Anxiety and pain can have a significant impact on childbirth and may predispose pregnant women to certain complications. Fear of pain is the most common reason for elective cesarean delivery, and anxiety and stress may reduce uterine contractions, increasing the duration of labor and possibly the likelihood of instrumental or cesarean delivery. Anxiety also increases the perception of pain severity and decreases pain tolerance during labor.
Aromatherapy with herbal essential oils (EOs) may help reduce anxiety and pain, and thus labor duration. Several EOs have been studied for their effects during labor, and many women have reported positive effects on pain and anxiety with EO therapy. The authors of two recent clinical trials evaluated the effects of chamomile (Matricaria chamomilla syn. M. recutita, Asteraceae) and Damask rose (Rosa × damascena, Rosaceae) aromatherapy on contraction intensity, pain, and anxiety in women during labor.
Chamomile Aroma Reduces Contraction Intensity in First Birth Experience
Reviewed: Heidari-Fard S, Mohammadi M, Fallah S. The effect of chamomile odor on contractions of the first stage of delivery in primpara [sic] women: A clinical trial. Complement Ther Clin Pract. August 2018;32:61-64. doi: 10.1016/j.ctcp.2018.04.009.
Chamomile has long been a popular medicinal plant used for a wide range of health conditions. EOs from the flowers are used as a calming agent in aromatherapy and may provide benefits in reducing pain and stress during labor. In this two-armed, randomized, controlled trial, researchers explored the effects of chamomile aromatherapy on the birthing experience of women delivering their first child. The study focuses on labor contractions and overall satisfaction with the birthing experience.
For the study, 130 pregnant women (18-35 years of age) were recruited at the Emdadi Hospital in Abhar, Iran. Included participants were between 37 and 42 weeks of gestation and carrying a single, healthy fetus of normal weight. They also had a normal pelvis and body mass index; had no history of sensory abnormalities, acute or chronic psychological disease, pain, or allergy to chamomile; did not use narcotics eight hours before the active stage of delivery; and had three to five contractions per minute. Participants were excluded from the analysis if they had an induced delivery or experienced any problems during delivery, such as abnormal fetal heart rate, prolapsed placenta, or lack of labor progress.
Data were collected before, during, and after labor using a form designed by the researchers. A panel of 10 faculty members of the Shahid Beheshti School of Nursing and Midwifery reviewed the form, and the researchers revised it based on their suggestions. Collected data included demographic and maternal information, examination and observation information (including findings from vaginal exam, Bishop score, cervical dilation, and vital signs throughout), and birthing satisfaction using a Likert scale of “satisfied,” “relatively satisfied,” and “dissatisfied.”
The experimental chamomile EO was produced by the Zardband Pharmaceuticals Company in Tehran, Iran. Water was used as the control. The intervention began at dilation of 4 cm and continued until the end of delivery. Two drops of EO or control were applied to a gauze pad, which was held 7-10 cm from the nose of the laboring participant (for an unstated amount of time) every 30 minutes for a total of three times during each dilation range. The participants were asked to smell the gauze pad. Blinding was not possible due to the distinctive scent of chamomile.
Researchers analyzed the number, duration, and intensity of contractions at dilations of 3-4, 5-7, and 8-10 cm, as well as subjective satisfaction scores. There were no statistically significant differences between the two groups in demographic data. The mean age of participants was 25 years, approximately 90% of the pregnancies were described as “unwanted,” approximately 10% of participants had received a higher education diploma, and approximately 72% were employed. An independent t-test, ² test, and Mann-Whitney U test were used to analyze the data.
No statistically significant differences were found between the two groups in duration of contractions (determined using a “standard Citizen watch”) or number of contractions. As for intensity of contractions (assessed by a “manual check of the abdomen”), no significant differences between groups were found at 3-4 or at 8-10 cm of dilation. However, in the chamomile group, contractions at 5-7 cm dilation were significantly less intense than in the control group (P = 0.004). During this phase, 16.9% of participants in the control group had moderate contractions, and 83.1% had strong contractions. In the chamomile group, 29.2% of participants had moderate contractions, and 70.8% had strong contractions. One person in the intervention group and two people in the control group were excluded due to emergency caesarean sections.
Participants receiving chamomile aromatherapy were significantly more satisfied with their birthing experience than those in the control group (64.6% vs. 0%; P < 0.0001). In addition, significantly more subjects in the chamomile aromatherapy group said they would use the method again in future deliveries (81.5% vs. 21.5%; P < 0.0001).
Satisfaction with the birthing process can have long-lasting benefits for mothers, their children, and family relationships. Other studies have shown that aromatherapy during labor using lavender (Lavandula angustifolia, Lamiaceae) EO and an EO blend containing chamomile increases satisfaction and reduces pain during labor. According to the authors, this is the first study to evaluate the effects of aromatherapy during labor using chamomile EO only. The findings of this study are preliminary and more research is needed, especially to compare chamomile to other EOs. Furthermore, ruling out a placebo effect is needed, but this is challenging with aromatherapy treatments. Nonetheless, the authors suggest that chamomile EO aromatherapy is a safe, cost-effective method to improve the birthing experience.
Damask Rose Aromatherapy Reduces Pain and Anxiety
Reviewed: Hamdamian S, Nazarpour S, Simbar M, Hajian S, Mojab F, Talebi A. Effects of aromatherapy with Rosa damascena on nulliparous women’s pain and anxiety of labor during first stage of labor. J Integr Med. March 2018;16(2):120-125. doi: 10.1016/j.joim.2018.02.005.
Damask rose is used in traditional herbal medicine for its relaxant, antitussive, hypnotic, antioxidant, antibacterial, and antidiabetic effects, which are mostly attributed to its phenolic compounds. Damask rose essential oil (DREO), extracted from flower petals via steam distillation, has been shown to have antispasmodic, analgesic, anti-inflammatory, and antidepressant properties. Potentially active compounds include linalool, nerol, geraniol, 1-nonadecene, n-tricosane, hexatriacontane, and n-pentacosane. Massage with DREO, in addition to aromatherapy, may be beneficial in dysmenorrhea and for reducing menstrual bleeding. DREO also is used to treat premenstrual symptoms and postpartum depression.
The authors conducted the first study of the effects of DREO aromatherapy on pain and anxiety of first-stage labor in a single-blinded clinical trial. Sample size was calculated to be 116 (58 per study arm), assuming a two-sided 5% significance level, power of 80%, and loss of 10% of subjects due to severe pain or obstetric complications. Parturient women (i.e., women about to give birth) experiencing a singleton, full-term, non-complicated, cephalic-presentation pregnancy, with adequate prenatal care and no history of allergy, were recruited at a hospital in Jajarm, Iran.* Exclusion criteria included severe pain, unexpected emergency, or symptoms of potential allergy during the intervention. Participants were randomly assigned to the intervention group or control group, but it appears that randomization had to be done by day, rather than by individual, because only one study substance (DREO or saline control) was provided to the clinic each day. This precaution was taken to preserve single blinding, due to DREO’s aroma. Researchers distilled one batch of DREO for the study, diluted to 2% with sesame (Sesamum indicum, Pedaliaceae) seed oil. Participants were told they would be given an inhaled liquid for pain, but not whether it would have an odor.
Data were collected via a demographic and fertility questionnaire completed by women upon consenting to join the study, an observational examination checklist completed by caregivers, a numerical pain rating scale, and the Spielberger anxiety questionnaire. Standard aromatherapy procedures, involving the attachment of a gauze pad moistened with DREO or saline to the collar, were initiated when cervical dilation reached 4 cm and continued until delivery. Severity of pain was measured 10 minutes after inhalation of DREO or saline aroma at three points of cervical dilation (4-5, 6-7, and 8-10 cm), between uterine contractions. Anxiety was assessed 10 minutes after inhalation at two points of cervical dilation (4-7 cm and 8-10 cm). All routine care practices were performed for all participants. Apgar scores (an assessment of infant health) from the first and fifth minutes after delivery and infant weights also were recorded.
The two study groups were not significantly different in their demographic and fertility characteristics or in their characteristics of labor, including duration and number of contractions, use of oxytocin to induce labor, and Bishop scores. Of 116 participants, 110 completed the study (55 in each arm). Six were excluded due to severe pain, emergency cesarean section, or bleeding. Pain severity in the DREO group was significantly lower than in the saline group at every data collection point (P < 0.05 for all). Anxiety levels were also significantly lower with DREO than control (P < 0.05 at both points). There were no significant between-group differences regarding mode of delivery or infant Apgar scores.
Results indicate that DREO may be a safe, useful, and inexpensive treatment for pain and anxiety during labor. The authors note that individual pain tolerance is variable and could not be controlled for since only subjective pain measures were used.
—Anne Louise Merrill and Mariann Garner-Wizard