Clause 13.5 of the Nursing and Midwifery Council (NMC) Code (NMC 2015) requires midwives to complete any necessary training before carrying out a new role. Maternity-related aromatherapy should involve an in-depth study of both clinical specialities, and any professional using essential oils for pregnant, labouring or newly birthed mothers must have a thorough understanding of all aspects of care. Midwives and doulas need to concentrate on learning about the principles of aromatherapy, including relevant physiology, chemistry and pharmacology, as well as how to blend and administer the oils safely and appropriately. Conversely, aromatherapists will need to study reproductive anatomy and physiology, and develop an appreciation of the conventional maternity services and their own roles and responsibilities when caring for maternity clients, whilst also applying their existing knowledge of aromatherapy to its use for maternity clients.
The extent to which an individual practitioner studies each element will depend on their professional background and their knowledge and experience to date. For example, midwives will already have an understanding of pregnancy-related anatomy and physiology and will be working within
the maternity services; doulas working as the mother’s advocate may have a good understanding of the psycho-emotional aspects of childbirth and may perhaps be more in tune with the concept of holism and energetic medicine.
Aromatherapists will obviously have a working knowledge of how, why and where essential oils work but may not understand the intricacies of orthodox antenatal, intrapartum and postnatal care or the specific issues relating to safety in pregnancy.
All practitioners must acknowledge the boundaries of their practice, dependent on their existing qualifications, experience and insurance. Above all, the safety of expectant mothers and their babies is paramount. Table 5.1 gives a summary of the minimum requirements for education and training of any professional intending to offer aromatherapy to pregnant, labouring and newly birthed mothers.
Table 5.1 Education and training requirements for maternity aromatherapy practice
MATERNITY-RELATED CONTENT AROMATHERAPY-RELATED CONTENT Anatomy and physiology of pregnancy,
labour and puerperium
Possible pathology, recognition and actions, including emergency aid Knowledge of contemporary antenatal, intrapartum and postnatal care Psychology of childbirth and basic listening skills
Health promotion and concepts of health Appreciation of healthcare ethics, legal aspects and professional accountability Understanding of research
methodologies, application of research findings to clinical practice
Understanding of role of midwives, doctors, other maternity professionals
Philosophy of complementary medicine
Anatomy and physiology of skin, sense of touch, olfaction, respiration Pharmacology and pharmacokinetics of essential oils
Basic chemical concepts, specific chemistry of essential and carrier oils Therapeutic properties of essential oils and related research
Methods of administration Methods of blending
Indications, contraindications and precautions to use of aromatherapy in pregnancy, labour and postnatal period
Within any maternity unit it is essential that all those using aromatherapy comply with the criteria laid down in the local clinical guidelines.
Therefore, any midwife who is also a qualified aromatherapist should be required to undertake the same training course as other colleagues to ensure standardisation of practice and to facilitate audit of the service and treatments. It may also be appropriate for any new members of staff to complete the in-house course, even if they have used aromatherapy elsewhere, to ensure conformity. Midwives who have undertaken appropriate training in the use of maternity aromatherapy must support their colleagues’
and students’ learning to assist them in developing professional competence
and confidence prior to permitting them to contribute to the aromatherapy service (Code clause 9.4) (NMC 2015).
Continuing professional development (CPD) is also essential in order to keep up to date with developments (Code clause 6.2) (NMC 2015) both in maternity care and in aromatherapy. Midwives must keep both their knowledge and skills up to date by taking part in appropriate and regular learning and professional development activities which assist in maintaining and developing competence and enhancing performance (Code clause 22.3) (NMC 2015). Aromatherapy updating, specifically applied to midwifery, should preferably be undertaken annually. This does not necessarily mean attending additional study days on aromatherapy; indeed, it is the application to midwifery/maternity care which is most significant and with which practitioners must maintain their competence and confidence.
CPD activities could include reading research studies, journals or new textbooks, visiting other maternity units in which aromatherapy is provided by midwives, writing up reflective case studies, including those with both positive and less positive outcomes, publishing an interesting case study in a professional journal, establishing a journal club in the local unit, developing a new profile for a specific essential oil to add to the available selection or recording conversations about aromatherapy which the practitioner has had with pregnant women.
The NMC requires registrants to undergo a process of revalidation, which is intended to strengthen registration renewal and is a continuous process concerned with promoting safe, effective, professional practice. All of the above suggested activities enable the midwife to comply with revalidation requirements, and could also be undertaken by other professionals as a means of maintaining contemporary maternity-aromatherapy practice.
The issue of midwives cascade training their colleagues in aromatherapy is a contentious subject. Many maternity managers supporting midwives to set up an aromatherapy service see fit to pay for just one or two midwives to undertake short training courses with external organisations, with the intention that these few midwives should then train the rest of the staff.
However, midwives who have completed an initial course on aromatherapy are not sufficiently competent to pass on their knowledge to others without consolidating their own learning and gaining further experience in treating women during pregnancy, labour and the postnatal period, with the full range of essential oils in which they have been trained. For example, recognising possible side-effects associated with specific essential oils cannot be taught to others without substantial experience of using aromatherapy for this client group. Further, these midwives are not qualified aromatherapists and have therefore studied a limited amount of a subject which is totally new to them, unlike undertaking professional development directly related to
midwifery, such as water birth workshops or courses on examination of the newborn. Not only do midwives need to be knowledgeable and competent to use aromatherapy, they must be able to apply the principles to midwifery practice, within the boundaries set by the Nursing and Midwifery Council (even when a midwife is a qualified aromatherapist).
In educational terms, learners are thought to retain about 60% of what they have been taught. Cascade training will therefore cause a natural dilution of the content imparted to others, with the worrying possibility that vital safety details may be missed, either by the trainers or by the learners. Cascade training should really only be considered by midwives with at least two years’
experience of using aromatherapy in their practice, and preferably following involvement in the implementation process, including the development of local clinical guidelines.
In some maternity units, it may be possible for support workers or maternity care assistants to be involved in providing massage for women.
However, the midwife must remain accountable for the treatment and should only permit junior colleagues to use aromatherapy oil blends if they have received training relevant to their scope of practice and competence (Code clause 11.1) (NMC 2015). The midwife is legally responsible for ‘prescribing’
the essential oil blend, so support workers are permitted to use only oils which have been blended by an appropriately trained midwife who has personally assessed the mother first, or oils which are commercially pre-blended, in order to perform massage. The midwife must ensure that the support worker fully understands the instructions and must confirm that the treatment given is appropriate and of the required standard (Code clause 11.3) (NMC 2015).
Similarly, since student midwives are not legally accountable for the care of women during pregnancy and labour, any use of aromatherapy by a student must be under the direction of an appropriately trained midwife.