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J Perinat Neonat Nurs

Vol. 24, No. 3, pp. 238–245
Copyright  c 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Uses of Aromatherapy

in Women’s Health
Jackie Tillett, ND, CNM, FACNM; Diane Ames, DNP, RN, CCAP

Aromatherapy is the practice of therapeutic use of essential plant-based oils. Essential

oils and aromatherapy have been used in the care of women for centuries. The
published research has used small samples and often combines other complementary
therapies with aromatherapy; however, the use of essential oils has not been shown to
cause harm and is accepted by women. Aromatherpay mixtures are appropriate for use
by nurses in labor and delivery settings. The article reviews the literature and discusses
appropriate essential oil mixtures for use in women’s health setting and labor and
delivery. Key words: aromatherapy, complementary healthcare, labor and delivery,
stress, women’ health

A romatherapy is the practice of therapeutic use of

essential plant-based oils. The term aromatherapy
was first used in France in 1928 by a French chemist.1
may benefit from an essential oil mixture. The thera-
peutic outcome would be the eradication of the organ-
ism, which may be confirmed by a wet prep and vaginal
However, the use of plant-based oils and extracts for culture once the treatment is completed.
healing has been practiced for millennia. Aromatherapy There is not a great amount of published rigorous re-
is a part of the repertoire of herbal medicines passed search testing aromatherapy oils and techniques, but
along formally and informally by networks of alterna- aromatherapy is a component of alternative and inte-
tive and complementary practitioners. There are com- grative healthcare practice and is used by many prac-
pendiums of essential oil treatments with mixtures de- titioners who provide healthcare for women, and the
veloped by the authors of this article.2–6 techniques are of interest to readers of the Journal of
Aromatherapy has been misunderstood and ma- Perinatal and Neonatal Nursing. There have been no
ligned by some allopathic practitioners because of the studies or published anecdotal evidence that demon-
connotation of “aroma” intertwined with the food and strate harm from essential oils to mother or fetus.
perfume industries. In clinical settings, the use of essen- This article will discuss aromatherapy and the use of
tial oils is the preferred terminology. Often patients and essential oils in women’s health, review available liter-
practitioners associate the term with candles, soaps, ature, and suggest some ways to employ these treat-
and lotions. However, clinical aromatherapy is a goal- ments in the care provided to women. Suggestions for
directed intervention with an expected therapeutic treatments are those used in the clinical practice of one
outcome. For example, a woman with recurrent vulvo- of the authors of this article (Diane Ames). Dr Ames is
candidiasis, which has been refractory to antifungals, a certified clinical aromatherapist.

Author Affiliation: Midwifery and Wellness Center, Aurora ESSENTIAL OILS

Sinai Medical Center, Milwaukee, Wisconsin, and University of
Wisconsin School of Medicine and Public Health, Madison (Dr
Tillett); Aurora Health Care, Milwaukee, Wisconsin (Dr Ames). Chemically, essential oils are volatile, fragrant organic
compounds obtained from distillation of plant mate-
Correspondence: Jackie Tillett, ND, CNM, FACNM, Midwifery and
Wellness Center, Aurora Sinai Medical Center, 1020 N 12th St, Mil- rial from roots, leaves, stems, bark, flowers, and seeds
waukee, WI 53233 ( or expressed from peels. An essential oil can be bro-
Submitted for publication: March 25, 2010 ken down into its individual components, which con-
Accepted for publication: June 14, 2010 sist primarily of esters, alcohols, aldehydes, terpenes,

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The Uses of Aromatherapy in Women’s Health 239

ketones, phenols, and oxides. Gas chromatography and sorbed by the body are generally small, the potential
mass spectrometry can be used to identify the compo- harm is unlikely and insignificant. Experienced health-
nents and the concentration that in turn determines care providers are aware that this is not always true;
the oil’s therapeutic properties. The quality and com- however, the use of essential oils is widespread and has
position of the oil may differ depending on the place not been shown to cause harm.
of origin, the climate, the method and place of distil- There is a body of published literature regarding aro-
lation, and the quality of the manufacturer. Currently, matherapy; however, there are few published clinical
there are no laws in the United States setting standards trials.11–14 The Cochrane collaboration review of com-
for essential oils, and oils are not regulated by the Food plementary and alternative therapies for pain manage-
and Drug Administration. ment in labor,15 updated in 2009, found only 1 trial
There are many books published on aromather- meeting the Cochrane standards. Herz16 analyzed sev-
apy but little published rigorous research. Concen- eral hundred articles after searching PubMed, and in
sus is lacking on the minimal skills necessary to prac- an article published in 2009, she found that only 18
tice as an aromatherapist. The United Kingdom has studies represented valid experimentation models or
been more progressive than the United States regard- addressed conceptual or methodological issues in re-
ing the licensing and standardization of training for search around aromatherapy. Simkin and Bolding17 re-
aromatherapists.1 Other European countries have var- viewed nonpharmacologic approaches for control and
ied and diverse regulation and licensing. Although relief of labor pain. They found 1 large, uncontrolled,
there is no licensing in the United States, there are prospective study in the published literature.18 Simkin
several clinical aromatherapy certification courses for and Bolding17 point out that adverse effects reported
practitioners interested in integrating this modality into by women treated during labor with essential oils may
practice.7,8 be due to labor itself, another barrier to effective re-
A number of practitioners subscribe to the functional search. The literature of aromatherapy falls into several
group theory of aromatherapy, which claims that major categories: clinical trials, anecdotal evidence, personal
chemical components within an oil have specific thera- recipes, and discussion of initiation of aromatherapy
peutic effects; for example, phenols are anti-infectious into existing programs.18–21
agents and terpenes have antiseptic properties. How- Early trials (1970–1990) centered on the use of es-
ever, other practitioners believe that this theory does sential oils as antimicrobials.22 Many constituents of es-
not account for synergism and harmony within an sential oils are known to be antimicrobial, including al-
oil.9 cohols, aldehydes, terpenes, and phenols. Early studies
found the antimicrobial effects difficult to quantify be-
cause of the variation in makeup of essential oils, even
REVIEW OF THE LITERATURE the same oil, from different manufacturers.22 Later clin-
ical trials examined the use of essential oils in pain re-
Although research trials are increasing in the field of lief in oncology care, in care of patients with dementia,
aromatherapy, the literature is still sparse and disparate. and pain management for women in labor.23–26 These
There are many essential oils, and many therapeutic studies found little differences in patients treated with
methods are used to administer the oils. It is diffi- essential oils but were small and limited in scope.
cult to conduct blinded, randomized clinical trials, and More recent clinical trials centered on women’s
there is temptation to use several oils during the same health have looked specifically at the use of aromather-
trial. Kusmirek10 acknowledged that one of the chal- apy for menopausal symptoms, postoperative pain, and
lenges with providing aromatherapy in a therapeutic dysmenorhea.27–29 Hur et al27 found that menopausal
manner is the rapid development of the popular use women with increased blood pressure experienced a
of the therapy. Even though the popular use of aro- reduction in systolic blood pressure after aromather-
matherapy has increased in the last 20 years, the lack of apy massage once a week for 8 weeks. The massage
clinical research has hindered the acceptance of the was performed with essential oils of lavender, rose gera-
therapy in the patient care environment. This lack nium, rose, and jasmine diluted in almond and evening
of reliable information regarding interactions between primrose oil. The massage intervention lasted 30 min-
essential oils with each other and with more ac- utes and was concentrated on the back, arms, and ab-
cepted and conventional medications and treatments domen. The researchers acknowledge that this study
can make acceptance of aromatherapy on clinical units cannot determine whether the positive effects of the
difficult. Hoffman1 points out that the public and some intervention are due to the aromatherapy, the massage,
clinicians assume that because the doses of oils ab- or the synergized combination of both.26

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240 Journal of Perinatal & Neonatal Nursing/July–September 2010

Japanese researchers used the Kupperman Index USES OF ESSENTIAL OILS IN

(KI) to measure the response of Japanese menopausal WOMEN’S HEALTH
women to a 30-minute aromatherapy massage.26 The
KI is a self-rating scale for menopausal symptoms in- Despite the lack of literature and randomized con-
cluding vasomotor effects, paresthesias, fatigue, pain, trolled trials regarding aromatherapy, there are guide-
and depression. Fifteen women were enrolled in the lines, uses, and protocols for essential oils that have
study. The women were given 1 massage of back, legs, been utilized by midwives and other caregivers for
chests, necks, and heads. The women were then given many years without causing harm to women, fetuses,
the oils and instructed to do self-massage and to use the or infants. Burns et al18 studied the use of essential
oils after bathing or before bedtime 3 to 4 times weekly. oils in 8058 laboring women and found that 1% of the
The oils were chosen by an aromatherapist on the basis women had a mild unpleasant response to the oils used,
of each woman’s menopausal symptoms. Eighteen dif- which included rose, jasmine, chamomile, eucalyptus,
ferent essential oils were used in combinations blended lemon, mandarin, clary sage, frankincense, lavender,
with macadamia nut oil. After 1 month, KI scores were and peppermint. None of the responses were harmful
significantly lower in all patients. All the women contin- to the woman or the fetus. The uses of essential oils can
ued with the intervention. Again, it is difficult to sep- be divided into those for women’s health issues such as
arate the effects of massage from the effect of the oil premenstrual syndrome (PMS), vaginal infections, and
application. other uses and those for laboring women.
Kim et al28 used lavender oil aromatherapy postop- Essential oils are concentrated substances and in
eratively for 25 women undergoing breast biopsy. The some cases may be irritating to the skin or mucous
researchers used a similar control group of 25 women. membranes. Conducting a patch test on the skin to
The experimental group received supplemental oxy- check for allergies is suggested prior to topical applica-
gen through a face mask with 2 drops of 2% laven- tion. Common practice is to mix the essential oils with
der oil. The control group received supplemental oxy- carrier oils. Carrier oils are generally those with larger
gen through a face mask but without the lavender oil. molecules and are long-chain fatty acids. Carrier oils
The researchers found no significant differences be- should be virgin or cold-pressed if available and work
tween the 2 groups regarding narcotic requirements, better if nonhydrogenated. It is important to match the
pain scale scores, and recovery room discharge time. clinical picture with the carrier oil, but each aromather-
The women in the intervention group did report sig- apist has combinations that he or she prefers or finds
nificantly higher satisfaction with pain control than the more effective. Carrier oils retain some nutrients such
women in the control group. as Vitamin A and Vitamin E and may be used therapeu-
Gedney et al30 exposed human subjects to thermal tically without essential oils for some purposes, such
pain stimuli and ischemic pain. Subjects were random- as massage. Carrier oils are generally extracted by heat
ized to treatment with applications of lavender oil, rose- extraction or solvent extraction. Heat extraction may
mary oil, or distilled water on a 2 by 2 gauze cotton change the molecular structure to that of a trans fat;
pad attached to the subject’s clothing after the pain however, solvent extraction uses petrochemicals, de-
stimuli were administered. The researchers found no stroys nutrients, and may cause skin irritations.
changes in the quantitative subjective pain sensitivity All-purpose carrier oils include grapeseed (Vitis
ratings between the groups. However, when the sub- vinifera), sweet almond (Prunus amygdalus), and
jects were asked to recall their pain experiences, the sesame (Sesamum indicum). Each of these oils has par-
impression of the intervention groups was that both ticular properties that may make the oil a preferred es-
pain intensity and pain unpleasantness were reduced sential component to a mixture. These properties are
significantly in the lavender group and marginally in the summarized in Table 1 (Diane Ames, written communi-
rosemary group. The researchers suggest that while es- cation, May 1, 2010).31,32 Other carrier oils are used in
sential oil therapy with lavender may not cause a direct lower proportions and have specific uses and proper-
analgesic effect, post-pain treatment with oils may al- ties. These oils are summarized in Table 2 (Diane Ames,
ter the appraisal of the pain experience, especially ret- personal communication, May 1, 2010).31,32 Other car-
rospectively. This would correlate with the findings of rier substances include herbal oils that contain active
Kim et al28 that patients treated with essential oils in ingredients, such as calendula and arnica, shea butter,
the postoperative period are more satisfied with their and aloe vera. Each practitioner may have preferences
treatment and remember the experience in a more pos- for mixtures that she or he finds useful, tolerated by
itive manner. patients and pleasing in odor and viscosity.

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The Uses of Aromatherapy in Women’s Health 241

Table 1. Carrier oilsa

Grapeseed oil Sweet almond oil Sesame Oil

Thin Thicker Medium consistency

Easily absorbed Slower absorption Good absorption
Nonoily Slightly oily Contains Vitamin E, minerals and lecithin
Contains vitamins, minerals and linoleic acid
Uses Uses Uses
Massage Massage Emollient
Emollient Emollient Dilution of essential oils
Dilution of essential oils Dilution of essential oils
Avoid if nut allergy

a From Battaglia,4 Price & Price,6 and Diane Ames (personal communication, May 1, 2010)

Women’s health concerns that may be treated menopausal symptoms can be mixed with neroli, man-
with essential oils include PMS, vaginal infections, darin, and clary sage in a carrier oil and administered
menopausal symptoms, cystitis, infertility, and lichen by massage to the solar plexus as needed. Oils that are
sclerosis, among others. Oils used for PMS depend on used for menstrual cramps include roman chamomile,
the symptomology of the individual woman. Women peppermint, black pepper, rosemary, sweet marjoram,
who experience PMS with fluid retention may bene- and ylang ylang. It is important when recommending
fit from juniper or lavender administered in a bath. an oil, to investigate its properties. For example, sweet
Women who experience PMS with stress and tension marjoram is good for menstrual cramps but is also an
symptoms may benefit from neroli, ylang ylang, or clary anaphrodisiac. This may make it an oil that would not
sage as a massage on the abdomen or chest as needed. be helpful for all women.
Women who experience breast tenderness may use Dysmenorrhea may be treated with clary sage, ro-
geranium, juniper, evening primrose oil, and/or vitamin mance chamomile, angelica, and yarrow. The oil should
E oil, as a massage up to 4 times a day. be massaged into the abdomen and lower back as
Menopausal symptoms may need estrogenic support. needed. Oils may also be added to a bath with carrier
Oils that provide this support include clary sage, fen- oil or Epsom salts or used as a compress.
nel, and geranium. Clary sage and fennel have estrogen- Women with recurrent cystitis may benefit from tea
like properties and it is best to avoid using these oils in tree and palma rose for vaginal use and juniper and
the care of women who have estrogen-receptor posi- pine for abdominal use. Essential oil treatment is not
tive breast cancer. An all-purpose formula for relief of a substitute for antibiotic treatment when indicated.
Essential oils for infertility include ylang ylang, clary
sage, geranium, fennel, anise, cypress, and rose. These
oils decrease stress and anxiety and may aid in concep-
Table 2. Specialty oilsa
tion. Inhalation, topical application on the abdomen
Specialty carrier oils Properties and low back, and massage may be beneficial. Spe-
cific mixtures for use in women’s health are listed in
Apricot Kernel Oil Light and moisturizing, good for Table 3 (Diane Ames, personal communication, May 1,
mature skin 2010).31,32
Avocado Oil Viscous, regenerative, good for
During pregnancy, the aromatherapist should be
penetration into adipose tissue
Evening Primrose Oil Anti-inflammatory, good for skin cognizant of treatment benefits and potential risks.
regeneration Aromatherapy is used in pregnancy for stress relief,
Jojoba Oil Closest to the natural sebum in relaxation, fatigue, and relief of physical symptoms. Es-
skin, emollient sential oils may provide a pregnant woman with emo-
Rosehip Oil Excellent for scars, wounds, and
tional comfort and support. The benefits of aromather-
Sunflower Oil Anti-inflammatory, inexpensive apy in pregnancy include the fast action of essential
Vitamin E Oil Antioxidant, preservative oils, the simplicity of therapy, the ease of control, and
the lack of adverse effects. Aromatherapy in pregnancy
a FromBattaglia,4 Price & Price,6 and Diane Ames (personal com- provides a sense of well-being and creates an emotional
munication, May 1, 2010) balance.

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242 Journal of Perinatal & Neonatal Nursing/July–September 2010

Table 3. Mixtures for healthy female conditionsa

Condition Essential oil Drops Carrier oil Quantity Instructions

Vulvocandidiasis and Tea tree 14 Grapeseed or other 35 mL Impregnate tampon with mixture.
Bacterial vaginosis carrier oil Insert into the vagina at HS and
remove in AM ×7 days
HSV Tea tree 5 Calendula-infused herbal 5 mL Adjunct to antiviral therapy, apply
topically to lesion 4 times a day
till resolved
Fibrocystic breasts Juniper 5 Evening primrose 5 mL Apply mixture to breasts bid
Cypress 5
Dysmenorrhea Roman 5 Carrier oil such as 5 mL Apply to abdomen and lower back
Chamomile grapeseed q 4–6 h as needed
Clary sage 5
PMS Geranium 3 Evening primrose oil 5 mL Apply to lower back and abdomen
Clary sage 3 q 4–6 h as needed
Lavender 4
Menopause Clary sage 10 Distilled water and a drop 60 mL Close eyes and spritz face and
Spritzer Geranium 10 or 2 or rubbing alcohol body as needed
Lavender 5

Abbreviations: AM, morning; HS, hours of sleep or bedtime; HSV, herpes simplex virus; PMS, premenstrual syndrome, premenstrual
a From Erickson,3 Price & Price,6 and Diane Ames (personal communication, May 1, 2010)

Factors that should be considered when using es- nication, May 1, 2010)31,32 suggests some essential
sential oils in pregnancy include the dose, the route oils and mixtures for various common discomforts of
used, the potential toxicity of the oil, and the poten- pregnancy. Aromatherapists and practitioners provid-
tial toxicity of the metabolites from the essential oil ing prenatal care may be cognizant that some essen-
and/or the carrier oil. For pregnancy, the most com- tial oils treat a variety of complaints. Recommenda-
mon routes used for aromatherapy are dermal applica- tions state that the mixture of essential oils should
tion, massage, and inhalation. Essential oils with high be blended to match the symptoms of the pregnant
amounts of phenols, ketones, and phenylpropanoids woman. For example, roman chamomile is useful for
are considered most toxic and best avoided. back pain and heartburn. Trial and error may help find
It is valuable to remember that essential oils do pen- the most useful essential oil or combination of essential
etrate the body and may reach maternal circulation. oils for each woman. The essential oils used during the
Permeability of the placenta is reduced for polar sub- pregnancy can also help to get relief from the discom-
stances, but lipid soluble substances do cross the pla- forts of the postpartum period.
cental barrier. Risk of spontaneous abortion for any rea- Aromatherapy is helpful for anxiety reduction during
son is highest in the first trimester of pregnancy. Some labor. Labor is a high-stress time for many women.
aromatherapists avoid treatment in the first trimester Anxiety and stress can heighten pain perception,
because of this risk and because the first trimester is delay effective labor, and lead to increased medical
the time of rapid fetal development. Women with a his- interventions. Essential oil therapy can provide a
tory of spotting or bleeding may be counseled to avoid nonpharmacologic means of pain relief and stress
aromatherapy during the first trimester. reduction. Lavender and frankincense are 2 oils that
Special considerations are applicable during preg- have been used to provide this therapy.17 Routes of
nancy. Women are sensitive to smell and aromathera- administration include inhalation, massage, and bath.
pists may begin with lower doses of oils. Prolonged in- Pinning a 2 by 2 gauze pad embedded with essential
halation of any fragrances, including essential oils and oils to the woman’s hospital gown can provide an easy
commercial perfumes, is discouraged for any pregnant route for administration and follows the woman in vari-
woman. ous positions and ambulation. Another option is for the
Common discomforts experienced by many women woman to choose a scent to diffuse into the room to
during pregnancy may respond well to aromatherapy reduce stress and promote relaxation not only for her
intervention. Table 4 (Diane Ames, personal commu- but also for her partner or coach. Topical application of

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The Uses of Aromatherapy in Women’s Health 243

Table 4. Mixtures for common conditions in a healthy pregnancya

Condition Essential oil Drops Carrier oil Quantity Instructions

Insomnia Lavender 1–2 Grapeseed or shea butter 5 mL Massage on to arms and

or chest at hour of sleep or
Back pain Frankincense 1–2 Grapeseed 5 mL Massage on to lower back.
or Pelvic tilts also helpful
Black pepper
Hemorrhoids Juniper 1 Witch hazel 5 mL Dab on to hemorrhoid
or every 4–6 h as needed
Cypress 1 Aloe vera gelly
Headaches Lavender 1–2 Grapeseed 5 mL Apply to forehead and neck
Basil every 4–6 h as needed
Edema Peppermint 5 2 cup of Epsom salts Warm water Soak feet and lower legs in a
Lavender foot bath to soothe and
reduce swelling
Stretch marks None None Shea butter None Apply to abdomen
Cracked nipples None None Shea butter None Apply after feeding to breast
Calendula-infused herbal
Anal fissure German 5 Calendula-infused herbal 5 mL Apply q 4–6 h as needed. Best
chamomile oil to wear a pad as German
Lavender 5 chamomile is blue and may
leave a stain on clothes

a From Worwood,2 Battaglia,4 Price & Price,6 and Diane Ames (personal communication, May 1, 2010)

essential oils to acupressure points may also be helpful be very soothing during the labor and delivery process.
along with footbaths. Footbaths are a simple and Essential oils helpful during labor are listed on Table 5
relaxing route of aromatherapy during labor. The ap- (Diane Ames, personal communication, May 1,
plication of a 1% to 2% dilution of a relaxing oil such as 2010).31,32 Any of the oils listed can be mixed as a 1%
lavender or frankincense in a carrier oil such as grape- to 2% dilution and applied as agreed to by the woman
seed applied to the shoulders, low back, and feet can and the practitioner.

Table 5. Essential oils used in the labor and delivery settinga

Common name Botanical name Reason used

Clary sage Salvia sclerae Increase contractions

Eucalyptus Eucalyptus globulus Nasal congestion, pain
Frankincense Boswellia carteri Anxiety, pain
Jasmine Jasminum grandiflorum Pain, depression
Lavender Lavandula angustifolia Anxiety, depression, pain
Lemon Citrus limon Elevate mood
Mandarin Citrus reticulata Relaxation
Neroli Citrus aurantium var. flos Relaxation
Peppermint Mentha piperita Nausea and vomiting
Roman Chamomile Chamaemelum nobile Relaxation, back pain
Rose Rosa centifolia Anxiety
Ylang ylang Cananga odorata Relaxation, depression

a From Diane Ames (personal communication, May 1, 2010), Burns et al,31 and Tiran.32

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244 Journal of Perinatal & Neonatal Nursing/July–September 2010

Developing a repertoire of aromatherapy treatments nurses to wear gloves while using essential oils for pa-
is reliant on the understanding and comfort of the prac- tients. Women using the therapy were extremely satis-
titioner and the patient.31 More effective results will be fied. Nurses can be cognizant of the effects and accep-
obtained if the patient likes a particular essential oil. It tance of aromatherapy by women and advocate for the
has been shown that more positive results are achieved use of this nonpharmacologic method of treatment.
if the patient and the practitioner have positive expec- For aromatherapy to become an accepted treatment
tations as to the effects of aromatherapy.1 For pregnant modality on inpatient units, it is essential that more
women, lower doses may be initiated when beginning research be conducted. Standardizing protocol treat-
therapy until therapeutic results are achieved. This is ments will aid in effective testing of essential oils. Mech-
more difficult with laboring patients, because labor is anisms for certification of aromatherapists may create
time limited. a standard for treatment.


The mixtures described in this article are suitable for Using essential oils for management of women’s health
use by nurses on labor and delivery units and in offices complaints is a simple and effective treatment that
providing obstetrical and gynecological care. Incorpo- causes no harm, engages a woman in her lifestyle de-
ration of new treatments is a unit wide discussion how- cisions, and avoids overuse of pharmaceuticals. Certi-
ever. Some hospitals may view essential oils as medi- fication is available but not standardized nationwide in
cations and limit the use of oils unless there is discus- the United States. Mixtures of essential oils and carrier
sion with the healthcare provider. Dhany12 describes oils may alleviate anxiety, facilitate relaxation, inhibit
the incorporation of essential oils and massage services abnormal vaginal flora, and relieve the pain of labor.
into a midwifery practice in Great Britain. Successful Combining the use of essential oils with other com-
implementation of the new service was facilitated by plementary therapies such as massage or acupressure
rigorous planning and attention paid to all aspects of may contribute to the acceptance of these therapies
aromatherapy as a treatment modality.12 Careful poli- and add to the effectiveness of their use. Nurses are
cies with specific mixtures were developed by the mid- ideal practitioners of complementary therapies and are
wives for use by all practitioners, including nurses, on positioned to contribute to the research base regarding
the obstetrical unit. It was not considered necessary for the use of essential oils in healthcare.

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The Uses of Aromatherapy in Women’s Health 245

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