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A Considerate Post on Clary Sage Use During Pregnancy, Birth and Postpartum

I can barely get to the question, “How far along are you?” before a momma is asking if she can use Clary Sage to induce labor. If you polled a room of expectant mommas and asked them to list essential oils, I promise you, Clary Sage would be in the list, probably right next to lavender. So what’s the answer? Can we safely use Clary Sage essential oil during pregnancy, birth and postpartum? Like I’ve discussed in previous posts, aromatherapy is not a black and white practice. It is a space filled with beautiful shades of grey, and answering these questions around Clary Sage is not a black and white issue. To help us try to discover some of these answers, we are going to look at how aromatherapy is researched, truths, myths in aromatherapy specific to Clary Sage, and known benefits and risks of Clary Sage.

 

Foundation of Research

Some areas of aromatherapy gift us with great, or at least adequate, amounts of evidence based research. Other areas, not so much. Unfortunately, pregnancy is one of those areas we lack research. Gratefully, more research is coming out and we can start to see a much better picture of how essential oils and pregnancy can co-exist. Research studies about essential oils that are specifically teratogenic(1) or abortificient (2), these are studies that have been tested only on animals, namely mice, due to the ethics of human trials in this area. That leaves us to draw conclusions about possible effects on humans based on what we do know about the compounds in the essential oil. These are often not facts since the animal and human parallels can only go so far. In the area of mutagenicity (3) we don’t have so much research at this time. So, research sometimes, leaves us in a grey area.

 

Truths & Myths

Solidifying some truths and destroying myths is important in aromatherapy because it helps us to navigate to the best possible decision, including using essential oils in pregnancy. Aromatherapy is a modality that has been around for hundreds of years. We are all aware of the “old remedies” that can be handed down from generation to generation, and, while some of them are true and helpful, others are just nonsense. So, with what we are certain of at this time, let’s separate some truth from fiction.

First, lets touch on truth concerning essential oils and herbs. My training is all in essential oils. The very minimal herbal knowledge I have is from self-study, so I do not personally provide recommendations about herbs, although I use them with my family and have connected with some amazing certified herbalists who help advise me for my family. I do, however, understand and know the difference between essential oils and herbal remedies to be this: concentration and composition. Essential oils are distilled from enormous quantities of plant material. This produces a highly concentrated, sometimes volatile substance. Sweet Fennel tea, for example, is great for digestion and nursing in herbal form, but in the form of the essential oil, it is a neurotoxin and contraindicated until age 2. There are also chemical compounds that are not carried over during distillation of plant material or change form. The implication is that sometimes herbs and oils have similar properties and other times they do not. Clary Sage is one of those times where the herb and oil are more different than alike.

It is true that there are some essential oils that can cross the placenta barrier and have an adverse effect on the baby. The oils that can do so are lipid (fat) soluble and have very small molecular make up. This is one of the reasons practicing aromatherapists advise that no oral, vaginal or rectal preparations be given during pregnancy as it increases those exposures. It is also the reason some essential oils are directly contraindicated for use during pregnancy like Wintergreen and Sweet Birch essential oils. These two oils, which contain high levels of methyl salicylate, are seen frequently in mass produced blends and marketed as safe for pregnancy and even labor while studies and science have proven that it prevents the closure of the neural tube in pregnant rats. Defects of the neural tube include spina bifida.

Clary Sage is a classic victim of perpetuated, generational confusion and misinformation. We do the best we can until we know better, then we do better! Our dear Clary is often seen classified as a emmenagogue oil, an essential oil that can increase the flow of menstruation due to the compound sclareol. Some claim this compound can enhance the “balancing of hormones”. It is said to be a hemorrhaging risk during birth as it stimulates the uterus and is even suspected to interfere with stability in pregnancy. Truth or Myth?

It is true that Clary Sage is classified as an emmenagogue oil, so the possibility could very well exist that it would increase blood flow to the uterus. Would this cause hemorrhaging during birth? Unfortunately, we do not have research to prove or disprove this possibility at this time, and this risk should be a point of consideration during use at a birth.

The compound sclareol is often what is said to give Clary Sage its “woman’s oil” reputation for balancing hormones. Some sources claim it mimics estrogen or is “estrogen-like” however, research and simple chemistry knowledge suggests that Clary Sage is not responsible for production of or mimicking estrogen in the body. Esters, a chemical compound family, make up a large portion of Clary Sage. This chemical family is said to have an affinity for the pituitary gland, part of the endocrine system, so the connection of Clary Sage with hormones could be due to the effects of the esters on the pituitary gland. Research is yet to confirm this conclusion but it is valid to note.

 

Benefits & Risks

Now that we have established that Clary Sage is an emmengagoue oil, let’s talk about some of the other benefits of this oil. While the aroma is very pungent, be ye warned, Clary Sage boasts of some beautiful therapeutic properties to the user. It is classified as an oil that is an analgesic, anti-inflammatory, anti-bacterial, anti-septic, anti-spasmodic, CNS sedative, immune-stimulant, aphrodisiac, calming, digestive and nerve tonic, hypotensive and uterine tonic. These sound like a power packed benefits for labor and birth!

Clary has long been used and recommended in the birth worker realm to “naturally induce labor”. While this study suggests there could be a link, it should be noted that Clary Sage was part of a blend of essential oils, so we can not directly tie Clary Sage itself to the encouragement of labor. It is also important to note that Jane Buckle, PhD, RN in her book Clinical Aromatherapy Essential Oils in Healthcare, 3rd Edition says on page 382 that,

“Clary sage was used to stimulate contractions but not found successful.”

It is also very hard at times to tie essential oil use directly to the stimulation of labor because often the oils are applied by massage. The modality of massage by itself is incredibly relaxing and carries analgesic effects, which can reduce stress, increase relaxation and therefore encourage labor. Adding essential oils to a massage may enhance these benefits but not be a direct or sole cause of them. It should be agreed on, with these considerations, that Clary Sage does not naturally induce labor.

Moving forward with specific use of Clary Sage during labor, birth and postpartum, lets cover some of the risks of use and times when Clary Sage should be avoided.

  • Where labor is established, avoid use, as it causes hypertonic contractions. This is where the uterus has been overly stimulated and stays tight during contractions. It blocks dilation of the cervix and usually locks out between 2-4cm. Contractions are weak and unproductive but extremely frequent and long. This increases the risk of a prolapsed cord and compression of the baby’s head. In a hospital, this condition is usually treated with Pitocin and more often than not leads to a cesearn section due to “failure to progress”.
  • If client has chosen any type of medical induction, including membrane striping, breaking of waters or epidural, do not use essential oils for at least 1 hour after the procedure to allow medical procedure or drugs to take effect.
  • Avoid Clary Sage completely if client elects to have an epidural as it can lower the blood pressure.
  • Avoid tea tree, manuka and kanuka essential oils during labor, as they can have effects on the myometrium.
  • Clary Sage, along with Rose and Jasmine which are also emmengagogue oils commonly used during birth, seem to be safe during labor but caution is advised during pregnancy. Rose should be avoided until after 34 weeks. Clary Sage and Jasmine avoided until term, or 37 weeks.
  • Clary Sage can be incredibly helpful to relax during labor as well as ease physical discomforts during birth. For relaxation benefits consider an aromastick or other inhalation method. To experience the physical analgesic properties, massage with a 1% dilution could be considered. Be sure to not put into a birth pool or tub. It is a strong smelling oil, so use topically with caution, letting mom smell before topically applying in a massage in case it produces nausea. Note that research has shown Clary sage is beneficial in a massage blend when combined with other oils such as Bergamot (FCF), Frankincense, Neroli, Geranium, Grapefruit or others depending on what else needs to be supported.
  • For postpartum use, Clary Sage is very helpful in an aromastick for respiratory and sinus needs as well as for over coming “baby blues”.
  • While not supported by all sources, experienced professionals working in both the fields of aromatherapy and birth note that, excessive, misapplication and preterm (37 weeks) use of Clary Sage has resulted in preterm labor, fetal distress, and even still birth. In talking with Denise Tiran on this subject of Clary Sage she shared,

“Whilst it is relatively safe in itself, it is being completely over-used by women who see it as a panacea for everything, getting themselves into labour, strengthening contractions, etc. They use it too early in pregnancy, too much and inappropriately and I’m extremely concerned. There are increasing reports of women going into preterm labour, having fetal distress and even, in one case I know of, still birth, possibly partly due to the fact that the mother took four times the dose by mouth.”

  • Effects of the essential oil Clary Sage are also reportedly felt by the birth team and support staff in an adverse ways, manifesting in drowsiness, lethargy, loss of concentration and menorrhagia. While some reports involve blatant misuse or over use of the essential oil these are important cautions to note as they give us an appropriate picture around misuse and incorrect dose and its prevalence in the birth world.
  • Clary Sage can be helpful in the situation of a retained placenta combined with fundal compression and with great caution.
  • Before using clary sage during birth, consider other factors that may be preventing mom and baby’s progression, including:
    • Emotions – stress, fear, anxiety, tired
    • Position – move and change position
    • Hydration
    • Urination

 

Conclusion

We have established a beautiful balance of risks and benefits that one should account for when considering use of Clary Sage during pregnancy, birth and postpartum. This essential oil’s incredible therapeutic properties can be used for many stages of life and should not be limited just to the delicate transition into montherhood. Weighing the risks and benefits, I hope you will find yourself a more educated consumer on this oil and be able to help me spread this cohesive collection of information allowing others the informed choice in how they use Clary Sage. Using before 37 weeks is not advised and truly urge the mother connect with a trained aromatherapist to visit if Clary Sage is needed at all.

Building a list of safe essential oils or safe practices for pregnancy comes not just from what we can deduce from research, but from a comprehensive education and understanding of the science of aromatherapy as well as a whole-person approach to practice so that we can minimize risk and navigate effects. If you get nothing else from this post, please hear this, the best way to navigate conflicting information is by using your B.R.A.I.N. informed consent process and with a trained aromatherapy practitioner you trust. B.R.A.I.N. stands for Benefits, Risks, Alternatives, Intuition, Nothing. You can read more about that here too! While your doctor, chiropractor, midwife or birth team member may have basic knowledge of essential oils, they are likely not completely up-to-date on safety and use. Unless they are certified aromatherapists in addition to their title (midwife, doctor, doula, etc.) working directly with a certified aromatherapist will always be your best choice in the use of essential oils. In an attempt to make this choice accessible for mother’s and their birth teams I have recently made two unique consults part of my practice offering, Pregnancy Consult and Postpartum Consult. Let’s team up and make this delicate transition the best it can be with safe essential oil support!

 

A special thank you to Leah Shultz for her expert proofing and comma skills.

Also to Denise Tiran who was such an encouragement and resource in writing this. You can visit her at www.expectancy.co.uk

 

Unlinked Sources/Definitions:

(1) an agent that can disturb the development of the embryo or fetus. Teratogens halt the pregnancy or produce a congenital malformation (a birth defect). Classes of teratogens include radiation, maternal infections, chemicals, and drugs. www.medicinenet.com/script/main/art.asp?articlekey=9334

(2) an agent (as a drug) that induces abortion. https://www.merriam-webster.com/dictionary/abortifacient

(3) is a physical or chemical agent that changes the genetic material, usually DNA, of an organism and thus increases the frequency of mutations above the natural background level. https://en.wikipedia.org/wiki/Mutagen

(4) Overman and White 1983

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