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Features

Clinical Aromatherapy

for Pregnancy, Labor and Postpartum

by Jane Buckle, PhD RN CCAP, Kathy Ryan, RNC-MNN CCAP and Karen B. Chin, RN MS CCAP

Abstract: Clinical aromatherapy is the


use of essential oils for clinical outcomes
that are measurable, for example nausea,
anxiety or pain. Essential oils are highly
complex mixtures distilled from aromatic
plants. They can be useful during pregnancy,
labor, delivery, and postpartum.
Essential oils can be applied in several
different ways and are simple and pleasant
to use. Essential oils are lipophilic
(they do not dissolve in water). This paper
will give an overview of published research
relevant to maternal health, followed
by examples of how aromatherapy
is currently being used in a large maternity
hospital, and give suggestions to
encourage further integration.

Keywords: aromatherapy, essential oils, labor, childbirth, postpartum

Introduction

Drawing on published research and clinical experience,


clinical aromatherapy may be a potentially effective
complementary practice in childbirth. This information will
be useful for those who teach and care for the childbearing
family. The aim is for clinical aromatherapy to become better
understood as a potential tool for maternal health, thus making
integration easier.

Smell is one of the first senses to develop in the womb.


Research has shown that babies can identify their mothers
from smells first experienced in the womb (Faas, Resino, &
Moya, 2011; Schaal, Marlier, & Soussignan, 2000). Odor has
a direct pathway to the limbic part of the brain, in particular
to the amygdala that governs fear (Buckle, 2007). Famil

iar smells can be calming and soothing at stressful times


(including childbirth), and some smells can have a profound
psychological effect (Vermetten, Schmahl, Southwick, &
Bremner, 2007). Most hospitals do not smell reassuring.

Aromatherapy is the use of essential oils, obtained from


aromatic plants, for therapeutic properties (Buckle, 2014, in
press). Clinical aromatherapy is recognized as part of holistic
nursing by the American Holistic Nurses Association and
by most State Boards of Nursing (Buckle, 2003). Clinical
aromatherapy is also used by doctors, massage therapists,
nurse practitioners, occupational therapists, and many other
healthcare workers (Cordell & Buckle, 2013).

Essential oils can have many beneficial properties relevant


to pregnancy, labor, delivery, and postpartum (Walls,
2009). For example, inhaling peppermint, spearmint, lavender,
and ginger can relieve nausea (Reagan, 2009). Lavender,
frankincense, and rose were found to relieve anxiety in labor
(Burns, Zobbi, Panzeri, Oskrochi, & Regalia, 2007). German
chamomile (Matricaria recutita) and Immortelle (Helicrysum
italicum) have strong anti-inflammatory and healing actions.
When diluted and applied topically, these two essential oils
could be added to lavender (Lavandula angustifolia) - already
found useful to aid perineal healing (Vakilian, Atarha,
Bekhradi, & Chaman, 2011).

Rose (Rosa damascena) and lavender (Lavandula


angustifolia) relieved anxiety and depression in postpartum
women (Conrad & Adams, 2012). Many essential oils, for
example teatree (Melaleuca alternifolia), have antimicrobial
properties, and these can reduce the possibility of Hospital
Acquired Infections (HAIs) such as Methicillin Resistant
Staphylococcus aureus (MRSA) or Acinetobacter baumannii
(Duarte, Ferriera, Silva, & Dominigues, 2012; Warnke, Lott,
Sherry, & Podschun, 2013).

Aromatherapy is widely recognized as being useful in


stress (Varney & Buckle, 2013), and clearly, labor is a stressful
time for most women. Therefore it is not surprising that cur-

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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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rent reports suggest aromatherapy can reduce stress in pregnancy


and childbirth (Conrad, 2010; Tillet & Ames, 2010).
This article is supported with information from hospitals in
Fort Worth, TX, Ridgewood, NJ, and Marshall, TX who use
aromatherapy in their L & D departments.

Published Evidence

Aromatherapy for laboring mothers was introduced


into a British hospital in the early 1990s by midwives Burns
and Blamey (1994). Burns and Blamey�s initial six-month
evaluation of aromatherapy on 500 laboring women in a
maternity hospital in Oxford led the way to a much larger
eight year study of 8,058 women (Burns, Blamey, Ersser,
Barnetson, & Lloyd, 2000). The essential oils used were
chamomile, clary sage, eucalyptus, frankincense, jasmine,
lavender, lemon, mandarin, peppermint and rose (Burns et
al., 2000). Women in labor were offered aromatherapy to
relieve symptoms such as anxiety, pain, nausea, and vomiting
or to help strengthen their contractions (Burns et al., 2000).
Routine data were collected over eight years on the women
who received aromatherapy and compared to the data on
women who were not given aromatherapy (n = 15,799)
(Burns et al., 2000). Outcome measures included mothers�
ratings of effectiveness, outcomes of labor, use of pharmacologic
pain relief, uptake of intravenous oxytocin, reported
associated symptoms, and annual costs (Burns et al., 2000).
More than 50% of mothers rated aromatherapy as helpful,
and only 14% found it unhelpful (Burns et al., 2000). The
use of aromatherapy was not confined to low-risk mothers -
60% were primigravidae, and 32% had induced labor (Burns
et al., 2000). Aromatherapy appeared to reduce the need for

Jasmine

22 | International Journal of Childbirth Education | Volume 29

Lavender

additional pain relief, and the use of pethidine declined from


6% to 0.2% of women during the study (Burns et al., 2000).
Aromatherapy also appeared to enhance labor contractions
in women in dysfunctional labor (Burns et al., 2000). A very
low number of associated adverse symptoms were reported
(1%) (Burns et al., 2000).

aromatherapy is a popular care option


for mothers and midwives in many
countries

Rose
A further study Burns, Zobbi, Panzeri, Oskrochi, and
Regalia (2007) carried out in an Italian maternity unit found
significantly more babies born to control participants were
transferred to NICU than in the aromatherapy group: 0 versus
6 (2%, p = 0.017) (Burns et al., 2007). Pain perception
was also reduced in the aromatherapy group for first time
mothers (Burns et al., 2007).

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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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Today, aromatherapy is a popular care option for mothers


and midwives in many countries for myriad symptoms,
such as nausea in pregnancy (and labor), hemorrhoids,
exhaustion, pain, sleeplessness, anxiety, postpartum mood
disorder, and episiotomy healing (Adams, 2012; Dhany,
2008; Maddocks-Jennings & Wilkinson, 2004; Tillet &
Ames, 2010).

A retrospective study by Dhany, Mitchell, and Foy


(2012) explored if an aromatherapy and massage intrapartum
service (AMIS) reduced the need for analgesia during labor.
Seven essential oils were used: bergamot, clary sage, frankincense,
lavender, jasmine, peppermint, and rose (Dhany et
al., 2012). The essential oils were intended to target specific
symptoms: symptoms requiring analgesia or antispasmodics;
reduction of fear; mood elevating; calming; and enhancement
of uterine action (Dhany et al., 2012). Some were also
used to help to balance emotions, nausea, bereavement, and
depression (Dhany et al., 2012). The analysis showed the
AMIS had a positive impact and reduced the need for anesthesia
during labor, thus contributing to improved maternal
and neonatal outcomes (Dhany et al., 2012).

Nausea

There have been several published studies on aromatherapy


for nausea. Most used peppermint (Hines, Steels,
Change, & Gibbons, 2012; Reagan, King, & Clements,
2009), ginger (Boone & Shields, 2009; Ensiyeh & Sakineh,
2009), citrus peel (Stringer & Donald, 2011), or mixtures
that included peppermint or ginger (de Pradier, 2006; Hunt,
Dienemann, Norton, & Hartley, 2012). While most studies
are on post-operative or chemo-induced nausea, studies
have found inhaled essential oils useful for both early
morning sickness and nausea in labor. However, an Iranian
study found a �mint� essential oil (no botanical name given)
floated in a bowl of water by the bed overnight did not
reduce nausea the following morning (Pasha, Behmanesh,
Mohsenzadeh, Hajahmadi, & Moghadamnia, 2010).

Analgesia

Maddocks-Jennings and Wilkinson (2004) found


women who used a range of essential oils often required less
analgesia. Kaviani, Azima, Alavi, and Tabaei (2014) found the
effect of lavender reduced the perception of labor pain, and

women�s self-evaluation showed them to be more content.


However, there were no differences in the duration of the
first or second stages of labor, nor was there a significant
difference regarding the 1st and 5th minute Apgar score
between the control and aromatherapy groups (Kaviani et
al., 2014).
Episiotomy Healing

Vakilian et al. (2011) conducted a randomized control


trial on 120 primiparous women with single pregnancy. The
women in Vakilian et al.�s study had had normal spontaneous
vaginal delivery and episiotomy and were not suffering from
any acute or chronic disease or allergy. They were randomly
allocated to the aromatherapy or control group (Vakilian et
al., 2011). The aromatherapy group received lavender (Lavandula
angustiolia) oil, and the controls received Povidoneiodine
(Vakilian et al., 2011). Incision sites were assessed on
the 10th day postpartum ( Vakilian et al., 2011). Vakilian
et al. reported 25 out of 60 women in the lavender group
reported no pain, whereas 17 mothers in the control group
had no pain (p=0.06).

Comfort

Coleman Smith (2012) taught comfort methods using


aromatherapy during childbirth classes to give the mother a
sense of control during their labor. Coleman Smith suggested
a foot soak of peppermint, a back massage with mandarin,
rose, or ylang ylang, or a hand massage with eucalyptus.
While aromatherapy can be of comfort in labor, having
a doula who also has experience of using aromatherapy
in labor can be very beneficial. Many cultures encourage

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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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women to have an experienced companion to encourage the


mother and be pro-active in her comfort (Gruber, Cupito, &
Dobson, 2013; Habanananda, 2004; Stevens, Dahlen, Peters,
& Jackson, 2011).

Labor and Delivery

Rose (Rosa damascena) can be especially good in early


labor when the woman may be more anxious. Rose can also
help women sleep. Hongratanaworakit (2009) explored the
effect of topically applied rose oil (Rosa damascena). When
compared to placebo, rose oil reduced respiration rate, O2
saturation, and systolic blood pressure. Participants in the
rose oil group rated themselves as more calm, more relaxed,
and less alert than those in the control group (Hongratanaworakit,
2009).

Jasmine, frankincense, and peppermint with back massage


or compression to the forehead have been shown to
be effective in active and transition (Coleman Smith, 2012;
Pollard, 2008; Horowitz, 2011). Clary sage (Salvia sclarea) is
thought to increase uterine contractility as well as acting as a
stress reducer and anti-depressant (Coleman Smith, 2012).

Postpartum Mood Disorder

Imura, Misao, and Ushijima (2006) conducted a controlled


study (n=26) to explore the use of aromatherapy massage
on postpartum mood. The aromatherapy group received
a mixture of neroli (Citrus aurantium flos) and lavender
(Lavandula officinalis) in a massage on the second postpartum
day, and the control group received standard medical
care (Imura et al., 2006). Four standardized questionnaires
were used before and after the intervention: Maternity Blues

Scale, State-Trait Anxiety Inventory, Profile of Mood States,


and Feeling Toward Baby Scale (Imura et al., 2006). In the
aromatherapy group, post treatment scores significantly
decreased for the Maternity Blues Scale (p=0.01), the State-
Anxiety Inventory (p=0.001), and all but one of the Profile of
Mood States subscales (Imura et al., 2006).

Infertility

Essential oils for infertility include ylang ylang, clary


sage, geranium, fennel, anise, cypress, and rose. These oils
decrease stress and anxiety and may aid in conception.
Inhalation, topical application on the abdomen and low
back, and massage may be beneficial (Tillett & Ames, 2010).
Buckle has had some success regulating irregular periods that
have contributed to infertility by using clary sage, geranium,
and rose 10% applied to abdomen and back from the last
day of period until ovulation.
Using Clinical Aromatherapy in a Hospital

Clinical aromatherapy was added to the RN�s toolkit of


comfort measures for labor and postpartum at St.Vincent
Women�s Hospital in Indianapolis, Indiana, five years ago.
Today, every bedside RN has completed training (under
direction of Kathy Ryan, RN CCAP) that enables them to
offer six essential oils for inhalation only . A clinical aromatherapy
policy was created to provide guidelines for the
safe administration of essential oils in a clinical setting as a
nursing intervention. This meant a physician order was not
required to use aromatherapy. After seeing the benefits of
clinical aromatherapy in action, the physicians became very
supportive of offering aromatherapy.

Patients are educated about the use of essential oils


during childbirth preparation classes and during their preadmission
Monogram Maternity appointment, where a birth
plan is created. Fliers describing each oil and instructions for
their use at home, are shared. Essential oils kits and resource
materials are kept in each unit�s secured Medicine room.
In order to address safety and infection control concerns,
preparations for individual patient use are made up in the
medicine room and then brought directly to the patient�s
room in a labeled medicine cup.

Medical history and allergies are reviewed before administering


any essential oil. One to two drops are placed on a
gauze square in a medicine cup, and safety precautions are
emphasized with the patient before giving them the medi

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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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cine cup. Patient are instructed to close their eyes and take a
long slow inhalation through their nose, repeating as needed.

Nurses are trained to understand the contraindications


and precautions of essential oils in this patient population.
Patients are told not to apply undiluted essential oils directly
to their skin; to only use them externally, avoiding the eyes;
and to keep the medicine cup out of the reach of children.
As an extra precaution, patients are advised to avoid inhaling
essential oils during the first trimester of pregnancy, and
nurses are told to observe this safety concern.

Essential Oil Choices for Patients

Essential oils offered (by inhalation only) are:


Lavender (Lavandula angustifolia) for relaxation and sleep

Bergamot (Citrus bergamia) for an uplifting and refreshing
way to reduce stress

Ginger (Zingiber officinalis) to relieve nausea

Mandarin (Citrus reticulata) for a gentle, calming effect

Peppermint (Mentha pipertia) for nausea, headaches,
fatigue and inability to void

Tea Tree (Melaleuca alternifolia) to relieve a stuffy nose
and congestion.
Patients are encouraged to use essential oils simultaneously
with the Skylight guided imagery programs available
through the hospital TV system. Lavender, mandarin, and
peppermint are the essential oils most frequently chosen,
and patients report success in relieving discomfort and
decreasing their stress.

Peppermint and ginger are available for use immediately


after a cesarean section to relieve nausea and to lessen the
potential use of antiemetic medications. The hospital has
found that inhaling 1 � 2 drops of peppermint, ginger, or a
blend of mandarin, peppermint, and ginger can relieve the
discomfort of nausea during labor.

Postpartum RNs frequently suggest the use of peppermint


when a patient is unable to void. A drop of peppermint
is placed on a tissue in the urine collection container while
the patient holds the medicine cup under their nose, taking
slow deep breaths of peppermint. With peppermint�s
smooth muscle relaxation qualities, RNs report that it can be
a successful strategy and is their first choice in this situation.
This is interesting as a few drops of spirit of peppermint were
placed in the urinary bottle if a male patient had problems
RNs with advanced training in the safety and mixing of
specific oils in small dilutions (often as low as 1%) have created
favorite blends for use in Labor and Postpartum. These
blends can be used in a massage lotion or oil, a soothing
foot-bath, or drops in the shower for a refreshing scented
steam. The ones most useful include:


Clary Sage, Roman Chamomile, and Lavender - While it
has not been observed to be effective to initiate contractions,
the nurses believe this blend may assist to increase
the strength of existing contractions. Contraindications
include a patient with a uterine scar, hyper stimulated
contractions, or in conjunction with Pitocin or any other
medication used to enhance labor. This is one blend that
is discussed with the patient�s physician before use. Documentation
of physician�s approval is placed in nursing
notes for the use of Clary Sage during labor.

Lavender and peppermint blended with fractionated
coconut oil and Epsom salts are added to warm water in a
basin for a refreshing foot-bath. Care partners are encouraged
to massage the patient�s feet at the same time.

A �Peace� blend containing Bergamot, Lavender and
Mandarin in fractionated coconut oil can be calming, yet
uplifting, during a long labor.

For those experiencing grief after a loss or an unexpected
outcome, spritzers containing various combinations of
Frankincense, Jasmine, Lavender, and Rose in a spray
bottle of water are offered. This can be comforting while
the patient is in the hospital, and their own spray is given
to them for use after discharge.

Lavender and Roman Chamomile are mixed with a lotion
and given to the Care Partners to use as a comforting
rub during Labor. One patient wrote to thank her nurse
stating: �The delivery made for a long day but the scent
urinating, over forty years ago!
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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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of lavender and chamomile helped me relax and make

it through! My mom and husband rubbed my back and

neck to help take my mind off things and to help with

the aches and pains of delivery! I use a little of the lotion

now every night � it reminds me of the beautiful night

my baby was born � scent is so tied to memory!�

essential oils are complex � training is


strongly recommended

It is a privilege to be present when a baby is born. The


goal of everyone present is to create a calm healing environment
so mothers can have a best possible birth experience.
Integrating clinical aromatherapy into maternal health care
can enhance the experience and improve the comfort of
laboring mothers, thus allowing them to focus on their goals
for labor, for their baby, and for their immediate future
together.

The Importance of Training

Essential oils are highly concentrated and some are


contra-indicated in pregnancy and in labor (Tisserand &
Young, 2013). It is strongly advised that those wanting to
use aromatherapy in pre- and postpartum care learn how
to use essential oils clinically. Training can be done easily
by undertaking a clinical training that is specifically created
for pregnancy and labor. This will enable the user to feel
confident and comfortable about advising mothers what to
use and what to avoid.

Take Home Message

Incorporating clinical aromatherapy into a childbirth


care program enhances the comfort of laboring mothers and
allows them to focus on their goals for labor � to produce a
healthy, beautiful baby. However, essential oils are complex,
concentrated extracts, and training is strongly recommended.

References

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Boone, S., & Sheilds, K. (2005). Treatment of pregnancy-related nausea and


vomiting with ginger. Annals of Pharmacotherapy, 39, 1710-1713.

Buckle, J. (2003). Clinical aromatherapy: Essential oils in practice (2nd ed.).


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Buckle, J. (2007). Literature review: should nursing take aromatherapy more


seriously? British Journal of Nursing, 16(2), 116-120.

Buckle J. (2014, in press). Clinical Aromatherapy in Healthcare. London,


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Coleman Smith, V. (2012). Aromatherapy as a comfort measure during the


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maternity program. Beginnings, 30(4), 12-14.

Conrad, P., & Adams, C. (2012). The effects of clinical aromatherapy for
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Complementary Therapies in Clinical Practice, 18(3), 164-168.

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craving on a U.S. campus: A small comparison study. Journal of Alternative
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Clinical Aromatherapy for Pregnancy, Labor and Postpartum

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Hines, S., Steels, E., Change, A., & Gibbons, K. (2012). Aromatherapy
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Vakilian, K., Atarha, M., Bekhradi. R., & Chaman, R. (2011). Healing advantages
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Varney, E., & Buckle, J. (2013). Effect of inhaled essential oils on mental
exhaustion and moderate burnout: A small pilot study. Journal of Alternative
and Complementary Medicine, 19(1), 69-71.
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breastfeeding. International Journal of Childbirth Education, 24, 29-37.

Warnke, P., Lott, A., Sherry, E., & Podschun, R. (2013). The ongoing battle
against multi-resistant strains: in vitro inhibition of hospital-acquired MRSA,
VRE, Pseudomonas, ESBL, E coli and Klebsiella species in the presence of
plant derived antiseptic oils. Journal of Cranio-Maxillofacial Surgery, 41(4),
321-326.

Dr. Jane Buckle is the Director RJ Buckle Associates LLC www.


rjbuckle.com and the author of Clinical Aromatherapy in Nursing
(1997), Clinical Aromatherapy in Practice (2003) and Clinical
Aromatherapy in Healthcare (due early 2015). In 1996, she created
the first clinical aromatherapy program (CCAP) in USA. It
was the first aromatherapy program to be endorsed by a national
organization (The American Holistic Nurses Association) in 1999.
She has trained over 3,000 nurses and doctors and now lives in
London.

Kathy Ryan, is the Clinical Coordinator of the Monogram Maternity


Program at St. Vincent Women�s Hospital, Indianapolis, IN.
Kathy has 37 years of experience in Maternal Child Nursing. Certificated
in the �M� technique and as a CCAP (Certified Clinical
Aromatherapy Professional), Kathy was instrumental in creating
The St. Vincent Integrative Health Team.

Karen B. Chin, RN, MS, CCAP is Adjunct Faculty, ADN Program


at Panola College, in Panola St, Carthage, Texas. Karen�s ground-
breaking, investigational study on the use of teatree (Melaleuca
alternifolia in wound-healing was published in the Journal of
Alternative & Complementary Medicine in 2013. She works
a staff RN in PACU at the Good Shepherd Medical Center in
Marshall, Texas.

The focus of the next issue of


the journal is �Fatherhood�.
If you want to contribute, please
send articles to editor@icea.org
by November 1, 2014.
Publishing Assistance to ICEA Provided by
Volume 29 Number 4 October 2014 | International Journal of Childbirth Education |
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Reproduced with permission of the copyright owner. Further reproduction prohibited
without
permission.
Effectiveness of Aromatherapy
Raju Janula1 and
Singh Mahipal2

and Biofeedback in Promotion


of Labour Outcome during 1 JJT University, Rajasthan, India

2
Akhil
Bharati
Vidyapeeth
Nursing
Childbirth among Primigravidas College,
Sikar,
Rajasthan,
India

Corresponding Author: Janula Raju

. janular@gmail.com

Abstract Research Scholar, Department of Nursing,


JJT University, Rajasthan, India

Background: Labour
pain
is
the
most
severe
form
of
pain
that
every
woman
may
experience
during
intranatal
life.
Severe
pain
makes
stress
response
which
may
lead
to
harmful
effects
on
both
mother
and
her
fetus.
This
study
was
carried
out
Tel: +91 7415159891
to
evaluate
the
effect
of
aromatherapy
and
biofeedback
in
promotion
of
labour
outcome
during
childbirth
among
primigravidas.

Methods: This
clinical
trial
was
performed
on
600
nulliparous
women
selected
randomly
who
were
expected
to
have
a
normal
childbirth.
Cases
were
randomly
assigned
to
Aromatherapy
group
(n=200),
biofeedback
group
(n=200)
groups
and
control
group
(n=200).
The
investigator
rated
the
pain
by
using
visual
pain
analog
scale.

Results: Sixty
Nine
percent
(n=137)
of
cases
in
aroma
massage
group
expressed
it
was
helpful,
provided
pain
relief
and
emotional
wellbeing
during
labour.
Our
findings
suggested,
aromatherapy
was
helpful
in
reduction
of
duration
of
labour
(p<0.0001).
Biofeedback
is
also
an
effective
in
reducing
pain
and
duration
of
labour
during
childbirth
compared
with
the
non-experimental
group.

Conclusion: The
results
of
thispresent
study
indicated
thatthe
useofAromatherapy
and
Biofeedback
were
both
effective
methods
of
reducing
pain
perception
and
duration
of
labour
among
women
during
labor.

Keywords: Aromatherapy;
Biofeedback;
Childbirth;
Labour
pain;
Primigravida

anxiety
and
fear
are
factors
contributing
towards
women�s

Introduction
perception
of
pain
and
may
also
affect
their
labour
and
birth
Childbirth
is
considered
a
life-changing
event
for
most
women
experience.
Pain
associated
with
labour
has
been
described
as
who
are
associated
with
great
risks,
and
in
certain
cases
it
may
one
of
the
most
intense
forms
of
pain
that
can
be
experienced
cause
disability
and
even
death
for
the
mother
or
child
[1].
[4].
Many
women
would
like
to
avoid
invasive
methods
of

According
to
the
World
Bank
report
the
maternal
mortality
pain
management
during
labour
and
this
may
contribute
to
ratio
in
India
was
high
as
200
maternal
deaths
per
100000
live
the
development
of
complementary
or
non-pharmacological
births
in
2013
[2].
Maternal
mortality
ratio
(MMR)
is
defined
methods
for
pain
management.
This
study
examined
the
use
of

as
the
death
of
a
woman
while
pregnant
or
within
42
days
of
aromatherapy
and
biofeedback
as
non-pharmacological
methods
termination
of
pregnancy
and
is
received
by
dividing
the
number
for
pain
management
in
labour
[5].
of
maternal
deaths
per
100
000
live
births.Women
with
adequate

In
aromatherapy
therapy,
essential
oils
from
plants
were

psychological
support
and
relaxation
techniques
had
reduced
the

massaged
in
the
skin,
in
a
form
of
bath
or
inhalation
using
a

incidence
of
caesarean
section.
Relaxation
techniques,
mainly

steam
or
burner.
Literature
revealed
that
essential
oils
were
used
breathing
exercises,
had
brought
50%
reduction
in
caesarean

to
heal
various
ailments
by
therapeutically
stimulating
the
nasal/

section
for
psychological
indications
[3].

olfactory
senses
(smell)
via
mental
responses,
circulatory
and
During
labour
conflicting
emotions
are
present;
fear
and
unease
respiratory
functions.
Moreover
it
enhances
physical
and
mental
that
can
be
coupled
with
anticipation
and
gladness.
Tension,
wellbeing
of
patients
[6].
Biofeedback
or
biological
feedback
2This article is available in: www.hsj.gr/archive
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 1:9
Health Science Journal
ISSN 1791-
809Xencompassesatherapeutictechniquewhereanindividualwillbetrainedtoimprovetheirown
healthandwellbeingthroughsignalscomingfromthirownbodies(temperature,heartrate,
musculartension,etc.)
[7].Theunderlyingprincipleisthatchangesinthoughtsandemotionsmayresultinchangesinbod
yfunctioning.Thepresentstudywascarriedouttocomparethereductionofpainanddurationofla
bourbetweenthearomatherapytherapyandbiofeedbacktherapygropduringchildbirthamongprim
igravidas.
Method and Material
ThedatacollectionwasdonefromDec2012toSep2013atselectedhospitalsinCoimbatoreDist,Tam
ilNadu,SouthIndia.
Inclusioncriteriacomprisedonlynulliparouswomen,withasingletonpregnancyofgestationag
e>36weeks,singletonpregnancywithcephalicpresentation,cervicaldilatation=4cmandhavin
gthreeuterinecontractionsin10minutesatleastwithadurationof30seconds.Exclusioncriter
iaincluded,thirdtrimesterbleeding,intrauterinefetalgrowthretardation,multiplepregna
ncy,breechpresentation,beingathletic,addiction(alcoholandcigarettes),usinganalgesic
during3hoursbeforeandduringtheintervention,theuseofsedativedrugs,historyofinfertili
ty,
allergictolavenderoilduringskintest.
Thiswasapost-
testonlyexperimentalgroupdesign.Informationwasgatheredintheformofashortquestionnair
etoelicitmaternalfeedbackaboutreceiving&administeringtheexperiment.Afterexplanation
andobtainingwrittenconsentofwomen,theywererandomlyassignedtothreegroups:
Group 1 Aromatherapy application
Theoilusedforaromatherapywaslavenderoilandwasappliedbymassageduringlabourbytheinves
tigator.Beforethetherapy,
skinallergieswerecheckedbyconductingapatchtestontheskin.Randomlyselectedsubjects(n=
200)receivedaromatherapywhereoilwasappliedoverthebackandabdomenwithaslightmassage.T
hemassagewascontinuedtilltheendoffirststageoflabour.8
ThepainwasassessedinLatentphase,activephaseandtransitionalphase.Routineintrapartumc
arealsogivenforthemotherbythemidwives[9,10].Nofamilymemberswereinvolvedinthisstudy.
Group 2 Biofeedback application
Theinvestigatorpersonallyexplainedthepurposeofthestudywiththerandomlyselectedsubjec
t(n=200).Cardiotokograph,
anelectronicmachinewasusedforbiofeedbackstudy.Inthis,
motheraskedtoexperiencebothfetalheartsoundandvariationinuterinecontractions.Ithelpe
dhertoconsciouslyregulatebothpsychologicalandphysicalprocesses,suchaspain,whichwere
notusuallyunderconsciouscontrol[5].ThepainwasassessedinLatentphase,activephaseandtr
ansitionalphase.Theroutineintrapartumcarealsogivenforthemotherbythemidwives.Nofamil
ymemberswereinvolvedinthisstudy.NeonataloutcomedataincludedAPGARscoresat1and5minute
.
Group 3 Control group (n=200)
Receivedonlyroutineinterventionsaccordingtohospitalpolicies.
Theroutinecarewasgivenbythemidwivesandtheinvestigatorhasrecordedthepainintensitylev
elanddurationoflabouraslikeexperimentalgroup
Ethical Considerations
ThistrialwasapprovedbytheResearchEthicsCommittee(Protocolno:2013/PhDN/KG/006)ofconc
ernedselectedhospitalinCoimbatore,India.Womencompletedinformedwrittenconsentform.Ea
chwomanwasassignedanIDcode,ensuringdatasetanonymity.Womencouldwithdrawfromthestudya
tanypoint.
Limitations of the Study
Thestudywaslimitedtoprimigravidamothersonlywithtwovariableslikepainanddurationoflab
our.Thestudywasconductedinfewteachinghospitalsinthecity.
Results
Theresultsofthepresentstudyarebasedonthefindingsobtainedfromstatisticalanalysisofco
llecteddata.Thewomenunderstudywereprimigravidas.Majorityofmothersunderstudywerehada
gebetween21-25yrs(41%inaromatherapygroup,
48%inBiofeedbackgroupand46%inControlgroup).Mostofthemotherswerethehousewifeinallthr
eegroups50%,53%and53%-
aromatherapygroup,BiofeedbackgroupandControlgrouprespectively.Remainingmothersweret
hecoolie,technicalandprofessionalworkers.
Inthisstudythemeanpainscore(Table1)foraromatherapygroupandbiofeedbackwasreducedwhen
comparedwithcontrolgroup.Similarlythemeanlengthofdurationoflabouralsoreducedinfirst
stageandSecondstageoflabour(Table2).
But�t�testdemonstratedthattherewasasignificantdifferencebetweenaromatherapyandbiofe
edbackgroupinpainscore(Table3)duringlatentphase,activephaseandtransitionalphase.
Whenconsideringthelengthoflabouritwasfoundsignificantdifferencebetweenaromatherapya
ndbiofeedbackgroupinfirststageoflabour(p<0.0001).Butnodifference(Table4)werefoundin
secondandthirdstageoflabour(p=0.0518,p=1.000respectively).Theassociationoffindingsw
ithdemographicandobstetricalscorewasassessedbyusingchi-
squaretest.Itwasreportedthatbodymassindex(.2=35.8),natureofonsetoflabourpain(.2=6.9
),analgesics(.2=43.7),andhistoryofdysmenorrhea(.2=43.7)werehavingassociationwithlab
ourpain(Table5).Butnatureofconception(.2=0.011)andregularantenatalcheckup(.2=3.15)i
snothavingassociationwithlabourpain.
Table 1 MeanandstandarddeviationofpainscoreTime of Assessment
Aromatherapy Group Control group Biofeedback Group
Mean SD Mean SD Mean SD
Latentphase6.20.138.60.57.80.15Activephase7.50.219.00.348.2
0.19Transitionalphase8.30.479.60.219.20.01
This article is available in: www.hsj.gr/archive
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 1:9
Health Science Journal
ISSN 1791-
809Xencompassesatherapeutictechniquewhereanindividualwillbetrainedtoimprovetheirown
healthandwellbeingthroughsignalscomingfromthirownbodies(temperature,heartrate,
musculartension,etc.)
[7].Theunderlyingprincipleisthatchangesinthoughtsandemotionsmayresultinchangesinbod
yfunctioning.Thepresentstudywascarriedouttocomparethereductionofpainanddurationofla
bourbetweenthearomatherapytherapyandbiofeedbacktherapygropduringchildbirthamongprim
igravidas.
Method and Material
ThedatacollectionwasdonefromDec2012toSep2013atselectedhospitalsinCoimbatoreDist,Tam
ilNadu,SouthIndia.
Inclusioncriteriacomprisedonlynulliparouswomen,withasingletonpregnancyofgestationag
e>36weeks,singletonpregnancywithcephalicpresentation,cervicaldilatation=4cmandhavin
gthreeuterinecontractionsin10minutesatleastwithadurationof30seconds.Exclusioncriter
iaincluded,thirdtrimesterbleeding,intrauterinefetalgrowthretardation,multiplepregna
ncy,breechpresentation,beingathletic,addiction(alcoholandcigarettes),usinganalgesic
during3hoursbeforeandduringtheintervention,theuseofsedativedrugs,historyofinfertili
ty,
allergictolavenderoilduringskintest.
Thiswasapost-
testonlyexperimentalgroupdesign.Informationwasgatheredintheformofashortquestionnair
etoelicitmaternalfeedbackaboutreceiving&administeringtheexperiment.Afterexplanation
andobtainingwrittenconsentofwomen,theywererandomlyassignedtothreegroups:
Group 1 Aromatherapy application
Theoilusedforaromatherapywaslavenderoilandwasappliedbymassageduringlabourbytheinves
tigator.Beforethetherapy,
skinallergieswerecheckedbyconductingapatchtestontheskin.Randomlyselectedsubjects(n=
200)receivedaromatherapywhereoilwasappliedoverthebackandabdomenwithaslightmassage.T
hemassagewascontinuedtilltheendoffirststageoflabour.8
ThepainwasassessedinLatentphase,activephaseandtransitionalphase.Routineintrapartumc
arealsogivenforthemotherbythemidwives[9,10].Nofamilymemberswereinvolvedinthisstudy.
Group 2 Biofeedback application
Theinvestigatorpersonallyexplainedthepurposeofthestudywiththerandomlyselectedsubjec
t(n=200).Cardiotokograph,
anelectronicmachinewasusedforbiofeedbackstudy.Inthis,
motheraskedtoexperiencebothfetalheartsoundandvariationinuterinecontractions.Ithelpe
dhertoconsciouslyregulatebothpsychologicalandphysicalprocesses,suchaspain,whichwere
notusuallyunderconsciouscontrol[5].ThepainwasassessedinLatentphase,activephaseandtr
ansitionalphase.Theroutineintrapartumcarealsogivenforthemotherbythemidwives.Nofamil
ymemberswereinvolvedinthisstudy.NeonataloutcomedataincludedAPGARscoresat1and5minute
.
Group 3 Control group (n=200)
Receivedonlyroutineinterventionsaccordingtohospitalpolicies.
Theroutinecarewasgivenbythemidwivesandtheinvestigatorhasrecordedthepainintensitylev
elanddurationoflabouraslikeexperimentalgroup
Ethical Considerations
ThistrialwasapprovedbytheResearchEthicsCommittee(Protocolno:2013/PhDN/KG/006)ofconc
ernedselectedhospitalinCoimbatore,India.Womencompletedinformedwrittenconsentform.Ea
chwomanwasassignedanIDcode,ensuringdatasetanonymity.Womencouldwithdrawfromthestudya
tanypoint.
Limitations of the Study
Thestudywaslimitedtoprimigravidamothersonlywithtwovariableslikepainanddurationoflab
our.Thestudywasconductedinfewteachinghospitalsinthecity.
Results
Theresultsofthepresentstudyarebasedonthefindingsobtainedfromstatisticalanalysisofco
llecteddata.Thewomenunderstudywereprimigravidas.Majorityofmothersunderstudywerehada
gebetween21-25yrs(41%inaromatherapygroup,
48%inBiofeedbackgroupand46%inControlgroup).Mostofthemotherswerethehousewifeinallthr
eegroups50%,53%and53%-
aromatherapygroup,BiofeedbackgroupandControlgrouprespectively.Remainingmothersweret
hecoolie,technicalandprofessionalworkers.
Inthisstudythemeanpainscore(Table1)foraromatherapygroupandbiofeedbackwasreducedwhen
comparedwithcontrolgroup.Similarlythemeanlengthofdurationoflabouralsoreducedinfirst
stageandSecondstageoflabour(Table2).
But�t�testdemonstratedthattherewasasignificantdifferencebetweenaromatherapyandbiofe
edbackgroupinpainscore(Table3)duringlatentphase,activephaseandtransitionalphase.
Whenconsideringthelengthoflabouritwasfoundsignificantdifferencebetweenaromatherapya
ndbiofeedbackgroupinfirststageoflabour(p<0.0001).Butnodifference(Table4)werefoundin
secondandthirdstageoflabour(p=0.0518,p=1.000respectively).Theassociationoffindingsw
ithdemographicandobstetricalscorewasassessedbyusingchi-
squaretest.Itwasreportedthatbodymassindex(.2=35.8),natureofonsetoflabourpain(.2=6.9
),analgesics(.2=43.7),andhistoryofdysmenorrhea(.2=43.7)werehavingassociationwithlab
ourpain(Table5).Butnatureofconception(.2=0.011)andregularantenatalcheckup(.2=3.15)i
snothavingassociationwithlabourpain.
Table 1 MeanandstandarddeviationofpainscoreTime of Assessment
Aromatherapy Group Control group Biofeedback Group
Mean SD Mean SD Mean SD
Latentphase6.20.138.60.57.80.15Activephase7.50.219.00.348.2
0.19Transitionalphase8.30.479.60.219.20.01
Table 2 Mean
and
standard
deviation
of
Duration
of
labour

Stages of labour in Aromatherapy Group Control group Biofeedback Group


hours:mts Mean SD Mean SD Mean SD
First
stage
11:55
2.4
14:58
2.9
13:52
2.6
Second
stage
1:5
0.33
1:58
0.37
1:55
0.15
Third
stage
0:28
0.02
0:30
0.05
0:28
0.03

Table 3 Comparison
of
Pain
score
between
aromatherapy
and
biofeedback
group

Pain assessment Groups Mean SD value of �t� P value Result


Latent
phase
Aromatherapy
group
6.2
0.13
113.95
P<0.0001
SBiofeed
back
group
7.8
0.15
Active
phase
Aromatherapy
group
7.5
0.21
34.96
P<0.0001
SBiofeed
back
group
8.2 0.19
Transitional
phase
Aromatherapy
group
8.3
0.47
27.07
P<0.0001
SBiofeed
back
group
9.2
0.01

Table 4 Comparison
of
Duration
of
labour
between
aromatherapy
and
biofeedback
group

Stages of labour Groups Mean SD value of �t P value Result


First
stage
Aromatherapy
group
11.55
2.4
7.87
P<0.0001
SBiofeed
back
group
13.52
2.6
Second
stage
Aromatherapy
group
1.5
0.33
1.95
P=0.0518
NSBiofeed
back
group
1.55
0.15
Third
stage
Aromatherapy
group
0.28
0.02
0.000
P=1.000
NSBiofeed
back
group
0.28
0.03

Table 5 Association
of
Pain
score
with
selected
obstetrical
variable

Individual
reviews
showed
that
there
is
no
significant
difference
between
aromatherapy
group
and
Biofeedback
Group.
Although
morewomeninaromatherapygroupweresatisfiedwithpainrelief
(p=0.6443)
and
caesarean
section
(p=0.0304)
was
reduced
(Table
6).
No
women
in
either
group
had
a
postpartum
haemorrhage
(p=1.000).
The
findings
of
the
study
were
concluded
that
aroma
therapy
and
biofeedback
were
found
effective
when
compared
with
control
group.

S.
No.
Selected
obstetrical
variables
Pain
score
Value
of
.2
P
value
At
5%
Level
of
significance
Result
Below
Median
Above
Median
1.
Quetelet�s
Body
mass
index
a) <
24
b) =
24
132
183
189
96
35.8401
0.
S
2.
Nature
of
onset
of
labour
pain
a) Spontaneous
b) Induced
181
134
133
152
6.9879
0.008206
S
3.
Nature
of
conception
a) Assisted
b) Natural
05
285
05
305
0.0113
0.915298
NS
4.
Analgesics
given
a) Yes
b) No
225
75
30
270
259.335.
0.
S
5
History
of
Dysmenorrhea
a) Yes
b) No
53
142
175
130
43.7265
0
S
6
Regular
antenatal
check
up
a)Yes
b)No
138
152
170
140
3.1547
0.07571
NS

Discussion

This
study
has
evaluated
the
effectiveness
of
aromatherapy
and
biofeedback
in
reduction
of
pain
and
duration
of
labour
during
childbirth.
Overall
there
was
a
slight
difference
between
aroma
therapy
and
biofeedback
therapy.
But
when
compared
with
aroma
therapy
there
was
a
limited
pain
reduction
in
biofeedback
therapy.
However
biofeedback
therapy
also
found
effective
when
compared
with
control
group.
Duchene,
1998
reported
that
4This article is available in: www.hsj.gr/archive
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 1:9
Health Science Journal
ISSN 1791-
809Xwomenwhopracticedbiofeedback,hadsignificantreductioninlaborpainaccordingtotheMc
GillPainQuestionnairescaleandalsoreductionindurationoflabour[10].
Aromatherapyisacosteffectivenonpharmacologicalpainreliefmethod.Thepresentstudyshowe
dthat,aromatherapywaseffectiveinreductionofpainanddurationoflabour.Nomaternalandneo
nataladverseeffectswereassociatedwitharomatherapy.
Themajorityofwomenreportedsatisfactionabouttheirlabourexperience.Toconfirmthis,Chan
getal.,
[11]demonstratedastudyinwhicharomatherapymassagewaseffectiveonpainreductionandallev
iationoffearduringlabor.Ourfindingalsoshowedthatmeanpainintensityinfirststageoflabo
rwasreducedwhencomparingwithnon-
experimentalgroup.ItwasalsosupportedbyanotherstudyconductedbyBurnsetal.,[12]
where,theyconcludedthataromatherapywasusefultorelievepainandalsostrengthentheuterin
econtractionsduringlabor.
TherecentstudybyAbbaspoor,
[13]alsoconfirmedthat,lavenderoilmassagewasacosteffectiveinterventionduringchildbir
thtodecreasepainanddurationoflabourduringthefirstandsecondstageoflbour.SimilarlyJen
nings[14]reportedthatlavenderoilpromotesrelaxation,anditmaygivesootheeffecttotheski
nandstimulatethenerveendingswhenapplyinglikeamassage.
Lavendermassageusedinaromatherapycanreducethepainduringfirststageoflaboranditcanred
uceawiderangeofworstlabouroutcomes.Aromatherapyisanalternativetreatmentduringlabour
inreductionofpain,insteadofusingpharmacologicalmethodsofpainrelievers[15].However,t
hefinalresultofourstudyalsoshowedthataromatherapywasmoreusefulthanbiofeedbacktherap
yanditwascomparedwithcontrolgroup.Aresearchstudyreportedthatlinaloolwhichispresenti
nlavenderoilishavingsedativeandlocalanestheticeffect.Thisconstituentmayreducetheper
ceptionoflabourpain.Italsoincreasethesecretionofepinephrinewhichmayresponsibleforth
ereductionofpainperceptionbythemother[16].
Biofeedbackisalsoavaluabletoolinreductionoflabourpainwhichfacilitatespsychologicali
nterventionsthataiddevelopinggreaterskillsfocopingandimprovedfunctioningonmeasureso
fpainintensity,adaptivebeliefsaboutpainandthelevelofdepression[17].Duringbiofeedbac
ktherapy,electrodeswereattachedtothepatient'sskin,whichsendsdatatoascrutinizingcart
on.Thebiofeedbacktherapistreadsthedimensionsandthroughtrialanderrorsignalsoutmental
undertakingsthathelpstonormalizethepatient'swhoebodyprocesses[18].
Giardinoetal.,
[19]statedthat,biofeedbackistomakeapersonwhoisinananxiousstatetobecomeawareofthephy
siologicalchangesandsledsmanipulatetobeinarelaxedstate.Sutartoetal.,
[20]examinedtheeffectofresonantbreathingbiofeedbackteachingfordecreasingstressamong
constructingoperators.
Outcomesdemonstratedthatdespondency,anxiety,andstresssignificantlydeclinedafterthet
raininginexperimentalgroup.Moreoverwhenusedasanadjuncttoothertherapeuticinterventio
nsitshownasaneffectivetreatmentforreducingoreliminatingsymptomsofseverapain-
relatedconditions,
includinglowbackpain[21].Asanon-
pharmacologicalnursingintervention,biofeedbacktherapyiseasytoadminister,costeffecti
ve,harmless,doesnotrequiremuchtraining,anditisappealingtothemother[22].Thepresentst
udyresultsshowedthatbiofeedbacktherapyalsoagoodandeffectivenonpharmacologicalmethod
forreductionofpainanddurationoflborwhencomparedwithcontrolgroupwhereas,whencompared
witharomatherapy,ithaslesssignificanteffectsonthe both variables.
Conclusion
Theresultsofthispresentstudysuggesttheuseofaromatherapyandbiofeedbackasaneffectivem
ethodofreducingpainperceptionanddurationoflaouramongwomenduringlabor.
Asanon-
pharmacologicalnursingintervention,theseareeasytoadminister,costeffective,harmless,
donotrequiremoretraining,
andappealingtothemother.Thisinterventionmaybeusedbyhealthcarepractitioners(midwives
,medicalandnursingstaff,
studentnurses)aspartoftheirroutinewhenprovidingcarewithwomenduringthelaborprocess.
Acknowledgements
Wesincerelythankallwomenwhogaveconsentandparticipatedinthisstudy.
Declarations
Funding: NofundingsourcesCompeting interests:
Therearenocompetingintereststodeclare.
Ethical approval: ThestudywasapprovedbytheInstitutionalethicscommittee.
Table 6 Resultsbyindividualreview-AromatherapytherapyversusBiofeedbackgroupOutcome
No of women in Aromatherapy
Group (n=200)
No of women in Biofeedback
Group (n=200))
RR95%CI p value
Positive
outcome
Negative
outcome
Positive
outcome
Negative
outcome
Painintensity15248148521.02700.9171to1.15010.6443Satisfactionwithpainrelief14852150
500.97370.8695to1.09040.6443Satisfactionwithhildbirthexperience13763135651.01480.88
71to1.16090.8303Assistedvaginalbirth12575130700.96150.8294to1.11480.6032Caesareanse
ction7822
180201.09091.0083to1.18030.0304Adverseeffectforwomen(PPH)20000200001.0000.9903to1.0
0981.000Postnataldepression1901018911
1.04420.9873to1.10430.1300Adverseeffectofinfants17822
180201.00530.9600to1.05280.8226APGARScore<7atfirst5minute17921 17228
1.04070.9671to1.11990.2865
This article is available in: www.hsj.gr/archive
ARCHIVOS DE MEDICINA
ISSN 1698-9465
2015
Vol. 9 No. 1:9
Health Science Journal
ISSN 1791-
809Xwomenwhopracticedbiofeedback,hadsignificantreductioninlaborpainaccordingtotheMc
GillPainQuestionnairescaleandalsoreductionindurationoflabour[10].
Aromatherapyisacosteffectivenonpharmacologicalpainreliefmethod.Thepresentstudyshowe
dthat,aromatherapywaseffectiveinreductionofpainanddurationoflabour.Nomaternalandneo
nataladverseeffectswereassociatedwitharomatherapy.
Themajorityofwomenreportedsatisfactionabouttheirlabourexperience.Toconfirmthis,Chan
getal.,
[11]demonstratedastudyinwhicharomatherapymassagewaseffectiveonpainreductionandallev
iationoffearduringlabor.Ourfindingalsoshowedthatmeanpainintensityinfirststageoflabo
rwasreducedwhencomparingwithnon-
experimentalgroup.ItwasalsosupportedbyanotherstudyconductedbyBurnsetal.,[12]
where,theyconcludedthataromatherapywasusefultorelievepainandalsostrengthentheuterin
econtractionsduringlabor.
TherecentstudybyAbbaspoor,
[13]alsoconfirmedthat,lavenderoilmassagewasacosteffectiveinterventionduringchildbir
thtodecreasepainanddurationoflabourduringthefirstandsecondstageoflbour.SimilarlyJen
nings[14]reportedthatlavenderoilpromotesrelaxation,anditmaygivesootheeffecttotheski
nandstimulatethenerveendingswhenapplyinglikeamassage.
Lavendermassageusedinaromatherapycanreducethepainduringfirststageoflaboranditcanred
uceawiderangeofworstlabouroutcomes.Aromatherapyisanalternativetreatmentduringlabour
inreductionofpain,insteadofusingpharmacologicalmethodsofpainrelievers[15].However,t
hefinalresultofourstudyalsoshowedthataromatherapywasmoreusefulthanbiofeedbacktherap
yanditwascomparedwithcontrolgroup.Aresearchstudyreportedthatlinaloolwhichispresenti
nlavenderoilishavingsedativeandlocalanestheticeffect.Thisconstituentmayreducetheper
ceptionoflabourpain.Italsoincreasethesecretionofepinephrinewhichmayresponsibleforth
ereductionofpainperceptionbythemother[16].
Biofeedbackisalsoavaluabletoolinreductionoflabourpainwhichfacilitatespsychologicali
nterventionsthataiddevelopinggreaterskillsfocopingandimprovedfunctioningonmeasureso
fpainintensity,adaptivebeliefsaboutpainandthelevelofdepression[17].Duringbiofeedbac
ktherapy,electrodeswereattachedtothepatient'sskin,whichsendsdatatoascrutinizingcart
on.Thebiofeedbacktherapistreadsthedimensionsandthroughtrialanderrorsignalsoutmental
undertakingsthathelpstonormalizethepatient'swhoebodyprocesses[18].
Giardinoetal.,
[19]statedthat,biofeedbackistomakeapersonwhoisinananxiousstatetobecomeawareofthephy
siologicalchangesandsledsmanipulatetobeinarelaxedstate.Sutartoetal.,
[20]examinedtheeffectofresonantbreathingbiofeedbackteachingfordecreasingstressamong
constructingoperators.
Outcomesdemonstratedthatdespondency,anxiety,andstresssignificantlydeclinedafterthet
raininginexperimentalgroup.Moreoverwhenusedasanadjuncttoothertherapeuticinterventio
nsitshownasaneffectivetreatmentforreducingoreliminatingsymptomsofseverapain-
relatedconditions,
includinglowbackpain[21].Asanon-
pharmacologicalnursingintervention,biofeedbacktherapyiseasytoadminister,costeffecti
ve,harmless,doesnotrequiremuchtraining,anditisappealingtothemother[22].Thepresentst
udyresultsshowedthatbiofeedbacktherapyalsoagoodandeffectivenonpharmacologicalmethod
forreductionofpainanddurationoflborwhencomparedwithcontrolgroupwhereas,whencompared
witharomatherapy,ithaslesssignificanteffectsonthe both variables.
Conclusion
Theresultsofthispresentstudysuggesttheuseofaromatherapyandbiofeedbackasaneffectivem
ethodofreducingpainperceptionanddurationoflaouramongwomenduringlabor.
Asanon-
pharmacologicalnursingintervention,theseareeasytoadminister,costeffective,harmless,
donotrequiremoretraining,
andappealingtothemother.Thisinterventionmaybeusedbyhealthcarepractitioners(midwives
,medicalandnursingstaff,
studentnurses)aspartoftheirroutinewhenprovidingcarewithwomenduringthelaborprocess.
Acknowledgements
Wesincerelythankallwomenwhogaveconsentandparticipatedinthisstudy.
Declarations
Funding: NofundingsourcesCompeting interests:
Therearenocompetingintereststodeclare.
Ethical approval: ThestudywasapprovedbytheInstitutionalethicscommittee.
Table 6 Resultsbyindividualreview-AromatherapytherapyversusBiofeedbackgroupOutcome
No of women in Aromatherapy
Group (n=200)
No of women in Biofeedback
Group (n=200))
RR95%CI p value
Positive
outcome
Negative
outcome
Positive
outcome
Negative
outcome
Painintensity15248148521.02700.9171to1.15010.6443Satisfactionwithpainrelief14852150
500.97370.8695to1.09040.6443Satisfactionwithhildbirthexperience13763135651.01480.88
71to1.16090.8303Assistedvaginalbirth12575130700.96150.8294to1.11480.6032Caesareanse
ction7822
180201.09091.0083to1.18030.0304Adverseeffectforwomen(PPH)20000200001.0000.9903to1.0
0981.000Postnataldepression1901018911
1.04420.9873to1.10430.1300Adverseeffectofinfants17822
180201.00530.9600to1.05280.8226APGARScore<7atfirst5minute17921 17228
1.04070.9671to1.11990.2865
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Reproduced with permission of the copyright owner. Further reproduction prohibited
without
permission.
Original Article Original Article
Effect of Lavender Oil Aroma in the Early Hours of Postpartum Period on
Maternal Pains, Fatigue, and Mood: A Randomized Clinical Trial

Abstract
Background: Busy care providers focus on the serious complications of postpartum
period. This
issue causes the seemingly trivial complications, such as mother�s pains, fatigue,
and psychological
status, to be less taken into account. The study aimed to determine the effect of
lavender oil aroma in
the early hours of postpartum period on maternal pains, fatigue, and mood in
primiparous mothers.
Methods: This randomized clinical trial was conducted on 56 participants; 29 in
intervention group
and 27 in control group. The intervention group received lavender oil in three
doses during the
first 24 h after delivery. Sesame oil was used in the control group. Intensity of
pain, fatigue, and
distress level was measured by visual analog scale before and after the
interventions. Besides, mood
status was assessed through the positive and negative affect schedule. Results: The
mean age of
all the participants was 23.88 � 3.88 years. After the first intervention and also
in the tomorrow
morning assessment, significant differences were found between the two groups
regarding perineal
pain (P = 0.004, P < 0.001), physical pain (P < 0.001), fatigue (P = 0.02, P <
0.001), and distress
scores (P < 0.001). In addition, significant differences were found concerning the
mean scores of
positive (P < 0.001) and negative (P = 0.007, P < 0.001) moods between the two
groups after the
interventions. Repeated measures analyses showed that the two groups were
significantly different
over time in all the evaluated variables. Conclusions: Lavender oil aromatherapy
starting in the first
hours of postpartum period resulted in better physical and mood status compared to
nonaromatic
group.
Keywords: Fatigue, lavender oil aromatherapy, mood, perineal pain, postpartum
Introduction

The mothers who give birth in maternity


wards are under the supervision of skilled

personnel in the immediate postnatal


period and are monitored regarding
the life-threatening conditions, such as

bleeding, hypertension, and infection.[1,2]


In addition to fatal complications, mothers
in the immediate postpartum period may
suffer from some problems, such as
perineal pain, back pain, uterine cramps,
and fatigue. Busy care providers focus on
the serious complications of postpartum
period. This issue causes the seemingly
trivial complications, such as mother�s
perineal pain, fatigue, and psychological
status, to be less taken into account.[1,3,4]
In addition, mothers may consider these
problems as the natural consequences of
labor and speak less about them.[5] Perineal
pain as well as other physical pain in the
postpartum period can lead to insomnia,
fatigue, confusion, anxiety, delay in the

This is an open access article distributed under the terms of the


Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.

For reprints contact: reprints@medknow.com

formation of relationship between the


mother and her baby, disability in caring
about the newborn, and inappropriate body
position during breastfeeding. In severe
pain and immobility cases, there is also a
risk of deep vein thrombosis.[5,6]

Perineal pain can be treated by a variety


of oral analgesics, rectal suppositories,
and topical anesthetics. In a previous
study, only about 63% of the mothers
described that painkillers were effective
in relief of perineal pain.[3] In our society,
sedative drugs such as mefenamic acid are
routine care managements of pain such as

perineal pain after delivery. Sedative drugs

act in relative manners that need other


complementary methods. Besides, these
drugs have some serious effects that result
in limiting consumption.

It should be noted that, in most cases in


Iran, mediolateral incision is made for
episiotomy and catgut thread is used for its
repair, resulting in more perineal pain.[1,7]

How to cite this article: Vaziri F, Shiravani M,


Najib FS, Pourahmad S, Salehi A, Yazdanpanahi Z.
Effect of lavender oil aroma in the early hours of
postpartum period on maternal pains, fatigue, and
mood: A randomized clinical trial. Int J Prev Med
2017;8:29.
Farideh Vaziri,
Mahsa Shiravani1,
Fatemeh Sadat
Najib2,
Saeedeh
Pourahmad3,
Alireza Salehi4,
Zahra Yazdanpanahi

Department of Midwifery,
School of Nursing and
Midwifery, Shiraz University of
Medical Sciences, Shiraz, Iran,
1Student Research Committee,
School of Nursing and
Midwifery, Shiraz University of
Medical Sciences, Shiraz, Iran,
2Department of Obstetrics and
Gynecology, Infertility Research
Center, Shiraz University of
Medical Sciences, Shiraz, Iran,
3Department of Biostatistics,
Medical School, Shiraz
University of Medical Sciences,
Shiraz, Iran, 4Research Center
for Traditional Medicine and
History of Medicine, Shiraz
University of Medical Sciences,
Shiraz, Iran

Address for correspondence:

Farideh Vaziri,
Department of Midwifery,
School of Nursing and
Midwifery, Shiraz University of
Medical Sciences, Zand Street,
Shiraz, Iran.
E-mail: vazirif@sums.ac.ir

Access this article online


Website:
www.ijpvmjournal.net/www.ijpm.ir
DOI:
10.4103/ijpvm.IJPVM_137_16
Quick Response Code:
Therefore, a lot of women in Iran and other countries (with
similar above-mentioned midwifery background) need

to be relieved from perineal pain during the first 24 h

postpartum.

Conventionally, fatigue and lack of energy have been


accepted as the common consequences of childbirth in the
postpartum period. In the past two decades, fatigue has

been one of the five most important issues for women in

the postpartum period. Fatigue is a condition that causes the


mother to have negative feelings and be uncomfortable.[8,9]

Lavender is an aromatic plant that is widely used in


aromatherapy. Researches have indicated that aromatherapy

with lavender has anti-inflammatory, anti-depressant,

hypnotic, sedative, muscle-relaxant, anti-bacterial, and


anti-spasmodic effects.[10,11] Aromatherapy with lavender
oil has been used to reduce pain and anxiety during labor,
and mothers have generally evaluated this approach as an
appropriate method.[12]

Considering the implementation of rooming-in method


in most maternity wards, it is important that mothers
experience less pain and fatigue, have a good mood
to establish an appropriate emotional relationship with
their infants in the early hours of postpartum period, and
can breastfeed and take care of their infants. Obviously,
supportive efforts from care providers result in an
successful initiation of breastfeeding that causes it to be
continued after release from hospital.[13] Discharge with
better physical and mental conditions in turn improves
women�s quality of life.[14,15] Thus, the present study aims
to assess the effect of lavender oil aroma in the early hours
of postpartum period on maternal physical pains, fatigue,
and mood in primiparous women.

Methods
Participants and setting

This clinical trial was conducted on 56 primiparous women


with normal vaginal delivery in one educational hospital

affiliated to Shiraz University of Medical Sciences. The

participants were under the immediate postpartum care in


the postpartum wards. Data collection was performed from
the second half of April to late June 2014. This study was

confirmed by the Ethics Committee of Shiraz University


of Medical Sciences (code: CT91-6943). The investigation

was also registered in the Iranian Registry of Clinical Trials


as IRCT2014060910327N7.

The inclusion criteria of the study were vaginal delivery


with episiotomy and without spinal or epidural anesthesia,
singleton pregnancy, live and normal infant, aged
18�35 years, not suffering from severe chronic diseases
such as cardiovascular and lung disease, at least 4 h later

than delivery, perineal pain score =4 in visual analog


scale (VAS), and having no history of allergy to lavender

plant. On the other hand, in case the mothers were not

willing to continue participation in the study, could not bear


the smell of lavender essential oil, and were susceptible to
complications such as hypertension, bleeding, and fever,
they were excluded from the study.

In the postpartum ward, the researcher selected the


participants based on the patients� records and interviews.
After description of the study objectives, the mothers were
encouraged to participate in the study, and if they were
willing, written informed consents were obtained from

them. Due to the possible emergency problems in the first

hour of postpartum, sampling was done after this period.

Tools and data collection

In the present study, physical pain was defined as back pain,

muscle pain, and uterine cramps. In addition, perineal pain


was considered as a pain in the external genitalia. Before
the intervention, the primiparous mothers were asked to

indicate the intensity of the above-mentioned pain by VAS.


If the mothers showed pain intensity =4, they were enrolled
into the study. A pain VAS scale is a 100 mm horizontal

line, representing no pain at the commence and the worst


possible pain at the end.[16]

A fatigue VAS scale, a 100-mm horizontal line quantifying

fatigue between the anchors �no fatigue� and �fatigue as


bad as can be, measured the fatigue.� With insertion of
a spot on the line, the participant expressed how much
fatigue she was experiencing at the study point time.

Distress perception was also assessed by VAS, fixed with

feeling rested at the beginning and completely distressed


at the end.[17] In our study, before the first intervention,
test-retest analyses showed the correlations of 0.93 and

0.90 for fatigue and peace perception, respectively.


Moreover, the mothers� mood was evaluated by the
Positive and Negative Affect Schedule (PANAS). This
scale consisted of 10 items for assessing the negative
moods and 10 items for evaluating the positive ones, which

were mixed in the PANAS. The items of this questionnaire

were responded through a Likert scale ranging from 1 to 5.


Thus, the total scores of both positive and negative moods
varied from 10 to 50.[18] It should be noted that the total
scores of positive and negative statements were analyzed

separately. In this study, for positive section of the PANAS,

we obtained a Cronbach�s alpha and a test-retest correlation


value of 0.88 and 0.85, respectively. In addition, for

negative section of the PANAS, a Cronbach�s alpha and a

test-retest correlation value of 0.87 and 0.89 were obtained,


respectively.

Interventions

In this study, the participants were selected by convenience


sampling. Then, they were randomly divided into a control
and an intervention group through block randomization.

In the intervention group, lavender oil was utilized.


Lavandula officinalis species was bought from the

International Journal of Preventive Medicine 2017, 8: 29


pharmacy of traditional medicine affiliated to Shiraz
University of Medical Sciences and its essence was

obtained using Apparatus Clevenger in the pharmacology

laboratory of School of Medicine, Shiraz University of


Medical Sciences. One percent lavender essential oil was

provided by the laboratory technician. The researcher

instilled five drops of lavender essential oil on a cotton

ball and asked the participants to hold it about 20 cm from


their nose for 10�15 min and breathe normally. One hour
later, the participants� physical pain, fatigue, and mood
were evaluated. The intervention with lavender oil was

repeated 6 h after the first intervention and at bed time. In

the following morning before discharge, the participants�


physical pain, fatigue, distress, and mood were measured
again. At present, there are no instructions in the Western
countries in setting standards for essential oils, and oils are
not regulated by the Food and Drug Administration. There
is not a great amount of published rigorous research testing
aromatherapy oils and techniques; therefore, consensus is
lacking on these subjects. Researchers selected the dose

and intervals of consumption anecdotally. Exactly 1 to

2% concentration of lavender oil was used intrapartum


to manage labor pain and anxiety without any harm for
mother or her fetus. Therefore, we followed this method in
our study.[19]

The previous study showed that lavender aroma in infancy


was not harmful.[20,21] However, in the present study, we
used low concentration of lavender oil (1%), and for more
caution, the mother was separated from her baby during the
aromatherapy period.

In the control group, sesame oil was used as placebo


similar to lavender oil in intervention group as

mentioned above. Sesame oil was provided from Oila

Company (manufactured in Tehran, Iran).

The participants were blinded for the types of the oils;


therefore, the study was a single-blinded study. The two
study groups received routine postpartum care including
sedative drugs.

Sample size and statistical analysis

Based on a previous study,[22] considering a = 0.05


and power of 80%, and using the statistical formula, a
60-subject sample size was determined for the study.
The data were analyzed using SPSS statistical software
version 16 (SPSS Inc., Chicago, IL, U.S.A). Besides,
P < 0.05 was considered statistically significant. At first,

normality of distribution of quantitative variables was

assessed by one-sample Kolmogorov�Smirnov test. If the

variables followed normal distribution, independent samples


t-test was used; otherwise, its equivalent nonparametric

test, i.e., Mann�Whitney U-test, was employed. In addition,

repeated measures analysis of covariance was applied to


determine changes over time in each group. Chi-square test
was also used for investigation of the qualitative variables.

Results

In this study, 76 primiparous women were interviewed,


62 of whom were eligible for the study and six women
were excluded from the study due to discharge from the
hospital before the end of the study. After all, the data of
56 participants (29 in the intervention group and 27 in the
control group) were analyzed.

The participants� age ranged from 18 to 32 years,


with a mean age of 23.88 � 3.88 years. In addition,
51.8% (n = 29) of the participants had primary and
high school education, 33.9% (n = 19) had high school
diplomas, and 14.3% (n = 8) had university education. All
the participants were homemakers. It should be noted that
the two groups were matched regarding age (P = 0.39) and
education level (P = 0.54).

The baseline severity of perineal pain was 70.55 � 17.92


in all the participants with a minimum and maximum of
40 and 100, respectively. Before the intervention, the mean
perineal pain was not statistically different between the
two groups (P = 0.82). However, a significant difference
was observed between the two groups after the first

intervention and at the tomorrow morning assessment.


The intragroup comparisons showed that the intensity of
perineal pain differed only in the intervention group over
time (P < 0.001) [Table 1]. According to Figure 1, two
groups were different with regard to perineal pain along time.

The baseline severity of other physical pain, such as


back pain and uterine cramps, was 62.64 � 20.12 and

69.54 � 23.29 in the intervention and control groups,


respectively, and the difference was not statistically
significant. Nevertheless, a statistically significant

difference was found between the two groups after the


interventions (P < 0.001) [Table 1].
The baseline severity of fatigue in the whole sample
was 40.19 � 15.59, with a minimum and maximum

Figure 1: Within-groups comparison related to the perineal pain scores: The


results showed, between the two groups, the difference regarding over-time
reduction of the perineal pain scores was statistically significant (P
< 0.001)

International Journal of Preventive Medicine 2017, 8: 29


Table 1: Comparison of the perineal and physical pain, fatigue, distress, and
Positive and Negative Affect Schedule
measurements between the two groups

Variables Time point

Mean�SD* P

Before the After the first The tomorrow Time.,..


Group.,� Time � group.,�
intervention intervention morning assessment

Perineal pain
Lavender 70.03�19.12 60.93�23.51 46.37�20.67 <0.001 0.001 <0.001
Control 71.11�16.88 77.00�16.00 74.48�15.01
P** 0.825 0.004 <0.001

Physical pain
Lavender 62.64�20.12 34.51�36.23 18.75�20.51 <0.001 <0.001 <0.001
Control 69.54�23.29 70.54�24.39 59.36�31.82
P*** 0.240 <0.001 <0.001

Fatigue
Lavender 41�16.25 30.95�15.86 21.68�14.30 <0.001 0.02 <0.001
Control 39.33�15.11 40.33�14.46 38.22�15.14
P** 0.69 0.02 <0.001

Distress perception
Lavender 26.20�18.65 17.13�17.28 8.55�11.53 0.04 0.009 <0.001
Control 24.74�15.88 25.40�17.42 32.85�19.66
P** 0.85 0.05 <0.001

Positive affect schedule


Lavender 36.27�3.31 39.41�3.01 42.75�3.22 <0.001 <0.001 <0.001
Control 36.29�2.86 36.18�2.82 36.62�2.84
P*** 0.908 <0.001 <0.001

Negative affect schedule


Lavender 13.68�4.06 11.20�1.54 10.37�0.62 0.003 <0.001 0.05
Control 12.74�2.86 12.88�2.77 13.55�3.81
P** 0.532 0.007 <0.001

*Mean�SD, **Student�s t-test, ***Mann-Whitney test, .Repeated measures test,


..Within-subjects results, �Between-groups results, �Interaction
between groups and time. SD=Standard deviation

of 8 and 88, respectively. Before the intervention,

no significant difference was observed between the

intervention and control groups regarding the intensity of


fatigue (P = 0.69). However, significant differences were
observed between the two groups after the first intervention

and at the tomorrow morning assessment (P = 0.02 and


P < 0.001, respectively). The intragroup comparisons
also showed that the intensity of fatigue followed a
descending trend in the lavender oil group, but not in
control group (P < 0.001 and P = 0.44, respectively)
[Table 1 and Figure 2]. Between-group analyses showed
that mean scores of distress in the lavender oil group were

significantly lower compared to the control group at the

tomorrow morning assessment (P < 0.001). Besides, the two


groups were significantly different along time [Table 1].
The highest scores of positive and negative moods were
42/50 and 24/50, respectively. The mean score of negative
moods was 13.23 � 3.53 at baseline and 11.91 � 3.10 in
the tomorrow morning assessment. These measures were,
respectively, obtained as 36.28 � 3.07 and 39.80 � 4.32

for positive moods. The results showed no significant

difference between the intervention and control groups


concerning the baseline negative and positive mood scores.

Figure 2: Within-groups comparison related to the fatigue scores: The


results showed, between the two groups, the difference regarding over-time
reduction of the fatigue scores was statistically significant (P< 0.001)

After the first intervention and at the tomorrow morning


assessment, however, significant differences were found

between the two groups regarding the negative and the


positive mood scores [Table 1]. Moreover, the intragroup
comparisons showed that the intervention group�s positive

International Journal of Preventive Medicine 2017, 8: 29


and negative mood scores significantly differed in the

three assessment times (P < 0.001) [Table 1]. The results


of repeated measures analysis (time effect, group effect,
and interaction between time and groups) were shown in
Table 1 for all variables.

Discussion

The result showed that aromatherapy with lavender oil


was effective in reducing pain, fatigue, and distress and
could improve maternal mood. One of the strong points
of this study was including a control group. Although
mother�s physical pain and fatigue may decrease by resting
after delivery, the effectiveness of the intervention was
determined after comparison with the control group. In
addition, over-time analyses (repeated measures analyses)
revealed that pain, fatigue, and distress decreased as well
as mothers� mood improved in the intervention group.
Nevertheless, the following points should be noted in the
control group. In this group, the severity of perineal pain

increased after the first intervention and in the tomorrow

morning assessment compared to before the intervention;

however, the differences were not statistically significant.

Furthermore, the mean intensity of fatigue importantly


increased in the tomorrow morning assessment compared
to before the intervention.

The negative mood scores in the PANAS questionnaire

could vary from 10 to 50. Overall, our participants had


a low mean score of negative moods, in such a way that
the mean scores of negative moods were 13.23 � 3.53 and

11.91 � 3.10 before the intervention and in the tomorrow


morning assessment, respectively. These low mean scores
might have resulted from the euphoria of motherhood.
In contrast to the intervention group, the mean scores of
negative moods followed a rising trend in the control group
over time. However, the differences were not statistically
significant. The positive mood scores showed no significant
changes in the control group over time. These findings also

demonstrated the effectiveness of lavender essential oil.

We could find no similar studies investigating the effect

of inhalation aromatherapy on pain relief, reduction of

fatigue, and improvement of mood during the first 24 h

after vaginal childbirth. However, several studies have been


conducted on postcesarean delivery pain and showed that
lavender aromatherapy could relieve postcesarean delivery
pain.[23-25]

Furthermore, the effects of lavender oil sitz bath on perineal


pain have been assessed in some studies. The results of the
study by Sheikhan et al. showed that lavender oil sitz bath
group experienced less perineal pain at 4 h and 5 days after
delivery.[22] Nevertheless, Vakilian et al. reported that the
intensity of perineal pain in the lavender oil sitz bath group
was not less than that of the control group.[26] Different
study population and accuracy in sample selection could
lead to obtain dissimilar results in these studies.

Postpartum fatigue starts soon after delivery, gets more


intense as time progresses, and may not be recovered
spontaneously.[27] Fatigue can interfere in the activities of
the new mothers and may also expose them to postpartum
blues and depression. Fatigue can occur due to various
factors, such as length of labor, type of delivery, postpartum
hemorrhage, perineal pain, and other physical pain.[8] By
shortening the duration of postpartum hospitalization,
health-care providers have lower opportunity to evaluate
and manage the above-mentioned complication; therefore,

the first 24 h after delivery is a critical time point.

In the study conducted by Lee, aromatherapy with lavender


oil inhalation was used 6 days after delivery to reduce
fatigue and improve sleep. Aromatherapy was given by a
necklace from 2 to 8 pm. At the end, the intervention group
reported less fatigue compared to the control group.[28]

Evidence has shown the importance of mother�s mood in

the 1st day postpartum and gives us an idea about the need
for appropriate actions. A link between the maternal mood
scores in the early days of postpartum and the mood scores
at 4, 6, 8, and 12 weeks after birth has been reported.[29-31]

The prior studies using aromatherapy in the postpartum


period and maternal mood were different from the present
one with respect to aromatherapy methods and assessment
instruments. These studies have shown the positive effect
of aromatherapy on mood in the postpartum period.[32,33]
In the study by Imura et al., after 30 min aromatherapy
massage, maternal blues and anxiety were measured. The
anxiety scores of the aromatherapy massage group was

significantly lower compared to the routine care group, and


none of them had maternal blues.[32] Studies in other fields
of medicine have also confirmed that lavender oil might

reduce anxiety and enhance mood scores.[34-36]

The present study has some limitations as follows: the

participants were selected from one maternity center. This


group of participants may not be representative of the
target population; sample size was small and we did not
control some confounder variables such as duration of
labor and psychological status during pregnancy; and our
study was done in a short period (24 h after delivery) and
the effect of such intervention was not assessed through
the following days or weeks. Hence, longer studies are
recommended to elucidate the effect of aromatherapy on
maternal morbidities during the early and late postpartum
periods.

Conclusions

In addition to the serious complications of labor and

delivery that may be fatal for mothers during the first 24 h

postpartum, other complications, such as physical pain


and fatigue, may also upset the mothers and decrease the
quality of their performance. To the best of our knowledge,

this study was the first to examine the effectiveness of

inhalation aromatherapy on the mothers� perineal and

International Journal of Preventive Medicine 2017, 8: 29


physical pain, fatigue, distress, and mood during the

immediate postpartum period. The findings showed that

inhalation aromatherapy practice in the early hours of


postpartum could reduce the mothers� pain and fatigue and
improve their mood.

Acknowledgments

This paper was extracted from Ms. Mahsa Shiravani's

M.S. thesis in midwifery approved by Shiraz University of


Medical Sciences (proposal no. 92-6943). Thanks also goes
to all the participants who took part in this research.

Financial support and sponsorship

The study was financially supported by the Research


Vice-chancellor of Shiraz University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

Received: 20 Apr 16 Accepted: 14 Feb 17


Published: 04 May 17

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Reproduced with permission of copyright owner.
Further reproduction prohibited without permission.
Aromatherapy as a
Comfort Measure

During the Childbearing Year

by Virginia Coleman Smith, MSN FNP-BC ICCE

Abstract: Aromatherapy, considered a


part of complementary and alternative
medicine (CAM), is the use of plant-based
essential oils for their many health-
inducing properties including relaxation,
anti-inflammatory, microbial, spasmodic,
and pain relief. Used with knowledge and
caution, the introduction of essential oils
into one�s practice during the childbearing
year can offer a natural, therapeutic
element that lifts the spirits and supports
a healing environment for the body.

key words: essential oils, aromatherapy, comfort measure, Pregnancy,


childbearing

Aromatherapy in the Childbearing Year

For thousands of years the use of plant-based essential


oils has been effective in meeting a variety of health-related
needs (Enteen, 2011). The term aromatherapy was coined by
Rene-Maurice Gatteefosse, a French chemist who experimented
with essential oils for wound healing during World
War I (as cited in Butje, Rapede, & Shattell, 2008). Gatteefosse
successfully treated, with lavender, a severe burn
incurred in his laboratory. This incident inspired him to
pursue research into the therapeutic applications of essential
oils (Horowitz, 2011; Enteen).

Aromatherapy is considered Complementary and Alternative


Medicine (CAM) and possesses anti-inflammatory,
anti-microbial, anti-anxiety, anti-spasmodic, and anti-pruritic
properties. Aromatherapy provides many benefits from natural
sources that address needs arising during the childbearing

year (Tillett & Ames, 2010). Enjoying more popularity in the

U.K. and Europe, with availability reportedly at 76% in German


obstetric departments, aromatherapy is only recently
being introduced into U.S. hospitals and clinics (Seol et al.,
2010; Horowitz, 2011; Conrad, 2010).
Although studies vary regarding the success of aromatherapy
in labor management, research indicates that the
use of essential oils can reduce anxiety, nausea, and the need
for pain medication, as well as provide a holistic approach
to caring for women during the childbearing period (Wray,
2011; Conrad, 2010; Smith, Collins, & Crowther, 2011).
Essential oils affect the brain�s limbic system by way of the
olfactory nerve and have calming, relaxing or invigorating
effects (Horowitz, 2011). Research into the specific effects
on mood, memory, and cognition has shown lavender and
rosemary to be stress reducers, with lavender having a more
relaxing, drowsy effect and rosemary stimulating more cognition
and memory (McCaffrey, Thomas, & Kinzelman, 2011).

Pure essential oils are volatile and concentrated. Oils


should be stored in dark glass containers, away from sunlight,
and blended in carrier oils to dilute their potency and
avoid irritating the skin. Sweet almond (Prunus Amygdalus),
contraindicated for those with a nut allergy, grapeseed (Vitis
vinifera), and sesame (Sesamum indicum) are the preferred
carrier oils and contain Vitamin E or A, making them acceptable
�stand alone� products for massage (Tillett & Ames,
2010). Pure oils, rather than mixed with mineral oil, are
preferred for maximum absorption (Raab, 2010). A patch
test should be conducted initially to determine any allergies;
but, as a general rule, aromatherapy is considered safe and
effective with a therapeutic outcome (Tillett & Ames, 2010).

During the 2004 International Childbirth Education


Association (ICEA) conference in Baltimore, aromatherapy

continued on next page

26 | International Journal of Childbirth Education | Volume 27 Number 3 July 2012


Aromatherapy as a Comfort Measure

continued from previous page

was the topic of a �break-out session.� Information regarding


essential oil properties, usage, and methods of delivery was
provided for participants, as well as an opportunity to sample
from a wide variety of essential oils. The session presented
aromatherapy beyond a cosmetic framework into one of
essential oils having a practical and therapeutic application.
Class participants learned about essential oils for specific
outcomes and left the session with additional options in
providing comfort to pregnant/laboring/and postpartum
women.

Caution

Because essential oils are highly concentrated substances


with chemical components, toxicity must be considered �
especially when working with women in the childbearing
year (Wray, 2011; Conrad, 2010). Several caveats to keep in
mind include the following: using the lowest doses possible
to achieve the desired effect; avoiding sun exposure after
using citrus oil; avoiding the use of an essential oil over a
prolonged period of time; and refraining from the use of
essential oils during the first trimester, when the majority of
fetal development is occurring (Tiran, 1996).

Knowledge of the properties of the essential oils that


are being used will guide practice. For instance, clary sage
and fennel have estrogenic effects that may increase uterine
contractility. These properties are useful during labor, but
contraindicated in pregnancy. Nutmeg and cinnamon, while
effective pain relievers, are also cardiac stimulants and should
be avoided during pregnancy when cardiac volume increases
by 40% (Beckmann, 2010; Tiran, 1996). Using herbs from
the garden can be an acceptable way to enjoy a fragrance yet
avoid the high concentration of essential oils.

Because essential oils are highly


concentrated substances with chemical
components, toxicity must be considered

� especially when working with women


in the childbearing year
Essential oils are lipophilic, blending easily into fat
soluble carrier oils, which are absorbed into the skin and can
cross the placenta (Tillett & Ames, 2010). Essential oils used

in massages cross into the bloodstream between 10 and 30


minutes after application, a much shorter than the normal
30 minute time frame for pain medications to take effect
(Dunning, 2005), and are quite effective at allaying anxiety,
reducing stress, and relaxing tense muscles. When adding
aromatherapy to one�s care of women during the childbearing
year, it is wise to begin with just a few essential oils
whose properties are familiar and to use only one at a time.
Because misleading information and impure products
are readily available by internet and in shops, choosing
reputable sources for information and products is important.
Keeping safety and knowledge at the core of one�s practice
increases the likelihood of success and longevity in a caregiving
profession (Tiran, 2011).

Pregnancy

Pregnancy, often a time of physical discomforts and


emotional instability, is an ideal time to introduce women
to the stress-reducing and mood elevating effects of aromatherapy.
The rapidly approaching labor and delivery experience
and the concept of becoming a parent contribute to the
anxiety that is frequently seen in pregnant women (Smith,
2012). Because some women may have a hypersensitive reaction
to certain essential oil blends, conducting a patch test
in a small area of skin is important before application to a
larger area of the body.

From the calming, sedating effect of lavender to the uplifting,


energizing effect of mandarin, the range of therapeutic
benefits of aromatherapy is impressive (Horowitz, 2011;
McCaffrey, Thomas, & Kinzelman, 2009). Bergamot, lemon
and grapefruit are ingredients found in hard candies made
especially to combat nausea. Small doses of peppermint and

ginger in the form of a


tea, spritz, or candle-
infused with essential
oils are especially
good for tension and
upset stomach (Toda
& Morimoto, 2011).

The aromatherapy sock, made from a tube sock, contains


dry white rice infused with essential oils. Warmed in the
microwave, it can be used as a neck/back wrap or placed
beneath the pregnant abdomen to provide comfort between
contractions. The sock can be personalized with essential oils
suited to individual preferences and makes a nice gift for use
during the childbearing year.

continued on next page

Debra Rose
Wilson

Volume 27 Number 3 July 2012 | International Journal of Childbirth Education | 27


Aromatherapy as a Comfort Measure

continued from previous page

In the last trimester, a daily perineal massage prepares


the delicate tissue of the perineum for the stretching that
will occur during delivery. By increasing circulation and
enhancing tissue elasticity, the perineal massage with a combination
of lavender and chamomile blended into almond or
grapeseed oil reduces perineal trauma (Beckmann & Garrett,
2009).

Childbirth Class

The childbirth educator, encouraging efforts that relax,


calm, and distract, can maximize the motivation of class
participants who are eager for suggestions to prepare for labor
and delivery. Comfort measures using aromatherapy can
give the mother and her partner more of a sense of control.
A foot soak of peppermint, a back massage with mandarin,
rose, or ylang ylang, or a hand massage with eucalyptus are
examples of comfort measures with essential oils that can
be taught in childbirth class (Conrad, 2010). Partners are
always open to ideas that will help them be more effective
during the labor experience. Massage, with its proven effects
of reducing stress hormone levels, as well as relaxing tense
muscles, is an easy tool to put in their kit of comfort measures.
Playing music with nature sounds from a rainforest or

the ocean, offering a basket of blended essential oils, lotions,


and massage tools for neck or hand massage, and providing
the time at the close of the class, sets the stage for breathing
and relaxation. The calming benefits of touch, along with
the stress and pain reducing properties of aromatherapy are
reinforced as the breathing and relaxation sessions offer the
laboring couple the opportunity to put it all together in dress
rehearsal fashion.

Labor and Delivery

If the milder contractions of early labor are a challenge,


a warm tub, foot soak, massage, or warm sock wrap with
lavender and chamomile provides distraction and relaxation
for the woman and �something to do� for the coach, who is
eager to help but not sure what is effective. Lavender, mandarin
and rose can be especially good in early labor when
the woman, frustrated with the pace of labor progression,
may be more anxious (Tillett, 2010; Conrad, 2010; Pollard,
2008).

Active and transition stages of labor may benefit from


the warming quality of frankincense, jasmine, and peppermint,
as a back massage, compress to the forehead or
abdomen (Pollard, 2008; Horowitz, 2011). Peppermint,
shown to �reduce cortisol levels and increase chromogranin
A (CgA) levels, a chemical associated with moderate, positive
eustress� is a great choice along with its anti-nausea property
(Toda & Morimoto, 2011, p. 432).

Clary sage, a multi-purpose essential oil during active labor,


increases uterine contractility and acts as a stress reducer
and anti-depressant, much like the action of dopamine (Seol
et al, 2010). The clean, refreshing aroma of eucalyptus is a
favorite for labor and delivery. It provides anti-microbial activity
that, along with thyme, has a synergistic effect against
strains of Methicillin-Resistant Staphylococcus Aureus
(MRSA) (Tohidpour et al., 2010).

Postpartum

Hormones plummeting to menopausal levels, chaotic


sleep routines, and a preoccupation with infant behaviors
contribute to the disorientation of postpartum. With the increased
demands of the newborn and self-care, the postpartum
woman may benefit from a diffuser as the most effective
delivery method to experience the benefits of essential oils.
Postpartum is a time that offers more options of essential
oils, as the concerns of pregnancy are left behind.

continued on next page

Brooke Kelly

28 | International Journal of Childbirth Education | Volume 27 Number 3 July 2012


Aromatherapy as a Comfort Measure

continued from previous page

Geranium, fennel, and clary sage with their estrogenic


and diuretic properties, can be used in the bath, massage, or
linen spray (Tillett & Ames, 2010). Uplifting and emotionally
balancing neroli, jasmine, and rose are good additions
to a tub soak, when someone else is holding the baby and
mom has a few moments to herself. Promoting calming and
relaxation, ylang ylang has sedative properties, which are
beneficial when trying to catch up on much needed sleep
(Tiran, 2011).

The combination of chamomile and lavender, with anti-


inflammatory properties, can be a comforting compress for
incisional discomfort of episiotomy or cesarean section. For
short episodes of baby blues, a lavender and juniper bath,
useful in PMS with fluid retention, as well as neroli, ylang
ylang or clary sage as a massage on the chest or abdomen
can be soothing (Tillett & Ames, 2010). Breast tenderness
benefits from evening primrose oil, juniper, geranium, or the
anti-inflammatory property of frankincense (Tillett & Ames,
2010).

The antispasmodic properties of essential oils can be especially


helpful with multigravidas having uterine cramping.
A warm compress, rice sock, or tub soak with fennel, ginger,
lavender, or bergamot can assist in relaxing tense muscles
(Butje et al., 2008).

Infant Care

The benefit of using natural baby products is becoming


increasingly accepted because many items containing essential
oils are now being offered on the market. A cautionary
word regarding infants and aromatherapy: most experts
agree no essential oils should be used on the infant in the
first 6 weeks and even after very few and small amounts.
Bronchospasm has been reported. Eucalyptus should be
avoided in young children, as it is potent and can overwhelm
their fragile nervous system (Osborn, 2004).

most experts agree no essential oils to be


used on the infant in the first 6 weeks,
and even after very few and in small
amounts

In using aromatherapy with infants and young children,


a small amount, 1 drop in 1 ounce of carrier oil is a good
safety rule. Lavender, in a randomized control trial, has been
shown to be effective in reducing symptoms of colic (�etinkaya
& Basbakkal, 2012). One drop of lavender, diluted in
an ounce of grape seed oil, is an effective product for infant
massage, offering gentle touch in combination with the
soothing benefits of this essential oil.

Implications for Practice


When childbirth educators, doulas, and labor and delivery
nurses are open to the vast array of comfort measures,
including aromatherapy, that are available, they can be an
excellent resource to women looking for an alternative to
medicinal treatment of the aches, pains and stresses that
accompany the childbearing year (Conrad, 2010; Horowitz,
2011; Butje et al., 2008).

Collecting an assortment of products is made easier


by taking advantage of seasonal sales at shops that offer
pure essential oils. Experimenting with essences that have
personal appeal is a good place to start in assembling a supply
of essential oils. Local health food stores, apothecaries
and reputable websites such as mountainroseherbs.com are
potential resources. Some essential oils such as melissa, rose,
and jasmine, are extremely expensive. Chamomile, frankincense
and sandalwood are fairly inexpensive, as are lavender,
rosemary, and orange (Enteen, 2011). Beware of same-pricing
for all essential oils, as this indicates a lower grade product.

Growing herbs in the garden with the fragrance of


lavender, rosemary, thyme, lemon verbena, and rose can be
a heady, relaxing experience that translates to immediate
access to the essential oils in bath and practice. Just offering
a back or hand massage with an uplifting peppermint lotion
can open up the topic of stress reduction. Then, the client is
breathing deeply, and tense muscles are beginning to relax.

References

Beckmann, M. & Garrett, A. (2009). Antenatal perineal massage for reducing


perineal trauma, Cochrane Reviews retrieved May 8, 2012 at http: summaries.
cochrane.org/CD005123/antenatal-perineal-massage-for-reducingperineal-
trauma

Beckmann, R., Ling, F., Barzansky, B., Herbert, W., Laube, D., Smith, R.
(2010). Obstetrics and Gynecology, 6th edition, Lippincott, Williams &
Wilkins: St. Louis.

Butje, A., Repede, E., Shattell, M. (2008). Healing scents: An overview of


clinical aromatherapy for emotional distress. Journal of Psychosocial Nursing
& Mental Health Services, 46(10), 46-52.

continued on next page

Volume 27 Number 3 July 2012 | International Journal of Childbirth Education | 29


Aromatherapy as a Comfort Measure

continued from previous page

�etinkaya, B., & Basbakkal, Z. (2012). The effectiveness of aromatherapy


massage using lavender oil as a treatment for infantile colic. International
Journal of Nursing Practice, 18(2), 164-169. doi:10.1111/j.1440172X.
2012.02015.x

Conrad, P. (2010). Aromatic childbirth: Developing a clinical aromatherapy


maternity program. Beginnings, 30(4), 12-14.

Dunning, T. (2005). Applying a quality use of medicines framework to using


essential ils in nursing practice, Complementary Therapies in Clinical Practice,
11, 172-181.

Enteen, S. (2011). Basic Aromatherapy: Recognize and Offer High Quality,


Massage Today, 11(1), 1-6.

Horowitz, S. (2011). Aromatherapy: Current and emerging applications.


Alternative & Complementary Therapies, 17(1), 26-31. doi:10.1089/
act.2011.17103

McCaffrey, R., Thomas, D., Kinzelman, A. (2009). The effects of lavender


and rosemary essential oils on test-taking anxiety among graduate nursing
students, Holistic Nursing Practice, 23(2), 88-93.

Osborne, K. (2004). Small doses: Aromatherapy for children, Massage and


BodyWork, April/May, 140-144.

Pollard, K. R. (2008). Introducing aromatherapy as a form of pain management


into a delivery suite. Journal of the Association of Chartered Physiotherapists
in Women�s Health, (103), 12-16.

Raab, A. (2010). Aromatherapy in the intensive care unit: An overview.


CONNECT: The World of Critical Care Nursing, 7(2), 127-130.

Seol, G. et al. (2010). Antidepressant-like effects of Salvia sclarea is explained


by modulation of dopamine activities in rats, Journal of Ethnopharmacology,
130, 187-190.

Smith, C. A., Collins, C. T., & Crowther, C. A. (2011). Aromatherapy for


pain management in labour. Cochrane Database of Systematic Reviews, (7)

Smith, V. C. (2012). Reluctance of women to respond to preterm labor


symptoms, International Journal of Childbirth Education, 27(2), 51-56.

Tillett, J. & Ames, D. (2010). The uses of aromatherapy in women�s health,


Journal of Perinatal Neonatal Nursing, 24(3), 238-245.

Tiran, D. (2011). Smell�s good! aromatherapy in midwifery. Practising Midwife,


14(10), 11-15.

Toda, M., & Morimoto, K. (2011). Evaluation of effects of lavender and peppermint
aromatherapy using sensitive salivary endocrinological stress markers.
Stress & Health: Journal of the International Society for the Investigation of
Stress, 27(5), 430-435. doi:10.1002/smi.1402
Tohidpour, A., Sattari, M. Omidbaigi, R. et al. (2010). Antibacterial effects
of essential oils from two medicinal plants against Methicillin-resistant
Staphylococcus aureus (MRSA). Phytomedicine, 17, 142-145.

Wray, J. (2011). Aromatherapy for pain management in labour. Julie Wray


continues our series. Practising Midwife, 14(10), 42-43.

A childbirth educator for 24 years and longtime gardener of


herbs and perennials, Virginia�s interest in the practical uses of
aromatherapy includes first aid as well as use as a comfort measure
during the childbearing year and throughout life.

ICEA Approved Workshops

Need certification? ICEA has approved a number of workshops for childbirth


educators, doulas, nurses, etc.
Please visit the link below and sign up to get your certifications today.

http://icea.org/content/icea-approved-workshops

30 | International Journal of Childbirth Education | Volume 27 Number 3 July 2012


Reproduced with permission of the copyright owner. Further reproduction prohibited
without permission.
Journal of Surgery

2015; 3(2-1): 8-13


Published online April 20, 2015 (http://www.sciencepublishinggroup.com/j/js)
doi: 10.11648/j.js.s.2015030201.12
ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online)

Effectiveness of Aromatherapy with Lavender Oil in


Relieving Post Caesarean Incision Pain

Mohamed Abdel-Hamed Metawie1, Hadayat AbdEl-Raof Amasha2, Ragaa Ali Abdraboo3,


Sally Ebrahim Ali4

1Dean of Faculty of Medicine, Port-Said University, Port-Said, Egypt


2Gynecological & Obstetrical Nursing, Faculty of Nursing, Port Said University,
Port-Said, Egypt
3Faculty of Nursing, Cairo University, Cairo, Egypt
4Governmental Hospital, El-Manzala, Egypt

Email address:

mohmetawie@hotmail.com (M. Abdel-Hamed Metawie)

To cite this article:

Mohamed Abdel-Hamed Metawie, Hadayat AbdEl-Raof Amasha, Ragaa Ali Abdraboo, Sally
Ebrahim Ali. Effectiveness of Aromatherapy
with Lavender Oil in Relieving Post Caesarean Incision Pain. Journal of Surgery.
Special Issue: Postoperative Pain Syndrome.
Vol. 3, No. 2-1, 2015, pp. 8-13. doi: 10.11648/j.js.s.2015030201.12

Abstract: Background: Post caesarean section pain is a common cause of pain in


obstetrics, safe pain control methods after
caesarean section is a greater challenge for health care providers because the
spread use of drugs can cause side effects. Non-
pharmacological measures are safer with fewer side effects than pharmacological
measures. Aim: The aim of the current study
was to evaluate the effectiveness of aromatherapy with lavender oil in relieving
post caesarean incision pain. Design: A quasi-
experimental design comprising two groups was used, with a sample of convenience of
100 post caesarean section mothers.
The study was conducted at the postpartum unit in Suez Canal University Hospital,
Ismailia City, Egypt between October 2013
and January 2014. Fifty mothers comprising the experimental group were inhaled 1 cc
of lavender essential oil via an oxygen
facemask and used for three minutes, while fifty participants of the control group
were given placebo then the pain level was
assessed after half an hour using Visual Analogue Scale (VAS) and Modified Johanson
Pain-O-Meter (MJPOM). Results of the
study showed that, aromatherapy with lavender oil via oxygen facemask effectively
relieving post caesarian incision pain, and
highly statistically significant differences in pain intensity between the groups
understudy (p< 0.001) was observed.
Conclusion: Lavender oil is a successful relieving pain after caesarean section.
Therefore, hospital staff managers are
encouraged to establish standards of aromatherapy care in maternity department and
add aromatherapy concepts and
techniques in the continued training program of nurses and midwives.

Keywords: Aromatherapy, Caesarean Section, Lavender Oil, Pain

1. Introduction
Caesarean section (CS) is the most common operation all
over the world, the rate of this operation reaches near 50% of
all types of deliveries (1). Pain is a major problem in surgery,
including post cesarean section pain and pain relief and
patient satisfaction are still inadequate in many cases (2) . Pain
can make the recovery difficult and delays mothers to get in
touch with the newborns, besides being an obstacle to a good
breastfeeding position, self-care, newborn care, and to do
daily activities (3). Therefore, relieving post caesarean pain is
an issue that cannot be ignored. Non-pharmacological
methods increased the individual control feeling, decreased
the feeling of weakness, improved the activity level and

functional capacity, and reduced the needed dosage of


analgesic drugs thus decreasing the side effects of the
treatment (4). In recent years, many complementary therapies
such as herbal medicines and aromatherapy are tried to help
manage pain (5) .

Aromatherapy is one of the non-pharmacological methods


for pain relief and lavender has analgesic properties.
However, lavender oil is commonly used in aromatherapy
that the scent of the essential oil from the flowers is inhaled
(6). Lavender oil used to alleviate pain in different conditions
such as changing dressings, palliative care, to control labor
pain as well as chronic pain (7). Some researchers concluded
Journal of Surgery 2015; 3(2-1): 8-13

that aromatherapy by using lavender essence is effective in


reducing pain after caesarean section (8) , as inhaled lavender

(9) (10,11)
essence and massage with lavender oil .

2. Methods
2.1. Design
A quasi-experimental design was used in the current study.
This study was conducted at Postpartum Unit affiliated to
Suez-Canal University Hospital, Egypt. The hospital
introduces teaching facilities and provides maternal and child
services around the clock, free charge.

2.2. Subjects
A sample of convenience of 100 mothers post CS, were
selected and assigned into two groups: group I was the study
group consisted of 50 mothers; and group II was the control
group consisted of 50 mothers. Both study and control groups
were selected according to the following inclusion criteria:
age from 21 � 35 years old, full term, after six hours of
operation, spinal anesthesia and not suffering from medical
and/or gynecological health problems.

2.3. Data Collection Instruments


Based on related literature review; the researchers used
three data collection tools related to socio-demographic,
history of current pregnancy, and pain assessment. Questions
regarding the socio-demographic data included mothers' age,
educational level, occupation, and their residence. History of
current pregnancy include weeks of gestation, parity and
gravidity. Other variables included antenatal care and
question regarding the wanted and unwanted pregnancy.

Visual Analog pain Scale (VAS) was used to assess the


degree of pain, and a Modified Version of Johansson Pain-O-
Meter (MJPOM) (1996) to measure the intensity of sensory
and affective components of pain (12) .

2.4. Procedure of the Study


The study proceeded as follows: before carrying out the
lavender oil implementation, the 4th author (Ali S.E) made
sure that each mother met the inclusion criteria, and willingly
agreed to the participate. The researcher explained briefly the
aim of the study and the procedure to the participants and
taught them how to report their degree of pain using the VAS.

The mothers took the routine treatment of the hospital as


post CS pain relief measures, and after six hours (when the
anesthesia had fully worn off), a researcher gave the
experimental group 1 cc of lavender oil (applied with a
cotton swab to the inside of an O2 face mask and used for
three minutes). In addition, the researcher gave oxygen
through a face mask with the placebo for three minutes to
mothers in control group. The researcher evaluated the pain
after half an hour, using VAS and MJPOM, for the two
groups. Finally, the researchers coded and transformed the
row data into coding sheets and then, analysis and

interpretation of the collected data were done. Three days per


week were specified for data collection (Sunday, Tuesday &
Thursday) over a period of data of four months from the
beginning of October 2013 tell ending of January 2014).

2.5. Ethical Considerations


Approval was obtained from the Dean of Faculty of
Nursing at Port Said University and directors of Suez Canal
University Hospital. The purpose of the study was explained
to each mother and an informed consent was obtained from
each of those who agreed to participate. They were assured
about confidentiality and privacy and that this information
will be used only for research purposes.

2.6. Statistical Analysis of Data


Data entry was done using Epi-Info 6.04 computer
software package, while statistical analysis was done using
the statistical package for social sciences (SPSS), version

15.0. Data were presented using descriptive statistics in the


form of frequencies and percentages for qualitative variables,
means and standard deviations for quantitative variables.
Qualitative variables were compared using Chi square test
(c2) as the test of significance, the p-value is the degree of
significance, and the correlation (r) test was used. A
significant level value was considered when p-value = 0.05,
while a highly significant level value was considered when p-
value = 0.001, and p-value > 0.05 indicates non-significant
results.

2.7. Operational Definition


Aromatherapy: The essential lavender oil of the
experimental group is pure plant oil, bought from Zamzam
factory established under the supervision of the Ministry of
Health, Egypt (No. 108/ 2008).

Incision pain: Refers to the mother's subjective pain self-


report and pain observation by Visual Analogue Scale (VAS),
it was developed by Melzack and Katz (1999) (12) . It
comprises 10 points numerical scale, corresponding to the
degree of pain, where zero indicates no pain, 10 indicates the
worst pain.

Modified Version of Johansson Pain-O-Meter (MJPOM),


was developed by Johansson, (1996) (13) . It was used to
measure the intensity of sensory and affective components of
pain, where the mother's choice of words is calculated to
determine pain intensity. One up to three indicates mild pain,
four up to six indicate moderate pain, and seven up to nine
indicate severe pain and finally, 10 indicates the worst pain.

3. Results
The mean age of the study group was 27.22 � 4.4, years
and that of the control group was 26.2 � 3.8 years. Figure 2
illustrates that 32.0% of the study group and 30% of the
control group were illiterate. Meanwhile, only 6.0 of the
study group and few percent (2.0%) of the control group
graduated from university.
10 Mohamed Abdel-Hamed Metawie et al.: Effectiveness of Aromatherapy with Lavender
Oil in Relieving Post Caesarean Incision Pain

Fig. (1). Distribution of the study and control groups according to their age
(n=100).

Fig. (2). Distribution of the study and control groups according to their
educational level (n=100).

As regards post-cesarean incision pain intensity measured control group; 2.0% of


the study group had experienced the
by visual analogue scale (VAS), the results reveal that, 16.0% worst pain, while
28.0% of the control group had experienced
of the study group had experienced mild pain compared to the worst pain. A highly
statistically significant difference was
none of the control group. Seventy percent of the study group found between both
groups (p<0.001) (table 1).
had experienced moderate pain compared to 18.0% of the
2 Mohamed Abdel-Hamed Metawie et al.: Effectiveness of Aromatherapy with Lavender
Oil in Relieving Post Caesarean Incision Pain

Table 1. Distribution of the study and control groups according to their incision
pain level as recorded by the Visual Analogue Scale (VAS) & Modified Version
of Johansson Pain-O-Meter MJPOM (n=100).

Study Group (n=50) Control Group (n=50)

Items

.
cccc2
2222 P value

No (%) No (%)

Incision Pain Level by VAS


Mild
Moderate
Severe
Very severe
Worst
Incision Pain Level by MJPOM
Mild
Moderate
Severe
Very severe
Worst

8 (16.0)
35 (70.0)
6 (12.0)
0 (0.0)
1 (2.0)

0 (0.0)
18 (36.0)
17 (34.0)
11 (22.0)
4 (08.0)

0 (0.0)
9 (18.0)
11 (22.0) 52.10 <0.001**
16 (32.0)
14 (28.0)
0 (0.0)
1(2.0)
0 (0.0) 50.97 <0.001**
29 (58.0)
20 (40.0)

** Significant at p-value<0.001

The same table shows distribution of pain intensity among


both study and control groups as recorded by the Modified
version of Johansson Pain-O-Meter (MJPOM). No one of
both groups had reported mild pain, 36.0% of the study group
had reported moderate pain compared to 2.0% of the control
group, 34.0% of the study group had reported severe pain.
While none of the control group reported severe pain, 22.0%
of the study group reported very severe pain, versus 58.0% of
the control group and 8.0% of the study group reported the
worst pain compared to 40.0% of the control group reported
the worst pain. A highly statistically significant difference
was found between both groups (p<0.001).

It was noticed from table 2 that an 8% of the study group


compared with 24.0% of the control group described their

pain by the word "cutting", while 6.0% of the control group


versus 2.0% of the study group described, their pain by the
word "burning", a lesser percentage 2.0% of the control
group described their pain by the word "cramping versus
none of the study group. On the other hand, more than third
of the control group (38.0%) compared to 60.0% of the study
group described their pain by the word "gnawing". Only
4.0% of the study group described their pain by the word
"pinching", versus more of the control group, and 22.0% of
the study group versus none of the control group described
their pain by the word "stinging". A highly statistically
significant difference was found between both groups in
relation to pain intensity (p<0.001).

Table 2. Distribution of the study and control groups according to their incision
pain intensity as recorded by the Modified Version of Johansson Pain-O-Meter
(MJPOM) (n=100)

Items
Study group (n=50) Control group (n=50) .
cccc
2
2222
P-value
No % No %
Sensory Pain
Cutting 4 8.0 12 24.0
Tearing 0 0.0 0 0.0
Sharp 0 0.0 3 6.0
Burning 1 2.0 3 6.0
Cramping 0 0.0 1 2.0
Pressing 0 0.0 11 22.0 35.80 <0.001**
Aching 2 4.0 1 2.0
Gnawing 30 60.0 19 38.0
Pinching 2 4.0 0 0.0
Stinging 11 22.0 0 0.0
Sore 0 0.0 0 0.0
Affective Pain
Torturing 4 8.0 12 24.0
Killing 0 0.0 0 0.0
Suffocating 0 0.0 3 6.0
Terrifying 1 2.0 3 6.0
Dreadful 0 0.0 1 2.0
35.80 <0.001**
Fearful 0 0.0 11 22.0
Troublesome 2 4.0 1 2.0
Tiring 30 60.0 19 38.0
Irritating 2 4.0 0 0.0
Nagging 11 22.0 0 0.0

** Significant at p -value<0.001
2 Mohamed Abdel-Hamed Metawie et al.: Effectiveness of Aromatherapy with Lavender
Oil in Relieving Post Caesarean Incision Pain
The same table indicates that the word "tiring" was the
most frequently used as an affective pain descriptor between
the two groups (study, 60.0% & control, 38.0%). However,
the word "killing" was not used as an affective pain
descriptor between the two groups. A highly statistically
significant difference also was found between both groups in
relation to pain intensity recorded (p<0.001).
Table 3 shows that there was a statistically significant
relation between the effect of lavender oil and educational
level (p < 0.05). Lavender oil was more effective between
educated mothers rather than non-educated ones. The same
table shows relation between pain intensity according to the
visual analogue scale and parity. A highly statistically
significant difference was found between the effect of
lavender oil and parity (p <0.001), lavender oil was more
effective with multiparous than primiparous. However, there
was no statistically significant relation between the others
selected variables (antenatal care & wanted pregnancy) and
lavender oil inhalation post CS (p= >0.05 & 0.05
respectively).
Table 3. Relation between pain intensity according to the visual analogue scale and
selected variables to the study group (n=50).
p-value .
.
Pain Level
Selected Variables Mild Moderate Severe Very Severe Worst
N (%) N (%) N (%) N (%) N (%)
Education
16.29. <0.05*
Non-educated (n=16) 1(6.3) 12(75.0) 3(18.8) 0(0.0) 1(6.3)
Educated (n=34) 7(20.6) 23(67.6) 3(8.8) 0(0.0) 0(0.0)
Parity
38.34 <0.001**
Para1(n=8) 0(0.0) 2.0(25.0) 5(62.3) 0(0.0) 1(12.5)
Para 2 (n=11) 0(0.0) 10(90.0) 1(9.1) 0(0.0) 0(0.0)
Para 3 or more (n=31) 8(25.8) 23(74.8) 0(0.0) 0(0.0) 0(0.0)
Antenatal care
1.70 >0.05
Yes (n=42) 5(11.9) 32(76.2) 4(9.5) 0(0.0) 1(2.4)
No (n=8) 3(37.5) 3(37.5) 2(25.0) 0(0.0) 0(0.0)
Wanted pregnancy
5.67 >0.05
Yes (n=34) 5(14.7) 26(76.5) 2(5.9) 0(0.0) 1(2.9)
No (n=16) 3(18.8) 9(56.3) 4(25.0) 0(0.0) 0(0.0)
* Significance at <0.05
Table 4. Correlation between Visual Analogue Scale score and Modified version of
Johansson Pain-O-Meter (MJPOM)
Variables
Modified version of Johansson Pain-O-Meter (JPOM)
r p- value
Visual Analogue Scale .522(**) .000
** Correlation is significant at the 0.01 level (2-tailed).
Table 4 shows that there was a positive correlation
between Visual Analogue Scale and Modified version of
Johansson Pain-O-Meter (r= .522 at p= .000).
4. Discussion
The pain control after cesarean delivery is a great
challenge for the health care provider because the spread use
of drugs can cause side effects such as; nausea, vomiting and
excessive sedation; and it can cause a delay in getting out of
bed and discharge from the hospital. In addition, the drugs
excrete in breast milk and can cause sedation in baby as well
(14). Pollard (2008) (15), observed that the use of aromatherapy
reduced the need for more invasive forms of pain
management and has a positive effect on client satisfaction.
Side effects of the oils were documented in only two cases
(1%); these side effects were skin irritation and headache. No
adverse reactions were documented with regard to babies
born in the birthing pool.
The result of current study goes in line with other studies
stated that there was a significant reduction in pain level of
postoperative cesarean section after inhaling lavender essence
(16,17) ,on episiotomy pain using lavender oil bath at
four hours and five days after delivery (18,19) .
The current study was in accordance with other studies
reporting analgesic effect of lavender oil and decreased the
number of required analgesics following tonsillectomy in
pediatric patients (20) and found that aromatherapy with
lavender oil a good alternative to reduce normal labour pain
and is more effective than breathing techniques (21). Our data
was also consistent with others of same interest who reported
that aromatherapy with inhalation lavender essential oil is
effective on anxiety and pain in IUD insertion(22) and in
reducing pain following needle insertion into a fistula in
hemodialysis patients (9).
5. Conclusion
In the light of the findings of the current study, it can be
concluded that, lavender oil was an effective method in
postoperative pain control with comparison to placebo
treatment. Lavender oil inhalation appears to be an effective
non-invasive and non-pharmacological intervention for postoperative
pain management. The efficiency of intervention is
2 Mohamed Abdel-Hamed Metawie et al.: Effectiveness of Aromatherapy with Lavender
Oil in Relieving Post Caesarean Incision Pain

found to be effective in pain reduction after 30 minutes, in


relation to lavender oil inhalation it can be used as an
effective nursing initiative in post cesarean section pain
control.

Recommendations

Based on the findings and conclusion, the following


recommendations can be suggested.


Hospital managers are encouraged to include
aromatherapy techniques in the training program for
maternity nurses and recommended to be included in
the hospital protocol for management of post-cesarean
incision pain.

Lavender oil inhalation for relieving post cesarean pain
may be added in maternal nursing curricula of nursing
schools.
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Razavi, S.F., & Bekhradi, R. The effect of inhalation of
aromatherapy blend containing Lavender essential oil on
cesarean postoperative pain. Anesthesiol Pain Med; 2013; 3(1),
203-7.
[18]
Sheikhan, F., Jahdi, F., Khoei, E.M., Shamsalizadeh, N.,
Sheikhan, M., & Haghani, H. Episiotomy pain relief: Use of
Lavender oil essence in primiparous Iranian women.
Complement Ther Clin Pract. 2012 Feb;18(1):66-70
[19]
Masoumi, Z., Keramat, A., & Hajiaghaee, R. Systemic review
on effect of herbal medicine on pain after perineal episiotomy
and cesarean cutting. J Med Plants;2011; 4(40), 1-6.
[20]
Soltani, R., Soheilipour, S., Hajhashemi, V., Asghari, G.,
Bagheri, M., & Molavi, M. Evaluation of the effect of
aromatherapy with lavender essential oil on post-
tonsillectomy pain in pediatric patients: A Randomized
Controlled Trial; Int J Pediatr Otorhinolaryngol. 2013
Sep;77(9):1579-81
[21]
Seraji, A., & Vakilian, K. The comparison between the
effects of aromatherapy with lavender and breathing
techniques on the reduction of labor pain. Complement Med;
2011; 1(1), 31-39
[22]
Shahnazi M, Nikjoo R, Yavarikia P, Mohammad-Alizadeh-
Charandabi S. Inhaled lavender effect on anxiety and pain
caused from intrauterine device insertion. J Caring Sci. 2012
Nov 28;1(4):255-61.
The Effect of Inhalation of Aromatherapy Blend containing Lavender Essential
Oil on Cesarean Postoperative Pain

Alireza Olapour 1, Kaveh Behaeen 1, Reza Akhondzadeh 1, Farhad Soltani 1, Forough


al Sadat Razavi 1, *, Reza Bekhradi 2

1 Department of Anesthesiology, Golestan Hospital, Ahvaz Jundishapur University of


Medical Sciences, Ahvaz, Iran 2 Barij Essence Research and Development Centre,
Kashan, Iran

*Corresponding author: Forough al Sadat Razavi, Department of Anesthesiology,


Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Tel: +98-6113743037, Fax: +98-6113743037, E-mail: fp.razavi@yahoo.com.

ABSTRACT

Background: Pain is a major problem in patients after cesarean and medication such
as aromatherapy which is a complementary therapy, in which the essences of the
plants oils are used to reduce such undesirable conditions.Objectives: In this
study, the effect of aromatherapy using Lavender (Lavandula) essential oil on
cesarean postoperative pain was assessed. Materials and Methods: In a triple blind,
randomized placebo-controlled trial study, 60 pregnant women who were admitted to a
general hospital for cesarean section, were divided randomly into two groups. After
cesarean, the Lavender group inhaled about 3 drops of 10% Lavender oil essence and
the placebo group inhaled 3 drops of placebo after the start of postoperative pain,
four, eight and 12 hours later, for 5 minutes from the 10 cm distance. Patient's
pain was measured by the VAS (Visual Analog Scale) score before and after each
intervention, and vital sign, complications and level of satisfaction of every
patient were recorded before and after aromatherapy.Results: There was no
statistically significant difference between groups in age, height, weight, and
time to the first analgesicrequirement. Patients in the Lavender group had less
postoperative pain in four (P = 0.008), eight (P = 0.024) and 12 (P = 0.011) hours
after first medication than the placebo group. The decreased heart rate and
patients' level of satisfaction with analgesia were significantly higher in the
Lavender group (P = 0.001). In the placebo group, the use of diclofenac
suppositories for complete analgesia was also significantly higher than the
Lavender group (P = 0.008).Conclusions: The inhaled Lavender essence may be used as
a part of the multidisciplinary treatment of pain after cesarean section, but it is
not recommended as the sole pain management.

Keywords: Pregnant Women; Aromatherapy; Lavandula; Cesarean Section; Pain

Copyright � 2013, Iranian Society of Regional Anesthesia and Pain Medicine


(ISRAPM); Published by Kowsar Corp.

.Article type: Research Article; Received: 22 Dec 2012, Revised: 16 Jan 2013,
Accepted: 26 Jan 2013; Epub: 01 Jul 2013; DOI: 10.5812/
aapm.9570
.Implication for health policy/practice/research/medical education:
The addition of inhalation aromatherapy using lavender essence oil to the pain
control protocol, which includes NSAIDs and opioids,
may decrease the side effects of such drugs and also may decrease treatment costs
of cesarean postoperative pain for patients
and decision makers and experts in the health sector.
.Please cite this paper as:
Olapour A, Behaeen K, Akhondzadeh R, Soltani F, al Sadat Razavi F, Bekhradi R. The
Effect of Inhalation of Aromatherapy Blend containing
Lavender Essential Oil on Cesarean Postoperative Pain. Anesth Pain. 2013;3(1):203-
7. DOI: 10.5812/aapm.9570
.Copyright � 2013, Iranian Society of Regional Anesthesia and Pain Medicine
(ISRAPM); Published by Kowsar Corp.
This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
1. Background
Pain is amongst the most common problems after surgery
(1). Pain is an unpleasant sensory and emotional experience,
which is associated with the real or probablydamage of tissue. Unrelieved
postoperative pain in addition
to creating fears in the surgical patients, it makesadverse psychological impact on
them (2, 3). The uncontrolled
postoperative pain will make a lot of acute and chronic effects, including systemic
mediators, hypercoagulability,
postoperative immunosuppression, and delayed
wound healing (4). So, one of the main aims of anesthesia
is to reduce postoperative pain. However, many drugs that are used for this
purpose, especially opioidsand NSAIDs (None Steroidal Anti Inflammatory Drugs),
have side effects such as respiratory distress, nausea, itching, and
gastrointestinal bleeding (5). Recent studieshave indicated interest in using
complementary therapies
such as heat and cold therapy, hypnotism, music therapy and aromatherapy.
Aromatherapy is used for the relief of pain, anxiety, depression, insomnia and
fatigue, using the existing oils in different parts of the plant such as Lavandula
angustifolia (6-11). Lavandula is a flowering plant from the Lamiaceae family,
native to the western Mediterranean region. The lipophilic monoterpenes atthe plant
are reacted to the cell membranes, and cause changes in the activity of ion
channels, carriers and nervous
receptors. Such property can explain the soothingand anti-bacterial effects of
Lavender oil (12).

2. Objectives
Cesarean surgery is common, especially in our country, and the patient's
postoperative pain is a serious problem. Furthermore, the extent of conventional
method for the pain relief is a prescription of opioids and NSAIDs, which are also
associated with certain complications, and needsadditional methods of the pain
control, consequently, we decided to assess the effect of the inhalation
aromatherapy
using Lavender oil essence on postoperative pain.

3. Materials and Methods


In a triple blind, randomized placebo-controlled trial,which was performed for the
first time in Ahvaz, a city located in the south western part of Iran, after
approving
by Ahvaz Jundishapur University of Medical Sciences (AJUMS) Ethical Committee, 60
pregnant women, whowere admitted to a general hospital for cesarean section,were
divided randomly into two groups. Subjects with pregnancy, ASA class I and II,
absence of hypertension, coagulation
disorders, migraines and chronic headaches,no history of allergies to medicinal
plants, no history of anosmia were included. Subjects with respiratory problems
during surgery, nausea, vomiting, sensitivity and dissatisfaction after the first
dose of aromatherapy using Lavender oil essence were excluded. The severity of pain

was documented based on the Visual Analog Scale (VAS).The VAS is a standard tool
like a 10 cm ruler including 10 numbers begin from 0 (no pain) and end to 10 (most
severe
pain). Different states of a human face in response to pain severity have been
plotted on the other side of ruler. The patients were asked to choose one of them
according
to their pain severity. The number shown on the back of the ruler was considered as
pain score. The Lavenders
(Lavandula angustifolia) are a genus of several species of flowering plants in the
mint family, Lamiaceae.
In this study, Lavender essence 10% was provided by the Barij Essence
Pharmaceudical Company (Kashan,Iran). Placebo was a base of aromatherapy blend
without Lavender essence which was provided by the Barij Essence
Pharmaceudical Company too. In the beginning, possible side effects of drugs used
in the study, were explained
to the patients, and after obtaining informedconsent, patients were entered into
the operating room. Patients were performed monitoring by ECG
(Electrocardiography),
monitoring for heart rate recording, NIBP(None Invasive Blood Pressure) and
Pulseoximetry. After embedding the peripheral intravenous cannula, 500 cc of
Ringer's crystalloid fluid was infused for patients. Afterwards,
regional block with spinal anesthesia was performed
with 60 mg of Lidocaine 5%, and then the patients underwent cesarean section.
Opioid or benzodiazepine was not used after cesarean section in operating room
assedation. Pain score were measured using the VAS score for all patients. After
the onset of postoperative pain (if VAS > 3), four, eight and 12 hours after that,
the inhalation aromatherapy was performed using Lavender essence. In one group,
three drops of aromatherapy blend containing
Lavender essence 10% (provided by The Barij Essence Pharmaceutical Compnay) were
poured on cotton incast containers, and the patient was asked to inhale itfor 5
minutes from a distance of 10 cm; and pain score was measured using the VAS again,
and if the VAS was greater than three, analgesic was given in accordance with the
hospital routine protocol (the first time, intramuscular injection of Diclofenac
sodume 75 mg and next times, Diclofenac suppositories 100 mg). Using the
sameprocedure, aromatherapy was performed in the othergroup by three drops of
placebo (a base of aromatherapy blend without Lavender essence) where its smell and
appearance
were similar to the Lavender oil essence. Heart rate, blood pressure, nausea,
vomiting, dizziness, andpatient's satisfaction were recorded before and after the
aromatherapy based on the questionnaire. During theresearch, the project executive
and the patients were notaware of the type of drug and placebo, and after the study
and data analysis, the Lavender and the placebo were disclosed
by the Barij Essence Pharmaceudical Company. All data were analyzed using the SPSS
for Windows (version19.0). Independent T-test was used compare the meanpain in two
groups; the Paired t- test was used to comparethe pain before and after
intervention. The significance
level was set to P = 0.05.

4. Results
In this study, all patients were ASA class I. At the time of the onset of the pain
after cesarean section, aromatherapy
with Lavender essence was performed. Average age, height, weight in the two groups
showed no significantdifference, and times of need to the first analgesic from
cesarean section were similar in the two groups (Table
1). After using the drug comparing it with before, therewas more decrease in the
VAS score in the Lavender group than the placebo group, these values were
significant in four, eight and 12 hours after the first intervention (Table

Table 1. Baseline Charactristics of Patients

2). In the Lavender group, the level of satisfaction from the drug was 90 %, while
in the placebo group, a 50% satisfaction
was reported (P = 0.001) (Figure 1). In the Lavender group, using Diclofenac
suppository for completing analgesia
was 43.3%, and in the placebo group was 76.7% (P =0.008) (Figure 2).

After using the drug comparing it with before, heart rateshowed a greater reduction
in the Lavender group compared
with the placebo group, which has been shown in the table (Table 3). However, no
difference was observed in terms of the blood pressure between the two groups. In
terms of the complication incidence, only one patient in the placebo group had
nausea, and none of the patients in both groups had vomiting and dizziness.

Lavender group, Mean � SD Placebo group, Mean � SD P value


Age, y 27.83 � 5.65 25.57 � 4.11 0.96 Height, cm 159.57 � 4.15 158.7 � 4.41 0.78
Weight, kg 79.57 � 8.99 76.07 � 9.35 0.78

Time of first request of analgesia after Spinal anesthesia 98.83 � 9.16 98.33 �
9.67 0.72
Table 2. Comparison of the VAS in Two Groups

Lavender group, Mean � SD Placebo group, Mean � SD P value Pain reduction after
medication for the first time 0.23 � 0.43 0.27 � 0.64 0.353
Pain reduction 4 hours after medication for the first time 1.37 � 0.89 0.5 � 0.57
0.008
Pain reduction 8 hours after medication for the first time 1.63 � 0.89 0.4 � 0.49
0.024

Pain reduction 12 hours after medication for the first time 1.40 � 0.62 0.2 � 0.48
0.011
Table 3. Comparison of Heart Rate in Two Groups

Lavender group, Mean � SD Placebo group, Mean � SD P value Pain reduction after
medication for the first time 4.83 � 5.96 0.63 � 2.45 < 0.001
Pain reduction 4 hours after medication for the first time 3.30 � 4.60 0.77 � 4.24
0.439
Pain reduction 8 hours after medication for the first time 4.30 � 5.62 0 � 3.16
0.016

Pain reduction 12 hours after medication for the first time 2.2 � 2.82 0.57 � 2.23
0.798
5. Discussion
This study investigated the effect of inhaled Lavender essence on the pain relief
after cesarean. The results showed that pain after surgery in four, eight and 12
hours after the onset of symptoms following inhalation of Lavender
essence have had a significant decrease compared with the placebo group. The pain
control after cesarean delivery is a great challenge for the anesthesiologists and
gynecologists, because the spread use of drugs can cause side effects such as
nausea, vomiting and excessivesedation; and it can cause a delay in getting out of
bed and discharge from the hospital. In addition, the drugsexcrete in breast milk
and can cause sedation in baby as

well (13). The use of non-opioid analgesics and alternative treatment alone has
failed to establish an effective and satisfactory analgesia for patients. It seems
necessary to use multiple methods of analgesia (multi-modal) for the pain relief
after Cesarean section and to have more research in this area (4). The effects of
various forms of Lavender essence on postoperative pain control have been
investigated in the previous studies. In a study performed
by Sobhani and Colleagues in 2004 in Rasht cityon pain relief after cesarean
section, in each three stages
of the intervention (in which its first stage was performed
six hours after the onset of the pain) there was a significant reduction in pain
after inhaling Lavender essence.
These results are similar to our study except that:
1) in the mentioned study, intervention was not immediately
performed after the onset of the pain and 2) we used Lavender essence 10% (14).

Figure 1. The Satisfaction From Using Drug in Two Groups

Figure 2. Frequency of Patients need to Take Diclofenac Suppositories to Complete


Pre-Operative Analgesia

In a study on women undergoing elective cesareansection performed in Tabriz city,


an important reduction was seen in pain at half, eight and 16 hours
afterintervention in the group using inhaled Lavender, while in our study, there
was no significant difference between the two groups at the first intervention at
the onset of the pain unlike for the four, eight and 12 hours. Also in our study,
the Lavender essence 10% was used (6). In a study performed by Sheikhan and
Colleagues on episiotomy pain using Lavender bath extract, pain in the Lavender
group at four hours and also five days after delivery was significantly reduced
(9). Moreover, in a similar study

conducted by Ailsa also using Lavender oil bath for 10 days after vaginal delivery,
the slight reduction of pain, though significant, was seen in the Lavender group
compared to the control group (15). Furthermore, in Khadivzadeh's study in which
Lavender cream has been used to relieve episiotomy pain, the pain on days three,
five and 10 afterbirth was significantly reduced compared to the controlgroup, but
this difference was not significant in the first 24 hours of the delivery (16). We
found that Diclofenac suppository dosage as a supplemental analgesic drug in the
Lavender group was significantly lower than the placebo group. These findings are
similar to a study by Jung TK on patients who underwent laparoscopic gastricbanding
surgery. But in our study the Lavender essence 10% was used. In that study, despite
the decrease of pain, the score was not significantly different in the two groups,
but morphine consumption was decreased significantlyin the Lavender group (17). In
the present study, patient's satisfaction with supplemental analgesia techniqueswas
considered, and it showed that satisfaction withtreatment in the Lavender group was
significantly higher than the placebo group. This satisfaction has also been
reported in two previous studies, which wereconducted on obese patients undergoing
laparoscopic adjustable gastric banding and patients undergoingbreast biopsy
surgery with the difference that we used Lavender essence 10% (17, 18). Also, in a
study conducted by Mohammadkhani on postpartum perineal pain,patients receiving
Lavender were more satisfied than controls (19). Due to the lack of reported side
effects such as nausea, vomiting and dizziness in the group treatedwith Lavandula
in our study and other studies on this drug, it can be concluded that this drug
doesnot have serious and common side effects of the opioid analgesics and NSAIDs,
and further studies could be used as part ofa multimodal analgesic treatment of
postoperative pain. Based on findings of our study, it can be concluded that the
inhaled Lavender essence may be used as a part of the multimodal analgesic
treatment after cesarean section,but it is not recommended using the sole analgesic
treatment.

Acknowledgements

This research is a result of residential thesis (Ref No:U90291). Hereby, we


acknowledge deputy vice-chancellor
for research and technology affairs of AhvazJundishapur University of Medical
Sciences, especiallyResearch Consultation Center (RCC) for technical support.

Authors� Contribution
Study concept and design: Olapour, Behaeen and Raza

vi. Analysis and interpretation of data: Olapour, Behaeen and Bekhradi. Drafting of
the manuscript: Akhondzadeh,
Soltani and Razavi. Collection and possession of raw data: Razavi. Critical
revision: Behaeen, Akhondzadeh and Razavi.

Financial Disclosure

The authors declare they have no financial disclosure.

Funding/Support

Ahvaz Jundishapur University of Medical Sciences, Vice Chancellor for Research and
Technology. Trial Registration:
www.irct.ir Identifier: IRCT201204249552N1.

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Iran Red Crescent Med J. 2015 April; 17(4): e25880. DOI:
10.5812/ircmj.17(4)2015.25880
Published online 2015 April 25. Research Article

Lavender Fragrance Essential Oil and the Quality of Sleep in Postpartum


Women

12,*2

Mahnaz Keshavarz Afshar ; Zahra Behboodi Moghadam ; Ziba Taghizadeh ; Reza


Bekhradi 3; Ali Montazeri 4; Pouran Mokhtari 1

Department of Midwifery, School of Nursing and Midwifery, Zanjan University of


Medical Sciences, Zanjan, IR Iran

Department of Reproductive Health, Nursing and Midwifery Faculty, Tehran University


of Medical Sciences, Tehran, IR Iran

Research and Development Unit, Barij Essence Company, Kashan, IR Iran

Mental Health Research Group, Health Metrics Research Center, Iranian Institute for
Health Sciences Research, ACECR, Tehran, IR Iran

*Corresponding Author: Zahra Behboodi Moghadam, Department of Reproductive Health,


Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, IR
Iran.
Tel: +98-9122494201, Fax+98-2166927171, E-mail: Behboodi@tums.ac.ir

Received: December 10, 2014; Revised: December 28, 2014; Accepted: January 11, 2015

Background: Labor and delivery is a stressful stage for mothers. During these
periods, sleep-related disorders have been reported. The
problems of inadequate sleep include decrease in concentration, judgment,
difficulty in performing daily activities, and an increase in
irritability. Even the effects of moderate sleep loss on life and health quality
can be similar to sleep deprivation. some research aggravated
by aromatherapy on sleep quality in different periods of life so might be useful
for the improve of sleep quality in postpartum women.Objectives: This study aimed
to determine the effect of aromatherapy on the quality of sleep in postpartum
women. The sample was
recruited from medical health centers of Zanjan University of Medical
Sciences.Patients and Methods: This study was a randomized clinical trial with the
control group. A total of 158 mothers in postpartum period
(with certain inclusion criteria) were enrolled in the study and assigned randomly
to two groups of control and intervention. Lavender
fragrance (made by Barij Essence Pharmaceutical Co.) was used by participants in
the intervention group nightly before sleeping.
The fragrance was dropped on cotton balls, which were placed on a cylindrical
container at mothers� disposal. Keeping the container
at a projected distance of 20 cm, the participants inhaled 10 deep breaths and then
the container was placed beside their pillow until
morning. This procedure was done 4 times a week for 8 weeks. For the control group,
the same intervention was done with the placebo. The
instrument for collecting data was Pittsburgh sleep quality index, which was
completed at the baseline, fourth, and eighth weeks after the
intervention. Data were analyzed using independent t test and repeated measures
analysis of variance calculated by SPSS16.Results: Before the intervention, there
were no significant differences between mothers in two groups (P > 0.05). After 8
weeks follow up, a
significant improvement appeared in mothers� sleep quality in the intervention
group. Aromatherapy increased sleep quality mean score
(�SD) from 8.2911 (� 2.1192) to 6.7975 (� 2.3663) (P < 0.05), but in the control
group sleep quality mean score (�SD) changes from 8.4557 (�
2.3027) to 7.5696 (� 1.1464) (P > 0.05). Comparing sleep quality between control
and intervention groups after 8 weeks from the beginning
of the intervention indicated that aromatherapy was effective in the improvement of
mothers� sleep quality (P < 0.05).Conclusions: Considering the effects of
aromatherapy on the improvement of mother�s sleep quality during postpartum period,

aromatherapy has been suggested as a non-pharmacological method for the improvement


of the maternal health.

Keywords: Sleep Disorders; Aromatherapy; Lavandula; Postpartum Period

1. Background
Labor and delivery is a stressful stage for mothers. This
stage entails a change in their life style (1). Pregnancy
and postpartum are two important stages for women
and their families (2). During these periods, sleep-related
disorders have been reported (3). Sleep is an important
process in human life. The problems of inadequate
sleep include decrease in concentration, judgment, difficulty
in performing daily activities, and an increase
in irritability (4). Research shows that inadequate sleep
affects hemostatic and nerve functions, as well as mood.
Even the effects of moderate sleep loss on life and health
quality can be similar to sleep deprivation. Many medical
practitioners and patients are faced with such prob

lems (5). Most mothers experience changes in their


quality of sleep during postpartum period. According
to the researches, changes in sleep duration and its patterns
have normally been reported. Sleep problems are
related to pain, wound discomfort, lactation, or uterine
contractions (6). Mothers in postpartum period normally
experience 20% increase in their wakefulness during
night (7). According to the National Sleep Foundation
survey in 2007, 67% of women in the postpartum period
reported disturbed sleep cycles (8).

In general, changes in sleep patterns during the first


year after delivery is the distinctive feature of this period,
which affects health and functions of mothers and

Copyright � 2015, Iranian Red Crescent Medical Journal. This is an open-access


article distributed under the terms of the Creative Commons Attribution-
NonCommercial
4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which
permits copy and redistribute the material just in noncommercial usages,
provided the original work is properly cited.
Keshavarz Afshar M et al.

creates a lot of problems not only for them but also for
their families (9). One of the most important side effects
of inadequate quality of sleep is the incident and severity
of postpartum depression (3, 10). Another adverse
side effect of impaired sleep patterns is the cessation of
breastfeeding and decreased mother-infant attachment
(11). Sleep deprivation can even decrease the growth of
infant (12), and reduce mothers� immune functioning,
metabolism, mood, and performance (13).

For many reasons, intervention and studies of sleeping


patterns after delivery are very important and sensitive
for a nascent family at this time. However, studying
sleep characteristics is a difficult and complicated
concept, as in this period, mothers and their families
try to incorporate a new member into their family (14).
What mothers could do regarding the quality of sleep,
its disturbance, and frequency at this crucial time is still
being investigated. Physical and mental health of mothers,
newborn outcomes, and maternal-infant relationship
are affected by fully understanding and correct recognition
of sleep during pregnancy and postpartum (3).
Midwives usually train mothers to reduce fatigue and
improve sleep, which most of these trainings are generally
not evidence-based (14). Drug therapy is another
way to improve sleep quality; however, it has many side
effects and not the best way to improve sleep quality
(15). Because of the mothers� concerns about the side effects
of drugs for themselves or for their nursing baby,
they seek alternative and complementary methods for
treating their symptoms. Therefore, the use of alternative
medicine is better for patients (15). Alternative therapies
for the treatment of various physical and mental
distresses are available for young women (16).

One of the treatment methods, which has expanded


in recent years is aromatherapy. This treatment is the
second alternative treatment method, which uses essential
oil extracted from aromatic plants for the treatment.
Lavender ( Lavandula angustifolia), which belongs
to green mint family and aromatic plants is one of the
most used aromatic plants in aromatherapy (15). Several
studies have been conducted on the effects of aromatherapy
in sleep-related disorders. For example, in a
study conducted by Chien et al. the overall score of quality
of sleep has been improved in the group who did
inhale lavender aroma (17). According to the research
conducted by Lee et al. who studied the effects of Lavender
oil aromatherapy on insomnia in Korean female
students, it was found that this treatment significantly
reduces insomnia (18). Also, the research of Moeini et
al. showed that lavender aromatherapy improved sleep
quality in patients in CCU (15). In another study, Arzi et
al. showed that the scent of lavender only improved the
repeated wakening and had no other effects (19). However,
there have been a few clinical trials that studied the
improvement of mothers� sleep quality during postpartum
period. For example, in a study conducted by Lee et
al. with the purpose of investigating the effects of aro

matherapy on sleep quality and fatigue in postpartum


mothers, the results showed that inhaled aromatherapy
has no significant effects on sleep quality with regard to
sleep duration, the numbers of waking up at nights, and
sleep satisfaction (11).

Given the importance of sleep quality in postpartum


period, its adverse effects on the quality of life and ability
of midwives to prescribe and use complementary
medicine and considering the lack of studies in Iran
on the effectiveness of aromatherapy (on sleep quality
in this period of life), we decided to assess the effects of
aromatherapy on sleep quality in postpartum period.

2. Objectives
This study aimed to determine the effect of aromatherapy
on the quality of sleep in postpartum women.
The sample was recruited from medical health centers
of Zanjan University of Medical Sciences. This study was
carried out with the hypothesis that the mean score of
quality of sleep would be better in postpartum women
in aromatherapy group compared to control group.

3. Patients and Methods


This study was a randomized clinical trial with a control
group, in which the data were collected from both
groups before and after the intervention. The study population
consisted of all women who have recently given
birth and covered by health-care referral governmental
centers affiliated to Zanjan University of Medical Sciences.
This study was registered in Iranian Registry of Clinical
Trials (registration number of IRCT201211179463N8)
and approved by the Ethics Committee of Tehran University
of Medical Sciences (No. 130/904/D/92).

The sampling began in December 19, 2013 and lasted


for 6 months. The sample size was calculated according
to the previous articles (15, 20) and by the advice of
the statistics professor using OpenEpi (www.OpenEpi.
com) software (21). The number of individuals in each
group was calculated as 61. Because of the availability
of samples and willingness of individuals to participate
in the study, 79 subjects were enrolled in each group.
Out of 4 health centers in Zanjan that conducted hypothyroidism
and phenylketonuria screening tests, 2
of them have been chosen randomly and sampling of
intervention and control groups began at those centers.
The reason for choosing centers that provide neonatal
screening for sampling was the attendance of the
mothers in first few days after delivery as well as future
referrals for postpartum care, which provided an easy
access to samples for the research. Participants satisfied
inclusion criteria were enrolled after completing
an informed consent form. Inclusion criteria included
primiparous women, uncomplicated vaginal delivery,
a minimum literacy tips, aged 18 - 35 years, absence of
acute or chronic physical and mental illness, being exclusive
breast-feeders of their infants, having healthy

Iran Red Crescent Med J. 2015;17(4):e25880


Keshavarz Afshar M et al.

baby without complications, and sleep disorders (The


Pittsburgh Sleep Quality Index score of 5 or higher). Exclusion
criteria were having chronic diseases (diabetes),
using certain drugs such as hypnotics or sedatives, having
a history of allergy to herbal remedies, and suffering
from depression. Randomization was performed by
simple allocation. Sampling continued until 79 patients
were allocated in each group. Then, the researcher followed
the participants with phone calls and text messages
and reminded them about the intervention so
that nobody dropped out of the study.

The aromatherapy blend used in this study consisted


of 10% lavender essential oil of sesame carrier
oil and placebo was just sesame carrier oil, which was
produced by Barij Essence Pharmaceutical Co. in Iran
under Batch No 9208051. The intervention consisted
of inhaling the aroma of lavender essential oil, by the
intervention group used at night and before sleeping.
They dropped 4 drops of essential oil on a cotton ball,
placed on a cylindrical container at their disposal and
with a projected distance of 20 cm. They inhaled 10 deep
breaths and then placed the container beside their pillow
until morning. The control group was also treated
in the same manner except that a placebo was inhaled
by the participants. All participants were asked to inhale
the lavender essential oil during bed time until the next
morning and preferably for 4 consecutive days per week
for 8 weeks. To ensure its proper execution, a check list
was provided for the participants, and each week, the researcher
reminded the participants of the intervention
with a phone call or short text message. Furthermore,
the contact number of the researcher was provided for
the participants. If for any reason, subjects did not complete
the aromatherapy for 4 times a week, they would
be excluded from the study.

In this study, the tools that have been used by the researcher
for demographic data collection comprised a
questionnaire survey of environmental confounding
factors affecting sleep, Pittsburgh sleep quality index,
and the Edinburgh Postnatal Depression Scale as well
as aromatherapy and registration forms that were completed
by mothers. Pittsburgh sleep quality index is an
international standardized tool that has been validated
in numerous studies (15, 20). Test-retest reliability and
content validity of its Iranian version have been reviewed
and approved in two studies done by Hossein Abadi et al.

(4) and Malekzadegan et al. (22) whose results showed


the specificity of 87% with a sensitivity of 90%. Test-retest
reliability has been determined in the study of Malekzadegan
et al. (22) and Cronbach a was evaluated at 88% in
the study of Hossein Abadi et al. (4, 20, 22, 23). Pittsburgh
Sleep Quality Index consisted of 19 questions that evaluate
the quality of sleep in the past month and measures 7
dimensions (24). The total score of this index ranges from
0 to 21, which a total score of 5 or more denotes poor sleep
quality and shows that the individual has some problems
in 2 or more dimensions (24). This scale was completed
by the researcher in the meetings with the mothers at the
health centers 3 - 5 days after birth, then at the end of the
first four weeks and finally at the end of the second four
weeks after labor. Because of the poor quality of sleep
in cases of postpartum depression in mothers (10), and
its effect as a confounding factor, Edinburgh Postnatal
Depression Scale has been performed by the researcher
in health centers at the beginning of the study and before
the intervention. In case of scoring 10 or higher, the
samples were excluded from the study with a diagnosis
of postpartum depression. Edinburgh Postnatal Depression
Scale is a universal standardized tool that its reliability
and validity have been confirmed by Boyed and
colleagues (20). Confounding factors have been also examined
by a researcher form that has been performed
before the intervention.

3.1. Statistical Analysis


Descriptive statistics, including means and standard
deviations were calculated for all variables. Independent
t test, Chi-square, and repeated measure test were
used to compare means of the impact of lavandula aromatherapy
and placebo on the sleep quality between
two groups (case and control). The data were analyzed
using version 16 of SPSS software. The characteristics of
the participants are presented as mean (SD), or number
(percentage). Differences between variables were determined
by independent t test and repeated measure test.
P value < 0.05 was considered as significant (Figure 1).

4. Results
Demographic characteristics of study subjects and
their husbands are shown in Table 1. Mothers in both
groups were similar in all demographic characteristics (P
> 0.05). In terms of individual-environmental confounding
factors affecting sleep disorders such as lighting a
bedroom, existence of noise, consuming tea and coffee,
consuming caffeinated soft drinks, herbal remedies,
complaining of pain, general sleep conditions of infants,
and assistance in infants care in two groups showed no
significant differences (P > 0.05). Table 2 shows the mean
and standard deviation of sleep quality index at the beginning
of the study, at the end of the four weeks, and
eight weeks after intervention in two groups. As a result,
the mean score of sleep quality at baseline in aromatherapy
was (8.28 � 2.11) and in placebo group was (8.45
� 2.30) and before the intervention there was no significant
difference between the two groups in mean score of
quality of sleep (P > 0.05). Four weeks after the intervention,
the result showed the mean of quality of sleep in
aromatherapy group was (7.59 � 2.53) and placebo group
was (8.06 � 2.20), and finally, the average of the quality
of sleep after eight weeks in the intervention group was

(6.79 � 2.36) and in the placebo group was (7.56 � 2.14).


Analysis of the data revealed that despite the improvements
in sleep quality after 4 weeks of intervention,
Iran Red Crescent Med J. 2015;17(4):e25880
Keshavarz Afshar M et al.

One hundred and fifty-eight postpartum women with sleep


score 5 or over were randomly devided in to two groups.
group B (n = 79)
case group
group A (n = 79)
control group
inhaling lavender essential oil inhaling placebo

79 persons included in two follow-up


in 8 weeks
79 persons included in two follow-up
in 8 weeks
Analysis with SPSS 16
Figure 1. Study Method Design

Table 1. Demographic Data of Women and Their Husbands Participating in the Study a

Variables Group

Case Control Independent t test and Chi-square Test

Women�s mean age, y 28.06 � 4.105 28.14 � 4.128 P Value = 0.908


Husbands� mean age, y 31.75 � 5.06 32.12 � 5.05 P Value = 0.649
Women�s degree of education P Value = 0.726
Primary School 3 (3.8) 2 (2.5)
High school 3 (3.8) 6 (7.6)
Diploma 24 (30.4) 25 (31.6)
University 49 (62) 46 (58.2)
Husbands� degree of education P Value = 0.854
Primary school 3 (3.8) 2 (2.5)
High school 6 (7.6) 6 (7.6)
Diploma 49 (52) 44 (55.7)
University 21 (26.6) 27 (34.2)
Womens� job P Value = 0.869
Housewife 58 (73.2) 59 (72.7)
Employee 12 (15.3) 14 (17.7)
Student 6 (7.7) 5 (6.3)
Self-employed 3 (3.8) 1 (1.3)
Husbands� job P Value = 0.352
Employee 28 (35.4) 23 (29.1)
Worker 15 (19) 10 (12.7)
Self-employed 33 (41.8) 41 (51.9)
other 3 (3.8) 5 (6.3)
The income from the perspective of women P Value = 0.897
Sufficient 27 (34.2) 28 (35.4)
Nearly Sufficient 49 (62) 49 (62)
Insufficient 3 (3.8) 2 (2.5)
a Data are presented as No. (%) or Mean � SD.
4 Iran Red Crescent Med J. 2015;17(4):e25880
Keshavarz Afshar M et al.

Table 2. Comparison of the Quality of Sleep in Postpartum Women Between Case and
Control Groups Before and After the Intervention

Variable Intervention Mean � SD P Value a


Before intervention 0.64
Case 8.2911 � 2.11922
Control 8.4557 � 2.30272
4 weeks after intervention 0.216
Case 7.5949 � 2.52941
Control 8.0633 � 2.20339
8 weeks after intervention 0.033
Case 6.7975 � 2.36632
Control 7.5696 � 1.14646

Independent t test.

Table 3. Comparison of the Quality of Sleep Between Postpartum Women in Control and
Case Groups After the Intervention a , b

Variable Before Intervention 4 Weeks After Intervention 8 Weeks After Intervention


P Value c
Quality of Sleep 0.002
Case 8.2911 � 2.1192 7.5949 � 2.5294 6.7975 � 2.3663
Control 8.4557 � 2.3027 8.0633 � 2.2033 7.5696 � 1.1464

Data are presented as Mean � SD.

Repeated measure test.

P value < 0.05 were considered as significant.

Estimated Marginal Means of PSQI Estimated Marginal Means of PSQI

time

8.50

group

.00

8.50

1.00

4.00
8.00

2.00

Estimated Marginal Means

Estimated Marginal Means

8.00

7.50

7.00

6.50

Figure 2. Estimated Marginal Mean of Pittsburgh Sleep Quality Index Figure 3.


Estimated Marginal Mean of Pittsburgh Sleep Quality Index

.00 4.00 8.00


time

1.00 2.00
group
there were no significant differences between the intervention
and control groups (P > 0.05). However, eight
weeks after intervention, a significant difference was observed
between two groups (P < 0.05). To examine differences
in sleep quality means between mothers in both
groups over time, repeated measures tests have been
performed. Before performing this analysis, assumptions,
including homogeneity of variances and normal
response variables were examined, which confirmed the

establishment of the assumptions. By considering time


and intervention concurrency at the end of eight weeks
compared to the pre-intervention condition, aromatherapy
significantly increased sleep quality from (8.28 � 2.11)
to (6.79 � 2.36) (P . 0.05). While at the end of eight weeks
(compared to the pre-intervention conditions), no significant
change was observed in placebo group in comparison
to aroma group: 8.45 � 2.30 to 7.56 � 2.14 (P .0.05)
(Table 3, Figures 2 and 3).

Iran Red Crescent Med J. 2015;17(4):e25880


Keshavarz Afshar M et al.

5. Discussion
The present study was conducted with the purpose of
investigating the effects of aromatherapy on sleep quality
of the women during their postpartum period. Comparing
two groups of intervention and control showed
the effectiveness of aromatherapy on mothers� sleep
quality. Inhaling this aroma affected some aspects of
sleep quality, including sleep latency and duration, while
it had no statistically significant impact on other aspects
(P < 0.05).

These findings are consistent with the results of Chien


et al. (17) study about the effects of lavender essential oil
on autonomic nervous system of middle-aged women
suffering from insomnia. The total score of sleep quality
after aromatherapy with lavender essential oil reduced
after the intervention, but there was no change in sleep
quality score in the control group. The results from a
study conducted by Hirokawa et al. (23) showed that lavender
essential oil improves sleepiness during wakefulness.
Also in a study conducted by Moeini et al. (15) the
total score of sleep quality in those who did inhale lavender
essential oil decreased while in the control group
there was no change in sleep quality score after the same
period of time. Another study by Field and colleagues
(2008) with the purpose of studying the effects of aromatherapy
in reducing infants� stress and crying as well as
enhancing their sleep showed the improvement of sleep
quality after aromatherapy with lavender oil (25). Based
on a study done by Lee about the effects of aromatherapy
on the quality of sleep and fatigue level of the mothers in
the postpartum period, inhaled aromatherapy had no effect
on the duration of sleep, frequency of night waking,
and sleep satisfaction (11). These different results might
be due to the following reasons:

1) mothers in this study were enrolled with adequate


sleep quality.

2) duration of aromatherapy was short

3) questionnaire used in the study was a self-designed


questionnaire; moreover

4) PSQL, RCSQ and HCAMQ standardized questionnaire


that has been used in the previous studies, were not used
in this particular study.

Today, aromatherapy has been considered as an alternative


medicine approach with a positive impact and tested
in various researches however, the mechanism of its effects
on sleep quality and its patterns are poorly understood.
Nevertheless, in principle the sense of smell plays
an important role in overall health as well as physical and
mental relaxation and the brain responds emotionally
to aroma (24). In the postpartum period, because of the
conditions and problems such as pain, sudden hormonal
changes in mothers and taking care of the baby, using
aromatherapy seems to be beneficial as a convenient and
easily accessible method for improving sleep quality of
mothers, which results in the infant and family health
too. Despite several studies in the field of aromatherapy

on sleep quality in different periods of life and under different


health conditions, a few studies have investigated
the effects of aromatherapy on the sleep quality in women
during the critical postpartum period to generalize
the results. Therefore, this field of investigation requires
more research. The strong points of this paper are the
careful and continuous follow-up in addition to use of
complementary medicine that has no known compilations.
The weak point of this study relates to the factors
that affect the quality of sleep and were out of our control.
This study is a clinical trial that examined the effects
of aromatherapy on sleep quality in women during postpartum
period. Lavender aromatherapy improves the
quality of sleep in postpartum women.

Acknowledgements

We would like to thank the participants in this research,


all people in charge in Tehran University of Medical Sciences,
Zanjan University of Medical Sciences and Barij Essence
Company, for their assistance and cooperation.

Funding/Support

This study was financially supported by Tehran University


of Medical Sciences.

Authors� Contributions

Mahnaz Keshavarz Afshar: Data collection, as well as design


and writing the manuscript, Zahra Behboodi Moghadam:
Supervisor, design and writing the manuscript,
Pouran Mokhtari and Ziba Taghizadeh: Counselor, Ali
Montazeri: Data analysis, Reza Bekhradi: Material providing.

Financial Disclosure

This project has been approved and financially supported


by Tehran University of Medical Sciences. The interventional
drug and placebo was manufactured by the
support of Barij Essence Company.

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Iran Red Crescent Med J. 2015;17(4):e25880
PENURUNAN INTENSITAS NYERI AKIBAT LUKA POST SECTIO
CAESAREA SETELAH DILAKUKAN LATIHAN TEKNIK RELAKSASI
PERNAPASAN MENGGUNAKAN AROMATERAPI LAVENDER DI
RUMAH SAKIT AL ISLAM BANDUNG

Ratna Pratiwi1Ermiati1Restuning Widiasih1

1Fakultas Ilmu Keperawatan Universitas Padjadjaran, Bandung, Jawa Barat

ABSTRAK

Persalinan dengan sectio caesarea dapat menimbulkan dampak setelah


operasi yaitu nyeri. Adapun teknik penurunan nyeri yang dapat dilakukan yaitu
dengan latihan teknik relaksasi pernapasan menggunakan aromaterapi lavender.
Penelitian ini bertujuan untuk mengetahui pengaruh latihan teknik relaksasi
pernapasan menggunakan aromaterapi lavender. Sampel penelitian ini berjumlah
30 ibu post sectio caesarea hari pertama yang diambil dengan teknik purposive
sampling. Pengambilan data dilakukan di ruang nifas Rumah Sakit Al Islam,
dengan menggunakan lembar observasi menggunakan skala VAS pada bulan Mei


Juni 2012. Analisa data menggunakan uji Wilcoxon. Hasil penelitian
menunjukkan intensitas skala nyeri sebelum dilakukan intervensi adalah 6.6
dimana nilai tersebut masuk dalam kategori nyeri berat tertahankan. Sedangkan
sesudah dilakukan adalah 3.6 dimana nilai tersebut masuk dalam kategori sedang.
Hasil analisis lebih lanjut didapatkan bahwa p= 0.000 dengan taraf signifikan <
0.05, yang berarti ada perbedaan yang signifikan dari intensitas nyeri sebelum dan
setelah dilakukan latihan teknik relaksasi pernapasan menggunakan aromaterapi
lavender.
Kata Kunci : Sectio Caesarea, Nyeri, Relaksasi Pernapasan, Aromaterapi

ABSTRACT

Parturition by sectio Caesarea may cause effects including pain after


surgery. The pain reduction techniques that can be done is to practice relaxation
breathing techniques using lavender aromatherapy. The aim this research is to
determine the effect of breathing exercises relaxation techniques using lavender
aromatherapy. The sample consists of 30 mother post sectio caesarea first day
taken by purposive sampling technique. Data is collected in the puerperal
Hospital Al Islam, using the observation sheet and VAS scale at May � June 2012.
Data analysis using Wilcoxon test. The results showed the average pain scale
before intervention 6.63 where the value is in the category of controlled severe
pain. Whereas after the relaxation breathing techniques exercise using lavender
aromatherapy is 3.6 where the value is in the category of moderate. The analysis
further found that p=0000 with <0.05 significant level, which means there is a
significant difference of pain intensity before and after breathing relaxation
techniques exercise using lavender aromatherapy.

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
Key words : Sectio Caesarea, Pain, Breathing Relaxation, Aromatheray

PENDAHULUAN

Persalinan normal merupakan proses dari mulai mulesnya ibu sampai pada
keluarnya bayi dengan kondisi kepala dahulu melalui vagina, dengan lama
persalinan kurang dari 24 jam (Whalley, 2008). Proses ini kadang tidak berjalan
semestinya dan janin tidak dapat lahir secara normal karena beberapa faktor, yaitu
komplikasi kehamilan, disproporsi sefalo-pelvik, partus lama, ruptur uteri, cairan
ketuban yang tidak normal, kepala panggul. Keadaan tersebut perlu tindakan
medis berupa operasi sectio caesarea (Padilla, et al.,2008). Sectio caesarea adalah

melahirkan janin melalui insisi pada dinding abdomen (laparotomi) dan dinding
uterus (histerotomi) (Cunningham, 2006).

Persalinan secara sectio caesarea dapat memungkinkan terjadinya


komplikasi lebih tinggi dari pada melahirkan secara pervagina atau persalinan
normal. Komplikasi yang bisa timbul pada ibu post sectio caesarea seperti nyeri
pada daerah insisi, potensi terjadinya thrombosis, potensi terjadinya penurunan
kemampuan fungsional, penurunan elastisitas otot perut dan otot dasar panggul,
perdarahan, luka kandung kemih, infeksi, bengkak pada ektremitas bawah dan
gangguan laktasi (Rustam M, 1998). Hal tersebut dapat diatasi secara langsung
oleh tim medis agar ibu cepat sembuh dan lama rawat inap lebih cepat.

Tindakan operasi sectio caesarea menyebabkan nyeri dan mengakibatkan


terjadinya perubahan kontinuitas jaringan karena adanya pembedahan. Pada
proses operasi digunakan anestesi agar pasien tidak nyeri pada saat dibedah.
Namun setelah operasi selesai dan pasien mulai sadar, akan merasakan nyeri di
daerah sayatan yang membuat sangat terganggu (Whalley, dkk 2008).

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
Nyeri tersebut akan menimbulkan berbagai masalah, salah satunya
masalah laktasi. Menurut Hillan (1992) dalam Anggorowati, dkk 2007 bahwa
68% ibu post sectio caesarea mengalami kesulitan dengan perawatan bayi,
bergerak naik turun dari tempat tidur dan mengatur posisi yang nyaman selama
menyusui akibat adanya nyeri. Rasa nyeri tersebut akan menyebabkan pasien
menunda pemberian ASI sejak awal pada bayinya, karena rasa tidak nyaman
selama proses menyusui berlangsung atau peningkatan intensitas nyeri setelah
operasi (Batubara dkk, 2008).

Adapun dampaknya terhadap bayi adalah dalam pemberian ASI dan


kurangnya perawatan bayi yang dilakukan oleh ibunya. Pemberian nutrisi untuk
bayi berkurang karena tertundanya pemberian ASI sejak awal, respiratorik
terganggu dan daya tahan imun rendah (Indiarti, 2009). Respon ibu dalam
memberikan ASI kurang, maka ASI sebagai makan terbaik bagi bayi dan
mempunyai banyak manfaat bagi bayi maupun ibunya tidak dapat secara optimal.

Penanganan yang sering digunakan untuk menurunkan nyeri post sectio


caesarea berupa penanganan farmakologi, biasanya untuk menghilangkan nyeri
digunakan analgesik yang terbagi menjadi dua golongan yaitu analgesik non
narkotik dan analgesik narkotik.

Pengendalian nyeri secara farmakologi efektif untuk nyeri sedang dan


berat. Namun demikian pemberian farmakologi tidak bertujuan untuk
meningkatkan kemampuan klien sendiri untuk mengontrol nyerinya (Van Kooten,
1999 dalam Anggorowati dkk., 2007). Sehingga dibutuhkan kombinasi
farmakologi untuk mengontrol nyeri dengan non farmakologi agar sensasi nyeri

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Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
dapat berkurang serta masa pemulihan tidak memanjang (Bobak, 2004). Metode
non farmakologi tersebut bukan merupakan pengganti untuk obat-obatan,
tindakan tersebut diperlukan untuk mempersingkat episode nyeri yang
berlangsung hanya beberapa detik atau menit. Dalam hal ini, terutama saat nyeri
hebat yang berlangsung selama berjam-jam atau berhari-hari, mengkombinasikan
metode non farmakologi dengan obat-obatan mungkin cara yang paling efektif
untuk mengontrol nyeri. Pengendalian nyeri non-farmakologi menjadi lebih
murah, simpel, efektif dan tanpa efek yang merugikan (Potter, 2005).

Menurut hasil penelitian tentang teknik relaksasi nafas dalam terhadap


penurunan tingkat nyeri pada pasien pasca operasi fraktur femur di Rumah Sakit
Karima Utama Surakarta tahun 2009 oleh Ayudianningsih menyebutkan bahwa
ada pengaruh yang signifikan teknik relaksasi nafas dalam terhadap penurunan
nyeri pada pasien pasca operasi fraktur femur antara kelompok eksperimen dan
kelompok kontrol di Rumah Sakit Karima Utama Surakarta. Adapun menurut
Saekhatun (2008) mengatakan bahwa ada hubungannya sikap perawat dengan
tindakan perawat dalam manajemen nyeri dengan teknik distraksi pada pasien
post operasi.

Ketika seseorang melakukan relaksasi pernapasan untuk mengendalikan


nyeri, di dalam tubuh tersebut meningkatkan komponen saraf parasimpatik secara
stimulan maka hormon adrenalin dan kortisol yang dapat menyebabkan stres akan
menurun sehingga meningkatkan konsentrasi serta merasa tenang untuk mengatur
napas sampai pernapasan kurang dari 60 �
70 x/menit. Kemudian kadar PaCO2
akan meningkat dan menurunkan pH sehingga akan meningkatkan kadar oksigen

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Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
dalam darah (Handerson, 2005). Teori relaksasi pernapasan ini menjelaskan
bahwa pada spinal cord, sel-sel reseptor yang menerima stimulasi nyeri periferal
dihambat oleh stimulasi dari serabut-serabut saraf yang lain. Stimulasi yang
menyenangkan dari luar juga dapat merangsang sekresi endorfin, sehingga
stimulasi nyeri yang dirasakan oleh klien menjadi berkurang (Priharjo, 2003).
Periode relaksasi pernapasan yang teratur dapat membantu untuk melawan
keletihan, ketegangan otot yang terjadi akibat meningkatkan nyeri (Smeltzer dan
Bare, 2002).

Pengaruh aromaterapi terhadap kenyamanan dapat diukur dengan melihat


berbagai indikator yang memperlihatkan kenyamanan. Indikator tersebut adalah
interpretasi terhadap aromaterapi itu sendiri akan menunjukan respon emosi fight
or flight, interpretasi terhadap rasa nyaman yang di dapat dari efek aromaterapi,
pernyataan bahwa aromaterapi meningkatkan kinerja, peningkatan konsentrasi,
pikiran lebih tenang, jiwa menjadi sejuk (Price, 1997). Respon non verbal
menunjukan kenyamanan (tidak ada kerut muka, tidak ada gerakan menjauhkan
diri, tidak ada pengatupan kelopak mata, tidak ada pemalingan wajah/seluruh
badan) (Atkinson, R 1999).

Menurut Hutasoit (2002), bahwa lavender mempunyai efek menenangkan.


Lavender memberikan ketenangan, keseimbangan, rasa nyaman, rasa keterbukaan
dan keyakinan. Selain itu lavender dapat mengurangi rasa tertekan, stress, rasa
sakit, emosi yang tidak seimbang, histeria, rasa frustasi dan kepanikan. Lavender
bermanfaat mengurangi rasa nyeri, dan dapat memberikan relaksasi (Woodcock,
2008 dalam Sulistyowati, 2009). Penelitian Hale (2008), bahwa wanita yang

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
menjalani persalinan menggunakan minyak lavender dapat mengurangi rasa nyeri
pada daerah perineum dan mengurangi kegelisahan.

METODE PENELITIAN

Jenis penelitian yang digunakan adalah Quasi Eksperimen dengan


rancangan penelitian One Group Pre-test Post-test yaitu sampel pada penelitian
ini diobservasi terlebih dahulu sebelum diberi perlakuan, kemudian diobservasi
kembali setelah diberi perlakuan (Notoatmodjo, 2010). Populasi pada penelitian
ini adalah ibu post sectio caesarea di ruang nifas Rumah Sakit Al Islam. Hasil
data dari laporan kegiatan instalasi obgin Rumah Sakit Al Islam jumlah ibu yang
melakukan persalinan sectio caesarea pada 3 bulan terakhir periode Oktober �
Desember 2011 berjumlah 127 orang (medical record Rumah Sakit Al Islam,
2011).

Pengambilan sampel dalam penelitian ini adalah dengan menggunakan


teknik purposive sampling. Dengan kriteria inklusi Pasien post sectio caesarea
yang menggunakan anastesi umum, belum mendapatkan latihan teknik relaksasi
pernapasan, pasien yang tidak alergi dengan aromaterapi. Teknik pengumpulan
data dalam penelitian ini dengan lembar observasi VAS. Peneliti bekerja sama
dengan kolektor data yang bertugas di ruang nifas Rumah Sakit Al Islam. Tetapi
sebelumnya, peneliti menyamakan persepsi dengan memberi pengarahan kepada
kolektor data yaitu perawat dengan menjelaskan tujuan dari penelitian.

Penelitian mengkategorikan intensitas nyeri sebelum dilakukan teknik


relaksasi pernapasan dan intensitas nyeri sesudah dilakukan teknik relaksasi
pernapasan. Skala pengukuran data yang digunakan untuk meneliti pengaruh

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
latihan teknik relaksasi pernapasan terhadap nyeri akibat post sectio caesarea
dalam penelitian ini adalah skala ordinal. Pengumpulan data ini dilakukan pada
ibu post sectio caesarea di ruang nifas Rumah Sakit Al Islam Bandung.
Pelaksanaan dan pengumpulan data dilakukan oleh peneliti dan dibantu oleh
kolektor data seorang perawat. Pengumpulan data dilaksanakan pada tanggal 14
Mei � 7 Juni 2012.

HASIL DAN PEMBAHASAN

Deskripsi hasil penelitian ditampilkan dalam tabel berikut:

Tabel 1 Distribusi Frekuensi Karakteristik Paritas Ibu Post Sectio Caesarea di


Rumah Sakit Al Islam Bandung (n=30)

Karakteristik Frekuensi Presentase


Paritas
Primipara 11 36.67
Multipara 19 63.33
Riwayat Persalinan
Pertama Sectio Caesarea 19 63.33
Pernah Sectio Caesarea 11 36.67
Rentang Usia
<20 Tahun 2 6.67
20 � 35 Tahun 23 76.67
>35 Tahun 5 16.67
Pendidikan
Dasar (SD, SMP) 3 10.00
Menengah (SMA) 7 23.33
Perguruan Tinggi 20 66.67
Pekerjaan
IRT 17 56.67
PNS 7 23.33
Karyawan 6 20.00

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Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21
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Email: pratiwiratna21@yahoo.com
Tabel 2 Frekuensi Intensitas Nyeri Sebelum dan Sesudah Dilakukan Latihan
Teknik Relaksasi Pernapasan Menggunakan Aromaterapi Lavander
(n=30)

Kategori Sebelum Sesudah


Skala Nyeri Frekuensi Persentase Frekuensi Persentase
Tidak nyeri 0 0 0 0
Nyeri ringan 0 0 13 43.33
Nyeri sedang 13 43.33 17 56.67
Nyeri berat 17 56.67 0 0
terkontrol
Nyeri berat tidak 0 0 0 0
terkontrol

Tabel 3 Tingkat Nyeri Sebelum dan Sesudah dilakukan Latihan Teknik Relaksasi
Pernapasan Menggunakan Aromaterapi Lavander (n=30)

Kelompok Mean SD Min Maks P


Value
Pre test 6.6 0.81 5 8 0.000
Post test 3.6 0.72 3 5

Penurunan intensitas nyeri pada responden ini terjadi karena ibu post sectio
caesarea dapat mempraktekkan latihan teknik relaksasi pernapasan menggunakan
aromaterapi lavender dengan benar dan lama waktu latihan kurang lebih 15 menit,
dilakukan pada saat ibu merasakan nyeri pada luka bekas sectio caesarea.
Menurut Indiarti (2009) menggunakan relaksasi dengan induksi latihan relaksasi
pernapasan selama 15 -20 menit secara teratur dapat mengurangi rasa nyeri.
Latihan teknik relaksasi pernapasan dengan aromaterapi lavender dapat dilakukan
sebelum keluhan nyeri terasa. Ibu post sectio caesarea dapat mempraktekkan
latihan pernapasannya untuk mengatasi rasa nyeri pada saat memiringkan badan
dan mengatur posisi. Latihan teknik relaksasi pernapasan bisa berhasil jika pasien
kooperatif (Potter dan Perry, 2006).

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
Hasil penelitian ini hampir sama dengan hasil penelitian yang telah
dilakukan oleh Priyani (2009) yang menyatakan bahwa ada pengaruh yang
signifikan antara pemberian teknik relaksasi napas dalam terhadap penurunan
nyeri dismenore pada remaja putri di Panti Asuhan Yatim Putri Islam Yogyakarta
dengan nilai signifikansi (p) = 0.000. Nyeri merupakan perasaan emosional yang
bersifat subjektif dan hanya seseorang dengan kondisi tersebut yang dapat
mendeskripsikan besarnya nyeri yang dirasakan. Sehingga akan berpengaruh
terhadap penurunan skala intensitas nyeri pada tiap responden. Nyeri sendiri
muncul karena adanya kiriman impuls yang memasuki medulla spinalis dan
berinteraksi dengan sel �
sel saraf inhibitor, sehingga akan ditransmisi mencapai
ke korteks serebral untuk diinterpretasikan sensasi nyeri (Potter dan Perry, 2005).

Reaksi lokal adanya nyeri itu juga mengaktifkan syaraf �


syaraf simpatif,
berupa keluarnya keringat yang berlebihan, respon metabolisme yang meningkat,
meningkatan kardiovaskuler. Nyeri tersebut menimbulkan perasaan sensori dan
emosional yang tidak menyenangkan akibat dari kerusakan jaringan. Tingkat dan
keparahan nyeri pasca operasi terganggu pada fisiologis dan psikologis individu
dan toleransi yang ditimbulkkan (Brunner dan Suddart, 2002). Pengontrolan nyeri
setelah post sectio caesarea sangatlah penting untuk mengurangi kecemasan dan
mempercepat mobilisasi serta rawat inap.

Nyeri yang dirasakan ibu post sectio caesarea dapat dikendalikan dengan
metode penatalaksanaan nyeri seperti yang dilakukan peneliti terhadap
penelitiannya. Metode penatalaksanaan nyeri tersebut dapat dikelompokkan
menjadi metode farmakologi dan metode non farmakologi. Penelitian yang sudah

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
dilakukan Kim pada tahun 2007 menyebutkan bahwa penggunaan terapi aroma
untuk perawatan post operasi anastesi dengan pemakaian aromaterapi lavender
memiliki pengaruh yang signifikan dan lebih efektif dibandingkan dengan
pemakaian sedatif. Selain itu, hasil yang diperoleh mengenai kegiatan penelitian
ini yaitu pemakaian terapi aroma lavender lebih efektif dalam proses penurunan
nyeri dibandingkan dengan pemakaian analgesik (P= 0.007). Kedua jenis metode
tersebut dapat dikombinasikan satu sama lain sehingga lebih cepat dalam proses
penurunan tingkat intensitas nyeri. Namun demikian, metode non farmakologi
memiliki kelebihan yaitu proses pelaksanaannya relatif sederhana, efektif, dan
tidak menimbulkan efek yang merugikan (Perry dan Potter, 2005).

Relaksasi merupakan salah satu metode pengendalian nyeri yang sering


digunakan dan memberikan masukan terbesar dalam penurunan nyeri. Hal ini
sesuai dengan penelitian yang dilakukan oleh Bagharpoosh dkk (2006) dalam
Sulistyowati (2009) menunjukkan bahwa relaksasi sangat efektif untuk
mengurangi nyeri, merupakan cara mudah yang dapat dilakukan, tanpa resiko dan
hanya memerlukan sedikit biaya.

Terapi aroma merupakan tindakan terapeutik dengan menggunakan


minyak esensial yang bermanfaat untuk meningkatkan keadaan fisik dan
psikologi. Latihan teknik relaksasi pernapasan menggunakan aromaterapi
lavender ini dimulai pada saat responden yaitu ibu post sectio caesarea menarik
napas, respon aroma yang dihasilkan aromaterapi lavender akan merangsang kerja
sel otak. Aromaterapi tersebut memiliki efek positif karena aroma atau baunya
yang segar dan harum mampu merangsang sensori dan reseptor sehingga dapat

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
mempengaruhi organ tubuh dan menimbulkan efek kuat terhadap emosi (Shinobi,
2008). Prinsip dasar teori penurunan nyeri oleh teknik relaksasi pernapasan
menggunakan aromaterapi lavender adalah teori gate control yang terletak pada
fisiologis sistem saraf otonom yang merupakan bagian dari sistem yang
mempertahankan homeostatis. Menurut Melzack dan Wall (1965) teori gate
control menjelaskan mekanisme pertahanan dan impul di saraf pusat.

Latihan teknik relaksasi pernapasan dengan aromaterapi lavender


mempengaruhi pelancaran sirkulasi darah, sehingga suplai nutrisi ke jaringan luka
dapat tercukupi dan proses penyembuhan akan lebih cepat. Teknik napas dalam
juga dapat memberikan individu kontrol diri ketika terjadi rasa ketidaknyamanan
atau cemas, stres fisik dan emosi yang menyebabkan nyeri meningkat. Penelitian
yang dilakukan Sulistyowati (2009) menyebutkan bahwa penggunaan terapi
aroma lavender dapat efektif digunakaan untuk mengatasi nyeri dan cemas pada
saat persalinan kala 1 dengan hasil selisih pre post test nyeri dan cemas
persalinan
antara kelompok kontrol dan eksperimen berbeda signifikan (p > 0.005) (p <
0.005). Pernyataan tersebut juga diperkuat oleh Hutasoit (2002) yang
menyebutkan bahwa lavender mempunyai aefek menenangkan sehingga dapat
memberikan ketenangan, keseimbangan, dan rasa nyaman. Di samping itu terapi
aroma lavender juga dapat mengurangi rasa tertekan, stres, rasa sakit, emosi yang
tidak seimbang, histeria, serta rasa frustasi dan kepanikan. Dalam penelitian ini
cara yang digunakan adalah dengan menyegarkan ruangan atau vapourizer dengan
menggunakan tungku pemanas. Cara tersebut sangat sederhana dengan hanya

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
meletakkan sedikit air dan aromaterapi di atas alat pemanas yang dibakar oleh
lilin aroma sehingga menimbulkan wewangian.

Berdasarkan pembahasan mengenai hasil penelitian dari peneliti dan


peneliti-peneliti sebelumnya, tentu saja diperlukan adanya solusi dari
permasalahan yang berkaitan dengan tingkat intensitas nyeri pada ibu post sectio
caesarea. Oleh karena itu, untuk mengatasi masalah ini tentu saja diperlukan
adanya peningkatan dari penggabungan metode farmakologi dan non farmakologi
secara efektif dan menyeluruh. Metode non farmakologi berupa latihan teknik
relaksasi pernapasan menggunakan aromaterapi lavender diharapkan dapat
menjadi komplementer bagi ibu post sectio caesarea untuk dapat mengontrol
nyeri yang dirasakan secara tiba-tiba sehingga nantinya aktivitas ibu post sectio
caesarea tidak terganggu serta dapat melewati fase latting go (kemandirian)
sesegera mungkin.
SIMPULAN

Berdasarkan hasil penelitian yang dilakukan terhadap 30 ibu post sectio


caesarea di ruang nifas Rumah Sakit Al Islam Bandung dapat disimpulkan
sebelum diberikan latihan teknik relaksasi pernapasan menggunakan aromaterapi
lavender, intensitas skala nyeri sangat tinggi dimana nilai tersebut masuk dalam
kategori berat tertahankan, adapun sesudah diberikan latihan teknik relaksasi
pernapasan menggunakan aromaterapi lavender intensitas skala nyeri pada
responden berubah tersebut masuk dalam kategori sedang. Terdapat perbedaan
yang signifikan antara intensitas skala nyeri sebelum dan sesudah diberikan
latihan teknik relaksasi pernapasan menggunakan aromaterapi lavender. Hal ini
mengindikasikan adanya pengaruh latihan teknik relaksasi pernapasasn

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
menggunakan aromaterapi lavender terhadap intensitas nyeri akibat luka post
sectio caesarea dengan p-value < 0.05 baik terhadap intensitas skala nyeri dan
berkurangnya nyeri yang dialami ibu post sectio caesarea dapat diatasi.

SARAN

Diharapkan bagi ibu post sectio caesarea dapat memahami tentang latihan
teknik relaksasi pernapasan menggunakan aromaterapi lavender terhadap
intensitas nyeri akibat luka post sectio caesarea. Informasi yang telah diterima
dapat dipraktekkan secara mandiri oleh ibu dalam kehidupan sehari �
hari
sehingga ketika terjadi nyeri, ibu dapat mengontrol sensasi nyeri dan aktivitas ibu

tidak terganggu.

Diharapkan dapat menjadi masukan bagi dokter, bidan dan perawat


terhadap program pelayanan ibu post sectio caesarea tentang penanganan nyeri
secara non farmakologi dengan latihan teknik relaksasi pernapasan menggunakan
aromaterapi lavender. Dengan adanya kombinasi antara farmakologi yang
diberikan dan non farmakologi dapat membantu mempercepat proses
penyembuhan.

Peneliti menyarankan untuk dilakukan penelitian lebih lanjut tentang


perbandingan latihan teknik relaksasi pernapasan menggunakan aromaterapi
dengan metode yoga untuk perawatan luka post sectio caesarea. Peneliti juga
menyarankan untuk pengukuran dengan skala nyeri lebih akurat.

UCAPAN TERIMA KASIH

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
Ucapan terima kasih penulis sampaikan kepada Rumah Sakit Al Islam

Bandung yang telah member izin penelitian.

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Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
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Brunner and Suddarth. (8 th edition). Jakarta: EGC.

Sulistyowati, D. 2009. Efektifitas Terapi Aroma Lavender Terhadap Tingkat

Nyeri dan Kecemasan Persalinan Primipara Kala I di Rumah Sakit dan

Klinik Bersalin Purwokerto.

Walley, J., Simkin, P., dan Keppler, A. (2008). Panduan Praktis Bagi Calon Ibu :
Kehamilan dan Persalinan. Jakarta : PT. Bhuana Ilmu Populer.

Ratna Pratiwi

Fakultas Ilmu Keperawatan Universitas Padjadjaran (Jl.Raya Bandung-Sumedang KM.21


Jatinangor-Sumedang)

Email: pratiwiratna21@yahoo.com
ISSN 2354-7642
Jurnal Ners dan Kebidanan Indonesia JOURNAL NERS
Tersedia online pada: AND MIDWIFERY INDONESIA
http://ejournal.almaata.ac.id/index.php/JNKI

Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineumpada Ibu Post Partum

Wiwin Widayani

DIII Kebidanan Poltekkes Kemenkes Bandung

Jalan Pajajaran No.56, Pasir Kaliki, Cicendo, Kota Bandung, Jawa Barat 40171

Email: wiwinbidbdg@gmail.com

Abstrak

Nyeri perineum dapat memengaruhi kemampuan wanita untuk mobilisasi sehingga dapat
menimbulkan
komplikasi seperti perdarahan post partum. Trauma pada perineum juga menimbulkan
rasa tidak nyaman
dan nyeri saat melakukan hubungan seksual. Karena itu, penanganan nyeri perineum
ini penting dilakukan.
Saat ini penanganan yang sering digunakan yaitu terapi komplementer aromaterapi
dengan minyak essensial
lavender, karena lavender mempunyai sifat antikonvulsan, antidepresi, anxiolytic,
dan menenangkan.
Aromaterapi akan menstimulasi hipotalamus untuk mengeluarkan mediator kimia yang
berfungsi sebagai
penghilang rasa sakit dan menimbulkan perasaan bahagia. Tujuan penelitian ini
adalah untuk mengetahui
pengaruh aromaterapi lavender terhadap intensitas nyeri luka jahitan perineum pada
ibu post partum. Penelitian
ini merupakan quasi eksperiment pre and post control pada ibu nifas yang berada di
Bidan Praktik Mandiri
Wilayah Kota Bandung. Pengambilan sampel penelitian ini menggunakan teknik
consecutive sampling. Data
diambil dengan menggunakan instumen yang diadaptasi dari Visual Analog Scale (VAS)
dengan analisis uji
wilcoxon. Hasil penelitian menunjukkan ada penurunan nyeri sebelum dan setelah
pemberian aromaterapi
lavender secara inhalasi (Z=-3,77) dengan p-value 0,001. Aromaterapi lavender dapat
menjadi alternatif
terapi komplementer untuk menurunkan nyeri pada ibu post partum akan tetapi
diperlukan penelitian lebih
lanjut dengan responden yang lebih banyak.

Kata Kunci: aromaterapi lavender, nyeri perineum

Lavender Aromatherapy Reduced the Intensity of Perineal Pain


among Post Partum Women

Abstract

Perineals pain affects woman ability to mobilize so that it can cause complications
such as post-partum

hemorrhagic. Trauma to the perineum also cause discomfort and dyspareunia,


therefore, perineal pain

management is important. Currently the handling used to relieve pain is


complementary therapy aromatherapy

with essential oils of lavender, because lavender has the properties of


anticonvulsant, antidepressant,

anxiolytic, and also soothing. Aromatherapy stimulates the hypothalamus to secrete


chemical mediators that

serve as pain relievers and give rise to feelings of happiness. The purpose of this
study was to determine the

effect of lavender aromatherapy to the perineal pain intensity in post partum


women. This study was a quasi

experiment pre and post non random control in postpartum women at Bidan Praktik
Mandiri in Bandung. This

study used was consecutive sampling technique. The data were taken using the
instrument adapted from a

Visual Analog Scale (VAS) and analyzed by the wilcoxon signed rank test. The result
showed that there was

a decrease in pain intensity before and after the administration of inhaled


lavender aromatherapy (Z=-3.77)

with p-value 0.001. Lavender aromatherapy can be a complementary alternative


therapy to reduce pain in

postpartum women but more research necessary is needed with more respondents.

Keywords: lavender aromatherapy, perineum pain

Info Artikel:
Artikel dikirim pada 21 September 2016
Artikel diterima pada 31 Oktober 2016

DOI : http://dx.doi.org/10.21927/jnki.2016.4(3).123-128

Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineum pada Ibu Post
Partum 123
PENDAHULUAN

Tanpa memperhatikan apakah perineum


mengalami trauma atau tidak, seorang ibu cenderung
merasakan adanya memar di sekitar vagina dan
jaringan perineum selama beberapa hari setelah
persalinan. Ibu yang mengalami laserasi perineum
akan merasakan nyeri selama beberapa hari sampai
penyembuhan terjadi (1).

Padabeberapaorang,nyeridapatmengganggu
dibanding gangguan akibat penyakit yang lain.
Setelah melahirkan secara pervaginam, seorang
ibu sering melaporkan nyeri dan trauma pada
perineum. Nyeri perineum merupakan hal yang
fisiologis pada ibu post partum, akan tetapi
nyeri ini memengaruhi kemampuan wanita untuk
mobilisasi sehingga dapat menimbulkan komplikasi
seperti perdarahan post partum. Nyeri perineum
akibat adanya trauma seperti adanya laserasi
perineum dapat menyebabkan rasa tidak nyaman
dan dispareunia. Di Rumah Sakit Royal Victoria
Australia dilaporkan bahwa 90% wanita mengalami
nyeri perineum. Nyeri dirasakan ketika berjalan
(33%), duduk (39%), dan tidur (45%) (2).

Hasil penelitian menjelaskan bahwa sebagian


besar wanita menggunakan analgesia untuk
mengatasi rasa sakit tersebut dengan menggunakan
obat analgetik dan ice pack (69%), oral analgesik
(75%) (2). Hal tersebut membuktikan bahwa nyeri
perineum sangat mengganggu bagi sebagian besar
wanita. Apabila kekhawatiran dan nyeri perineum
berlangsung lama, maka dapat berdampak negatif
terhadap fungsi dan pengalaman awal menjadi
seorang ibu. Oleh karena itu, penanganan nyeri
perineum ini penting untuk dilakukan.

Penanganan untuk mengurangi nyeri


perineum dapat dilakukan secara farmakologi
dan non farmakologi. Namun penggunaan secara
farmakologi sering menimbulkan efek samping
dan kadang tidak memiliki kekuatan efek yang
diharapkan. Aromaterapi digunakan sebagai
salah satu alternatif penanganan nyeri non
farmakologik. Berbagai macam aroma terapi yang
dapat digunakan antara lain cendana, kemangi,
kayumanis, kenanga, sitrus, melati, cengkih,
lavender, mawar, jasmine. Saat ini penanganan yang
sering digunakan untuk mengurangi rasa nyeri yaitu
terapi komplementer aromaterapi dengan minyak
essensial lavender, karena lavender mempunyai
sifat-sifat antikonvulsan, antidepresi, anxiolytic, dan
bersifat menenangkan (3).

Saat aromaterapi dihisap, zat aktif yang


terdapat di dalamnya akan merangsang hipotalamus
(kelenjar hipofise) untuk mengeluarkan hormon
endorpin. Endorpin diketahui sebagai zat yang
menimbulkan rasa tenang, relaks dan bahagia.
Di samping itu, zat aktif berupa linaool dan linalyl
acetate yang terdapat dalam lavender berefek
sebagai analgetik (4,5).

Banyak penelitian melaporkan pengaruh


aromaterapi lavender terhadap penurunan nyeri,
tetapi pengaruh aromaterapi lavender terhadap nyeri
perineum belum banyak. Vakilian melaporkan bahwa
pemberian aromaterapi lavender dapat mengurangi
nyeri perineum pada 60 ibu nifas yang mengalami
laserasi spontan dan episiotomi, 40% di antaranya
dilaporkan tidak merasakan sakit. Dale & Cornwell
melaporkan nyeri perineum berkurang pada 635 ibu
post partum yang mandi dengan menambahkan
minyak lavender (6). Oleh karena itu, perlu dilakukan
penelitian pengaruh aromaterapi lavender terhadap
penurunan nyeri luka jahitan perineum ibu post partum.

BAHAN DAN METODE

Penelitian ini dilakukan dengan menggunakan


penelitian quasi experiment dengan rancangan
one group pre dan post test. Tempat penelitian
adalah Bidan Praktik Mandiri (BPM) yang ada di wilayah
Kota Bandung. Penelitian dilakukan mulai dari Bulan
Mei sampai September 2015, dengan jumlah sampel
28 orang.

Teknik pengambilan sampel pada penelitian ini


adalah dengan non probability sampling berupa teknik
consecutive sampling yaitu dengan memilih sampel
yang memenuhi kriteria penelitian sampai kurun
waktu tertentu sehingga jumlah sampel terpenuhi.

Kriteria inklusi pada penelitian ini adalah


ibu post partum hari ke 1, ibu post partum
yang melahirkan normal (pervaginam) dan
mengalami rupture derajat 2, ibu post partum yang
mengalami luka jahitan perineum. Sedangkan kriteria
eksklusinya yaitu ibu post partum yang melahirkan
dengantindakanoperasiatauvakum,ibu post partum
yang mengalami vaginitis, hematoma dan abses di
perineum,ibu post partumyangmemilikiriwayatalergi
obat, ibu post partum yang memiliki penyakit asma.

Intervensi dilakukan setelah 2 jam dilakukan


penjahitan perineum. Setelah mengisi kuesioner
pretest, reponden diberikan intervensi aromaterapi
lavender inhalasi dalam kurun waktu menit ke

124 Wiwin Widayani, 2016. JNKI, Vol. 4, No. 3, Tahun 2016, 123-128
10, 30 dan 60, aromaterapi diberikan selama 10
menit. Kemudian dilakukan posttest seiring dengan
observasi masa nifas 2 jam, dengan cara memeriksa
luka jahitan perineum menggunakan pinset anatomis.
Saat diperiksa luka jahitan, peneliti melihat reaksi
wajah responden.

Instrumen yang digunakan yaitu Visual


Analogue Scala (VAS) dengan skala nyeri 0-10,
dengan batasan kategori nyeri diadaptasi ke dalam
Bahasa Indonesia, yaitu tidak nyeri (0); nyeri ringan
(1-3); rasa nyeri seperti rasa gatal, rasa tersetrum,
melilit, terpukul, perih, nyut-nyutan, kram; nyeri
sedang (4-7); rasa nyeri seperti nyut-nyutan/ kram;
nyeri berat (8-9): sangat nyeri, sulit bergerak tapi
masih terkontrol; dan nyeri sangat berat (10): sangat
nyeri, sulit bergerak sampai tidak terkontrol seperti
menangis, menjerit.

Bahan yang digunakan adalah uap minyak


lavender dengan konsentrasi 100%, diberikan
4-5 tetes dilarutkan dalam 200 ml air, diberikan
secara inhalasi melalui vaporizer atau alat listrik.
Sebelum inhalasi, cawan tungku aromaterapi
yang telah diberikan air ditunggu sampai hangat
baru diteteskan essens aromaterapi. Jarak antara
tungku dengan responden kurang 30 cm. Setelah
tercium wangi aromaterapi, pasien diminta relaks
dan menghirup wangi aromaterapi selama 10 menit.
Responden dikondisikan dalam ruangan dengan
ukuran antara 10-16 m2 dan tidak banyak ventilasi
udara. Analisis data yang digunakan analisis
univariat dan bivariat. Analisis bivariabel sebelum
dan setelah diberikan perlakuan digunakan uji
wilcoxon.

HASIL DAN BAHASAN

Berdasarkan Tabel 1 dapat diketahui bahwa


karakteristik responden berdasarkan umur terbanyak
adalah 20-35 tahun (71,4%) sedangkan karakteristik
responden berdasarkan pekerjaan sebanyak 92,9%
tidak bekerja. Berdasarkan pendidikan responden,
terbanyakpadapendidikanSMA(39,3%). Berdasarkan
riwayat melahirkan, responden terbanyak pada
pada riwayat melahirkan =2 kali (57,1%).

Tabel 1. Distribusi Frekuensi Nyeri Luka Jahitan


Perineum Berdasarkan Karakteristik Responden

Karakteristik n %
Usia
< 20 Tahun 7 25
20-35 tahun 20 71,4
>35 tahun 1 3,6
Pekerjaan
Tidak bekerja 26 92,9
Bekerja 2 7,1
Pendidikan
SD 3 10,7
SMP 8 28,6
SMA 11 39,3
Perguruan Tinggi 6 21,4
Paritas
Melahirkan 1 kali 12 42,9
Melahirkan > 2 kali 16 57,1
Jumlah 28 100

Sumber: Data Primer Tahun 2015

Tabel 2 di bawah ini merupakan frekuensi


intensitas nyeri luka jahitan perineum sebelum dan
sesudah intervensi.

Tabel 2. Distribusi Frekuensi Intensitas Nyeri Luka


Jahitan Sebelum dan Sesudah Intervensi

Intensitas Nyeri Sebelum


n %
Sesudah
n %
Tidak Nyeri 2 7,1 7 25
Nyeri Ringan 6 21,4 11 39,3
Nyeri Sedang 10 35,7 9 32,1
Nyeri Berat 8 28,6 1 3,6
Nyeri Sangat Berat 2 7,1 0 0
Jumlah 28 28

Sumber: Data Primer Tahun 2015

Berdasarkan Tabel2 diketahui bahwa intensitas


nyeri sebelum diberikan intervensi paling banyak
berada pada nyeri sedang (35,7%). Setelah diberikan
intervensi, intensitas nyeri paling banyak menjadi
nyeri ringan (39,3%)

Tabel 3 merupakan tabel perbedaan intensitas


nyeri luka jahitan perineum sebelum dan sesudah
diberikan aromaterapi lavender.

Tabel 3. Perbedaan Intensitas Nyeri Luka Jahitan Perineum Sebelum dan Sesudah
Intervensi

Sebelum Sesudah

Skor Intensitas

Perlakuan Perlakuan p-value

Nyeri Perineum

(n=28) (n=28)

Median (Rentang) 3,00 (1-5) 2,00(1-4) <0,001*


Sumber: Data Primer Tahun 2015
*Uji Wilcoxon (Z= -3,77)

Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineum pada Ibu Post
Partum 125
Pada Tabel 3 dapat diketahui bahwa nilai
median dan rentang dari skor intensitas nyeri luka
perineum setelah perlakuan menjadi lebih rendah
dibandingkan sebelum perlakuan. Berdasarkan
hasil uji statistik nilai p<0,05 sehingga terdapat
perbedaan skor pada kelompok responden sebelum
perlakuan dan setelah perlakuan. Oleh karena itu
dapat diasumsikan bahwa pemberian aromaterapi
lavender berpengaruh terhadap penurunan intensitas
nyeri luka perineum.

Nyeri luka perineum akan dirasakan setelah


persalinan sampai beberapa hari pasca persalinan.
Bagi seorang perempuan kekuatan otot perineum
sangat penting, karena robekan perineum yang
terjadi selama proses persalinan dapat menyebabkan
melemahnya otot-otot dasar panggul. Selain itu,
robekan perineum dapat menyebabkan rasa tidak
nyaman dan dispareunia. Hasil penelitian didapatkan
bahwa responden mengalami nyeri sedang (35,7%).
Nyeri yang dirasakan ini dapat terjadi karena adanya
proses penghantaran nyeri dari sel syaraf aferen atau
neuron sensori, serabut konektor atau interneuron
dan sel saraf eferen atau neuron motorik yang
dihantarkan ke otak, sehingga dipersepsikan tubuh
menjadi rasa nyeri.

Nyeri perineum dapat terjadi setelah persalinan


pervaginam akibat laserasi spontan pada saat bayi
lahir dan dapat diperparah apabila terdapat robekan
padaperineumyangdisebabkantindakanepisiotomi.
Tindakan ini akan memerlukan penjahitan dan
dengan penjahitan tersebut dapat menyebabkan
nyeri pada daerah luka jahitan. Sebanyak 33% wanita
mengalami nyeri perineum karena tindakan episiotomi
dan 52% merupakan laserasi spontan (7).

Pengurangan rasa nyeri luka jahitan perineum


padaibu post partumdilakukandenganberbagaicara,
salah satunya dengan pemberian inhalasi melalui
aromaterapi lavender. Berdasarkan hasil penelitian
bahwa terdapat perbedaan signifikan intensitas nyeri
antara kelompok perlakuan dan kelompok kontrol
dengan p-value 0,01.

Sesuai hasil penelitian Stea Susana menunjukkan


bahwa terapi esensial minyak lavender berpengaruh
secara positif terhadap kecemasan insomnia
dan mengontrol rasa sakit (8). Dengan demikian
aromaterapi lavender dapat menjadi salah satu
alternatif penanganan nyeri luka perineum yang dapat
mengakibatkan kondisi fisik maupun psikologis ibu
menjadi lebih baik. Begitu juga hasil penelitian Salamati
didapatkan bahwa rasa sakit sebelum dan setelah

menghirup minyak esensial lavender berpengaruh

secara signifikan terhadap pengurangan rasa sakit


dengan p-value <0,05 (9). Menurut Dochterman,
aromaterapi adalah pemberian minyak esensial
melalui metode massase, salep topikal, inhalasi,
mandi kompres (panas, dingin) untuk mengurangi
nyeri dan dapat menimbulkan efek relaksasi dan terapi
pengobatan (7). Bentuk aromaterapi yang banyak
digunakan untuk mengurangi rasa nyeri serta memiliki
sifat antiseptiknya adalah lavender. Penelitian yang
dilakukan Dale & Cornwell pada 635 wanita yang
pada kelompok pertama ditambahkan minyak lavender
murni pada air mandi mereka sebanyak 6 tetes pada
hari ke 10 pertama pascanatal. Pada hari kesepuluh
wanita dan bidan menyelesaikan kuesioner mengenai
nyeri perineum. Data yang diperoleh menunjukkan
bahwa 90% ibu melaporkan merasa lebih baik setelah
mandi menggunakan minyak lavender dan tidak
ditemukan efek samping (10).

Kristanti menjelaskan bahwa molekul dan


partikel lavender saat dihirup akan masuk melalui
hidung, kemudian diterima oleh reseptor saraf sebagai
signal yang baik dan kemudian diinterpretasikan
sebagai bau yang menyenangkan, dan akhirnya
sensori bau tersebut masuk serta memengaruhi
sistem limbic sebagai pusat emosi seseorang,
sehingga saraf dan pembuluh darah perasaan akan
semakin relaks dan akhirnya rasa nyeri berkurang
(11).

Dijelaskan juga oleh Pratiwi bahwa penurunan


nyeri dengan aromaterapi lavender mengacu pada
konsep gate control yang terletak pada fisiologi
mekanisme penghantaran impuls nyeri yang terjadi
saat sistem pertahanan dibuka, dan sebaliknya
penghantaran impuls nyeri dapat dihambat saat
sistem pertahanan ditutup. Aromaterapi lavender
merupakan salah satu upaya untuk menutup sistem
pertahanan tersebut. Selain itu, aromaterapi lavender
memengaruhi kelancaran sirkulasi darah, sehingga
suplai nutrisi ke jaringan luka tercukupi dan proses
penyembuhan akan lebih cepat (12).Saat aromaterapi
dihisap, zat aktif yang terdapat di dalamnya akan

merangsang hipotalamus (kelenjar hipofise) untuk

mengeluarkan hormon endorpin. Endorpin diketahui


sebagai zat yang menimbulkan rasa tenang, relaks,
dan bahagia. Di samping itu, zat aktif berupa linaool
dan linalyl acetate yang terdapat dalam lavender
berefek sebagai analgetik (4,5).

Karlina dkk juga menjelaskan bahwa pemberian


aromaterapi lavender terbukti dapat menurunkan

126 Wiwin Widayani, 2016. JNKI, Vol. 4, No. 3, Tahun 2016, 123-128
intensitas nyeri persalinan fisiologis kala satu fase

aktif. Begitu juga Kartika dkk menyebutkan bahwa


terdapat perbedaan signifikan pada intensitas
nyeri persalinan normal kala satu, sebelum dan
sesudah diberikan lilin aromaterapi lavender. Hal
ini membuktikan bahwa efek aromaterapi lavender
yang memberikan rasa tenang dan analgetik sangat
berpengaruh terhadap penurunan rasa nyeri. Seperti
yang telah dijelaskan sebelumnya bahwa zat kimia
yang dihasilkan dari hormon endorpin sebagai akibat
rangsangan hipotalamus oleh aromaterapi lavender,
dapat menghasilkan rasa tenang, rasa bahagia dan
relaks, serta melemasakan otot-otot yang tegang
akibat rasa nyeri, salah satunya melemaskan otototot
perineum yang tegang karena rasa nyeri luka
laserasi (4,5,13,14).

SIMPULAN DAN SARAN

Terdapat penurunan intensitas nyeri luka jahitan


perineum sebelum dan setelah diberikan aromaterapi
lavender. Aromatepi lavender berpengaruh secara
signifikan terhadap penurunan nyeri luka jahitan
perineum pada ibu post partum dengan p-value 0,01.

Inhalasi aromaterapi lavender dapat digunakan


sebagai alternatif terapi komplementer pada ibu post
partum dengan luka jahitan perineum. Diperlukan
penelitan lebih lanjut dengan sampel yang lebih
banyak dengan responden yang tidak hanya memiliki
luka jahitan perineum derajat dua.

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Pengaruh Aromaterapi Lavender secara Inhalasi
terhadap Penurunan Intensitas Nyeri Persalinan
Fisiologis pada Primipara Inpartu Kala Satu Fase
Aktif di BPM Fetty Fathiyah Kota Mataram. Maj
Kesehat Fak Kedokt Univ Brawijaya [Internet].
Aromaterapi Lavender dapat Menurunkan Intensitas Nyeri Perineum pada Ibu Post
Partum 127
2015;2(2). Available from: http://majalahfk.ub.ac.
id/index.php/mkfkub/article/view/59.

14. Kartika R, Susilo J, Lestari P.


Efek Lilin
Aromaterapi Lavender Terhadap Perubahan
Intensitas Nyeri Persalinan Normal Kala I Fase
Aktif. ejurnal Ngudi Waluyo [Internet]. 2015;7(24).
Available from: http://ejournalnwu.ac.id/article/
view/1435905534.

128 Wiwin Widayani, 2016. JNKI, Vol. 4, No. 3, Tahun 2016, 123-128
PERBEDAAN TINGKAT NYERI SEBELUM DAN SESUDAH PEMBERIAN
AROMATHERAPI LAVENDER PADA IBU POST SECTIO CAESAREA
DI RSUD AMBARAWA

Prita Swandari

Program Studi Diploma IV Kebidanan STIKES Ngudi Waluyo Ungaran

ABSTRACT

Background: Childbirth with sectio caesarea is childbirth with a tear abdomen to


get a fetus. The
process will cause pain as a result of surgery and recovery trough the seams. The
post-SC surgical
wound in the abdomen area will cause pain. Lavender aromatherapy is a non
pharmacological
treatment for the pain. The of aromatherapy lavender is able in increasing
relaxation, lowering stress,
and reducing pain. The purpose of this study is to find the differences in levels
of pain before and after
getting lavender aromatherapy in the mothers with post-SC at Ambarawa Public
Hospital.

Method: This was a quasi-experimental study with the samples of 26 patients with
post-SC sampled by
using accidental sampling technique. The levels of pain were measured by using
numerical scales. The
bivariate analysis used the Wilcoxon test.

Results: The results of this study indicated that there were 21 respondents (80.8%)
who have pain in
the category of medium, and 5 respondents (19:20%) who had pain in the category of
mild, whereas
after the lavender aromatherapy given indicated that there were 20 respondents
(76.92%) who have
pain in the category of mild, and 6 respondents (23.1%) who had pain in the
category of medium. The
bivariate analysis indicated that there was a difference in the levels of pain in
the patients with post-
SC before and after getting lavender aromatherapy with p-value of 0.000 < a = 0.05.

Advice: From the research that can be used as reference to to condiser aromatherapi
of lavender as
therapi to reduce pain in patients post sectio caesarea.

Keywords : Levels of sectio caesarea pain, Lavender aromatherapy

PENDAHULUAN

Persalinan normal merupakan proses dari


mulai mulesnya ibu sampai pada keluarnya
bayi dengan kondisi kepala dahulu melalui
vagina, dengan lama persalinan kurang dari
24 jam (Whalley, 2008). Proses ini kadang
tidak berjalan semestinya dan janin tidak dapat
lahir secara normal karena beberapa faktor,
yaitu komplikasi kehamilan, disproporsi
sefalo-pelvik, partus lama, ruptur uteri, cairan
ketuban yang tidak normal, kepala panggul.
Keadaan tersebut perlu tindakan medis
berupa operasi sectio caesarea (Padilla, et
al.,2008).

Persalinan secara sectio caesarea dapat


memungkinkan terjadinya komplikasi lebih
tinggi daripada melahirkan secara pervaginam
atau persalinan normal. Komplikasi yang bisa

timbul pada ibu post sectio caesarea seperti


nyeri pada daerah insisi, potensi terjadinya
thrombosis, potensi terjadinya penurunan
kemampuan fungsional, penurunan elastisitas
otot, perut dan otot dasar panggul,
perdarahan, luka kandung kemih, infeksi,
bengkak pada ekstremitas bawah, dan
gangguan laktasi (Rustam M, 2008)

Pada proses operasi digunakan anestesi


agar pasien tidak nyeri pada saat dibedah.
Namun setelah operasi selesai dan pasien
mulai sadar, akan merasakan nyeri di daerah
sayatan yang membuat sangat terganggu
(Whalley, dkk 2008). Menurut Rustam M
(2008) dalam Pratiwi (2012) nyeri yang
dikeluhkan pasien post operasi SC yang
berlokasi pada daerah insisi, disebabkan oleh
robeknya jaringan pada dinding perut dan
dinding uterus. Rasa nyeri yang dirasakan post

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
SC akan menimbulkan berbagai masalah, salah
satunya masalah laktasi. Rasa nyeri tersebut
akan menyebabkan pasien menunda pemberian
ASI sejak awal pada bayinya, karena rasa tidak
nyaman dan peningkatan tingkat nyeri setelah
operasi (Batubara dkk, 2008).

Ibu post operasi SC akan merasakan


nyeri, dan dampak dari nyeri akan
mengakibatkan mobilisasi ibu menjadi
terbatas, Activity of Daily Living (ADL)
terganggu, bonding attachment (ikatan kasih
sayang) dan Inisiasi Menyusui Dini (IMD)
tidak terpenuhi karena adanya peningkatan
tingkat nyeri apabila ibu bergerak. Hal ini
mengakibatkan respon ibu terhadap bayi
kurang, sehingga ASI sebagai makanan terbaik
bagi bayi dan mempunyai banyak manfaat bagi
bayi maupun ibunya tidak dapat diberikan
secara optimal (Purwandari, 2009).

Penanganan yang sering digunakan untuk


menurunkan nyeri post sectio caesarea berupa
penanganan farmakologi. Pengendalian nyeri
secara farmakologi efektif untuk nyeri
sedang dan berat. Namun demikian
pemberian farmakologi tidak bertujuan
untuk meningkatkan kemampuan klien sendiri
untuk mengontrol nyerinya (Van Kooten, 1999
dalam Anggorowati dkk., 2007).
Sehingga dibutuhkan kombinasi farmakologi
untuk mengontrol nyeri dengan non
farmakologi agar sensasi nyeri dapat
berkurang serta masa pemulihan tidak
memanjang (Bobak, 2004).

Pengendalian nyeri non-farmakologi


menjadi lebih murah, simpel, efektif, tanpa
efek yang merugikan, dan ibu dapat
mengendalikan sendiri keluhan nyerinya
(Potter, 2005). Manajemen nonfarmakologi
yang sering diberikan antara lain yaitu dengan
meditasi, latihan autogenic, latihan relaksasi
progresif, guided imagery, nafas ritmik,
operant conditioning, biofeedback, membina
hubungan terapeutik, sentuhan terapeutik,
stimulus kutaneus, hipnosis, musik,
accupresure, aromatherapi (Sulistyo, 2013).

Aromatherapi merupakan salah satu


therapi non farmakologis untuk mengurangi
nyeri persalinan, yaitu sebuah terapi
komplementer yang melibatkan penggunaan
wewangian berasal dari minyak esensial.
Minyak esensial dapat dikombinasikan dengan
base oil (minyak campuran obat) yang dapat
dihirup atau di massase ke kulit yang utuh
(Brooker, 2009).
Aromatherapi digunakan untuk
menyembuhkan masalah pernafasan, rasa
nyeri, gangguan pada saluran kencing,
gangguan pada alat kelamin, dan juga masalah
mental dan emosional. Hal ini terjadi karena
aromatherapi mampu memberikan sensasi
yang menenangkan diri dan otak, serta stress
yang dirasakan (Laila 2011).

Pengaruh aromaterapi terhadap


kenyamanan dapat diukur dengan melihat
berbagai indikator yang memperlihatkan
kenyamanan. Indikator tersebut adalah
interpretasi terhadap aromaterapi itu sendiri
akan menunjukan respon emosi fight or flight,
interpretasi terhadap rasa nyaman yang di
dapat dari efek aromaterapi, pernyataan
bahwa aromaterapi meningkatkan kinerja,
peningkatan konsentrasi, pikiran lebih
tenang, jiwa menjadi sejuk (Price, 2007).
Respon non verbal menunjukan kenyamanan
(tidak ada kerut muka, tidak ada gerakan
menjauhkan diri, tidak ada pengatupan
kelopak mata, tidak ada pemalingan
wajah/seluruh badan) (Atkinson, R 2009).

Menurut Dr. Alan Huck (Neurology


Psikiater dan Direktur Pusat Penelitian Bau
dan Rasa), aroma berpengaruh langsung
terhadap otak manusia, mirip narkotika.
Hidung memiliki kemampuan untuk
membedakan lebih dari 100.000 bau yang
berbeda yang sangat berpengaruh pada otak
yang berkaitan dengan suasana hati, emosi,
ingatan, dan pembelajaran. Dengan menghirup
aroma lavender maka akan meningkatkan
gelombang-gelombang alfa di dalam otak dan
gelombang inilah yang membantu kita untuk
merasa rileks (Simkin, 2008).

Bunga yang digunakan untuk


aromatherapi adalah lavendula atau biasa
disebut lavender. Lavender adalah tumbuhan
berbungan dalam suku lamiaceae yang
memiliki 25-30 spesies. Lavender berasal dari
wilayah selatan laut tengah Afrika tropis dan
ke timur sampe india. Saat ini lavender telah
ditanam dan dikembangkan di seluruh dunia.
Tanaman cantik dan berbungan kecil berwarna
ungu ini memiliki khasiat yang sangat
bermanfaat bagi manusia. Minyak
aromatherapi lavender dikenal sebagai minyak
penenang, efek sedative lavendula angustifolia
terjadi karena adanya senyawa-senyawa
coumarin dalam minyak tersebut (Ogan,
2005).

Secara teoritis aromatherapi lavender


bekerja dengan mempengaruhi tidak hanya

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
fisik tetapi juga tingkat emosi (Balkam, 2004).
Kandungan lavender oil yang terdiri dari
linalool, linalyl acetate, dan 1,8 -cincole dapat
menurunkan, mengendorkan, dan melemaskan
secara spontan ketegangan pada tikus yang
mengalami spasme pada otot intestinalnya.
Mekanisme massage pada tubuh dapat
menstimulasi produksi endhorpin di otak,
sehingga dapat memblokir transmisi stimulus
nyeri. Sedangkan apabila minyak aromatherapi
masuk ke rongga hidung melalui penghirupan
langsung akan bekerja lebih cepat karena
molekul-molekul minyak esensial mudah
menguap oleh hipotalamus karena aroma
tersebut diolah dan dikonversikan oleh tubuh
menjadi suatu aksi dengan pelepasan subtansi
neurokimia berupa zat endorphin dan serotinin
sehingga berpengaruh langsung pada organ
penciuman dan dopersepsikan oleh otak untuk
memberikan reaksi yang membuat perubahan
fisiologis pada tubuh., pikiran, jiwa, dan
menghasilkan efek menenangkan pada tubuh
(Nurachman, 2004).

Zat endorphin merupakan zat kimia yang


diproduksi tubuh hasil dari stimulasi eksternal
dan menghasilkan perasaan tenang, senang,
rileks, terangsang, serta melemaskan otot-otot
yang tegang seperti rasa sakit, gembira, dan
pengerahan tenaga secara fisik. Sementara itu
zat serotinin adalah neurotransmiter yang
mempengaruhi suasana hati, pola tidur, dan
selera makan. Aromatherapi lavender dihirup
selama 15 hingga 30 menit dengan
menggunakan kapas yang telah diberi 2-3 tetes
minyak esensial lavender sehingga didapatkan
efek terapeutik dapat mengendurkan otot-otot
yang tegang sehingga dapat membuka aliran
darah yang sempit (Primadiati, 2002)

Penelitian Hale (2008) mengatakan


bahwa wanita yang menjalani persalinan
dengan sectio caesarea menggunakan
aromatherapi dengan minyak lavender dapat
mengurangi rasa nyeri pada daerah insisi dan
mengurangi kegelisahan. Aromaterapi dapat
digunakan sebagai alternatif untuk
menurunkan tingkat nyeri tanpa menimbulkan
efek-efek yang merugikan seperti pada
pemberian obat farmakologi.

Berdasarkan studi pendahuluan tentang


data persalinan yang ditangani secara sectio
caesaria di RSUD Ambarawa, didapatkan
rata-rata 40 ibu tiap bulan selama 1 tahun
terakhir periode Januari hingga Maret yang
melakukan persalinan dengan sectio caesaria
tersebut. Untuk menangani nyeri persalinan
tersebut, telah dilakukan beberapa metode
penanganan nyeri seperti pemberian obat
analgetik dan dukungan psikologis dari
keluarga dekat. Dari hasil wawancara dengan 5
ibu bersalin, 3 diantaranya mengatakan bahwa
ia merasa tidak nyaman dan bosan dengan
konsumsi obat yang terus menerus. Ia juga
mengatakan bahwa jika tidak mengkonsumsi
obat ia merasa takut, cemas dan khawatir luka
insisi tidak lekas sembuh. Dilema yang ini
terjadi pada ibu bersalin ini mendorong
peneliti untuk melakukan penelitian lebih
lanjut apakah pemberian aromatherapi
lavender ini akan memberikan perubahan pada
tingkat nyeri ibu bersalin tersebut.

Berdasarkan hal tersebut diatas maka


penulis berminat melakukan penelitian tentang
�Perbedaan Tingkat Nyeri Sebelum dan
Sesudah Pemberian Aromatherapi Lavender
Pada Ibu Post Sectio Caesar Di RSUD
Ambarawa�

METODOLOGI PENELITIAN

Desain Penelitian

Penelitian ini menggunakan desain pre


experiment designs dengan rancangan one
group pre test-post test design, dimana tidak
menggunakan kelompok kontrol sebagai
pembanding, tetapi paling tidak sudah
dilakukan observasi pertama (pretest) yang
memungkinkan peneliti dapat menguji
perubahan-perubahan yang terjadi setelah
adanya eksperimen (program). Peneliti
menggunakan desain eksperimen one-group

pretest-posttest
mempertimbangkan
jumlah subyek peneliti, dan biaya.
design
keterbatasan
dengan
waktu,
Populasi dan Sampel
Populasi

Populasi dalam penelitian ini adalah ibu


post sectio caesarea di RSUD Ambarawa yang
didapatkan dari hasil rata-rata tiap bulan dalam
waktu satu tahun terakhir periode Januari 2013
hingga Januari 2014 dengan jumlah 40.

Sampel

Besar sampel dalam penelitian ini


ditentukan berdasarkan estimasi (perkiraan)
untuk menguji hipotesis beda rata-rata pretest
dan posttest.

Berdasarkan perhitungan yang telah


dilakukan, diperoleh sampel sebesar 26. Jadi

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
jumlah responden yang digunakdigunakan dalam
penelitian ini adalah sejumlah 26 ibu post
sectio caesaria di RSUD Ambarawa barawa.
digunakan dalam
penelitian ini adalah sejumlah 26 ibu post
sectio caesaria di RSUD Ambarawa barawa.

Teknik sampling yang digunak digunakan pada


penelitian ini adalah accidenaccidental sampling.
Peneliti pada penelitian ini hanya akan
mengambil sampel yang termasuktermasuk dalam
kriteria inklusi yang antara lain: lain: 1) Ibu post
sectio caesarea hari kedua yangyang bersedia
menjadi subyek penelitian; 2) IIbu post sectio
caesarea dengan nyeri skala ringringan sampai
dengan sedang; 3) Ibu post sectiosectio caesarea
yang menggunakan analgetik golong golongan sama,
yaitu injeksi ketorolac; 4) Ibu bu post sectio
caesarea dengan usia reproduksi sehat. duksi sehat.

Adapun kriteria eksklusi pada pada penelitian


ini adalah ibu post sectio caesar caesarea yang sudah
pernah melakukan operasi SC/ la / laparotomi.

Tempat dan Waktu Penelitian

Penelitian ini dilakukan an di RSUD


Ambarawa yaitu pada ibu post sectio sectio caesarea
yang mengalami nyeri dengan skala ringan.
Penelitian dilakukan pada tangg tanggal 21 Juli-6
Agustus 2014.

Pengumpulan Data

Data primer

Peneliti memperoleh data a atau materi


yang peneliti kumpulkan sendisendiri yang
diperoleh secara langsung dari ibuibu post sectio
caesarea dengan mengukur skala nyeriny ala nyerinya.

Data sekunder

Peneliti memperoleh data secara tidak


langsung dari objek penelitian, penelitian, yaitu berasal
dari sumber-sumber tertulis yangyang terdapat
dalam arsip yang dimiliki bagian bagian rekam medik
RSUD Ambarawa. Data sekundersekunder yang
diperlukan oleh peneliti berupa berupa jumlah ibu
bersalin dengan sectio caesarcaesarea di RSUD
Ambarawa.

Alat Ukur

Alat ukur yang digunakan pada pada penelitian


ini berupa lembar observasi untuk untuk mengetahui
skala intensitas nyeri yang dial dialami ibu post
sectio caesarea sebelum diberi perlakuan dan
sesudah diberi perlakuan. Pengukuran
intensitas nyeri menggunakan skala skala penilaian
numerik (Numerical Rating Scale, Scale, NRS).

GambarGambar 1.
Skala penilaian numerik merik (Numerical Rating
Scale, NRSNRS)

Analisa Data

Penelitian ini merupakan erupakan penelitian untuk


membedakan antara satsatu variabel terikat
(dependent variabel) deng dengan variabel bebas
(independent variabel). D Dimana analisis data
dilakukan secara komputeri puterisasi yaitu dengan
program SPSS (Statistic PProduct And Service
Solution).

Analisa Univariat

Pada penelitian ini data numerik dicari


mean dan standar deviasiny inya yakni skala nyeri
sebelum dan sesudah dibe diberi perlakuan berupa
pemberian aromatherapi atherapi lavender melalui
statistik deskriptif. Hasil sil data dibuat dalam
bentuk tabel.

Analisa Bivariat

Analisa ini dilakukan an dengan tujuan untuk


menguji variabel-variabelvariabel penelitian yaitu
variabel independen dengan variabel
dependen.

Uji statistik t-tes dependeependent atau paired t


test, digunakan untuk mengetahui adanya
pengaruh intensitas nyeri sebelum dan sesudah
diberikan aromaterapi lavender, yang
merupakan uji statistik param ik parametrik.

Uji yang digunakdigunakanan untuk menguji


normalitas data maka menggunakan uji
Shapiro-Wilk untuk transformtransformasi data kecil (=
50), hasil normalitas didap didapatkan hasil sebelum

(0.006) dan sesudah (0.001) pemberian


aromatherapi lavender masingasingm-masing kurang
dari 0.05 maka data berdistribu istribusi tidak normal,
sehingga uji yang dilakukandilakukan adalah uji
wilcoxon.
4 Perbedaan Tingkat Nyeri SebelumSebelum dan Sesudah Pemberian Aromatherapi
Lavender padapada Ibu Post Sectio Caesarea
di RSUD Ambarawa
HASIL PENELITIAN

Analisis Univariat

Nyeri Sebelum Pemberian Aromatherapi


Lavender

Tabel 1.
Distribusi Frekuensi Berdasarkan Nyeri
Sebelum Pemberian Aromatherapi
Lavender

Nyeri sebelum
No pemberian n %
aromatherapi lavender

1. Ringan 5 19.2
2. Sedang 21 80.8
Jumlah 26 100,0
Sumber: Data Primer diolah (2014)

Berdasarkan Tabel 1 dapat diketahui


bahwa nyeri sebelum pemberian aromatherapi
lavender, sebagian besar responden mengalami
nyeri sedang, yaitu ada 21 responden dengan
persentase 80.8%.

Nyeri Sesudah Pemberian Aromatherapi


Lavender

Tabel 2.
Distribusi Frekuensi Berdasarkan Nyeri
Sesudah Pemberian Aromatherapi
Lavender

Nyeri sesudah
No pemberian n %
aromatherapi lavender

1. Ringan
20 76.92
2.
Sedang 6 23.1
Jumlah 26 100,0
Sumber : Data Primer diolah (2014)

Berdasarkan Tabel 2. dapat diketahui


bahwa nyeri sesudah pemberian aromatherapi
lavender, sebagian besar responden mengalami
nyeri ringan, yaitu ada 20 responden dengan
persentase 76.92%.

Analisis Bivariat

Tabel 3.

Hasil uji normalitas data


Variabel
df p value Ket.

Nyeri sebelum pemberian aromatherapi lavender 26 0,006 Tidak normal

Nyeri sesudah pemberian aromatherapi lavender 26 0,001 Tidak normal

Hasil uji normalitas didapatkan semua p berdistribusi tidak normal, maka uji
bivariat
value < 0,05 sehingga dapat disimpulkan data menggunakan uji wilcoxon.

Tabel 4.
Test Statistics Perbedaan Nyeri Sebelum Dan Sesudah Pemberian Aromatherapi Lavender
Pada
Ibu Post Sectio Caesar Di RSUD Ambarawa

Variabel n Mean Z p value


Nyeri sebelum pemberian aromatherapi lavender 26 4.414 -4.311 0.000
Nyeri sebelum pemberian aromatherapi lavender 26 2.829 -4.311 0.000

Dari Tabel 4 dapat diketahui bahwa


penurunan tingkat nyeri sebesar 1,585.
Sedangkan nilai Z sebesar -4.311, jika level
signifikansi 0.05 dan menggunakan uji dua
sisi. Nilai Z kritis antara -1.96 dan 1.96, yang
berarti berada di daerah penerimaan H1.
Begitu juga diperoleh sig p-value sebesar
0,000, artinya bahwa nilai p (0.000) < 0,05
maka Ho ditolak.

Hal ini berarti bahwa terdapat perbedaan


nyeri sebelum dan sesudah pemberian
aromatherapi lavender pada ibu post sectio
caesar di RSUD Ambarawa.

PEMBAHASAN

Analisis Univariat

Nyeri Sebelum Pemberian Aromatherapi


Lavender

Berdasarkan Tabel 1 gambaran tingkat


nyeri sebelum diberikan aromatherapi lavender
di RSUD Ambarawa dari 26 responden
diperoleh data bahwa nyeri sebelum pemberian
aromatherapi lavender sebagian besar
responden mengalami nyeri sedang, yaitu ada
21 responden (80.8%), mengalami nyeri ringan
terdapat 5 responden (19.2%), dan tidak ada

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
responden yang mengalami nyeri berat ataupun
sangat berat.

Pada proses operasi digunakan anastesi


agar pasien tidak merasakan nyeri pada saat
dibedah. Namun setelah operasi selesai dan
pasien mulai sadar dan efek anestesi habis
bereaksi, pasien akan merasakan nyeri pada
bagian tubuh yang mengalami pembedahan.

Rasa nyeri yang dirasakan post SC akan


menimbulkan berbagai masalah, salah satunya
masalah laktasi. Rasa nyeri tersebut akan
menyebabkan pasien menunda pemberian ASI
sejak awal pada bayinya, karena rasa tidak
nyaman dan peningkatan tingkat nyeri setelah
operasi (Batubara dkk, 2008).

Penelitian mengenai nyeri sebelum


diberikan aromatherapi lavender ini didapatkan
hasil sebagian besar adalah responden dengan
nyeri sedang yaitu sebanyak 21 responden
(80,8%). Nyeri sedang adalah nyeri yang
menyebar ke perut bagian bawah tetapi pasien
masih dapat menunjukkan lokasi nyeri dengan
tepat dan dapat mendeskripsikan, pasien dapat
mengikuti perintah dengan baik dan responsif
terhadap tindakan manual.

Ibu post operasi SC akan merasakan


nyeri, dan dampak dari nyeri akan
mengakibatkan mobilisasi ibu menjadi
terbatas, Activity of Daily Living (ADL)
terganggu, bonding attachment (ikatan kasih
sayang) dan Inisiasi Menyusui Dini (IMD)
tidak terpenuhi karena adanya peningkatan
tingkat nyeri apabila ibu bergerak. Hal ini
mengakibatkan respon ibu terhadap bayi
kurang, sehingga ASI sebagai makanan terbaik
bagi bayi dan mempunyai banyak manfaat bagi
bayi maupun ibunya tidak dapat diberikan
secara optimal (Purwandari, 2009).

Banyak ibu yang mengeluhkan rasa nyeri


dibekas jahitan, keluhan ini sebetulnya wajar
karena tubuh tengah mengalami luka dan
penyembuhannya tidak bisa sempurna, apalagi
jika luka tersebut tergolong panjang dan
dalam. Pada operasi SC ada 7 lapisan perut
yang harus disayat. Sementara saat proses
penutupan luka, 7 lapisan tersebut dijahit satu
demi satu menggunakan beberapa macam
benang jahit. Rasa nyeri di daerah sayatan
yang membuat sangat terganggu dan pasien
merasa tidak nyaman (Walley, 2008).

Hasil penelitian ini didukung oleh


penelitian Khasam (2012) yang berjudul
pengaruh teknik relaksasi erhadap penurunan
tingkat nyeri post SC di Rs Kajen Kabupaten
Pekalongan. Penelitian ini menggunakan

metode penelitian dengan desain penelitian


pre-experiment, pendekatan one group pretest
dan posttes design without control group
dengan teknik accidental sampling. Adapun
populasinya yaitu pasien dengan post operasi
SC. Hasil penelitian tersebut menunjukan
bahwa sebagian responden mengalami nyeri
sedang sebelum diberikan teknik relaksasi, dan
sesudah diberikan teknik relaksasi hasil
terbanyak responden mengalami nyeri ringan.

Perbedaan Tingkat Nyeri Sebelum dan


Sesudah Pemberian Aromatherapi Lavender

Berdasarkan Tabel 2 gambaran tingkat


nyeri sesudah diberikan aromatherapi lavender
di RSUD Ambarawa dari 26 responden
diperoleh data bahwa nyeri sesudah pemberian
aromatherapi lavender sebagian besar
responden mengalami nyeri ringan, yaitu ada
20 responden (76.92%), mengalami nyeri
sedang terdapat 6 responden (23.1%), dan
tidak ada responden yang mengalami nyeri
berat ataupun sangat berat.

Penelitian mengenai nyeri sesudah


diberikan aromatherapi lavender ini didapatkan
hasil sebagian besar adalah responden dengan
nyeri ringan yaitu sebanyak 20 responden
(70.92%). Nyeri ringan adalah nyeri tidak
mengganggu aktivitas mobilisasi atau secara
obyektif pasien dapat berkomunikasi dengan
baik, tindakan manual dirasa sangat
membantu. Hal ini disebabkan karena
responden dalam penelitian ini memiliki rasa
nyaman setelah mendapatkan aromatherapi,
sehingga menurunkan angka nyeri pada luka
operasi. Pasien post SC yang diberikan
aromatherapi lavender mengalami penurunan
tingkat nyeri tetapi tidak menghilangkan nyeri
tersebut karena luka dari operasi SC tersebut
merupakan luka yang dibuat mulai dari lapisan
perut sampai ke lapisan uterus yang
penyembuhannya bertahap sehingga masih
merasakan nyeri.

Hal ini juga dibuktikan dengan hasil


penelitian Lestari (2012) tentang perbedaan
disminore primer sebelum dan sesudah
diberikan aromatherapi lavender pada
mahasiswi program studi DIII Kebidanan
semester II Stikes Ngudi Waluyo Ungaran
2012. Hasil penelitian menunjukan bahwa
sebelum diberikan aromatherapi lavender
sebagian besar responden mengalami intensitas
nyeri yang ringan yaitu 11 responden (64,7%)
dan p value < 0.05 yang berarti ada perbedaan
bermakna pada disminore primer sebelum dan

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
sesudah diberikan aromatherapi lavender pada
mahasiswa DIII Kebidanan semester II Stikes
Ngudi Waluyo.

Hasil analisis data menggunakan Uji


Wilcoxon bahwa nilai Z sebesar -4.311, jika
level signifikansi 0.05 dan menggunakan uji
dua sisi. Nilai Z kritis antara -1.96 dan 1.96,
yang berarti berada di daerah penerimaan H1.
Begitu juga diperoleh sig p-value sebesar
0,000, artinya bahwa nilai p (0.000) < 0,05
maka Ho ditolak. Hal ini berarti bahwa
terdapat perbedaan nyeri sebelum dan sesudah
pemberian aromatherapi lavender pada ibu
post sectio caesar di RSUD Ambarawa
Kabupaten Semarang.

Tingkat nyeri sebelum diberikan


aromatherapi lavender mengalami tingkat
nyeri diantara 5-6 atau nyeri sedang, setelah
pemberian aromatherapi lavender nyeri
berkurang, saat pasien merasa nyaman
penurunan nyeri menurun sampai ke tingkat
nyeri 3 sampai 2 atau nyeri ringan. Fisiologi
nyeri ini pada tahap modulasi sehingga nyeri
berkuranf menjadi tingkat nyeri ringan. Pasien
post SC yang telah diberikan aromatherapi
lavender merasa lebih nyaman dan santai
sehingga efektif untuk menurunkan tingkat
nyeri.

Menurut Koensoemardiyah (2009)


aromaterapi digunakan untuk mempengaruhi
emosi seseorang dan membantu meredakan
gejala penyakit. Minyak lavender merupakan
minyak esensial yang paling populer. Minyak
lavender berasal dari semak yang sangat
digemari di daerah mediterania. Istilah
lavender berasal dari kata lavandus, yang
berarti membersihkan.

Hasil observasi dan tanya jawab yang


dilakukan pada saat penelitian sebelum
diberikan aromatherapi lavender, pasien post
SC mengalami nyeri di daerah perutnya pada
saat posisi berbaring, apabila pasien bergeser
atau miring tingkat nyeri bertambah sehingga
menggangu pasien. Aromatherapi lavender
yang diberikan memberikan kenyamanan pada
pasien khususnya pada saat pasien menghirup
aromatherapi lavender pasien dapat
mengalihkan nyeri post SC.

Pengaruh aromaterapi terhadap


kenyamanan dapat diukur dengan melihat
berbagai indikator yang memperlihatkan
kenyamanan. Indikator tersebut adalah
interpretasi terhadap aromaterapi itu sendiri
akan menunjukan respon emosi fight or flight,
interpretasi terhadap rasa nyaman yang di

dapat dari efek aromaterapi, pernyataan bahwa


aromaterapi meningkatkan kinerja,
peningkatan konsentrasi, pikiran lebih tenang,
jiwa menjadi sejuk (Price, 2007). Respon non
verbal menunjukan kenyamanan (tidak ada
kerut muka, tidak ada gerakan menjauhkan
diri, tidak ada pengatupan kelopak mata, tidak
ada pemalingan wajah/seluruh badan)
(Atkinson, R 2009).

Secara teoritis aromatherapi lavender


bekerja dengan mempengaruhi tidak hanya
fisik tetapi juga tingkat emosi (Balkam, 2004).
Kandungan lavender oil yang terdiri dari
linalool, linalyl acetate, dan 1,8 -cincole dapat
menurunkan, mengendorkan, dan melemaskan
secara spontan ketegangan pada tikus yang
mengalami spasme pada otot intestinalnya.
Mekanisme massage pada tubuh dapat
menstimulasi produksi endhorpin di otak,
sehingga dapat memblokir transmisi stimulus
nyeri. Sedangkan apabila minyak aromatherapi
masuk ke rongga hidung melalui penghirupan
langsung akan bekerja lebih cepat karena
molekul-molekul minyak esensial mudah
menguap oleh hipotalamus karena aroma
tersebut diolah dan dikonversikan oleh tubuh
menjadi suatu aksi dengan pelepasan subtansi
neurokimia berupa zat endorphin dan serotinin
sehingga berpengaruh langsung pada organ
penciuman dan dopersepsikan oleh otak untuk
memberikan reaksi yang membuat perubahan
fisiologis pada tubuh., pikiran, jiwa, dan
menghasilkan efek menenangkan pada tubuh
(Nurachman, 2004).

Hasil penelitian ini didukung oleh hasil


penelitian Restiana (2013), yang berjudul efek
lilin aromatherapi lavender terhadap perubahan
intensitas nyeri persalinan normal kala 1 fase
aktif pada primigravida di wilayah kerja
Puskesmas Bergas Kabupaten Semarang.
Penelitian ini menggunakan metode penelitian
quasy experimental design dengan desain
penelitian pretest-posttest time control design,
dengan teknik accidental sampling. Adapun
populasinya yaitu ibu bersalin kala 1 fase aktif
pada primigravida. Hasil penelitian
menunjukkan bahwa ada pengaruh yang
signifikan lilin aromatherapi lavender terhadap
perubahan intensitas nyeri persalinan kala I
fase aktif pada primigravida di wilayah kerja
Puskesmas Bergas Kabupaten Semarang (pvalue
= 0,000 < a (0,05).

Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
Keterbatasan Penelitian

Dalam penelitian inipun mempunyai


keterbatasan, yaitu peneliti tidak dapat
mengendalikan faktor-faktor lain yang dapat
mempengaruhi nyeri pada ibu post SC seperti
faktor usia, kebudayaan, perhatian, keletihan,
pengalaman sebelumnya, dan dukungan
keluarga dan sosial.

KESIMPULAN

Sebagian besar responden mengalami


nyeri sedang sebelum pemberian aromatherapi
lavender yaitu 21 responden atau 80.77%.

Sebagian besar responden mengalami


nyeri ringan sesudah pemberian aromatherapi
lavender yaitu 20 orang atau 76.92%.

Penurunan tingkat nyeri sebelum dan


sesudah diberikan aromatherapi lavender
adalah sebesar 1.585. Terdapat perbedaan
nyeri sebelum dan sesudah pemberian
aromatherapi lavender pada ibu post sectio
caesar di RSUD Ambarawa yaitu dengan p
value 0.000 < a (0.05).

SARAN

Hasil penelitian diharapkan dapat


dipergunakan sebagai sumber pengetahuan
peneliti mengenai manfaat aromaterapi (aroma
lavender) terhadap perubahan tingkat nyeri ibu
pada ibu post sectio caesaria.

Hasil penelitian diharapkan dapat


dipergunakan sebagai sumber pertimbangan
bagi tempat penelitian untuk menerapkan
metoda aromaterapi (aroma lavender) dalam
mengatasi perubahan tingkat nyeri ibu pada
ibu post sectio caesaria.

Hasil penelitian diharapkan dapat


dipergunakan sebagai salah satu metode
menurunkan nyeri pada saat responden
merasakan nyeri post SC.

DAFTAR PUSTAKA

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Efektifitas pemberian
intervensi spiritual �spirit ibu� terhadap
nyeri post sectio caesarean (SC) pada Rs
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penelitian kuantitatif. Jakarta : Raja
grafindo persada.
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Hypnobirthing .Yogyakarta.Gosyen
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Batubara, dkk. (2008). Hubungan
pengetahuan, nyeri pembedahan sectio
caesaria dan bentuk puting dengan
pemberiann air susu ibu pertama kali
pada ibu post partum. Jurnal
Keperawatan Soedirman (The Soedirman
Journal of Nursing), Volume 3 No.2 Juli
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Bobak. (2004). Buku ajar keperawatan
maternitas edisi 4. Jakarta : EGC.
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(2006). Obstetri Williams.
Jakarta: EGC.
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Dahlan, Sopiyudin (2009). Besar Sampel
dan Cara Pengambilan Sampel. Jakarta :
Salemba Medika
[8]
Jacob, T. (2004). Etika Penelitian Ilmiah.
Warta Penelitian Universitas Gadjah
Mada (Edisi Khusus), 60-63.
[9]
Koensoemardiyah. (2009). A-Z
Aromaterapi untuk Kesehatan,
Kebugaran, dan Kecantikan. Yogyakarta:
Lily Publisher.
[10] Laila. (2011).
Buku Pintar Menstruasi.
Yogyakarta: Bukubiru
[11] Mochtar.
(2008). Sinopsis Obstetri.
Jakarta: EGC.
[12] Notoadmodjo,
S (2010). Metodologi
Penelitian Kesehatan. Jakarta: Rineka
Cipta
[13] Nursalam, (2010). Konsep dan Penerapan
Metodologi Penelitian Ilmu keperawatan.
Jakarta: Salemba Medika
[14] Ogan, M. (2005). A pilot study evaluating
mindfulness based stress reduction and
massage for the management of chronic
pain. USA
[15] Padilla. (2008). Risk Factors in Cesarean
Section. Ginecol Obstet Mex Article in
Spanish.
[16] Potter
& Perry. (2005). Buku ajar
fundamental keperawatan, edisi ke-4.
Penerbit buku kedokteran. Jakarta: EGC.
Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
[17] Potter
& Perry. (2006). Buku ajar
fundamental keperawatan, konsep,
proses, dan praktik edisi 4. Jakarta : EGC.
[18] Saryono. (2008)
Metodologi penelitian
kesehatan. Yogyakarta: Mitra cendekia.
[19] Simkin.
(2008). Paduan Lengkap
Kehamilan, Melahirkan, dan Bayi.
Jakarta: Arcan.

[20] Smeltzer. (2002). Buku ajar keperawatan


medikal bedah Brunner and Suddarth. (8
th edition). Jakarta: EGC.
[21] Sugiyono.
(2007). Metode penelitian
kuantitatif kualitatif dan R&D. Bandung:
Alfabeta.
[22] Sulistyowati.
(2009). Efektifitas Terapi
Aroma Lavender Terhadap Tingkat Nyeri
dan Kecemasan Persalinan Primipara
Kala I di Rumah Sakit dan Klinik Bersalin
Purwokerto.
[23] Whalley.
(2008). Panduan lengkap
kehamilan, melahirkan, dan bayi, edisi
revisi. Jakarta: Arcan.
[24] Yuliatun.
(2008). Penangangan nyeri
persalinan dengan metode
nonfarmakologi. Malang: Bayumedia
Publishing.
Perbedaan Tingkat Nyeri Sebelum dan Sesudah Pemberian Aromatherapi Lavender pada
Ibu Post Sectio Caesarea
di RSUD Ambarawa
EFEKTIVITAS AROMATERAPI LAVENDER DAN AROMATERAPI

LEMON TERHADAP INTENSITAS NYERI POST SECTIO CAESAREA

(SC) DI RUMAH SAKIT BUDI RAHAYU KOTA MAGELANG

Ina Rahmawati �, Dr. Heni Setyowati E. R., S. Kp., M. Kes�, Ns. Rohmayanti, M.
Kep�

Abstrak

Latar belakang: Nyeri merupakan suatu keadaan yang tidak nyaman yang sering
dirasakan oleh
pasien post sectio caesarea. Aromaterapi dapat digunakan untuk mengatasi nyeri post
sectio
caesarea. Tujuan:Penelitian ini bertujuan untuk mengetahui efektivitas antara
aromaterapi
lavender dan aromaterapi lemon di Rumah Sakit Budi Rahayu Kota Magelang.
Metode:penelitian
ini menggunakan metodequasy experimentdengan rencangan two group pre-test and post-
test
designdengan sampel 56 responden, 28 responden kelompok aromaterapi lavender dan 28

responden kelompok aromaterapi lemon. Teknik pengambilan sampel menggunakan


consecutive
samplingInstrumen yang digunakan adalah numeric rating scale (NRS). Data diolah
dengan uji
Wilcoxon dan uji Mann Whitney.Hasil: hasil penelitian ini menunjukkan bahwa
aromaterapi
lavender dan aromaterapi lemon efektif dalam menurunkan skala nyeri post sectio
caesarea
dengan p value 0,009 (p < 0,05). Kesimpulan: Aromaterapi levender dan aromaterapi
lemon
efektif dalam menurunkan skala nyeri post sectio caesarea,tetapi aromaterapi lemon
lebih efektif
dalam mengatasi nyeri post sectio caesarea dengan nilai rata-rata sebesar 4 lebih
besar
dibandingkan rata-rata aromaterapi lavender yaitu 2,15.Saran: Rekomendasi
penelitian ini adalah
supaya menggunakan aromaterapi lavender dan aromaterapi lemon sebagai intervensi
alternatif
yang digunakan untuk menurunkan nyeri post sectio caesarea.

Kata Kunci : Aromaterapi Lavender, Aromaterapi Lemon, Nyeri Post Sectio Caesarea

1. PENDAHULUAN
caesarea 24,6%. Selain itu angka
Section caesarea suatu tindakan kejadian sectio caesarea di Australia
pembedahan atau suatu persalinan pada tahun 1998 sekitar 21% dan
buatan yang tujuannya untuk pada tahun2007 sekitar 31%. Di
mengeluarkan bayi dengan cara Indonesia angka kejadian sectio

membuka dinding perut dan rahim caesarea mengalami peningkatan


ibu dengan sayatan rahim ibu dalam pada tahun 2000-2006 sebesar
keadaan utuh serta berat janin diatas 48,85% dan pada tahun 2011-2013

500 gram (Lia, 2010).


sebesar 49,6% (Kulas, 2008).
Dari tahun ke tahun angka Masalah yang muncul pada
kejadian sectio caesarea terus tindakan setelah operasi sectio
meningkat. Angka persalinan melalui caesarea akibat insisi oleh robekan
sectio caesarea di Amerika Serikat jaringan dinding perut dan dinding
telah meningkat empat kali lipat, dari uterus dapat menyebabkan terjadinya

5,5 per 100 kelahiran pada tahun perubahan kontinuitas sehingga ibu
1970 menjadi 22,7 per 100 kelahiran merasa nyeri karena adanya
pada tahun 1985.Di Inggris, pada pembedahan ( Asamoah, 2011).
tahun 2008-2009 angka sectio
Penanganan yang sering
digunakan untuk menurunkan nyeri
post sectio caesarea berupa
penanganan farmakologi dan non
farmakologi. Salah satu terapi non
farmakologi yang dapat digunakan
yaitu aromaterapi. (Anggorowati,
2007).

Efek aromaterapi positif karena


aroma yang segar dan harum
merangsang sensori dan akhirnya
mempengaruhi organ lainnya
sehingga dapat menimbulkan efek
yang kuat terhadap emosi.
Aromaterapi ditangkap oleh reseptor
dihidung, kemudian memberikan
informasi lebih jauh karena di otak
yang mengontrol emosi dan memori
serta memberikan informasi ke
hipotalamus yang merupakan
pengatur sistem internal tubuh,
sistem seksualitas, suhu tubuh, dan
reaksi terhadap stres (Hale, 2008).

Mekanisme kerja aromaterapi


dalam tubuh manusia berlangsung
melalui dua sistem fisiologis, yaitu
sirkulasi tubuh dan sistem
penciuman. Wewangian dapat
mempengaruhi kondisi psikis, daya
ingat, dan emosi seseorang.
Aromaterapi lemon merupakan jenis
aromaterapi yang dapat digunakan
untuk mengatasi nyeri dan cemas
(Wong, 2010).

Jenis aromaterapi diantaranya


adalah aromaterapi lavender dan
buah lemon. Aromaterapi lavender
dapat memberikan ketenangan,
keseimbangan, rasa nyaman, rasa
keterbukaa, dan keyakinan.

Disamping itu juga dapat


mengurangi rasa tertekan, stres, rasa
sakit, emosi yang tidak seimbang,
histeria, rasa frustasi dan kepanikan.
Lavender dapat bermanfaat untuk
mengurangi rasa nyeri, dan dapat
memberikan relaksasi (Hutasoit,
2002).

Aromaterapi lemon merupakan


jenis aroma terapi yang dapat
digunakan untuk mengatasi nyeri dan
cemas. Zat yang terkandung dalam
lemon salah satunya adalah linalool
yang berguna untuk menstabilkan
sistem saraf sehingga dapat
menimbulkan efek tenang bagi
siapapun yang menghirupnya (Wong,
2010).

Aromaterapi lavender dan buah


lemon dapat digunakan untuk
mengatasi nyeri post sectio caesarea.
Didukung oleh penelitian dari
Wening Dwijayanti, Sri Sumarni,
dan Ida Ariyanti dengan hasil
penurunan nyeri rata-rata antara
sebelum dan sesudah pemberian
aromaterapi lavender secara inhalasi
adalah sebesar 1,13. Hasi penelitian
didapatkan p value 0,001(<0,05) dan
hasil t-hitung sebesar 9,000 (>ttabel=
2,042) yang berarti ada
perbedaan yang signifikan antara
sebelum dan sesudah pemberian
aromaterapi lavender secara inhalasi
dan juga penelitian lain yang
mendukung ialah penelitiannya
Fadhla Purwandari, Siti Rahmalia,
dan Febrian Sabrian dengan hasil
yang melalui uji statistik diperoleh
nilai p (0,000) < a (0,05), maka dapat
disimpulkan bahwa terdapat
perbedaan yang signifikan antara
rata-rata skala nyeri sebelum dengan
rata-rata skala sesudah menghirup
aroma lemon pada kelompok
eksperimen. Namun belum diketahui
perbedaan efektivitasnya, sehingga
peneliti tertarik meneliti perbedaan
efektivitas aromaterapi lavender dan
aromaterapi lemon terhadap
intensitas nyeri post sectio caesarea.

2. METODOLOGI PENELITIAN
Penelitian ini merupakan penelitian
quasi eksperiment dengan desain
rancangan two group pre test and
post test design. Instrumen yang
digunakan dalam penelitian ini
berupa data karakteristik dan
kuesioner. Pada data karakteristik
data berupa lembaran demografi
yang berisi data karakteristik
responden yang meliputi usia,
pendidikan terakhir, dan pekerjaan.
Pada kuesioner skala numeric Rating
Scale adalah suatu garis lurus yang
digunakan untuk mengukur intensitas
nyeri dan pendeskripsi verbal pada
setiap ujungnya dengan rentang nyeri

0-10 sesuai dengan tingkatnya yang


berarti 0 adalah tidak nyeri, 1-3
adalah nyeri ringan, 4-6 adalah nyeri
sedang dan 7-10 adalah nyeri yang
tidak terkontrol. Adapun populasi
target dari penelitian ini adalah ibu
bersalin dengan cara sectio caesarea.
Populasi terjangkau dalam penelitian
ini yaitu ibu bersalin dengan sectio
caesarea.Adapun populasi target dari
penelitian ini adalah ibu bersalin
dengan cara sectio caesarea.
Populasi terjangkau dalam penelitian
ini yaitu ibu bersalin dengan sectio
caesarea. pemilihan sampel dengan
cara non-probability sampling,
Dengan tanik consecutive sampling.
Sedangkan penentuan sampel
kelompok aromaterapi lavender dan
kelompok aromaterapi lemon
menggunakan undian. Analisa data
yang digunakan menggunakan uji
Wilcoxon dan Mann-Whitney.

3. HASIL DAN PEMBAHASAN


Berikut penjelasan karakteristik
responden diantaranya umur,
pendidikan, dan pekerjaan
Tabel 1
Berdasarkan karakteristik

Aromaterapi Aromaterapi
variabel
Lavender (n=28) Lemon (n=28)
P
Mean Sd Jumlah Mean Sd Jumlah
value
% %
Usia 21,36 1,890 21,25 2,238 2,238 0,059
18-25
Tingkat
pendidikan
SD
25,0
28,6
17,9
42.9
0,310
SMP 35,7 28,6
SMA 10,7 10,7
Perguruan
Tinggi
Pekerjaan 0,261
IRT 64,3 64,3
PNS 28,6 10,7
KARYAWAN 7,1 25,0

Tabel 1 menunjukkan bahwa hasil uji varian yang sama sehingga dapat
homogenitas pada kedua kelompok disimpulkan bahwa kelompok
pada masing-masing karakteristik intervensi aromaterapi lavender dan
menunjukkan P value >0.05 yang kelompok aromaterapi lemon
artinya kedua kelompok memiliki memiliki karakteristik yang sama.

Tabel 2
Uji Normalitas Nyeri Post Sectio Caesarea Sebelum dan Setelah Dilakukan
Tindakan Pada Kelompok Aromaterapi Lavender

Shapiro-Wilk
Statistik df sig
AT lavender ke 1 ,605 28 ,000
Pre test
AT lavender ke 2
AT Lavender ke 3
,800
,774
28
28
,000
,000
AT Lavender ke 4 ,867 28 ,002
AT Lavender ke 1 ,926 28 ,049
Post test
AT Lavender ke 2
AT Lavender ke 3
,786
,904
28
28
,000
,014
AT Lavender ke 4 ,861 28 ,002

Tabel 2 menunjukkan bahwa


variaabel nyeri responden sebelum
diberikan aromaterapi pada
kelompok aromaterapi lavender
dengan menggunakan uji Shapirow-
Wilk pada kelompok aromaterapi
lavender ke 1 didapatkan hasil P=0,
000, pada kelompok aromaterapi
lavender ke 2 didapatkan hasil
P=0,000, pada kelompok

aromaterapi lavender ke 3
didapatkan hasil P=0, 000, pada
kelompok aromaterapi lavender ke 4
didapatkan hasil P=0,002. Dan
setelah diberikan aromaterapi
lavender, pada kelompok
aromaterapi lavender ke 1
didapatkan hasil P=0,049, pada
kelompok aromaterapi lavender ke 2
didapatkan hasil P=0,000, pada
kelompok aromaterapi lavender ke 3 kelompok aromaterapi lavender ke 4
didapatkan hasil P=0,014, pada didapatkan hasil P=0,002

Tabel 3
Uji Normalitas Post Sectio Caesarea Setelah Dilakukan Tindakan Pada
Kelompok Aromaterapi Lemon

Shapiro-Wilk
Statistik df sig
AT Lemon ke 1 ,842 28 ,001
Pre test AT Lemon ke 2 ,734 28 ,000
AT Lemonke 3 ,833 28 ,000
AT Lemonke 4 ,879 28 ,002
AT Lemon ke 1 ,915 28 ,026
Post test AT Lemon ke 2 ,871 28 ,003
AT Lemonke 3 ,920 28 ,034
AT Lemon ke 4 ,858 28 ,001

Tabel 3 menunjukkan bahwa


variaabel nyeri responden sebelum
diberikan aromaterapi, pada
kelompok aromaterapi lemon dengan
menggunakan uji Shapirow-Wilk
pada kelompok aromaterapi lemon
ke 1 didapatkan hasil P=0, 001, pada
kelompok aromaterapi lemon ke 2
didapatkan hasil P=0,000, pada
kelompok aromaterapi lemon ke 3
didapatkan hasil P=0, 000, pada

kelompok aromaterapi lemon ke 4


didapatkan hasil P=0,002. Dan
setelah diberikan aromaterapi lemon
pada kelompok aromaterapi lemon
ke 1 didapatkan hasil P=0,026, pada
kelompok aromaterapi lemon ke 2
didapatkan hasil P=0,003, pada
kelompok aromaterapi lemon ke 3
didapatkan hasil P=0,034, pada
kelompok aromaterapi lemon ke 4
didapatkan hasil P=0,001

Tabel 4
Perbedaan Skor Nyeri Post Sectio caesareaSebelum dan Setelah Dilakukan
Terapi Aromaterapi Lavender pada Tindakan 1, 2, 3 dan 4

Variabel Mean Meandefferent sd P value


Nyeri post SC Intervensi 1 1,43 ,000
Sebelum 8,14 0,448
sesudah 6,71 1,084
Nyeri post SC Intervensi 2 1,75 ,000
Sebelum 7,50 0,638
Sesudah 5.75 1,295
Nyeri post SC Intervensi 3 2,61 ,000
Sebelum 6,68 0,723
Sesudah 3,89 1,257
Nyeri post SC Intervensi 4 2,15 ,000
Sebelum 5,54 1,105
Sesudah 3,39 1,474

*Uji Wilcoxon
Tabel 4 menunjukan bahwa terdapat aromaterapi lavender pada tindakan
penurunan signifikan skor nyeri ke 4 sebesar 5,54 dan setelah
sebelum dan setelah diberikan diberikan aromaterapi lavender pada
aromaterapi lavender pada kelompok tindakan ke 4 sebesar 3,39 dengan
aromaterapi lavender dengan hasil p=0,000
rata-rata nyeri sebelum diberikan
Untuk Memperjelas perbedaan skor nyeri post sectio caesarea sebelum dan
sesudah pemberian aromaterapi lavender peneliti gambarkan dengan histrogram.

Histrogram 1
Perbedaan Skor Nyeri Post Sectio Caesarea Sebelum Dan Sesudah
Dilakukan Aromaterapi Lavender

0
1
2
3
4
5
6
7
8
9
Tindakan ke1 tindakan ke 2 Tindakan ke 3 Tindakan ke 4
pre
post
Tabel 4.5
Perbedaan Skor Nyeri Post Sectio caesarea Sebelum dan Setelah Dilakukan
Terapi Aromaterapi Lemon pada Tindakan 1, 2, 3 dan 4

Variabel mean Mean sd P value


defferent
Nyeri post SC Intervensi 1 2,43 ,000
Sebelum 7,93 0,858
Sesudah 5,50 1,427
Nyeri post SC Intervensi 2 post SC Intervensi 2 3,14 ,000
Sebelum 7,46 0,637
Sesudah 4,32 1,249
Nyeri post SC Intervensi 3 3,04 ,000
Sebelum 6,18 0,723
Sesudah 3,14 1,380
Nyeri post SC Intervensi 4 4 ,000
Sebelum 5,39 0,875
Sesudah 1,39 1.066

*Uji Wilcoxon
Tabel 5 menunjukan bahwa terdapat rata nyeri sebelum diberikan
penurunan signifikan skor nyeri aromaterapi lemon pada tindakan ke
sebelum dan setelah diberikan 4 sebesar 5,39 dan setelah diberikan
aromaterapi lemon pada kelompok aromaterapi lavender pada tindakan
aromaterapi lemon dengan hasil rata-ke 4 sebesar 1,39 dengan p=0,000

Untuk Memperjelas perbedaan skor nyeri post sectio caesarea sebelum dan
sesudah pemberian aromaterapi lavender peneliti gambarkan dengan histrogram.

Histrogram 4.2
Perbedaan Skor Intensitas Nyeri Post Sectio Caesarea Sebelum Dan Sesudah
Dilakukan Aromaterapi Lemon

0
1
2
3
4
5
6
7
8
9
Tindakan ke 1 Tindakan ke 2 Tindakan ke 3 Tindakan ke 4
pre
post
Tabel 4.6
Perbedaan penurunan Skor Nyeri Post Sectio Caesarea sebelum dan setelah
diberikan tindakan Aromaterapi Lavender dan Aromaterapi Lemon Pada
Tindakan 1, 2, 3 dan 4

Tindakan Aromaterapi Aromaterapi Mean P value


lavender lemon Different
Tindakan ke 1
Sebelum
Sesudah
Tindakan ke 2
Sebelum
Sesudah
Tindakan ke 3
Sebelum
Sesudah
Tindakan ke 4
Sebelum
Sesudah
Sebelum
Sesudah
Tindakan ke 2
Sebelum
Sesudah
Tindakan ke 3
Sebelum
Sesudah
Tindakan ke 4
Sebelum
Sesudah

8,14
6,71

7,50
5,75

6,68
3,89

5,54
3,39

7,93
5,50

7,46
4,32

6,18
3,14

5,39
1,39

0,257

0,028

1,39

0,019
0,25

0,009

1,85

*Uji Mann Whitney

Tabel 6 menunjukan bahwa terdapat


perbedaan yang signifikan terdapat
rata-rata nyeri post sectio caesarea
diantara kedua kelompok pada
tindakan ke 4 didapatkan hasil p=
0,009.

Hasil penelitian ini menunjukkan


bahwa Aromaterapi lemon lebih
efektif dalam mengatasi nyeri post
sectio caesarea dengan nilai rata-rata
sebesar 4 lebih besar dibandingkan
rata-rata aromaterapi lavender yang
sebesar 2,15. Hasil penelitian ini
juga didukung oleh penelitian yang
sebelumnya yang dilakukan oleh Isa

Khasani (2013) tentang


pengaruhpemberian aromaterapi
terhadap nyeri pada pasien post

operasi sectio caesrea di RSUD


kajen kabupaten pekalongan dengan
p value sebesar 0,001 (P < 0,05).

Hasil penelitian lainnya yaitu


dilakukan oleh Nurfitriani (2016)
menyatakan bahwa ada pengaruh
pemberian aromaterapi lemon secara
inhalasi terhadap derajat disminorea
primer dengan p value 0,000 (P <
0,05). Pada penelitian Jaya (2013)
menyatakan bahwa ada pengaruh

pemberian aromaterapi terhadap


tingkat nyeri pada ibu bersalin
primipara kala 1 fase aktif di RSUD
kabupaten kediri dengan p value
0,002 (P < 0,05.

Aromaterapi lemon efektif untuk


menurunkan nyeri post sectio
cesarea karena aromaterapi lemon
mengandung minyak atsiri yang
bermanfaat sebagai anti stres.
Minyak atsiri lemon mampu
menenangkan, sehingga dapat
membantu dalam menghilangkan
kelelahan mental, pusing, gelisah,
gugup, ketegangan saraf dan
menurunkan nyeri. Minyak atsiri
lemon memiliki kemampuan untuk
menyegarkan pikiran, yaitu dengan
menciptakan pikiran dalam bingkai
positif dan menghapus emosi negatif.
Menghirup minyak atsiri lemon
dapat membantu dalam
meningkatkan konsentrasi dan
kewaspadaan (Anonim, 2013).
Banyaknya manfaat tersebut akan
terbuang bila minyak lemon mudah
menguap dan mudah habis, untuk itu
diperlukan cara untuk melindungi
bahan aktif dalam minyak lemon
agar tidak cepat menguap.
4. KESIMPULAN DAN SARAN
KESIMPULAN
1. Intensitas
nyeri post sectio
caesarea sebelum diberikan
aromaterapi lavender yaitu 5,54
2. Intensitas
nyeri post sectio
caesarea sesudah diberikan
aromaterapi lavender yaitu 3,39
3. Terdapat
perbedaan penurunan
intensitas nyeri post sectio
caesarea sebelum dansesudah
diberikan aromaterapi lavender
yaitu 2,15
4. Intensitas
nyeri post sectio
caesarea sebelum diberikan
aromaterapi lemon yaitu 5,39
5. Intensitas
nyeri post sectio
caesarea sesudah diberikan
aromaterapi lemon yaitu 1,39
6. Terdapat
perbedaan penurunan
intensitas nyeri post sectio
caesarea sebelum dan sesudah
diberikan aromaterapi lemon yaitu
4
7. Terdapat
perbedaan intensitas
nyeri post sectio caesarea setelah
pemberian aromaterapi lavender
dan lemon yaitu 1,85.
SARAN

1. Bagi
Ibu Post Sectio Caesarea
dan Masyarakat
Dengan penelitian ini diharapkan ibu
post sectio caesarea dan masyarakat
dapat menjadikan aromaterapi
sebagai salah satu pengobatan
alternatif bagi masyarakat yang
mengalami nyeri post sectio caesrea
agar menggunakan aromaterapi
lavender dan aromaterapi lemon
sebagai terapi non farmakologi
dalam mengatasi nyeri.

2. Pelayanan Keperawatan
Dengan penelitian ini diharapkan
pelayanan keperawatan bukan hanya
memberikan terapi farmakologis
dalam mengatasi nyeri post sectio
caesarea pada ibu post sectio
caesarea, namun dapat memberikan
terapi komplementer yang berupa
aromaterapi laveder dan aromaterapi
lemon untuk menangani nyeri post
sectio caesarea dalam melaksanakan
perannya sesuai undang-undang
keperawatan.

3. Penelitian Selanjutnya
Dengan penelitian ini diharapkan
penelitian selanjutnya dapat
menjadikan penelitian ini sebagai
referensi bagipeneliti lain untuk
melakukan penelitian dengan
intervensi yang berbeda. selain itu
penelitian selanjutnya diharapkan
dapat meneliti jenis-jenis
aromaterapi yang lainnya, dalam
mengatasi nyeri post sectio caesarea.

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..........................
AROMATERAPI LAVENDER SEBAGAI MEDIA RELAKSASI

IGA Prima Dewi AP

Bagian Farmasi Fakultas Kedokteran Universitas Udayana

ABSTRAK

Aromaterapi adalah salah satu teknik pengobatan atau perawatan menggunakan baubauan

yang menggunakan minyak esensial aromaterapi. Proses ekstraksi (penyulingan)


minyak esensial ini secara umum dapat dilakukan dengan tiga cara, yaitu penyulingan

dengan dengan air (direbus), penyulingan dengan air dan uap (dikukus), dan
penyulingan dengan uap (diuapkan). Salah satu aroma yang paling digemari adalah
lavender. Kandungan utama dari bunga lavender adalah linalyl asetat dan linalool
(C10H18O). Linalool adalah kandungan aktif utama yang berperan pada efek anti cemas

(relaksasi) pada lavender. Menurut hasil dari beberapa jurnal penelitian,


didapatkan
kesimpulan bahwa minyak esensial dari bunga lavender dapat memberikan manfaat
relaksasi (carminative), sedatif, mengurangi tingkat kecemasan, dan mampu
memperbaiki mood seseorang

Kata kunci: aromaterapi, lavender, linalool, relaksasi

LAVENDER AROMATERAPHY AS A RELAXANT

ABSTRACT

Aromatherapy is a kind of treatment that used aroma with aromatherapy essential


oil.
Extraction process from essential oil generally doing in three methods, there are
distilling with water (boiled), distilling with water and steam, and distilling
with steam.
One of the most favorite aroma is lavender. The main content from lavender is
linalyl
acetate and linalool (C10H18O). Linalool is main active contents in lavender which
can
use for anti-anxiety (relaxation). Based on some research, the conclusion indicates
that
essential oil from lavender can give relaxation (carminative), sedative, reduce
anxiety
level and increasing mood.

Keywords: aromatherapy, lavender, linalool, relaxation


PENDAHULUAN

Tuntutan hidup yang semakin besar dan keinginan orang untuk mendapatkan
hidup yang lebih baik mendorong setiap orang untuk bekerja lebih keras sehingga
menimbulkan rasa lelah, baik itu dalam pikiran maupun fisik. Saat ini berwisata
juga
bertujuan untuk mendapatkan ketenangan yang dapat dilakukan dengan wisata spa. Bali

sebagai daerah tujuan wisata yang sangat diminati oleh para wisatawan juga
menyediakan fasilitas wisata spa tersebut. Wisata spa saat ini menjadi salah satu
trend
terbaru bagi wisatawan yang berlibur di Bali, banyak wisatawan yang memang sengaja
datang ke Bali dengan tujuan melakukan wisata spa. Bahkan salah satu spa terbaik di

dunia terdapat di Bali.

Salah satu aroma untuk aromaterapi yang paling digemari adalah lavender.
Berasal dari bunga levender yang berbentuk kecil dan berwarna ungu. Bunga lavender
dapat digosokkan ke kulit, selain memberikan aroma wangi, lavender juga dapat
menghindarkan diri dari gigitan nyamuk4. Aromaterapi menggunakan minyak lavender
dipercaya dapat memberikan efek relaksasi bagi saraf dan otot-otot yang tegang
(carminative) setelah lelah beraktivitas5. Bunga lavender juga memiliki efek

5,6,7

memberikan rasa kantuk (sedatif).

Melalui tulisan ini, diharapkan dapat memberikan tambahan wawasan atau ilmu
pengetahuan bagi pembaca tentang gambaran umum dan zat yang terkandung dalam
bunga lavender, proses pengolahan minyak lavender, serta manfaat relaksasi bunga
lavender.
BUNGA LAVENDER

Bunga lavender memiliki 25-30 spesies, beberapa diantaranya adalah Lavandula


angustifolia, lavandula lattifolia, lavandula stoechas (Fam. Lamiaceae)8.
Penampakan
bunga ini adalah berbentuk kecil, berwarna ungu kebiruan, dan tinggi tanaman
mencapai 72 cm. Asal tumbuhan ini adalah dari wilayah selatan Laut Tengah sampai
Afrika tropis dan ke timur sampai India. Lavender termasuk tumbuhan menahun,
tumbuhan dari jenis rumput-rumputan, semak pendek, dan semak kecil. Tanaman ini
juga menyebar di Kepulauan Kanari, Afrika Utara dan Timur, Eropa selatan dan
Mediterania, Arabia, dan India. Karena telah ditanam dan dikembangkan di tamantaman

di seluruh dunia, tumbuhan ini sering ditemukan tumbuh liar di daerah di luar
daerah asalnya9 (Gambar 1).

Tanaman ini tumbuh baik pada daerah dataran tinggi, dengan ketinggian berkisar
antara 600-1.350 m di atas permukaan laut. Untuk mengembangbiakkan tanaman ini
tidaklah sulit, dimana menggunakan biji dari tanaman lavender yang sudah tua dan
disemaikan. Bila sudah tumbuh, dapat dipindahkan ke polybag. Bila tinggi tanaman
telah mencapai 15-20 cm, dapat dipindahkan ke dalam pot atau bisa ditanam di
halaman

4,10

rumah.

Nama lavender berasal dari bahasa Latin �lavera�


yang berarti menyegarkan dan
orang-orang Roma telah memakainya sebagai parfum dan minyak mandi sejak zaman
dahulu9. Bunga lavender dapat digosokkan ke kulit, selain memberikan aroma wangi,
lavender juga dapat menghindarkan diri dari gigitan nyamuk. Bunga lavender kering
dapat diolah menjadi teh yang dapat kita konsumsi. Manfaat lain bunga lavender
adalah
dapat dijadikan minyak esensial yang sering dipakai sebagai aromaterapi karena
dapat
memberikan manfaat relaksasi dan memiliki efek sedasi yang sangat membantu pada
orang yang mengalami insomnia. Minyak esensial dari lavender biasanya diencerkan
terlebih dahulu dengan minyak lain dari tumbuh-tumbuhan (carrier oil) seperti sweet

almond oil, apricot oil, dan grapeseed oil agar dapat diaplikasikan pada tubuh
untuk
massage aromaterapi1.

Zat yang Terkandung pada Minyak Lavender

Minyak lavender memiliki banyak potensi karena terdiri atas beberapa kandungan.
Menurut penelitian, dalam 100 gram bunga lavender tersusun atas beberapa kandungan,

seperti: minyak esensial (1-3%), alpha-pinene (0,22%), camphene (0,06%),


betamyrcene
(5,33%), p-cymene (0,3%), limonene (1,06%), cineol (0,51%), linalool
(26,12%), borneol (1,21%), terpinen-4-ol (4,64%), linalyl acetate (26,32%), geranyl

acetate (2,14%), dan caryophyllene (7,55%). Berdasarkan data di atas, dapat


disimpulkan bahwa kandungan utama dari bunga lavender adalah linalyl asetat dan
linalool7 (C10H18O).

Diteliti efek dari tiap kandungan bunga lavender untuk mencari tahu zat mana
yang memiliki efek anti-anxiety (efek anti cemas/relaksasi) menggunakan Geller
conflict test dan Vogel conflict test. Cineol, terpinen-4-ol, alpha-pinene, dan
betamyrcene
tidak menghasilkan efek anti cemas yang signifikan pada tes Geller. Linalyl
asetat sebagai salah satu kandungan utama pada lavender tidak menghasilkan efek
anti
cemas yang signifikan pada kedua tes. Borneol dan camphene memberikan efek anti
cemas yang signifikan pada tes Geller, tapi tidak signifikan pada tes Vogel.
Linalool,
yang juga merupakan kandungan utama pada lavender, memberikan hasil yang
signifikan pada kedua tes. Dapat dikatakan, linalool adalah kandungan aktif utama
yang
berperan pada efek anti cemas (relaksasi) pada lavender7.
Proses Pembuatan Minyak Lavender

Kandungan minyak esensial dari tumbuh-tumbuhan, seperti pada batang, daun,


akar, buah, dan bunga dapat diisolasi atau dipisahkan dengan berbagai cara, salah
satunya adalah dengan penyulingan (distilation). Penyulingan merupakan proses yang
sangat menentukan untuk mendapatkan minyak esensial dari suatu tanaman. Terdapat
beberapa cara penyulingan yang dapat dilakukan untuk menghasilkan minyak esensial
dan cara-cara tersebut tergantung pada volume serta ketersediaan alat-alat
pendukung di
lokasi penyulingan. Alat penyulingan minyak sebaiknya terbuat dari bahan stainless
steel. Jika proses penyulingan dibuat dari bahan lain (non-stainless steel), minyak
yang
dihasilkan akan tampak keruh3.

Pertama yang harus kita lakukan sebelum penyulingan adalah memotong bunga
lavender menjadi bagian yang lebih kecil. Hal ini bertujuan agar kelenjar minyak
pada
bunga dapat terbuka sebanyak mungkin sehingga memaksimalkan produksi minyak
esensial3.

Tahap selanjutnya adalah mengeringkan bunga lavender pada tempat yang teduh
atau ruang tertutup selama kurang lebih dua hari. Hal ini bertujuan untuk
mempercepat
proses penyulingan dan mendapatkan hasil yang lebih baik. Jangan langsung
mengeringkan di bawah sinar matahari karena dapat mengakibatkan sebagian minyak
dari bunga ikut menguap. Selain itu, pengeringan yang terlalu cepat dapat
mengakibatkan bunga menjadi rapuh dan sulit untuk disuling. Bila dua tahap di atas
telah dikerjakan, bunga lavender siap untuk disuling menjadi minyak esensial3.

Menurut Tuhana Taufik (2007), teknik penyulingan minyak esensial dapat


dilakukan dengan tiga cara, yaitu penyulingan dengan air (direbus), penyulingan
dengan
air dan uap (dikukus), dan penyulingan dengan uap (diuapkan).
1. Penyulingan dengan air (direbus)
Teknik penyulingan ini adalah teknik yang paling pertama dilakukan dan masih
digunakan sampai saat ini oleh petani tradisional. Dalam teknik ini, ketel
penyulingan diisi air sampai sampai volumenya hampir separuh dari volume ketel,
lalu dipanaskan. Sebelum air mendidih, bahan baku dimasukkan dalam ketel
penyulingan. Dengan demikian, penguapan air dan minyak terjadi secara
bersamaan, sehingga disebut teknik penyulingan langsung (direct distilation). Uap
air yang keluar dialirkan melalui kondensor (alat pendingin) agar menjadi cair
(terkondensasi). Selanjutnya, cairan tersebut (campuran minyak dengan air)
ditampung dan dibiarkan beberapa saat sampai cairan terpisah menjadi bagian air
dan minyak. Bahan yang berat jenisnya lebih besar akan berada di bawah. Lalu,
dengan membuka keran pada alat penampung, minyak dan air dapat dipisahkan.

Teknik ini adalah yang paling sederhana dan tidak memerlukan banyak modal,
namun teknik ini lebih cocok terhadap bahan yang jumlahnya tidak terlalu banyak.
Ada beberapa kelemahan dari teknik ini, yaitu kualitas minyak yang dihasilkan
cukup rendah, kadar minyak sedikit, dan produk minyak bercampur dengan hasil
sampingan.

2. Penyulingan dengan air dan uap (dikukus)


Teknik penyulingan ini menghasilkan kualitas dan produksi minyak esensial
yang lebih baik dibandingkan dengan teknik direbus. Prinsip kerjanya adalah ketel
penyulingan diisi air sampai batas saringan. Bahan baku diletakkan di atas saringan

sehingga tidak berhubungan langsung dengan air yang mendidih, tetapi nantinya
akan berhubungan dengan uap air. Oleh karena itulah, teknik ini disebut
penyulingan tidak langsung (indirect distilation). Pada teknik ini, air yang
menguap
akan membawa partikel-partikel minyak dan dialirkan melalui pipa ke alat
pendingin sehingga terjadi pengembunan dan uap air yang bercampur minyak akan
mencair kembali. Selanjutnya, campuran ini dialirkan ke alat pemisah untuk
memisahkan minyak dari air dengan membuka keran pada tabung pemisah.

Teknik ini cocok untuk penyulingan bahan yang jumlahnya lebih banyak
dibandingkan dengan teknik merebus. Teknik penyulingan ini sering dipakai petani
untuk mendapatkan minyak dengan kualitas baik untuk diekspor dan alat-alatnya
pun dapat dibuat sendiri oleh petani.

3. Penyulingan dengan uap (diuapkan)


Teknik ini tergolong untuk penyulingan dalam skala perusahaan besar dan
memerlukan biaya yang cukup besar karena memakai dua buah ketel dan sebagian
besar peralatan memakai bahan stainless steel (SS) dan mild steel (MS). Biaya
besar untuk pengadaan alat-alat sepadan dengan hasil minyak esensial yang
diperoleh, dimana kualitas minyak jauh lebih sempurna dibandingkan dengan kedua
teknik yang telah dijabarkan sebelumnya (Gambar 2).

Prinsip kerja teknik ini sebenarnya hampir sama dengan teknik dikukus, namun
antara ketel uap dan ketel penyulingan harus dipisah. Ketel uap yang berisi air
dipanaskan, lalu uapnya dialirkan ke ketel penyulingan yang berisi bahan baku.
Suhu uap diusahakan tidak lebih dari 1000 celcius, agar tidak terlalu panas dan
dapat merusak hasil sulingan. Partikel-partikel minyak pada bahan baku terbawa
bersama uap dan dialirkan ke alat pendingin. Di dalam alat pendingin terjadi proses

pengembunan sehingga uap air yang bercampur minyak akan mengembun dan
mencair kembali. Setelah itu, campuran ini dialirkan ke alat pemisah yang akan
memisahkan minyak dari air. Dalam tabung pemisah, minyak akan berada di bagian
atas karena berat jenisnya lebih ringan daripada air. Selanjutnya, dengan membuka
keran pada tabung pemisah, air yang ada dalam tabung dapat dikeluarkan dan yang
tertinggal dalam tabung hanya minyak hasil penyulingan3 (Gambar 3).

KERJA EKSTRAK LAVENDER SEBAGAI MEDIA RELAKSASI

Indra penciuman memiliki peran yang sangat penting dalam kemampuan kita untuk
bertahan hidup dan meningkatkan kualitas hidup kita. Dalam sehari kita bisa mencium

lebih kurang 23.040 kali1. Bau-bauan dapat memberikan peringatan pada kita akan
adanya bahaya dan juga dapat memberikan efek menenangkan (relaksasi)1. Tubuh
dikatakan dalam keadaan relaksasi adalah apabila otot-otot di tubuh kita dalam
keadaan
tidak tegang. Keadaan relaksasi dapat dicapai dengan menurunkan tingkat stres, baik

stres fisik maupun psikis, serta siklus tidur yang cukup dan teratur.

Minyak lavender dengan kandungan linalool-nya adalah salah satu minyak


aromaterapi yang banyak digunakan saat ini, baik secara inhalasi (dihirup) ataupun
dengan teknik pemijatan pada kulit. Aromaterapi yang digunakan melalui cara
inhalasi
atau dihirup akan masuk ke sistem limbic dimana nantinya aroma akan diproses
sehingga kita dapat mencium baunya. Pada saat kita menghirup suatu aroma, komponen
kimianya akan masuk ke bulbus olfactory, kemudian ke limbic sistem pada otak.
Limbic adalah struktur bagian dalam dari otak yang berbentuk seperti cincin yang
terletak di bawah cortex cerebral. Tersusun ke dalam 53 daerah dan 35 saluran atau
tractus yang berhubungan dengannya, termasuk amygdala dan hipocampus. Sistem
limbic sebagai pusat nyeri, senang, marah, takut, depresi, dan berbagai emosi
lainnya.
Sistem limbic menerima semua informasi dari sistem pendengaran, sistem penglihatan,

dan sistem penciuman. Sistem ini juga dapat mengontrol dan mengatur suhu tubuh,
rasa
lapar, dan haus. Amygdala sebagai bagian dari sistem limbic bertanggung jawab atas
respon emosi kita terhadap aroma. Hipocampus bertanggung jawab atas memori dan
pengenalan terhadap bau juga tempat dimana bahan kimia pada aromaterapi
merangsang gudang-gudang penyimpanan memori otak kita terhadap pengenalan
baubauan1.

Minyak lavender adalah salah satu aromaterapi yang terkenal memiliki efek
menenangkan. Menurut penelitian yang dilakukan terhadap tikus, minyak lavender
memiliki efek sedasi yang cukup baik dan dapat menurunkan aktivitas motorik
mencapai 78%11, sehingga sering digunakan untuk manajemen stres. Beberapa tetes
minyak lavender dapat membantu menanggulangi insomnia, memperbaiki mood
seseorang, dan memberikan efek relaksasi.

Penelitian lain yang dilakukan terhadap manusia mengenai efek aromaterapi


lavender untuk relaksasi, kecemasan, mood, dan kewaspadaan pada aktivitas EEG
(Electro Enchepalo Gram) menunjukkan terjadinya penurunan kecemasan, perbaikan
mood, dan terjadi peningkatan kekuatan gelombang alpha dan beta pada EEG yang
menunjukkan peningkatan relaksasi. Didapatkan pula hasil yaitu terjadi peningkatan
secara signifikan dari kekuatan gelombang alpha di daerah frontal, yang menunjukkan

terjadinya peningkatan rasa kantuk5.

MANFAAT EKSTRAK LAVENDER

Minyak lavender berwarna jernih sampai kuning pucat dengan bau wangi yang sangat
khas12 . Minyak lavender adalah salah satu aromaterapi yang terkenal memiliki efek
sedatif, hypnotic, dan anti-neurodepresive baik pada hewan maupun pada manusia6.
Karena minyak lavender dapat memberi rasa tenang, sehingga dapat digunakan sebagai
manajemen stres. Kandungan utama dalam minyak lavender adalah linalool asetat yang
mampu mengendorkan dan melemaskan sistem kerja urat-urat syaraf dan otot-otot yang
tegang. Dikatakan juga linalool menunjukkan efek hypnotic dan anticonvulsive pada
percobaan menggunakan tikus6. Karena khasiat inilah bunga lavender sangat baik
digunakan sebagai aromaterapi. Selain itu, beberapa tetes minyak lavender dapat
membantu menanggulangi insomnia, memperbaiki mood seseorang, menurunkan
tingkat kecemasan, meningkatkan tingkat kewaspadaan, dan tentunya dapat
memberikan efek relaksasi.

Wisatawan merupakan orang yang melakukan wisata ke berbagai tempat dengan


tujuan untuk memperoleh kesenangan atau ketenangan. Tentunya para wisatawan
memerlukan stamina dan kondisi tubuh yang selalu fit agar dapat menempuh perjalanan

wisata yang nyaman. Oleh karena itu manfaat aromaterapi khususnya aroma lavender
dengan kandungan zat yang dimiliki akan dapat memberikan kenyamanan bagi para
wisatawan yang sedang melakukan perjalanan.

Bagi orang yang sehari-harinya melaksanakan berbagai kesibukan dengan tingkat


kelelahan dan stres yang tinggi serta kurangnya waktu yang dapat digunakan untuk
beristirahat dan berwisata, dapat melakukan aromaterapi menggunakan teknik inhalasi

aroma minyak lavender di rumah masing-masing, dengan meneteskan minyak lavender


pada bantal ataupun memakai bantuan bakaran lilin aromaterapi. Selain karena
manfaatmanfaat
aromaterapi lavender yang sangat sesuai dengan kebutuhan, waktu yang
diperlukan untuk melakukan teknik tersebut juga tidak banyak. Sehingga akan sangat
memungkinkan bagi orang-orang yang tidak memiliki banyak waktu luang.

Wisatawan memperoleh manfaat, dalam aspek fisik maupun psikis apabila


melakukan aromaterapi menggunakan minyak lavender. Manfaat aspek fisik dari
aromaterapi ini dapat merelaksasikan otot-otot yang kaku setelah melakukan
perjalanan
wisata yang cukup jauh. Aroma lavender juga memberikan efek sedatif yang cukup baik

sehingga para wisatawan dapat beristirahat dengan cukup setelah melakukan


perjalanan
wisatanya dan dapat melakukan perjalanan wisata lain dengan kondisi tubuh yang
lebih
baik. Dari segi psikis, melihat adanya manfaat dalam memperbaiki mood dari minyak
lavender, tentunya para wisatawan dapat melakukan wisatanya dengan perasaan yang
tenang dan nyaman serta jauh dari depresi dan tekanan.

Pemakaian minyak lavender sebagai aromaterapi telah dilakukan sejak zaman


dahulu. Seiring perjalanannya, sempat dilaporkan bahwa ada beberapa efek samping
yang ditimbulkan dari pemakaian minyak lavender secara inhalasi, diantaranya, mual,

muntah, sakit kepala, dan menggigil. Dermatitis kontak dan phototoxicity juga
dilaporkan terjadi pada penggunaan minyak lavender secara topikal12 .

DISKUSI

Penelitian yang dilakukan oleh Jeffrey J. Gedney, Psyd., Toni L. Glover, MA.,
RN., dan Roger B, Fillingim, PhD. dengan judul �Sensory and Affective Pain
Discrimination After Inhalation of Esensial Oils�. Metode penelitian yang digunakan

adalah randomized crossover design dengan melakukan penelitian 26 orang sehat,


tidak
merokok, dan tidak dalam pengobatan (13 laki-laki dan 13 wanita belum menopause).
Dalam studi ini didemonstrasikan bahwa inhalasi dari minyak esensial lavender dan
rosemary tidak menemukan hasil adanya efek analgesik. Tetapi evaluasi subjek secara

retrospektif dari pengaruh aroma terhadap perubahan intensitas nyeri dan nyeri yang

tidak mengenakkan menunjukkan mereka memperoleh manfaat yang menguntungkan,


khususnya untuk lavender. Jadi dalam evaluasi klinis secara retrospektif tentang
efektivitas treatment, aromaterapi dapat menimbulkan perubahan hubungan klinis pada

laporan pasien mengenai rasa nyeri. Oleh karena itu kecenderungan efek samping yang

diperoleh dari penelitian ini adalah bahwa aroma terapi dapat membantu dalam terapi

yang berhubungan dengan nyeri dan adanya kerusakan jaringan2.

Penelitian yang dilakukan oleh Miguel A. Diego, Nancy Aaron Jones, Tiffany
Field, Maria Hernandez-Reif, Saul Schanburg, Cynthia Kuhn, Virginia McAdam,
Robert Galamaga, dan Mary Galamaga, dengan judul �Aromatherapy Positively Affects
Mood, EEG Patterns of Alertness, and Math Computations�. Dengan melakukan
penelitian menggenakan aroma lavender dan rosemary pada 40 orang mahasiswa dan
staf dari Universitas Miami Medical School, yang terdiri dari 30 wanita dan 10
laki-laki.
Penelitian ini dibagi menjadi tiga tahap. Penelitian tahap pertama menggunakan data

laporan langsung menunjukkan bahwa, kedua kelompok baik lavender maupun


rosemary mengalami penurunan yang signifikan dalam score tingkat kecemasan yang
dites menggunakan kuisioner STAI (State Anciety Inventory), hanya kelompok lavender

yang mengalami perbaikan mood secara signifikan setelah pemberian aroma terapi,
yang diketahui dari penurunan score POMS (The Profile of Mood States), kedua
kelompok merasa lebih rileks, dan kelompok rosemary cenderung merasa lebih
waspada. Penelitian tahap kedua menggunakan math computations menunjukkan bahwa
kedua kelompok dapat mengisi math computations dengan lebih cepat setelah diberi
aroma terapi, tetapi hanya kelompok lavender yang mengalami peningkatan ketelitian
atau ketepatan dalam pengisian. Penelitian tahap ketiga menggunakan data EEG pada
saat sebelum, selama, dan setelah menggunakan aroma terapi, hasilnya menunjukkan
bahwa kelompok yang mengalami peningkatan gelombang alpha pada daerah frontal
secara signifikan adalah kelompok lavender ditandai adanya peningkatan rasa kantuk,
sementara kekuatan gelombang alpha pada daerah frontal menurun pada kelompok
rosemary ditandai adanya peningkatan kewaspadaan, (2) Kedua kelompok aroma terapi
mengalami peningkatan gelombang beta yang ditandai adanya rasa kantuk5.

Kedua penelitian sama-sama menggunakan aroma lavender dan rosemary sebagai


objek penelitian dan sama-sama meneliti efek yang diakibatkan oleh kedua
aromaterapi
tersebut. Penelitian pertama, meneliti efek aroma lavender dan rosemary terhadap
rasa
nyeri atau efek analgesik. Penelitian kedua meneliti efek aroma lavender dan
rosemary
terhadap perbaikan mood, kewaspadaan, dan pengaruh terhadap rasa kantuk.

Menurut hasil dari beberapa jurnal penelitian, didapatkan kesimpulan bahwa


minyak esensial dari bunga lavender dapat memberikan manfaat relaksasi
(carminative),
sedatif, mengurangi tingkat kecemasan, dan mampu memperbaiki mood seseorang.
Belum terdapat jurnal yang membahas mengenai bagaimana mekanisme kerja linalool
pada CNS (Central Nervous System) sehingga lavender dapat memberikan berbagai
manfaat seperti tersebut di atas.

RINGKASAN

Kandungan utama dari bunga lavender adalah linalyl asetat dan linalool (C10H18O).
Linalool adalah kandungan aktif utama yang berperan pada efek anti cemas
(relaksasi)
pada lavender. Minyak lavender dengan kandungan linalool-nya adalah salah satu
minyak aromaterapi yang banyak digunakan saat ini, baik secara inhalasi (dihirup)
ataupun dengan teknik pemijatan pada kulit. Minyak lavender adalah salah satu
aromaterapi yang terkenal memiliki efek menenangkan, sehingga dapat digunakan
sebagai manajemen stres. Menurut beberapa penelitian, minyak lavender lavender
sendiri berpengaruh secara signifikan terhadap penurunan tingkat kecemasan,
peningkatan relaksasi, dan peningkatan rasa kantuk, serta adanya perbaikan mood .

DAFTAR PUSTAKA

1.
Buckle J. Aromatherapy and Diabetes. Diabetes Spectrum 2001: vol. 4 no. 3;
124-126
2.
Gedney JJ, Glover TL, Fillingim RB. Sensory and Affective Pain Discrimination
After Inhalation of Esensial Oils. Psychosomatic Medicine 2004: 66; 599-606
3.
Taufiq T. 2007. Menyuling Minyak Atsiri. PT. Citra Pramana: Yogyakarta
4.
http://lilyflowers-8.blogspot.com/2009/05/bunga-lavender.html. Diakses tanggal 20
Januari 2011
5.
Diego AM, Jones NA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C,
McAdam V, Galamaga R, Galamaga M. Arometherapy Positively Affects
Mood, EEG Pattern of Alertness and Math Computations. International Journal
of Neuroscience 1998: vol 96; 217-224
6.
Yamada K, Mimaki Y, Sashida Y. Effect Inhaling of the Vapor of Lavandula
burnatii super-Derrived Esensial Oil and Linalool on Plasma
Adrenocorticotropin Hormone (ACTH), Catecholamine and Gonadotropin Level
in Experimental Menopausal Female Rats. Pharmaceutical Society of Japan
2005: 28 (2); 378-379
7.
McLain DE. Chronic Health Effects Assessment of Spike Lavender Oil. Walker
Doney and Associates, Inc 2009; 1-18
8.
Barocelli E, Calcina F, Chiavarini M, Impicciatore M, Bruni R, Bianchi A,
Vallabeni V. Antinociceptive and Gastroprotective Effect of Inhaled and Orally
Administered Lavandulahybrida Reverchon �Grosso� Esensial oil. Science
Direct 2004: 76; 213-223
9.
http://en.wikipedia.org/wiki/Aromatherapy. Diakses tanggal 20 Januari 2011
10.
http://id.shvoong.com/social-sciences/counseling/2089560-khasiat-dan-manfaat-
bungalavender/.
Diakses tanggal 20 Januari 2011
11.
Snow AL, Hovanec L, Brandit J. A Controlled Trial of Aromatherapy for
Agitation in Nursing Home Patients with Dementia. The Journal of Alternatif
and Complementary Medicine 2004: vol. 10 no. 3; 431-437
12.
Sweetman SC. 2002. The Complete Drug Reference. Pharmaceutical Press:
London
13.
http://www.google.co.id/imglanding?q=alat+penyulingan+minyak&hl=en&gbv=2&tbs
=isch:1&tbnid=5CFKsGwLBh3FhM:&imgrefurl=http://business.dinomarket.com/ads/9
14452/Jual-DESTILATOR-PENYULING-MINYAKATSIRI/&
imgurl=http://media.dinomarket.com/docs/imgusr/mesindestilatorminyaknila
m_ll.jpg.jpg&ei=_2k5TcP8OoLSsAOGwOn8Ag&zoom=1&w=500&h=314&iact=hc&
oei=92k5TfyWDsysrAedj_2wCA&esq=2&page=2&tbnh=114&tbnw=182&start=20&n
dsp=18&ved=1t:429,r:5,s:20&biw=1280&bih=588. Diakses tanggal 20 Januari 2011
14.
http://www.google.co.id/images?hl=en&biw=1280&bih=588&gbv=2&tbs=isch%3A1&
sa=1&q=alat+penyulingan+lavender&aq=f&aqi=&aql=&oq=. Diakses tanggal 20
Januari 2011
Gambar 1. Bunga Lavender7

Gambar 2. Alat Penyulingan dengan Uap13


Gambar 3. Alat Penyulingan Minyak Lavender14
Jurnal Keperawatan Soedirman (The Soedirman Journal of Nursing), Volume 8, No.2,
Juli 2013
120
PENGARUH AROMATERAPI LAVENDER TERHADAP INTENSITAS NYERI PADA PASIEN
PASCA OPERASI DI RUMAH SAKIT DUSTIRA CIMAHI
Argi Virgona Bangun1, Susi Nur�aeni2
1,2 Program Studi Keperawatan Sekolah Tinggi Ilmu Kesehatan
Jendral Achmad Yani Cimahi
ABSTRACT
Lavender as aromatherapy give effect of relaxing and sedation. Research aimed to
know the
influence of lavender aromatherapy on pain intensity on major surgical post
operative patient.
This research used pre-experimental design with one group pretest-posttest design
form.
Sample in this research as many as 10 people by purposive sampling technique and
data
analysis by paired t-test. Statistical test result obtained p value 0,001. There is
seen a
significance difference of pain intensity before and after lavender aromatherapy
provision.
Suggestion for Dustira Hospital Cimahi, research could become input for Hospital to
applied
lavender aromatherapy provision on post operative patient. Lavender aromatherapy
should be
taught before surgery, and patients can be applied in patients after surgery.
Key Words : Aromatherapy, Lavender, Post Surgery Pain, Pain Intensity
ABSTRAK
Lavender sebagai aromaterapi memberikan efek relaksasi dan sedasi. Tujuan
penelitian untuk
mengetahui pengaruh aromaterapi lavender terhadap intensitas nyeri pada pasien
pasca
operasi. Penelitian ini menggunakan desain pre-eksperimental dengan bentuk
rancangan one
group pretest-posttest design selama Januari - April 2013 dengan sampel yang
dipilih secara
purposive sampling. Analisa data dengan uji paired t-test. Hasil uji statistik
didapatkan nilai p
value 0,001 berarti ada perbedaan intensitas nyeri antara sebelum dan sesudah
diberikan
aromaterapi lavender. Penelitian ini dapat menjadi masukan bagi Rumah Sakit untuk
menerapkan pemberian aromaterapi lavender pada pasien pasca operasi.
Kata kunci : Aromaterapi, Lavender, operasi, Intensitas Nyeri
Jurnal Keperawatan Soedirman (The Soedirman Journal of Nursing), Volume 8, No.2,
Juli 2013
121
PENDAHULUAN
Pembedahan merupakan suatu
tindakan pengobatan yang menggunakan
cara invasif dengan membuka dan
menampilkan bagian tubuh yang akan
ditangani. Pembukaan bagian tubuh ini
umumnya dilakukan dengan membuat
sayatan. Setelah bagian yang akan
ditangani ditampilkan, selanjutnya
dilakukan perbaikan yang diakhiri dengan
penutupan dan penjahitan luka. Setiap
pembedahan selalu berhubungan dengan
insisi yang merupakan trauma bagi
penderita yang menimbulkan berbagai
keluhan dan gejala. Salah satu keluhan
yang sering dikemukakan adalah nyeri
(Sjamsuhidajat & Jong, 2005). Adapun
bentuk nyeri yang dialami oleh klien pasca
pembedahan adalah nyeri akut. Nyeri akut
secara serius mengancam penyembuhan
klien pasca operasi sehingga menghambat
kemampuan klien untuk terlibat aktif dalam
mobilisasi, rehabilitasi, dan hospitalisasi
menjadi lama (Perry & Potter, 2006).
Nyeri setelah pembedahan
merupakan hal yang fisiologis, tetapi hal ini
menjadi salah satu keluhan yang paling
ditakuti oleh klien setelah pembedahan.
Sensasi nyeri mulai terasa sebelum
kesadaran klien kembali penuh, dan
semakin meningkat seiring dengan
berkurangnya pengaruh anestesi. Adapun
bentuk nyeri yang dialami oleh klien pasca
pembedahan adalah nyeri akut (Perry &
Potter, 2006). Tujuan dari manajemen
nyeri pasca operasi adalah untuk
mengurangi atau menghilangkan rasa sakit
dan ketidaknyamanan pasien dengan efek
samping seminimal mungkin. Salah satu
intervensi yang efek sampingnya minimal
adalah penatalaksanaan nonfarmakologi
seperti stimulasi dan massase kutaneus,
terapi es dan panas, stimulasi saraf
elektrik transkutaneus (TENS), distraksi,
teknik relaksasi, imajinasi terbimbing,
hipnosis (Bare G & Smelzer C, 2002).
Salah satu fungsi independen yang
merupakan fungsi mandiri dan tidak
tergantung pada petugas medis lain,
dimana perawat dalam melaksanakan
tugasnya dilakukan secara mandiri dengan
keputusannya sendiri dalam melakukan
tindakan dalam rangka pemenuhan
kebutuhan dasar manusia (Hidayat, 2004).
Aromaterapi adalah terapi
komplementer dalam praktek keperawatan
dan menggunakan minyak esensial dari
bau harum tumbuhan untuk mengurangi
masalah kesehatan dan memperbaiki
kualitas hidup. Sharma (2009) mengatakan
bahwa bau berpengaruh secara langsung
terhadap otak seperti obat analgesik.
Misalnya, mencium lavender maka akan
meningkatkan gelombang-gelombang alfa
didalam otak dan membantu untuk merasa
rileks. Berdasarkan studi pendahuluan
pada 10 orang pasien pasca operasi
bedah mayor yang mendapatkan terapi
analgesik dengan dosis dan cara
pemberian yang sama didapatkan bahwa
skala nyeri mereka ada pada rentang yang
berbeda-beda. Selain itu diketahui bahwa
upaya lain untuk mengatasi nyeri selain
obat adalah hanya dengan melakukan
relaksasi nafas dalam. Penelitian ini
bertujuan untuk mengetahui pengaruh
aromaterapi lavender terhadap intensitas
nyeri pada pasien pasca operasi bedah
mayor di Rumah Sakit Dustira Cimahi.
METODE PENELITIAN
Penelitian dilaksanakan di ruang
perawatan bedah wanita RS Dustira
Cimahi pada April sampai dengan Mei
2013. Penelitian ini menggunakan desain
Quasi-experimental dengan one group
Jurnal Keperawatan Soedirman (The Soedirman Journal of Nursing), Volume 8, No.2,
Juli 2013
122
pretest posttest. Responden terdiri dari 10
orang pasien paska operasi bedah mayor
hari ke-2 yang tidak memiliki riwayat
dioperasi sebelumnya, berusia 18-45
tahun, jenis kelamin perempuan, dan
mendapatkan jenis analgetik yang serupa.
Responden dikaji skala nyerinya
menggunakan Verbal Descriptor Scale
(VDS) lalu diberikan aroma terapi lavender
sebanyak 3 tetes dengan menggunakan
pembakar minyak dan tungku selama 10
menit. Responden diminta bernafas
normal, tidak melakukan aktivitas lain
selama menghirup aroma terapi, dalam
kondisi ruangan yang tenang. Selanjutnya
satu jam kemudian skala nyeri diukur
kembali. Analisis bivariat dilakukan melalui
uji paired t-test.
HASIL DAN BAHASAN
Tabel 1. Rerata Intensitas Nyeri Pasien Pasca Operasi Sebelum Pemberian Aromaterapi

Lavender di Rumah Sakit Dustira Cimahi.


Variabel Mean SD Minimum
Maksimum
95%CI
Intensitas Nyeri
Sebelum
Aromaterapi
Lavender
4,80 2,530 2-10
2,99
6,61
Dari hasil analisa tabel 1 terlihat
bahwa intensitas nyeri sebelum diberikan
aromaterapi lavender 4,80, dengan
intensitas nyeri terendah 2 dan tertinggi
10. Dari tingkat kepercayaan pasien
disimpulkan bahwa 95% diyakini bahwa
rata-rata intensitas nyeri antara 2,99
sampai 6,61. Hasil penelitian ini sejalan
dengan penelitian yang telah dilakukan
oleh Marzouk, et al (2012) yang
menunjukkan bahwa kombinasi dari efek
lavender dengan analgesik, sedatif, dan
antikonvulsan dapat mengurangi nyeri efek
anestesi lokal serta penelitian Maryati
(2010) menunjukan bahwa aromaterapi
lavender berpengaruh terhadap nyeri haid
primer dengan nilai p=0,000, p value < a
(a=0,05). McCaffery (2009) mendefinisikan
nyeri sebagai �orang yang mengalami
nyeri dalam segala hal dan terjadi kapan
saja orang tersebut mengatakan bahwa ia
merasakan nyeri� (Kozier, et al. 2009).
Berdasarkan International Association For
Study of Pain (IASP), nyeri adalah sensori
subjektif dan emosional yang tidak
menyenangkan yang didapat terkait
dengan kerusakan jaringan aktual maupun
potensial, atau menggambarkan kondisi
terjadinya kerusakan (Lyndon, 2013).
Nyeri setelah pembedahan
merupakan hal yang fisiologis, tetapi hal ini
merupakan salah satu keluhan yang paling
ditakuti oleh klien setelah pembedahan.
Sensasi nyeri mulai terasa sebelum
kesadaran klien kembali penuh, dan
semakin meningkat seiring dengan
berkurangnya pengaruh anestesi. Adapun
bentuk nyeri yang dialami oleh klien pasca
pembedahan adalah nyeri akut yang
terjadi karena adanya luka insisi bekas
pembedahan (Perry dan Potter, 2006).
Pada nyeri pasca bedah rangsangan nyeri
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disebabkan oleh rangsangan mekanik
yaitu luka (insisi) dimana insisi ini akan
merangsang mediator-mediator kimia dari
nyeri seperti histamin, bradikinin,
asetilkolin, dan substansi prostaglandin
dimana zat-zat ini diduga dapat
meningkatkan sensitifitas reseptor nyeri
yang akan menimbulkan sensasi nyeri.
Selain zat yang mampu merangsang
kepekaan nyeri, tubuh juga memiliki zat
yang mampu menghambat (inhibitor) nyeri
yaitu endorfin dan enkefalin yang mampu
meredakan nyeri (Bare G & Smelzer C,
2002).
Hasil penelitian menunjukan bahwa
rata-rata intensitas nyeri pasien pasca
operasi bedah mayor sebelum pemberian
aromaterapi lavender adalah antara 2,99
sampai 6,61. Hal itu bermakna mereka
merasa nyeri ringan sampai dengan nyeri
hebat tak tertahankan. Tujuan dari
manajemen nyeri pasca operasi adalah
untuk mengurangi atau menghilangkan
rasa sakit dan ketidaknyamanan pasien
dengan efek samping seminimal mungkin.
Pendekatan farmakologi merupakan
tindakan kolaborasi antara perawat
dengan dokter, yang menekankan pada
pemberian obat yang mampu
menghilangkan sensasi nyeri. Sedangkan
strategi penatalaksanaan nyeri
nonfarmakologi dapat diterapkan berbagai
tindakan keperawatan holistik. Pada
implementasi trapi holistik di Indonesia,
strategi tindakan holistik dipandang
sebagai tindakan komplementer (Perry &
Potter, 2006).
Tabel 2. Rerata Intensitas Nyeri Pasien Pasca Operasi Sesudah Pemberian Aromaterapi

Lavender di Rumah Sakit Dustira Kota Cimahi.


Variabel Mean SD Minimum
Maksimum
95%CI
Intensitas Nyeri
Sesudah
Aromaterapi
Lavender
4,10 2,807 1-10
2,09
6,11
Dari hasil analisa tabel 2 intensitas
nyeri sesudah diberikan aromaterapi
lavender 4,10, dengan intensitas nyeri
terendah 1 dan tertinggi 10. Dari tingkat
kepercayaan pasien disimpulkan bahwa
95% diyakini bahwa rata-rata intensitas
nyeri antara 2,09 sampai 6,11. Dipandang
dari segi biaya dan manfaat, penggunaan
manajemen nonfarmakologi lebih
ekonomis dan tidak ada efek sampingnya
jika dibandingkan dengan penggunaan
manajemen nyeri farmakologi. Selain itu
juga mengurangi ketergantungan pasien
terhadap obat-obatan. Perawat
mengajarkan keperawatan mandiri atau
terapi komplementer kepada pasien atau
keluarga pasien. Salah satu terapi
komplementer adalah aromaterapi, dimana
aromaterapi ini bermanfaat mengurangi
ketegangan otot yang akan mengurangi
tingkat nyeri.
Hasil penelitian menunjukan
penurunan bermakna dari intensitas nyeri
paska pemberian aromaterapi Lavender,
yaitu 2,09 sampai 6,11. Bau yang
merupakan stimulan ingatan yang sangat
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kuat, secara spontan memberikan tandatanda
emosi yang disebabkan karena
keunikan dari sistem penciuman yang
berhubungan langsung dengan sistem
limbik dan emosi kita (Romantyo & Harini,
1999) Sistem limbik adalah bagian dari
otak yang dikaitkan dengan suasana hati,
emosi, memori, dan belajar kita. Semua
bau yang mencapai sistem limbik memiliki
pengaruh langsung pada suasana hati kita
(Sharma, 2009).
Tabel 3. Pengaruh Aromaterapi Lavender Terhadap Intensitas Nyeri Pada Pasien Pasca
Operasi Bedah Mayor di Rumah Sakit Dustira Kota Cimahi.
Variabel Mean SD Perbedaan
Rata-rata
P Value N
Intensitas Nyeri
Pre
Post
4,80
4,10
2,530
2,807
0,700 0,001 10
Dari hasil analisa tabel 3 didapatkan
bahwa rerata intensitas nyeri sebelum
pemberian aromaterapi lavender adalah
4,80 dengan standar deviasi 2,530.
Intensitas nyeri sesudah pemberian
aromaterapi lavender 4,10 dengan standar
deviasi 2,807. Terlihat nilai mean
perbedaan rata-rata sebelum dan sesudah
adalah 0,700. Hasil uji statistik didapatkan
perbedaan yang signifikan karena nilai p =
0,001, p value < a (a = 0,05). Maka dapat
disimpulkan ada perbedaan yang
signifikan rata-rata sebelum dan sesudah
pemberian aromaterapi lavender.
Aromaterapi lavender bermanfaat
untuk relaksasi, kecemasan, mood, dan
pasca pembedahan menunjukkan
terjadinya penurunan kecemasan,
perbaikan mood, dan terjadi peningkatan
kekuatan gelombang alpha dan beta yang
menunjukkan peningkatan relaksasi.
Gelombang alpha sangat bermanfaat
dalam kondisi relaks mendorong aliran
energi kreativitas dan perasaan segar dan
sehat. Kondisi gelombang alpha ideal
untuk perenungan, memecahkan masalah,
dan visualisasi, bertindak sebagai gerbang
kreativitas seseorang. Minyak lavender
adalah salah satu aromaterapi yang
terkenal memiliki efek menenangkan.
Menurut penelitian yang dilakukan
terhadap tikus, minyak lavender memiliki
efek sedasi yang cukup baik dan dapat
menurunkan aktivitas motorik mencapai
78%, sehingga sering digunakan untuk
manajemen stres. Beberapa tetes minyak
lavender dapat membantu menanggulangi
insomnia, memperbaiki mood seseorang,
dan memberikan efek relaksasi. Pendapat
ini juga didukung oleh Sharma (2009) yang
menyatakan bahwa lavender bersifat
analgesik; untuk nyeri kepala, nyeri otot,
bersifat antibakterial, antifungal,
antiinflamasi, antiseptik, dan penenang.
Sejauh ini tidak ada kontraindikasi yang
diketahui dan tidak terdapat iritasi jika
digunakan pada kulit dan juga tidak
mengiritasi mukosa. Bahwa mencium
lavender maka akan meningkatkan
gelombang-gelombang alpha didalam otak
dan membantu untuk merasa rileks.
Hasil penelitian juga
memperlihatkan bahwa ada 3 responden
dengan skala nyeri yang tetap sesudah
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125
diberikan aromaterapi lavender. Menurut
data yang peneliti lakukan, semua
responden menyukai wangi aromaterapi
lavender. Walaupun semua responden
menyukai wangi aromaterapi, ada 3
responden intensitas nyerinya tetap. Hal ini
terjadi dikarenakan perbedaan karakteristik
nyeri yaitu 2 responden mengalami nyeri
yang berlangsung lama sampai merintihrintih
kesakitan, gelisah, dan menangis.
Sedangkan 1 responden hanya gelisah
saja. Diagnosa medis responden pertama
yaitu HNP lumbal skala nyerinya 10,
responden kedua yaitu amputasi dengan
DM type II skala nyerinya 3, dan
responden ketiga yaitu cholelitiasis skala
nyerinya 7. Usia dari 3 responden ini 45
tahun dan usia ini paling tua dibanding
dengan 7 responden yang lain. Sesuai
dengan (Perry & Potter, 2006), usia
merupakan variabel penting yang
mempengaruhi nyeri. Perbedaan
perkembangan dan kesensitifan terhadap
nyeri, yang membuat hasil intensitas
nyerinya tetap berbeda dengan 7
responden yang hasil intensitas nyerinya
berkurang.
Responden yang mengalami skala
tetap, setelah dihubungkan dengan konsep
dari teori dalam keperawatan akan sesuai
dengan pengertian nyeri adalah sebuah
sensasi subjektif sehingga tidak ada dua
orang yang berespons dengan cara yang
sama. Nyeri dapat secara langsung
mengganggu kesehatan dan memperlama
penyembuhan dari pembedahan, penyakit,
dan trauma. Seseorang mendapat suatu
stresor, dalam hal ini nyeri maka orang
tersebut akan berespon untuk
mempertahankan kesehatannya
(mengurangi nyeri). Sehingga responden
akan menggunakan kopingnya untuk
memenuhi kebutuhan rasa nyamannya
Gaffar (1999, dalam Yudistira, 2011).
SIMPULAN DAN SARAN
Aromaterapi lavender berpengaruh
dalam penurunan intensitas nyeri pada
pasien pasca operasi bedah mayor
ditandai dengan penurunan nilai rata-rata
intensitas nyeri sebelum dan sesudah
diberikan aromaterapi lavender. Perawat
perlu mengintegrasikan hasil penelitian ini
sebagai salah satu intervensi dalam
asuhan keperawatan pada pasien paska
operasi. Perawat juga perlu
mensosialisasikan penggunaan aromatrapi
lavender kepada pasien, keluarga, dan
masyarakat melalui pemberian pendidikan
kesehatan. Desain penelitian dapat dicoba
ulang dengan melibatkan kelompok kontrol
dan kelompok intervensi dan menambah
jumlah sampel.
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