The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”
Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients. This analysis shows that:
Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.
This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.
Tips for Choosing a Care Provider - great overview! from Henci Goer
by Marlene Ericksen Mothering Summer '94 COPYRIGHT 1994 Peggy O'MaraSome discomforts in pregnancy arise from ordinary fluctuations and bodily changes. Some signal a call for dietary or lifestyle adjustments. Most can be eased with the additional use of essential oils. Aromatherapy is of great help not only in pregnancy, but in preparing the body and mind for pregnancy.
As you begin journeying toward the creation of new life, explore the
joys of beautifying and caring for yourself. Volatile essential oils extracted
from flowers, plants, trees, fruit, and roots provide a natural means of
nurturing both body and psyche. Aromatherapy can be used on a regular basis
throughout the childbearing year to ease discomforts, alleviate emotional
stress, and maintain health and beauty.
The rose is considered the epitome of the feminine. It is associated with the Virgin Mary, who is often depicted with a rose in her hand. Rosaries, from which the Catholic rosary was named, were originally made from dried rosebuds. Hippocrates recommended rose for use in obstetrics. Cleopatra used essence of rose on the sails of her barge to entice the unsuspecting Mark Antony: "The winds were lovesick.... From the barge a strongly invisible perfume hits the sense of the adjacent wharf" (William Shakespeare, Antony and Cleopatra).
In the three months prior to conception, rose essential oil (Rosa damascena)--or
rose otto, as it is sometimes called--can be of great assistance. To begin
with, this oil is known as a fertility promoter. For an increased sperm
count, have your partner take warm baths with 4 to 10 drops of rose otto.
(Hot baths and hot tubs are to be avoided for three months prior to conception
because heat can damage sperm.) Rose oil also helps purify the uterus and
regulate the menstrual cycle. To absorb the oil directly into your pelvic
region, try sitz baths with 3 to 7 drops of rose otto. [For preparation
guidelines, see "Methods and Dosages."] More than anything else, rose oil
facilitates relaxation and nurtures the emotions. Partners wishing to nourish
each other and strengthen bonds before childbearing are advised to massage
each other with 4 to 7 drops of rose oil mixed with 1 ounce of carrier
oil (grapeseed, sweet almond, hazelnut, or other vegetable oil). Other
essential oils are also beneficial at this time. Geranium (Pelargonium
x asperuin) can help balance the menstrual cycle and hormonal activity.
Bergamot (Citrus bergamia), neroli (Citrus aurantium), ylang-ylang (Cananga
odorata), and clary sage (Salvia sclarea) are relaxing and uplifting. To
make a female fertility blend that can counteract the effects of stress,
add to 2 ounces of carrier oil: 3 drops of rose, 4 drops of geranium, 3
drops of clary sage, 2 drops of ylang-ylang, and 2 drops of bergamot. A
nightly abdominal massage with this blend just before sleep is particularly
comforting. Using small, clockwise movements, massage around the entire
abdomen, tracing along the inner portion of the pelvic bones, along the
diaphragm, and over the solar plexus, then focusing on the lower abdomen
in the region of the uterus.
Nausea, headache, and morning sickness. A woman's sense of smell is heightened during pregnancy You may be intensely attracted to some odors and strongly repelled by others. To keep the atmosphere appealing, use an aromatic diffuser or simply place a few drops of essential oil in a bowl of water so that they can evaporate naturally, scenting the room. The diffuser method, which relies on heat from a candle or an electric bulb, vaporizes the essential oil molecules, spreading the scent faster and farther than the bowl-of-water method. Diffusing antiseptic essential oils into your breathing space will also cleanse the environment of harmful airborne bacteria.
To make a diffuser recipe effective in alleviating morning sickness and headache, mix 3 drops of lavender (Lavendula officinalis or Lavendula vera) with 1 drop of peppermint (Mentha pipperita). If colds or flu are in the air, add 1 drop of eucalyptus (Eucalyptus globulus) as a preventative.
To help combat nausea, place a cool lavender oil compress on your forehead and a warm lavender oil compress over the front of your rib cage. A deep whiff of peppermint oil will often cure nausea, as will a cup of tea or honey water prepared with 1 drop of peppermint oil. (Do not overuse peppermint, as it can have stimulating effects, and do not take essential oils internally on an empty stomach.
Lavender and peppermint are good remedies for headaches as well. At the first sign of headache, place 1 drop of undiluted lavender oil on each temple, or lying down in a dimly lit room, place a cool peppermint oil compress on your forehead. To counteract noxious odors when out and about, keep a cotton hankie dabbed with 1 drop of lavender or peppermint oil in a plastic bag in your purse. To prevent headache or nausea, hold the hankie over your nose and inhale deeply; repeat as necessary.
Morning sickness often occurs during the third month of pregnancy, usually in response to the siting of the placenta. It can also arise in response to low blood sugar levels after a night of fasting. Nutritionist Adele Davis recommends a healthy, protein-rich snack along with carbohydrates and fruit before bed and again in the morning before getting up. Morning sickness can also result from a vitamin B-6 deficiency
To alleviate vomiting, add 7 drops of lemon (Citrus limon) or lavender oil to 1 ounce of carrier oil, and massage over the abdomen--or simply inhale the essences. A cup of red raspberry leaf (Rubus strigosus) tea can provide relief while toning the uterus. If morning sickness is severe, try tincture of wild yam root (Dioscorea villosa); add the extract to boiling water or hot tea as recommended on the label.
Legal ailments and hemorrhoids. Weight gain and abdominal pressure due to increased blood volume and the softening effects of progesterone on the venous walls may cause varicose veins, edema, other leg discomforts, and hemorrhoids, particularly in the second trimester. Leg discomforts during pregnancy are also attributed to nutrient deficiencies. A boost in vitamin B-6 is often recommended for varicose veins, edema, and leg cramps. Vitamin E helps prevent varicose veins and blood clots. Garlic cleanses the circulatory system. Sodium helps alleviate leg cramps, as does calcium.
Varicose veins respond well to the toning and astringent properties of cypress (Cupressus sempervirens), geranium, lemon, and lavender oils. Elevating your legs, alternate warm and cool compresses of any combination of these oils to the affected area. Bathe in warm water mixed with 3 drops of cypress and 3 drops of lemon. Using a blend of 7 drops of cypress and 7 drops of lemon mixed with 2 ounces of carrier oil, gently stroke from the feet upward. While massaging, be careful not to apply strong pressure over a varicosity or just below the point at which a varicosity begins.
Edema (fluid retention) of the ankles or legs responds to lavender, geranium, and rosemary (Rosmarinus officinalis) oils, all of which stimulate the lymphatic system to drain excess fluids from the body Using upward strokes, gently massage a blend of these oils to the feet and ankles. If your feet are hot, tired, or swollen, try tepid-to-cool footbaths with 3 drops of geranium or lemon and 3 drops of lavender. To reduce swelling, sleep with a pillow under your legs, and take afternoon naps with your legs elevated higher than your heart. To strengthen the venous walls, add vitamin C and buckwheat to your diet. Exercise, especially walking and swimming, will stimulate circulation, as will support hose worn on a regular basis. Baths with lemon, mandarin (Citrus reticulata), or other citrus oils contain vitamin C and will provide a mild diuretic action.
Dilated veins that cause swollen anal tissue result from the same conditions that cause varicose veins; they also result from repeated straining to pass stool. The herb nettle leaf (Urtica dioica) can be taken as an infusion or tincture to improve elasticity of the veins and reduce hemorrhoids. Also add oat bran to your breakfast cereal, and be sure to eat plenty of fruit and vegetables. Cool sitz baths with 7 drops of lemon oil will help, as will a follow-up massage using 7 drops of cypress plus 7 drops of lemon oil in 2 ounces of carrier oil.
Insomnia and nightmares. Comfortable sleeping positions can be hard to find in the later stages of pregnancy. If you are having trouble getting to sleep, or staying asleep, try lying on your side with a pillow between your knees and additional pillows supporting your arms and back. Sprinkle neroli blossom or sandalwood (Santalum album) oil around your bed, or dot a drop or two on your pillow. These oils, soothing to the mind and emotions, act as sedatives to relieve anxiety; their fragrant aromas will help you drift easily off to sleep. Also try sprinkling a few drops of essential oil in a bowl of water near a radiator or heat vent. A warm neroli oil bath before bed can help relieve the day's stress and invite a sound sleep. If muscle cramps are keeping you awake, take a calcium-magnesium supplement before retiring.
Pregnant women's nightmares about themselves or their babies are considered a normal release of anxiety about parenthood and the well-being of the child. The remedy of choice is essential oil of frankincense (Boswellia carterii). Sprinkle it around your bed, place a drop or two on your pillow, put a few drops in a bowl of water near a heat source, or massage your chest with 1 drop of frankincense mixed with 1 teaspoon of carrier oil. Applied to the back of the neck, this oil is said to be especially protective. A cup of tea made with skullcap (Scutellaria lateriflora) extract soothes raw nerves and restores deep sleep.
Stretch marks. To prevent stretch marks and keep your skin soft and supple, use topical applications of vegetable oils. To maintain elasticity, stock up on vitamins C and E. Evening primrose oil capsules, taken internally, also nourish the skin and help maintain elasticity. Wheat germ oil, applied topically, is a wonderful stretch mark preventative, for it neutralizes acidity and toxins and is a natural source of vitamin E. Hazelnut oil is similarly rich in vitamin E. To make a stretch mark blend, mix 1 ounce of hazelnut oil and 1 ounce of wheat germ oil with 4 drops of neroli, 2 drops of carrot seed (Daucus carota), and 2 drops of geranium oil. Morning and evening, massage this blend into thighs, hips, breasts, and belly. Or add the blend to warm bathwater mixed with seaweed extract or seawater concentrate for a mineralizing soak. To avoid dehydrating your skin, do not take overly hot baths and do not soap up your entire body After emerging from the tub, pat off excess water with a towel, leaving the skin damp. Then apply stretch mark blend and body lotion.
Chloasma. The so-called mask of pregnancy (hyperpigmentation) has been linked to the inability of the liver to remove excess hormones from the bloodstream. Pigmentation problems also result from a deficiency of folic acid, PABA, vitamin B-12, or vitamin B-6. To protect your skin from sunlight, wear sunscreen and a hat. At night, apply several drops of the following essential oil blend to your facial skin: 3 drops of lemon plus 4 drops of myrtle (Myrtus communis) to 1 ounce of carrier oil. Work the blend into your skin with cool water or a floral water. Then apply your preferred face cream.
Acne. Some women say that their skin never looked better than when they
were pregnant. Others prone to the surging hormonal activity of pregnancy
say the opposite. If you are among those subject to acne, dab on a tiny
amount of undiluted lavender oil. For an inflamed pustule, use 1 drop of
tea tree oil (Maleleuca alternafolia). A weekly mask of seaweed extracts
and mineral-rich clay will help keep skin clear of dead cells and debris.
Care of the perineum. Much can be done during pregnancy to prepare the perineum to stretch beyond its everyday limits for birth, and to do so without tearing and without the need for surgical cutting. Midwives who incorporate aromatherapy into their practice have found that episiotomy or tearing occurs in only 48 percent of birthing women who perform perineal massage during pregnancy, compared with 77 percent of those who do not.(1)
For optimum results, massage your perineum for 5 to 10 minutes a day beginning five or six weeks before your due date. First, empty your bladder. Follow with a 5- to 15-minute warm water and lavender oil sitz bath to relax the vaginal wall. Then, inserting two well-washed index fingers or thumbs into the vagina just enough to stretch the perineal tissue, press the vaginal wall back toward the rectum. Massaging in a U-shaped motion with a blend of 3 drops of lavender, I drop of geranium, and 1 ounce of wheat germ oil, stretch the vagina open for 20 to 60 seconds, or until you feel a tingling or slight burning sensation-precisely what you will feel with the crowning of baby's head in labor. Over time, the perineal tissue will become soft and supple.
With daily massages of this sort, the perineum is likely to remain highly elastic--and intact--during birth. If tearing should occur, or if an episiotomy becomes necessary, treat yourself to warm postpartum baths or sitz baths to speed the healing. Add cypress, lavender, or geranium oil to the bathwater to help tighten the stretched or severed tissue, prevent infection, and stop the bleeding. For an effective soak, use 3 drops of cypress and 3 drops of lavender.
Care of the full body. Treat every part of your body to an essential
oil massage, especially in the later months of pregnancy. A foot massage
is a wonderful way to enliven the entire body and relieve the legs of pressure.
To position yourself for massage of the back and neck, sit backward on
a straight-backed chair, or sit on a stool and lean forward onto a table
piled with pillows for support. Reclining, prop yourself up with cushions
and pillows for massage of the neck, back, shoulders, and limbs. And remember,
massage of the abdomen calls for the lightest of strokes.
Whether you are planning to birth your baby in a hospital, at a birthing center, or at home, have ready the following items:
* Blended oils for massage. Bottle the mixtures in dark glass containers at least three weeks in advance of your due date.
* Undiluted essential oils for baths, compresses, inhalations, and diffuser. An aromatic diffuser. An electric model is preferable if there will be toddlers about or if you will be using a hospital or birthing center room.
* Flannels and bowls for compresses.
* A plastic baby tub for sitz baths.
Plan on creating a magical birthing environment, complete with soft lights, music, and your favorite essential oils. Neroli, bergamot, rose, and frankincense can help relieve anxiety and fears you might be harboring about birth. Breathing in any of these oils as they waft through the air from your diffuser will help you relax between contractions, inviting your body's production of endorphins to provide natural pain relief. Simply add to the diffuser 3 or 4 drops of your chosen oil.
Lavender (Lavendula augustifolia) can promote relaxation and pain relief during labor. Once your contractions are established and your cervix has dilated at least 2 centimeters, plan on taking a long lavender soak. Women who bathe for 30 minutes or more during this phase of labor experience improved progress and a significant decrease in the need for drugs.(3)
An essential oil massage between contractions can be soothing and comforting while stimulating pain relief. A foot massage may be ideal, or perhaps a low back massage with gentle, yet firm strokes, using the palm of the hand. For a topnotch labor blend, combine 20 drops of lavender and 8 drops of clary sage in 4 ounces of carrier oil.
To help stimulate and strengthen contractions, request a jasmine (lasminum grandiflorum) compress on the lower abdomen or sacrum. For pain, use lavender or clary sage. Cool compresses to the forehead can help ward off fatigue and keep you refreshed. If nausea crops up, take a whiff of peppermint or lavender.
Spikenard (Nardostachys jatamansi), an exotic essential oil not often mentioned in aromatherapy literature, is profoundly relaxing. Spikenard's sedative action is useful if pain and tension are keeping you from opening into your contractions. In such instances, be sure to ask for an abdominal massage with 8 drops of spikenard mixed with 7 drops of jasmine and 3 drops of lemon verbena in 4 ounces of carrier oil. Or apply a compress of this blend just above the pubic hair. Evening primrose oil can be massaged directly on the cervix if it remains rigid and nondilating.
Labor is a wondrous act of nature, and unique to every childbearing
woman. If pain or tension gets you down, remember that this stage will
pass. Envision yourself as a powerful woman, and know that in a very short
time, you will be experiencing the gift of birth.
Certain essential oils are emmenagogic (bringing on menstruation) and are subject to controversy. Some texts list them as unsafe in pregnancy, whereas others point out that they are wonderful for pregnancy. Essential oil researcher and pharmacologist Tony Balacs explains: "I have found no evidence of any danger in pregnancy. Even if an essential oil is proven to have an emmenagogic action, this does not necessarily mean it is a potential abortifacient."(1) The following essential oils are emmenagogic: camphor, caraway, cedarwood, chamomile, clary sage, cypress, jasmine, juniper, lavender, marjoram, nutmeg, peppermint, rose, and rosemary.
Certain essential oils are known abortifacients and are to be avoided during pregnancy These include: ajowan, aniseed, basil, bitter almond, boldo, buchu, camphor, dove, cornmint, cotton lavender, fennel, horseradish, hyssop, lavendula stoechas, mugwort, mustard, myrrh, oregano, parsley seed, pennyroyal--American and European, pimenta racemosa, plecanthrus, rue, sage (not to be confused with clary sage), sassafras, savin, savory, star anise, sweet birch, sweet marjoram, tansy, tarragon, thuja, thyme (C.T. thymol), West Indian. bay leaf, wild thyme, wintergreen, wormseed, and wormwood.
(1.) Tony Balacs, "Safety in Pregnancy," International Journal of Aromatherapy 4, no. 1 (Spring 1992): 15.
Methods and Dosages
Massage blends. The maximum dosage for use in pregnancy is a 1 percent dilution. To prepare a 1 percent dilution, add 10 to 14 drops of essential oil to 2 ounces of carrier oil, or add 5 to 7 drops of essential oil to 1 ounce of carrier oil. Two percent dilutions are suitable for use before and after pregnancy. Never use undiluted essential oils directly on your skin unless specifically recommended.
Baths and sitz baths. Use a maximum of 6 drops of essential oil per bath. To prepare a sitz bath, set a large plastic baby tub in your bathtub, fill with water, add the oils, and agitate to spread. Lower yourself into the baby tub, keeping your feet on the outside, and soak for 20 minutes unless otherwise directed. An aromatherapy bath in the morning can prepare you for a smooth and easy-to-cope-with-stress day. To eliminate the urge for caffeine, try an uplifting oil such as lemon or geranium oil. An evening bath with relaxing oils such as sandalwood or frankincense can soak away the day's troubles and calm the nervous system for a sound sleep.
Compresses. Fill a bowl with cool or warm water, depending on your needs. Add 3 or 4 drops of essential oil. For cool compresses, drape a flannel across the top of the cool water to pick up a film of the oil, then wring out the flannel and place it on the appropriate body area; repeat when the compress has warmed. For warm compresses, drape the flannel, wring it out, place it on the body, and cover it with plastic and a towel; repeat when the compress has cooled.
Inhalations. For a diffuser, use 3 to 4 drops of essential oil. For a hankie, use 1 drop.
(1.) Juliette Guenier, RGN, RM, "Essential Obstetrics," International Journal of Aromatherapy 4, no. 1 (Spring 1992): 7. (2.) Grace Lafan, "Case Studies," International Journal of Aromatherapy 4, no. 1 (Spring 1992): 33-34. (3.) Lynne Reed and Lynne Norfolk, "Aromatherapy in Midwifery," Aromatherapy World (Summer 1993):13.
Davis, Patricia. Aromatherapy A-Z. Great Britain: C. W. Daniel Co., Ltd., 1988. Davis, Adele. Let's Have Healthy Children. New York: New American Library, 1972. Donsbach, Kurt W. Pregnancy. Baja California, Mexico: Wholistic Publications, 1981. Dye, Jane. Aromatherapy for Women & Children. Great Britain: C. W. Daniel Co., Ltd., 1992. England, Allison. Aromatherapy for Mother and Baby. Rochester, VT. Healing Arts Press, 1994. Ericksen, Marlene. "Essential Oils: Determining Quality." Massage Magazine (Jan 1994). Green, James. The Male Herbal. Freedom, CA: The Crossing Press, 1991. Hotchner, Tracy. Pregnancy & Childbirth. New York: Avon Books, 1979. Lake, Max. Scents and Sensuality. Great Britain: John Murray, Ltd., 1989. McCauley, Carole Spearin. Pregnancy after 35. New York: Simon & Schuster, 1978. Ryman, Daniele. The Aromatherapy Handbook. Great Britain: C.W Daniel & Co., 1984. Shannon, Marilyn M. Fertility, Cycles and Nutrition, 2nd ed. Cincinnati, OH: Couple to Couple League, 1992. Tisserand, Maggie. Aromatherapy for Women. Rochester, VT: Healing Arts Press, 1988. Weed, Susan S. Wise Woman Herbal for the Childbearing Year. Woodstock, NY: Ash Tree, 1986.
For More Information
Distributors of Therapeutic-Quality
Essential Oils Lennon-Ericksen Aromatherapy Day Spa 1424 Agua Fria Santa Fe, NM 87501 505-988-4158 Original Swiss Aromatics PO Box 6842 San Rafael, CA 94903 415-459-3998 Oshadi 15 Monarch Bay Plaza, Suite 346 Monarch Beach, CA 92629 714-240-1104 Simplers Botanical Company Box 39 Forestville, CA 95436 707-887-2012 Whole Spectrum 5018 North Hubert Avenue Tampa, FL 33614 813-877-9698
To Find a Certified Aromatherapist
National Association for Holistic Aromatherapy PO Box 17622 Boulder, CO 80308 303-258-3791 For more information on aromatherapy, see the following articles in past issues of Mothering: "Scent and Pregnancy: Herbal Aromatics," no. 29; "Aromatherapy," no. 48; "Aromatherapy: Making Good Scents," no. 59; and "Essential Oils for Body and Mind," no. 66.
Marlene Ericksen is a certified aromatherapist who has been practicing since 1983, She is also a licensed massage therapist and aesthetician, and is certified in manual lymph drainage. She lives in Santa Fe, New Mexico, where she and her husband William Lennon own an aromatherapy salon and day spa.
Special thanks to Aromaland of Santa Fe (800-933-5267), for the use
of one of their line of Aromatherapy diffusers in the photo illustration
on page 74.
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