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The effect of lavender aromatherapy on pain perception and intrapartum outcome in primiparous women Article in
British Journal of Midwifery · February 2014
DOI: 10.12968/bjom.2014.22.2.125 om.2014.22.2.125
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The effect of lavender aromatherapy on pain perception and intrapartum outcome in primiparous women Abstract Introduction: Labour pain is a main preoccupation of pregnant women. In this study, the authors determined the effect of lavender aromatherapy on pain intensity perception and intrapartum outcome in primiparous women. Methods: In this randomised controlled trial, 160 participants were divided into two groups. The aroma group received 0.1ml of lavender essential oil mixed with 1ml of distilled water via tissues attached to their gowns close to their nostrils. Meanwhile, the control group received 2ml of distilled water in a similar way. Pain intensity perception was measured by Visual Analogue Scale (VAS) before the intervention and at 30 and 60 minutes afterwards. Results: The mean of pain intensity perception in the aroma group was lower than that of the control group at 30 and 60 minutes after the intervention ( p <0.001).Conclusion: This study revealed that aromatherapy decreased the labour pain, but did not affect the duration of labour phases and Apgar score.
A Maasumeh Kaviani Faculty Member School of Nursing and Midwifery, Shiraz University of Medical Sciences Sara Azima Faculty Member School of Nursing and Midwifery, Shiraz University of Medical Sciences Narges Alavi Student Midwife Shiraz University of Medical Sciences Mohammad Hossein Tabaei Associate Professor of Medicinal Chemistry Shiraz University of Medical Sciences
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lthough childbirth is a natural phenomenon, it is accompanied by severe pain in most cases (Tournaire and Theau-Yonneau, 2007), and negative experiences can lead to emotional and mental disorders in the postpartum period (Lee et al, 2004). The fear and anxiety from labour pain can also often lead to an increase in surgical interventions (Lee et al, 2004). Labour pain is one of t he main reasons for women’s fear of delivery and preference for caesarean section (Smith et al, 2011). In comparison to vaginal delivery, caesarean section could result in an increase in the risk of infection, bleeding, urinary tract infection and thrombosis emboli in the mother (Cunningham et al, 2010). Today, many women are seeking to have a natural delivery using non-medical pain reduction methods (Yoshioka et al, 2012). Aromatherapy is a non-medical complementary treatment which is applied using the senses of touch and smell. When herbal aromatic essence is inhaled, impulses are transferred to the brain by the smelling receptors, leading to the release of specific neurological and harmonic substances which are able to stimulate, suppress, soothe or inebriate and finally result in
physical and psychological changes (Tillett and Ames, 2010). Aromatherapy has also been reported to be effective in reduction of pain and anxiety (Simkin and Bolding, 2004). Lavender is widely applied in aromatherapy (Habanananda, 2004). Its oil essence has releasing and tranquillising effects (Cavanagh and Wilkinson, 2002), and studies on the use of essential oils for reducing pain and creating calmness in labour have indicated lavender as the most effective oil (Goldberg, 2001). By studying the effect of aromatherapy on the fetus, Bastard and Tiran (2006) reported that essential oils can cross the placental barrier and be transferred to the infant via breast milk; however, this does not imply the risk of toxicity as lavender aromatherapy (inhaled, incense or massage) is not harmful to the fetus (Bastard and Tiran, 2006). Furthermore, Burns et al (2000) reported that aromatherapy not only leads to reduction of stress and anxiety during delivery, but also decreases the consumption of painkillers up to 2% and, as a result, can reduce the costs of care. As non-pharmacolo gica l meth ods are increasingly being used for labour pain relief, this research aimed to determine the effect of lavender aromatherapy on pain intensity perception and intrapartum outcome in primiparous women.
Method The present study was a semi-experimental clinical trial. The subjects were selected from mothers referring to the hospitals of Shiraz University of Medical Sciences, Shiraz, Iran, for normal vaginal delivery between December 2008 and June 2009. Based on the study by Lehrner et al (2005), considering variance=7.25, d=0.49, confidence level=99%, power=95%, and loss rate=6%, and using the following formula, a 160-subject sample size was determined for the present study with 80 subjects in each group. The sample included 160 primiparous pregnan t women who were divided into a control and an aroma group. The primiparous pregnant women British Journal of Midwifery • February 2014 • Vol 22, No 2
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who were at 36 weeks or more gestation, single pregnancy and 3–4 centimetres dilatation were entered into the study. Those with medical and delivery problems or aromatherapy limitations— such as asthma, allergy, cold and specific anosm ia for lavender based on a specialist’s diagnosis— women who were ready for voluntary caesarean, and those applying for other methods of conductive anaesthesia and analgesia on entering the labour room were excluded from the study. As the st udy could not be blinded, in order to avoid bias, the intervention days were divided into two groups. Even days were specified to the aroma group and odd days to the control group based on a lottery. The data were gathered through questionnaires involving the demographic specifications, pregnancy status, delivery process, the intensity of the feeling of pain, and the pain measuring scale. In this study, pain was measured using Visual Analogue Scale (VAS), which is a ruler-like device numbered from 0 to 10: 0 means no pain and 10 means the highest intensity of pain. VAS has been proven to be reliable (Gaston-Johanson, 1996) and valid for assessing the labour pain (Mårtensson et al, 2008). In the women with 3–4cm dilatation, the intensity of pain was measured before and at 30 and 60 minutes after the intervention using this device. In the study, lavender officinalis species was used. In the aroma group, 15x15cm tissues containing 0.1ml of lavender essence mixed with 1ml of distilled water were used. In addition, cotton fabrics were used in order to maintain the aromas. The fabrics were treated in a completely sterile distilled water and lavender essence and were stored in sterile packages—a method derived from the study by Anderson and Gross (2004). In fact, using the tissues prevents percutaneous absorption (Denda et al, 2000). The control group inhaled 2ml of distilled water under the same conditions. Before the intervention, the pain intensity was measured through the pain measuring scale and the data were gathered. The data were entered into the SPSS statistical software and analyzed using Chi- square and t-test. The study protocol was reviewed and approved by the Human Ethics Committee of Research Council of the Dean of Research Affair of Shiraz University of Medical Sciences, Shiraz, Iran. d t L e r a c h t l a e
Results:
As age, education and gestational age are effective H factors in the intensity of pain, the two study A M 4 groups were matched regarding these factors at 1 0 2 © the beginning of the study. The mean age of the British Journal of Midwifery • February 2014 • Vol 22, No 2
study participants was 23±3.9 years in the aroma group and 22±3.86 years in the control group. In addition, the gestational age of the aroma group and the control group was 38±1.6 and 39±1.49 weeks respectively, and the difference between the two groups was not statistically significant. Therefore, both groups were similar regarding their demographic specifications. The duration of th e first stage of d elivery was 3.6±1.39 hours in the aroma group and 3.9±0.5 hours in the control group and t he difference was not significant. Also, no significant difference was found between th e two groups regarding the mean duration of the second stage of delivery, type of delivery and the mean of the 1 st and the 5th minute Apgar. Before the intervention, no significant difference was observed between the two groups regarding the mean of labour pain intensity perception. Nonetheless, a significant difference was shown between the aroma and the control group 30 and 60 minutes after the intervention ( p<0.001) ( Table 1 ). By posing a question about the contentment of the individuals, the aroma group was more content compared to the control group ( p<0.001) ( Table 2). No significant difference was found between the two groups regarding the mean of Apgar in the 1 st
Table 1. Comparison of the mean of pain severity before and 20 and 60 minutes after intervention Before intervention
30 minutes after intervention
60 minutes after intervention
Aroma group
6.8±1.9
6.6±2.2
6.9±2.3
Control group
7.1±2.2
7.8±1.9
8.5±1.6
p -value
0.286
<
0.001
0.001
<
Table 2. Comparison of the frequency of contentment test Contentment
Not contented
Number
Percentage
Number
Percentage
51.2
41
48.8
39
Control group 23.8
19
76.2
61
Aroma group p -value
0.001
0.001
<
<
Table 3. Comparison of the mean of the 1st and 5th minute Apgar score Aroma group
Control group
Apgar score
Mean
SD
Mean
SD
1st minute
8.75
0.604
8.74
0.775
0.927
9.97
0.205
9.94
0.289
0.749
th
5 minute
p -value
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and 5th minutes after the babies’ birth ( p=0.927, p=0.749) (Table 3).
Discussion The intense fear of labour pain could be a risk factor affecting the fetus as well as the mother’s life, as stress can cause vasoconstriction which can decrease the blood supply to the uterus and fetus (Hadi, 2006). Therefore, suitable planning and performing midwifery interventions to control the pain during delivery seem to be necessity. The first objective of the present study was to determine the effect of lavender aromatherapy on pain severity. The results of the current study demonstrated a significant difference between the aroma and the control groups regarding the intensity of labour pain at 30 and 60 minutes after the intervention ( p<0.001) and the least intensity of pain was observed at the 30th minute after the intervention. Similar results were also obtained by Han et al (2006) studying the aromatherapic scent on dysmenorrhoea. Burns et al. (2007) studied the effect of aromatherapy on the level of anxiety and the intensity of labour pain in primiparous and multiparous women. They reported that aromatherapic scent had little effect on the pain realisation of the primiparous women. In addition, the pain intensity realization continued in the multiparous women and pain and anxiety increased by the progress of delivery in both groups. The difference between the results might be due to the fact that two groups of primiparous and multiparous women were compared in the study by Burns et al. (2007), while the present study only compared the primiparous women. Memory is one of the important factors related to the effect of scent. Because different scents provoke memories and make the individuals review the details of the events (Goldberg, 2001), it seems that the scent of lavender resulted in less concentration and stopped the pain realisation in the aroma group. Aromatherapy affects the body in three ways: pharmacological effects of the hormones and
Key points l l
l
l l
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Childbirth is accompanied by severe pain in most women Aromatherapy is a non-medical complementary treatment for labour pain relief Aromatherapy oils reduce stress hormones and increase the secretion of beta-endorphins Lavender is widely applied in aromatherapy Aromatherapy with lavender can be effective in reducing the labour pain and has no adverse effects on the baby’s Apgar score
enzymes that can cause chemical changes in the body; psychological effects, including relaxation and sedative effects on the body; and physiological effects resulting from the brain’s response to inhaling aromas (Trevelyan and Booth, 1994). The studies conducted on the issue have shown that lavender aroma might suppress the activity of the sympathetic nervous system (Heuberger et al, 2004; Toda et al, 2008) . Volatile compounds may enter the bloodstream through the nasal or lung mucosa, or directly diffuse into the olfactory nerve and pass up to the limbic system which can influence the sympathetic nervous system (Toda and Morimoto, 2008). Anxiety influences the pain intensity and mothers’ anxiety during labour is an important factor in the severity of labour pain (Lang et al, 2006; Curzik and JokicBegic, 2011). Aromatherapy oils reduce the stress hormones and increase the secretion of betaendorphins; thus, pain perception is reduced (Burns et al, 2000). Rho et al (2006) demonstrated that aromatherapy, particularly with lavender, decreased anxiety in elderly women and increased self-confidence. The second objective of the present study was to determine the effect of lavender aromatherapy on the duration of the first and second stages of labour .The findings of the study indicated no significant difference between the two groups regarding the duration of the first and second stages, which is in agreement with the results obtained by Burns et al (2007). However, Hur and Park (2003) reported that aromatherapy with lavender and rose reduced the labour duration. Another objective of the current study was determining the effect of lavender aromatherapy on the babies’ Apgar score. The study results revealed no significant difference between the two groups regarding the 1 st and 5th minute Apgar score. Therefore, the scent of lavender had no effect, which is consistent with the findings of the studies performed by Hur and Park (2003) and Burns et al (2000). Evaluation of the women’s contentment was the fourth objective of this study. According to the findings, the women in the aroma group were significantly more content compared to the control group. Although the study subjects did not have any previous experience of the lavender scent, inhaling it was pleasing for them. Kim et al (2006) conducted a study on the effect of lavender on treating post-operative pain after breast biopsy and revealed that the contentment of pain control in aromatherapy by lavender was higher than that in the control group. Also, in the previous study by Burns et al (2000), most women had chosen the British Journal of Midwifery • February 2014 • Vol 22, No 2
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scent of lavender as their preferred pain reliever among all the scents.
Conclusion According to the results of this study, the women in the lavender aromatherapy group reported lower intensity of labour pain. However, this technique was not effective in the duration of delivery, type of delivery, stages of the delivery, and 1 st and 5th minute Apgar scores of the newborn. The results of this study could recommend that lavender aromatherapy could be practised in health centres for pregnant women in order for them to apply its healing methods to soothe labour pains and, consequently, reduce unnecessary caesarean sections that are caused by fear of labour pain. BJM
Acknowledgements: This article was extracted from a thesis written by Narges Alavi and was financially supported by Shiraz University of Medical Sciences, Iran. The authors gratefully acknowledge all the pregnant women involved in the research. Research Improvement Center of Shiraz University of Medical Sciences and Ms A Keivanshekouh are also acknowledged for improving the use of English in the manuscript. The corresponding author for this paper is Sara Azima.
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Anderson LA, Gross JB (2004) Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. Journal of Perianesthesia Nursing 19(1): 29–35 Bastard J, Tiran D (2006) Aromatherapy and massage for antenatal anxiety: Its effect on the fetus. Complemetary Therapies in Clinical Practice 12(1): 48–54 Burns E, Blamey C, Ersser SJ, Lloyd AJ, Barnetson L (2000) The use of aromatherapy in intrapartum midwifery practice an observational study. Complementary Therapies in Nursing and Midwifery 6(1): 33–4 Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A (2007) Aromatherapy in childbirth: A pilot randomized controlled trial. BJOG 114: 838–44 Cavanagh HM, Wilkinson JM (2002) Biological activities of lavender essential oil. Phytotherapy Research 16(4): 301–8 Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C (2010) Williams Obstetrics (23rd edn.). McGraw-Hill, New York. Curzik D, Jokic-Begic N (2011) Anxiety sensitivity and anxiety as correlates of expected, experienced and recalled labour pain. Journal of Psychosomatic Obstetrics and Gynaecology 32(4):198–203 Denda M, Tsuchiya T, Shoji K, Tanida M (2000) Odorant inhalation affects skin barrier homeostasis in mice and humans. British Journal of Dermatology 142(5): 1007–10 Gaston-Johansson F(1996) Measurement of pain: The psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices. Journal of Pain and Symptom Management 12(3): 172–81 Goldberg L (2001) Massage and aromatherapy: A practical approach (2nd edn.). Nelson Thornes Ltd, Cheltenham
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Habanananda T (2004) Non-pharmacological pain relief in Labour. Journal of the Medical Association of Thailand 87(Supplement 3): 194–202 Hadi N (2006) Maternal and Child Health. Shiraz University of Medical Sciences Publication, Shiraz Han SH, Hur MH, Buckle J, Choi J, Lee MS (2006) Effect of aromatherapy on symptoms of dysmenorrhoea in college students: A randomized placebo-controlled clinical trial. Journal of Alternative and Complementary Medicine 12(6): 535–41 Heuberger E, Redhammer S, Buchbauer G (2004) Transdermal absorption of (-)-linalool induces autonomic deactivation but has no impact on ratings of well-being in humans. Neuropsychopharmacology 29(10): 1925–32 Hur MH, Park MH (2003) Effects of Aromatherapy on Labour Process, Labour Pain, Labour Stress Response and Neonatal Status of Primipara: Randomized Clinical Trial. Korean Journal of Obstetrics and Gynecology 46(4): 776–83 Kim JT, Wajda M, Cuff G, Serota D, Schlame M, Axelrod DM, Guth AA, Bekker AY (2006) Evaluation of aromatherapy in treating postoperative pain: Pilot study. Pain Practice 6(4): 273–7 Lang AJ, Sorrell JT, Rodgers CS, Lebeck MM (2006) Anxiety sensitivity as a predictor of labour pain. European Journal of Pain 10(3): 263–70 Lee MK, Chang SB, Kang DH (2004) Effect of sp-6 acupressure on labour pain and length of delivery time in women during labour. Journal of Alternative and Complementary Medicine 10(6): 956–65 Lehrner J, Marwinski G, Lehr S, Johren P, Deecke L (2005) Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiology and Behavior 86(1–2): 92–5 Mårtensson L, Stener-Victorin E, Wallin G (2008) Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain. Acta Obstetricia et Gynecologica Scandinavica 87(2): 171–7 Rho KH, Han SH, Kim KS, Lee MS (2006) Effects of aromatherapy massage on anxiety and self-esteem in korean elderly women: A pilot study. International Journal of Neuroscience 116(12): 1447–55 Simkin PT, Bolding A (2004) Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering. Journal of Midwifery and Women’s Health 49(6): 489–504 Smith CA, Collins CT, Crowther CA (2011) Aromatherapy for pain management in labour. Cochrane Database of Systematic Reviews 6(7): CD009215 Tillett J, Ames D (2010) The uses of aromatherapy in women’s health. Journal of Perinatal and Neonatal Nursing 24(3): 238–45 Toda M, Morimoto K (2008) Effect of lavender aroma on salivary endocrinological stress markers. Archives of Oral Biology 53(10): 964–8 Tournaire M, Theau-Yonneau A (2007) Complementary and alternative approaches to pain relief during labour. Evidence Based Complementary and Alternative Medicine 4(4): 409–17 Trevelyan J, Booth B (1994) Complementary Medicine for Nurses, Midwives and Health Visitors. Palgrave Macmillan, London Yoshioka T, Yeo S, Fetters MD (2012) Experiences with epidural anesthesia of Japanese women who had childbirth in the United States. Journal of Anesthesia 26(3): 326–33
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