Advancing Clinical Aromatherapy Education in Women’s Health

pam-conradPam Conrad Discusses Her New Evidence-Based Program

Interview by Leslie Moldenauer CHNC, HHP, Cert. Aroma

Pam Conrad, PGd, BSN, RN, CCAP, earned her Bachelor of Science Nursing degree from Purdue University and has been a registered nurse for over 25 years. Pam completed R J Buckle and Associates 18-month Clinical Aromatherapy course for healthcare professionals in 2000. Pam’s focus in Aromatherapy has always been integrative; combining time-honored nursing and clinical Aromatherapy.

Upon completion of Dr. Buckle’s course, her family moved to England for two years where she studied advanced Aromatherapy with nurses and midwives, and completed a Post Graduate Diploma in Complementary Studies at the University of Westminster Graduate School of Integrated Health, in London. This is where Pam met Denise Tiran and Ethel Burns–two of her mentors–who both specialize in Aromatherapy and pregnancy/childbirth and postpartum. Pam became Ms. Tiran’s first international intern and was able to learn first-hand how to integrate complementary Aromatherapy alongside her traditional practice.

In 2008, Pam taught a group of 12 obstetrics (OB) nurses evidence-based clinical Aromatherapy and developed the first hospital OB Aromatherapy program in the United States (Burns et al., 2000 and 2007).  Since that time, multiple hospitals in Indiana (and now Santiago, Chile) have completed this course and developed clinical programs.

Pam currently has the only evidenced-based women’s health/ maternity/clinical Aromatherapy course in the United States that is approved by the American Holistic Nurses Association (AHNA).

LM: Pam, let’s talk a bit more about your evidence-based program being taught here in America. This is a substantial advancement for the industry. What makes your course unique? What is your course offering to potential students?

PC: Historically, the class has been nurses and nurse midwives. The program has recently extended to teach certified doulas as well as certified Aromatherapists. The International Journal of Professional Holistic Aromatherapy will be hosting the first class that includes certified Aromatherapists in February 2017.

The course is focused on labor, childbirth and postpartum. As new clinical evidence emerges, the course content is revised with Aromatherapy interventions for the nine months of pregnancy.

The program takes a clinical approach, which stands out from what is currently being taught in the United States. There are many factors that come into play when making a clinical decision with a patient, not just looking at the chemistry of a particular essential oil. We teach everyone how to analyze the person standing in front of them, looking at their medical history, medications, and to discern how they have responded to different therapies over the course of their lives. Some people react paradoxically to a therapy or an essential oil, this is taken into consideration as well. The clinical judgment and knowledge along with the property of the oils backed by evidence-based research is the basis of how the students are taught.

Another aspect that is covered in great detail is knowing how to decide which women are good candidates for Aromatherapy and which ones are not. We look at possible issues surrounding the neonate, so we teach what should be done for the mom with the baby as well as separate of the baby, in other words without baby present in the room.

In taking this well-rounded and evidence-based clinical approach, I believe that the program is incredibly unique, and very important to the community at large.

LM: Pregnancy and childbirth has until very recently carried with it a stigma, viewing it as a medical condition, rather than a natural and beautiful part of life. Can you talk briefly about how Aromatherapy is being used to facilitate the birthing process?

PC: Pregnancy, labor and childbirth are a beautiful and natural process for the female body. In normal healthy pregnancies, our bodies are well designed to adjust the many functions of our bodies as well as accommodate the growth and development of a fetus. Healthy nutrition, rest, and regular exercise can accomplish this task. At times women do become so uncomfortable with nausea, ingestion, stress, and aches and pains that Aromatherapy is a good choice. Occasional, very dilute and select essential oils used externally; i.e. Lemon (Citrus limon), Lavender (Lavandula angustofolia), and Red Mandarin (Citrus reticulata) have been very effective in our programs.

Unlike what seems like a popular notion, there is no need to help start the labor process. Utilizing Clary sage (Salvia sclerea) for example, is being overused with the idea that a therapist or a nurse can get labor started. This area needs to be understood more fully. If the mother is already in labor, there is no need to increase the contractions. This actually causes what is called hyper-contractions from uterine hyperstimulation (a potential complication of labor induction). This could create a risk for the mother or baby, especially if there are conditions such as cord around the babies neck, placenta previa1 or abrupto.2

The overall goal is to make the mother more comfortable. The more relaxed and comfortable she is, the more likely that natural labor is going to progress, as it should.

LM: Lavender was at one time considered an emmenagogue (uterine stimulant) and was considered contraindicated during pregnancy. In his book, Essential Oil Safety, 2nd Ed., Robert Tisserand dismissed this as a myth as he found no credible research to support that. Recently there has been some debate over this topic. Where do you currently stand on the issue?

PC: There have been some changes recently as far as opinions surrounding Lavender. The experts that I refer to are the clinical experts. When it comes to Aromatherapy, we all find a place to work from that we feel most comfortable, based on our own professional background. Being in the medical field for decades, I focus on the clinical experts and the evidence base, as well as our patient responses. Since beginning our program, we have collected patient data from over 1500 OB hospital interventions.

Historically, the agreement between Ethel Burns and Denise Tiran has been no topical application of Lavender until after the 24th week of pregnancy. The percentage for an acceptable essential oil during pregnancy is 0.5-1%. Once term labor begins this can be increased to 2%. This is a fraction of the dilution that you may have seen recommended often times in the industry.

In a clinical setting, when working with someone who has previous medical conditions or any other red flags; i.e. past miscarriages, in vitro fertilization (IVF),  multiples (twins, triplets,etc.) various blood lab abnormalities, high or low blood pressure, and swelling, the decision to be more conservative with Aromatherapy is recommended. For someone with no red flags, a decision may be made to use Lavender at the dilutions mentioned above before the 24-week mark. At that point, the only Lavender that would be used is Lavandula angustifolia, as ketones are a concern with other varieties of Lavender. If the soon-to-be-mother is going through such a high level of stress that it is insurmountable and puts a risk on the pregnancy and she needs help, Lavender (Lavandula angustifolia) may be used.

As long as the mother is not allergic to or dislikes Lavender, it can be used throughout labor and postpartum for anxiety and pain. Red Mandarin is also very helpful for anxiety, indigestion, and nausea and is emotionally uplifting.

As a nurse for many years, the clinical perspective, patient care experience and evidence base all play a part in my practice and courses.

LM:  I would like to talk a little bit about your 2012 study conducted with Cindy Adams, “The effects of clinical Aromatherapy for anxiety and depression in the high risk postpartum woman.” Can you tell us a little bit about that clinical study?

The aim of the study was to determine if Aromatherapy is effective at improving anxiety and depression in women at high risk of postpartum depression. It was a study that included 28 women who were all 0-18 months postpartum. The treatment groups were randomized to either inhalation or the Aromatherapy ‘M’ Technique. The treatment consisted of 15 min sessions, twice per week for four consecutive week using a 2% blend of Rose (Rosa damascena) otto and Lavender (Lavandula angustifolia). The non-randomized group avoided all Aromatherapy during this same time period. Allopathic treatment continued for all of the participants.

All subjects completed the Edinburgh Postnatal Depression Scale (EPDS) and

Generalized Anxiety Disorder Scale (GAD-7) at the beginning of the study. The scales were then repeated at the midway point (two weeks), and at the end of all treatments (four weeks).

No significant differences were found between Aromatherapy and control groups at baseline. However, the midpoint and final scores indicated that Aromatherapy had significant improvements greater than the control group on both EPDS and GAD-7 scores. No adverse effects were reported.

The study shows that Aromatherapy is very effective and safe as a complementary therapy in both anxiety and depression with postpartum women.

LM: What do you hope to see for the future of Aromatherapy? What other areas of support for women are you hoping to target in the near future?

Where I see the greatest importance for Aromatherapy during this passage of life is during the post-partum phase and early motherhood. The ability to identify a mom who is at risk for post-partum depression (PPD) is crucial. We can work with them to using Aromatherapy and other complementary therapies to help avoid PPD. We demonstrated the empowering use of the essential oil on mothers and their children in our published pilot study (Conrad and Adams, 2012).

The time during pregnancy and labor is the perfect time to teach a woman how to properly take care of herself during the post-partum period and beyond. When we are able to work as a team, thereby giving us nine months to provide the education to the mom as a complement to their care, greatly increases their quality of life. A mom can then to go to Aromatherapy first, rather than medical treatments, after birth. The postpartum period involves the mother navigating through a myriad of changes, both emotionally and physically. Aromatic complementary therapies can be a perfect stand alone support during the postpartum period for some women. In others, when medication is indicated, it can further support the mother physically and emotionally to improve her quality of life in early motherhood.

The IJPHA is proud to present Pam’s course in Women’s Health for Aromatherapists, nurses, nurse Aromatherapists, midwives, and doulas February 4-5, 2017 in Boulder, Colorado. For information about this program and to register, visit the IJPHA website at http://www.ijpha.com.

[1] Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.

[2] Placenta abrupto is when the placenta detaches from the wall of the womb (uterus) before delivery.

References

Burns E et al.. (2000). An investigation into the use of Aromatherapy in intrapartum midwifery practice. The Journal of Alternative and Complementary Medicine. 6 (2), p141-147.

Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. (2007). Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG. 114 (7), p838-844.

Conrad P and Adams C. (2012). The effects of clinical Aromatherapy for anxiety and depression in the high risk postpartum woman-A pilot study. Complementary Therapies in Clinical Practice. 18 (3), 164-168.

Leslie Moldenauer has been studying natural living and holistic wellness for over 10 years. She is the owner of Lifeholistically.com, a trusted resource that covers essential oil safety and encompasses all that natural living has to offer. Leslie is passionate about providing education and tools to help others make decisions regarding safety above all things when utilizing aromatherapy in the home. Leslie earned her degree in Complementary and Alternative Medicine (CAM) at the American College of Healthcare Sciences in Portland, Oregon. She is currently earning an advanced diploma in Aromatic Medicine with Mark Webb (Australia), and has trained with Aromatherapy researcher and educator Robert Tisserand.

Putting some order into Matricaria recutita et Chamaemelum nobile

A wonderful article written by Cathy Skipper comparing and contrasting Roman and German Chamomile!

Cathy Skipper

The choice of Chamomile came up for the first edition of our magazine by chance but one of those chances where you feel that you are being gently pushed in a certain direction, A conversation on a herbal forum about the differences betweenChamaemelum nobile L and Matricaria recutita triggered me into trying to put some order into this vast subject and pin point some of the differences between Roman and German chamomile.

ImageTo begin with chamomile is one of those plants that everyone has heard of as a herbal tea, it was probably the first herbal tea I made myself as a young student thirty years ago in London when I started to feel the need for plants in my diet. The only snag with this is that in most of these cases, it probably wasn’t chamomile but Matricaria recutita, ok so I am being too pernickety I hear…

View original post 3,649 more words

CO2 Extracts for Aromatherapeutic Use

 

CO2extracts

Image: naturalwisdom.co.uk

What are CO2s?

Aromatics produced via carbon dioxide extraction (CO2 extracts) have been around and in use for the past 15-20 years. While some, like German Chamomile and Calendula have become commonplace within the aromatherapy world, there are still many CO2 Extracts with little to no information available.

CO2 extracts are oils similar to distilled essential oils that can be used in Aromatherapy and Aromatic Medicine. They can be more subtle in fragrance and perhaps a little stronger in flavor as compared to essential oils. CO2 extracts have a different chemistry than their essential oil counterparts making them more suitable in a variety of aromatherapeutic preparations. CO2 extracts have the taste and aroma closer to that of the fresh plant, are more shelf stable and cost effective.

CO2 extracts are produced by using carbon dioxide under high pressure (solvent) to extract the aromatic compounds. Subcritical carbon dioxide processing carefully extracts only the aromatic compounds (Select CO2) while Supercritical carbon dioxide processing extracts the aromatic compounds, as well as the heavier non-volatile molecules like colors, resins and waxes (Total CO2). The process is done at low temperatures (just above room temperature) so it does not alter the extracted compounds. The process is efficient and yields little waste.

CO2 extraction technology video – YouTube © Nisgara Biotech 2014

Supercritical CO2 is used as a solvent to extract lipophilic compounds from natural herbs. These extracts are concentrated as high as 250 times as compared to the raw herb. Thus a small quantity in any product is enough, leading to cost effectiveness as compared to other products from different extraction techniques. This technology is environment friendly with minimum carbon footprint and CO2 is recycled as much as 95% in the system.

Visit http://www.nisargabiotech.com for more information.

Want to learn more?

The International Journal of Professional Holistic Aromatherapy (IJPHA) is hosting a 2-day seminar entitled CO2 Extracts: The How, What, When, Where and Why in Aromatic Therapies with Mark Webb, B.Sc. in Boulder, Colorado October 15-16, 2016. Participants will earn 12 CPDs (continuing professional development credits).

mark webb 2Mark Webb holds a B.Sc. Degree in Biochemistry and Plant Physiology and Biology from Macquarie University, Sydney, Australia. He is an associate member of the International Aromatherapy and Aromatic Medicine Association (IAAMA), and a member of the Australian Society of Cosmetic Chemists (ASCC).  Mark has over a decade of experience formulating with CO2 extracts. Making him well placed to discuss their uses within the fields of cosmeceutical and aromatic therapies applications. His knowledge about how to incorporate these extracts in food and beverages for both therapeutic and non-therapeutic use enables him to provide a broad range of practical and day to day examples. If you have been curious about using CO2 extracts, this is the workshop to answer your questions

In this 2-day workshop, Mark will delve deeply into the world of CO2 Extracts, looking firstly at the production technology and how this effects the end product. He will compare and contrast a range of volatile and non-volatile, Select and Total CO2 extracts with their essential and fixed oil counterparts and oleoresins, discussing safe and effective usage within topical and internal formulations.

Learner outcomes include:

  • An overview of what CO2 extracts are & how they compare to essential and expressed oils, absolutes and oleoresins.
  • A detailed look at of how CO2 extracts are made and the differences between Select, Total, volatile and non-volatile extracts.
  • Comparing and contrasting the chemistry of CO2 extracts to other aromatics; such as essential oils.
  • Discussing the various applications of CO2 extracts across a variety of dose forms and application techniques.
  • Safe use and handling of CO2 extracts, recognizing which extracts to watch for and the importance of dilution within formulating.

Webb.4For more information about this class and to register, visit our website at http://www.ijpha.com.

 

I’ve Jumped off the Essential Oil Bandwagon

normal after all

Photo courtesy of Honolulu Media https://www.flickr.com/photos/68909241@N07/ Photo courtesy of Honolulu Media https://www.flickr.com/photos/68909241@N07/

Okay, not so much the essential oil bandwagon but definitely the MLM essential oil bandwagon.

A couple of years ago, I was introduced to doTerra essential oils. I was intrigued by the idea of the therapeutic use of essential oils. I signed up and was excited to learn more.  Prior to that, my only experience with essential oils was using them for making homemade cleaning products.  I had tried using lavender essential oil a few times and hated it – it always gave me a headache.  After starting with doTerra, I learned that I didn’t hate lavender, I only hated adulterated lavender, which is most lavender available to purchase in stores.  I learned there was a difference between oils bought in most stores and doTerra’s Certified Pure Therapeutic Grade (CPTG) oils and of course I learned that doTerra is the only company with CPTG…

View original post 1,009 more words

Aromatherapy Research

writingAromatherapy may be making its way to the mainstream but that doesn’t mean it will be widely embraced by everyone. One reason for this is that there isn’t much research involving essential oils, as compared to pharmaceutical drugs. This is an issue that needs to be addressed in order to have Aromatherapy be respected by all people. Most aromatherapy users know the beneficial properties of essential oils but there is little to no evidence to support those claims. Lavender is known for its calming properties, Lemon can be used as an fever-reducer, and Rosemary has been recommended for hair loss and memory improvement. The benefits of essential oils are endless, but where is the research to back up these claims?

Now, this could be an entire blog post about money distribution in research and how “Big Pharma” has all the money. Instead this blog is about getting more people involved in conducting research. Many people have testimonials about certain blends and treatments but no research to prove it. Verification of testimonials is one way to conduct research. Investigating testimonials and a review of traditional literature you can transform the information into a case study.

From testimonials to case studies

The number one topic discussed on facebook groups and Aromatherapy articles are the testimonials about essential oils and blends. These testimonials are great and they help improve the lives of many people, but at the end of the day that is all they are…testimonials with no research to back up the claim..

Turning testimonials to a case study does require a little bit of work but, the little bit of work will go a long way to adding to the pool of knowledge in Aromatherapy. Begin with a question you want to answer. Find a client who is seeking a therapeutic outcome relevant to your question and obtain their consent for treatment. Choose an oil you believe to be well-suited to your client’s needs and how much to use, the method of application, and how long you intend to use the oil in this manner. Before any treatment is given it is important to note why that specific treatment is being used and why it works. This is where the little bit of work comes in. Do some investigation into why the oil you selected should be able to treat the patient’s complaint. Be sure that the oil is safe for your client. It is important to write down every step of the process to be referenced.

After some investigation to confirm your protocol, you may begin your treatment. This part simply requires documentation on the progress of the treatment. Documentation is half the battle when it comes to case studies. Once the treatment is over, the results must be analyzed, and the initial question will be answered.

Get out and do your own research

There are many questions to be answered regarding the use of essential oils. Aromatherapy needs more voices in research and this research can lead to more credibility. I encourage everyone to go out find a question that they want to find an answer to and do the research. Conducting the same procedure on multiple clients and combining the individual case studies creates a case series. From there you can take what you have learned and develop a pilot study.

Create a question, then do the research to find out if anyone else has done the same research. Find out as much information as possible about the question, and then create a hypothesis. This is a proposed explanation of the question. An example would be, I believe ‘A’ will happen because of ‘B.’ This is a simple idea that explains what you think will happen during the experiment. After this the actual testing begins. This is where documenting the process is important. Writing down the all the steps and outcomes will allow for referencing. If the procedure isn’t working then redesign how the test is administered.

Analyzing data is the final part and is the most exciting because it determines if the hypothesis is correct. Even if the results don’t prove the hypothesis you will have learned something by completing the process and you now have information to share.

Writing up your case study is easy if you follow this simple outline:

  1. Ask a question
  2. Background research
  3. Hypothesis
  4. Test or procedure
  5. Analyze data and draw a conclusion
  6. Communicate results.

Research doesn’t end if the result isn’t what you thought it would be. Everyone can do research. Remember it begins with a question and some passion to find the answer. Ask a question, be curious, and go do some research.

by Bryant Hernandez, Graduate Healthcare Administration

For a more detailed outline on how to write up your case study visit www.ijpha.com and click on “Case Study Outline.”

the big, burning question, part ii: how I choose my essential oil suppliers

The Untamed Alchemist further discusses the important factors that matter in selecting essential oils as they matter to her…and I wholeheartedly agree!

the untamed alchemist

The big, burning question I so often get is, “what brand of essential oils do you recommend?” The first part of my response to the question, focused on the question itself, can be found in part i of this series here. In this post you’ll find part ii of iii, focused on the criteria I use in choosing my essential oil suppliers.

Part II: How I Choose My Primary Essential Oil Suppliers

There are a wide variety of essential oil suppliers and they can vary tremendously in the quality and purity of their oils, their commitment to sustainability, their customer care, their empowerment of safe use, and their engagement with the aromatherapy community; choosing the best among them can be difficult, but there are a surprising number of companies who offer quality essential oils who have met my relatively stringent standards.

There are two categories of things I consider when choosing my suppliers: the nitty-gritty details of…

View original post 3,580 more words

Aromatherapy–A Growing Industry

EOs and bottlesAromatherapy is a complementary therapy that has been on the rise over the last several years and has gone mainstream. More specifically the increase use of essential oils is making its presence on the market. The Aromatherapy and essential oil market had a record breaking year in 2015 displaying large revenue for essential oil participants (Aromatherapy and Essential Oil Markets, 2016). According to various research articles, the top two multi-level marketing companies had revenue over $1 billion each in 2015 (Aromatherapy and Essential Oil Markets, 2016).These numbers are very promising for aromatherapy and essential oils.

The reason for the big increase in the Aromatherapy market is, in part, due to the use of herbal medicine treatments. Globally, Aromatherapy is trending as a self-treatment to avoid doctor visits (Saha, 2016). This trend is leading to a huge increase in the market for essential oils, creating a large demand for more oil. Top oils globally include: Basil, Black Pepper, Clove, Eucalyptus, Jasmine, Lavender, Lemon, Sandalwood, and Tea Tree (Saha, 2016). The high demand for the oils is good news for multi-level marketing companies (Saha, 2016). These companies are the key players in the Aromatherapy market, and vary in quality. With Aromatherapy predicted to have a great impact on the global market by 2025, more companies are getting on board.

Quality in oils

The question that needs to be asked is, how will the big demand for Aromatherapy affect essential oils and essential oil availability? Right now it is too early to say, but there is already growing concern for the sustainability and the ethical harvesting of the plants used in the production of essential oils. An increase in demand suggests that there will be an increase in essential oils and essential oil companies. Big retailers in the United States such as Wal-Mart and Target are beginning to sell various brands of essential oils in the store, but also sell Aura Cacia in their online store. Wal-Mart has launched their essential oils with claims that 7 of the 9 are 100% pure essential oil (Jenkins, 2016). This is a bold statement since no information could be found to backup their claim that their oils are 100% pure. The essential oils also retailing at $5.97 for all the oils in the line.

With essential oils selling at $5.97 each, something isn’t quite adding up. Anyone who is familiar with essential oils knows that not every oil is going to sell for the same price. Right away this is a red flag because it begs the question what are they putting in bottle to sell at a low price?

Over at Essential Oil University, Dr. Robert Pappas has done some testing on the essential oils sold at Wal-Mart. According to his analysis, the oil labeled as Cinnamon oil in fact contains Cassia oil which cost a fraction of true Cinnamon bark and has a different chemistry. Additional testing also disclosed that the Lavender oil was not Lavender, but the lesser expensive Lavandin essential oil. From the odor alone Dr. Pappas could determine that the oil was not Lavender but rather Lavandin, a hybrid of Lavender oils. Lavandin has different Aromatherapeutic benefits when compared to lavender, so customers will be getting different results. Dr. Robert Pappas also goes on to evaluate Peppermint with predictable results, finding that the oil in the bottle was Cornmint. Not all the oils from Wal-Mart were not tested, but there was a pattern of deceit.

GuruNanda will be launching their essential oil blends into Wal-Mart this April with a $10.99 retail price across the board and scratch and sniff lids (Johnsen, 2016). The maker of GuruNada had this to say about their blends, “We’ve taken the guesswork out of Aromatherapy with these blends that combine carefully selected ingredients for maximum effect,” (Johnsen, 2016).

Any aromatherapist knows that their work isn’t “guess work” and actually involves a lot training and knowledge. If aromatherapy was about guessing then anyone could be an Aromatherapist. Once again it should be noted that no testing has been done yet to determine if the blends are pure. Production of an essential oil can vary from plant to plant which in turn affects the final cost. Quality of essential oils needs to be a high priority, even more so now, with the growing trend of Aromatherapy and essential oil use.

The future of essential oils

The growing field of Aromatherapy is great and wonderful for everyone. There are so many benefits from practicing Aromatherapy, but there should also be caution. With the growing popularity of Aromatherapy there is much concern for the quality and availability of essential oils. Creating a better awareness for essential oils, and how they are obtained, as well as their sustainability status is needed.

References

Aromatherapy and Essential Oils Market 2016. (2016, February). Retrieved April 12, 2016, from http://www.researchandmarkets.com/research/ctdhw4/aromatherapy_and

Jenkins, A. (2015, June 3). Essential Oils Review. Retrieved April 12, 2016, from http://whoawaitwalmart.com/post/120626397235/what-we-think-earthly-elements-hello-friends

Johnsen, M. (2016, February 26). GuruNanda brings latest aromatherapy offerings to mass outlets. Retrieved April 12, 2016, from http://www.drugstorenews.com/article/gurunanda-brings-latest-aromatherapy-offerings-mass-outlets

Saha, S. (2016, February 22). Aromatherapy Market To Make Great Impact In Near Future by 2025. Retrieved April 12, 2016, from http://empowerednews.net/aromatherapy-market-to-make-great-impact-in-near-future-by-2025/1882526/

Dr. Robert Pappas Essential Oil University Links

Facebook: https://www.facebook.com/EssentialOilUniversity/

Website: https://essentialoils.org/

by Bryant Hernandez, Graduate Healthcare Administration