The effect of the two methods of massage and aromatherapy with salvia essence on labor pain severity in nulliparous women

Document Type : Original Article


1 M.Sc. student in Midwifery Education, Student Research Committee, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.

2 Instructor, Department of midwifery, Clinical Care Research Center, Research Institute for Health Development, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.

3 Assistant Professor, Department of Biostatistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

4 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.

5 Assistant Professor, Department of Midwifery, Clinical Care Research Center, Research Institute for Health Development, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.


Introduction: Despite many advances in midwifery, proper management of labor pain is still one of the major problems related to women's health. This study was performed with aim to compare the effect of the two methods of massage and aromatherapy with salvia essence on labor pain severity in nulliparous women.
Methods: This single-blind parallel randomized controlled clinical trial study was done in 2019 on 96 nulliparous pregnant women referred to the delivery ward of Besat hospital in Sanandaj. The subjects were randomly divided into three groups: aromatherapy and massage therapy with salvia essence and control. Data collection tools were a researcher made questionnaire and Numeric pain raiting scale. With the onset of dilatations of 4-5, 7-6 and 8-10 cm of the cervix and during contractions, in the aromatherapy group, a cloth soaked in 10 drops of salvia essence was used and massage with this essence was used in massage group for 20 minutes. Control group did not receive any intervention. Pain intensity was measured at the onset of dilatations and 20 minutes later in three groups. Data were analyzed using SPSS software (version 22) and Chi-square and analysis of variance for repeated measures tests. P<0.05 was considered statistically significant. 
Results: Mean pain intensity scores after the intervention in intervention groups in different dilatations of the cervix showed a significant difference with before intervention (P=0.001), but in the control group, this difference was not significant (P>0.05). Before intervention, there was no significant difference between two intervention groups with the control group in terms of the mean pain intensity scores in dilatations of 4-5 (P = 0.131), 6-7 (P = 0.05) and 8-10 cm of cervix (P= 0.243), but the difference was significant after the intervention (P=0.001) and this difference was not significant between the two intervention groups (P=0.917).
Conclusion: Massage and aromatherapy methods with saliva essence significantly reduced the mean severity of labor pain in various dilatations and as a nonpharmacological method of reducing labor pain is recommended to nulliparous women with the inclusion criteria of this study.


  1. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd New York: McGraw-Hill Education; 2018.
  2. Czech I, Fuchs P, Fuchs A, Lorek M, Tobolska-Lorek D, Drosdzol-Cop A, et al. Pharmacological and non-Pharmacological methods of labour Pain reliefe stablishment of effectiveness and comParison. International journal of environmental research and Public health 2018; 15(12):2792.
  3. Saxbe D, Rossin-Slater M, Goldenberg D. The transition to Parenthood as a critical window for adult health. American Psychologist 2018; 73(9):1190-200.
  4. Hajiamini Z, Masoud SN, Ebadi A, Mahboubh A, Matin AA. Comparing the effects of ice massage and acupressure on labor Pain reduction. Complementary Therapies in Clinical Practice 2012; 18(3):169-72.
  5. Nanji JA, Carvalho B. Pain management during labor and vaginal birth. Best Practice & Research Clinical Obstetrics & Gynaecology 2020:100-12.
  6. Maria I. Labour Pain and Pharmacological Pain relief Practice Points. Health science journal 2009; 3(4):197-201.
  7. NazarPoor S. Physiologic labor and non-Pain. Tehran: Golban; 2016.
  8. Fraser J, Kerr JR. Psychophysiological effects of back massage on elderly institutionalized p Journal of advanced nursing 1993; 18(2):238-45.
  9. Gönenç IM, terzioglu F. Effects of massage and acupressure on relieving labor pain, reducing labor time, and increasing delivery satisfaction. Journal of Nursing Research 2020; 28(1):e68.
  10. Ali SA, Ahmed HM. Effect of change in position and back massage on pain perception during first stage of labor. Pain Management Nursing 2018; 19(3):288-94.
  11. Khavandizadeh Aghdam S, Adib A, Kazemzedeh R. The effects of massage during labor on Pain and length of delivery in nulliparous women. Iran J Obstet Gynecol Infertil 2014; 16(83):15-20.
  12. Gallo RB, Santana LS, Ferreira CH, Marcolin AC, PoliNeto OB, Duarte G, et al. Massage reduced severity of pain during labour: a randomised trial. Journal of Physiotherapy 2013; 59(2):109-16.
  13. Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in Primiparous women: A systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iranian journal of nursing and midwifery research 2017; 22(4):257-61.
  14. Chen SF, Wang CH, Chan PT, Chiang HW, Hu TM, Tam KW, et al. Labour pain control by aromatherapy: A meta-analysis of randomised controlled trials. Women and Birth 2019; 32(4):327-35.
  15. Tanvisut R, Traisrisilp K, Tongsong T. Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial. Archives of gynecology and obstetrics 2018; 297(5):1145-50.
  16. Tabatabaeichehr M, Mortazavi H. The effectiveness of aromatherapy in the management of labor Pain and anxiety: A systematic review. Ethiopian journal of health sciences 2020; 30(3):448-58.
  17. Jolaei Rad N, Salehi Moghaddam F. Nausea and vomiting pregnancy and Aromatherap Tehran: Golban; 2014.
  18. Bahraini S, Naji A, Mannani R. Effects of aromatherapy and its app Nursing And Midwifery Journal 2011; 9(1):1-8.
  19. Cho MY, Min ES, Hur MH, Lee MS. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention Patients in intensive care units. Evidence-Based Complementary and Alternative Medicine 2013; 2013:1-6.
  20. Vakilian K, Karamat A, Mousavi A, Shariati M, Ajami E, Atarha M. The effect of Lavender essence via inhalation method on labor pain. Journal of Shahrekord University of Medical Sciences 2012; 14(1):34-40.
  21. Ozgoli G, Aryamanesh Z, Mojab F, Alavi Majd H. A study of inhalation of peppermint aroma on the Pain and anxiety of the first stage of labor in nulliparous women: a randomized clinical trial. Qom University of Medical Sciences Journal 2013; 7(3):21-27
  22. Hur MH, Cheong NY, Yun HS, Lee MK, Song Y. Effects of delivery nursing care using essential oils on delivery stress response, anxiety during labor, and postpartum status anxiety. Journal of Korean Academy of Nursing 2005; 35(7):1277-84.
  23. Kaviani M, Maghbool S, Azima S, Tabaei MH. Comparison of the effect of aromatherapy with Jasminum officinale and Salvia officinale on Pain severity and labor outcome in nulliparous women. Iranian journal of nursing and midwifery research 2014; 19(6):666-72.
  24. Eidi A. Antinociceptive effects of ethanolic extract of salvia aethiopis in NMRI mice. Armaghane danesh 2014; 19(1):24-35.
  25. Rahimi F, Ahmadi M, Rosta F, Alavimajd H, Valiani M. Investigating the effect of progressive muscle relaxation training on infants outcome in high risk pregnant women. scientific journal of ilam university of medical sciences 2018; 25(6):10-20.
  26. Heydarpour S, Sharifipour F, Salari N. Effect of aromatherapy using Salvia officinalis on sleep quality of postmenopausal women. Iran J Obstet Gynecol Infertil 2020; 23(3):50-7.
  27. Ghorbani A, Esmaeilizadeh M. Pharmacological properties of Salvia officinalis and its comp Journal of traditional and complementary medicine 2017; 7(4):433-40.
  28. Akbarzadeh Pasha H. Comprehensive clinical culture of herbal medicine: Iran, Indochina, Europe and America. Tehran: Golban; 2012.
  29. Alavi Fili A, Askari M, Vahhabi S, Bagheri P, Dashtinejhad E. Comparison of effect of massage therapy with jasmine oil and aroma therapy with jasmine oil in reducing delivery p Iran J Obstet Gynecol Infertil 2017; 20(3):40-7.
  30. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain 2011; 152(10):2399-404.
  31. Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic p Acta dermato-venereologica 2012; 92(5):502-7.
  32. Nasiriani K, Kahdoui S, Nasrabadi SN. Psychometric properties of pain Intensity Scales in Isfahanian Geriatric pop Elderly Health Journal 2019 ;5(1):47-52.
  33. Burns EE, Blamey C, Ersser SJ, Barnetson L, Lloyd AJ. An investigation into the use of aromatherapy in intrapartum midwifery p The Journal of Alternative and Complementary Medicine 2000; 6(2):141-7.
  34. Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology 2007; 114(7):838-44.
  35. Sharifipour F, Mirmohammad Ali M, Hashemzadeh M. Comparison of the effect of Citrus arantium and Salvia officinalis aroma on post-cesarean section p Iran J Obstet Gynecol Infertil 2017; 20(2):41-9.
  36. Roberts CL, Raynes-Greenow CH, Nassar N, Trevena L, McCaffery K. Protocol for a randomised controlled trial of a decision aid for the management of pain in labour and childbirth [ISRCTN52287533]. BMC Pregnancy and Childbirth 2004; 4(1):1-9.
  37. Azizi M, Yousefzadeh S, Rakhshandeh H, Behnam HR, Mirteymouri M. The Effect of Back Massage with and without Ginger Oil on the pain Intensity in the Active phase of Labor in primiparous Women. Journal of Midwifery and Reproductive Health 2020; 8(1):2033-40.
  38. Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain 2007; 127(3):214-20.
  39. Sriasih NG, Hadi MC, Suindri NN, Surati GA, Mahayati NM. The effect of massage therapy using frangipani aromatherapy oil to reduce the childbirth pain i International journal of theraPeutic massage & bodywork 2019; 12(2):18-24.
  40. Smith CA, Collins CT, Crowther CA. AromatheraPy for pain management in labour. Cochrane Database Syst Rev 2011(7).
  41. Hejazi SH, Shirani-Bidabadi L, Zolfaghari-Baghbaderani A, Saberi SE, Nilforoushzadeh MA, Moradi SH, et al. Comparison effectiveness of extracts of Thyme, Yarrow, Henna and Garlic on cutaneous leishmaniasis caused by L. major in animal model (Balb/c). Journal of Medicinal Plants 2009; 8(30):129-60.
  42. Khodakarami N, Safarzadeh A, Fathizadeh N. Effect of massage therapy on pain severity and labor of PrimiPara women. Iranian Journal of Nursing and Midwifery Research 2010; 10(3).
  43. Evans M. Postdates pregnancy and complementary therap Complementary therapies in clinical practice 2009; 15(4):220-4.
  44. Suija K, Rajala U, Jokelainen J, Liukkonen T, Härkönen P, Keinänen-Kiukaanniemi S, et al. Validation of the Whooley questions and the Beck Depression Inventory in older adults. Scandinavian journal of primary health care 2012; 30(4):259-64.
  45. Mora S, Millán R, Lungenstrass H, Díaz-Véliz G, Morán JA, Herrera-Ruiz M, et al. The hydroalcoholic extract of Salvia elegans induces anxiolytic-and antidepressant-like effects in rats. Journal of ethnopharmacology 2006; 106(1):76-81.