AROMATHERAPY - CLINICAL GUIDELINE FOR MIDWIVES

Transcription

1 AROMATHERAPY - CLINICAL GUIDELINE FOR MIDWIVES 1. Aim/Purpose of this Guideline 1.1. Aromatherapy is occasionally requested by some pregnant women. This guideline is to guide Midwives on its utilisation. There is however a lack of robust clinical evidence to support its benefits Aromatherapy is the use of essential oils by topical application or inhalation to promote psychological and physical wellbeing. Essential oils extracted from various parts of different plants are used for their therapeutic properties and offer a means of helping women cope with the discomfort and pain of labour. 2. The Guidance 2.1. Do not offer or advise aromatherapy during the latent first stage of labour for pain relief, if a woman wants to use aromatherapy respect her wishes (NICE 2014). If requested by the woman with medical and/or obstetric conditions then an individual care plan will be agreed with the midwife trained in aromatherapy. Midwives without a recognised qualification wishing to use aromatherapy must first undertake an approved workshop or other recognised workshop specifically designed to train them in aromatherapy application for use on pregnant women (RCN 2007). Evidence of usage for NMC revalidation is essential Operational Policy A register of midwives practising aromatherapy will be kept within the Division The request or assessed need, implementation and evaluation of individual aromatherapy treatment will be documented in the woman s maternity records and Aromatherapy Client Record Form (See Appendix 3) The midwife providing the aromatherapy treatment accepts personal accountability for her practice (NMC 2008) 2.3. Referral Women are to self-refer 2.4. Standard Women must be assessed prior to each aromatherapy treatment to ensure no contra-indications have developed since booking. Continual assessment to be made in labour. The completed Aromatherapy Client Record Form (including evaluation) should be kept securely within the birth setting for audit purposes. An anonymised photocopy should be kept by the midwife for reflection and supervision. Page 1 of 15

2 The midwife will only practice aromatherapy treatments subject to the availability of time and the needs of the service. Normal midwifery commitments must take priority Essential Oils to be used Lavender Lavandula Augustifolia Clary Sage Salvia Sclarea Frankincense Boswelia Carteri Chamomile Anthemis Nobilis Peppermint Mentha Piperita Eucalyptus Eucalyptus Globulus Rose Rosa Centifolia/Damascena Jasmine Jasminum Officinale Mandarin Citrus Reticulata Lemon Citrus Limonum Essential Oils will be purchased from a reputable supplier 2.6. Storage of Oils Essential Oils will be stored in a locked cupboard Oils brought in by women for their own use may not be used by the Midwife as their purity may not be able to be verified. They may be used by the woman s individual aromatherapist. PLEASE ALSO SEE AROMATHERAPY FOLDER HELD IN THE SAME LOCATION 2.7. Inclusion Criteria Women who have been assessed and diagnosed as being in the active phase of labour in any setting Retained placenta without excessive bleeding Contra-indications have been excluded Verbal consent to treatment given by woman and documentation of consent noted in the maternity records 2.8. Exclusion Criteria Women who do not give consent Antenatal women not in labour Midwives who are pregnant should not perform aromatherapy treatments 2.9. Contra-Indications to Aromatherapy Use in Labour Allergies only use Roman Chamomile Page 2 of 15

3 If women are using homeopathic remedies avoid Eucalyptus and Peppermint oils. These oils are thought to antidote the effect of homeopathic remedies (Tiran 2000). Previous LSCS -do not use Clary Sage, Rose and Jasmine, these oils are thought to enhance contractions (Tiran 2000) Lavender should be avoided by all asthma/allergy sufferers Eucalyptus oil should not be used by Diabetic or Epileptic women. Eucalyptus oil has the potential to lower blood sugars and so is contraindicated in Diabetic or Gestational Diabetic women. Eucalyptus oil is contraindicated in epileptic women as the odour could potentially trigger an epileptic attack (Tiran 2000) General Contra-indications Avoid massage directly over varicose veins DO NOT USE essential oil on babies Methods of Use Massage 1 drop of essential oil to 5ml grape seed carrier oil One oil to be used at a time (no blending) Oil can be wiped off after use and does not need to be washed off prior to entering a birthing pool. Any oil droplets that are seen in the pool can be dissipated with a few drops of full fat milk Bath (NOT for use in birthing pool) 4-6 drops of essential oil added to carrier oil or teaspoon of full fat milk, add to bath after the bath is filled. Add only once and only in labour. Re-run bath but do not top up with water/oils Compress 4 drops of essential oil in hot water for pain or cold water for swelling Soak flannel, wring out and apply to skin When flannel is the same temperature as the skin re-soak and reapply to the skin Do this as often as required BUT do not add more essential oil if water is topped up Tissue 1-2 drops of undiluted essential oil onto a tissue/taper. May be repeated every 2 hours Inhalation 2-4 drops of essential oil in a bowl of hot water or diffuser. Inhale. The diffuser should be used for a maximum of 10 minutes in every 2 hours Retained Placenta Jasmine has been used by inhalation with success to expel a retained placenta. (Tiran, 2000) Apply 2-3 drops on a tissue and encourage the woman to inhale Page 3 of 15

4 This is in addition to current guidelines for management of retained placenta and should be abandoned before transfer by ambulance or where the blood loss is excessive Essential Oil Safety Do not take essential oils internally Most essential oils should not be directly used onto the skin- except Lavender Take care that undiluted essential oils do not come into contact with sensitive areas i.e. eyes, nose, face, neck Wash hands thoroughly after using oils in massage Keep essential oils away from naked flames, they are highly flammable Keep essential oils away from children Dealing with Adverse Skin Reactions Wash skin with unperfumed soap (located in clean utility room cupboard) to remove oil Expose skin to air to encourage evaporation of the oil If undiluted essential oil is accidentally splashed into the eyes: Flush the eyes with clean warm water, saline eye wash or milk For any accident with oils, complete a Datix form Peppermint oil tends to persist on the fingers Wash hands thoroughly after using any essential oil Disposal of Unused Oil Plastic pots containing oils should be soaked up with a tissue which is then disposed of in a yellow clinical waste bag Water containing essential oils used for compresses/footbaths should be disposed of down the sluice sink Baths/bowls should be thoroughly cleaned with hard surface wipes following the use of essential oils 3. Monitoring compliance and effectiveness Element to be Use of Aromatherapy monitored Adverse outcomes Lead Maternity Risk Management Midwife Tool Were only the recommended essential oils used Was consent documented in the notes Were any adverse reactions noted What method/s of aromatherapy was used Massage, bath, compress, tissue, inhalation If used to expel a placenta did the placenta deliver without requiring Manual Removal Frequency Within the year of the introduction of this guideline or earlier if concerns After each case where aromatherapy was used Page 4 of 15

5 Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Obstetric Risk Management Forum or Clinical Audit Forum Supervisor of Midwives Individual feedback to midwife Risk Management Newsletter Reported via the Obstetric Risk Management Forum and the Clinical Audit Forum. 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 5 of 15

6 Appendix 1. Governance Information Document Title Date Issued/Approved: 17 th December 2015 AROMATHERAPY - CLINICAL GUIDELINE FOR MIDWIVES Date Valid From: 31 st December 2015 Date Valid To: 31 st December 2018 Directorate / Department responsible (author/owner): Angela Whittaker Supervisor of Midwives Obs & Gynae Directorate Contact details: Brief summary of contents This guideline gives guidance to Midwives upon the use of Aromatherapy Oils in labour. Suggested Keywords: Target Audience Executive Director responsible for Policy: Aromatherapy, oil, essential, massage, labour, placenta, retained, pain RCHT PCH CFT KCCG Medical Director Date revised: 17 th December 2015 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes New Issue Maternity Guidelines Group Obs and Gynae Directorate Divisional Board for noting Head of Midwifery Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Not required. {Original Copy Signed} Internet & Intranet Intranet Only Clinical/Midwifery and Obstetrics None Page 6 of 15

7 Related Documents Training Need Identified? Intrapartum Care CG ) NICE Clinical Guideline Battaglia S 2004 The Complete Guide to Aromatherapy. The Perfect Potion Australia. Burns E, Zobbi V, panzeri D, Oskrochi R, Regalia A 2007 Aromatherapy in childbirth: a pilot randomised controlled trial. British Journal of Obstetrics and Gynaecology 114 (7) p Fanner F 2005 The Use of Aromatherapy for pain management through labour. International Journal of Clinical Aromatherapy. Vol Fowler P. William 1997 COSHH/CHIPS Ensuring the Safety of Aromatherapy House of Lords 2000 Select committee on Science and technology. 6 th report. CAM London. Lawless J 2002 Encyclopaedia of Essential Oils: the complete guide to the use of aromatic oils in Aromatherapy, Herbalism, Health & Well being. Thorsons, Harper Collins, London Lewith G, Jonas W & Walach H 2002 Clinical Research in Complementary Therapies. Churchill Livingstone. NMC 2008 Complementary & Alternative Therapies & Homeopathy. NMC London Tiran D 2000 Clinical Aromatherapy for Pregnancy and Childbirth 2 nd ed. Churchill Livingstone. London. Tiran D 2003b Implementing complementary therapies into midwifery practice. Complementary Therapies in Nursing & Midwifery Yes. Bespoke training and competency assessment for Midwives Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) Page 7 of 15

8 17 th December 2015 V1.0 New Issue Angela Whittaker Supervisor of Midwives All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 8 of 15

9 Appendix 2. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): AROMATHERAPY GUIDELINE - CLINICAL GUIDELINE FOR MIDWIVES Directorate and service area: Obs & Gynae Directorate Is this a new or existing Policy? New Name of individual completing assessment: Elizabeth Anderson Telephone: Policy Aim* Who is the strategy / policy / proposal / service function aimed at? This guideline gives guidance to Midwives upon the use of Aromatherapy Oils in labour 2. Policy Objectives* Safe use of essential oils in established labour 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Improved maternal experience Compliance monitoring tool All pregnant women requesting the use of essential oils in labour No N/A N/A 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Page 9 of 15

10 Age X All pregnant women Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership X X X X X All pregnant women All pregnant women All pregnant women All pregnant women All pregnant women Pregnancy and maternity X All pregnant women Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian X All pregnant women You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No X 9. If you are not recommending a Full Impact assessment please explain why. N/A Signature of policy developer / lead manager / director Angela Whittaker Date of completion and submission 17 th December 2015 Names and signatures of members carrying out the Screening Assessment 1. Angela Whittaker 2. Elizabeth Anderson Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed: Elizabeth Anderson Date: 17 th December 2015 Page 10 of 15

11 Appendix 3: Essential Oils for use in Labour Type of Oil Potential Properties Indications in Labour Contra-Indications in Labour Chamomile Anthemis nobilis Anti-inflammatory, anti-spasmodic, soothing and pain relieving, good for skin rashes, eczema, and puritis. Helpful for those with multiple allergies (Lawless 2002). Pain relief Relaxation Anxiety Clary sage Salvia Sclarea Eucalyptus Eucalyptus Globulus Frankincense - Boswellia Carteri Calms nervous tension, stress and insomnia. Due to its oestrogen-like properties and antispasmodic effect it is useful for accelerating labour, assisting contractions and relieving uterine pain. Clary sage is helpful for depression and dissipating anxiety. It is thought to reduce hypertension. A cooling, refreshing nasal decongestant and antiseptic, reduces pyrexia alleviates many symptoms of respiratory infections. Good for muscular aches and pains, helpful for asthma. May be a skin irritant. Good for calming, anxiety and panic/hyperventilation by slowing and deepening the breathing. Labour use only Sinus congestion, pain relief Anxiety Calming Depression Previous LSCS Not advisable in the bath Epilepsy and Diabetes Women using homeopathic remedies Not advisable in the bath (dilates capillaries so will cool skin too quickly) Asthmatics Page 11 of 15

12 Type of Oil Potential Properties Indications in Labour Contra-Indications in Labour Jasmine Jasminum Officinale Lavender Lavender Augustifolia Lemon Citrus Limonum Mandarin Citrus Reticulata Antidepressive, thought to be helpful for anxiety, produces feeling of optimism and has an energising effect on the emotions. Massage on the abdomen and lower back in early labour. Strengthens contractions and helps with the pain. A highly versatile oil, emotionally calming, relaxing and slightly analgesic. Useful for easing uterine pain of contractions. Refreshing, emotionally uplifting, stimulates the immune system. Antiseptic for combating colds, pyrexia and throat infections. May help to reduce hypertension. Anti-spasmodic. It is often used to enhance the effect of other oils. NB: Lemon oil is phototoxic, avoid exposure of the skin to the sun. Uplifting, emotionally good for restlessness and agitation, insomnia and nervous tension. Pain relief Enhance contractions Retained placenta Third Stage of Labour guidelines) Pain relief Enhance contraction Relaxation Infected sutures Backache Aid sleep and relaxation To uplift Insomnia/nervous tension Previous LSCS Not to use for women suffering from hayfever related asthma (Young 2002) Women with sensitive skin/ allergic to citrus fruit Women with sensitive skin/ allergic to citrus fruit Page 12 of 15

13 Type of Oil Potential Properties Indications in Labour Contra-Indications in Labour Peppermint Mentha Piperita Rose Rosa Centifolia/ Damascena It is sedating and anti-spasmodic. Often used to enhance the effect of other oils. NB: Do not expose skin to harmful sun s rays or use sunbed after application. A cool, refreshing oil useful for nausea, vomiting and stress. It clears headaches and helps migraines. Antidepressant, helpful for anxiety, depression and stress. Good for eczema, dry and sensitive skin. Helps to tone theuterus/enhance contractions (Tiran 2000). Mild Constipation Uplifting emotionally Nausea/vomiting Headaches Relaxation Anxiety Enhance contractions Women using homeopathic remedies in labour Not advisable in the bath. Previous LSCS Page 13 of 15

14 Appendix 3: Aromatherapy Client Record Form Name and address (stick label) Date Time Allergies? Previous aromatherapy use? Medication/Homeopathy? Checklist; Roman Chamomile is the only oil recommended for women who suffer any allergies Do not use Eucalyptus or Peppermint with women who use homeopathic remedies Do not use Clary sage, rose or jasmine for women with a scar on the uterus Do not use oils in the birthing pool Do not use Eucalyptus for women who suffer with Diabetes or Epilepsy Midwives who are pregnant should not perform aromatherapy treatments Client reason for use; I have obtained verbal consent from the woman and explained the reasons for using aromatherapy during childbirth and the possible side effects (such as a local rash). Midwife Signature: Print. Page 14 of 15 See reverse..

15 Practitioner Information on Essential Oils used in Labour (tick those used) Grape seed carrier oil Lemon Clary Sage Mandarin Eucalyptus Peppermint Frankincense Roman Chamomile Jasmine Lavender Rose Method of Use Massage Inhalation via tissue Compress Inhalation via bowl Footbath Inhalation via diffuser Woman s effectiveness rating No Help Very Helpful Woman s comments; Midwives effectiveness rating No Help Very Helpful Midwives comments Please record any observed or associated symptoms following administration of essential oils; Thank you. Please return this form to Helston Birth Unit for audit purposes. Page 15 of 15