What care must the nurse take when implementing aromatherapy for a patient in labor

A variety of non-pharmaceutical pain managements have been used to control pain. Aromatherapy, a treatment method that applies fragrant extracts from herbal plants generally through inhalation and/or massage, existed long ago in medical history as one of the major treatment options for pain.1 One of the most painful condition in humans occurs in labouring process. The labouring woman goes through three labour stages: first, second, and third. The first stage which includes early (latent) labour phase, active labour phase, and transition phase, has the longest duration among the three stages. The contractions initiate from irregular patterns during early labour phase and gradually become stronger, more intense, regular and sometime overlapping during transition phase. The second stage is the hardest period in which the mother actively pushes to give birth to the baby and the duration depends on a variety of factors and the third stage is when the placenta is finally delivered.2 Although labour pain is natural occurring, the extent of extreme pain causes marked physiological changes in cardiopulmonary functions and oxygen consumption, generalised neuroendocrine stress response, maternal acidemia, and incoordinate uterine contractility.3 A reasonable reduction of the pain intensity and duration in the safe range is necessary. Standard oral analgesics (e.g., paracetamol, tramadol, pethidine, Entonox, etc.) or epidural analgesia are given to labouring women upon request.4 Some of these analgesics, e.g., the opioid drug – pethidine, reduce labour pain but increase maternal drowsiness, nausea, and vomiting and may cause respiratory depression in the newborn.5 Although epidural analgesia is generally safe and effective for relieving pain in labour, it is associated with longer labour, more operative interventions, and additional costs.6 Moreover, these standard pain control methods may not be available in financially low-resource areas.7

Probably because of its simplicity and affordability, aromatherapy has been used as an optional choice in some medical settings, either alone or together with standard pain control protocol. One large uncontrolled prospective study in the United Kingdom over an 8-year period between 1990 and 1998 suggested that aromatherapy reduces fear, anxiety, pain, nausea and vomiting, and strengthens sense and improves contractions during labour process.8 Smith et al conducted the first systematic review focusing specifically on the effects of aromatherapy on labour process in 2011 and concluded a lack of studies evaluating the role of aromatherapy for labour pain management.9 A number of controlled trials testing the effectiveness of aromatherapy in labour pain and duration have been published in the last few years and some of them were selected for systematic review and meta-analysis.10 Though, a more comprehensive meta-analysis of the effectiveness of aromatherapy in labour pain and duration is still lacking. We conducted a meta-analysis of randomised controlled trials (RCTs) that examined the effectiveness of aromatherapy in reducing labour pain and duration. We also concerned the influences of aromatherapy on mother safety and thus related outcomes were analysed.

Inclusion and exclusion criteria

RCTs assessing the effectiveness of aromatherapy in labour process in full term labouring women who arrived at the hospital waiting for delivery were recruited. The inclusion criteria were clear definitions of (1) essential oils; (2) method of application; (3) labour phases or stages and (4) pain levels or duration. We excluded trials that meet at least one of the following criteria: (1) aromatherapy with other auxiliary treatment without controlling for the additional effect (e.g., massage

Study selection

Screening and selection process for the trials are delineated in Fig. 1. Our initial search yielded 206 records. A total of 171 records were retained after removing the duplicated. After screening on the titles and abstracts, we removed 132 records which were non-RCT, other types of studies, and conference abstracts. Full-text of the remaining 39 RCTs were assessed for eligibility. Nineteen of the trials were excluded due to the following reasons: 1 with undefined aromatherapy, 14 with topics

Discussion

We found that aromatherapy reduced labour pain during the 8–10 cm dilatation transition phase of the first stage labour. In addition to the pain-relieving effects, aromatherapy reduced the labour duration of the active phase and the third stage, with a trend toward significance in the second stage. Aromatherapy did not change the risk of emergency C-section and labour events of the mothers.

With the advance of surgery, anesthesiology, monitoring facilities and other medical technologies,

Conclusion

Our findings suggest that aromatherapy is effective in reducing labour pain and duration. The therapy is generally safe to the mothers. However, due to the heterogeneity of some of the outcomes in pain and duration, further trials with device-based pain measurements, larger sample size, and more stringent design, should be conducted before strong recommendation. Whether the add-on of aromatherapy enhances the effects of standard pain management remains to be investigated.

Conflict of interest

None.

Funding sources

Collaborative grant of the Shuang Ho Hospital, Taipei Medical University and En Chu Kong Hospital (grant number: 106ECK-SHH-01-2).

Role of the funding source

The funding agent had no role in study design; in collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Ethical statement

No applicable.

Acknowledgements

We thank the following experts for their help: Dr. Katayon Vakilian, assistant professor of the Arak University of Medical Sciences, Iran, and Dr. Parvin Abedi, associate professor of the Community Nutrition School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, for clarification of their work published in Persian language; Miss Mindy Chien-Meng Ni, Korean community service center of Greater Washington, Fairfax, Virginia, USA, for explaining the contents

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