The Effect of Lavender Aromatherapy Giving on Perineum Pain in

Post Partum Mothers

Vitrilina Hutabarat, Stefani Anastasia Sitepu, Megawati Sinambela, G. F. Gustina Siregar

Health Institute of Deli Husada Deli Tua Medan

Street Besar Delitua No. 77 Delitua District Deli Serdang Regency

*Correspondence: Vitrilina Hutabarat

Keywords: Perineum Pain, Lavender Aromatherapy

Abstract: Perineum pain in post-partum mothers is a physiological condition that is experienced by post-partum

mothers, but it can interfere mobilization that causes complications such as post-partum hemorrhage.

Lavender aromatherapy is proven to reduce perineum pain. The purpose of this study was to determine the

effect of lavender aromatherapy giving on perineum pain. This study used quasy experimental method with

pre-test post-test with control group approach with total of 36 research subjects. Subjects were in 2 groups

which there were18 research subjects in each group. The study was conducted twice with pain observation

sheets or VAS (Visual Analogue Scale), i.e. during the active phase. Statistical analysis tests used Wilcoxon

test with Mann Whitney test. There was a difference on perineum pain in post-partum mothers in the

assessment before and after lavender aromatherapy given with p value = 0,000 (p <0.05) whereas pain level

of pre-test in Lavender therapy group majority of severe pain category (72.2%) and after post-test the

majority are moderate pain categories (77.8%).

1 INTRODUCTION

Based on WHO data, there are as many as 99% of

maternal deaths due to childbirth or birth problems

that occur in developing countries. The annual

pregnancy ratio in developing countries is the

highest with 450 maternal deaths per 100,000 live

births when it is compared to the maternal mortality

ratio in 9 developed countries and 51 commonwealth

countries due to complications during pregnancy and

childbirth, and 25% during the postpartum period

(WHO, 2016). The maternal mortality rate in

Indonesia is still high at 359 per 100,000 live births.

The fifth global MDG (Millennium Development

Goals) target is to reduce Maternal Mortality Rate

(MMR) to 102 per 100,000 live births in 2015. It is

referring to current conditions, the potential to

achieve these targets is off track, it means that it

requires hard work and really to achieve it (SDKI,

2012).

One of the efforts that is taken to reduce

maternal mortality is save motherhood program,

which is about post-partum care where there are

often occur complications such as bleeding, sepsis

and perineum trauma. Post-partum care must really

be considered, because 50% of maternal deaths

occur after giving birth (post-partum).

Post-partum is a period of six weeks from the

baby is born until the reproductive organs return to

normal before pregnancy. There are majority of

women who have vaginal delivery experience some

degree of perineum pain after childbirth, both

women who have perineum injury or not due to

episiotomy. Mothers who experience perineum

laceration will feel pain for several days until

healing occurs. Perineum tears or rupture occur in

almost first labor and it is not infrequently in

subsequent deliveries. It is occurred in primiparous

or first-time births when the fetal head comes out.

Episiotomy wounds that are not handled properly

will cause complications, such as blood loss due to

episiotomy too early, infection due to contamination

with urine and feces, dyspareunia, and local

hematomas that cause infections.

According to Smeltzer & Bare (2013), pain is an

unpleasant sensory and emotional experience due to

actual and potential tissue damage. Pain is the main

reason for someone to seek health care assistance.

According to the International Association for the

Study of Pain (IASP) defines pain as a subjective

Hutabarat, V., Sitepu, S., Sinambela, M. and Siregar, G.

The Effect of Lavender Aromatherapy Giving on Perineum Pain in Post Partum Mothers.

DOI: 10.5220/0009514903410347

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 341-347

ISBN: 978-989-758-460-2

341

sensory and unpleasant emotional experience

associated with actual or potential or damaged tissue

damage felt in events where damage occurred. In

some people, pain can be more troublesome than

other diseases. After giving birth, a mother often

reports pain and trauma to the perineum. Perineum

pain is physiological in post-partum mothers, but

this pain will affect a woman's ability to mobilize so

that it can cause of complications such as post-

partum hemorrhage. Perineum pain due to trauma

such as perineum laceration can cause discomfort

and dyspnoenia (Widayani, 2017).

Vakilian (2015) reports that the lavender

aromatherapy giving can reduce perineum pain on

60 postpartum mothers with spontaneous laceration

and episiotomy, 40% of whom do not feel pain.

According to research that is conducted by Widayani

(2017) there is a decrease in pain intensity of

postpartum perineum suture before and after being

given lavender aromatherapy with inhalation

techniques. It is also supported by Vaziri F (2017)

that lavender aromatherapy that is given to post-

partum mothers has better mood and physicality.

Aromatherapy is a treatment technique by using

odors that come from plants, flowers, trees that

smell nice and delicious (Ali B, 2015). The use of

aromatherapy inhaled can stimulate endorphin

expenditure so that it can reduce pain (Vakilian,

2015). Endorphin substances are chemicals that are

produced by the body as a result of external stimuli

and it produces feelings of calm, pleasure, relaxes,

stimulated and relaxes tense muscles such as pain

and physical exertion (Aprilia, 2015).

Lavender aromatherapy is a therapeutic action

that is beneficial to improve the physical and

psychological condition of maternity mothers.

Physically it is good to be used to reduce pain,

whereas psychologically it can relax the mind,

reduce tension and anxiety and provide calm (Ali B,

2015). Currently the handling used to relieve pain is

complementary therapy aromatherapy with essential

oil of lavender, because lavender has the properties

of anticonvulsant, antidepressant, anxiolytic, and

also soothing. Lavender aromatherapy can be a

complementary alternative therapy to reduce pain in

postpartum women. Ten pleasant odors will

stimulate the thalamus to release encephalin which

have the functions as a natural painkiller and

produces feelings of well-being. Encephalin is same

as endorphins, namely endogenous chemicals

(produced by the body) that have structure similar to

encephalin opioids that are thought to cause

presynaptic barriers (neurons that secrete transmitter

material) and postsynaptic barriers (where the

transmitter works) in the commudorsalis. This

process achieves inhibition by encephalin, the

inhibition of substance P so that pain is reduced to

the brain.



2 METHOD

The research type was quasy experimental design

with pre-test and post-test with control group

approach, this design used two groups where the

first group is given lavender aromatherapy

(treatment group), while the second group as control

was not given lavender aromatherapy and both

groups undergo a test beginning and end. The results

of this study were comparing the groups treated with

control group to determine the effect of lavender

aromatherapy giving on perineum pain in

postpartum mothers in working area of Sibolangit

Public Health Centre, Deli Serdang District. The

population of this study were post-partum mothers in

Sibolangit Health Centre in March until May 2019.

The samples of this study were post-partum mothers

who experienced perineum tears. Inclusion criteria

were mothers during the 1

active phase,

physiological deliveries, mothers who had

experienced perineum tears and they were willing to

be respondents. Exclusion criteria were mothers who

gave birth surgically and mothers who had asthma.

The sampling technique in total sampling is done

by taking the case of the entire population of 36

subjects. This research was conducted after

obtaining approval from the head of Public Health

Centre. The study instruments were the observation

sheet of respondents' characteristics (Name, Age,

Ethnicity, Education, occupation) and observation

sheet of Visual Analogue Scale (VAS) pain. While

the tools used in this study were diffuser and

lavender aromatherapy oils for 10 minutes at 10, 30,

and 60 minutes. It is done to find out the decrease in

pain scale by using Visual Analogue Scale (VAS).

With the assessment of pain intensity on a scale of 0

there was no pain, pain intensity on a scale of 1 to 3,

pain such as itching or electric shock or twitching or

twisting or beating or aching or colic. Pain intensity

on a scale of 4 to 6, such as ham or stiff or depressed

or difficult to move or burn or stab. Very painful on

a scale of 7 to 9 but it can still be controlled by the

client. Pain intensity is very severe on a scale of 10

uncontrolled pains.

Substances that are contained in lavender oil

have a lot of potential because it consists of several

ingredients. According to research, in 100 grams of

lavender oil composed of several ingredients, such

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

342

as: essential oils (13%), alpha-pinene (0.22%),

camphene (0.06%), beta-myrcene (5.33%), p-

cymene (0.3%), limonene (1.06%), cineol (0.51%),

linalool (26.12%), borneol (1.21%), terpinen-4-o1

(4, 64%), linet acetate (26.32%), geranyl acetate

(2.14%), and caryophyllene (7.55%). Based on the

data above, it can be concluded that the main content

of lavender is linail acetate and linalool (C10H18O).

This research analysis used univariate and

bivariate. Bivariate analysis is used to prove the

existence of periods before and after each group by

using Wilcoxon test.

Figure 1: Research Flowchart

Figure 2: Lavandula officinalis chaix

3 RESULTS

The results showed that there was an influence of

lavender aromatherapy giving on perineum pain in

post-partum mothers. From table 1 it can be seen

that the group which was not given lavender

aromatherapy, the majority of pre-test categories

were moderate pain levels that were 72.2%, the

majority of post-tests were in the category of severe

pain levels namely 88.9%, it can be seen in the

Table 1.

From Table 1 can be known that group were not

given lavender aromatherapy, the pre-test majority

category of moderate pain level is 72.2%, the post-test

majority category of severe pain levels is 88.9%.

Table 1: Distribution of perineum pain without lavender

aromatherapy.

Score

Pain

Level

(VAS)

(Pre)



(Post)



 

N % N %

0 No pain

0 0 0 0

1-3

Mild

pain

0 0 0 0

4-6

Moderate

pain

13 72,2 2 11,1

7-9

Severe

pain

5 27,8 16 88,9

Very

heavy

pain

0 0 0 0

From Table 2 it can be seen that in the group that is

not given lavender aromatherapy, the pre-test pain

level was lower than the post-test pain level, it was

indicated by a median of 3 and 7.5, respectively. At

the time the pre-test, the highest level of pain was

score of 7 (severe pain), and the lowest was score of

5 (moderate pain). Whereas at the time of the post-

Manage research permit

Informed Consent

Responden Sample

Group A

(Intervension)

Subjects who will

meet the inclusion

Group B (Control)

Post Test : Fill in the characteristic

observation sheet, measure the pain

scale with VAS, post test is done

after 2 hours of perineum suturing.

Total

Sampling

Data Processing

Pre-test: Filling in the

characteristic observation

sheet, Pain scale

measurement wi

h VA

Pre-test: Filling in the

characteristic observation

sheet, Pain scale

measurement with VA

Data

Analysis

The Effect of Lavender Aromatherapy Giving on Perineum Pain in Post Partum Mothers

343

test, the highest level of pain was score of 9 (severe

pain), and the lowest was score of 6 (moderate pain).

Table 2: Wilcoxon test for perineal pain levels without

lavender aromatherapy

Median

P Value

(Minimum-Maximum)

Pre Pain

Level

(N=18)

3 (5-7)

0,001

Post Pain

Level

(N=18)

7,5 (6-9)

Based on the Wilcoxon Test results p value

<0.05 means that there are statistically significant

differences in pain levels between pre-test and post-

test in groups that were not given lavender

aromatherapy. It can be concluded that there was an

increase in the level of perineum pain in the group

not given lavender aromatherapy.

From Table 3, it can be seen that in the group

that was given lavender aromatherapy, the majority

pre-test in the category of severe pain level was

72.2%, the majority of post-test in the category of

moderate pain level was 77.8%.

Table 3: The Frequency of perineum pain with lavender

aromatherapy.

Score

Pain

Level

(VAS)

(Pre)

(Post)

0 No pain 0 0 0 0

01-

Mar

Mild

pain

0 0 0 0

04-

Jun

Moderate

pain

5 27,8 14 77,8

07-

Sep

Severe

pain

13 72,2 4 22,2

Very

heavy

pain

0 0 0 0

From Table 4, it can be seen that the median value

of the group that was given lavender aromatherapy,

the pretest pain level (7.5) was higher than the

posttest pain level (5.5).

Table 4: Wilcoxon test for perineal pain level with

lavender aromatherapy.

Median

P Value

(Minimum-Maximum)

Pre pain

level

(n=18)

7,5 (6-9)

Post pain

level

(n=18)

5,5 (4-8)

The Wilcoxon test resulted p value <0.05, it is to

conclude that statistically there were significant

differences in pain levels between pre-test and post-

test, it means that there was a decrease in perineum

pain level after being given lavender aromatherapy.

From Table 5, it can be seen that in the post-test,

most of the groups were not given lavender

aromatherapy experienced severe pain category as

much as 88.9% while those in the groups were given

lavender aromatherapy experienced a category of

moderate pain level that was as much as 77.8%.

Table 5: The Differences on perineum pain in post-partum

mother’s pre-test without and with lavender aromatherapy.

Score

Pain

Level

VAS

(post-

test)

Groups

Groups that

were not given

Lavender

Aromatherapy

Groups that

were given

Lavender

Aromatherapy

N % N %

0 No pain 0 0 0 0

01-Mar

Mild

Pain

0 0 0 0

04-Jun

Moderate

Pain

2 11,1 14 77,8

07-Sep

Severe

Pain

16 88,9 4 22,2

Very

Heavy

Pain

0 0 0 0

     

Total 18 100 18 100

From Table 6, it can be seen that the groups were

not given lavender aromatherapy; there were 2

subjects (11.1%) that experienced moderate pain,

and 16 subjects (88.9%) that experienced severe

pain. In the groups that were given lavender

aromatherapy, there were 14 subjects (77.8%) that

experienced moderate pain, and 4 subjects (22.2%)

that experienced severe pain.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

344

Table 6: Wilcoxon test post-test pain levels without and

with lavender aromatherapy

Pain Level Post-Test

Mild

Pain

Moderate

Pain

Severe

Pain

Very

Heavy

Pain

(1-3) (4-6) (7-9) -10

N % N % N % N %

Groups that

were not given

lavender

aromatherapy

0 0 2 11,1 16 88,9 0 0 0.000

Groups that

were given

lavender

aromatherapy

0 0 14 77,8 4 22,2 0 0

Total 0 0 16 44,4 20 55,5 0 0

The Wilcoxon test resulted p value <0.05, it

concluded that statistically there were significant

differences in the level of post-test pain between the

groups that were not given, and the groups were

given lavender aromatherapy. The mean level of

post-test pain in the groups without lavender

aromatherapy was 8.00 while the mean level of pain

in the post-test groups given lavender aromatherapy

was 0.00.

4 DISCUSSION

4.1 Perineum Pain Levels with

Lavender Aromatherapy

Changes in the level of pain in the pre-test and post-

test in the groups which are given lavender

aromatherapy was the higher level of pre-test pain

than the level of post-test pain. At the time of pre-

test, the highest level of pain was severe pain, the

lowest was pain moderate. While at the post-test the

highest level of pain was severe pain and the lowest

was mild pain.

Based on the Wilcoxon test results in the groups

which were given aromatherapy, it is obtained p

value = 0.001 which was smaller than α = 0.005 thus

there were differences in the level of pain pre-test

and post-test in the groups which were given

aromatherapy lavender. Aromatherapy lavender was

given pre-test and post-test, there were 18 peoples

who experienced an increase and there were 17

peoples experienced an increase in pain levels.

4.2 Changes in Perineum Pain Levels

with Lavender Aromatherapy

A change in the level of pain in the pre-test and post-

test in the groups that were not given lavender

aromatherapy was the higher level of pre-test pain

than the level of post-test pain. At the time of pre-

test, the highest level of pain was the lowest

moderate pain namely severe pain. While in the

post-test the highest level of pain was severe pain

and the lowest was moderate pain.

Based on the Wilcoxon test, it resulted in groups

that were not given lavender aromatherapy p values

= 0.001 which was smaller than α = 0.05 thus there

were differences in the level of pain pre-test and

post-test in the groups that were given lavender

aromatherapy. Lavender aromatherapy was given

pre-test and post-test there were 18 peoples who

experienced an increase and 17 peoples who

experienced an increase in pain levels and who

experienced the same level of pain were as many as

1 person who looked worried because the husband

was absent in labor because the husband was

working.

Aromatherapy is one of the non-pharmacological

methods to reduce pain. Aromatherapy is a healing

process using concentrations of essential oils

extracted from plants to improve the health and

well-being of the body, mind and spirit. The scent is

captured by nasal receptors and then provides further

information to areas in the brain that control

emotions and memory as well as information to the

hypothalamus which is the body's internal system of

immersion, including the sexuality system, body

temperature, and reactions to stress.

Lavender Aromatherapy has bactericidal,

analgesic, and antidepressant, antispasmodic when

aromatherapy is inhaled, the substances contained in

it will stimulate the hypothalamus to release

endorphin hormones because it can relax and calm

the body as well as active substances in the form of

linalool and linalyl acetate in the effects of lavender

as analgesic.

The results showed that lavender aromatherapy

can reduce the intensity of post sectio Caesarea

wound pain and Marni's study (2015) proved that

aromatherapy can reduce labour pain from the pain

scale from 9.58 to 7.30. It is also supported by Nasiri

A (2016) that the administration of Lavender

essential oil can relieve pain in patients with

osteoarthritis of the knee. According to Salamati

(2016) in his research it was found that pain before

and after inhalation of lavender essential oil

significantly affected pain reduction. Lavender

The Effect of Lavender Aromatherapy Giving on Perineum Pain in Post Partum Mothers

345

aromatherapy contains linalyl acetate and linalool

inhaled into the nose that is captured by the olfactory

bulb and then entered through the second branched,

lateral and non-medial olfactory ducts. On the lateral

side, this channel sneaks in the third neuron in the

amygdala, seminular gyrus and gyrus ambiens which

are part of the limbic. The medial side line also

terminates in the limbic system. Limbic is part of the

brain, shaped like the letter C as the centre of

memory, mood, and intellect. Part of the limbic,

namely amygdala is responsible for our emotional

response to its aroma. After limbic aromatherapy

stimulates are exposure encephalin or endorphins to

the hypothalamus gland, and rostral ventromedial

spinal cord. Enkephalin stimulates an area in the

cerebellum called raphe nucleus to secrete serotonin

to create a relaxed, calm and low anxiety effect.

Based on the research result that is conducted at

the health centre, which consists of the treatment and

control group, it can be summarized as follows:

There was an effect of lavender aromatherapy on

perineum pain in post-partum mothers in health

centre with p value of 0,000 <0.05.

4.3 Pain Reduction without and with

Lavender Aromatherapy

Lavender aromatherapy has an effect on reducing

pain level with a proven difference in the average

level of perineum pain as measured by VAS (Visual

Analogue Scale). It can be seen that the pain level in

post-test group that is given lavender aromatherapy

with mean value 24.17 is higher than post-test with

mean value 12.83. From Wilcoxon test results it was

concluded that there were significant differences in

post-test pain levels between groups that were not

given lavender aromatherapy with groups were

given lavender aromatherapy, which was p = 0,000.

The study results were consistent with the study

of Ghiasi A (2019) that Lavender aromatherapy can

be applied as a complementary therapy to reduce

anxiety during labour. Likewise, the research result

on post-partum post episiotomy mothers that the use

of Lavender oil is effective in reducing perineum

pain due to episiotomy. Supported also by

Ramadhan (2017) Lavender flower (Lavandula

angustifolia) has sedative effect because it contains

linalool (C10H18O). The effect of linalool is

stimulate nucleus raphe, an area in brain and will

secrete serotonin that can make someone sleep or

relax. A review of clinical trial data found that when

lavender is used during labour as aromatherapy,

women reported less pain. Other studies have found

that lavender can reduce pain, nausea, and dizziness

after caesarean section, as well as pain, redness, and

need for topical pain relief after episiotomy when

used in a sitz bath (M.D. Patel. 2018).

The decrease in pain intensity is due to the

subject got the benefits of lavender aromatherapy

that functions which serves to calm. Lavender can

also provide calm, balance, comfort, a sense of

openness and confidence. Besides that, lavender can

also reduce stress, stress, pain, emotional imbalance,

hysteria, frustration, and panic. Lavender can be

useful to reduce pain, and it can provide relaxation

(Vaziri, 2017).

Lavender Aromatherapy contains linalyl acetate

and linalool which are ester compounds that are

formed by combining organic acids and alcohols.

The fragrance produced by lavender aromatherapy

will stimulate the thalamus to release encephalin as a

natural painkiller. Encephalin is a neuromodulator

that functions to inhibit physiological pain.

Enkephalin is a neuromodulator that have functions

to inhibit physiological pain. The fragrance of

lavender will be passed on by the olfactory nerve to

the part of the cerebellum, namely nucleus raphe

which then releases the neurochemical serotonin.

Serotonin works as a neuromodulator to inhibit

nociceptive information in the spinal cord.

This neuromodulator closes the defence

mechanism by inhibiting the release of substance P

in the dorsal horn. The release of the substance P

neurotransmitter causes the transmission of synapses

from the peripheral nerve (sensory) to the

spinothalamic tract nerve. This matter allows the

pain impulses to be transmitted further into the

central nervous system. Inhibition of nerve fibbers

that transmit pain (nociceptive) will make pain

impulses unable to pass through transmission cells

(T cells), so that they cannot be forwarded to higher

processes in the somatosensory, transitional, cortical

cortex, and so on.

Lavender essential therapy positively influences

anxiety, controls insomnia and controls pain.

Serotonin also acts as a neuromodulator to inhibit

nociceptive information in the spinal cord. This

neuromodulator closes the defence mechanism by

occupying receptors in the dorsal horn so as to

inhibit the release of the substance P. The substance

P itself is one example of neurotransmitter with

excitatory action. Inhibition of p substance will

make the impulse of pain unable to pass through the

projection of neurons, so it cannot proceed to a

higher process in the sensory cortex, parietal lobe,

frontal lobe and midbrain so that it cannot be felt as

pain and pain is reduced (Cardia, 2018 ).

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

346

5 CONCLUSION

The conclusion in this study is that there are

significant differences in pain levels in post-partum

mothers who is given lavenderpre and post

aromatherapy (p value = 0,000).

The pre-test pain level in the Lavender therapy

group was in the majority category of severe pain

level (72.2%) and the post-test was in the moderate

pain level category (77.8%).

ACKNOWLEDGEMENTS

This research was supported By Institut Kesehatan

Deli Husada Delitua Institut Kesehatan Medistra

Lubuk Pakam, Sembiring Hospital Foundation, and

GrandMed Hospital Foundation, Indonesia.

The head of Sibolangit Health Centre and all

medical staffs who work at Sibolangit Health Centre

in Deli Serdang District.

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