See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/269516747

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

CITATIONS READS

6 1,635

1 author:

Sara Azima
Shiraz University of Medical Sciences
14 PUBLICATIONS   66 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Sara Azima on 14 December 2016.

The user has requested enhancement of the downloaded file.

research
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
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
Maasumeh Kaviani the postpartum period (Lee et al, 2004). The fear
Faculty Member
and anxiety from labour pain can also often lead
School of Nursing
and Midwifery, Shiraz to an increase in surgical interventions (Lee et
University of Medical al, 2004). Labour pain is one of the main reasons
Sciences for women’s fear of delivery and preference
for caesarean section (Smith et al, 2011). In
Sara Azima
Faculty Member comparison to vaginal delivery, caesarean
School of Nursing section could result in an increase in the risk of
and Midwifery, Shiraz infection, bleeding, urinary tract infection and
University of Medical thrombosis emboli in the mother (Cunningham
Sciences et al, 2010).
Narges Alavi Today, many women are seeking to have a
Student Midwife natural delivery using non-medical pain reduction
Shiraz University of methods (Yoshioka et al, 2012). Aromatherapy is a
Medical Sciences non-medical complementary treatment which is
applied using the senses of touch and smell. When
Mohammad Hossein
herbal aromatic essence is inhaled, impulses are
Tabaei
Associate Professor of transferred to the brain by the smelling receptors,
Medicinal Chemistry leading to the release of specific neurological and
Shiraz University of harmonic substances which are able to stimulate,
Medical Sciences
suppress, soothe or inebriate and finally result in
30
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-pharmacological methods 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
© 2014 MA Healthcare Ltd
present study with 80 subjects in each group.
The sample included 160 primiparous pregnant
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
 research

who were at 36 weeks or more gestation, single study participants was 23±3.9 years in the aroma
pregnancy and 3–4 centimetres dilatation were group and 22±3.86 years in the control group. In
entered into the study. Those with medical and addition, the gestational age of the aroma group
delivery problems or aromatherapy limitations— and the control group was 38±1.6 and 39±1.49
such as asthma, allergy, cold and specific anosmia weeks respectively, and the difference between
for lavender based on a specialist’s diagnosis— the two groups was not statistically significant.
women who were ready for voluntary caesarean, Therefore, both groups were similar regarding
and those applying for other methods of their demographic specifications.
conductive anaesthesia and analgesia on entering The duration of the first stage of delivery was
the labour room were excluded from the study. 3.6±1.39 hours in the aroma group and 3.9±0.5
As the study could not be blinded, in order to hours in the control group and the difference was
avoid bias, the intervention days were divided not significant. Also, no significant difference
into two groups. Even days were specified to was found between the two groups regarding the
the aroma group and odd days to the control mean duration of the second stage of delivery,
group based on a lottery. The data were type of delivery and the mean of the 1st and the
gathered through questionnaires involving the 5th minute Apgar.
demographic specifications, pregnancy status, Before the intervention, no significant
delivery process, the intensity of the feeling of difference was observed between the two groups
pain, and the pain measuring scale. In this study, regarding the mean of labour pain intensity
pain was measured using Visual Analogue Scale perception. Nonetheless, a significant difference
(VAS), which is a ruler-like device numbered was shown between the aroma and the control
from 0 to 10: 0 means no pain and 10 means the group 30 and 60 minutes after the intervention
highest intensity of pain. VAS has been proven (p<0.001) (Table 1). By posing a question about
to be reliable (Gaston-Johanson, 1996) and valid the contentment of the individuals, the aroma
for assessing the labour pain (Mårtensson et al, group was more content compared to the control
2008). In the women with 3–4cm dilatation, the group (p<0.001) (Table 2).
intensity of pain was measured before and at No significant difference was found between the
30 and 60 minutes after the intervention using two groups regarding the mean of Apgar in the 1st
this device.
In the study, lavender officinalis species Table 1. Comparison of the mean of pain severity before and
was used. In the aroma group, 15x15cm tissues 20 and 60 minutes after intervention
containing 0.1ml of lavender essence mixed with
Before 30 minutes after 60 minutes after
1ml of distilled water were used. In addition,
intervention intervention intervention
cotton fabrics were used in order to maintain the
aromas. The fabrics were treated in a completely Aroma group 6.8±1.9 6.6±2.2 6.9±2.3
sterile distilled water and lavender essence and Control group 7.1±2.2 7.8±1.9 8.5±1.6
were stored in sterile packages—a method derived p-value 0.286 <0.001 <0.001
from the study by Anderson and Gross (2004).
In fact, using the tissues prevents percutaneous
absorption (Denda et al, 2000). The control Table 2. Comparison of the frequency of contentment test
group inhaled 2ml of distilled water under the Contentment Not contented
same conditions. Before the intervention, the
Number Percentage Number Percentage
pain intensity was measured through the pain
measuring scale and the data were gathered. Aroma group 51.2 41 48.8 39
The data were entered into the SPSS statistical Control group 23.8 19 76.2 61
software and analyzed using Chi-square and t-test. p-value <0.001 <0.001
The study protocol was reviewed and approved
by the Human Ethics Committee of Research
Table 3. Comparison of the mean of the 1st and 5th minute
Council of the Dean of Research Affair of Shiraz
University of Medical Sciences, Shiraz, Iran.
Apgar score
Aroma group Control group p-value
Results:
© 2014 MA Healthcare Ltd

Apgar Mean SD Mean SD

As age, education and gestational age are effective score
factors in the intensity of pain, the two study
1st minute 8.75 0.604 8.74 0.775 0.927
groups were matched regarding these factors at th
the beginning of the study. The mean age of the 5 minute 9.97 0.205 9.94 0.289 0.749

British Journal of Midwifery • February 2014 • Vol 22, No 2 31

research
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
ll Childbirth is accompanied by severe pain in most women
ll Aromatherapy is a non-medical complementary treatment for labour
pain relief
ll Aromatherapy oils reduce stress hormones and increase the
secretion of beta-endorphins
ll Lavender is widely applied in aromatherapy
ll Aromatherapy with lavender can be effective in reducing the labour pain
and has no adverse effects on the baby’s Apgar score
32
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 Jokic-
Begic, 2011). Aromatherapy oils reduce the stress
hormones and increase the secretion of beta-
endorphins; 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 1st 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
© 2014 MA Healthcare Ltd
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

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 1st 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.
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,
© 2014 MA Healthcare Ltd
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
British Journal of Midwifery • February 2014 • Vol 22, No 2
View publication stats
research
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
33