Tag Archives: approaches to healthcare

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.

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Providing Help for Children with Special Needs?

Earlier this year, the Autism Awareness site posted a social meme regarding the use of essential oils in the treatment of Autism put together by an independent EOs for autism YLdistributor of one of the larger multi-level essential oil companies.  As a Registered Clinical Aromatherapist and the mother of a son with Autism, I was very put off by the recommendations being shared virally as any essential oil regimen for Autism should be a properly educated one. I did share my concerns with the website, but received no reply.

While I am happy that the use of essential oils is becoming more commonplace, like others I have concerns about the advice being shared virally. I am profoundly disheartened by the apathy exhibited by many qualified practitioners who have become jaded by all the social debate over protocols shared by independent distributors online. We can’t give up! More and more I am being introduced to new essential oil protocols intended to treat children with intellectual disabilities and other comorbid neurological conditions.

This came before I learned from a colleague about a Pediatric Autoimmune Neurological Disorder Associated with Streptococcus bacteria (P.A.N.D.A.S. or P.A.N.S.) in which an child presents with motor tics and symptoms similar to Tourette’s Syndrome. She inquired as to what I knew about this disorder and treating it with essential oils. A new client came to see her regarding her three children afflicted with the disorder and an essential oil regimen she had been using to treat them. I was appalled by the copious amounts of essential oils ingested on a daily basis and the overuse of neat oils used topically in a manner similar to the Raindrop Technique employed by one of the larger essential oil distribution companies. In reading through the website connected to this regimen, there is nothing to indicate that any professional put together this “targeted” treatment, yet the family has set up the site to advise the parents of other children with the disorder. They provide consultation and instruction on where to purchase and how to use the essential oils. While I am pleased for the family that they have found some help for their own son, I shudder at the thought of their advice to others based on their experience as P.A.N.D.A.S. , as in autism, is not the same for every child.

I am a huge proponent in the use of natural means to support the treatments offered to those children with Autism and other comorbid disorders, however I am heartsick with the careless disregard for safety with some of the advice provided.  Parents of children with disabilities are already under tremendous stress and always looking for something…anything that can help their beloved child. My fear is that they have become prey for those looking to make a buck by “developing” these new and potentially harmful practices and offering hope to parents. As responsible practitioners, no matter how weary you have grown with the social media sharing, we are bound by the responsibility of our education to advise when we see a potential for harm, especially to a child.

On April 7th, a local news station in Central Florida reported that a mom received a letter from the principal of her son’s school in which the principal threatened to suspend her son because of the essential oils she uses to treat the behaviors associated with his autism. His mom uses three essential oils (unknown which oils and whether or not they were single oils or blends) on the back of his neck and behind his ears each morning before school.  While none of the students ever complained of the smells and no one had ever asked to be moved, she got a letter from the district stating that the odor from the oils has presented a problem in the environment for the other students and staff.  Add to this the age-old question “why is it okay to put chemical smells into the environment, but not natural ones?” By the next morning the news reported that the mother had won a battle with the Lake County School and the decision to suspend her child. District officials said they will work with the student’s family and school administrators to find a better solution, however the news report indicated that the administration was at a loss as to how to do this (http://www.clickorlando.com/news/mom-says-school-threatens-to-suspend-autistic-boy-over-essential-oils/32263998?utm_campaign=Live%20Well%20Learn%20Well&utm_content=14187170&utm_medium=social&utm_source=facebook). I was really struck by this report as a mom of an autistic child. While I am not condoning the current way she is using the essential oils on her son, I do support her choice of using the essential oils with him. After seeing this report and watching the news report, I contacted the superintendent of the school district where he goes to school, as well the news reporter to offer my support for safe and responsible uses that could be employed in the school. I didn’t expect much to come of it, but hoped that my letter would be well received and considered by the district. Today I received an email  from the superintendent to say that they were happy to receive my letter and will be in touch regarding the information I shared. We may not always be heard, but we have to try.

Every one of us has a family member or knows someone with a child with Autism of other (mental or physical) health concern. Please get involved to promote better safer practices.  Below are some of the suggestions I shared for essential oil use in the school.

Here are some suggestions for safe use as well as alternatives to keep the scent close to the child without affecting the other children in the room:

  • Twelve drops of an essential oil blend can be put into a 10 ml roller bottle with the bottle topped up with carrier oil.   The blend should be rolled onto the clavicle before school and again when returning home from school.  Also, it can be done one more time before bed to aid sleep.
  • The dilution should be 1.5% which is 15 drops in 50 ml of a carrier oil or unscented lotion for general topical use. A hand massage can be given at school with the scented lotion if there is a provision for that or it is in his IEP.
  • Personal inhaler.  Add 20 drops of the essential oil to the wick, then place in the tube. Push the cap tightly into the bottom and replace the cover and screw to close. To use: just inhale through the left nostril while holding the right one closed, then inhale through the right while closing the left, and repeat. The other students will not smell the essential oils. NOTE: Some schools require a doctor’s note for this.
  • Aromatic jewelry that looks like a wristwatch can be purchased very inexpensively from a company called Diffusing Mama’s (www.diffusingmamas.com). These have a simple band of black rubber the runs through the bottom of a hinged locket that is perforated.  There is a little wool wick inside.  Place 3-4 drops of essential oil on the wick, place it in the locket and close the cover. Inhale as needed for stress and anxiety.
  • Diffusing Mamas also makes necklaces (blue and black rubber with lockets with arrow heads and soccer balls).  This is better yet as it is under his nose and stays personal to the child.

Aromatic patches (Aromatic patches come in two types: transdermal and another that affixes to your clothing.):

  •  The transdermal patches are from a company called Naturopatch of Vermont. For a child, the patch can be cut in half.  Place 1/2 patch on the skin on the inside shoulder and dress as normal.  The essential oils are suspended in an olive oil base and the patch offers a slow release. When the child bathes in the evening, he can slowly peel it off and a new one can be put on the next morning. These are already impregnated with the essential oils and come in tins of 10 and individual use envelope packaging.
  • The other type of patch uses an extra step. You peel off the top layer foil to uncover the scent chamber, then peel off the covering of the adhesive side. Stick the adhesive side to a shirt collar and you are good to go.  These can be purchased at www.jodibaglien.com.  Jodi created these patches for hospital use and they are being used successfully in hospital systems and nursing homes throughout Minnesota.

Lora Cantele is a Registered Clinical Aromatherapist and the editor/publisher of the International Journal of Professional Aromatherapy, and co-author of The Complete Aromatherapy & Essential Oils  Handbook for Everyday Wellness.

Use all health care options available

rosemary-essential-oil-5When we think of health care, we usually think of traditional medical care that involves the diagnosis and treatment of chronic illness, cancer, etc., which many people refer to as “Western medicine.”

In addition to the type of medical care we have all grown up with, there are several other approaches to health care that are known as “complementary” and “alternative.” Other areas of nontraditional health care include “integrative medicine” as well as “functional medicine.” So, what do all these terms mean and why should we think about using these types of health care?

In general, these are different approaches to health care with a history of use and origins outside of mainstream medicine; and although the term CAM uses the words complementary and alternative together and often interchangeably, these two words refer to somewhat different concepts of health care.

“Complementary” refers to using non-mainstream health care together with traditional or conventional medical care. The term “alternative” refers to using non-mainstream health care in place of traditional health care.

Another term we hear is “integrative medicine.” Think of the use of massage therapy or guided imagery. These are ways of treating a person using nontraditional means to help them heal. They integrate traditional medical care with alternative therapies. As an example, some cancer treatment centers use integrative health care programs which offer acupuncture or meditation to help manage symptoms and side effects of the cancer along with its traditional treatments (chemotherapy, radiation therapy, etc.).

It is interesting to see that “integrative health care” is happening now and is a growing trend among people who understand the benefits. For these individuals it is important to utilize any and all means of health care that will help them treat their illness or, in the case when a person does not have a defined illness, simply stay healthy. The National Center for Complementary & Alternative Medicine (NCCAM) uses the term “complementary health approaches” when discussing natural products or, mind and body health care practices.

“Natural” products include herbs and botanicals, vitamins, minerals and probiotics which are often marketed as dietary supplements. Evidence shows that the value of these alternative products is significantly underestimated. When you look at the research and the scientific evidence for the use of botanicals (herbs and plants) for the treatment and prevention of illness and disease, the evidence is overwhelming. There are hundreds if not thousands of research reports that support the use of natural products for treatment and prevention. Examples include fish oil, echinacea, and mineral supplements. It is interesting to remember that penicillin comes from a fungus; and digoxin, a heart medication, comes from the foxglove plant. When we talk about using anti-oxidants to lower the risk of cardiovascular disease, we need to understand that most of these come from plants.

NCCAM also includes “mind and body practices” as other forms of alternative health care. These include acupuncture, massage therapy, meditation, relaxation techniques, spinal manipulation, osteopathic manipulation, chiropractic therapies, tai chi, yoga, hypnotherapy, to name a few. NCCAM is the government’s lead agency for scientific research on health care practices outside of mainstream medicine. Its mission is to define through scientific investigation the usefulness and safety of complementary health care approaches and to understand their roles in improving health. This scientific evidence will help people make informed decisions about their health care. More information about this organization can be found at nccam.nih.gov/about/ataglance.

Another area of complementary medicine is called “functional medicine,” which focuses on alternative treatments emphasizing the interaction between the environment and the gastrointestinal, endocrine and immune systems. Knowing the function of these systems within the body helps to understand the approach of functional medicine. The gastrointestinal (GI) system is the first line of defense the body has to bacteria, viruses, toxins, chemical, and other potentially harmful substances. Maintaining a healthy GI tract is necessary if we are going to be able to ward off these invaders. The endocrine system is the chemical system of the body which contains and controls the hundreds of hormones that keep us healthy. Knowing that there are so many environmental, health and life factors that affect our hormones is a no-brainer to understand why it is so important to keep this system healthy. The immune system allows us to fight infections and probably also helps us to deal with cancer cells and other illnesses.

Keeping the body functional should be one of the most important goals for health care. How do you do this? The answer to this is what I like to refer to as lifestyle management. This is a daily approach to life that allows you to maintain good health:

• a functional GI, endocrine and immune system;

• a sound and productive brain;

• a musculoskeletal system that allows you to move around and do all the physical things you want to do every day;

• a social and spiritual personality that brings you happiness and fulfillment and enables you to give back, pay it forward and to be grateful for all the blessings you have.

I can tell you from personal and professional experience that one of the most rewarding things you can do is to practice lifestyle management. I do this in my medical practice and in my personal life. It is so enjoyable to see a person take control of their health by taking control of their life. When they realize the power they have over their health, and all the benefits they get from keeping good health practices as the No. 1 priority in life, it is amazing to see what a person can accomplish and what a wonderful life they can enjoy!

Functional medicine is practiced by many physicians who find it important to not only treat a person’s illness but also to prevent illness, disease and disability. The American Board of Functional Medicine (ABFM) is an independent organization that certifies physicians who practice functional medicine.

I believe in and have practiced traditional medical care as a board certified internist for 20 years so I can attest to the significant benefits of this approach. With the addition of complementary health care products and services, we add another dimension to our health care and make available many other prevention and treatment approaches. Therefore, the recommendation would be to continue to rely on traditional medical/health care and add on complementary products, services and treatment approaches as necessary. This will enable you to take full advantage of all that is offered from Western and Eastern philosophies.

Dr. Salvatore Lacagnina is vice president of health and wellness for Lee Memorial Health System. Dr.Sal@Leememorial.org

This was first published July 17, 2014 by new-press.com and is republished here with the author’s permission.