NIM : PO71241220197
DOSEN PENGAMPU
PENELITIAN
PENGARUH PIJAT OKSITOSIN TERHADAP PRODUKSI ASI
PADA IBU NIFAS
Yusari Asih*
*Dosen Jurusan Kebidanan Poltekkes Tanjungkarang
e-mail: yusariasih@gmail.com
ASI tidak keluar adalah kondisi tidak diproduksinya ASI atau sedikitnya produksi ASI. Hal ini disebabkan
pengaruh hormon oksitosin yang kurang bekerja sebab kurangnya rangsangan isapan bayi yang
mengaktifkan kerja hormon oksitosin. Pijat oksitosin merupakan salah satu solusi untuk mengatasi
ketidaklancaran produksi ASI. Tujuan penelitian ini untuk mengidentifikasi perbedaan produksi ASI pada
ibu nifas yang diberi perlakuan pijat oksitosin dan tanpa perlakuan di BPM Lia Maria Kecamatan
Sukarame Bandar Lampung tahun 2017. Metode penelitian yang digunakan dalam penelitian ini adalah
eksperimental dengan desain rancangan posttest dengan kelompok kontrol. Populasi pada penelitian ini
adalah ibu nifas 3 jam postpartum di BPM Lia Maria berjumlah 80 orang. Sampel dalam penelitian ini
diambil melalui cara purposive sampling. Sampel berjumlah 32 orang yang terdiri dari 16 orang sebagai
responden yang di intervensi dan 16 orang sebagai variabel kontrol. Instrumen penelitian yang digunakan
berupa lembar observasi untuk mengamati produksi ASI pada hari ke 6 dan timbangan. Hasil Uji statistik
menggunakan chi-square (x2) diperoleh p-value= 0,037 (p-value ≤0,05) yang berarti ada pengaruh
signifikan antara pijat oksitosin terhadap produksi ASI pada ibu post partum di BPM Lia Maria Sukarame
Bandar Lampung Tahun 2017. Diharapkan hasil penelitian ini dapat meningkatkan kualitas pelayanan
bagi tenaga kesehatan terutama bidan sebagai pelaksana sehingga dapat meningkatkan pengetahuan ibu
akan pijat oksitosin dan dapat memotivasi ibu dan keluarga untuk melakukan pijat oksitosin dan
memberikan bimbingan serta penyuluhan kepada ibu nifas tentang manfaat pijat oksitosin.
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Populasi pada penelitian ini adalah ibu Tabel 3: Distribusi Frekuensi Responden
nifas 3 jam postpartum di BPM Lia Maria Berdasarkan Pekerjaan
berjumlah 80 orang. Sampel dalam
penelitian ini diambil melalui cara Pekerjaan f %
purposive sampling. Sampel berjumlah 32 Bekerja 2 6,2
orang yang terdiri dari 16 orang sebagai Tidak bekerja 30 93,8
responden yang di intervensi dan 16 orang Jumlah 32 100
sebagai variabel kontrol.
Data penelitian dikumpulkan dengan Berdasarkan tabel 3 diketahui dari 32
melakukan pemijatan oksitosin setelah 3 responden sebagian besar responden tidak
jam postpartum dan selama 5 hari tiap pagi bekerja yaitu 30 responden (93,8%).
dan sore hari selanjutnya dilakukan
observasi pada hari ke-6. Data yang Tabel 4: Distribusi Frekuensi Responden
terkumpul selanjutnya diproses dan Berdasarkan Paritas
dianalisis secara univariat dan bivariat
menggunakan uji chi-square dengan Paritas f %
bantuan perangkat lunak komputer.
Primigravida 9 28,1
Multigravida 23 71,9
Jumlah 32 100
HASIL
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diperoleh pula nilai OR =11,667 (1,227- frekuensi bayi BAK dan lama bayi tidur
110,953), yang artinya ibu post partum setelah menyusu.
yang melaksanakan pijat oksitosin Menurut analisa peneliti kecukupan
mempunyai peluang 11,667 kali produksi ASI pada ibu nifas di BPM Lia
mengalami produksi ASI cukup Maria Kecamatan Sukarame Bandar
dibandingkan dengann ibu yang tidak Lampung adalah baik. Pijat oksitosin yang
melakukan pijat oksitosin. dilakukan pada ibu nifas dapat membuat
rileks dan nyaman, sehingga dapat
mengurangi rasa lelah setelah melahirkan
PEMBAHASAN terutama pijat yang dilakukan setelah 3
jam postpartum. Ibu nifas yang dilakukan
Produksi ASI pada Ibu Nifas yang pijat oksitosin mengatakan bahwa selama
Melakukan Pijat Oksitosin dilakukannya pijat oksitosin ibu merasa
Berdasarkan hasil penelitian nyaman dan rileks sehingga selama
diketahui bahwa dari 16 responden yang pemijatan ibu merasakan adanya aliran
melakukan pijat oksitosin terdapat 15 ASI yang menetes keluar.
orang memiliki produksi ASI yang cukup Pijat oksitosin juga mudah dilakukan
dan 1 responden yang memiliki produksi dengan gerakan yang tidak terlalu banyak
ASI yang kurang. sehingga dapat diingat oleh keluarga untuk
Hal ini sejalan dengan teori yang ada dilakukan dan tak membutuhkan waktu
bahwa pijat stimulasi oksitosin untuk ibu yang lama. Dukungan dari suami dan
menyusui berfungsi untuk merangsang keluarga juga berperan penting dalam
hormon oksitosin agar dapat memperlancar menyusui. Salah satu wujud dukungan
ASI dan meningkatkan kenyamanan ibu. tersebut dapat dilihat dari suami dan
Pijat oksitosin merupakan salah satu keluarga menyetujui untuk melakukan pijat
solusi untuk mengatasi ketidaklancaran oksitosin sehingga ibu dapat termotivasi
produksi ASI. Pijat oksitosin adalah untuk menyusui bayinya serta adanya
pemijatan pada sepanjang tulang belakang anggota keluarga yang bersedia membantu
(vertebrae) sampai tulang costae kelima- melakukan pekerjaan rumah yang biasa
keenam dan merupakan usaha untuk dilakukan ibu.
merangsang hormon prolaktin dan
oksitosin setelah melahirkan. (Rahayu, Produksi ASI pada Ibu Nifas yang
2016) Pijat ini dilakukan untuk Tidak Melakukan Pijat Oksitosin
merangsang refleks oksitosin atau refleks Berdasarkan hasil penelitian
pengeluaran ASI. Ibu yang menerima pijat diketahui bahwa dari 16 responden yang
oksitosin akan merasa lebih rileks. tidak melakukan pijat oksitosin terdapat 9
(Monika, F.B. Monika, 2014). orang memiliki produksi ASI yang cukup
Hasil penelitian yang dilakukan oleh dan 7 orang memiliki produksi ASI yang
Emy Suryani dan Kh Endah Widhi Astuti kurang.
di BPM wilayah kabupaten Klaten Beberapa faktor yang diidentifikasi
didapatkan Hasil Analisa bivariat dapat mempengaruhi laktasi di antaranya
menunjukan adanya perbedaan rata rata adalah Faktor Biologis (Nutrisi, kondisi
berat badan bayi dengan p value : 0.001 payudara, sistem endokrin, paritas, umur
,ada perbedaan frekuensi BAK yang kehamilan, kebiasaan, istirahat), faktor
bermakna dengan p value=0,001 dan ada psikologis, faktor sosial (sosio-emosional,
perbedaan frekuensi menyusu yang sosio-ekonomi, tingkat pendidikan, faktor
bermakna dengan p value=0,001 serta ada lainnya (perawatan payudara, pijat
perbedaan lama tidur yang bermakna oksitosin, teknik marmet)
dengan p value=0,001. Dapat disimpulkan Hasil penelitian yang dilakukan Siti
bahwa ada pengaruh pijat oksitosin Nur Endah dan Imas Masdinarsah di
terhadap produksi ASI dengan indikasi Ruang Kebidanan Rumah Sakit
berat badan bayi, frekuensi bayi menyusu, Muhammadiyah Bandung Tahun 2011
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Jurnal Keperawatan, Volume XIII, No. 2, Oktober 2017 ISSN 1907 - 0357
2010) ( Dalam Fakultas Ilmu Keperawatan ibu nifas cara melakukan pijat oksitosin,
Universitas Padjadjaran, Leli Khairani dkk, melakukan penyuluhan mengenai pijat
2012) oksitosin di kelas ibu dan dapat
Hasil penelitian yang dilakukan Leli memotivasi ibu dan keluarga untuk
Khairani, Maria Komariah, dan Wiwi melakukan pijat oksitosin selama masa
Mardiah mengenai pengaruh pijat oksitosin nifas, dan menyediakan leaflet atau brosur
terhadap involusi uterus pada ibu post mengenai pijat oksitosin sehingga dapat
partum di ruang post partum kelas III meningkatkan pengetahuan ibu nifas akan
RSHS Bandung yaitu teridentifikasi pijat oksitosin.
pengaruh oksitosin terhadap involusi
uterus pada ibu post partum di Ruang Post
Partum Kelas III RSHS Bandung, melalui DAFTAR PUSTAKA
uji statistik Chi-square dengan nilai p <
0.05. Endah, Siti Nur dan Imas Masdinarsah.
Berdasarkan teori dan hasil 2011. Pengaruh Pijat Oksitosin
penelitian di atas menurut peneliti adanya terhadap Pengeluaran Kolostrum
pengaruh pijat oksitosin terhadap produksi pada Ibu Post Partum di Ruang
ASI di BPM Lia Maria Kecamatan Kebidanan di Rumah Sakit
Sukarame Bandar Lampung Tahun 2017 Muhammadiyah Bandung Tahun
karena dengan melakukan pijat oksitosin 2011. Stikes Jendral A. Yani Cimahi
dapat merangsang hormon oksitosin yang F.B. Monika. 2014. Buku Pintar ASI dan
berfungsi dalam pengeluaran ASI. Dilihat Menyusui. Jakarta: Noura Books
dari segi pekerjaan, sebagian besar Fikawati, Sandra; dkk. 2015. Gizi Ibu dan
responden tidak bekerja, seharusnya Bayi. Jakarta: PT Rajagrafindo
memungkinkan untuk melaksanakan pijat Persada
oksitosin baik oleh suami di pagi dan sore Hendrik, H. 2006. Problema Haid. Solo:
hari ataupun dilakukan oleh keluarga. PT. Tiga Serangkai Pustaka Mandiri.
Kemenkes RI. 2014. Profil Kesehatan
Indonesia 2014. BandarLampung:
KESIMPULAN Dinas Kesehatan Kota Bandar
Lampung
Berdasarkan hasil analisis data dan Khairani, Maria dkk. 2012. Pengaruh Pijat
pembahasan penelitian dapat disimpulkan Oksitosin Terhadap Involusi Uterus
ada pengaruh pijat oksitosin terhadap pada Ibu Post Partum Di Ruang Post
produksi ASI pada ibu nifas di BPM Lia Partum Kelas III RSHS Bandung.
Maria Kecamatan Sukarame Tahun 2017 Fakultas Ilmu Keperawatan
yaitu 93,8% ibu nifas yang melakukan Universitas Padjadjaran
pijat oksitosin sebagian besar memiliki Rahayu, Anik Puji. 2016. Panduan
produksi ASI yang cukup, 56,2% ibu nifas Praktikum Keperawatan Maternitas.
yang tidak melakukan pijat oksitosin Yogyakarta:DeepublishRamadhy,
terdapat 9 orang yang memiliki produksi Suryani, Emy & Kh Endah Widhi Astuti.
ASI yang cukup. 2013. Pengaruh Pijat Oksitosin
Hasil analisis statistik lebih lanjut Terhadap Produksi Asi Ibu
menyimpulkan bahwa ada pengaruh yang Postpartum Di BPM Wilayah
signifikan antara pijat oksitosin terhadap Kabupaten Klaten. Jurusan
produksi ASI pada ibu nifas dengan p- Kebidanan Poltekkes Surakarta.
value 0,037. Walyani, Elisabeth Siwi dan Endang
Berdasarkan kesimpulan tersebut Purwoastuti. 2015. Asuhan
penulis menyarankan kepada BPM Lia Kebidanan Masa Nifas dan
Maria untuk melakukan pijat oksitosin Menyusui. Yogyakarta: PT. Pustaka
setelah 3 jam postpartum dan mengajarkan Baru.
[214]
192 SEBATIK 2621-069X
ABSTRAK
Praktek menyusui merupakan optimalisasi kesehatan dan perkembangan anak. Namun, pemberian Air Susu Ibu terkadang
mengalami hambatan, beberapa ibu sering mengalami kesulitan dalam menyusui bayinya karena ASI yang tidak keluar
ataupun ASI yang dirasa kurang . Memanfaatkan tanaman berupa daun kelor yang mengandung laktagogum dapat
membantu merangsang produksi ASI, sehingga dapat membantu ibu dalam mengatasi masalah menyusui. Tujuan
penelitian ini menganalisis potensi daun kelor terhadap peningkatan produksi ASI Pada Ibu Postpartum. Metode yang
digunakan Quasi Experiment dengan rancangan Nonequivalent Control Group Desain yang dilakukan pada 22 ibu
postpartum dan dibagi menjadi 2 kelompok dengan memberikan air rebusan daun kelor pada kelompok intervensi.
Penelitian dilakukan selama 7 hari. Hasil dari uji Friedman dan Mann Whitney menunjukkan bahwa nilai P < 0,05 hal ini
berarti terdapat perbedaan peningkatan produksi ASI antara 2 kelompok. Kesimpulannya daun kelor memiliki potensi
dalam meningkatkan produksi ASI pada ibu Postpartum.
Kata Kunci: Daun Kelor, Postpartum, Menyusui, Produksi Air Susu Ibu (ASI), Laktagogum
1. PENDAHULUAN dilakukan oleh Zakaria menunjukkan bahwa volume ASI
Praktek menyusui secara luas diakui sebagai pada ibu yang diberikan ekstrak daun kelor meningkat
optimalisasi untuk kesehatan dan perkembangan anak, pesat (Zakaria, 2016).
termasuk inisiasi segera dan pemberian Air Susu Ibu Dari latar belakang tersebut peneliti tertarik untuk
(ASI) Eksklusif selama 6 bulan (Horta, 2013). Di mengetahui potensi daun kelor terhadap peningkatan
Indonesia Sendiri kesehatan ibu dan anak dipusatkan produksi ASI pada ibu postpartum.
salah satunya kepada program pemberian ASI Eksklusif
guna mendorong jumlah anak-anak yang hidup melewati 2. RUANG LINGKUP
usia 5 tahun. Hasil Pemantauan Status Gizi (PSG) tahun Ruang lingkup dalam penelitian ini mencakup :
2016, cakupan pemberian ASI Eksklusif pada usia 0-5 1. Penelitian ini adalah sebagai salah satu upaya dalam
bulan adalah sebesar 54,0%, sedangkan bayi yang telah bidang kesehatan ibu dan anak dalam rangka
mendapatkan ASI Eksklusif sampai 6 bulan adalah meningkatkan derajat kesehatan ibu dan anak
sebesar 29,5% . terutama bayi baru lahir, selain itu penelitian ini
Pemberian ASI Eksklusif dipengaruhi oleh berbagai ditekankan pada permasalahan ASI sehingga
faktor antara lain ASI tidak keluar setelah melahirkan, diperlukan usaha untuk bisa meningkatkan ASI.
produksi ASI kurang, kesulitan bayi dalam menghisap, 2. Penelitian ini dilakukan pada ibu postpartum < 40
keadaan puting susu ibu yang tidak menunjang ibu hari dengan riwayat persalinan normal, dengan waktu
bekerja, dan pengaruh/ promosi pengganti ASI (Siregar, penelitian selama 7 hari.
2004). Penelitian yang dilakukan Mardiah (2005) pada 3. Rencana hasil yang didapatkan yakni peningkatan
ibu-ibu yang menyusui 30 menit setelah melahirkan produksi ASI yang berdampak pada peningkatan
diperoleh rata-rata ASI yang keluar adalah 5 jam setelah berat badan bayi, frekuensi BAK dan BAB bayi dan
melahirkan. frekuensi menyusu bayi.
Upaya yang dilakukan untuk mengatasi masalah
menyusui pada ibu postpartum adalah pemberian terapi 3. BAHAN DAN METODE
farmakologis dan nonfarmakologis. Salah satu terapi Periode postpartum dimulai setelah selesainya
nonfarmakologis yang dapat dilakukan memanfaatkan persalinan dan berakhir setelah alat-alat reproduksi
tanaman yang dapat merangsang pengeluaran ASI kembali ke keadaan sebelum hamil/tidak hamil sebagai
(Mortel,2013). akibat perubahan fisiologi dan psikologi karena proses
Daun kelor mengandung senyawa fitosterol yakni, persalinan. Standar kesehatan pada ibu postpartum
alkaloid, saponin dan flavanoid yang berfungsi setidaknya ada empat kali kunjungan masa nifas. Pada
meningkatkan dan memperlancar produksi ASI (Mutiara, kunjungan pertama dan kunjungan ketiga, ibu dianjurkan
2011). Penelitian tentang ekstrak daun kelor yang untuk memberikan ASI kepada bayinya, selain itu bidan
SEBATIK 1410-3737 193
bahwa pemberian ekstrak daun kelor pada ibu menyusui 7. DAFTAR PUSTAKA
dapat meningkatkan volume ASI (Zakaria, 2016).
Kandungan saponin dan alkaloid yang terdapat pada Addo, OY., Aryeh, D & Horta BL, Matrnal Height and
daun kelor memliki fungsi yang langsung bekerja pada Child Growth Patterns. The Journal Of
semua otot polos. Ketika otot polos berkontraksi, maka Pediatrics,163(2), 549-554.
akan terjadi pengeluaran ASI serta peningkatan jumlah Bianncuzzu, 2003, Breastfeeding The Newborn : Clinical
dan diameter alveoli rata-rata sebanding dengan Strategies For Nurses. St. Lous; Mousby.
peningkatan ASI yang dihasilkan (Gunanegara, 2010). Brown JE, Isaacs J, Krinkle B, Lechtenverg E. Nutrition
Produksi ASI yang baik akan berimbas pada Trought the Life Cycle International Student
peningkatan berat badan bayi, frekuensi BAK bayi, Edition. United States; 2002.
frekuensi BAB bayi dan frekuensi menyusui bayi ( Hubertin SP. Penerapan ASI. Jakarta: EGC; 2004.
Biancuzzu, 2003). Gunanegara, RF., Suryawan, A., Sastrawinata, US,
Presentase perubahan berat badan dari berat lahir Efektivitas Ekstrak Daun Katuk Dalam Produksi
merupakan indikator asupan nutrisi. Apabila penurunan Air Susu Ibu Untu Keberhasilan Menyusui.
berat badan berlebihan biasanya disebabkan oleh JKM,2(9),105-17
pemberian susu yang tidak efektif sehingga pasokan ASI Mortel, M., & Metha,SD, Systematic Review Of The
tidak mencukupi (Widayanti, 2013). ASI dapat Efficacy Of Herbal Galactogogues. Jurnal Human
mempenngaruhi berat badan bayi karena ASI Lactation,29(2),154-62
mengandung laktose yang terdapat pada saluran Mutiara,T, 2011.Uji Efek Pelancar ASI Tepung Daun
pencernaan bayi. Kemudian laktose akan diubah menjadi Kelor (Moringa Oilefera) Pada Tikus Putih Galur
glukose dan galaktose dan akhirnya dimetabolisme Wistar. Laporan Hasil Penelitian Disertasi Doktor.
menjadi energi serta kalori yang dapat berpengaruh Malang
terhadap berat badan bayi (Wiji, 2013). ASI juga Restuning W. Masalah-masalah dalam Menyusui.
mempengaruhi frekuensi BAK dan BAB bayi, protein Bandung: Universitas Padjajaran; 2008.
dan elektrolit dalam ASI mempengaruhi ekresi ginjal Roesli U. Mengenal ASI Eksklusif. Jakarta; Trubus
untuk mengatur pembuangan zat-zat dalam urine. Agriwisya; 2005.
Kandungan protein dan oligosakarida didalam ASI tidak Saleh, L, Faktor-Faktor Yang Menghambat Praktik ASI
dapat dicerna, sehingga dapat meningkatkan volume, Eksklusif Pada bayi Usia 0-6 Bulan (Studi
osmolaritas dan dapat menigkatkan defekasi. Ketika bayi Kualitatif) di Desa Tridana Mulya, Kec. Landono
menyusu maka akan terjadi reflek gastrolik yang Kab. Konawe Selatan, Sulwesi Tenggara. Semarang
meningkatkan frekuensi BAB (Tehuteru, 2001). : Universitas Diponegoro; 2011.
Ketika produksi ASI semakin baik, maka frekuensi Siregar, 2004, Pemberian ASI Eksklusif dan Faktor-
menyusu juga akan meningkat. Stimulus dari isapan bayi Faktor Yang Mempengaruhi, Medan; FKM USU.
akan merangsang hiposfisis anterior untuk melepas Tehuteru, Hegar B, Firmansyah A, 2001, Pola Defekasi
hormon prolaktin dan sel-sel alveolar pada kelenjar Pada Anak, Sari Pediatri.
mamma untuk mempertahankan sekresi ASI. (Saleh, Widayanti, W,2013, Efektivitas Metode SPEOS
2011). Terhadap Pengeluaran ASI Ibu Nifas ( Quasi
Eksperimen di BPM Wilayah Kabupaten Cirebon).
5. KESIMPULAN Wiji, 2013, ASI Dan Pedoman Ibu Menyusui.
Daun kelor memiliki efek potensial untuk Yogyakarta; Nuha Medika.
meningkatkan produksi ASI pada ibu postpartum, hal ini Zakaria, Hadju,V., As’ad, S., Bahar, B, Pengaruh
terbukti dari peningkatan berat badan bayi, peningkatan Pemberian Ekstrak Daun Kelor Terhadap Kuantitas
frekuensi BAK Bayi, peningkatan frekuensi BAB bayi, Dan Kualitas Air Susu Ibu Pada Ibu Menyusui Bayi
dan frekuensi menyusui. 0-6 Bulan. Jurnal IKMI, 12(3).
Heni Nurakilah
Universitas Bhakti Kencana PSDKU Tasikmalaya, Prodi D3 Kebidanan
(heni.nurakilah@bku.ac.id)
ABSTRAK
Penatalaksanaan pembengkakan payudara yang berdampak pada ketidaklancaran
pengeluaran ASI dapat dilakukan dengan terapi non-farmakologis, yaitu dengan kompres lidah
buaya (aloe vera). Tujuan penelitian ini untuk efektivitas terapi kompres lidah buaya (aloe vera)
terhadap kelancaran pengeluaran ASI. Penelitian ini dilakukan di Puskesmas Karanganyar Kota
Tasikmalaya pada Bulan Januari s.d Februari 2022. Penelitian ini merupakan pre-eksperimen
dengan rancangan penelitian one group pretest-posttest. Subjek penelitian sebanyak 40 orang
ibu nifas 2-3 hari. Variabel kompres lidah buaya (aloe vera) terhadap kelancaran pengeluaran
ASI di analisis menggunakan Uji Wilcoxon untuk mengetahui efektivitas sebelum dan sesudah
pemberian kompres lidah buaya (aloe vera). Hasil penelitian diperoleh kelancaran pengeluaran
ASI dengan nilai rerata posttest pada kelompok intervensi 9,10 dan nilai rerata posttest pada
kelompok kontrol 6,70. Terapi kompres lidah buaya (aloe vera) menunjukan kelancaran
pengeluaran ASI dengan rerata ±SD 9,20±0,304 (p=0,001). Simpulan: Pengompresan dengan
lidah buaya (aloe vera) memiliki efektivitas terhadap kelancaran pengeluaran ASI pada ibu 2-3
hari post partum di wilayah kerja Puskesmas Karanganyar Kota Tasikmalaya.
Kata kunci : ASI, Lidah Buaya (Aloe Vera), Kelancaran Pengeluaran ASI.
ABSTRACT
The management of breast engorgement that results to unexpenditure of breast milk
production can be used non pharmacologist therapy with aloe vera compresses. The purpose of
this study was determine the effectiveness of aloe vera compresses therapy on smooth expulsion
of breast milk. This research was conducted at the Karanganyar Public Health Center,
Tasikmalaya City from January to February 2022. This study was a pre-experimental research
design with one group pretest-posttest. The research subjects were 40 women postpartum 2-3
days. Variable of aloe vera compress on the expenditure of breast milk were analysed using the
Wilcoxon test to determine the effectiveness before and after giving aloe vera compresses. The
results of the study obtained that flow of breast milk was smooth with the posttest mean in the
intervention group 9,10 and the posttest mean in the control group 6,70. Aloe vera compress
therapy showed smooth milk production with a mean of ±SD 9,20±0,304 (p=0,001). The
conclusion that compressing with aloe vera ha been effectiveness on the smooth expulsion of of
breast milk for mothers 2-3 days postpartum at Karanganyar Public Health Center,
Tasikmalaya City.
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JURNAL BIMTAS Volume: 6 Nomor 1
FIKes-Universitas Muhammadiyah Tasikmalaya E-ISSN: 2622-075X
mengandung protein untuk daya tahan ASI yang rendah dan cara menyusui yang
tubuh dan pembunuh kuman dalam jumlah benar, yaitu sebesar 19,07%; pelayanan
tinggi sehingga pemberian ASI eksklusif konseling laktasi dan dukungan dari
dapat mengurangi risiko kematian pada petugas kesehatan kurang sebesar 15,23%;
bayi. Kolostrum berwarna kekuningan persepsi masyarakat yang salah kaprah
dihasilkan pada hari pertama sampai hari mengartikan tentang ASI sebesar 20,40%;
ke-3. Hari ke-4 sampai hari ke-10 ASI perilaku bagi para ibu bekerja yang tidak
mengandung imunoglobulin, protein, dan memberikan ASI eksklusif sebesar 21,12%;
laktosa lebih sedikit dibanding dengan dan pemasaran agresif oleh perusahaan
kolostrum, tetapi lemak dan kalori lebih pembuat susu bayi yang tidak hanya
tinggi dengan warna susu lebih putih. memengaruhi para ibu, tetapi juga para
Selain mengandung zat-zat makanan, ASI petugas kesehatan sebesar 24,18%.
juga mengandung zat penyerap berupa (Ibrahim IA et al., 2014).
enzim tersendiri yang tidak akan Bendungan ASI dipengaruhi oleh
mengganggu enzim di usus. (Meiharti, beberapa faktor di antaranya adalah faktor
2019) ibu yang meliputi faktor psikologis, nutrisi,
Persentase pemberian ASI eksklusif teknik menyusui, perawatan payudara, dan
bayi usia 0-5 bulan secara Nasional ASI eksklusif, sedangkan faktor bayi
mencapai 71,58% pada tahun 2021, angka disebabkan oleh daya hisap bayi yang
tersebut mengalami peningkatan dari tahun lemah. Dampak pembengkakan payudara
sebelumnya yaitu 69,62%. Pemberian ASI yang berkelanjutan dapat menyebabkan
eksklusif di Jawa Barat tahun 2020 infeksi payudara (mastitis).
mencapai 68,09 %, menurut kisaran (Rahayuningsih, 2018). Payudara terasa
Kabupaten/Kota cakupan ASI eksklusif nyeri, panas, keras pada perabaan, tegang
pada bayi umur 0-6 bulan antara 20,34% di serta bengkak yang terjadi pada hari ke-3
Kabupaten Bandung sampai 113,11% di sampai hari ke-5 masa nifas dan hal ini
Kabupaten Tasikmalaya. Sedangkan data bersifat fisiologis. Nyeri payudara
cakupan ASI di Kota Tasikmalaya tahun meningkat pada hari ke-3 setelah
2018 mencapai 56,91 % dan tahun 2019 melahirkan karena perkembangan kelenjar
(68,31 %), sehingga gambaran ini masih di susu dan pembengkakan payudara. (Lim
bawah cakupan target nasional tahun 2019 AR et al., 2015). Pembengkakan payudara
sebesar 69,62%. dapat diatasi dengan cara terapi
Beberapa hal yang menghambat farmakologis, yakni dengan pemberian obat
pemberian ASI eksklusif adalah anti nyeri dan terapi non-farmakologis
pengetahuan para ibu mengenai manfaat dengan cara kompres panas, kompres
29
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dingin, kompres daun kubis, kompres lidah Persetujuan etik penelitian didapat dari
buaya (aloe vera), kompres gel, pijat UPMI Universitas Bhakti Kencana PSDKU
payudara, dan pengikatan payudara. (Disha Tasikmalaya dengan surat No:
AR et al., 2015). 028/03.K.TSK/UBK/I/2022.
30
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JURNAL BIMTAS Volume: 6 Nomor 1
FIKes-Universitas Muhammadiyah Tasikmalaya E-ISSN: 2622-075X
34
Journal of Caring Sciences, 2013, 2(4), 279-286
doi:10.5681/jcs.2013.033
http:// journals.tbzmed.ac.ir/ JCS
Article Type:
Introduction: Episiotomy is used for enlarging the perineum. Aloe vera and Calendula
Original Article have been used for treating different diseases from ancient times, limited researches
have been done regarding the healing of these plants. Since the effect of their ointment
on episiotomy healing has not been studied, this study is being done for determining
Article History: the impact of Aloe vera and Calendula on episiotomy healing in primiparous women.
Received: 25 Jul. 2012
Accepted: 3 Apr. 2013
Methods: This clinical trial involves 111 qualified primiparous women admitted in
ePublished: 30 Nov. 2013 Lolagar hospital. They were randomly categorized into three groups of control (n=1)
and experimental (n=2) groups. The women in experimental group used Aloe vera and
Calendula Ointment every 8 hours and the control group used hospital routine on
Keywords: episiotomy for 5 days. The data were collected by demographic questionnaire and
Aloe vera
Calendula officinalis
redness, edema, ecchymosis, discharge and approximation scale (REEDA) which
Ointment investigated the episiotomy healing before and five days after intervention in two
Episiotomy groups. ANOVA, Tukey test, Kruskal-wallis, Chi-square were used for data analysis.
Primiparity Results: The three groups do not have statistically significant different regarding
demographic and other intervening variables. Comparing the mean of REEDA in five
days after delivery showed statistically significant difference between control and
experimental groups.
Conclusion: According to the results, using Aloe vera and Calendula ointment
considerably increases the speed of episiotomy wound healing so it can be used for
quickening the episiotomy healing.
postpartum women.4 According to results of by many people of the society and 40% of
studies, perineal injury not only causes common drugs are derived from plants and
physical damage but it also causes emotional natural resources.5 Aloe vera (family
and psychological harms and delay in wound Liliaceae) is from the group of flowering
healing leads to bad anatomic results in plants, monocots and native North Africa
perineal and delay in linkage of wound edges and is one of the important medicinal species
and increasing the intensity of pain at which is being used for treating many
perineal area.5 Perineal healing is one of the diseases from very ancient times. It has
issues which shall be taken into account; in healing, anti-inflammation, analgesic, anti-
this regard Cavanaugh wrote that “it is virus, anti-bacteria, antifungal, purgative,
necessary that perineal shall be healed as anti-itching and moisturizing.9 Aloe vera
soon as possible. This part cannot be directly including collagen increases the tissue
observable by mother and leads to increasing granules and is effective in wound healing
the maternal complications.6 The delay in due to its anti-inflammatory properties. Its
perineal healing leads to increasing the anti-inflammatory effects are due to the
complications such as blooding, pain, pain availability of Salicylic acid which inhibits the
during intercourse, and anxiety.7 Although formation of Bradykinin and Histamine and
these problems are not acute or life- due to oxidation of arachidonic acid which
threatening, their potential impact on daily inhibits Prostaglandin synthesis.10 Several
function of mother is important.4 Episiotomy researches have been done about studying
needs care like any other surgery. Many the effect of Aloe vera on wound healing at
actions have been proposed for quickening other parts of the body. The results of study
the episiotomy wound healing such as using by Avizhgan et al., about studying the
disinfectant techniques during healing, healing effect of Aloe vera gel for treating
prevention from unnecessary damage in pressure ulcer indicated that the time need
cutting area such as using round-head for reducing the redness, inflammation,
needle, stitch yarns with high absorbability discharge and the time needed for full
and less sensitivity, observing perineum wound closure were significant while using
health, keeping dry of wound area, using Aloe vera gel.11 The study by Tafazolie et al.,
localized methods such as cold or hot water was done for comparing the impact of Aloe
ischiadic bath including salt, cetrimide and vera Gel and Lanolin ointment on treating
betadine, Kegel exercises, using herbal the nipple fissure, showed that Aloe vera gel
extracts pads such as lavender, chamomile, is more effective than Lanolin ointment in
fecundity and calendula, etc.5 At now, the treating the nipple fissure.12 Calendula is the
researchers pay attention to using cheap, other herb which is used for quickening the
effective, proper methods which are wound healing which has anti-inflammatory
accessible in health centers apart from and anti-inflammation properties, anti-virus,
hospitals and meanwhile, being acceptable by anti microbe and antifungal activity, anti-
postpartum women.8 In this regard, cancer, anti oxidant and healing function.13
complementary medicine including tradi- Flavonoids and saponins in calendula
tional and herbal medicine, homeopathy, and prevents from releasing of harmful and
Aromatherapy solutions has special place in histamine enzymes which cause sensitivity
promoting the care quality after delivery. and inflammation and heal the redness and
Nowadays, using non-traditional or pain and inhibits plasma discretion to the
comprehensive treatment methods are tissues by decreasing the capillary
increasing and according to world health permeability. Meanwhile, it reduces the
organization, herbal medicine is part of the immigration of white blood cells to inflamed
complementary medicine which is accepted area. Its anti-inflammatory effects are due to
280 | Journal of Caring Sciences, December 2013; 2(4), 279-286 Copyright © 2013 by Tabriz University of Medical Sciences
Aloe vera and calendula on episiotomy wound healing
noted that REEDA is a global scale and there clinic and the qualified samples which were
is no need for measuring the reliability and considered on statistical analysis were
validity. Four hours after episiotomy, the replaced. SPSS ver. 13 was used for analyzing
intervention was done. The subjects were the data by independent Anova, t-test, Chi-
requested to cleanse the episiotomy with square and Kruskal-Wallis. It shall be noted
water; the researcher rubbed 3 cc of that the ethical considerations in this study
mentioned ointment for the first time on includes the following: the permission for
episiotomy area by disposable glove for giving up the research subjects at any phase
training and according to given training, the of research, being confident of the
mother continued using ointment every 8 confidentiality of all the data of research
hours. The control group received the units, informing the subjects to disrupt using
hospital routine as episiotomy cleansing with the drug in case of any sensitivity or
2 spoons betadine in 4 glasses of water every inflammation at perineal area and to inform
4 hours. The researcher became aware of the the researcher to refer to the specialized
manner of using ointment by patients by call. physician. Full observing the ethics and
In order to blind the study, the second step of trusteeship from other researches and
assessing the episiotomy healing was done 5 resources by the researcher, observing the
days after intervention by the trained contents related to Helsinki convention in the
researcher assistant in the hospital clinic and research, publishing detailed and real results
were registered in appraisal form of REEDA. even reaching to the results which indicated
The questions related to postpartum factors the ineffectiveness of probable complications
were added to the questionnaire by her. All of ointments and announcing the research
subjects were given a card on which group’s results to the authorities of Lolagar Hospital.
code and date of referring for mother’s
reminding and researcher’s Tel was Results
registered, so that the researcher assistant The three groups did not significant different
could assess the episiotomy healing without
in terms of personal information such as age,
prior awareness and could record it.
education, economical status, job experience,
Although the results of researches have not
episiotomy length, duration of first, second
reported any problem related to consumption
and third stages of labor, number of surface
of Aloe vera or Calendula, the mother is
stitches, head circumference of child,
requested to call the researcher if there would
postpartum factors such as mother’s position
be any problem such as sensitivity, infection
during lactation, time of starting daily
or other evidences, so that necessary actions
activities after delivery and BMI of mothers
were taken. It shall be noted that the primary
(Table 1)
intervention was done by researcher and Comparing the sum of grades resulted from 5
further interventions by trained mother. variables of REEDA scale showed that the
Meanwhile, the mother was trained about mean of REEDA scale grade 5 days after
observing personal health and manner of
intervention which indicated statistically
filling the form at home. The excluding
significant difference among three groups
criteria were non accurate use of Aloe vera
(P<0.001). (Table 2)
and Calendula ointment, sensitivity to
Tukey test showed that the mean of REEDA
desired ointment, non-willingness to
grade 5 days after episiotomy has statically
continuing the participation in the study,
significant different between Aloe vera
having sexual intercourse in first 5 days after
ointment group and control (P<0.001) and
delivery and not referring to the clinic of
between Calendula and control group
which 11 were excluded due to inaccurate
(P<0.001) but there was not significant
use of ointment and 9 due to not referring to
282 | Journal of Caring Sciences, December 2013; 2(4), 279-286 Copyright © 2013 by Tabriz University of Medical Sciences
Aloe vera and calendula on episiotomy wound healing
different between Aloe vera and Calendula had statistically significant difference
ointment groups (P=0.98). between Aloe vera and control group
Studying episiotomy regarding redness 5 (P=0.009), between Calendula and control
days after intervention showed statistically group (P=0.009). There was not statistically
significant difference among three groups significant difference between Aloe vera and
(P=0.002). Tukey test showed that the mean Calendula groups (P=0.94). Studying
grade of redness 5 days after episiotomy had ecchymosis of wound 5 days after
statistically significant difference between intervention showed that the three groups
Aloe vera ointment and control group (P= had statistically significant difference
0.006) and between Calendula ointment and (P=0.005). Studying discharge of wound 5
control group (P=0.016). There was no days after intervention showed that the three
significant difference between Aloe vera and groups did not have different and did not
Calendula ointment groups (P=0.94). have statistically significant difference among
Studying edema of episiotomy area 5 days three groups and also between two
after intervention showed that edema grade experimental groups (P=0.13). Studying the
in experimental group was lower than approximation showed statistically
control group and the three groups has significant difference among three groups
statistically significant difference (P=0.003). (P=0.005). Tukey test showed that the mean
Tukey test showed that the mean of edema of approximation grade 5 days after
grade 5 days after episiotomy had statistically episiotomy had statistically significant
significant difference between Aloe vera and difference between Aloe vera and control
control group (P=0.004), between Calendula group (P=0.007), between Calendula and
and control group (P=0.001). There was not control group (P=0.04). There was not
statistically significant difference between statistically significant difference between
Aloe vera and Calendula groups (P=0.88). Aloe Vera and Calendula groups (P=0.69)
Tukey test showed that the mean of (Table 3).
Ecchymosis grade 5 days after episiotomy
Copyright © 2013 by Tabriz University of Medical Sciences Journal of Caring Sciences, December 2013; 2 (4), 279-286| 283
Farideh Eghdampour et al.
Table2: Mean and Standard deviation REEDA in episiotomy healing before intervention and 5
days after intervention among 3 groups
Time/Group Aloe vera Calendula Control P
Mean (SD) Mean (SD) Mean (SD)
Before intervention 4.32(1.20) 4.40(1.48) 4.32(1.38) 0.939
5 days after intervention 1.62(0.92) 1.67(1.10) 3.48(1.77) < 0.001
Table3: Mean and Standard deviation Redness, Edema, Ecchymosis, Discharge and
Approximation of episiotomy base on REEDA 5 days after intervention in 3 groups
Discussion
According to the results of current study, of water group. Meanwhile, 5 days
using Aloe vera and Calendula ointment postpartum, the edema less than 1 cm was
considerable quickens the episiotomy healing observed in 60% of samples using betadine
5 days postpartum compared to Betadine. No and 62% of samples using water.18
study has been done regarding the effect of Meanwhile, the current study is partialy
Aloe vera and calendula ointment on consistent with the study by Golmakanie et
episiotomy wound healing but difference al., aimed at studying the effect of turmeric
studies have been done regarding the effect ointment on episiotomy healing. In
of herbal plants on episiotomy wound Golmakanie’s study, the mean of redness
healing. In this regard, Sheykhan et al., grade in experimental groups was 1.06 (0.80)
conducted a research to study the effect of and in control group, it was 1.52 (0.76) which
lavender extract on episiotomy healing and showed statistically significant difference.
the results indicated that the mean grade of But the mean of edema grade in experimental
wound healing of samples who used groups was 0.84 (0.72) and in control group,
levender extract 5 days after episiotomy were it was 1.16 (0.73) which did not show
lower than control group (P<0.001) statistically significant difference. So this part
Meanwhile, the study by Malek Pour et al., is not consistence with current study.
regarding the effect of Turmeric on Meanwhile, none of the samples at the
episiotomy wound healing is consistent with experimental group has ecchymosis at 7 days
current study.5 The current results are postpartum. The mean of ecchymosis grade
consistent with the results of study by Tork in experimental groups was 0.31 (0.64) and in
Zahrani aimed at comparing the betadine control group, it was 0.65 (0.79) which
and water in the process of episiotomy showed statistically significant difference.
healing. It shall be noted that the control The mean of approximation grade in
group in the current study used the hospital experimental groups was 0.72 (0.63) and in
routine that is betadine. The redness between control group, it was 1.03(0.65) which
two groups of using betadine and water was showed statistically significant difference, so
not statistically significant difference. The this is consistent with current study.16 In a
redness below 3 mm was reported on 46% of study by Vakilian et al., entitled as studying
betadine group and 60% the effect of lavender and betadine on
284 | Journal of Caring Sciences, December 2013; 2(4), 279-286 Copyright © 2013 by Tabriz University of Medical Sciences
Aloe vera and calendula on episiotomy wound healing
episiotomy healing, the mean and standard from available researches, the researchers
deviation of healing in experimental group propose to do more studies regarding the
was 1.88 (2.66) and in control group it was verification of using these ointment on
3.01 (3.12) which did not show statistically episiotomy wound healing and regarding the
significant difference. The edema grade was effect of these ointment on quickening the
reported lower in lavender extract episiotomy healing, and also regarding that
consuming group, the ecchymosis, discharge none of the mothers has reported auxiliary
and approximation grades did not have complication from using the ointments, these
statistically significant difference between ointments are used as promoter of
two groups.19 The reasons for inconsistency episiotomy healing in primiparous women.
of Vakilian et al., research with the current
research can be related to the different Acknowledgement
manner of using Aloe vera ointment, All the related expenses were paid by
Lavender extract, type of used treatment, University of Tehran and hereby, the
difference mechanism of these three herbal researchers appreciate the research vice-
plants on wound healing, dosage and time of chancellor of the Faculty of Nursing and
using medicinal plant, laceration and Midwifery, Barij Essence Pharmacy
difference of laceration degree or the Company, the professors and reviewers with
availability of infection. The healing is their great accuracy, the participated mothers
difference in different people and this can be and all who assisted us in doing this
resulted from personal differences, physical research.
status and economical status which can
increase or decrease the speed of healing Ethical issues
which are considered as the limitation of the
research. None to be declared.
Copyright © 2013 by Tabriz University of Medical Sciences Journal of Caring Sciences, December 2013; 2 (4), 279-286 | 285
Farideh Eghdampour et al.
study. J Altern Complement Med 2010; 16(6): 647- 15. Hur MH, Han SH. Clinical trial of aromatherapy
50. on postpartum mother's perineal healing. Taehan
10. Boudreau MD, Beland FA. An evaluation of the kanho hakhoe chi 2004; 34(1): 53-62.
biological and toxicological properties of Aloe 16. Golmakani N,Rabiei Motlagh E,Tara F, Asili J,
barbandesis (miller), Aloe vera. J Environ Sci Shakeri MT. The effects of turmeric (curcuma
Health C Environ Carcinog Ecotoxicol Rev. 2006; longa L) ointment on healing of episiotomy site in
24(1): 103-54. primiparous women. Iranina Journal of
11. Avizheghan M. Aloe vera gel as an effective and Obstetrics, Gynecology and Infertility
cheap option for treatment in chronic bed sores. 2009;11(4): 29-38. (Persian)
faculty of medicine of Ghilan university of 17. Khadivzadeh T, Molkizadeh M, Rakhshandeh H,
medical sciences 2003; 13(50): 45-50. (Persian) Khajedaloui M. The impact of Lavender Cream
12. Tafazolie M, Saedie R, Rebatsanghie MG, on Episiotomy Pain and Wound Healing in
Mazlom SR. Aloe vera gel Vs. lanolin ointment in Primiparous Women. Journal of Mashhad School
the treatment of nipple sore: a randomized clinical of Nursing & Midwifery 2009; 9(1): 19-24.
trial. Tehran University Medical Journal (TUMS). (Persian)
2010; 67(10): 699-704. (Persian) 18. Tork Zahrani Sh, Amirali Akbari S, Valaie N.
13. Chandran P, Kuttan R. Effect of Calendula Comparison of the effect of Betadine and water in
officinalis flower extract on acute phase protein, episiotomy wound healing. Feyz Journals of
antioxidant defense mechanism and granuloma Kashan University of Medical Sciences 2002;
formation during thermal burns. J Clin Biochem 5(4): 80-5. (Persian)
Nutr 2008; 43: 58-64. 19. Vakilian K, Atarha M, Bekhradi R, Ghebleh F,
14. Muley BP, Khadabadi SS, Banarase NB. Hatami Z, Ceraj A. The effect of lavender in care
Phytochemical Constituents and Pharmacological of postpartum episiotomy wounds. Journal of
Activities of Calendula officinalis Linn Shahrekord university of medical sciences 2008;
(Asteraceae): A Review. Tropical Journal of 10(3): 63-9. (Persian)
Pharmaceutical Research 2009; 8(5): 455-65.
286 | Journal of Caring Sciences, December 2013; 2(4), 279-286 Copyright © 2013 by Tabriz University of Medical Sciences
Original
Article
Abstract
Background: Stress, anxiety, and postpartum depression are the most common problems among women in their childbearing
age. Research has shown that aromatherapy administered during labor reduces anxiety in mothers. With regard to the specific
biological conditions in postpartum period and the subsequent drop in hormone levels, this study investigated the effect of lavender
on prevention of stress, anxiety, and postpartum depression in women.
Materials and Methods: In a clinical trial, 140 women admitted to the obstetric and gynecological unit were randomly divided
into aromatherapy and non‑aromatherapy groups immediately after delivery. Intervention with aromatherapy consisted of inhaling
three drops of lavender essential oil every 8 h with for 4 weeks. The control group received routine care after discharge and was
followed up by telephone only. After 2 weeks, 1 and 3 months of delivery, women were assessed by the 21‑item Depression,
Anxiety, and Stress Scale and the Edinburgh stress, anxiety, and depression scale in the two groups. Data analysis was performed
by Mann–Whitney, analysis of variance (ANOVA), and post hoc tests. Level of significance was set as 0.05 for all tests.
Results: The results showed that the mean stress, anxiety, and depression at time point of 2 weeks (P = 0.012, P < 0.0001, and
P = 0.003, respectively) and stress, anxiety, and depression scores at time points of 1 month (P < 0.0001) and 3 months after
delivery (P < 0.0001) were significantly lower in the study group compared with the control group.
Conclusions: Inhaling the scent of lavender for 4 weeks can prevent stress, anxiety, and depression after childbirth.
Key words: Anxiety, depression, lavender, postpartum period, prevention, scent of lavender, stress
P
regnancy and delivery are pleasant physiological on the events and feel helpless, and are involved in
phenomena, but at times, changes occur in pregnant confusion and manifest signs such as depression, anxiety,
women’s mood that make them so sensitive and posttraumatic stress disorder.[3] Modares et al. reported
the prevalence of stress disorder as 20%, while after a
traumatic delivery, it was 37.7%.[4] Post delivery anxiety
1
Nursing and Midwifery Care Research Center, Faculty of Nursing
and Midwifery, Isfahan University of Medical Sciences, Isfahan, influences 5–20% of the mothers.[5] Eventually Postpartum
Iran, 2Student Research Center, Faculty of Nursing and Midwifery, depression (with a variant prevalence of 5–40% in different
Isfahan University of Medical Sciences, Isfahan, Iran, 3Student societies) accounts for 12.5% of the women’s hospital
Research Center, School of Pharmacy, Isfahan University of Medical admissions due to psychological problems.[6] Postpartum
Sciences, Isfahan, Iran depression is among the most important complications
Address for correspondence: Ms. Maryam Kianpour, of postpartum stress, which increases mothers’ and
Nursing and Midwifery Care Research Center, School of Nursing infants’ vulnerability.[4] Stress can lead to anxiety which
and Midwifery, Isfahan University of Medical Sciences, is a mental reaction to a real or mentally made threat.
Isfahan, Iran. Lack of sleep, poor nutrition, high consumption of
E‑mail: kianpour@mail.mui.ac.ir
Submitted: 21‑Nov‑14; Accepted: 20‑Sep‑15
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Kianpour, et al.: The effect of the fragrances lavender on the prevention of stress, anxiety and depression in the postpartum period
caffeine, smoking, and physical diseases are among the mother–infant interaction have been reported.[18] Conrad
manifestations of anxiety.[7] Anxiety in mothers decreases and Adams conducted a comparative study on the effects of
oxytocin secretion and milk production. A study in Japan inhalation and massage aromatherapy using a combination
showed that postpartum anxiety and depression led to of lavender rose essentials and reported that both methods
lower self‑confidence and, consequently, decreased breast significantly reduced depression and anxiety although
feeding.[8] Although minor anxiety can somehow encourage massage aromatherapy was more effective.[15] One of the
the individuals to take charge of their responsibility properly scented essential oils used in aromatherapy is lavender
or to learn how to modify their lifestyle and habits, severe oil. Its scientific name is Lavandula angustifolia from the
anxiety can be very disabling. Anxiety increasing as much group of mints with the English name of lavender. Among
as a panic disorder can cause disability.[9] Postpartum the effective ingredients is a combination of linalool and
depression can have negative effects on mothers’ role linalyl acetate. Linalool acts as a tranquilizer by affecting
and, in some cases, impair maternal interest to infant and aminobutyric acid receptors in the central nervous
family members. As birth is considered a pleasant event, system.[19] Oil essence of this plant contains phenol aldehyde
mothers’ mental suffering can be very confusing for the or alcohol with the highest germicidal effect.[20] With regard
family members. It also negatively affects their sexual desire to the high prevalence of stress, anxiety, and postpartum
and, consequently, their marital relationship. Postpartum depression and lack of adequate research on the effect of
depression is a major health problem that impairs healthy inhalation aromatherapy on prevention of stress, anxiety,
mother–infant relationship.[10] If not treated, depression and postpartum depression, the present study aimed to
gradually subsides normally 6 months after delivery, while a investigate the effect of lavender on the prevention of stress,
longer period of time increases the number of complications anxiety, and postpartum depression in women.
and their severity.[11] The first step in treatment of such
disorders is prevention. Recent studies show that treatment
Materials and Methods
interventions before and after delivery act very successfully
in reduction of risk among the women with severe
This is a clinical trial (No. 392556) that was conducted
delivery‑related disorders.
after obtaining permission from the ethics committee of
Isfahan and Lorestan universities of medical sciences. In
Preventive treatments during delivery and immediately
this study (2014), 171 women hospitalized in the midwifery
after that include supportive psychotherapy, interpersonal
and gynecology ward of Charity Hospital of Asali in
psychotherapy, and medication. Prophylactic medication
is recommended for high‑risk mothers immediately after Khorramabad, Iran were selected through convenient
delivery.[12] Since use of psychotropic drugs by breast sampling based on the inclusion criteria after delivery and
feeding mothers causes problems such as severe drowsiness they were explained about Golkaran the goals of study
and diminished response of mothers to the cries of infants and asked to sign a written consent form. Inclusion criteria
during sleep, changes in sexual function, fatigue, changes were being literate, having Iranian nationality, a single
in role, confusion, hypotension, tachycardia, etc., and also tone pregnancy, termination of pregnancy between 37
due to their tranquilizing effect on the infant through the and 42 weeks of gestational age, birth of a healthy infant,
milk they receive, these medications are limited during no postpartum complications such as acute hemorrhage
breast feeding.[13] Research shows that one of the existing and infection, no maternal problems such as preeclampsia
treatments to reduce stress, anxiety, and depression is during their current pregnancy, no congenital abnormality in
aromatherapy.[14,15] Sahebalzamin et al. reported that infants or not being hospitalized in ICU, no drugs or alcohol
aromatherapy inhalation of lavender and rose essence consumption by the mother, mother not being affected by
combination significantly decreased the level of anxiety known chronic or systemic diseases, no consumption of
and depression among the students residing in hostels.[9] anti‑depressant, anti‑anxiety, or anti‑stress medications
A significant decrease in cortisol release from the adrenal in their recent pregnancy, no history of asthma, allergy,
gland, a significant increase in secretion of serotonin from or dermatitis diagnosed by a physician, no history of
the digestive system, and a significant reduction of anxiety eczema and allergy to flowers and plants diagnosed by a
during delivery have been all reported after inhalation of physician, and no disorder in olfactory sense. Exclusion
lavender in Mirzaei et al. ’s study.[16] Pemberton and Turpin criterion was appearance of signs of allergy to lavender
reported the effect of lavender and sage on the reduction of essential in the subjects or their family members. Firstly,
stress resulting from working in ICU among the nurses.[17] the subjects’ background characteristics questionnaire
There are some studies on aromatherapy in postpartum was filled. Then, the subjects were randomly assigned
period, including Imura et al. in which mothers’ and infants’ to study (aromatherapy) and control (no aromatherapy)
physical and mental status improvement and facilitation of groups by picking up the cards of the related groups.
Iranian Journal of Nursing and Midwifery Research | March-April 2016 | Vol. 21 | Issue 2 198
Kianpour, et al.: The effect of the fragrances lavender on the prevention of stress, anxiety and depression in the postpartum period
One subject in the aromatherapy group in the first stage of reliability of DASS‑21 have been frequently investigated
sampling and two subjects in the control group (one in the and established. [22] The resultant data of study were
first stage and the other in the second stage of sampling) analayzed by SPSS19, ANOVA, Mann–Whitney, t-test, and
were left out of the study as they developed acute anxiety. post hoc tests. P < 0.05 was considered significant.
Also, 27 subjects were excluded in the first stage of sampling
as they were not willing to continue in the study. One Results
subject was excluded due to her claim that lavender was
unpleasant. Intervention in the study group consisted of In the present study, 140 women who were hospitalized
inhalation of lavender essential (prepared from the leaves in the maternity unit were studied after delivery. The
of lavender plant) manufactured by Golkaran company background characteristics of both groups have been
(Kashan, Isfahan). Firstly, The mothers were trained presented in Table 1 (there was no significant difference
how to inhale the aroma, subsequently administered the in the background characteristics). Variance analysis
process once Under supervision of the researcher. In the results showed a significant difference in depression
study group, the subjects took three drops of lavender scores between the study and control groups at 2 weeks,
essential on their palms, rubbed them together three times 1 month, and 3 months after delivery (P < 0.0004).
a day (with an 8 h interval), and continued the intervention Mean score of depression was lower in the study
for 4 weeks after discharge from the hospital. The subjects group in different time points, compared to the control
were followed up through phone calls to find out if they did group (P < 0.0001) [Table 2]. Variance analysis results
the intervention and had no allergy to the lavender essential. showed a significant difference in the mean scores of anxiety
The subjects in both groups filled the Edinburg stress,
between the study and control groups at 2 weeks, 1 month,
anxiety, and depression scale and the 21‑item Depression,
and 3 months after delivery (P < 0.0001).
Anxiety, and Stress Scale (DASS‑21) questionnaire 2 weeks,
1 month, and 3 months after intervention. During the
Mean scores of anxiety were lower in the study group
follow‑up period, the women receiving high scores of stress,
in different time points, compared to the control
anxiety, and acute depression were excluded and referred
group (P < 0.0001) [Table 2]. Variance analysis results
to a psychiatrist. Data collection tools were demographic
showed a significant difference in the mean scores of
characteristics questionnaire and a checklist including
stress between the study and control groups at 2 weeks,
standard Edinburg test and DASS‑21. Edinburg standard
1 month, and 3 months after delivery (P < 0.0001).
test includes 10 four‑option questions, each scored between
It was less in the study group compared to control
0 and 3. Based on Edinburg questionnaire, the subjects
group (P < 0.0001) [Table 2]. As observed in Table 3,
with scores less than 13 were not depressed and those
Chi‑square test showed a significant difference in the
with scores equal to or higher than 13 were counted as
level of depression in the two groups of study and control
depressed. Edinburg 10‑item standard questionnaire was
at 2 weeks (P = 0.023), 1 month (P < 0.0001), and
designed by Cocks et al. in 1978 and has been frequently
3 months (P < 0.0001) after delivery.
adopted for diagnosis of depression. Its sensitivity and
specificity and prediction value have been confirmed in
Iran.[6] DASS‑21 standard scale of depression, anxiety, and Discussion
stress is a self‑reporting 21‑item questionnaire that is capable
of evaluating depression, anxiety, and stress concurrently. This study was conducted to investigate the effect
Each of the three subscales of depression, anxiety, and of lavender on the prevention of stress, anxiety, and
stress contains seven questions. The subjects’ score in each postpartum depression in women. The obtained results
subscale is calculated by adding up all subscale scores. In showed that mean differences of stress, anxiety, and
this questionnaire, the items are scored between 0 and 3. postpartum depression scores and incidences of their
DASS‑21 has been investigated in some studies; Among signs were significantly lower at the time point of 2 weeks
them is a study of Honari and Vekraford (2005), which was after delivery in the study group compared to the control
conducted with a large sample size in England (1794).[21] group. Mean differences in the scores of stress, anxiety,
and depression at time points of 1 month and 3 months
In their study, Cronbach alpha values for the scale overall after delivery were significantly different in the study and
and the three subscales of depression, anxiety, and stress control groups; therefore, aromatherapy with lavender had
were reported as 0.93%, 0.88%, 0.82%, and 0.90%, a positive effect on reducing their signs. Mean scores of
respectively. stress, anxiety, and postpartum depression had a higher
reduction in the study group compared to control at
Factor analysis also confirmed the subscales of depression, 2 months after the intervention, indicating the longevity
anxiety, and stress (each with seven items). Validity and of lavender aromatherapy effect. Mean differences in
Iranian Journal of Nursing and Midwifery Research | March-April 2016 | Vol. 21 | Issue 2 199
Kianpour, et al.: The effect of the fragrances lavender on the prevention of stress, anxiety and depression in the postpartum period
the scores of stress, anxiety, and postpartum depression through time in women after delivery. Therefore, although
were significantly different at 2 weeks, 1 month, and they normally decrease through time, this decrease was
3 months after delivery between the study and control higher with lavender aromatherapy, which prevents or
groups. Meanwhile, mean differences in the scores of reduces the complications resulting from stress, anxiety,
stress, anxiety, and postpartum depression were different and postpartum depression.
between the study and control groups at time points of
2 weeks, 1 month, and 3 months after delivery. So, the Our results are in line with Sahebalzamin et al., who
mean scores of stress and postpartum depression decreased reported a significant reduction of anxiety and depression
of the students residing in a hostel after lavender and
Table 1: Background characteristics of subjects in the study rose essential aromatherapy,[9] and Mirzaei et al., who
and control groups
reported a significant reduction in cortisol release from
Descriptive statistics Test Test Total P, t
the adrenal gland, an increase in serotonin secretion
No. (%) No. (%) No.(%)
from the digestive system, and reduction of anxiety level
Education
during delivery after aromatherapy with lavender.[16] Our
Under diploma 26 (44.1) 33 (55.9) 59 (100) P=0.599 obtained results are also consistent with the study results
t=1.873
Diploma 32 (55.2) 26 (44.8) 58 (100) of Imura et al. on the application of aromatherapy after
University education 12 (47.8) 11 (52.2) 23 (100) delivery, reporting an improvement in mothers’ and infants’
Delivery mode physical and psychological conditions as well as facilitation
Natural 29 (53.7) 25 (46.3) 54 (100) P=0.487 of maternal–infant interaction,[18] and Conrad and Adams
t=0.482 on the effect of inhalation and hand aromatherapies
Occupation with a combination of lavender and rose essentials, in
Homemaker 67 (50) 67 (50) 134(100) P=10.00 which hand massage aromatherapy was more effective.
Type of pregnancy
[15]
It should be noted that in all conducted researches,
Unwanted 8 (57.1) 6 (42.9) 14 (100) P=0.573 the goal was reduction of stress, anxiety, and diagnosed
t=0.317 depression, while the present study was conducted to
Child’s gender prevent these disorders and also investigate the longevity of
Unwanted 12 (46.2) 14 (53.8) 26 (100) P=0.664 aromatherapy, which had been ignored in previous studies.
t=0.189 The present study faced limitations such as studying the
Social satisfaction subjects immediately after delivery. Especially those who
None 4 (36.4) 7 (63.6) 11 (100) P=0.346 have underwent CS, were reluctant to fill the psychological
t=0.888 status questionnaire due to unappropriate physical and
Marital satisfaction psychological conditions. The questionnaires were not also
None 3 (37.5) 5 (62.5) 8 (100) P=0.466 completed before intervention. In order to overcome this
t=0.530
limitation and having two identical groups with regard to
Economic status satisfaction psychological conditions.
None 10 (55.6) 8 (44.4) 18 (100) P=0.614 • Conducting random sampling, meeting the inclusion
t=0.255
criteria, investigating any diagnosed incidence or history
Table 2: Comparison of mean and standard deviation (SD) of stress, anxiety, and depression scores between the two groups in
different time points
Time Group Stress Anxiety Depression
Mean (SD) P value* Mean (SD) P value, t Mean (SD) P value, t
Two weeks after intervention Study 5.31 (4.42) 0.012 2.19 (2.42) P=0.001 3.39 (2.78) P=0.003
t=−4.466 t=−3.587
Control 7.34 (5.16) 3.63 (3.88) 5.6 (4.37)
One month after intervention Study 4.10 (3.92) 0.001 1.27 (2.15) P=0.001 2.21 (2.4) P=0.001
t=26.274 t=−6.149
Control 7.59 (5.14) 4.46 (3.66) 5.73 (4.13)
Three months after intervention Study 3.81 (3.48) 0.001 1.23 (1.94) P=0.001 2.13 (2.44) P=0.001
t=−5.877 t=−5.287
Control 7.27 (5.11) 4.13 (3.43) 5.07 (3.97)
ANOVA significance level to investigate 0.001 0.001 0.001
the effect of time
ANOVA significance level to investigate 0.001 0.001 0.004
the effect of group
*Mann-Whitney test. SD: Standard deviation
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Kianpour, et al.: The effect of the fragrances lavender on the prevention of stress, anxiety and depression in the postpartum period
Table 3: Comparison of frequency distribution of depression 2005;32:11‑9.
between the two groups in different time points 4. Abedini Z, Soltani N, Mokhber N, Esmaeili H. Study of
Time Group No. (%) P value* posttraumatic stress disorder in women with preeclampsia in
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5. Azizi M, Lamyian M, Faghihzade S, Nematollahzade M. The
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*Chi‑square
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• Although the subjects were randomly selected and between breastfeeding and postpartum depressive symptoms
aromatherapy was conducted in two phases of “at appearing at 1‑5 months after delivery. J Affect Disord
2011;133:553‑9.
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subjects could be hospitalized on the beds next to each
Effects of inhalation aromatherapy on female students’ anxiety
other and could distinguish the difference between and depression settling in dormitory of Tehran University of
lavender essential from placebo making a bias in Medical Sciences. IAU-TMUJ 2010;20:175‑81.
the study, no intervention except routine care was 10. Santos IS, Matijasevich A, Tavares BF, da Cruz Lima AC,
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complementary method to prevent these disorders. 1st ed. Isfahan: Jahad Daneshgahi Publication; 2004. p. 51
13. Alavi Majd H, Sadr S, Taghizade S, Nahidi F. Effects of Omega‑3
Acknowledgment fatty acids on postpartum depression. IJOGI 2012;14:24‑31.
This article was derived from a master thesis of akram mansuori 14. Tiran D, Mack S. Complementary Therapies for Pregnancy and
with project number 392556 Isfahan University of Medical Childbirth. 1st ed. Kangash Publication; 2000. p. 176.
Sciences, Isfahan, Iran. We appreciate Clinical Research 15. Conrad P, Adams C. The effects of clinical aromatherapy for
Development Center of Charity Hospital Haji Karim Asli. We anxiety and depression in the high risk postpartum women ‑ a
pilot study. Complement Ther Clin Pract 2012;18:164‑8.
greatly appreciate the authorities of Isfahan University of Medical
16. Mirzaei F, Keshtgar S, Kaviani M, Rajaeifard A. The effect
Sciences and the staff of Asali Charity Hospital, as well as all those
of lavender essence smelling during labor on cortisol and
who helped us in this research (No. 392556).
serotonin plasma levels and anxiety reduction in Nulliparous
women. JKMU 2009;16:245‑54.
Financial support and sponsorship 17. Pemberton E, Turpin PG. The effect of essential oils on
Isfahan University of Medical Sciences, 392556 work‑related stress in intensive care unit nurses. Holist Nurs
Pract 2008;22:97‑102.
Conflicts of interest 18. Imura M, Misao H, Ushijima H. The psychological effects
of aromatherapy‑massage in healthy postpartum mothers.
There are no conflicts of interest.
J Midwifery Womens Health 2006;51:e21‑7.
19. Perry R, Terry R, Watson LK, Ernst E. Is lavender an anxiolytic
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