Essential Oils for Pain Relief

When I first started dabbling in essential oils, I tried Panaway from Young Living Oil for a tooth ache. It worked marvelously, although when its effects had worn off it seemed to stop working immediately and the pain would return in a flood. Its effectiveness was so great however, that I ended up with an extensive root canal that required a specialist to remedy, and had inflammation in my jaw for another twelve months. Panaway was my go-to remedy after breaking my wrist, requiring surgery, as I tried to avoid narcotics at every cost. I can’t imagine not having Panaway in our home, because it genuinely offers narcotic-level pain relief without the side effects or addictive properties. I use it frequently on my young boys who frequently have leg cramps in the middle of the night. I’ve learned however, that it can mask a serious underlying issue, so I need to use it judiciously.

Narcotics

Narcotics were almost entirely derived from opioids originally, from the plant Papaver somniferum, although more recently synthetic alternatives have come into play. Morphine for example, is derived from the opium poppy and works by depressing the cerebral cortex, resulting in reduced powers of concentration and pain. This same drug reduces respiratory drive and the cough reflex, causes constipation and potentially, addiction.

The essential oil ylang ylang (Cananga odorata) has a mild, opioid-like property and can sometimes enhance the effects of opioid drugs. Codeine is another popular narcotic derived from the opium poppy, and is used not only for pain, but also for its side effect, as a cough suppressant.

Aspirin & Acetaminophen

These are well-known pain relieving drugs, although non-narcotics, which also offer anti-inflammatory properties. Aspirin was originally derived from salacin, a glycoside found in willow tree bark. It is the most commonly used nonsteroidal antiinflammatory drug, but its greatest risk is increased bleeding, particularly in the gut. Tylenol is another very common non-narcotic which has been the focus of recent controversy, with recommended dosing decreasing to no more than every six hours.

Aromatherapy

Pain is an individual experience that is hard to describe. Our fears, experiences, attitudes, culture and perspectives can all influence our sensation of pain. Aromatherapy works on the sensory system and appears to enhance the parasympathetic response, which is closely linked to endorphins. Using aromatherapy in combination with touch or massage can further modify our pain response beyond the oil’s pharmacologically active components. Persons who are utilizing pharmaceutical drugs for pain relief can add aromatherapy to their pain regimen as a complementary source of pain management.

Aromatherapy allows for a complex mixture of volatile chemicals reaching sites within the brain that arouse pleasure, effecting neurotransmitters, and interacting with sensory fibers in the skin through massage. More than two thousand years ago, the willow plant and poplar were used to alleviate pain. Black pepper, clove bud, frankincense, ginger, juniper, lavender, lemongrass, marjoram, myrrh, peppermint, rose, rosemary, and ylang ylang have all been used to treat chronic pain. Lemongrass in particular has had several studies demonstrating its effectiveness on mice, and the property myrcene is thought to be the specific active ingredient. This same property is also found in rosemary, frankincense, juniper, rose, and ginger. Several studies have been performed on humans demonstrating peppermint as effective for headaches, Roman chamomile improved pain in cancer patients, lavender reduced pain in the critically ill, and hot pepper cream reduced pain in those with arthritis, shingles and in post-surgical pain.

A 1992 study by Rose, found that benzoin, camphor, clove, coriander, ginger, hops, lemongrass, marjoram, black pepper, pine, savory, and ylang ylang have analgesic properties. Others have found white birch, chamomile, frankincense, wintergreen, clove, lavender and mint, while there are other aromatherapy experts that state all essential oils have analgesic properties. Lawless (1994) has stated that in pre-Christian times, myrrh was added to wine to dwell the pain in those about to be crucified. Myrrh contains terpenes, esters, and phenol called eugenol, all of which are reputed to be analgesics (Franchomme & Penoel, 1991).

Using clove prior to a venipuncture has been suggested as both offering a local anesthetic, but also creating more prominent veins. Gretchen! Did you see this!!

Muscle spasms are another source of pain and one that Deep Blue, by doTerra, is the perfect remedy. Esters are particularly beneficial as an antispasmodic and are present in many essential oils. The greater the number, the greater the antispasmodic effect. Roman chamomile has more esters than any other essential oil and is also recognized as an analgesic. Clary sage, dill, fennel, frankincense, nutmeg, and lavender also help to reduce the twitch response to nerve stimulation. Peppermint has been used to calm irritable bowel syndrome.

Application

Smell oils prior to applying for pain. Always use oils slowly and gently. Lavender and tea tree oil are often applied neat, as are many others from high quality essential oil produces, but others can and should be diluted. Diffusing oils while utilizing pharmaceutical remedies can enhance pain relief.

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Breastfeeding & Galactosemia

This past year our practice had two newborn metabolic screenings return with abnormal findings. One child was found to be a carrier for galactosemia, and another was found to have a variant form of galactosemia. When the call came in, the messenger informed me in a very emergent voice that it was absolutely pertinent that the family be notified immediately to discontinue breastfeeding and switch exclusively to a soy-based formula.

Galactosemia

Classic galactosemia, or galactose 1-phosphate uridyltransferase [GALT] deficiency, is a contraindication for breastfeeding. It is among the most common disorders of carbohydrate metabolism and can be life-threatening during the newborn period (Berry & Walter, 2011, p 1). These infants have a high level of galactose in their blood because they lack an important enzyme, GALT, which converts galactose into glucose. When the body is deficient, a toxic build-up occurs, leading to feeding difficulties, lethargy, failure to thrive, liver damage, sepsis, and shock.

Classic galactosemia is an autosomal recessive genetic disorder caused by mutations in the GALT gene. Both parents must have copies of the gene to have classic galactosemia. The incidence is estimated at 1 in 50,000 in the United States, but substantially more common in Ireland.

All mammalian milk is eliminated from the diets of those with galactosemia, including ice cream, yogurt, lactose-containing infant formula, and sometimes cheese and butter.

Screening

Newborn metabolic screening is the first step to identifying galactosemia and is available to all infants within the United States as part of a public health program. A number of conditions exist which are unidentifiable initially and without early identification and treatment, severe insult including death could occur. The first screening is performed after 48 hours in the state of Indiana and is only indicative that a problem may be present, and then a second diagnostic test confirms whether or not the problem or disease is truly present.

After receiving the call above and notifying the parents, I encouraged mom to continue pumping so in the event the diagnostic test proved this diagnosis to be incorrect or her son had a variant form of galactosemia, we could resume some level of breastfeeding. In spite of my engorgement, I recognized that this is a challenging scenario and one that proves impossible for many mothers. To my surprise, this momma triumphed and maintained her supply over the next month, as we awaited test after test after test, to determine the exact diagnosis. Confirmation of the test had to be done in California so there was some turn around time, and then results were unexpected so had to be repeated and then typed. Of course, our office had to call and remind them of the urgency, as I suspect they simply assume other families simply switch formula brands. We were counting every moment he was away from mommas breast, and yes, this little guy was already quite attached.

Important Tips for Providers Regarding Screening

False positive tests are more frequent when screening cards are expired. Check expiration dates! If water, glove powder, hand lotions, or other material comes into contact with the screening card, it should be destroyed. Blood collection should be from the heel, not from a venipuncture or any other part of the body. As well, the screening card should be allowed to dry before being mailed. Gal-1-P is sensitive to extreme heat which can occur in mailboxes or delivery trucks, causing a false positive.

Treatment

Babies with galactosemia have a severe deficiency of GALT and have no other option but to eliminate all forms of lactose from the diet, including breastmilk. Our young fellow had a variant form and therefore, was less severe than classic galactosemia. As the baby’s primary provider at this time, I contacted the state’s expert and coordinated a plan for continued breastfeeding. At first, this came to a surprise to the medical team, and they didn’t quite understand why I felt this was so pertinent. It was outside their comfort zone. My rationale was that we know there are risks associated with artificial breastmilk and substantial benefits to human milk, particularly breastfeeding relationships. After speaking to the family, we all agreed to try various regimens such as breastfeeding at night and supplementing during the day, and then testing by-products after a few weeks. Each test demonstrated encouraging results so we would continue to increase breastfeeding sessions, and by six months of age, we had transitioned to exclusive breastfeeding.

The primary care role of the nurse-midwife is typically only six weeks and this family did transition care to a pediatrician after our six week visit, but management of the breastfeeding and galactosemia was largely continued by our practice in a very collaborative manner. Breastfeeding should be encouraged wherever possible.

I say “we” in this post only in that I felt so invested in the care of this client, in spite of my clearly not putting in a fraction of the work these parents did for their precious son.

Mom’s Story

Henry continues to be breastfed today after being diagnosed with galactosemia variant at two weeks of age.

Henry continues to be breastfed today after being diagnosed with galactosemia variant at two weeks of age.

found out that Henry might have galactosemia when he was about 2 weeks old. I remember the day well. I just sat down to nurse Henry and a few minutes later Joe walks in and says that we have to go to the hospital because something is wrong with Henry. I remember thinking how could anything be wrong, he’s right here in my arms. Joe couldn’t remember the name of what was wrong with him but that it meant I couldn’t breastfeed him anymore. I was crying all the way to the hospital. I’ve always been so pro breastfeeding that it was heartbreaking to hear that I couldn’t anymore. When we got to the hospital I was a mess. We had to wait quite some time for the blood draw and no one knew what was going on. It was so hard to watch my sweet little baby get pricked several times by a needle. Especially since I knew that if I gave him the breast it would make it all better and I couldn’t. After we left the hospital Penny helped me figure out what was next. I knew very little about pumping and even less about bottle feeding. I was so thankful that we were able to find organic soy formula but it still didn’t read all that well. I couldn’t understand how all this fake processed stuff could be good for my baby but my own milk could be poisoning him. While we were waiting on the test results I had to exclusively formula feed. The first time I gave Henry a bottle I felt dead inside. He didn’t feel like mine anymore. I wasn’t able to find joy in someone else being able to feed him. Instead it hurt every time I had to but a bottle in his mouth. Pumping was difficult at first too. I struggled with it for a few weeks and had mastitis twice. It took a long time to get the test results back and when we did, they weren’t sure so they wanted to retest to make sure. Then they had to test again just to be positive. Honestly if it weren’t for Penny I don’t know when we would have ever found out. At one point I considered just giving up on pumping and the thought that I would ever nurse him again. Finally we learned that he had variant galactosemia and that we would be able to breastfeed some of the time. We started with just night feedings. I can’t describe the feeling of being able to nurse your baby after you weren’t allowed to. In a way I felt whole again. After a month or so of night feeding we got to try nursing a few times during the day too. That was tricky. He did not want the breast at all during the day. It was really frustrating trying to figure out how to get him to nurse again but we made it. We finally got down to only two formula feeds a day. At six months we stopped the formula all together and I am happy to say that he is still nursing like a champ at 18 months. In hind sight I feel like I may have been a bit dramatic at the time but I was so unsure of our breastfeeding future. Honestly if it weren’t for Penny we wouldn’t have the beautiful breastfeeding relationship we have today.

A Bit Dramatic? What!?!

Casey’s response is not only appropriate for a breastfeeding mother, but demonstrates her love and deep bond with her son. This is a perfect testimony to why healthcare providers need to advocate and think outside the box in effort to support the breastfeeding relationship in every way that is desired and safe. Sadly, it is support that is often the missing link to success, not milk supply or sore nipples or loss of interest. This mother is one I will always remember. Her dedication to her son makes me so proud to be a midwife, and I am so honored to have a role in women’s lives in this way.

Indiana’s Infant Mortality Rate

The top priority of the Indiana State Health Department is addressing our high infant mortality rates. For more than 100 years, Indiana has had one of the highest infant mortality rates (IMR) in the nation. The Indiana State Health Commissioner, William C VanNess II, M.D., argues this poor outcome reflects on the fact that Indiana mothers have limited access to care, with approximately 1/3 of Indiana mothers (31.9%) do not receiving prenatal care in their first trimester. Additionally, there is concern that as more people obtain health insurance through the Affordable Care Act that there will be a significant shortage of primary care providers. Currently, forty-two of the 92 counties in Indiana are without sufficient primary care providers.

The Indiana Health Commissioner argues that the access to care issue is exacerbated in rural communities by the underutilization of physician assistants, nurse practitioners, dental assistants, pharmacies, and mental health providers. His recommendation is to increase the utilization of advanced practice registered nurses (APRN) collaborating with physicians, as “the single provider care is just no longer feasible or sustainable.” He also argues that healthcare in Indiana would benefit by “increased emphasis on self-management and prevention.” Is this not the expertise of a nurse?

Per a discussion at a recent Access to Care conference in Indiana, the Commissioner shared that Blue Cross/Blue Shield is considering collaborative care models and new financial programs. Additionally, an Indiana legislative summer study will address issues of access to care and workforce shortages. Finally, the Commissioner recognizes that the scope of the APRN has been restricted and questions if this is directly impacting the care of Indiana citizens.

“Perhaps we can start working together and demonstrate not only to each other, but to all Hoosiers and those around the country – that Indiana is truly serious about making changes and improving the Health of our population.” ~ William C. VanNess II, M.D., Indiana State Health Commissioner

News: Recent Changes

Anticipating the arrival of a second nurse-midwife this fall, we are excited to announce a few practice changes that will allow for better extension of services to our clientele.

First, and simply, we have had a deadline for payment in full for maternity services of 32 weeks, and this we are extending effective immediately to all our clientele to the 36th week of pregnancy. The past two years we have had a lengthy waiting list for maternity care so wanted to identify those who would be unable to pay and offer someone opportunity from the waiting list in a timely manner, but we no longer have the need now to continue with a waiting list due to our addition of a second nurse-midwife.

Secondly, we have hired a nutritionist and will be implementing an hour consultation into the maternity package. If you are a current client of Believe, obtaining maternity care, and would like to take advantage of this opportunity, simply call Naomi to set up an hour consultation. Each consultation for optimizing your nutrition while pregnant and breastfeeding is $95; however, this fee is a component of the overall maternity package so if you have paid in full, you have secured this consultation. Mrs. Megan Barnes RD offers a plethora of services, and is continuing to update her services, which can be viewed on our website here.

Third, we have purchased new hearing screen equipment and Welch Allyn has promised a better experience than our previous set-up, which as graciously loaned to us via a grant from the Indiana State Department of Health. If you are in need of a newborn hearing screening and have otherwise paid in full for your maternity package, please notify our nurse to schedule an appointment.

Fourth, we have discontinued offering intrauterine insemination (IUI) services. While Dr. Lane, nurse-midwife, continues to provide consultation services for enhancing conception and optimizing pregnancy, IUI services unfortunately, incur expenses that require a larger clientele base to support. As well, the community is now offering more cost-effective resources such as these for infertility clients so Believe Midwifery Services, LLC would prefer to turn its attention to addressing the resource-limited discipline of menopausal care.

Fifth, the nurse-midwives will be offering group prenatal care in the fall. Briefly, this entails all clients, due within the same month, meeting for each of their prenatal visits within a two hour group session so that they can discuss similar pregnancy milestones in fellowship with one another. Group meetings are scheduled ahead for the entire pregnancy so that those with busy schedules can better organize their commitments. Believe Midwifery Services, LLC extended this service several years ago and it was quite popular. Not only does this allow for greater time with your midwifery team, but it offers an excellent avenue for forging new like-minded relationships. Our childbirth education program will be incorporated into these sessions so no need to travel for additional classes. It is our hope to integrate the pregnancy sessions into well baby sessions through the first year, after we have identified that family nurse practitioner who would fit well into our practice.

Sixth, this is a little change, but worth mentioning. We have added the blue light bulb to the homebirth kit that is purchased by our maternity clients so there will be no further need to purchase these on your own, although we would still appreciate recycling them through our boutique so we can limit our footprint on the earth.

Seven, the boutique is growing by leaps and bounds. We moved into the Indianapolis center with approximately 100 products, and currently have 512. We’ve added bulk herbs, expanded our supplement line, added slings, cloth diapers, bras, boppies, bach flower remedies and so much more.

Eight, one of our Registered Nurses, Chelsey, is a certified passenger safety technician and will be offering car seat clinics this spring. Stay tuned for more information on our website.

Nine, Dr. Lane has created an exclusive page on our website for our essential oil distributors with growing resources for increasing your knowledge and confidence in utilizing aromatherapy. We will also be hosting an AromaTouch workshop with special discounts for our distributors. We anticipate this being in June, but again, stay tuned to our website.

And finally, number Ten, Saturday, June 14th, Father’s Day weekend is our Garden Party!! Enjoy our herb-inspired celebration with blueberry mohitos, minted strawberries and white wine, floral foods and light music.

 

Solo Practice: A Reflection

I am not entirely sure if this post is going to be a humble note of gratitude to my phenomenal staff or a prideful boast about my being an independent business woman, or if I am just going to whine incessantly about the trials of solo practice… but, I am feeling the need to be reflective of the process and the journey I’ve traveled these past seven years. For the record, I would do it all again. Knowing what I know now, I really would endure all the battles that accompany the complexity of this role, as I do believe it is an honor to be asked to join in the birth of a child, and witnessing the expansion of a family.

As a solo owner and operator of this practice, I have not only strived to offer the very best clinical care in the maternal and child healthcare industry, but I’ve worked hard to be a partner and advocate for my clients. Simultaneously, I’ve also worked to establish a flourishing business in an economy that is failing and in a discipline that is viewed as being on the fringe of society. My expectations are grand, and my personal losses have been significant. I could write a lengthy book about the trials and tribulations I’ve endured, but they wouldn’t compare to the beauty witnessed. There have been moments of doubt, but through it all I have reminded myself, that this is the Lord’s practice. He can build it up, and He can tear it down. Today, I am His soldier and will keep up the good fight.

While a blog post certainly can not capture my life’s journey, the trials my family has endured for this calling, and the beauty I’ve witnessed… I did want to share a moment of irony that inspired this brief reflection. You see, while I have so much to be grateful for, and even cautiously proud, this past week delivered a unexpected event that for lack of a better word, has left me dumbfounded

A nurse-midwife half way across the country, sent me a cautionary email requesting a talk because she felt it was necessary to educate me in what it is like to be a solo midwife. I am not sure why it took me by such surprise because I’ve already recognized that she prefers to view me as naive and someone she has to corral. As an intelligent woman, I’ve learned I can intimidate and appreciate that bullying is a defense mechanism of the insecure. I generally extend grace and allow a bit of time to mature relationships that initiate in this way, as in time I know my true nature to be revealed as genuine, credible, and worthy of a little respect. I was waiting patiently… then the blow came.

As my jaw sat on my desk and the multitude of what-fors and what-the-hecks ran through my mind, I responded with, “I am a solo midwife in the event you were unaware and have been for seven years.” Need I remind you that I haven’t left a 90 minute radius for more than three weeks in the last seven years because I’ve been on-call, cell phone attached to my hip, ready to pounce at the first trickle of amniotic fluid! Can there possibly be anyone within my little circle that isn’t acutely aware that I work hours and hours and hours on end, harboring guilt that I am loosing precious time with my children, and neglecting my Bible studies, and haven’t sufficient time in my schedule to sleep, eat well, or exercise?

Solo midwives entangle their personal identities with those of their practice so it is hard not to take a statement like this very personal. To state that I was incapable of recognizing the position of a solo midwife discredits all that I have accomplished and ignores all that I have sacrificed. I am glad I kept my response simple and quickly recognized her approach as bullying. However, I am at a point in my life when I am no longer willing to cower. I have work to do and I am going to push forward. This is a sort of pecking order, I suppose, which I’ve otherwise not given proper credit. It seems a silly waste of time, but sadly, much of leadership is about learning to play the game and properly socialize.

Her response, “I know you are a solo midwife, but I think your having an office and staff is different than a small solo midwife that essentially does it all with only the help of birth assistants at a birth.”

The prideful soul deep within me is arguing that my practice has been based out of my home since day one, and continues to be today. In fact, appointments were exclusively within either my home or the client’s until only a few months ago when we added the second office in Indianapolis. Gretchen, my fabulous nurse who has also wrapped her identity up with the practice, only joined forces with me in the office two years ago. All four-and-a-half years prior, I was battling every single demand independently. My husband argues that it is also important to mention that we put all our money back into the practice, so I have yet to earn as much as I did as a bedside nurse and haven’t health insurance, retirement, paid vacation, or educational reimbursement.

Miss Prideful actually can launch a pretty good attack here, because to be frank, the statement above is both incredibly inaccurate and exceptionally ignorant. However, in a back-handed way, it is also very complementary to all that I have accomplished as a solo midwife with the number one accomplishment being the assembly a kick-ass midwifery team! I did not send a final response because if our practice looks like a well-oiled operation, raking in the bucks, and prominent within the community and I am not extended any of the credit, than I’ve done well.

However, if this is may be her backwards way of asking, “How do you do it all?” Let me tell you about my Awesome Father

 

Getting Enough Sleep

I don’t need to point out to most of you my middle section has increased in size at an alarming rate these past few years and I am currently weighing more than I did when I gave birth to any of my five children. Last year, my husband and I joined the gym and started seeing a trainer twice each week. I kept up well with the training, but in nine months, gained an additional twenty pounds. He contributed it to my diet, which isn’t perfect, but since I am quite mindful of healthy eating, I couldn’t rationalize the weight gain. Wanting to dig a little deeper, I ordered one of those arm monitors that records your movement, steps, resting and sleeping, and allows you to enter your nutritional content. I discovered quickly that my calories were actually too low, but more importantly, I was averaging only three hours a night of sleep. Never would I argue that I get enough sleep, but three hours a night! I was genuinely astonished, but it became clear to me that my body was in a fight or flight response and my aggressive work-outs were further stressing my body, causing the additional weight gain.

NeuroScience is a functional medicine modality that we utilize often in our practice, although primarily for mood disorders, so I thought I would also take advantage because they also offer testing to assess the health of the adrenals. While my neurotransmitters were all very stable, my adrenals were literally non-responsive. Picture asystole. Flat as a pancake. I could improve my diet and add another workout into my regimen, but until I gained control of my sleep, I was not going to loose any inches around the middle.

I suspect we all understand the importance of sleep for optimal health, but maybe we don’t really prioritize it as we should. I’ve made asking about sleep a priority in my practice and am amazed at how the deprivation of sleep is directly correlated with the intensity of one’s anxiety symptoms. I remind mothers, while also reminding myself, that sleep deprivation is a form of torture.

Without adequate sleep, which for adults means less than seven to eight hours a night, neurotoxins build up and may start to degrade communication between networks in the brain – and that’s just the tip of the iceberg. From brain function to weight gain to mortality, every single bodily process is compromised by lack of sleep. ~emerson ecologics

Brain Function

Sleep is vital to optimal brain function. There are reports that sleep helps one memorize, organize, and synthesize new information, so sleeping after studying and prior to a test can greatly enhance performance. However, lack of sleep makes for sloppy thinking. The rationale is that while one is sleeping, the flow of cerebrospinal fluid is enhanced washing away harmful proteins and removing toxins.

Metabolism & Weight

Some of the most compelling research specific to sleep is directly related to weight gain. It makes sense that the longer we are awake, the more we tend to eat, but sleep and metabolism are controlled by the same brain sectors. One of our consulting functional medicine experts shared with us recently, “She will never get control of her metabolism until she gets control of her sleep habits.” That certainly resonated with me as well. This is step one to weight loss. Insufficient sleep wreaks havoc on the hormones that affect our appetite and regulate how we store calories. Interestingly, the worse your sleep, the less self-control one has in avoiding junk food as well. And who goes to the gym when they are that exhausted!?!

Safety

I am pointing out the obvious here, but lack of sleep contributes to car crashes, industrial disasters, and other work place accidents. One in twenty people have admitted to falling asleep at the wheel at least once a month! Driving while exhausted is as reckless as driving while drunk. Don’t do it.

Mood

I mentioned consulting clients with complaints of anxiety, depression, ADHD, and even postpartum psychosis and what I typically find is sleep deprivation. Sleep certainly makes one more irritable and can trigger a serious mental health crisis, and its odd how many don’t recognize what-so-ever that lack of sleep is the cause.

Cardiovascular Health

Yes, it gets more serious. Sleep disorders are linked to inflammation that can manifest as hypertension, increased stress hormone levels, and an irregular heartbeat. If you’re getting less than six hours of sleep each night, you quite likely have higher levels of inflammatory proteins than those who get more sleep.

Disease

Sleep affects us on a cellular level, so if inadequate, we will suffer ill health. Our immune system is built up while we are asleep, so if weakened, it will fail to defend us from disease.

Don’t underestimate the importance of sleep. This can be as critical as your nutrition and exercise. Don’t make a habit of burning the midnight oil, and please, put down the iPhone or iPad and shut off Netflix. The bedroom is for sleep and intimacy, not electronic devices which are known to deplete your melatonin when utilized an hour prior to bed.

Share with us your experiences and what tricks you’ve learned to improve your sleep habits. Did you experience weight loss?

Our First Commercial

Call The Midwife

Believe Midwifery Services, LLC has sponsored the entire season of Call the Midwife on PBS, so watch for our commercial on any of the eight episodes!!

What do you think of this series? Are you loving this season?

Essential Oils: Toxicity & Contraindications

This is a tricky subject for a number of reasons. Essential oils are quite safe, especially when compared to modern medicines. However, in spite of being natural, they are not without risk. There are practitioners passionate on both sides of the argument. Depending on one’s training and experience, they may or may not recommend ingestion of essential oils or applying therapeutic oils neat or with a carrier oil. Others may recommend using essential oils daily, while some will instruct to limit exposure or suffer the consequence of damaged organs.

Essential oils have been used throughout time, and were spoken of often in the Old Testament. The number of toxic reports are so few, that basic common sense supports their use as a health modality when applied sensibly. Perhaps the larger issue is that common sense is not always common.

Many adverse effects can be avoided by using pure essential oils. When steam distillation is used and the essential oil is pure, without adulteration, there are no byproducts for which to interact. If one is especially allergy-prone or consuming a number of medications, adverse reactions are more likely.

Ingestion

Ingesting essential oils has potential for greater toxicity than diffusing or diluting them and applying to the skin. When used in this way, essential oils are clearly being utilized for medicinal purposes and unless the practitioner has a license to prescribe, this could be argued as practicing medicine or nursing without a license. However, one could also argue that the utilization of herbs in the United States is not a regulated practice and therefore, no licensing is required. Reports of toxicity to date are almost exclusively in doses ingested much greater than what is normally advised, and quite often in children.

A study performed by Burfield, in 2001, found 74 of 100 essential oil poisonings in children were from ingesting eucalyptus. Access was gained through their home vaporizer. The range of safety varies greatly. For example, death in adults has occurred after ingesting as little as 4 to 5 ml, which seems minimal, but rarely does someone survive after ingesting more than 30 mL (MacPherson, 1925). There have been cases of recovery however, after ingesting 220 mL of eucalyptus essential oil (Gurr & Scroggie, 1965). There are additional case studies of toxicity from children ingesting as much as two teaspoons of tea tree oil and various amounts of lavender essential oil.

Skin Reactions

Essential oils are thought to be dangerous by some when applied to the skin undiluted, otherwise called “neat.” These are typically oils high in phenols (clove, oregano, and thyme) or aromatic aldehydes (cinnamon). Negative reactions are typically related to irritation, allergic sensitivity, or phototoxicity.

When skin irritation does occur, a local response is almost immediate. Avoid using water to wash away the oil, which will only push the essential oil into the dermis. Rather, apply a carrier oil, and then wash with soap and water if necessary to eliminate any heat or burning. Those who utilize essential oils, and especially share them with others, should always have at hand a carrier oil for this purpose.

Sensitivity to an essential oil occurs over time. There is no response at first exposure, but with repeated application stronger reactions occur. These can range from very mild to severe, and can initiate with the very next exposure or occur after long-term exposure. A rash, sneezing, or shortness of breath are common responses when sensitivity occurs. This is reason why some experts caution against long-term use, in effort to avoid sensitivity. Again, those taking a number of medications or those with allergies, asthma, and eczema are more likely to respond negatively.

Sandalwood, thyme, and guaiacwood oils have caused sensitivity in those who have adverse reactions to balsams. Ylang ylang may cause a similar problem with those who are sensitive to perfume products. It is believed that sensitivity to essential oils has developed because of the increase of fragrances within food, household products, cosmetics, paints and medicines.

Photosensitivity can occur with selected essential oils. When applied and exposed to ultraviolet rays, reactions can vary from pigmentation of the skin to severe full-thickness burns. The most common essential oils to cause this reaction are furanocoumarins (lemon, lime, orange, and angelica root oils).

Inhaled Toxicity

No reports of any toxic effects have been documented, to my knowledge, from inhaling essential oils. However, one should diffuse oils within a ventilated area.

Essential Oil Dynamics within the Body

Because of the highly lipid nature of essential oils, they tend to gain easy access to the brain. As they travel through the bloodstream, they are also readily available to the adrenal glands and kidneys, are excreted by the kidneys, lungs, skin and feces. Nursing mothers also excrete essential oils via their breast milk. Essential oils can compete with pharmaceutical drugs at the cellular level.

Essential oils containing b-asarone or d-pulegone may increase the toxic effects of some pharmaceuticals because they both induce the detoxifying enzyme cytochrome P450. Progesterones (birth control pills) and diphenhydramine (Benadryl) are two examples which could have adverse outcomes when used in combination with wintergreen, cultivated carrot seed, calamus, and pennyroyal. However, Tisserand and Balacs (1995) state the amount of exposure to these essential oils for aromatherapy is insignificant and does not pose a risk. A review of the literature shows that those who are medicated with anti-seizure medications should be cautious when using essential oils, as their medication may reduce the effectiveness of their medication.

Acetaminophen is a common analgesic that is considered safe during pregnancy; however, it reduces the level of glutathione in the liver, which is responsible for absorbing free radicals. When glutathione levels fall, reactive molecules can attack the liver and can be fatal. While this is extremely unlikely in doses used for aromatherapy, if taking the maximum recommended dose of Tylenol, it might be wise to avoid essential oils containing transanethole, estragole, and eugenol. These would include fennel (also used to support lactation), aniseed, basil and clove.

A Closer Look

Wintergreen is often recommended as an essential oil to avoid in pregnancy. This is likely due to its high levels of methyl salicylate, which is related to aspirin. This is also true of sweet birch (Tisserand & Balacs, 1995). However, wintergreen is found in several proprietary creams for sprains and strains, as well as a number of chewing gums and candy. It would take more than 10mL to equate 250mg of methyl salicylate, equivalent to a single aspirin, and only half would be absorbed. It can however be absorbed through the skin and affect warfarin anticoagulation therapy (Littleton, 1990; Yip et al 1990).

Essential oils that are typically recommended as needing dilution in a carrier oil include oregano, clove bud and leaf, cinnamon bark, camphor, and red thyme. Although no published data to my knowledge demonstrates a direct correlation between essential oils and hypertension, it is suggested that rosemary, spike lavender, hyssop, juniper, thyme, and clove be used with caution in those with hypertension.

Homeopathy and Essential Oils

Generally speaking, it is recommended that homeopathy therapies and essential oils not be used simultaneously. Homeopathy and essential oils are by their very nature, completely opposite of each other – one very concentrated and one very dilute. This opinion is not shared by all, but oils in particular to avoid when working with homeopathy are peppermint, eucalyptus, thyme, and those with strong aromas.

Essential Oils and Pregnancy

The use of essential oils in pregnancy is largely a mystery. The first three months however, are a vulnerable period for the growing fetus and the typical recommendation is to avoid any potential toxin during these first few weeks in effort to diminish risk. Some aromatherapists simply won’t work with pregnant women. It is believed that essential oils do cross the placenta. Oddly, perfume does not carry a warning sign cautioning use during in pregnancy. Many midwives utilize aromatherapy and essential oils for therapeutic use in pregnancy and throughout labor. Hospitals are also incorporating their use as a nursing measure in labor.

If you believe your child has drank an essential oil, call the Poison Control Center. Encourage them to drink milk if they are capable of drinking safely. If essential oils get into the eyes, wash them out with milk as well, or use a carrier oil and then rinse with water. Keep in mind that essential oils do not mix well with water.

Store your essential oils safely away from children. If used within the hospital, essential oils should be in a locked cabinet.

Food For Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has." Sir William Osler

Food for Thought

Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy. Aviva Romm

Food for Thought

Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Snyderman and Weil

Food for Thought #1

They say that time changes things. But you actually have to change them yourselves. Andy Warhol

Food for Thought

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole." Rixa Freeze PhD

Food for Thought

Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective. Dr. Penny Lane, nurse-midwife

Food for Thought

When the debate is lost, slander becomes the tool of the loser. Socrates

Food for Thought

To accomplish great things, we must not only act but also dream; not only plan, but also believe. Anatole France

Food for Thought

"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'" Grimes (1986)

Food for Thought

American physicians are rewarded for doing things to patients, not for keeping them well. Grimes, 1986

Food for Thought

The false idol of technology. "Having a widget screwed into one's scalp has become an American birthright." Grimes, 1986

Food for Thought

"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days." Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it." Goer & Romaro, 2012, p 35

Food for Thought

"If you play God, you will be blamed for natural disasters." Marsden Wagner (2006)

Food for Thought

An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't. Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

When you have exhausted all possibilities, remember this: you haven't. THOMAS EDISON

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer

Food for Thought #2

Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast.

Psalm 22:9