the lochial discharge has stopped, as it may precipitate a haemorrhage if bits of the placenta remain in the uterus; if she has had a caesarean section, it may be too painful for some weeks to work directly over the abdomen. If the mother is suffering constipation (a common problem in the early days), for which you may normally have chosen to perform abdominal massage, work instead in a � rm clockwise movement on the arches of the feet, where the re� exology zones for the intestines are located.

While leg and ankle massage can do wonders for oedema, the swelling may be so severe for a few days (worse than in pregnancy) that the skin is too tight and tender, so massage may be contraindicated. In this case, aromatherapists could offer a compress, using relevant essential oils, such as cypress and lemon, to reduce the oedema. If either leg appears red and hot to touch, or the mother complains of a pain in her calf, do not massage the area as this may be a deep vein thrombosis (DVT) developing, or blood clot, to which women in the early puerperium are susceptible. Indeed, in this case, it is wise not to treat her at all, but to refer her immediately to her midwife or GP because, left untreated, a DVT can lead to fatal stroke or heart attack.

Mothers who had an epidural during labour frequently experience back, neck or headache in the days after delivery, but you should use caution when massaging the lower back where the epidural cannula (catheter) was inserted as this can remain painful and is also a source of potential infection through to the cerebrospinal � uid. Be alert to severe headaches occurring in the � rst 48 hours after birth, particularly if the mother had pregnancy hypertension, because eclamptic � ts, which can occur in severe pre-eclampsia, are most common at this time. In practice, it is unlikely that you would be treating a woman in this

Many expectant mothers use essential oils at home or consult aromatherapists for

treatment during pregnancy, even though there is no de� nitive list of ‘safe’ oils that can be used at this time. Increasingly, too, women choose to use aromatherapy in childbirth to ease pain and aid progress; some have the luxury of giving birth in maternity units where midwives now use essential oils (Burns et al 2000; Dhany 2008).

However, while much has been written and discussed relating to pregnancy and labour (Tiran 2000), less is published about the use of aromatherapy in the days and weeks immediately afterwards, yet it can be invaluable in helping mothers to recover from the birth, aiding lactation and facilitating adaptation to parenthood.

Postnatal careIn the UK, most births take place in hospital or midwife-led birthing centres, although a small percentage of women give birth at home. Mothers without any pregnancy or medical complications, or issues arising from the birth, usually go home within 24 to 48 hours of delivery, or on the third day if they have had a caesarean section.

The midwife is legally responsible for the care of mother and baby in the early days, transferring their care to the health visitor at between 10 and 28 days after birth. The midwife examines the mother to ensure her body is recovering from the birth, that breastfeeding is becoming established (or the milk is drying up if the mother is bottle feeding) and to advise her on caring for her baby. However, while postnatal care was once the pride of British midwifery, cost savings and alterations in care provision now mean that most mothers are visited at home on only three occasions, usually in the � rst 10 days. In some areas, mothers are even required to attend postnatal clinics at the hospital for their check-ups.

Maternal adaptationsThe postnatal period (the puerperium) involves physical, psycho-emotional and social adaptation. All the systems of the mother’s body, which have changed to accommodate the growing foetus and to birth her baby, need to recover and return to normal, although her body will never return completely to its pre-pregnancy state.

The uterus shrinks through a process of involution, in which excess tissues are dissolved and the resulting � uid excreted; this causes an increase in micturition (urination) and, occasionally, a worsening of any ankle and leg oedema, as the kidneys struggle to cope with the extra � uid. The

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Holistic | Post-birth

A moment for motherDenise Tiran looks at the changes a mother experiences following childbirth, and how

massage and aromatherapy may offer support remnants of the placenta and other products of conception are passed vaginally as lochia, initially being red blood, like a heavy period, then turning to brown and then serous or whitish � uid. The major organs of the body – the lungs, heart, kidneys, liver and brain – must all adapt.

Establishing lactation also requires various physiological changes, which in turn can lead to a rollercoaster of emotions. The massive endocrine upheaval resulting from expulsion of the placenta at delivery, and the consequent rise in hormones for lactation, frequently give rise to third or fourth day ‘blues’ or tearfulness which, in susceptible women, may progress to postnatal depression. Finally, the social adaptation to parenthood – the change of role from wife/partner and worker to mother, and the loss of control that a new baby wreaks on the family – brings other issues to the fore, which may also contribute to emotional distress.

It is important for therapists wishing to work with new mothers to have an in-depth understanding of the physiological changes that occur in the � rst six to eight weeks and to be able to recognise when things are not proceeding according to expected norms. Treating women in the � rst two weeks of the puerperium also requires aromatherapists and practitioners of other therapies to liaise with the midwife (not the doctor, who plays little part in the woman’s postnatal care). It is likely that you will have to visit the mother at home in the early days, not least because it takes new mothers time to establish a routine. Later, when mothers attend your consulting room or clinic, you should accept that some will be late for appointments, some will forget and some will bring the baby with them, which is not ideal if she/he wakes during the treatment.

Massage in the puerperiumIt may not be possible to perform a full body massage on a new mother. In practical terms, this may be because the treatment is disrupted by the baby crying to be fed or the mother needing to pass urine.

Physically, the mother may still be uncomfortable and you will need to adapt your treatment accordingly, including her position, the duration, and the body parts on which you work.

Abdominal massage is inadvisable until

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A moment for mothercondition since she is normally kept in hospital for a few days, for this very reason.

Essential oils in the puerperium Many essential oils are contraindicated during pregnancy, although some are permitted for use in labour to potentially enhance uterine contractions where appropriate. There is no de� nitive list of oils suitable for use in pregnancy, but as a general rule, the whole range of citrus oils is considered safe, together with oils including certain chamomiles and lavenders, peppermint/spearmint, cypress, geranium, ylang ylang, frankincense, black pepper, and tea tree. In addition, jasmine and clary

Breastfeeding and essential oils

While a minute dose of the essential oils applied topically to mother can be passed on to baby via her breast milk, the effects on baby appear to be negligible. However, if the mother has essential oils on her breasts, for example, after immersing in bath water that contains oils, she should wash her breasts before breastfeeding.

sage may be used in labour, but on no account should clary sage be used before the expected date of delivery, or the onset of labour after 37 weeks, if this occurs sooner.* In addition, research has indicated that ginger can potentially shorten labour and therefore should not be used before 40 weeks.1

Postnatally, all the oils that have been used in pregnancy are appropriate for the mother, but clary sage is still contraindicated until the lochial discharge has stopped; geranium should be used with caution, as should ginger, because they may interfere with blood clotting if used to excess.2 Clotting mechanisms are altered physiologically at this time as nature’s way of preventing blood clots

developing. Jasmine oil is particularly

good for

Post-birth | Holistic

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18 Issue 95 January 2011 InternatIonal therapIst www.fht.org.uk

Holistic | Post-birth

preventing or reducing the severity of postnatal depression, or you could advise the mother to drink jasmine tea. Fennel oil, contraindicated in pregnancy, is brilliant for stimulating lactation, especially if you use it to perform a foot massage while the mother is feeding her baby, which has been shown by midwives to encourage the hormonal process that facilitates milk production. Black pepper is useful for pain and discomfort of the legs or back, and tea tree and lavender in the bath can be helpful for wound healing and prevention of infection of the perineal stitches (Dale and Cornwell 1994), or an abdominal wound after caesarean section.

The dose of essential oils for postnatal treatments should not exceed two per cent, including any drops used in addition to the massage on tissues or in vapourisers. Childbirth is a normal physiological event, but recovery from birth takes time and the mother’s body remains compromised, so it is not appropriate to return to the standard three per cent adult dose until at least six to eight weeks afterwards.

Conclusion Aromatherapy offers the newly-birthed mother some valuable ‘me time’ and can be beneficial in easing her transition from pregnancy to the postnatal period, relieving

*Clary sage can potentially make the uterus contract and is increasingly being misused by mothers, and even some aromatherapists, who do not understand the chemistry and potential powerful effects of this essential oil. In my clinical experience, I have numerous accounts of over-stimulation of the uterus where expectant mothers have tried to induce labour through the use of essential oils such as clary sage. this is a highly dangerous practice. expectant mothers and aromatherapists need to appreciate that chemicals in essential oils act in exactly the same way as drugs, and anY attempt to start labour before it starts spontaneously – even with so-called ‘natural’ substances – is an intervention, similar to the medical induction of labour. 1 Calvert I (2005). Ginger: an essential oil for

shortening labour? Pract Midwife. 8(1): 30-4.2 Ulbricht C et al (2008). Clinical evidence of herb-

drug interactions: a systematic review by the natural standard research collaboration. Curr Drug Metab. 9(10): 1,063-1,200. Burns E, Blamey C, Ersser SJ, Lloyd AJ, Barnetson L (2000). The use of aromatherapy in intrapartum midwifery practice: an observational study. Complement Ther Nurs Midwifery 6(1): 33-4. Dale A, Cornwell S (1994). The role of lavender oil in relieving perineal discomfort following childbirth: a blind randomized clinical trial. J Adv Nurs. 19(1): 89-96. Dhany A (2008). Essential oils and massage in intrapartum care. Pract Midwife. 11(5): 34-9. Tiran D (2000). Clinical Aromatherapy in Pregnancy and Childbirth (2nd Ed). Elsevier, Edinburgh.

References and comments Denise Tiran is a midwife and educational director of expectancy, and a visiting lecturer at the University of Greenwich, london. expectancy provides

accredited courses for therapists wishing to work with pregnant, labouring or new mothers, including the Fht accredited Caring for pregnant Clients course. Members who book any 2011 course before 31 March 2011 can obtain a 10 per cent discount – please quote your membership number. www.expectancy.co.uk

aches and pains, helping lactation and boosting her confidence in her mothering abilities. With a few precautions, this is a wonderful area in which to specialise and you may contribute to a more relaxed mother, in turn leading to a relaxed baby.

Editor’s comment: a note on essential oil usetherapists who are not qualified aromatherapists can only use essential oils that are pre-blended by a reputable supplier or aromatherapist, and should pay due attention to which oils are included in the blend when treating an expectant or recently birthed mother, to ensure these are not contraindicated.