Study the effect of massage with jasmine oil in comparison to aromatherapy with jasmine oil on childbirth process in hospitals of Abadan city in 2013

Backgrounds and Purpose: Since childbirth is a natural phenomenon and is as old as the history of humanity, man has always been involved with the problem of pregnancy and childbirth. Childbirth is one of the most important events of women’s life and negative events of this event result in adverse psychological consequences for her and her family. Therefore, some solutions have been concerned to experience a pleasant childbirth and reduce pain and shorten the duration of childbirth that it would lead to a reduction in cesarean sections in women. Methods: For this purpose, an experiment was done to examine the effect of massage with jasmine oil, in comparison to aromatherapy with jasmine oil on childbirth process in Abadan city hospitals in 2013. This was a clinical experimental study. In this study, statistical population consisted of pregnant women with singleton, 18–35 year old, a low-risk pregnancy-cephalic-entering the active phase childbirth. This was a clinical experimental study. Research units consisted of mothers who were referred for delivery to hospitals of Abadan. In this study, inclusion criteria were pregnant women with singleton, term 18–35 year old a low-risk pregnancy-cephalic-entering the active phase childbirth. Totally, 120 patients were enrolled and randomly divided into one control group and two groups. Results: About the aromatherapy procedures also results from the study showed positive effects of this method in relation to the purpose of the study. What is clear is allowing the use of very simple and it should this should be done by trained personnel to achieve the best result achieved and prevent the adverse effects. What is important whenever both methods are integrated, their effects in reducing pain and anxiety are more efficiently. According to the study, it can be found that no pharmacological pain management methods that increased the tolerance of pregnant women about the pain on the one hand, on the other hand, reduce sense of loneliness and elevated and strengthened confidence to reduce the level of anxiety and fear of childbirth. At the end of researcher pointed out that the continuation of studies on the use of adjuvant therapies to have beneficial effects to those in the chain of service delivery methods on implementing methods, aware, and be more efficient. In addition the most basic proposal, its preparation as head of a team of technical education and interested, or as a partner in the form of a highly qualified team to provide technical training content “up to date” to families and pregnant women officials at the ministerial level lets by having needed information. Conclusion: During the various sessions in the country, particularly in Abadan and Khorramshahr, rates to reduce maternal mortality and to make informed choices about the health of mothers and babies and help maintain an effective delivery method.

Keywords: Aromatherapy with jasmine oil, childbirth, jasmine oil massage

Childbirth is one of the most important events of women’s life and negative consequences of this event result in adverse psychological consequences for her and her family. Therefore, some solutions have been concerned to experience a pleasant childbirth and reduce pain and shorten the duration of childbirth that it would lead to a reduction in cesarean sections in women. Although vaginal birth is diagnosed as the best method of delivery in most cases, unfortunately is declining, due to an increase in the cesarean rate. View of pregnant women to cesarean in the last century an important role in reducing deaths and complications from childbirth in maternal and fetal. However, concern in modern midwifery, high levels of cesarean sections are done every day. Review process cesarean rate in some industrialized countries and developing countries reflects this fact.

Medically, cesarean is a major surgery that requires anesthesia. Risk of developing bleeding, infection, likely to need a blood transfusion and the risks of anesthesia in cesarean mother is more than mothers with vaginal birth. Accordance with the World Health Organization requires cesarean delivery in a community should be 15%–20%. Gheranmaei and Rezaeipour ^[4] conducted a study in the city of Marand in 2009 showed a significant relationship between fear of pain and increase the rate of cesarean childbirth. An intense fear of complicated childbirth 6%–10% deliveries to be and puts the nightmare list and result in physical complaints and problems concentrating in office and family activities as well. Mother’s fear of childbirth or to demand cesarean sections is cause of 7%–22% in Finland, Sweden, and the UK. From 1965 to 1988, the incidence of cesarean delivery in America and most developed nations in the world increase of 4.5%–25% of total deliveries and promoting vaginal birth after cesarean then due and to reduce cesarean delivery in nulliparous women, was decreased. However, then again from 1996 to 2006, this figure reached 26% of total deliveries.

Studies in Iran during 1991–1997 show, 77% of vaginal deliveries, vacuum or forceps 1%–22% by cesarean section and then has been uptrend. As in the early 80’s, incidence of cesarean delivery in nulliparous women was 26.8% and in the nulliparous women was 25.5%, it was estimated that the nongovernmental hospitals and public hospitals by 87% to 15% to 39%. Unnecessary cesarean and increased maternal and neonatal health-care costs would be; maternal mortality is approximately 2–4 times higher than vaginal delivery and cesarean almost every year 140 women in America die without medical cause. As Anderson and Jonnson ^[1] pointed out, attention to reducing the pain of delivery and providing appropriate pain relief methods, in hospitals and maternity increase willingness to perform vaginal delivery in the country.^[2]

Therefore, all nonpharmacological methods of pain relief childbirth widely induce mother’s consent. Most nonpharmacological methods of pain relief childbirth who used include acupressure, aromatherapy, relaxation massage, reflexology, healing Reiki, vegetable oils, and so on. Studies have shown that aromatherapy massage with aromatic oils during the contractions and between contractions, decrease the excitability of pain and release of endorphins and accelerated circulation of blood and oxygen to the tissue,^[3] on the other hand, although various studies show positive effects of aromatherapy and massage on a variety of clinical conditions, however, nurses still need more research in this field.^[4]

Use of complementary therapies such as aromatherapy is considered as professional goals of nursing. Aromatherapy is the use of essential oils from aromatic plants to treat and regulate the mind, body, and spirit that combines the physiological effects of massage with special oils. One goal of this therapy is to reduce anxiety and stress and aid in relaxation. One of the important factors in controlling nonmedicated childbirth pain relief and relaxation is massage. Local massage stimulates the body to release natural pain-relieving substances called endorphins and increases the morale of the mothers. Yasaii and Rajaee study’s found that women who received massage during delivery compared with the control group (who were not massaged) feel less pain, less anxiety, they had shorter duration of delivery and postpartum depression was observed less.^[5] In general, use of these techniques and the use of these methods reduces anxiety and stress, childbirth pain relief, reduction in symptoms after delivery and so on. The combination of massage using lavender oil or Yasmin to reduce fear and anxiety and pleasant concentration and thus will be result in progress of delivery in various stages of ^[6] service providers should be aware of the principles of chemical structure and physical properties (benefits and drawbacks); these oils are quite familiar with the drugs and medications given to control pain (epidural anesthesia-pethidine-spinal anesthesia) are expensive and side effects of these drugs, including an increased need for surgical intervention has been shown in some studies.^[7]

In the near future, likely demand to use of complementary and alternative medicine (CAM) is increasing and one of the major medical problems is lack of suitable studies and projects to help and advice patients that they would need to do further studies;^[8] on the other hand, the high rate of cesarean in the country is the highest international statistics and currently according to the announcement of the Ministry of Health the cause of more than half of the cesarean cases is because of fear of delivery pain.^[9] Therefore, the researcher intends to carry out this research and use its results to determine the effect of CAM in the production of knowledge and effort and obtained data available to the medical community partners and high rate of cesarean little step in reducing unnecessary and reduce their fear of labor pain.

The study “labor pain relief using ice massage” in 2011 by was conducted in ^[9] 165 nulliparous women were randomly divided into three groups, acupressure, massage, and ice control. Each group consisted of 55 women nulliparous, intervened in the dilation of 3–4 cm in point (L1–L4) and was applied for 30 min. Group one was applied under acupressure and group two from ice massage was used. The severity of childbirth pain and anxiety levels in three groups of pain expressed by the graph (VIS) and Spielberger questionnaire position was evaluated in two stages. The duration of the first and second stage of the three groups was compared with each other.

Based on the results of this study, both acupressure and ice massage can help reduce pain, duration of childbirth, and the level of anxiety in nulliparous women, but it was further indicated that the effect of ice massage reduces pain, duration of delivery, and the level of anxiety in nulliparous women. Zahrani et al. 2009.^[10] randomized clinical trial on 75 nulliparous mothers referred to Shahid Ayatollah Beheshti Hospital with labor pains, randomly into three groups: massage, routine care, and support group were assigned. Group of study were qualified. Comparison between groups using the Mann–Whitney test and Bonferroni correction showed that 5–4 cm dilation stage support groups and massage (P < 0.001) and significant differences was observed between massage and routine care (P < 0.001) in the average change in score. Massage significant difference in intensity between the support group was also observed.

In stage 8–10 cm, dilation between the two groups, as well as support and massage and routine care differences between the two massage groups was observed (P < 0.001) but between the two support groups and care routine, there was no significant difference. The results showed that massage is effective on pain intensity in the first stage of delivery. Although support could reduce pain, managed to hold it in the second stage.^[10] In this clinical trial study conducted by Safarzadeh in 2010^[11] to determine the effect of massage therapy on Severity of childbirth pain, 60 nulliparous pregnant women in Mahdieh and Hedayat hospitals in Tehran, selected by simple sampling and randomly divided into two groups of control and massage therapy (case).

Data in the two groups using Chi-square and t-tests were compared. Before the intervention, pain scores between the two groups was not significant. Mean of pain intensity, respectively, in the intervention and control groups at the beginning of the active phase was 5.18 ± 8.07 and 6.17 ± 5.39 (P < 0.01), at the beginning of the transitional phase was 7.00 ± 9.89 and 8.15 ± 4.06 (P < 0.05) and at the end of the first stage was 0.01 ± 6.69 and 9.07 ± 3.58 (P < 0.05). The duration of first stage of delivery in 246.98-min massage group and the control group was 362.11 min (P < 0.001) due to the effect of massage therapy in reducing delivery pain and speed up the childbirth process, training, and use of this method in delivery centers reduced cesarean sections.^[11]

Methodology of research

This was an experimental and clinical research.

Research society

In this study, statistical population was pregnant women with singleton, term-18–35 year’s old-a low-risk pregnancy-cephalic presentation-entering the active phase. Based on the findings of studies and the number of deliveries in Abadan city and due to the possible loss, 139 samples were intended that 40 were divided into 3 groups which one contains two groups of 40 rats in that each one has 1, 2, and 1 control group, respectively. Two questions should be responded to select samples:First, how many people in what manner and that the sample should be selected for sampling.

Method

The present study was an experimental study and clinical trial. Research units were mothers who referred for delivery to hospitals of Abadan. Totally, 120 patients were enrolled and randomly divided into one control group and two case groups.

1. The control group consisted of normal pregnant women participating in the study; there were no intervention on them
2. The first cases were pregnant women who were jasmine oil massage
3. The second group, pregnant women who were with jasmine oil aromatherapy.

For the purpose, this work was explained to mothers while satisfying their mothers for the study, and consent forms were completed by mothers to conduct massage or aromatherapy to facilitate and accelerate the childbirth of drugs and any disruption in the childbirth of Medicine-Research Unit were excluded from the study.

Data to determine the severity of labor pain were collected through Visual Analog Scale or McGill Pain ruler that this standard scales and has been used in research and has repeatedly supported by research and practical studies and to determine the severity Anxiety Inventory Spiel Berger and also to determine the duration of labor Partograph charts and clocked out pair of chronometer (second) were used.

For massage group, regular massage was carried out for 20 min in areas (shoulder-sides-sacral region of the spine) in three stages dilatation (5-4) and (7-6) and (10-8) during the first contraction after contraction by first researcher, and second researcher is and after the end pain tend to decrease pain or pressure on the sacrum was carried across the back and shoulders.

Then, with starting the mother’s delivery pain, pain score was recorded on the pain scale. Yasmin oils used to massage and aromatherapy was nonfood type which was prepared from extracts of jasmine. Case Group II were under aromatherapy using hand towels and dropping 10-5 using oil drops jasmine (citing studies adviser to the advice of traditional medicine) Sniff towels in three stages dilatation (5-4) and (7-6) and (10-8) during the contraction, after contraction repeatedly until delivery through the first and second research under the supervision.

To control sampling better and supervision, sampling was done three groups separately in separate days. Collected Information was analyzed by SPSS software using statistical tests.

It is worth noting that fear of childbirth results in concern, anxiety, and disorder of abnormal fetal heart rate pattern and progression and ultimately feel and experience pain. Natural childbirth can be useful in many ways for mothers and children and result in medical and physical-psychological and financial benefits.

In recent years, pregnant women have used advanced therapies, such as muscle relaxation, visualization, and breathing techniques to reduce the childbirth pain. Results of this study showed that nonmedicated control methods of massage and aromatherapy were effective to reduce the duration of childbirth (P < 0.001). In other words, statistical methods showed significant difference between the mean duration of the three-stage childbirth in the second case group and the control group, (P < 0.001) and this difference was very impressive in massage group. The findings of this study (a significant difference in the field of massage with jasmine oil and aromatherapy group with jasmine oil) are consistent to the results of Mohammad Ibrahim ^[12] and as empirical research to examine the effect of massage therapy on progress of delivery on 30 nulliparous women (P = 0.05). In other hand, study by bourns belamy on the effect of aromatherapy in 1998–1990 showed that aromatherapy can reduce contraction during delivery and modify functional disorder of delivery and reduce the time of delivery.^[12] With results of this study on the positive effects of aromatherapy on the progress of childbirth and reducing the duration of labor in three stages of childbirth compared with the control group match, but compared with the effect of massage therapy did not match, although one study in Korea, about the effect of aromatherapy on childbirth process only significant difference in the duration of phase decreased.^[13]

Results of Seraji study et al. on the evaluation of aromatherapy on the labor compared with breathing technique on 120, during the active phase of labor showed no significant difference between the duration of labor in the first stage (P = 0.08) and second stage between the groups (P = 0.13). Findings of ^[3] on 62 nulliparous women in 2005 showed no significant difference in transitional stage between the massage group and control group (P < 0.4) but in this study, significant differences between the duration of delivery in proving the superiority of reducing the effective time that massage group with oil jasmine compared to the group aromatherapy with oils of jasmine and aromatherapy compared to the control group were determined (P < 0.001). Massage is the oldest natural ways to improve health. In general, massage stimulates the well-being and development of the art of touch. Massage of different parts of the body such as waist and abdomen during pregnancy, especially during childbirth and also perineal massage occurs to improve and thus reduce the complications of vaginal birth and urinary incontinence.^[3] Research findings compared the effects of massage on pain childbirth showed a significant difference between massage groups and the control group significantly (P = 0.001). Research findings on the effect of massage on labor pain during different phases of childbirth are consistent to,^[5] which showed a decrease in the active phase of labor, and massage technique is suggested as an effective and a strong method to reduce labor pain.^[1] Findings of Zahrani et al. 2008^[10] in clinical trial on 75 nulliparous, the intervention also reflects the impact of massage on pain intensity in two steps of the method childbirth was supportive (P = 0.001). That result of these studies is consistent with the findings of the current study. In the present study, the effect of massage with jasmine oil that childbirth pain relief, in all of labor in comparison with notes of jasmine oil treatment difference was significant (P < 0.001). Research of Berns and Bellamy on the effects of aromatherapy during labor on 8085 during 8 years, indicates a reduction in childbirth pain in the use of aromatherapy and reduce the consumption of analgesic drugs from 6% to 2% at the time of delivery.^[12] However, the findings of this study the effect of aromatherapy with oils of jasmine, in comparison with a massage with jasmine oil that less pain relief, and this difference was significant too (P < 0.001). Finding of ^[8] on the effect of ice massage in Yazd city on Hugo area, in comparison with the touch area of Hugo, indicates a reduction in mean pain score in the experimental group (P < 0.017) and was the difference in pain scores, research finding present a strong effect of massage in reducing pain (P < 0.001).

Research Berns and rolly-Eskrochi as 2007 “the use of aromatherapy that during childbirth midwifery” on 513 pregnant women undergoing aromatherapy also indicates a reduction in pain. This finding corresponds with the positive effect of aromatherapy in reducing pain in comparison to the control group, but in contrast to massage with jasmine oil, jasmine with oil aromatherapy effect was less significant. In addition, research findings with the findings of Safarzadeh ^[12] aimed at influencing massage therapy on the severity of childbirth pain on 60 nulliparous pregnant women in labor were in Tehran reflects the reduction in childbirth pain that all stages of childbirth (P = 0.05). The results of the above research findings are consistent in the field of massage therapy has a positive effect in reducing childbirth pain. Findings of study on the reduction of fear and anxiety, suggesting a significant effect of both methods of massage with jasmine oil and aromatherapy with oil massage using jasmine that groups more efficiently in two stages of childbirth. These effects are clear in reducing fear and anxiety at all stages of childbirth, but that first stage of labor, the null hypothesis is rejected with strong potential that the massage (P = 0.001) and revealed the efficiency of massage interventions to reduce fear and anxiety in comparison with the aromatherapy group. Results of comparison of massage and aromatherapy techniques to reduce fear and anxiety indicated higher effect of aromatherapy than massage to reduce anxiety in two stages of childbirth, however, this effect was more effective that first stage of labor (P = 0.001). Findings of ^[8] on 165 nulliparous women showed stronger effect of massage in reducing the level of anxiety in nulliparous women compared to acupressure. Review study of Savad Zadeh (196-2007) with study scientific articles on the site, emphasizing the fact that aromatherapy reduces stress and anxiety and increases individual comfort and efficiency, which consistent with the findings of this study although the findings of this study such as previous studies by other researchers suggest positive effects of complementary medicine, the effects of nonmedicated control methods and setting priorities among them with stronger effects and fewer side effects, given the increasing development of complementary medicine is still in need of further research. On the other hand, it is necessary to share findings with target group as pregnant women and provide services by authorities and labor centers to provide this type of service, in spite of the increasing of these methods in term of immune of the effects in comparison with control methods for medicinal. Between the two methods of massage and aromatherapy at all stages of the study, the mechanisms of massage effect and increased the feeling of pleasant touch were significant and indicated that a more appropriate choice of massage that pain management, reduce fear and anxiety during pregnancy, and ultimately reduce the length of childbirth.

What is important is providing service by another person that this person should be someone interested, trained, and aware of the effects of the procedure.

1. Using knowledgeable employees interested authorities with regard to legal measures, such as incentives or contact through the process of using DOULA (individual training) technical or nontechnical person that can be a no pharmacological pain management was aware of the method, this will be possible
2. The role DOULA labor centers in all Western countries now enjoy a special status. Related reports in Iran indicate the use of traditional forms of labor to facilitate this process in some parts of the country.

Achieving this would require centers to educate people as DOULA or using technical people.

About the aromatherapy procedures also results from the study showed positive effects of this method in relation to the purpose of the study. What is clear to allow its use is very simple, and this is by trained personnel, should be transferred to the laborer to achieve the best results adverse effects it must be prevented. What is important whenever merge the two methods, can strengthen the effects in reducing pain and anxiety to used more efficiently.

The researcher and his assistants do the research, believe that no pharmacological pain management methods increased pregnant women in relation to pain capacity on the one hand, on the other hand somewhat elevated his sense of loneliness and with sense of confidence in him to significantly reduce the level of anxiety and fear of childbirth.

At the end of researcher points out that continue studies on the use of auxiliary medicine methods is to have beneficial effects to providing services in the field of application of methods, aware and be more efficient.

As well as have declared the most basic proposal, its preparation as head of a team of technical education and interested or as a partner that the form of a highly qualified team to provide technical training content “updated” to families and pregnant women at the ministerial level officials, through having the information required, during various meetings of the rates of the country, especially in Abadan and Khorramshahr that was an important factor in reducing maternal mortality and to make informed choices regarding their health of mothers and babies and help maintain an effective delivery method.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_245_17