Comparing the effects of lavender aromatherapy and epidural analgesia during the active phase of labor on fear of childbirth: A randomized controlled trial

Abstract

Abstract Background & aim: While epidural analgesia is regarded as the gold standard for managing labor pain, some studies suggest it may be linked to increased postpartum fear of childbirth (FOC). This study aimed to compare the effects of lavender aromatherapy and epidural analgesia on FOC during and after delivery as primary outcomes and on some secondary outcomes such as pain intensity, satisfaction with delivery and duration of labor. Methods: In this randomized trial, 56 singleton pregnant women with a gestational age of 37+0 to 41+6 who were admitted for vaginal delivery in Izidi Hospital in Qom city, were equally allocated in the lavender aromatherapy group or the epidural analgesia group at the beginning of the active phase of labor. The allocation sequence was created using a computer program with randomly varying block sizes of four and six, and a 1:1 allocation ratio, stratified by parity (nulliparous/parous) and the onset of labor (spontaneous/induced). Allocation concealment was ensured using sequentially numbered opaque sealed envelopes. In the aromatherapy group, 0.1 mL 10% standard lavender essential oil based on bitter almond oil was applied to a 15 x 15 cm piece of fabric and placed near the women’s nostrils. In the epidural group, an anesthesiologist (from the research team), performed the intermittent injection technique. Depending on the patients' pain levels and individual needs, 5-10 mL of ropivacaine at a concentration of 0.1% was administered every 30-60 minutes up to three doses. Fear during childbirth was assessed with the Delivery Fear Scale, fear after delivery with the Wijma Version B questionnaire, pain intensity with the Visual Analog Scale, childbirth satisfaction with the Revised Birth Satisfaction Scale (BSS-R). Results: 28 eligible women were randomly assigned to each of the studied groups at the beginning of the active phase of labor. All women were followed up and analyzed. The average age of the women was 26.3 years, more than half of the participants (66%) were primiparous, and 42% of the women had induced labor. The two groups were similar in terms of demographic and reproductive characteristics, except for the woman's occupation, as well as on the baseline scores of fear of childbirth and pain intensity. There was no significant difference in mean FOC scores between the two groups at one hour post-intervention (46.0 vs. 46.7; adjusted mean difference (AMD) -1.6, 95% CI -8.2 to 5.0). Postpartum mean FOC scores were significantly lower in the aromatherapy group compared with the epidural group at both two hours (47.0 vs. 63.8; AMD -7.2, 95% CI -26.5 to -8.0) and five weeks (40.0 vs. 66.1; AMD -26.4, 95% CI -36.1 to -16.7) postpartum. In the aromatherapy group compared with epidural group, the mean labor pain intensity was higher in active phase (7.1 vs. 6.1; AMD 1.5, 95% CI 0.8 to 2.2), second stage (8.6 vs. 6.8; AMD 2.3, 95% CI 1.0 to 3.5) and one hour after delivery (2.1 vs. 1.8; AMD 0.1, 95% CI 0.1 to 1.0); childbirth satisfaction was significantly higher (29.2 vs. 24.8; AMD 3.9, 95% CI 1.7 to 6.2); and the duration of the active phase was shorter (3.2 vs. 4.8; AMD -1.6, 95% CI -2.3 to -0.9), However, there was no significant difference in duration of the second and third stages between the two groups. Conclusions: Although lavender aromatherapy is not as effective as epidural analgesia in alleviating labor pain intensity, it appears to reduce postpartum childbirth fear and may also shorten the first stage of labor while enhancing childbirth satisfaction. Considering the promising results of this trial regarding the possibility of using aromatherapy in the active phase of labor, it is recommended to conduct multi-center trials in different settings with larger samples and longer follow-up to increase the generalizability of the results and evaluate neonatal and long-term outcomes. Trial registration: Iranian Registry of Clinical Trials [IRCT20100414003706N39]; Registration date: 23/09/2021 (Registered prospectively)