Implementing aromatherapy: aims and outcomes of the intended service

It is important to identify realistically the purpose of the intended aromatherapy service and the justification for its introduction in midwifery practice. Midwives should explore the immediate and long-term aims and goals and decide what could be achieved by offering aromatherapy to women in their care. The initial reason may be that it is an additional means of pain relief in labour, but longer-term outcomes might be a desire to minimise intervention, to reduce women’s complaints, or to set up a research study. It can sometimes be easier to tackle implementation through formal research channels, but this does, of course, risk discontinuation of the service in the event of results which are not sufficiently statistically significant to justify aromatherapy use.

It is useful to undertake some preliminary research, both from the available professional literature and in practice. A literature search will reveal some of the contemporary evidence for safety and effectiveness of aromatherapy in pregnancy and/or labour. A feasibility study can be done, to assess women’s interest in having an aromatherapy service (evaluating demand to justify implementation). It can also be useful to conduct a survey of midwifery and medical colleagues to ascertain their knowledge of and views on aromatherapy and their thoughts on the possible introduction of the service. Making contact with midwives in other units in which aromatherapy is already established can provide useful anecdotal evidence and also maintain morale – knowing that others have succeeded despite initial ‘teething problems’ can be reassuring and encourage midwives to continue with their proposal. Some midwifery or medical colleagues may be sceptical about complementary therapies, either because they know very little about the subject or have had negative personal or professional experiences.

It is essential to present a convincing case which demonstrates that effective, safe and cost-effective aromatherapy services can be offered, based on both direct and indirect evidence.

One common objection raised by managers may be the lack of time and human resources to take on any new initiatives, and certainly there is a need to justify something such as aromatherapy, which is rarely seen as a priority.

This is why it may be easiest to start by offering intrapartum aromatherapy since most women receive one-to-one care in labour, and aromatherapy treatments can be performed around observations, record-keeping and other clinical interventions. Simple massage techniques can also be taught to the woman’s birth companion in a very short time, possibly leaving the partner to use the aromatherapy oils which the midwife has blended. Highlighting the beneficial effects of both massage and the essential oils, notably the fall in cortisol, which facilitates oxytocin release, may help to convince colleagues that intrapartum aromatherapy can contribute to reduced intervention through greater relaxation of women.

It is vital to be aware of any potential adverse effects (see Chapter 4), not least because obstetricians and midwifery managers are likely to raise this issue. Being alert to possible risks enables midwives involved in setting up the aromatherapy service to take steps in advance to minimise them and to demonstrate that the new service will be safe. It is useful to consider as many issues as possible before moving ahead with plans to bring in the aromatherapy service.

A SWOT analysis is one way of identifying some of the issues and helping midwives to focus on appropriate planning and implementation where the best chances of success lie. A SWOT analysis enables planners to identify Strengths, Weaknesses, Opportunities and Threats (see Box 5.1).

Box 5.1 SWOT analysis for implementing aromatherapy in midwifery practice

S

Compile a list of the aromatherapy and massage skills and strengths within the local team. What relevant resources, other than clinical aromatherapy skills, are there in the implementation team? Do team members have any experience of introducing new initiatives, developing guidelines, or overcoming obstacles in other areas of midwifery practice? This needs to be realistic as it demonstrates why a manager, supervisor or obstetrician should support the aromatherapy service.

How can the strengths within the implementation team be ‘sold’ to other colleagues, especially those who are sceptical? For example, would it be acceptable to offer mini-taster sessions of massage and aromatherapy so that colleagues who have not previously experienced aromatherapy have the chance to do so, perhaps from a hand or foot massage?

W

It is also important to identify areas for improvement within the implementation team, including not only aromatherapy and massage skills, knowledge and application to midwifery practice, but also managerial and organisational skills and experience.

Where there are weaknesses or gaps in the expertise required, identify whether these can be improved, perhaps with further training, or whether there are other colleagues who may be able to fill these gaps.

Also pinpoint anything that should be avoided when setting up the aromatherapy service, such as extending it too far, too fast or inappropriately.

O

Establishing a new venture, whether it is aromatherapy or another service, can also create opportunities for mothers and for staff, individually and collectively, and it can be useful to determine these. Explore whether new opportunities might arise from changes in technology, local, national and international health policies and directives, or socio-economic and lifestyle factors.

Could there be increased opportunities for the future of the aromatherapy service by building on the strengths within the implementation team and eliminating or reducing any weaknesses?

T

Identify any obstacles which may impact on the implementation process and maintenance of the aromatherapy service. For example, could any weaknesses in the team have an adverse effect on the possible success of the venture, and how could these problems be overcome? Identifying the threats can clarify what has to be done, but will also help to put matters into perspective.