A number of years ago I was involved in a debate on the use of essential oils (EO) in massage during pregnancy. Side A was against the use of the oils due to general controversy regarding the use of EOs during pregnancy, and Side B was supportive because they had experience using the oils safely on pregnant women. The objective of the debate had been to reach a resolution on a mutually acceptable course of action.
Aromatherapy is the therapeutic use of EOs, and can be used by applying the oils to the skin, either through direct application or through massage, bath, compress, or face and body products. It can also be inhaled directly or via diffusers, ingested, or through suppositories, although these last two means are not recommended. It is usually applicable for people in all stages of life, depending on the oil and the condition (Rhind, 2012).
Pregnancy is considered a contraindication to the use of herbal medicines, which includes aromatherapy (Treasure, 1995). There is little evidence in support of this or of the contrary, because it is hard to justify conducting a study due to the potential of causing harm to the fetus or to the mother.
Going back to the debate I had a few years ago, Side A advocated that the use of these EOs had not been certified or approved by any governing agency in the United States, and that there was no evidence to indicate that they were safe to use on pregnant women. Side B argued that similarly, there was no evidence to indicate that these oils were not safe. Additionally, Side B had cared for several hundreds of mothers-to-be over the course of 20 years using certain oils, and had not seen any negative effects.
It was hard for both sides to come to an agreement, and in the end, they asked me to come up with a solution. Even though I did not have the knowledge or the experience to make this decision at the time, I chose to err on the side of caution and opted not to use the oils during pregnancy. At the time, I did not know as much about aromatherapy as I do now. Since then, I have done a lot of research on aromatherapy and pregnancy, particularly since I became a Registered Aromatherapist™.
Both Sides of the Controversy
Use of EOs during pregnancy is considered controversial for a few reasons. The reasons stand on both sides of the argument, either for or against the use of EOs during pregnancy.
First, the action or effect of many EOs has not been tested on pregnant women. As a result, it is unknown whether or not the EO could have a damaging effect on the mother, the pregnancy, or the baby. Unfortunately (or not), given the delicate state of pregnancy it is difficult and unethical to test or conduct studies to determine the effect of EOs during pregnancy.
Second, given the lack of information, evidence, or studies on the effects of EOs during pregnancy, it is best to err on the side of caution, and rather than have a woman try an EO and potentially suffer from ill or adverse effects, it is best practice to simply avoid using the EO.
Thirdly, despite the lack of evidence and the caution surrounding trying EOs on pregnant women, there have been some cases where the use of EO has resulted badly. There are not many cases, some would argue, but the cases do exist. For example, Buckle (2003) stated there were women who suffered from abortion after consuming too much pennyroyal.
This leads to the fourth caution around the use of EOs on pregnant women, and that is the dosage. Excessive use of EOs has been linked to many of the adverse effects of EO use during pregnancy. These dosages were often higher than what would be considered normal, even for a person not experiencing pregnancy. Thus, to avoid adverse effects, caution should be used in dosages given to pregnant women. EOs can be diluted, and although dosages vary by oil and by conditions, a general indication provided by Buckle (2003) was to administer one to five drops of EO in a given dose, and to administer no more than 10 to 20 drops of EO per day.
This may help support the fifth point, and that is that traditionally many cultures have successfully used EOs during pregnancy, without any adverse effects. For instance, consider the years of experience from Side B. They kept journals of the treatments they had conducted on pregnant women, as a measure to document what had worked well. Weiss & Fintelmann (2000) noted that proof of efficacy of a drug can be obtained through reputable published works, controlled studies, experimental studies, data analysis, or additional conclusive findings or observations. A review of the journals Side B kept could have led to empirical evidence, observations and/or findings that could have supported their view. They may not have had the required evidence, and I may have come to the same conclusion, but at least they may have been able to put forth a stronger case.
Nonetheless, I rest with the assurance that erring on the side of caution is what is best advised during pregnancy, and opting for not using the oils was the safest solution.
How To Use Aromatherapy During Pregnancy
Overall, for the sake of safety, it is best to avoid aromatherapy and EOs in the first trimester, when the pregnancy is not as secure and the embryo is going through a critical development stage. In addition, it is best to avoid use of EOs on women who have had miscarriages or difficult pregnancies in the past, so as to not risk a similar occurrence, as well as on those who are currently having a difficulty in their pregnancy so as to not cause any additional complications.
There are certain toxic substances called teratogens, which are known to cause damage to the embryo or fetus. Some of the common ones include alcohol, certain drugs, radiation, chemicals and pesticides, among others. There are a few EOs that have teratogenic effect, namely those containing sabinyl acetate, such as savin, Juniperus sabina, and Spanish sage, Salvia lavandulifolia (Buckle, 2003).
Other oils that are contraindicated for pregnancy include those that have emmenagogue effects on the body. This means that they help bring on or induce menstruation, and if used during pregnancy, they could result in a miscarriage. Oils that are classified as emmenagogues include, angelica, anise, basil, bay, black pepper, carrot seed, clary sage, cypress, German chamomile, Roman chamomile, cinnamon, citrus, fennel, geranium, ginger, hyssop, jasmine, juniper, lavender, lemongrass, marjoram, myrrh, melissa, niaouli, oregano, peppermint, rose, rosemary, sandalwood, spearmint, thyme, vetiver, and yarrow (Buckle, 2003; Petersen, 2014).
Certain EOs are known abortifacents, such as pennyroyal and parsley seed, and these should be avoided as well.
Efficacy of Aromatherapy During Pregnancy
A randomized, controlled trial in Japan on 13 pregnant women who were in their 28th week of pregnancy were given aromatherapy to determine its effect on mood and parasympathetic nervous system (PNS) activity, which is responsible for the relaxation response (Igarashi, 2013). Six of the participants received a control treatment consisting of no aromatherapy, and 7 participants received an experimental treatment and were offered a choice between lavender (Lavandula angustifolia), petitgrain (Citrus aurantium), or bergamot (Citrus bergamia) placed in a diffuser for 5 minutes. Mood was measured on a six-part scale that included tension-anxiety (higher the score the more tense), depression-dejection (the higher the score the more self-confidence), anger-hostility (the higher the score, the more anger), vigor (the lower the score the less energy), fatigue (the higher the score the more fatigue), and confusion (the higher the score the more confusion). In addition, PNS activity was measured through heart rate. The participants who received aromatherapy experienced a decrease in tension in the tension-anxiety measure, a decrease in anger on the anger-hostility scale, a decrease in fatigue, although not significant, and an increase in PNS activity (Igarashi, 2013). The control group experienced more sense of calm, but the measurement values were not significantly improved. The study suggested using essential oils would be effective in relieving stress during pregnancy (Igarashi, 2013).
Pregnancy-Induced Hypertension (PIH) is a serious condition in pregnant women, and causes 15% of deaths. It usually requires bed rest with elevated feet. Aromatherapy and touch can support. A study using a combination of the M technique, a specific massage technique for the application of essential oils during massage, and a 2% solution of lavender, Lavandula angustifolia, reduced blood pressure on 8 patients suffering from PIH in New York in 2000 (Buckle, 2003).
Efficacy of Aromatherapy During Labor
Psychoneuroimmunology (PNI) looks at how the mind, brain, and immune system work together within the body (Buckle, 2003). Aromatherapy has been effective in PNI studies, particularly in achieving relaxation. A study in the UK in 1993 showed that 36 out of 38 women who used five drops of lavender during labor experienced less pain and enhanced relaxation (Buckle, 2003). A 1994 study on 585 women in labor showed that they all had reduction of stress by using essential oils of “lavender, clary sage, peppermint, eucalyptus, mandarin, chamomile, jasmine, rose, frankincense, or lemon” (Buckle, 2003, p. 242-243).
In a 1988 study in the UK with 8,053 participants, aromatherapy helped lower the rate of epidurals and pain killer injections (Burns, Zobbi, Panzeri, Oskrochi, Regalia, 2007). Another study conducted in 2000 on 8,058 women showed beneficial effects on 50% of the participants who used EO’s during labor. Essential oils of rose, lavender, jasmine, Roman chamomile, blue gum, mandarin, clary sage, frankincense, peppermint, or lemon were used, and the aromatherapy users had fewer epidurals & less need for pain relief (Buckle, 2003).
In 2001, 25 women in labor successfully used EOs at 1% dilution, specifically, lavender for relaxation and to relieve backache; geranium to relieve perineal swelling and hemorrhoids; and frankincense for extreme anxiety and to help transition into stage 2 of labor (Buckle, 2003). A study conducted in 2000, showed that 25 women used lavender to reduce anxiety during labor, and some experienced better sleep, and relieved headaches as well (Buckle, 2003).
A randomized controlled trial on 513 women looked at the role of aromatherapy during labor. 262 of the women were part of the control group that had standard care, with no aromatherapy, and 251 of the women were in the experimental group that had choice of oils. The selection included Roman chamomile, Chamaemelum nobile, clary sage, Salvia sclarea, frankincense, Boswellia carterii, lavender, Lavandula augustifolium, and mandarin, Citrus reticulata. Essential oils were applied on acupressure points, via massage, included in the birthing pool, or through compresses or footbaths. Within the experimental group, 45% of the women selected lavender, 25% chose mandarin, 11% clary sage, 10% frankincense, and 10% Roman chamomile. From the same group, 37% of the women used aromatherapy through taper, 32% through massage, 20% added essential oils in the birthing pool, 5% applied it via acupressure, and 4% used compresses. The aromatherapy group experienced a reduction of anxiety, fear, and pain; enhanced wellbeing; less artificial rupture of membranes; reduction of infants in the Neonatal Intensive Care Unit; and no ill or adverse effects.
Further studies are necessary to better understand the benefits of aromatherapy during pregnancy. However, it is unethical to get participants for studies, given the potential risk. Thus, the best advice I can give is to know which EOs to avoid during pregnancy. Also, use oils according to their specifications and preferably in lower doses. If in doubt, it is always best to err on side of caution, and not use aromatherapy. I believe that as long as safe and prudent practices are observed during pregnancy, EOs can help support certain conditions and symptoms of pregnancy.
Buckle, J. (2003). Clinical Aromatherapy: Essential Oils In Practice (2nd ed.). London, United Kingdom: Churchill Livingstone.
Burns, E., Zobbi, V., Panzeri, D., Oskrochi, R., Regalia, A. (2007). Aromatherapy in childbirth: a pilot randomized controlled trial. BJOG, 114, 838-844. doi:10.1111/j.1471-0528.2007.01381.x
Igarashi, T. (2013). Physical and psychological effects of aromatherapy inhalation on pregnant women: a randomized controlled trial. The Journal of Alternative and Complementary Medicine, 19(10), 805-810. doi:10.1089/acm.2012.0103
Petersen, D. (2014). Aromatherapy and pregnancy. ACHS Aroma 501, Aromatherapy Science. Portland, OR: American College of Healthcare Sciences.
Rhind, J.P. (2012). Essential Oils: A Handbook for Aromatherapy Practice (2nd ed.). London, United Kingdom: Singing Dragon.
Treasure, J. (1995). Side Effects / Toxicity of Herbs. Henriette’s Herbal Homepage. Retrieved from http://www.henriettesherbal.com/archives/best/1995/side-effects.html
Weiss, R. F. & Fintelmann, V. (2000). Herbal Medicine: Second Edition, Revised and Expanded. Stuttgart: Thieme.