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

net/publication/306349518

The effect of aromatherapy with lavender essence on severity of labor pain

and duration of labor in primiparous women

Article  in  Complementary Therapies in Clinical Practice · August 2016

DOI: 10.1016/j.ctcp.2016.08.008

CITATIONS READS

32 3,292

2 authors:

Mansoureh Yazdkhasti Arezoo Pirak

Alborz University of Medical Sciences Iranshahr University of medical Sciences
30 PUBLICATIONS   232 CITATIONS    3 PUBLICATIONS   42 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

EFECT OF SUPPORT GROUP IN QUALITY OF LIFE View project

SYSTEMATIC REVIEW OF STREET CHILDREN View project

All content following this page was uploaded by Mansoureh Yazdkhasti on 14 October 2017.

The user has requested enhancement of the downloaded file.

 Complementary Therapies in Clinical Practice 25 (2016) 81e86

Contents lists available at ScienceDirect

Complementary Therapies in Clinical Practice

journal homepage: www.elsevier.com/locate/ctcp

The effect of aromatherapy with lavender essence on severity of labor

pain and duration of labor in primiparous women
Mansoreh Yazdkhasti a, Arezoo Pirak b, *
a
Department of Midwifery, Faculty of Midwifery and Assistant Professor, Alborz University of Medical Sciences, Karaj, IR Iran
b
Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The aim of this study was to investigate the effect of Lavender essence inhalation on severity
Received 8 May 2016 of labor pain and duration of labor.
Received in revised form Methods and materials: This single-blind, randomized clinical trial was conducted on 120 pregnant
14 August 2016
women in two groups. The experimental group received 2 drops of Lavender essence inhaled at three
Accepted 15 August 2016
stages (4e5, 6e7, 8e9 cm cervical dilation) and severity of the labor pain and duration of labor was
measured before and after intervention. The control group was treated with distilled water as a placebo
Keywords:
in the similar ways, too.
Labor pain
Lavender essence
Results: The results showed that difference in the labor pain before and after intervention in two groups
Primiparous women was significant (P ¼ 0/001). But there was no difference in mean duration of the active phase and the
Aromatherapy second stage of labor between the two groups.
Conclusion: Lavender essence aromatherapy may be an effective therapeutic option for pain manage-
ment for women in labor.
Published by Elsevier Ltd.

1. Introduction properties [8]. Aromatherapy is used to relieve pain, treat anxiety

Labor pain, which is among the most severe pains experienced,
can be very diverse in terms of the intensity felt and its location [1].
In some cultures, women prefer Caesarean section delivery to avoid
the pain of labor [2].
Labor pain relief methods are divided into non-pharmacological
(psychoprophylactic, hypnotism, acupuncture, healing touch ther-
apy, relaxation exercises, massage therapy, music therapy, …) [3]
and pharmacological (systemic medicines, inhalation anesthesia,
general anesthesia, regional anesthesia) methods [4]. Use of non-
pharmacological pain relief techniques help the labor progress
and shorten the duration of delivery [5].
Mohammadkhani-Shari quotes Melzak and Wall writing, “non-
pharmacological approach to pain relief includes a wide variety of
techniques to address not only the physical sensations of pain but
to prevent pain induced psychological suffering” [6]. One of the
newest therapies is aromatherapy [7] which is an ancient art that
uses the essences extracted from various herbs for their medical
* Corresponding author. Postal address: Nosrat St, Tohid Sq, 1419733171, Tehran,
Iran.
E-mail address: pirak.arezoo@yahoo.com (A. Pirak).
and depression, insomnia, fatigue and asthma. It also helps to build
confidence, inspiring creativity and success [9]. Essential oils may
be administered through the skin (massage), inhalation, com-
presses, in baths and oral administration [8]. Review of the
literature between 1996 and 2002 suggests aromatherapy as an
effective way for managing pain and psychological impacts of in-
terventions [10].
One of the means of action is the aroma of these oils sent as a
signal to the olfactory bulb which has close anatomical ties to the
limbic system. The limbic system is the emotional center of the
brain, where all major emotional expressions are generated. The
limbic system influences the endocrine and the autonomic nervous
[11].
Inhalation of essential oils has given rise to olfactory aroma-
therapy, where simple inhalation has resulted in enhanced
emotional wellness, calmness, relaxation or rejuvenation of the
human body. The release of stress is welded with pleasurable scents
which unlock odor memories [12].
Aromatherapy offers relaxation and can induce sleep. It also
enhances the mother's ability to cope with the pain in labor [13].
One of the essential oils used in aromatherapy is Lavender
(Lavandula angustifolia). This compound has analgesic properties
and contains Linalyl acetate [8]. Lavender is a herbaceous plant and

http://dx.doi.org/10.1016/j.ctcp.2016.08.008
1744-3881/Published by Elsevier Ltd.
82 M. Yazdkhasti, A. Pirak / Complementary Therapies in Clinical Practice 25 (2016) 81e86
its roots have been shown to produce anticonvulsant effects. Its
leaves and flowers are used for pain management, too [14]. Lav-
ender essential oil has a wide range of benefits including a sedative,
analgesic, disinfectants, anti depressant, …[15].
Many of the studies that have examined the effects of aroma-
therapy with lavender essential oils have had conflicting results.
According to the findings of a study conducted in 2000 by Burns
et al., aromatherapy with lavender essential oils did not signifi-
cantly affect the labor pain intensity and, also, the number of
caesarean section deliveries. However, the exposure is effective in
reducing fear and anxiety during childbirth and reduces the need of
analgesics during the birth as well [16]. Then in a study conducted
in 2007 Burns et al. concluded that using different methods of
aromatherapy in labor such as massage, bath, inhalation and belts,
could be helpful in reducing delivery pain and improving birth
outcomes [17]. Sobhani et al. evaluated the effect of lavender
aromatherapy as a treatment to help relieve pain after C-section.
The findings showed a decrease in pain intensity after using
aromatherapy treatment [9]. DaghighBeen suggested in his study
that, compared to honey, using lavender cream had a better effect
on perineal pain reduction and wound healing following episi-
otomy [18], which is inconsistent with the findings of a survey by
Vakilian that showed no reduction in pain intensity after episi-
otomy [11].
By using new non-pharmacological methods the entire process
of giving birth becomes a pleasant experience, decreasing mother's
tendency towards C-section [19]. On the other hand, non-
pharmacological interventions have no side effects on the mother
and baby and do not require a doctor's prescription. They also are
viable alternatives to the pharmacological approaches [17]. There-
fore the present study was conducted to evaluate the impact of
aromatherapy with Lavender essence on the intensity and duration
of labor pain in nulliparous women referred to Iran Hospital in
Iranshahr.
1.1. Sample and sampling method
This single-blind, randomized clinical trial was conducted from
September 2011 to January 2012. This study was performed at the
Iran Hospital in Iranshahr city (Sistan-Balouchestan province, Iran).
The study population comprised all women referred to this hospital
for childbirth at the time of data collection. The eligibility criteria
included nulliparous pregnant women with singleton pregnancy,
gestational age over 37 weeks, cervical dilation greater than
3e4 cm, cephalic presentation and receiving no analgesia during
labor. Exclusion criteria were set as follows: cephalopelvic dispro-
portion, the subject's withdrawal from the clinical trial, history of
allergy to herbs, factors leading to an emergency Caesarean section
and diagnosis of underlying diseases in the mother.
In order to determine the sample size a pilot study was under-
taken on 15 subjects. Based on the results of the comparison be-
tween the two averages, and, also, statistical consultants'
comments, the sample size with a confidence level of 95% was
determined to be 60 in each group. The subjects selected using a
convenience sampling method, were randomly divided into two
experimental and control groups. Randomization numbers were
sealed in a predetermined computer-made randomization opaque
envelope. The pregnant women’ screening sequence numbers were
printed outside the envelope, whereas the group names were
printed inside. All envelopes were numbered consecutively and
connected. Researchers who screened the eligible pregnant women
after baseline separated the envelopes from the strain and opened
them according to the pregnant women’ screening sequence
numbers, and then assigned the patients to either the experimental
group or the control group.
1.2. Measurement instruments
A visual analog pain scale which is a standard pain assessment
scale made of a 10 cm ruler between zero (no pain) and 10 (worst
possible pain) was used to record the subject's pain level; its val-
idity has been established in a number of studies. Melzak in-
troduces numerical pain rating scale as a valid and reliable measure
for assessing pain intensity [7]. The reliability of the mentioned tool
was determined using equivalent method. In the pilot study the
pain intensity in 10 mothers was measured using the above
mentioned scales by the researcher and the research assistant,
separately, and the correlation between their measurements was
r ¼ 0.93.
Data was gathered through inclusion of demographics (age,
occupation, education, gestational age) and information about de-
livery process (duration of labor active phase, duration of labor
second stage and neonates Apgar scores in the first and fifth mi-
nutes). The validity and reliability of the questionnaire were
determined using, respectively, the content validity method and
equivalent reliability method. Thus, in the pilot study the above
mentioned inventory was completed by the researcher, research
assistant and midwives in the maternity wards separately; reli-
ability was r ¼ 0.91.
1.3. Ethical considerations
This study was approved by the Medical Research and Ethical
Committee of Iranshahr University of Medical Sciences. Each
participant was verbally provided with information regarding the
study and the contents of the information sheet. All participants
signed a consent form in which the study procedures were
explained.
1.4. Procedure
The first assessment, pain was performed before intervention
(dilatation 3e4 cm) in both control and experimental groups using
the visual analog pain scale. The VAS is a 0e10 pain rating ruler in
which the respondent selects a number that accurately represents
her pain. The Lavender essence was made with Lavandula angus-
tifolia and was produced by the Barij Essence Pharmaceutical
Company (Kashan, Iran). Given that pure lavender essence is highly
concentrated and can cause irritation, the essence was diluted 1:10
with distilled water. In the experimental group two droplets of
lavender essence 10% was diluted with distilled water 1:10. A
dropper was used to drop the essence on to the patient's palm, then
they were asked to rub their hands together and inhale the inhale
the scent for 3 min while the hands were 2.5e5 cm distance from
the nose. Aromatherapy with lavender essence was performed by
the second researcher (A.P) who is an expert midwife. The pain
intensity of the subjects was measured 30 min after the contraction
ended. The intervention was carried out in 3 phases (dilation 5-6-,
7e8, and 9e10 cm). Pain intensity of the subjects in the experi-
mental group was assessed before and 30 min after the three phase
intervention while the subjects in the control group were treated
with distilled water as a placebo in a similar way. The length of
active phase and the second stage of labor, neonates Apgar scores in
the first and fifth minutes in both study groups were measured and
compared.
1.5. Data analysis
Data were analyzed with SPSS (Statistical Package for Social
Science, version20) using descriptive statistics (mean, standard
deviation and percentage), and analytical tests (Chi-square,
 M. Yazdkhasti, A. Pirak / Complementary Therapies in Clinical Practice 25 (2016) 81e86
independent t-test, paired t-test and KolmogoroveSmirnov test).
2. Results
Only one pregnant woman from the control group was excluded
because of Emergency caesarean section due to fetal distress,
resulting in 60 pregnant women in the experimental group and 60
pregnant women in the control group. (See Fig. 1).
The results showed that the mean age of participants was
19.13 ± 2.56 (range 15e32 years) and 18.26 ± 2.83 (range 15e34
years) in the experimental and control groups, respectively. The
demographic characteristics of the participants are summarized in
Table 1.
The comparison of pre-intervention mean pain intensity scores
(dilatation 3e4 cm) of two study groups showed no significant
difference between pain levels of the participants. But significant
difference was noted for the mean pain intensity scores between
two groups in 5e10 cm dilated. Namely pain intensity was
decreased in the treated group (Table 2).
Comparison of the prior and 30 min after intervention scores
using paired t-test showed that post intervention mean pain score
of the subjects in the experimental group at different dilations was
significant (P ¼ 0/001). That is, the subjects in the experimental
group felt less pain after intervention. While the control group
stated no difference pre and post intervention results (Table 3).
The durations of active phase of labor in experimental and
control groups (dilatation 5e10 cm) were, respectively, 170/2 ± 91/
08 and 181/5 ± 93/6 min. Performing independent t-test showed no
significant difference in the scores of two groups (P ¼ 0/5).
The durations of the second phase of labor in experimental and
control groups (dilated 10 cm to fetus expulsion) were, respectively,
Fig. 1. Consort flowchart.
83
59/4 ± 35/4 and 48/66 ± 23/5 min. Performing independent t-test
showed no significant difference in the scores of two groups (P ¼ 0/
6) (Table 4).
The mean first-Apgar score of the neonates in experimental and
control groups were (respectively) 8/8 ± 0/37 and 8/7 ± 1/01 while
independent t-test suggested no significant difference between
two groups (P ¼ 0/4). Mean fifth-Apgar score of the experimental
and control groups were, respectively, 9/9 ± 0/35 and 9/7 ± 1/01
which were not statistically significant (P ¼ 0/33) (Table 5).
3. Discussion
Findings indicated difference comparing pain intensity pre-and-
post intervention. On the other hand, the mean pain score in the
subjects in the Experimental group showed significant improve-
ment compared to control group (P < 0.001).
These results are consistent with the findings of the study by
Alavi et al. which suggested the effectiveness of aromatherapy with
lavender essential oil (P < 0.05) [20]. In their study 0.1 ml lavender
essential oil and 1 ml distilled water was put on two tissues and the
subjects were asked to inhale deeply, then the rate of pain intensity
reduction was measured 30 and 60 min after the intervention.
Aromatherapy uses essential oils extracted from aromatic
botanical sources to treat and balance the mind, body and spirit
[21]. Essential oils are thought to increase the secretion of the
body's own sedative, stimulant and relaxing neurotransmitters
(paracrine and endocrine) [22].
The mechanism of their action involves integration of essential
oils into a biological signal of the receptor cells in the nose when
inhaled. The signal is transmitted to limbic and hypothalamus parts
of the brain via olfactory bulb. These signals cause brain to release
84 M. Yazdkhasti, A. Pirak / Complementary Therapies in Clinical Practice 25 (2016) 81e86

Table 1
Women demographic characteristics in two groups.

Control group Experimental group P value

Age (year) 19.13 ± 2.56 18.26 ± 2.83 0/91

Occupation Employed, Unemployed (7)%11/7 (4)%6/7 0/52
(52)%88/3 (56)%93/3
Education Illiterate (9)%15 (6)%10 0/92
Primary school Middle and high school (16)%26/7 (16)%26/7
Graduate (26)%44/9 (31)%51/6
(8)%13/4 (7)%11/7
Gestational age (week) 39/6 ± 0/91 39/7 ± 0/64 0/42

Table 2
Mean pain intensity in two groups before and after intervention.

Pain Group

Control Experimental t-test result

Mean ± S.D Mean ± S.D

Mean pain intensity before intervention (dilatation 3e4 cm) 6/1 ± 0/77 6/2 ± 0/52 t ¼ 0/58
df ¼ 118
P ¼ 0/58
Mean pain intensity after intervention (dilatation 5e10 cm) 8/5 ± 1/3 6/9 ± 1/7 t ¼ 5/5
df ¼ 118
P ¼ 0/001*

Table 3
Mean of pain intensity at different dilatation in two groups.

Mean of pain Control group Paired t- test Experimental group Paired t- test

Before intervention 30 min after P- Value Before intervention 30 min after intervention P- Value

Dilatation 5e6 cm 7/7 ± 2/1 7/7 ± 2/1 P¼1 8 ± 2/2 6/1 ± 2/3 P ¼ 0/001*
Dilatation 7e8 cm 8/4 ± 2 8/6 ± 1/6 P ¼ 0/2 8/8 ± 1/5 6/7 ± 2 P ¼ 0/001*
Dilatation 9e10 cm 9/3 ± 1/3 9/4 ± 1/1 P ¼ 0/32 9/55 ± 0/9 7/93 ± 2/1 P ¼ 0/001*

Table 4 anxiety and pain intensity of labor [6]. The results of the studies by
Mean duration of active labor and the second phase (min) in two groups. Ahmadi et al., Vakilian et al. and Seraj and Vakilian suggested a
Group Duration of active Duration of second significant reduction in labor pain intensity of the women in the
labor (min) phase (min) intervention group by using aromatherapy with lavender essential
Mean ± S. D Mean ± S.D oil inhalation [24e26], which is consistent with the findings of our
research. The study by Burns et al. showed no significant difference
Experimental group 170/2 ± 91/08 59/4 ± 35/4
Control group 181/5 ± 93/6 48/66 ± 23/5
in labor pain and, also, in caesarean section rate reduction [16]. The
t-test result t ¼ 0/66 df ¼ 118 P ¼ 0/5 t ¼ 1/95 df ¼ 118 P ¼ 0/6 inconsistency of their findings with ours could be due to the
different method of administration in the Burns study, in which
massage was used in addition to inhalation, which brings in
Table 5
another variable of the midwife-patient relationship and the cul-
Mean neonates Apgar scores in the first and fifth minutes in two groups.
tural differences. Honofer indicated age as one of the factors
Group First apgar scores Fifth apgar scores affecting labor pain intensity [17]. The mean age of mothers
Experimental group 8/8 ± 0/37 9/9 ± 0/35 participating in the present study was 18.3. While it was about 29
Control group 8/7 ± 1/01 9/7 ± 1/01 years in the participants in the Burn study.
t-test result t ¼ 0/83 df ¼ 118 P ¼ 0/4 t ¼ 0/96 df ¼ 118 P ¼ 0/33
In a study by Sheikhan et al. on the effect of lavender essential
oil on the post episiotomy pain intensity, the mothers in the
experimental group received the intervention of bathing in laven-
neuro messengers like serotonin, endorphin etc., to link our ner- der essential oil twice a day (each time 6 drops in 5 L of water)
vous and other body systems, assuring a desired change and to while those in the control group were given the hospital routine
provide a feeling of relief. Serotonin, endorphin and noradrenalin (Betadine) for bathing in for 5 days. The results showed significant
are released from calming oil, euphoric, and stimulating oil reduction in pain intensity on the fifth day [27]. In the study carried
respectively to give expected effect on mind and body [23]. out by Kingberg et al., adding 6 drops of lavender essential oil and
In one research study 8058 expectant mothers received using the bath during 10 days postpartum would help to decrease
aromatherapy (modes of application included acupressure points, vulvar discomfort [28]. While in the research conducted by Vaki-
taper, compress, foot bath, massage or birthing pool) during labor lian, using lavender essence was not helpful in the post episiotomy
under the supervision of midwives that relieved anxiety and fear pain relief [11].
and decreased the need for epidural analgesia [16]. According to the A study by Kim et al. (2006) evaluated the analgesic efficacy of
findings of a survey by Mohammad KhaniShahri, message aroma- postoperative lavender essential oil aromatherapy in patients
therapy with lavender essential oil would significantly decrease
 M. Yazdkhasti, A. Pirak / Complementary Therapies in Clinical Practice 25 (2016) 81e86
undergoing breast biopsy surgery. The patients in the intervention
and control groups received, respectively, supplemental oxygen
through a mask with 2% lavender essential oil and without laven-
der. Pain intensity was measured 30 and 60 min postoperatively.
The results showed no significant difference in narcotic re-
quirements between the two groups. However, the patients in the
intervention group reported a higher satisfaction rate with pain
control than the subjects in the control group (P ¼ 0.001) [29].
The other objective of our study was to evaluate the benefits of
using lavender essence on duration of first and second stages of
labor. The present research showed no significant difference in la-
bor stage duration which is consistent with the results of the survey
by Burns et al. (2000, 2007) [16,17]. On the other hand, there was no
significant difference in labor stage duration in the control and
experimental groups of the studies by Alavi et al., Vakilian et al. and
Seraj and Vakilian [20,25,26], which is also consistent with our
findings. However, the duration of the first and second labor stages
of the subjects in lavender aromatherapy group of the research by
Ahmadi et al. and Mohammad-KhaniShahri et al. were shorter than
the control ones which was inconsistent with our findings [24,30].
In another research the participants who used a sitz bath of lav-
ender oil for 30 min showed significantly better labor progress and
less need for pain killers [31e33]. In this study, women were asked
to inhale lavender essential oil during their contractions. In this
distracted them from concentrating on the pain, too. Besides, the
effects of lavender could be measured during contraction. It is likely
that the obtained difference in our study with other surveys is due
to the method of using lavender essential oil. Given the results of
this study indicate no significant difference in first and fifth Apgar
scores of the infants of both groups, it can be concluded that the
lavender essential oil administration had no effect on the Apgar
score. A study by Burns et al. (2000, 2007) showed that lavender
aromatherapy had no impact on the infants 1, 5, 10 min Apgar
scores [16,17]. In a research by Ahmadi et al. the first and fifth Apgar
scores were similar in both experimental and control groups, sug-
gesting no decrease in Apgar scores [24] that is consistent with the
results of our study. In the research by Burns et al. (2007) a higher
proportion of infants of the mothers in the control group were
admitted to the NICU compared to the subjects in the experimental
group [17]. It should be noted that in the present study admission
rate of neonatal intensive care unit has not been quantified. Given
the available evidence reported in the results, it can be concluded
that aromatherapy is a safe, inexpensive and cost-effective process
and no side effects have been reported so far for aromatherapy on
maternal and fetus outcomes [17].
4. Conclusion
Today, aromatherapy is considered as an alternative medicine
approach with a positive impact and is tested in various research
studies. The results of this study confirmed aromatherapy with
lavender essence as a simple, inexpensive, noninvasive, and effec-
tive intervention to reduce labor pain. By using aromatherapy the
entire process of giving birth becomes a pleasant experience,
decreasing mother's tendency towards C-section.
Conflicts of interest
The authors have no conflict of interest to declare.
Acknowledgment
We would like to thank all the pregnant women who partici-
pated in this study.
85
References
[1] R. Melzack, P.D. Wall, Handbook of Pain Management: a Clinical Companion to
Wall and Melzack's Textbook of Pain, Churchill Livingstone, 2003.
[2] S.A.Z. Aram, M. Zamani, Yadegar. The relative of the selected delivery method
in the pregnant women referring to the medical center of Isfahan, Isfahan Uni
Med. Sci. 4 (7e8) (2002) 74e79.
[3] K.W. Arendt, J.A. Tessmer-Tuck, Nonpharmacologic labor analgesia, Clin.
Perinatology 40 (3) (2013 Sep) 351e371.
[4] F. Cunningham, K. Leveno, S. Bloom, J. Hauth, D. Rouse, C. Spong, Abnormal
Labor, Williams Obstetrics, 2010, pp. 415e434.
[5] J. Adams, C.W. Lui, D. Sibbritt, A. Broom, J. Wardle, C. Homer, et al., Women's
use of complementary and alternative medicine during pregnancy: a critical
review of the literature, Birth 36 (3) (2009) 237e245.
[6] L. Mohammadkhani Shahri, Z. Abbaspoor, N. Aghel, H. Mohammadkhani
Shahri, Effect of massage aromatherapy with lavender oil on pain intensity of
active phase of labor in nulliparous women, J. Med. Plants 2 (42) (2012)
167e176.
[7] F. Sindhu, Are non-pharmacological nursing interventions for the manage-
ment of pain effective? eA meta-analysis, J. Adv. Nurs. 24 (6) (1996 Dec)
1152e1159.
[8] J. Tillett, D. Ames, The uses of aromatherapy in women's health, J. Perinat.
neonatal Nurs. 24 (3) (2010 Jul-Sep) 238e245.
[9] A. Sobhani, H. Sharemi, R. Orangpur, F. Shokohi, M O, Effect of levand on post
cesarean pain relief, J. Gilan Uni Med. Sci. 16 (62) (2007) 80e86 (Persian).
[10] D. Fellowes, K. Barnes, S. Wilkinson, Aromatherapy and massage for symptom
relief in patients with cancer, Cochrane database Syst. Rev. 2 (2004)
CD002287.
[11] K. Vakilian, M. Atarha, R. Bekhradi, R. Chaman, Healing advantages of lavender
essential oil during episiotomy recovery: a clinical trial, Complementary Ther.
Clin. Pract. 17 (1) (2011 Feb) 50e53.
[12] T. Habanananda, Non-pharmacological pain relief in labor, J. Med. Assoc.
Thail. ¼ Chotmaihet Thangphaet. 87 (Suppl 3) (2004 Oct) S194eS202.
[13] D. Tiran, H. Chummun, Complementary therapies to reduce physiological
stress in pregnancy, Complementary Ther. Nurs. midwifery 10 (3) (2004 Aug)
162e167.
[14] L.A.E. Erland, S.S. Mahmoud, Chapter 57-Lavender (Lavandula angustifolia)
oils A2-Preedy, victor R. Essential Oils in Food Preservation, Flavor and Safety,
Academic Press, San Diego, 2016, pp. 501e508.
[15] P.H. Koulivand, M. Khaleghi Ghadiri, A. Gorji, Lavender and the nervous sys-
tem, Evidence-based complementary Altern. Med. ECAM 2013 (2013) 681304.
[16] E.E. Burns, C. Blamey, S.J. Ersser, L. Barnetson, A.J. Lloyd, An investigation into
the use of aromatherapy in intrapartum midwifery practice, J. Altern. com-
plementary Med. (New York, NY) 6 (2) (2000 Apr) 141e147.
[17] E. Burns, V. Zobbi, D. Panzeri, R. Oskrochi, A. Regalia, Aromatherapy in
childbirth: a pilot randomized controlled trial, BJOG Int. J. Obstetrics Gynecol.
114 (7) (2007 Jul) 838e844.
[18] E. Daghighbin, Comparison of Honey and Lavender Cream on Pain and Wound
Healing in Primigravidas Episiotomy, Ahvaz Junishapur University of Medical
Sciences, Ahvaz, 2007.
[19] U. Waldenstrom, I. Hildingsson, E.L. Ryding, Antenatal fear of childbirth and
its association with subsequent caesarean section and experience of child-
birth, BJOG Int. J. Obstetrics Gynecol. 113 (6) (2006 Jun) 638e646.
[20] N. Alavi, M. Nemati, M. Kaviani, H TM, The effect of aromatherapy lavender on
perception of pain labor intensity and outcome of delivery, Armaghan Danesh
15 (1) (2010) 31e35 (Persian).
[21] A.D. Allaire, Complementary and alternative medicine in the labor and de-
livery suite, Clin. Obstetrics Gynecol. 44 (4) (2001) 681e691.
[22] L. Jones, Pain management for women in labor: an overview of systematic
reviews, J. Evidence-Based Med. 5 (2) (2012) 101e102.
[23] B. Ali, N.A. Al-Wabel, S. Shams, A. Ahamad, S.A. Khan, F. Anwar, Essential oils
used in aromatherapy: a systemic review, Asian Pac. J. Trop. Biomed. 5 (8)
(2015) 601e611.
[24] A. Ahmadi, S. Karimi, N. Aj, A J, The effect of lavender essence on labor pain in
nulliparous women referred to kuosar hospital 2010, Edrak J. 32 (2013)
10e18 (Persian).
[25] K. Vakilian, A. Karamat, A. Mousavi, M. Shariati, M.E. Ajami, M A. The effect of
Lavender essence via inhalation method on labor pain, J. Shahrekord Uni Med.
Sci. 14 (1) (2012) 34e40 (Persian).
[26] A.K.V. Seraji, The comparison between the effects of aromatherapy with lav-
ender and reathing techniques on the reduction of labor pain, Complement.
Med. J. Nurs. Midwifery 1 (1) (2011) 34e41 (Persian).
[27] F. Sheikhan, F. Jahdi, E.M. Khoei, N. Shamsalizadeh, M. Sheikhan, H. Haghani,
Episiotomy pain relief: use of Lavender oil essence in primiparous Iranian
women, Complementary Ther. Clin. Pract. 18 (1) (2012 Feb) 66e70.
[28] S. Kindberg, M. Stehouwer, L. Hvidman, T.B. Henriksen, Postpartum perineal
repair performed by midwives: a randomized trial comparing two suture
techniques leaving the skin unsutured, BJOG Int. J. Obstetrics Gynecol. 115 (4)
(2008 Mar) 472e479.
[29] J.T. Kim, M. Wajda, G. Cuff, D. Serota, M. Schlame, D.M. Axelrod, et al., Eval-
uation of aromatherapy in treating postoperative pain: pilot study, Pain Pract.
Official J. World Inst. Pain 6 (4) (2006 Dec) 273e277.
[30] L.M. Shahri, S.S. Birjandi, H.M. Shahri, Effect of massage Aromatherapy with
Lavandula on the duration of first and second stage of labor in nulliparous
86 M. Yazdkhasti, A. Pirak / Complementary Therapies in Clinical Practice 25 (2016) 81e86

women, Bimon. J. Hormozgan Univ. Med. Sci. 17 (2) (2013) 145e154.
[31] H.G. Hall, L.G. McKenna, D.L. Griffiths, Midwives' support for complementary
and alternative medicine: a literature review, Women birth J. Aust. Coll.
Midwives 25 (1) (2012 Mar) 4e12.
[32] V. Coleman Smith, Aromatherapy as a comfort measure during the
childbearing year, Int. J. Childbirth Educ. 27 (3) (2012).
[33] H.G. Hall, D.L. Griffiths, L.G. McKenna, The use of complementary and alter-
native medicine by pregnant women: a literature review, Midwifery 27 (6)
(2011 Dec) 817e824.

View publication stats