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The Effect of Aromatherapy Inhalation on Nausea and Vomiting
in Early Pregnancy: A Pilot Randomized Controlled Trial

Rania (ah)ou* +,*el -hani
1
' +*lia .awfi/ +h)e* I,rahi)
2

1. +ssistant Professor of (aternal an* New,orn 0ealth Nursing' 1acult2 of Nursing' 3ing 3hali* 4ni5ersit2'
3S+
2. +ssistant Professor of Ps2chiatric (ental 0ealth Nursing' 1acult2 of Nursing' 3ing 3hali* 4ni5ersit2' 3S+
67orreson*ing author
)oha)e*8louia92ahoo.co)

A!stract
Nausea an* 5o)iting *uring regnanc2 negati5el2 i)acts fa)il2 relationshis an* has )a:or
conse;uences on the regnant wo)an<s wor/ing caa,ilities (Jewell an* =oung' 2##3!. +i)> .his stu*2 ai)e*
to esti)ate the effect of )i?e* essential oils inhalation on nausea an* 5o)iting in earl2 regnanc2. @esign>
Ran*o)iAe* controlle* trial. Setting> .his stu*2 was con*ucte* in +,ha )aternit2 teaching hosital-3ing 3hali*
4ni5ersit2 at the outatient clinics. In a**ition to three )aternal an* chil* health centers. +,ha- 3ing*o) of
Sau*i +ra,ia. Sa)le> Si)le ran*o) sa)le of one hun*re* one regnant wo)en with single fetus were
recruite* in the stu*2. .he inclusion criteria were wo)en who can rea* an* write' their age ,etween 1"-38 2ears'
,etween 8 an* 16 wee/s gestational' free fro) an2 )e*ical *isor*ers' who ha* nausea an*Bor 5o)iting' re;uire*
anti-e)etics an* were not hositaliAe*. .ools an* )easure)ents> .he Rho*es in*e? for nausea an* 5o)iting
assess)ent' 5isual analogue )oo* scale' the fatigue se5erit2 scale' oil ,urners' an* la5en*er an* eer)int oils
were the tools ha5e ,een use* in this stu*2. Proce*ure> Co)en in the stu*2 grou were as/e* to use the
re*efine* essential oils twice a *a2' rior naing or sleeing. +ll articiants in the stu*2 grou were as/e* to
recor* eiso*es of nausea an* nu),er of 5o)itus within twel5e hours starting fro) inhalation of fragrance *ail2
for three *a2s. Results> Nausea an* 5o)iting eiso*es were *ecrease* at thir* *a2 essential oils inhalation
co)are* with ,aseline assess)ent a)ong regnant wo)en in the stu*2 grou. (oreo5er' wo)en felt energetic
after essential oils inhalation. (oo* scores range* ,etween )il* to )o*erate energ2. 1inall2' although there was
a significant change in fatigue score at thir* *a2<s treat)ent' the fatigue scores still high. 7onclusion> Inhalation
of )i?e* two erfu)es of la5en*er an* eer)int oils )a2 )ini)iAe the se5erit2 of nausea eiso*es' enhance
energ2 le5el an* *ecrease fatiga,ilit2 sensation.
"ey #ords: Nausea' &o)iting' Pregnanc2' +ro)athera2' Dssential oils' Ea5en*er oil' Peer)int oil

Introduction
Nausea an* 5o)iting are 5er2 co))on in earl2 regnanc2 (N&P!. Pregnant wo)en e?erience nausea'
5o)iting an* retching )ostl2 in the first tri)ester. Nausea an* 5o)iting are co))on ,etween si? an* twel5e
wee/s' ,ut this can continue to 2# wee/s an* ersist after this ti)e for u to 2#F of wo)en (Jewell G =oung'
2##3!. .he h2sical an* e)otional i)act of N&P often results in an?iet2 an* concern a,out ossi,le fetal
effects (+rsenault G Eane' 2##2!. Nausea an* 5o)iting *uring regnanc2 negati5el2 i)acts fa)il2
relationshis an* has )a:or conse;uences on the regnant wo)an<s wor/ing caa,ilities (Jewell G =oung'
2##3!..he cause of nausea an* 5o)iting *uring regnanc2 is still un/nown. .herefore' wi*e 5arieties of
treat)ent ha5e ,een use* e)iricall2 (Nor*eng G 0a5nen' 2##4!. Prescrition *rugs are usuall2 a5oi*e* in earl2
regnanc2 *ue to concern for otential teratogenic effect. &ita)in H6 is fre;uentl2 use* as a first line treat)ent
for regnant wo)en e?eriencing nausea an* 5o)iting (Jennifer G Nie,2l' 2#1#!. 0owe5er' a large nu),er of
regnant wo)en re;uire a**itional *rugs' such as *i)enh2*rinate an* ro)ethaAine (Juec/stoc/' 3aestner G
(2lonas' 2#1#I (2lonas' -ingel)aier G 3ainer' 2##J!. .hese *rugs )a2 cause si*e effects such as se*ation'
)outh *r2ness' )otor wea/ness an* 5isual *istur,ance. Hecause of concern a,out har)aceuticals in earl2
regnanc2' non-har)aceutical )anage)ent is increasingl2 use* to )ini)iAe nausea an* 5o)iting in
regnanc2.

.he use of co)le)entar2 theraies in )ainstrea) )e*icine is increasing. (aternit2 health care
ro5i*ers are reson*ing to this ,2 incororating these theraies into )o*els of care within their ser5ices. .wo
national sur5e2s in the 4S+ reorte* the highest co)le)entar2 an* alternati5e )e*icine (7+(! uta/e a)ong
wo)en of rero*ucti5e age (Disen,erg' etal.' 1$$3I +llaire' (oos G Cells' 2###!. %ne of the )ost oular
for)s of co)le)entar2 thera2 is aro)athera2 (.ho)as et al. 2##1!.

+ro)athera2 is the na)e gi5en to a uni;ue ,ranch of her,al )e*icine that uses the )e*icinal an*
theraeutic roerties of the oils foun* in 5arious lants (Ran/in' 2##4!. +ctuall2' essential oils can ,e use* in
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)an2 *ifferent wa2s. .he2 can ,e alie* to articular arts of the ,o*2 through )assage (Price an* Price'
2##2!. (oreo5er' a few *ros can ,e ut on a han*/erchief or tissue to hel eole slee. %thers are for)ulate*
into ,ath salts or gels which can ,e *issol5e* into running ,ath water to gi5e a rela?ing fragrance. .he )ost
oular wa2 to use essentials oils is to ut the) in *e5ices that allow the s)ell to *iffuse into the air
(Nana2a//ara' 2##1!. In a**ition' aro)athera2 is consi*ere* an i*eal wa2 to *eal with e)otions ,ecause the
sense of s)ell is *irectl2 lin/e* to the center of e)otions an* )e)or2 in the ,rain. Dssential oils carr2 *ee
archet2al )essages which wor/ on the h2sical an* siritual ,asis of illness to heal ,o*2' )in* an* soul (Perr2
G Perr2' 2##6!.

+ro)athera2 )a2 ,e ercei5e* as natural an* therefore lower ris/ than )e*ications. 1urther'
aro)athera2 can ,e i*eal to ste) off )orning sic/ness when use* the right essential oil li/e ginger' car*a)o)
or eer)int essential oils twice a *a2 in for) of eating or *rin/ing (7hittu))a' etal. 2##J!. +lthough
aro)athera2 has ,een use* in chil*,irth for centuries' there are no high ;ualit2 stu*ies e?a)ining whether the
treat)ent wor/s (+llaire' (oos G Cells' 2###!. +ll stu*ies u till now e?a)ine* the effect of aro)athera2
consi*ere* it as a wa2 to *ecrease nausea an* 5o)iting through *rin/ing or eating (+rsenault G Eane' 2##2I
S)ith' etal. 2##4' Horrelli' etal. 2##"!. In a**ition to *ecrease *eression' an?iet2' ,ac/ ain *uring regnanc2
(1iel*' 2#1#!. +s well as relie5e intraartu) ain (@han2' 2##8I Hurns' etal. 2##JI Hurns' etal. 2###!. 0owe5er'
one reort referre* that' inhalation of ure )e*icalgra*e essential oils are generall2 safe in regnanc2
(Nana2a//ara' 2##1!.

0ealth care ro5i*ers in general an* )i*wi5es in secific nee* to :ustif2 their use of co)le)entar2
theraies using the a5aila,le e5i*ence. .his e5i*ence shoul* a**ress issues of effecti5eness an* har). Chile
ran*o)iAe* controlle* trials ro5i*e the )ost relia,le for) of e5i*ence of effecti5eness' further researches are
nee*e* to un*erstan* atient e?erience of theraies. In or*er to achie5e this urose' the resent stu*2
con*ucte* to *eter)ine the feasi,ilit2 of using )i?e* essential oils (eer)int an* la5en*er! inhalation as a
care otion that )a2 i)ro5e nausea an* 5o)iting in earl2 regnanc2.

$ethodology
Aim:
.his stu*2 ai)e* to esti)ate the effect of )i?e* essential oils inhalation on nausea an* 5o)iting in
earl2 regnanc2.

%ypotheses:
1. Inhalation of )i?e* essential oils will )ini)iAe nausea an* 5o)iting eiso*es a)ong regnant
wo)en.
2. Inhalation of )i?e* essential oils will i)ro5e the energ2 le5el a)ong regnant wo)en who ha5e
nausea an* 5o)iting.
3. Inhalation of )i?e* essential oils will )ini)iAe the state of fatigue a)ong regnant wo)en who
ha5e nausea an* 5o)iting.
&esign:
Ran*o)iAe* controlle* trial.
'etting:
.his stu*2 was con*ucte* in +,ha )aternit2 teaching hosital-3ing 3hali* 4ni5ersit2 at the outatient
clinics. In a**ition to three )aternal an* chil* health centers (el (anhal' el -a,el an* Sha)asan!. +,ha-
3ing*o) of Sau*i +ra,ia.
'ample:
Si)le ran*o) sa)le of one hun*re* an* one regnant wo)en with single fetus were recruite* in the
stu*2. .he inclusion criteria were wo)en who can rea* an* write' their age range* ,etween 1"-38 2ears'
,etween 8 an* 16 wee/s gestational age confir)e* ,2 ultrasoun*' free fro) an2 )e*ical *isor*ers' no histor2 of
s)o/ing or *rug use' who ha* nausea orBan* 5o)iting' re;uire* anti-e)etics an* were not hositaliAe*. Co)en
were e?clu*e* if the2 ha* ta/en other )e*ications those )ight aggra5ate or alle5iate nausea an* 5o)iting'
hositaliAe* for h2ere)esis gra5i*aru)' if the2 ha* an2 /nown chest allerg2 orBan* ha* other )e*ical *isor*ers
(i.e. gastrointestinal *iseases! that )ight )anifest with nausea an* 5o)iting. .he sa)le siAe has ,een
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*eter)ine* utiliAing sa)le e;uation ,ase* on the *ail2 nu),ers of a*)ission into the outatient clinics
accor*ing sa)le criteria (JF!.

Protection of human rights
.his stu*2 was aro5e* ,2 the 3ing 3hali* 4ni5ersit2<s re5iew ,oar* for scientific research. +n
ethical consent was o,taine* fro) ethical co))ittee in 3ing 3hali* 4ni5ersit2 (RD7K2#13-#2-#"!. In a**ition'
an official er)ission was o,taine* fro) the a*)inistrati5e authorities of +,ha )aternit2 teaching hosital' as
well as fro) three )aternal an* chil* health care centers for con*ucting the stu*2. .he ai) an* the roce*ure of
the stu*2 were e?laine* to the su,:ects. Critten consent was o,taine* fro) those who accete* the stu*2<s
con*ition. Particiants un*erstoo* that the2 ha* the otion to lea5e the stu*2 at an2 ti)e. .he2 were also
infor)e* that an2 cost resulting fro) the stu*2 woul* ,e ai* ,2 the researchers.
Tools and measurements
1- The Rhodes Index for assess)ent of nausea an* 5o)iting. It is a "-oint Ei/ert scaleI it searatel2 scores as
categorical 5aria,les' the nu),er of 5o)iting eiso*es er *a2' the siAe of the 5o)iting' the length of nausea an*
retching' as well as the *istress associate* with the con*ition. In a**ition to an o5erall score' one can reort
searatel2 on the fre;uenc2 an* changes in nausea' 5o)iting' retching an* stress. Eowest score was 3 an* the
highest score was 1" in*icating se5ere nausea an* 5o)iting (Rho*es' Catson G Johnson' 1$84!. .his
;uestionnaire was translate* into +ra,ic' an* content 5ali*it2 gaine* through its re5ision ,2 three secialists in
the sa)e fiel*.
2- Visual Analogue Mood Scale: It assesses internal )oo* states. .he &+(S are relia,le an* 5ali* )easures of
searate eight secific )oo*s statesI afrai*' confuse*' sa*' angr2' energetic' tire*' ha2' an* tense (Cillia) G
3illgore 1$$$!. .he &+(S were foun* to ha5e e?cellent *iscri)inant an* con5ergent 5ali*it2 (0ooer' 1$$J!.
.he scale has a neutral sche)atic )oo* faces (an* acco)an2ing wor*! along 1#c) 5ertical line. Reson*ents
in*icate the oint that ,est *escri,es how the2 are currentl2 feeling. In the resent stu*2' we assesse* energ2
le5el with nausea an* 5o)iting accor*ing to )others< :u*g)ent. .he score of energetic )oo* range* fro) #-
1#c)' with 1#c) reresenting a )a?i)al le5el of energ2 an* Aero reresenting a )ini)al le5el (or a,sence! of
energ2. .o achie5e accurate scoring' the scale was categoriAe* ,2 the researchers into three colore* categories
(green' orange an* re*!. -reen color an* its *egrees (1-3."c)! for )il* energ2' orange an* its *egrees (4-J." c)!
for )o*erate energ2 an* re* with its *egrees (J."-1# c)! for e?tre)el2 energetic. .he energ2 le5el has ,een
i*entifie* ,2 choosing the aroriate face' wor* an* color' an* then confir)e* ,2 the *egree relate* to the re-
i*entifie* color.
3- The Fatigue Severity Scale FSS!: It is se5en oints Ei/ert scale' it is a )etho* for e5aluating the i)act of
fatigue on *ail2 acti5it2. .he 1SS is a short nine state)ents ;uestionnaire that re;uires rating the le5el of fatigue.
+ low 5alue (e.g.' 1!I in*icates strong *isagree)ent with the state)ent' whereas a high 5alue (e.g.' J!I in*icates
strong agree)ent. Co)en as/e* to )a/e circle on the suita,le nu),er (fro)1 to J!I for e5er2 ;uestion. + total
score of less than 36 suggests that wo)an )a2 not ,e suffering fro) fatigue. + total score of 36 or )ore
suggests that wo)an )a2 nee* further e5aluation ,2 a h2sician (Eauren' etal. 1$8$!.
"- #il $urner which has a s)all tea light can*le an* oil container in a recetacle a,o5e (-ol*estin G Peter'
2##$!.
%- &avender and 'e((er)int oils. Dach of these oils *ilute* in ratio of 2>1## ercent' translate* into 2 *ros of
essential oil er 1## *ros of carrier oil in or*er to ,e safe (R2an G 0arrison' 2##3I Peter' 2##"!. .his for)
alrea*2 reare* an* ac/e* in an oa;ue glass containers for co))ercial use an* a5aila,le in her,al stores.
&avender: Is an anti-infla))ator2 an* an anti-)icro,ial. It has great effect on inso)nia' *eression' hea*aches'
sore )uscles an* it soothes the sto)ach (7a5anagh G Cil/inson' 2##2!. Ea5en*er essential oil is sai* to ,e 5er2
effecti5e for nausea an* 5o)iting (0ollan*' 2#1#!.
'e((er)int oil: Is an antisas)o*ic an* anti,acterial. ItLs goo* for nausea (+llaire' (oos an* Cells' 2###!. It is
effecti5e for treating a wi*e range of *igesti5e co)laints (i.e. easing irrita,le ,owel s2n*ro)e an* sto)ach
sas)s!. Peer)int oil is refreshing to the )in*' ,o*2 an* sirit (R2an G 0arrison' 2##3!. Peer)int oil has
)oo* ele5ating roerties enhance )ental erfor)ance that )a/e it useful for alle5iating s2)to)s of an?iet2
an* *eression ((oss' etal. 2##8!.

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Procedures
@ata collection roce*ure too/ lace ,etween Sete),er 2#12 an* Januar2 2#13. .he trial was
ro)ote* within the co))unit2 ,2 using )e*ia (osters in antenatal clinics!. Referrals were )a*e ,2 general
ractitioners an* other health care ro5i*ers.

Recruitment of participants and randomization
In or*er to ensure accurate rocess of ran*o)iAation. +llocation conceal)ent was aroache* through
two traine* rofessional researchers. .wo stes selection rocess were use* to ensure the ran*o)iAation. .he
first of which was i*entif2ing the ran*o) sa)le' this ste was *one on the a*)ission to the antenatal clinics.
Dach )other enters the h2sician roo) for h2sical e?a)ination an* uterine ultrasonograh2. (other who )et
the eligi,ilit2 criteria an* who ha* an o** nu),er on her a*)ission tic/et' car*s or files was recruite* in the
stu*2. .he secon* *rawing was ran*o) assign)ent of the sa)le into two grous after signing the written
consent. Nu),ers fro) one to one hun*re* an* two were inserte* in searate oa;ue en5eloes that were *rawn
in ascen*ing consecuti5e or*er. D5en nu),ers were assigne* to the Stu*2 -rou (S-! who recei5e* the essential
oils' while o** nu),ers to the 7ontrol -rou (7-! who recei5e* stan*ar* hositalLs care in for) of routine
regnanc2 chec/ u. .a,le (1! *e)onstrates the total nu),er of wo)en who were inter5iewe* through the *ata
collection rocess.

.a,le 1. Inclusion of the sa)le into the trial.
A total of 300 pregnant women were interviewed through the data collection period

Women were ineligible (n=149)
Co)en recei5e* antie)etic *rugs (nM4"!
Co)en were *ia,etics (nM 3#!
Co)en were asth)atics (nM34!
Co)en ha* re5ious histor2 of recurrent a,ortion (nM2"!
Co)en ha* histor2 of h2ere)esis gra5i*aru) (nM1"!
Women refused to participate in the trial (n=0)
Women who enter the trial (n=101)
Stu*2 grou (nM"#!
7ontrol grou (nM"1!

Inter(ie#ing and history ta)en
.wo stes inter5iew were achie5e*. 1irst ste consi*ere* the *e)ograhic infor)ation an* )other<s
o,stetric histor2 in or*er to reach the eligi,ilit2 criteria. Chile secon* ste aroache* after ran*o)iAation
rocess in or*er to e?lain the ai) of the stu*2 as well as getting the ,aseline *ata of Ro*es scale' 5isual
analogue )oo* scale an* fatigue se5erit2 scale. Dach inter5iew sent aro?i)atel2 thirt2 )inutes. Dach )other
in the control grou )et once to recor* the ,aseline *ata for co)aring urose.

Implementation
.he o5erall inter5ention ele)ents were groun*e* ,2 the %re) self care theor2 (%re)' 2##1! an*
Neu)an )o*el *Neu)an' 1$J4!. +ccor*ing to %re)' self care is the ractice of acti5ities that in*i5i*uals
ersonall2 initiate an* erfor) on their own ,ehalf to )aintain health an* well,eing. %re) i*entifies three ,asic
t2es of nursing s2ste)s to )eet the in*i5i*ualLs nee*s. %ne of the) is the suorti5e e*ucati5e s2ste). It is a
s2ste) where the in*i5i*ual is a,le to learn in or*er to erfor) the re;uire* self care )easure. In the resent
stu*2' the regnant wo)an taught how to use the )i?e* essential oils to )ini)iAe the eiso*es of nausea an*
5o)iting. .he fi5e (+Ls! strateg2 has ,een use* with the regnant wo)en (as/' assess' a*5ise' assist an* arrange
follow u!. Chile Neu)an sees a erson as an oen s2ste) interacts with the en5iron)ent. Neu)an *efine*
stressors as forces lea* to state of insta,ilit2 within the clients s2ste). She i*entifie* three t2es of re5entions
in or*er to a5oi* negati5e i)act of these stressorsI ri)ar2' secon*ar2 an* tertiar2 re5ention. .he resent
stu*2 focuse* on ri)ar2 re5ention. Pre5ention of the unnecessar2 effects of an act or situation as ossi,le.
Strengthen the caacit2 of the regnant wo)an to )aintain an oti)u) le5el of functioning was the )ain core.
.his achie5e* ,2 heling wo)en to realiAe that there is a relationshi ,etween goo* nutrition' rest an* their
a,ilities to *eal with stressors.

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+ll articiants in ,oth grous recei5e* written instructions relate* to health2 ha,its with )orning
thic/ness. +ll articiants in ,oth grous were a*5ise* to a5oi* fatt2' sic2 foo*s an* to increase the nu),er of
)eals to fi5e s)all )eals throughout the *a2.

.he regnant wo)en in the stu*2 grou were as/e* to use the re*efine* essential oils twice a *a2'
,efore naing or sleeing for three *a2s (Ra2,ern' 2#1#!. +ll the stu*2 grou<s wo)en were as/e* to ta/e a
se)i-setting left lateral osition in a well 5entilate* roo). Dnsuring that the wa2 of *isersing the fragrance of
essential oils was ,2 heating the *issol5e* fi5e *ros' four *ros fro) la5en*er oils an* one *ro fro) the
eer)int oil in one ,ig soon of water (ratio 4>1>1! using the oil ,urner (S)ith' 2#12I -raha)' etal. 2##3!.
Hreath *eel2 for twent2 )inutes till the roo) air ,eco)es saturate* with the fragrance. +ll articiants in the
stu*2 grou were as/e* to recor* eiso*es of nausea an* 5o)iting within twel5e hours starting fro) inhalation
of the fragrance *ail2 for three *a2s. Dnsuring that' an2 a,nor)al sign (i.e. running nose' s/in rash' itching'
hea*ache' ,urning e2es an* a,*o)inal ain! aeare* throughout the treat)ent erio*' the treat)ent shoul* ,e
stoe* an* contact i))e*iatel2 with the researchers to chec/. .elehone contact ha* ,een use* to follow
wo)an con*ition after first session essential oils inhalation. In or*er to again )other<s final reort an* co)lete
the ;uestionnaire' the regnant wo)en too/ an aoint)ent to ,e re5ise* ,2 the o,stetrician. .he follow u 5isit
inclu*e* h2sical e?a)ination an* uterine ultrasonograh2. +ll )others in ,oth grous *i* not ta/e an2 other
)e*ication e?cet their routine 5ita)ins (i.e. folic aci*!.

E(aluation:
Pri)ar2 outco)e>
.he ri)ar2 outco)e was assess)ent the change of nausea an* 5o)iting ost treat)ent scores.
Secon*ar2 outco)e>
.he secon*ar2 outco)e was assess)ent the change of )oo* an* fatigue ost treat)ent scores.

'tatistical analysis + results
Statistical ac/age for the social science (SPSS! was use* for statistical anal2sis of the *ata. 1or all the
statistical tests *one' the le5el of significance was fi?e* at the "F le5el (P-5alue!.

@escriti5e characteristics of the sa)le
+ll regnant wo)en were Sau*i. .here were no statistical significant *ifferences ,etween grous relate* to
age' gestational age' height' weight an* e*ucational le5el. .he age range* ,etween 1"-38 2ears ol*' height
,etween 14"-16# c) an* weight ,etween 4"-8" /g. +ll articiants ha* *ifferent le5els of e*ucation an* )ost of
the) were ri)igra5i*a' nulliarous wo)en (ta,le 2!.
Haseline assess)ent a)ong ,oth grous
%n ,aseline assess)ent of nausea an* 5o)iting eiso*es within 12 hours' the regnant wo)en a)ong
,oth grous reorte* that' nausea an* 5o)iting eiso*es were recurrent. It )a2 e?ten* to fi5e or si? ti)es within
12 hours with s)all a)ount' aro?i)atel2 half cu. .he total Ro*e score in*icate* se5ere nausea an* 5o)iting.
In a**ition' all of wo)en reorte* )il* le5el of energ2 with se5ere le5el of fatigue. .here were no statistical
significant *ifferences ,etween grous relate* to ,oth assess)ents (ta,le 3!.

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.a,le 2. 7haracteristics of )others a)ong the stu*2 an* the control grous.
Ite)s Stu*2 grou
(nM"#!
7ontrol grou
(nM"1!


t


P $ean '& $ean '&
+ge 24.$4 1.23 2".38 1.1$ -1.81 #.#J
-estational age (wee/s! 1#.# 2.61 1#.2 2.2$ - #.4# #.68
0eight (c)! 1"".84 2.6$ 1""."8 2.68 #.48 #.63
Ceight (/g! "J."4 2.66 "J.16 3.34 #.62 #."3
!ducation level
No, - No, - .
/
P
Rea* G Crite 4 8.# 2 3.$ #.J# #.4#
Pri)ar2 School " 1#.# 8 1".6 #.J$ #.3J
Prearator2 School 2 4.# 3 ".8 #.1$ #.66
Secon*ar2 School 1" 3#.# 1J 33.4 #.18 #.66
4ni5ersit2 24 48.# 21 41.3 #.4J #.4$
"arit#
$o% of pregnanc# No, - No, - .
/
P
Pri)igra5i*a 18 36.# 13 2"." 2.#J #.1"
-ra5i*a 2 1# 2#.# J 13.J #.J1 #.3$
-ra5i*a 3 12 24.# 13 2"." #.#3 #.86
-ra5i*a 4 " 1#.# 6 11.J #.#8 #.JJ
-ran* gra5i*a N" " 1#.# 12 23.6 2."3 #.11
$o% of deliveries
Nulliara 18 36.# 13 2".6 1.31 #.2"
Para 1 1# 2#.# J 13.J #.J1 #.3$
Para 2 12 24.# 13 2".6 #.#3 #.86
Para 3 " 1#.# 6 11.J #.#8 #.JJ
Para 4-" 3 6.# 6 11.J 1.#3 #.3#
-ran* ara N" 2 4.# 6 11.J 2.#8 #.14
Ee5el of significance at O#.#"
.a,le 3. 7o)arisons ,etween ,oth grous relate* to ,aseline assess)ent.
Ite)s Stu*2 grou
(nM"#!
7ontrol grou
(nM"1!


.
/



P No, - No, -
$ausea episodes within 1& hours
1-2 ti)es 1$ 38.# 21 41.2 #.1# #.J4
3-4 ti)es 26 "2.# 24 4J.# #.24 #.61
"-6 ti)es " 1#.# 6 11.8 #.#8 #.JJ
'omiting episodes within 1& hours
1-2 ti)e 5o)iting 1$ 38.# 2# 3$.2 #.#2 #.$#
3-4 ti)e 5o)iting 16 32.# 1" 2$.4 #.#8 #.JJ
"-6 ti)e 5o)iting 1" 3#.# 16 31.4 #.#2 #.88
$ean '& $ean '& T P
(ean no% of nausea 2.J2 #.64 2.J# #.J6 #.1# #.$1
(ean no% of vomiting 1.$6 1.24 1.84 1.#2 #."1 #.6#
)otal *odes+ scale
23.#6 6.3J 21.J4 J.3# 1.#6 #.34
)he fatigue severit# score
"#.68 J.66 4$."# J.J$ #.J6 #.4"
!nerg# level
1.$4 1."4 1.86 1.16 #.28 #.JJ
Ee5el of significance at O#.#"

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Dffect of aro)athera2 on nausea an* 5o)iting a)ong the stu*2 grou.
.here were highl2 statistical significant *ifferences were notice* on regular assess)ent of nausea an*
5o)iting eiso*es throughout the three *a2s treat)ent. Nausea an* 5o)iting eiso*es were *ecrease* at thir*
*a2<s essential oils inhalation co)are* with ,aseline assess)ent a)ong the stu*2 grou. +lthough there was an
o,5ious effect of treat)ent that starte* at the secon* *a2' the essential oils inhalation ha* ,etter effect on nausea
than on 5o)iting eiso*es. None of )others re;ueste* *ose re*uction an* none of the) reorte* an olfactor2
sensation. In a**ition' there was an o,5ious statistical significant *ifference ,etween the two rea*ings of the total
Ro*e score' although it still high an* in*icate* se5ere nausea an* 5o)iting (ta,le 4!.
.a,le 4. Haseline an* ost-treat)ent nausea an* 5o)iting scores a)ong the stu*2 grou.
Ite)s Stu*2 grou (nM"#!
t

P $ean '& $ean '&
Haseline +fter treat)ent
$ausea episodes within 1& hours
1irst *a2 treat)ent
2.J2

#.64
2."4 1.#" 1.84 #.#J
Secon* *a2 treat)ent 2.16 #.J$ 6.4J #.###1
.hir* *a2 treat)ent 1.86 #.J# 6.J2 #.###1
'omiting episodes within 1& hours
1irst *a2 treat)ent
1.$6

1.24
1.64 #.8# 1.83 #.#J
Secon* *a2 treat)ent 1.22 #.J3 ".#1 #.###1
.hir* *a2 treat)ent 1.12 #.68 "."4 #.###1
)otal *ode+s score at third da#
23.#6 6.3J 1J.6# 6.#8 J.$2 #.###1
Paire* t-tests> P #.#"

Dffect of aro)athera2 on )otherLs )oo* an* fatigue status a)ong the stu*2 grou
%n co)arison a)ong the stu*2 grou relate* to )oo* scores ,efore an* after essential oils inhalation'
)others reorte* that' the2 felt energetic after essential oils inhalation. (oo* scores range* ,etween )il* to
)o*erate energ2. +lthough' there was a significant change in fatigue score at thir* *a2<s treat)ent' the fatigue
scores still high. @ata *enote* that' there were statistical significant *ifferences ,etween ,aseline an* the thir*
*a2<s scores (ta,le "!.
.a,le ". Haseline an* ost-treat)ent )oo* an* fatigue scores a)ong the stu*2 grou
Ite)s Stu*2 grou (nM"#!
t

P $ean '& $ean '&
Haseline +fter treat)ent
(ood score (!nerg#)
.hir* *a2 treat)ent 1.$4 1."4 4.62 #.6$ -11.42 #.###1
,atigue severit# score
.hir* *a2 treat)ent "#.68 J.66 44.$2 6.83 $.#6 #.###1
Paire* t-tests> P #.#"

7o)arison a)ong the stu*2 grous ,etween )ean ,aseline *ata an* the thir* *a2<s treat)ent.
%n co)arison a)ong the stu*2 grou ,etween the ,aseline *ata an* the thir* *a2<s treat)ent' there
were statistical significant *ifferences ,etween nausea an* 5o)iting eiso*es as well as the total ro*e score.
1urther' there was a significance increase in energ2 le5el associate* with little *ecrease in fatigue score (figure
1!.
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1igure 1. 7o)arison a)ong the stu*2 grou ,etween )ean ,aseline *ata an* the thir* *a2<s treat)ent.
$ethodological consideration
+ccor*ing to Research Institute for 1ragrance (aterials an* International 1ragrance Research
+ssociation' Ea5en*er an* Peer)int consi*ere* safe oils for using in *ifferent wa2 ((artin' 2#12!. +n* ,oth
eer)int an* la5en*er oils are not contrain*icate* *uring regnanc2 (National 7enter for 7o)le)entar2 G
+lternati5e (e*icine' 2##4!. .here were no reorts for an2 a*5erse effect in the e?tensi5e aro)athera2
literature (+ro)athera2 science' 2##6!. Inhalation of ure' )e*icalgra*e essential oils is generall2 safe in
regnanc2 (Schaal' (arlier G Soussignan' 2###!..he short *uration of treat)ent an* few *ros of essential oils
are gui*e* co)lie* with the South Dastern S2*ne2 +rea 0ealth Ser5ice roce*ural gui*elines on
co)le)entar2 theraies (-assi,-Sain' etal. 2##1!. +**itionall2' it is co))on for aro)athera2 te?ts to clai)
that co),ination oils are )ore effecti5e than single-oil selections. +lthough the *ail2 *uration of e?osure was
relati5el2 ,rief' rai* s2ste)ic a,sortion of these 5olatile oils ,2 resirator2 e?osure occurre* within a few
)inutes' an* the *uration of e?osure to achie5e a,sortion was )ore than a*e;uate.

It was a challenge in the resent stu*2 to ,e ,lin*e*. +lthough it )a2 ,e ossi,le to /ee the
researchers in the *ar/ regar*ing which grou is which' articiants will certainl2 ,e aware of whether the2
s)ell so)ething or not. 1urther' allocation conceal)ent was achie5e* successfull2 ,2 the assistant researchers.
.he rocess of ran*o)iAation was un*er the consultant o,ser5ation. 1urther' there was no *ro out reorte* in
the resent stu*2. +ll articiants /een to follow the researchers in or*er to )a/e further h2sical assess)ent
an* )e*ical chec/. 1inall2' intention to treat anal2sis was utiliAe* in the statistical anal2sis (i.e. *ata anal2Ae* as
ran*o)iAe*!.

&iscussion
Nausea an* 5o)iting of regnanc2 (N&P! affects negati5el2 on "# - $#F of regnant wo)en
(+rsenault' 2##2!. .he e?act cause is un/nown' ,ut is ro,a,l2 *ue to nu),er of factors such as increase*
hor)ones le5el' stress an* fatigue (Quinlan G 0ill' 2##3!. Reaching a state of ,alance re;uiring )other
a*e;uatel2 coes with stressors ,2 )aniulating the en5iron)ent to re*uce stressors (Neu)an' 1$J4!. Self care
is carrie* out to fulfill the )ain re;uisites in the interest of )aintaining well-,eing (%re)' 2##1!. Raising
wo)enLs awareness towar* aro)athera2 )a2 hel the) to carr2 the resonsi,ilit2 of changing their lifest2le in
or*er to o5erco)e the negati5e feeling of fatiga,ilit2.

4sing essential oils inhalation for )aniulating nausea an* 5o)iting of regnanc2 (N&P! has not ,een
wi*el2 stu*ie*. So' this stu*2 ai)e* to esti)ate the effect of )i?e* essential oils inhalation on nausea an*
5o)iting in earl2 regnanc2. .he ai) of using )i?e* essential oils eer)int an* la5en*er was that' the
co)le? aro)as re5ent the unwante* si*e effect of con*itione* a5ersion. In a stu*2 in5ol5ing chil*ren
un*ergoing che)othera2 an* using eer)int oil onl2 for relie5ing nausea' results *enote* that the rea*il2
i*entifia,le an* u,i;uitous nature of eer)int cause* the atients to e?erience nausea whene5er the2 s)elle*
eer)int toothaste' gu)' )ints' etc (0errste*t' 2##4!. It is /nown that essential oils can ,e a,sor,e* ,2 the
,o*2 through toical alication to the s/in' oral ingestion an* ,2 inhalation. .he fastest' safest an* si)lest
)etho* is inhalation ((ir/ari)i' etal. 2#11!. +,sortion into the ,loo* strea) was rai* 5ia the nasal an* lung
Baseline data,
Nausea, 2.72
Baseline data,
Vomiting, 1.96
Baseline data,
Rode Scale,
23.06
Baseline data,
Energy e!el,
1.9"
Baseline data,
#atigue Score,
$0.6%
&'ird day
treament,
Nausea, 1.%6
&'ird day
treament,
Vomiting, 1.12
&'ird day
treament, Rode
Scale, 17.6
&'ird day
treament,
Energy e!el,
".62
&'ird day
treament,
#atigue Score,
"".92
&'ird day treament
Baseline data
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)ucosa an* 5er2 low le5els were re;uire* to ro*uce se*ati5e effect (Huc/le' 2##J!. H2 s)elling the aro)atic
5aor of essential oils' the )olecules tra5el u the olfactor2 tract to the li),ic s2ste)' which in turn' trans)it the
inut to the central ner5ous s2ste) (NoleriAe' 2##4!. In a**ition' sti)ulation of trige)inal ner5e ,2 aro)atic
5aor which locate* within the lining of the nose can ro*uce sensations such as war)ing or cooling. .hese
ner5e fi,ers can also affect the ercetion of nasal airflow *uring ,reathing (Sa5ic' 2##1!. +nother asect of
aro)a rocessing is that' o*or cues ro*uce )e)ories with greater intensit2 of e)otions than an2 of the other
senses (0erA' 2##"!. Cith one *ee ,reath through the nose' a erson will trans)it the ,eneficial )olecules fro)
the essential oils to the central ner5ous s2ste)' recogniAe if the s)ell is leasant or fa)iliar an* what )e)ories
are e5o/e or create (Sa5ic' 2##1!.

Results of the resent stu*2 suggeste* that' )i?e* essential oils of eer)int an* la5en*er ha5e ,een
use* effecti5el2 ,2 nu),er of regnant wo)en who suffere* fro) nausea an* 5o)iting of regnanc2. .heir
ositi5e effect on nausea was ,etter than their effect on 5o)iting. .hese results )a2 ,e *ue to the eer)int
effect. Peer)int affects on )otion sic/ness' anore?ia an* *2sesia. .he aro)atic' sas)ol2tic' car)inati5e
an* a,sor,ent roerties of eer)int suggest that it has *irect effect to e?ert its antisas)o*ic influence on the
gastric lining an* colon through its alcohol co)oun*s )enthone an* )enthol. In a s)all ran*o)iAe*' lace,o
controlle* stu*2 of 18 wo)en ostoerati5e for g2necological surger2 there was a statisticall2 significant
re*uction in nausea an* 5o)iting a)ong wo)en those recei5e* oral eer)int essential oil co)are* to others
who recei5e* lace,o (.ate' 1$$J!. 1urther' eer)int oil show a rela?ing effect on the gall-,la**er an* the
for)er slows s)all intestinal transit in atients suffering fro) )otilit2 *isor*ers (-oerg G Sil/er' 2##3!.

In general' se5eral stu*ies ha5e e?lore* the a,ilit2 of o*orants to influence cognition an* ,eha5ior
states (0erA' 2##1* 0erA' Helan* G 0ellerstein' 2##4* 0erA' Schan/ler G Helan*' 2##"I 0erA' 2##"!. 1urther'
aro)athera2 was a*)inistere* to re*uce fear' an?iet2 an* alle5iate ain (Ho*e/er' etal. 2##"!. %ne coul* sa2
then that an2 treat)ent which results in rela?ation an* stress re*uction can ena,le the ,o*2<s organs an* s2ste)s
to function )ore effecti5el2 thus ena,ling the ,o*2 to *eal with otential illness (Jennifer G Nie,2l' 2#1#!. .he
resent results *enote* that there were ositi5e effects of )i?e* essential oils on )oo* an* fatiga,ilit2 state. .he
e?erience of fatigue in earl2 regnanc2 )a2 ,e relate* to other h2siologic changes' erhas hor)onal' that
)e*iate h2siologic an* s2chological 5aria,les (Ree5es' etal. 2#11!. .he correlation ,etween fatigue an*
nausea is alwa2s ositi5eI as nausea increase* so *i* the se5erit2 of fatigue (&an Eier' etal. 2##J!. .hese results
)a2 intererate* as' on e)otional le5el' la5en*er oil is effecti5e in *ealing with *eression' grief' low self-
estee)' i)ro5ing )ental alertness an* energ2 (Pollar*' 2##8I Cil/inson' 2##"!. Ea5en*er (Ea5an*ula
angustifolia! is urorte* to ha5e se*ati5e effects when inhale* ,2 hu)ans an* ani)als (0aAe' etal. 2##2!. In
a**ition to its< anticon5ulsi5e' )otor inhi,itor2 an* sas)ol2tic effect (7hien' etal. 2#12!. Inhalation of la5en*er
*e)onstrate* greater i)ro5e)ent in )oo*' less an?iet2' greater rela?ation' less *eression a)ong JJF of 122
atients in an intensi5e care unit ((oss G 7oo/' 2##3!. +s the fine oil articles enter through the nose 5ia cilia
change the electrical con*ucti5it2 cause an electrical charge to tra5el through the ,o*2 (Sa2orwan' et al. 2#12!.
In a**ition' serotonin )e*iate* 5aso*ilating roerties of ,oth essential oils are roagate* 5ia nasal inhalation.
Rela?ation an* in*uce* sleeing effect )a2 hel to renew an* raising energ2 le5el. Ea5en*er is soothing an*
rela?ing in cases of )ental fatigue. It can ,oth cal) the )in* an* ulift the sirit' )a/ing it e?cellent for chronic
fatigue s2)to)s ((oto)ura' Sa/urai G =otsu2a' 2##1!.

%n the other han*' on the h2sical le5el' eer)int inhalations was associate* with increase in )oti5ation'
energ2' see*' alertness' reaction ti)e' confi*ence an* strength as well as lower the le5els of fatigue an*
frustration (Rau*en,ush' etal. 2##4!. 7a)enni' etal. (2##4! atte)te* to *eter)ine whether the changes in
)oo* an* h2siolog2 ,rought a,out ,2 o*or a*)inistration woul* ha5e an2 effect on athletic erfor)ance. .he2
conclu*e* that' eer)int o*or a*)inistration significantl2 re*uce* ercei5e* h2sical wor/loa*' te)oral
wor/loa*' effort' an* frustration. Self-e5aluate* erfor)ance was also greater in the eer)int con*ition an*
articiants rate* their le5el of 5igor higher an* their le5el of fatigue lowers. In a**ition' Rau*en,ush' etal.
(2##4! atte)te* to *eter)ine if actual h2sical tas/s woul* ,e aug)ente* ,2 the a*)inistration of eer)int
o*or. .he eer)int o*or con*ition resulte* in increases in running see*' han* gri strength an* nu),er of
ush-us. 1inall2' when the stu*ies e?a)ine* the effect of resenting la5en*er an* eer)int o*ors on
attention allocation an* ercei5e* e?ertion while erfor)ing a han*gri tas/. %lfactor2 sti)uli ha5e ,een foun*
to e?ert influence o5er affecti5e' h2siological' ,iological' cogniti5e an* ,eha5ioral 5aria,les (Har/er' etal.
2##3I (archan* G +rsenault' 2##2!.

0owe5er' an2 theraeutic strateg2 that a**resses onl2 h2sical s2)to)s' i.e. anti-e)etic )e*ications'
,ut *isregar*s the s2chosocial )or,i*it2 an* nee* for e)otional suort' is li/el2 to ,e su,-oti)al an*
ossi,l2 futile.
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2#1

Conclusion
Inhalation of )i?e* two erfu)es of la5en*er an* eer)int oils )a2 act as an alternati5e choice for
)aniulating nausea an* 5o)iting in earl2 regnanc2. .he2 )a2 )ini)iAe the se5erit2 of nausea eiso*es'
increase energ2 le5el an* *ecrease the sensation of fatigue.

Recommendation
1urther ran*o)iAe* controlle* trials with large sa)le siAe an* longer treat)ent *uration are
reco))en*e*.

Implications for practice

7o)le)entar2 )o*alities such as aro)athera2 ro5i*e holistic aroach which enco)asses the
,o*2' )in*' an* sirit. (i*wifer2 training shoul* inclu*e the oortunit2 to learn a,out it as an alternati5e
thera2.

Implications for research
D5i*ence that essential oils can ro*uce changes has ,een re*o)inantl2 anec*otal' *eri5ing fro) s)all
trials an* case stu*ies (Huc/le' 2##1I Coo*' 2##3!. 1ew stu*ies e?a)ine* its effect in )aternal an* new,orn
fiel*. So the resent stu*2Ls results )a2 a** in )eeting the challenges of re*ucing )orning sic/ness associate*
with earl2 regnanc2.

Ac)no#ledgement
.his wor/ was financiall2 suorte* fro) 3ing 3hali* 4ni5ersit2 research an* researchers suort
rogra) un*er the research ro:ect of 3348S14#833. 3.S.+.

Conflict of interest: No conflict of interest *eclare*.


RE0ERENCE'
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+llaire' +.' @.' (oos' (.' 3. an* Cells' S.' R. (2###!. 7o)le)entar2 an* alternati5e )e*icine in
regnanc2> + sur5e2 of North 7arolina certifie* nurse-)i*wi5es. #$stet+ ,ynecol+ $">1$R23.

+ro)athera2 Science. (2##6!. Phar)aceutical Press. (ISHN> # 8"36$ "J8 4!.
+rsenault' (. an* Eane' 7.' +. (2##2!. 7linical Practice %,stetrics 7o))ittee. .he )anage)ent of nausea
an* 5o)iting of regnanc2. -+ #$stet+ ,ynaecol+ .an. 24(1#!> 81J-23.

Har/er' S.' -ra2he)' P.' 3oon' J.' Per/ins' J.' Chalen' +.' G Rau*en,ush' H. (2##3!. I)ro5e*
erfor)ance on clerical tas/s associate* with a*)inistration of eer)int o*or. 'erce(tual and Motor
S/ills0 120 1##JR1#1#.

Ho*e/er' -.' %ng' 7.' 3.' -run*2' 7.' Hurfor*' -. an* Shein' 3. (2##"!. C0% glo,al +tlas of tra*itional'
co)le)entar2 an* alternati5e )e*icine. 3o,e' Jaan> Corl* 0ealth %rganiAation' 7entre for 0ealth
@e5elo)ent.

Horrelli' 1.' 7aasso' R.' +5iello' -.' Pittler' (.' IAAo' +. +. (2##"!. Dffecti5eness an* safet2 of ginger in
the treat)ent of regnanc2-in*uce* nausea an* 5o)iting. #$stet ,ynecol+ 1#"(4!> 84$-"6.

Huc/le' J. (2##J!. Eiterature re5iew> shoul* nursing ta/e aro)athera2 )ore seriousl2S 3r+ - 4urs+ 16 (2!>
116-12#.

Huc/le' J. (2##1!. .he role of aro)athera2 in nursing care. 4urs .lin 4orth A). 36>"J-J2.

Hurns' et al. (2###!. .he use of aro)athera2 in intraartu) )i*wifer2 ractices an o,ser5ational stu*2
7o)le)ent .her Nurs. (i*wifer2. 6 (1!>33-4

Hurns' et al. (2##J!. +ro)athera2 in chil*,irth> a ilot ran*o)iAe* controlle* trial HJ%-. 114(J!>838-44.
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2#2

7a)enni' 7. D.' 7rawle2' D. J.' G (eier' (. D. (2##4!. Role of suggestion in o*orin*uce* )oo* change.
Ps2chological Reorts. $4(32!> 112JR1136.

7a5anagh' 0.' (.' +. an* Cil/inson. J.' (. (2##2!. Hiological acti5ities of Ea5en*er essential oil.
Ph2tother. Res. 16' 3#1R3#8. Pu,lishe* online in Cile2 InterScience (www.interscience.wile2.co)!. @%I>
1#.1##2Btr.11#3.

7hien'

E. 7heng'

S. an* Eiu' 7. (2#12!. .he Dffect of Ea5en*er aro)athera2 on autono)ic ner5ous s2ste)
in )i*life wo)en with inso)nia. D5i*ence-,ase* co)le)entar2 an* alternati5e )e*icine. I@ J4#813'
*oi>1#.11""B2#12BJ4#813
7hittu))a' P.' 3aew/iatti/un' 3. an* Ciri2asiriwach' H. (2##J!. 7o)arison of the effecti5eness of ginger
an* 5ita)in H6 for treat)ent of nausea an* 5o)iting in earl2 regnanc2> + ran*o)iAe* *ou,le-,lin*
controlle* trial. - Med Assoc Thai+ $#(1!>1"-2#.

@han2' +. (2##8!. Dssential oils an* )assage in intraartu) care. 'ractMid5i6e+11 ("!>34-$.

Disen,erg' @.' (.' @a5is' R.' H.' Dttner' S.' E.' +el' S.' Cil/e2' S. an* &an Ro)a2 ('et al. (1$$8!.
.ren*s in alternati5e )e*icine use in the 4nite* States' 1$$#R1$$J> Results of a follow-u national sur5e2.
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1iel*' .. (2#1#!. Pregnanc2 an* la,or )assage. 7x(ert Rev #$stet ,ynecol. "(2!>1JJ-181.

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Pri)rose 0ouse' South Dast 0ealth' @olls Point' +ustralia. P 1$-24 ()anual!.

-ol*estin' .. G Peter' R.' J. (2##$!. =our si)le gui*e to +ro)athera2. 0ttBwww.
+ro)athera24health2li5ing.co)..-RP. ro*uction. 1ree Natural 0ealth D-,oo/s. P. 23-2J.

-oerg 3. J. G. Sil/er' .. 0. (2##3!. Dffect of eer)int oil an* carawa2 oil on gastrointestinal )otilit2 in
health2 5olunteers> + har)aco*2na)ic stu*2 using si)ultaneous *eter)ination of gastric an* gall-,la**er
e)t2ing an* orocaecal transit ti)eT' +li)ent Phar)acol .her. 1J> 44"R4"1. *oi> 1#.1#462##2.> 44"-
4"1.

-raha)' P.' 0.' Hrowne' E. 7o?' 0. an* -raha)' J. (2##3!. Inhalation aro)athera2 *uring ra*iothera2>
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0aAe' S.' Sa/ai' 3.' -oAu' =. (2##2!. Dffects of fragrance inhalation on s2)athetic acti5it2 in nor)al
a*ults. -'4 - 'har)acol+ $#>24J-2"3

0ollan*' S. (2#1#!. J Dssential %ils for (orning Sic/ness No5 3. htt>BBsuite1#1.co).

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i)aire* atients> @escrition an* initial 5ali*it2 e5i*ence. A(hasiology+ 11>"$-J1.

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nausea an* 5o)iting. D?ert %in @rug Saf. 3 (3!> 231-48.

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changing o*or he*onics through association. Int. J. 7o). Ps2chol.0 1J in (ress!+
0erA' R.' S.' Schan/ler' 7. an* Helan*' S. (2##"!. %lfaction' e)otion an* associati5e learning> effects on
)oti5ate* ,eha5ior. (oti5. D)otion0 2$ (in ress!.
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
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2#3
0erA' R.' S. (2##"!. %*or-associati5e learning an* e)otion> Dffects on ercetion an* ,eha5ior. %?for*
Journal che)ical Senses. &ol. 3# No. sul 1. %nline ISSN 1464-3""3 - Print ISSN #3J$-864U

Jennifer' R. G Nie,2l' (.@. (2#1#!. Nausea an* 5o)iting in regnanc2. 4 7ngl - Med 363I 16.1"44 org
%cto,er 14.

Juec/stoc/' J.' 3.' 3aestner' R. an* (2lonas' I. (2#1#!. (anaging h2ere)esis gra5i*aru)> + )ulti)o*al
challenge. 3M. Medicine' 8>46 *oi> 1#.1186B1J41-J#1"-8-46.

Jewell' @. an* =oung' -. (2##3!. Inter5entions for nausea an* 5o)iting in earl2 regnanc2 (7ochrane
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(archan*' S. G +rsenault' P. (2##2!. %*ors )o*ulate ain ercetion> + gen*er-secific effect. 'hysiol
3ehav+ 280 2"1R2"6.

(artin' C. (2#12!. Dssential oil safet2- the /nown an* un/nown. +ro)athera2 glo,al online research
archi5e. www.agorain*e?.orgB1rag.2#12

(ir/ari)i' S.' Na:afi' E. -hiasi' (. 3a)al5an*' +. (ahalleh' 0. Hah)an' (. (2#11!. Stu*2ing the effect
of aro)athera2 inhalation on fe)ale stu*ents< an?iet2 li5ing in *or)itor2 co)le? of .ehran 4ni5ersit2 of
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an* )oo* in health2 a*ults. Int - 4eurosci. 113(1!> 1" -38.
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aro)as of eer)int an* 2lang-2lang. 4t - 4eurosci+ 118(1!>"$-JJ.
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'erce(t Mot S/ills. $3>J13-J18.
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Nor*eng' 0. an* 0a5nen' -.' 7. (2##4!. 4se of her,al *rugs in regnanc2> + sur5e2 a)ong 4## Norwegian
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%re)' D. (2##1!. 7oncets of ractice. 2n* e*. (c-raw-0ill Hoo/ 7o.' New =or/.
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.3' No."' 2#13

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Perr2' N. an* Perr2 D. (2##6!. +ro)athera2 in the )anage)ent of s2chiatric *isor*ers> 7linical an*
neurohar)acological ersecti5es. .4S+ 9rugs. 2#(4!>2"J28#.

Peter' H.' 7. (2##"!. Dssential oils G aro)athera2+ Notes fro) the .i) Hlec/le2 lecture on +ro)athera2
fro) a lecture gi5en at D?o Dast. Cashington @7 Sete),er 2##" G a lecture *one at Hrighter @a2 in the
fall of 2##4.

Pollar*' 3. R. (2##8!. Intro*ucing aro)athera2 as a for) of ain )anage)ent into a *eli5er2 suite. -
Assoc .har 'hysiother ;o)en<s =ealth. 1#3' 12R16.

Price' S. an* Price' E. (2##2!. +ro)athera2 for health rofessionals. 7hurchill Ei5ingstone. 4S.

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Rau*en,ush' H.' 7orle2' N.' G Dich' C. (2##1!. Dnhancing athletic erfor)ance through the
a*)inistration of eer)int o*or. - S(ort and 7xercise 'sychol.23> 1"6-16#.

Rau*en,ush' H.' S)ith' J.' -raha)' 3.' G (c7une' +. (2##4!. Dffects of eer)int o*or a*)inistration on
aug)enting ,as/et,all erfor)ance *uring ga)e la2. 7he)ical Senses' 2$' sule)ent.

Ra2,ern' @. (2#1#!. Dssential %ils for Pregnanc2' 7hil*,irth G Infants. www.sharinggreathealth.co). .he
+rticle Ei,rar2 .a,.
Ree5es' N.' Pote)a' 3. an* -allo +. (2#11!. 1atigue in earl2 regnanc2> +n D?lorator2 Stu*2. - 4ur-
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for nausea an* 5o)iting. 7ancer Nurs. J>33R 41.

R2an' N. an* 0arrison' (.' +. (2##3!. +ro)athera2 G Dssential %ils. htt>BBwww.HeCholeHeCell.co).

Sa2orwan'C.' Siriornanich'&.' Piri2aun2aorn'..' 0ongratanawora/it'..' 3otcha,ha/*i' N. an*
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Schaal' H.' (arlier' E. an* Soussignan' R. (2###!. 0u)an fetuses learn o*ors fro) their regnant )otherLs
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S)ith' J. (2#12!. Dssential oils an* regnanc2- )orning thic/ness. JoLs 0ealth
7ornerBwww.naturall2sorts.co).

S)ith' 7.' 7rowther' 7.' Cillson' 3.' 0otha)' N. an* (c(illian' &. 2##4. + ran*o)iAe* controlle* trial
of ginger to treat nausea an* 5o)iting in regnanc2. #$stet ,ynecol+ 1#3(4!> 63$-44.

.ate' S. (1$$J!. Peer)int oil> + treat)ent for ostoerati5e nausea. - Adv 4urs. 26 (3!> "43-4$.
.ho)as' 3.' J.' Nicholl' J.' P. an* 7ole)an' P. (2##1!. 4se an* e?en*iture on co)le)entar2 )e*icine in
Dnglan*> + oulation-,ase* sur5e2. 7o)le)entar2 .heraies in (e*icine. $> 2-11.
&an Eier' @.' (anteuffel' H.' @ilorio' 7. an* Stalcu (. (2##J!. Nausea an* fatigue *uring Darl2
Pregnanc2. -+ 3irth+ 2# (4!> 1$3-1$J.
Journal of Natural Sciences Research www.iiste.org
ISSN 2224-3186 (Paer! ISSN 222"-#$21 (%nline!
&ol.3' No."' 2#13

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Cil/inson' J.' (. (2##"!. Ea5en*er essential oil> + re5iew. Aus In6ection .ont -+ 1# (1!> 3"-3J.

Cillia)' @. an* 3illgore' S. (1$$$!. .he 5isual analogue )oo* scale> 7an a single ite) scale accuratel2
classif2 *eressi5e )oo* stateS Ps2chological Reorts> &olu)e 8"' Issue' . 1238-1243.
*oi>1#.2466Br#.1$$$.8".3f.1238.

Coo*' 3. (2##3!. .he ro)ise of aro)athera2. 'rovider+ 2$>4J-48.