hand in this smaller amount of water.
Compresses can be made by soaking a cloth (face flannel, tea towel, etc.) in water to which essential oils have been added. The temperature of the water can be hand-hot or cold, depending on the condition to be treated and the mother’s preference. The amount of water will depend on the size of the area to be covered. To each litre of water, 2–3 drops of essential oil can be added, without a carrier oil, and dispersed by hand. The cloth is soaked, excess water is squeezed out so that it is not dripping and the compress is applied to the affected area. The compress may need to be changed regularly, especially if the water is hot as it will cool quickly in the air. This method is good for targeting specific small areas of the body – for example, for a headache, lumbosacral pain in labour, shoulder and neck pain, acute antenatal suprapubic discomfort or oedema of the legs and ankles. For some women, it is also preferable to receiving a massage and enables them to enjoy the benefits of aromatherapy without needing to be touched. Compresses are not, however, the most appropriate method of administration for longer-term problems such as ongoing backache.
Essential oils can also be used in water as a vulval wash, for the treatment of infections, leucorrhoea or for general hygiene and freshening after the birth and to aid perineal healing. To a litre of warm or cool water, 2–3 drops of essential oil can be added without carrier oil. With the mother sitting on a bedpan or over a toilet or bidet, the water is then gently sluiced over the vulval and perineal area. The area should be dried gently and thoroughly afterwards, especially if the purpose of the wash is to aid perineal healing.
Please note: Essential oils should not be added to the birthing pool at all. They should not be added to the bath once the membranes have ruptured, otherwise the mother will need to get out for the bath to be emptied and refilled with clean water. If a woman has received a massage prior to entering the birthing pool there is little risk to the baby, as the oils will have absorbed into the skin or evaporated. Further, whilst essential oils can be added to jacuzzis and saunas, use of these methods is contraindicated in pregnancy, due to the risks of high temperatures and the theoretical risk of amniotic embolism.
Box 2.4 lists the methods of administration of essential oils suitable for use in midwifery/maternity care and Box 2.5 summarises the principles of administration of essential oils in pregnancy, labour and the puerperium.
(See also Chapter 6 for further discussion and justification.)
Box 2.4 Summary of methods of administration of essential oils
Massage: For foot, hand, neck and shoulders, back and full body massage, blend the essential oils in a suitable carrier oil to the correct dosage.
In the bath: Add 4–6 drops of essential oil in approximately 2 ml of carrier oil as the water is running into the bath.
In a foot bath: Add 3–4 drops of essential oil to a bowl of warm or cool water, as preferred, and mix thoroughly.
Compress: Add 3–4 drops of essential oil to 0.5 litres of warm or cool water, then soak a cloth in the water and apply to the relevant body part. (NB Should not to be used for perineal healing.) Neat: Add a single drop of oil (e.g. frankincense) to the centre of the mother’s palm for her to inhale. (NB Essential oils should not normally be applied neat.) On a tissue, gauze swab or cotton wool ball: Add a maximum of 2 drops of essential oil for the mother to inhale. (NB Only for immediate use, discard after use.) As a facial spray: Add 2–3 drops of mild essential oil (e.g.
grapefruit, bergamot) to boiled, cooled water, for use in labour.
(NB Keep in refrigerator and discard after 24 hours.) Vulval wash: Add 2–3 drops of essential oil
to a litre of warm or cool water.
Vaporisation: This is contraindicated in an institutional setting. Mothers wishing to vaporise oils at home should be advised to use an electrical vaporiser (rather than a naked flame) for no longer than 15 minutes at a time.
Box 2.5 Principles of administration of aromatherapy in pregnancy and childbirth
A maximum of three essential oils should be used in a blend.
Dosages: 1–1.5% in pregnancy (i.e. 1 drop of essential oil to 5 ml carrier oil).
Dosages: 2% in labour and during the puerperium (i.e. 2 drops of essential oil to 5 ml carrier oil).
Dosages: 3% for natural induction in post-dates pregnancy only (i.e. 3 drops of essential oil to 5 ml carrier oil).
Ensure that the treatment can be carried out in a safe and private environment.
Obtain verbal informed consent and document it.
Assess skin condition for dryness, sensitivity, etc.
Discuss the choice of oils and the reason for treatment with the mother.
Avoid hypotensive essential oils (e.g. lavender, ylang ylang) in labour if an epidural is in situ.
Avoid essential oils which facilitate uterine action (e.g. clary sage, jasmine) when syntocinon is commenced or within one hour of other means of stimulating contractions.
Do not add essential oils directly to the water in the birthing pool.
Do not add essential oils to the water if the mother is labouring in the bath with ruptured membranes.
Avoid abdominal massage if the woman has an anteriorly situated placenta or following a Caesarean section.
Avoid clary sage if the mother has excessive lochia or retained products of conception.
Avoid sedating essential oils (e.g. chamomile, ylang ylang) if the mother has a history of postnatal depression.
Ask the mother to wash her breasts after aromatherapy treatment, prior to putting her baby to the breast.
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