Epidural? All I need is rose oil

Can aromatherapy offer pregnant women a stress-free delivery? A new survey suggests it can soothe anxieties and reduce the need for medical intervention. So should we throw away the pain killers?

A unique eight year study involving more than 8,000 mothers who gave birth in Oxford between 1990 and 1998 shows that aromatherapy offers more than just a pleasant scent. The Use of Aromatherapy in Intrapartum Midwifery Practice, published by Oxford Brookes University, reveals that aromatherapy can reduce maternal anxiety and fear, feelings experienced to some extent by most women in the course of their labour, and enhance the sense of well-being. This is an important finding because it is known that the more anxious and fearful a mother is, the less able she is to cope and the greater her perception of pain.

A unique eight year study involving more than 8,000 mothers who gave birth in Oxford between 1990 and 1998 shows that aromatherapy offers more than just a pleasant scent. The Use of Aromatherapy in Intrapartum Midwifery Practice, published by Oxford Brookes University, reveals that aromatherapy can reduce maternal anxiety and fear, feelings experienced to some extent by most women in the course of their labour, and enhance the sense of well-being. This is an important finding because it is known that the more anxious and fearful a mother is, the less able she is to cope and the greater her perception of pain.

Pain is not a simple reaction to a stimulus, like a bell ringing when you press a button. It is made much worse if you are frightened or feel trapped in a situation you cannot control. If ways of improving a mother's coping skills and building her self-confidence can be found, she can maintain more control over events in labour, and handle pain better.

Compared with those who did not have aromatherapy, fewer women in the aromatherapy group had their labours stimulated with intravenous syntocinon because contractions were weak, and fewer ended up with emergency Caesarean sections. More research is needed into this.

Eighty-eight per cent of women who had aromatherapy rated it most effective in transition, the phase immediately before full dilatation of the cervix, when contractions are almost continuous and the mother may feel like a swimmer caught in cross-currents. Some like it much earlier. Debbie Lockley told me that she was "stressed out" because of all the things being done to her, but was offered a massage with mandarin oil and frankincense on the palm of her hand, and found it "really comforting". Marysia Nowak was induced because of premature rupture of the membranes, so she was experiencing painful, artificially stimulated contractions from the beginning. She was given a back massage with rose oil. She says: "It's not like a painkiller. It doesn't take the pain away. But it makes you feel more at ease and relaxed." She went on to have an epidural because the pain was so intense. She says she was "counting on a Caesarean" because she had had one the time before, but gave birth spontaneously. "It definitely worked for me."

The essential oils used in this research included lavender, frankincense, camomile, rose, jasmine, eucalyptus, peppermint, lemon, mandarin and clary sage. Sometimes they were blended, sometimes used singly. (Most smell delicious, though clary sage is redolent of wet dog. You need either to have a cold in the head or be very fond of dogs.) A carrier oil was used for massage, which became an increasingly popular way of using aromatherapy over the years of the study. Other methods included a taper which was impregnated with an essential oil; a warm compress; a footbath; a deep bath in which the woman could soak in a softly lit room; a drop of oil on her palm or forehead; and a comforting camomile rinse, if she was bruised or had needed stitches. Though it is not included in the report, anxious fathers were sometimes offered an aromatherapy footbath or a shoulder massage, too - with impressive results. There were few side-effects. One per cent of women reported itchy skin or a rash or weepy eyes for a while.

Caroline Blamey, an aromatherapist midwife who is one of the authors of the report, agrees that it is difficult to come to conclusions about the effectiveness of aromatherapy because many other changes were occurring in the Oxford Radcliffe Maternity Hospital at the same time. The delivery suite acquired a birthing-pool, which was used by an average of three women in every 24 hours - about 1,000 a year. Instead of continuous electronic foetal monitoring, midwives started to get the women up and moving about, and used a hand-held sonic aid to record the foetal heart beat intermittently.

Most important of all was the dramatic reduction in the use of opiates. Women often chose to have aromatherapy as their first option, and pain-relieving drugs only if they ended them later. Pethidine does not do much to kill pain, and can make women confused, nauseous, unable to remember what happened and often very groggy. In comparable large teaching-hospitals, the average rate of use at that time was 30 per cent. By 1997 it was down to 0.4 per cent in Oxford. The epidural rate rose only from 30 per cent in 1991 to 35 per cent in 1997. It is 75 per cent or more in similar large teaching-hospitals. Epidurals produce their own side-effects, including a sudden drop in maternal blood pressure, fever in both mother and baby, and an increased likelihood of operative vaginal delivery.

Ethel Burns, primary author of the research and the midwife who introduced aromatherapy in the delivery suite, says: "Childbirth is still viewed as a pathological rather than a natural life event. Hospitals are geared towards the small proportion of about 5 per cent of women whose pregnancies are seriously complicated. As midwives have become more technically skilled with electronic equipment, many have found it difficult to develop confidence in giving truly woman-centred care. Some never get the chance to learn how to do this."

Aromatherapy is easy to administer and costs very little. It changes the whole atmosphere of the birth room. It is not just the mother who can be more relaxed; the staff caring for her end up feeling calmer and happier, too. It may be that this reduces the number of unnecessary obstetric interventions and keeps birth normal.

Aromatherapy is not a magic charm. But it is one way in which a midwife can communicate warmth, sensitivity and friendship to a mother in an institutional and medical environment.

Further information is available at Sheila Kitzinger's website: www. sheilakitzinger. com