Aromatherapy (Inhalation)

for Pain Management in Labour RNM LAI On Ki

Delivery Suite Department of Obstetrics & Gynecology

Princess Margaret Hospital Hospital Authority Convention 2017 (F8.5)

Objectives

Provide guidance for practicing Aromatherapy safely & effectively Provide informed choice for labouring women to cope with pain Promote positive experience in labour

Introduction

Aromatherapy Use of Essential oils, derived from aromatic plants,

from therapeutic properties First introduced to Maternity care in early 1990s May shorten duration of labour, reduce anxiety,

fear and pain May reduce the needs for additional pain relief

methods

(Buckle et al 2014, Burns et al 2007, Pollard 2008, Vakilian & Keramat 2013)

Department Recommended Essential Oils

Neroli 橙花 (Citrus auranthium var.

amara)

Sweet Orange 甜橙

(Citrus sinensis)

Bergamot 彿手柑

(Citrus bergamia)

Linalool <38% Limonene <17% β-pinene <12%

Limonene <39% Linalool <8% Linalyl acetate <28%

Limonene <89% Linalool <0.1% Myrcene <2% β-bisabolene <2% Methyl N-Methyl anthranilate <1%

Linadool & Linalyl acetate improved mood states increased parasympathetic nerve activity

Effects: Stimulating & uplifting Calming and balancing Spasmolytic Analgesic Antiseptic, bactericidal & antiviral

(Igarashi 2013 & Rashidi-Fakari et al 2015)

Citrus group essential oils

Selection Criteria

Started from July 2015

Term Pregnancy (≥37 weeks) with no complications

Opt to use Aromatherapy (Inhalation) as pain relief method during labour

Contraindications Allergy or sensitive to the essential oils or citrus

fruits Skin disorders Asthma Epilepsy Renal or Hepatic disease Hypertension or Hypotension Bleeding or bleeding tendency Presence of Uterine Scar

Monitoring & Evaluation Information Sheet • Effects of essential oil • Methods of application

Pre-printed CMS • Verbal consent obtained • Checking eligibility of women

Evaluation Form • Background • Pain Score (0, 30 & 120 mins) • Maternal & neonatal Outcomes

Woman’s Satisfaction Survey • Feedback from women post

delivery

Results (Jul 2015 – Dec 2016)

Background & Labour Outcomes

Neroli (N=34)

Sweet Orange (N=364)

Bergamot (N=247)

Total (N=645)

Parity Nulliparae 21 (61.8%) 275 (75.5%) 196 (79.4%) 492 (76.3%) Multiparae 13 (38.2%) 89 (24.5%) 54 (20.6%) 153 (23.7%)

Onset of labour Spontaneous 15 (44.1%) 145 (39.8%) 102 (41.3%) 262 (40.6%) Induction 19 (55.9%) 219 (60.2%) 145 (58.7%) 383 (59.4%)

Previous experience on Aromatherapy, Yes 2 (5.9%) 36 (9.9%) 21 (8.5%) 59 (9.1%) Mode of Delivery Normal Delivery 24 (70.6%) 259 (71.2%) 155 (62.8%) 438 (67.9%)

Instrumental Delivery 3 (8.8%) 55 (15.1%) 51 (20.6%) 109 (16.9%) Cesarean Section 7 (20.6%) 50 (13.7%) 41 (16.6%) 98 (15.2%)

Duration of using Aromatherapy (Mean, hrs) 4.73 5.16 5.76 5.4 Duration of Labour 1st stage (Mean, hrs) 5.72 7.63 6.05 6.92

2nd stage (Mean, mins) 23 39 44 39.8 3rd stage (Mean, mins) 7 9 9 8.82

Complications Primary PPH 1 (2.9%) 13 (3.6%) 13 (5.3%) 27 (4.2%) Maternal Fever 0 2 (0.5%) 2 (0.8%) 4 (0.6%) Retained Placenta 0 1 (0.3%) 2 (0.8%) 3 (0.5%)

Essential Oil Used

Table 1 Background and Labour Outcomes

Results (Jul 2015 – Dec 2016) (con’t)

Baby Outcomes

Neroli (N=34)

Sweet Orange (N=364)

Bergamot (N=247)

Total (N=645)

Apgar Score at Birth AS<7 (1st min) 0 4 (1.1%) 3 (1.2%) 7 (1.1%) AS<7 (5th min) 0 1 (0.27%) 0 1 (0.2%)

Baby transfer out to Postnatal 29 (85.3%) 273 (75%) 182 (73.7%) 484 (75%) SCBU 5 (14.7%) 89 (24.5%) 61 (24.7%) 155 (24%) NICU 0 2 (0.5%) 4 (1.6%) 6 (0.9%)

Reason to SCBU/NICU Neonatal fever 4 (11.8%) 69 (19%) 47 (19%) 120 (18.6%)

RDS 0 9 (2.5%) 9 (3.6%) 18 (2.8%) Maternal GBS with limited evaluation 1 (2.9%) 5 (1.4%) 1 (0.4%) 7 (1.1%)

Maternal fever 0 0 1 (0.4%) 1 (0.2%) Others* 0 6 (1.7%) 7 (2..8%) 13 (2%)

Skin to Skin Contact, Yes 22 (64.7%) 217 (59.6%) 149 (60.3%) 388 (60.2%) Mode of Feeding Breastfeeding 18 (52.9%) 183 (50.3%) 113 (45.7%) 314 (48.7%)

Artificial Feeding 4 (11.8%) 63 (17.3%) 32 (13%) 99 (15.3%) Mixed Feeding 12 (35.3%) 118 (32.4%) 102 (41.3%) 232 (36%)

*Others (maternal medical conditions, fetal structural & medical problems)

Essential Oil Used

Table 2 Neonatal Outcomes

Results (Jul 2015 – Dec 2016) (con’t)

2015 2016

Essential Oil Used Aroma Group Neroli Sweet

Orange Bergamot

Breastfeeding 1467 (30%)

1206 (24.4%)

18 (52.9%)

183 (50.3%)

113 (45.7%)

314 (48.7%)

Artificial Feeding

976 (15.9%)

1059 (21.4%)

4 (11.8%)

63 (17.3%)

32 (13%)

99 (15.3%)

Mixed Feeding 2455 (50.1%)

2681 (54.1%)

12 (35.3%)

118 (32.4%)

102 (41.3%)

232 (36%)

Table 3 Mode of Feeding on Discharge Home in 2015, 2016 and Aromatherapy Group

Women’s Satisfactory Survey Table 4 Pain Score difference at 30 mins & 120 mins post-Aromatherapy

30 min Post-Aroma PSdiff 120 min Post-Aroma

115 (16.9%)

1

Less

er P

ain

-7

Less

er P

ain

0

38 (7.4%)

0 -6 0

1 -5 0

1 -4 1

5 -3 4

30 -2 12

68 -1 21

41.5% 260 No Change 0 No

Change 90 17.6%

261 (41.6%)

114

Mor

e P

ain

1

Mor

e P

ain

99

384 (75%)

107 2 112

23 3 75

13 4 55

3 5 31

0 6 9

0 7 2

1 8 1

0

50

100

150

200

250

300

-10 -5 0 5 10

Pain Score Difference 30 min Post-Aroma120 min Post-Aroma

More Pain

Lesser Pain

Women’s Satisfactory Survey (con’t) Table 5 Pain Score Difference after Aromatherapy by women self-rated after delivery

Pain Score Difference After Aromatherapy

Lesser Pain

-9 1

171 (26.5%)

-8 0

-7 1

-6 0

-5 0

-4 5

-3 10

-2 57

-1 97

No Change 0 204 31.6%

More Pain

1 87

245 (38%)

2 90

3 28

4 26

5 7

6 5

7 0

8 2

0

50

100

150

200

250

-10 -5 0 5 10

Pain Score Difference after Aromatherapy by women self-rated after delivery

Lesser Pain

More Pain

Women’s Satisfactory Survey (con’t)

Women’s Satisfaction Neroli Sweet

Orange Bergamot Total

Relieving Labour Pain (N=593) Very Much 很多 1 (3.1%) 20 (5.9%) 7 (3.2%) 28 (4.7%) Moderate 一般 10 (31.2%) 79 (23.3%) 50 (22.5%) 139 (23.4%) Some 少許 11 (34.5%) 128 (37.8%) 85 (38.3%) 224 (37.8%) Not at all 沒有 10 (31.2%) 112 (33%) 80 (36%) 202 (34.1%)

Alleviating anxiety (N=639) Very Much 很多 2 (6.1%) 38 (10.5%) 17 (7%) 57 (8.9%) Moderate 一般 9 (27.3%) 105 (29.1%) 73 (30%) 187 (29.3%) Some 少許 13 (39.4%) 148 (41%) 96 (39.2%) 257 (40.2%) Not at all 沒有 9 (27.2%) 70 (19.4 %) 59 (23.8%) 138 (21.6%)

Relaxation (N=638) Very Much 很多 5 (15.2%) 38 (10.6%) 17 (7%) 60 (9.4%) Moderate 一般 7 (21.2%) 110 (30.6%) 67 (27.3%) 184 (28.8%) Some 少許 16 (48.5%) 143 (39.7%) 105 (42.9%) 264 (41.4%) Not at all 沒有 5 (15.1%) 69 (19.1%) 56 (22.58%) 130 (20.4%)

Essential Oil Used

Table 6 Women’s Satisfactory Report 1

Women’s Satisfactory Survey (con’t)

Women’s Satisfaction Neroli Sweet

Orange Bergamot Total

Discomfort noted while using Aromatherapy (N=637) NO 31 350 236 617 (96.9%) YES Nausea 0 3 5 8

Dizziness 2 3 0 5 Dry Mouth 0 1 0 1

Willing to use in next pregnancy (N=638) YES 27 268 175 470 (73.7%) NO, Why? Discomfort 0 1 1 2

Ineffective 5 76 59 140 Others (Scent is too strong, Plan not to pregnant again ) 1 5 5 11

Willing to recommend to other pregnant women (N=638) YES 25 288 184 497 (77.9%) NO, Why? Discomfort 0 0 2 2

Ineffective 8 63 56 127

Essential Oil Used

Table 7 Women’s Satisfactory Report 2

Conclusion

Aromatherapy NO significant adverse maternal and baby

outcomes Useful non-pharmacological pain relief

methods during labour Reducing labour pain Alleviating anxiety Enhancing relaxation

Limitations and Suggestions

Limitations Limited choices of Essential Oils Inhalation only

Suggestions Further studies on length of labour More trainings More varieties of Essential Oils used More methods used on Aromatherapy

References Buckle J, Ryan K and Chin KB. (2014). Clinical Aromathrapy for Pregnancy, Labour and Postpartum. International Journal of Childbirth Education. 29(4):21-27.

Burns E, Zobbi V, Ranzeri D, Oskrochi R and Regalia A. (2007). Aromatherapy in Childbirth: a pilot randomized controlled trial. BJOG. 114: 838-844.

Igarashi T. (2013). Physical and Psychologic Effects of Aromatherapy Inhalation on Pregnant Women: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 19(10): 805-810.

Pollard KR. (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.

Price S and Price L. (2012). Aromatherapy for Health Professionals (4thed). Churchill Livingstone: Elsevier.

Rashidi-Fakari F, Tabatabaeichehr M and Mortazavi H. (2015). The effect of aromatherapy by essential oil of orange on anxiety during labour: A randomized clinical trial. Iranian Journal of Nursing and Midwifery Research. 29(6): 661-664.

Vakilian K and Keramat A (2013) The effect of the Breathing Technique with and without aromatherapy on the length of the active phase and second stage of labour. Nursing and Midwifery Studies. 1(3): 115-119.

Thank You!