Effects of aromatherapy with Rosa damascena on nulliparous women’s pain and anxiety of labor during first stage of labor

Abstract

Background

Reducing labor pain and anxiety is one of the most important goals of maternity care.

Objective

This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.

Design, setting, participants and interventions

This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4–5, 6–7, and 8–10 cm). Anxiety was measured twice, once each at two stages of cervical dilation (4–7 and 8–10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann–Whitney U test and Chi-square test.

Main outcome measures

Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.

Results

Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4–5, 6–7, and 8–10 cm; P < 0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4–7 and 8–10 cm; P < 0.05).

Conclusion

Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.

Trial registration

Iranian Registry of Clinical Trial: IRCT201306258801N3.

Introduction

Childbirth is one of the most painful experiences of life, and labor is a complex phenomenon involving multiple physiological and psychological interactions [1]. Fear of labor pain is the most common reason for refusal of normal vaginal delivery and selection of elective cesarean delivery [2]. Anxiousness and the stressful condition of the childbirth process may reduce uterus contractions, and increase labor duration, the rate of instrumental delivery and the rate of delivery by cesarean section [3]. Fear and anxiety related to labor pain may also lead to maternal and infant complications [2]. Anxiety, which is experienced by 24% of pregnant women, increases the severity of pain and decreases tolerance to pain [2].

One of the most important aims of midwifery care is the reduction of labor pain and anxiety, especially as it pertains to making a positive experience of delivery [4], [5]. While chemical analgesics have side effects, using aromatherapy during labor gives women the opportunity to control the pain and thus decide more rationally about the mode of delivery [6]. Aromatherapy is a traditional medicine which uses herbal essences for treatment of some diseases [7], [8]. Aromatherapy can help to provide an experience of labor with relaxation, reduced pain, shorter duration and greater satisfaction [9]. The molecules stimulate the limbic system, which has a direct relationship with feeling and memories, and can decrease anxiety leading to pain reduction, as there is a direct relationship between pain and anxiety [1]. Aromatherapy may also help to reduce anxiety through cortisol reduction and increasing serotonin levels [10].

Aromatherapy with different herbal essences has been examined in the reduction of labor pain. Ten different essences have been studied for use in the labor process, with no adverse side effects experienced by mothers; additionally, more than 50% of mothers were satisfied with its effect on reducing pain and anxiety [8].

Rosa damascena is used in herbal medicine for several purposes [6]. It is reported to have relaxant, antitussive, hypnotic, antioxidant, antibacterial and anti-diabetic effects. Several components were isolated from flowers, petals and hips of R. damascena. The major components of the oil are phenylethyl alcohol, citrenellol, nonadecane, geraniol, ethanol, nonadecane, geraniol, nerol, heneicosane and kaempferol [11]. The medicinal functions of R. damascena are mainly attributed to the phenolic compounds which have a wide range of pharmacological activities, such as antioxidant, free-radical scavenging, anticancer, anti-inflammatory, anti-mutagenic and antidepressant [12].

The essence of R. damascena is used in aromatherapy and produced from distillation of petals of the herb [11]. The essence has also anti-spasmodic, analgesics and anti-inflammatory effects which lead to reduced pain [11], [13], [14]. It has an anti-depressant effect, and so it is demonstrated to be effective on premenstrual symptoms as well as on postpartum depression [11].

Studies have shown no particular side effects in the use of essence of R. damascena [14], [15]. It seems that using essence of R. damascena can be also effective on reducing anxiety with no side effects for mothers and infants [7]. With regard to the accessibility, affordability and popularity of R. damascena in Iran, aromatherapy can be an alternative to synthetic medicines used during labor for reducing pain and anxiety. As such it can promote normal vaginal delivery and act as an effective step in reducing the rate of cesarean.

Since there is a gap in the knowledge about the effects of aromatherapy with R. damascena on labor pain, and the application of aromatherapy is easier than many other alternative medicines such as acupuncture, homeopathy and hypnotism, this study aimed to assess the effects of aromatherapy with the essence of R. damascena on severity of pain and anxiety during the first stage of labor.