Effects of Citrus aurantium aroma on post-cesarean anxiety

Document Type : Original Article


1 MSc. of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.

2 Instructor, Department of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.

3 Instructor, Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.


Introduction: Today, cesarean section has been regarded as one of the most common gynecological surgeries. Post-cesarean anxiety is associated with reduced resistance against infections, increased use of analgesics, and delayed wound healing. So, management of post-cesarean anxiety is very important for maternal health and newborn care and breastfeeding. This study was performed with aim to evaluate the effect of Citrus aurantium aroma on post-cesareananxiety.
Methods: This two-group randomized clinical trial study was performed on 80 pregnant women referred to Kermanshah Motazedi Hospital for cesarean in 2014. In intervention group, aromatherapy with 3 drops of citrus aurantium essence was performed immediately after pain onset and 12 hours later, and in control group, aromatherapy using normal saline was performed in the same way. Level of anxiety was evaluated using STAI[1] scale before and half hour after the both interventions. Data was analyzed using SPSS software (Version 18), and Fisher-test, chi-square, independent t-test, Repeated Measurement-test, and paired t-test. P< 0.05 was considered statistically significant.
Results: The mean of anxiety before the intervention was 62.2± 5.617 in intervention group and 62.48±5.67 in control group that was not statistically significant. After the intervention, mean of anxiety immediately after the onset of pain (first stage of intervention) in intervention group was 44.25± 7.8 and 12 hours later (second stage of intervention) 29.15±  5.54 that compared with control group in the first stage of intervention was 60.23± 5.37 and the second stage of intervention 49.02± 4.64, was significantly reduced (P<0.001).
Conclusion: According to effectiveness of Citrus aurantium aroma in reducing anxiety in women after cesarean, it can be optimized as a method used in post-caesarean section. In addition to cost-effectiveness and easy access, the mother's complications caused by anxiety can be reduced.


  1. Baricevic D, Sosa S, Della Loggia R, TubaroA, Simonovska B, Krasna A, et al. Topical anti-inflammatory activity of Salvia officinalis L. leaves: the relevance of ursolic acid. J Ethnopharmacol 2001; 75(2):125–32.
  2. Gibbons L, Belizan JM, Lauer JA, Betran AP, Meriald M, Althabe F. The global numbers and cost of additionally needed and unnecessary cesarean section performed per year: Overuse as a barrier to univrsal coverage. World Health Re 2010; 30:1-31.
  3. Latifi S, Rabiee OL, Saifi S. The effect of hand and foot massage on post-cesareansection. Anesthesiol Pain Med J 2012; 2(7):102-7. (Persian).
  4. Miller R. Anesthesia. 6th ed. Philadelphia: Churchill Livingstone; 2005. P. 379-430.
  5. Shafiei Z, Babaee S, Nazari A. The effectiveness of massage therapy on depression, anxiety and stress of patients after coronary artery bypass graft surgery. J Surg Iran 2013; 21(1):120-4.
  6. Bailey L. Strategies for decreasing patient anxiety in the perioperative setting. AORN J 2013; 92(4):445-57.
  7. Rahmanpoor H, Hosseini SN, Mosavinasab SN, Tadayon P, Karimi F. Comparison of diclofenac with pethidine on the pain after cesarean section. Int J Pharmacol 2007; 3:201-3.
  8. Sobhani A, Sepehri J. Pharmacology for nursing, midwifery and health care and operating room. 17th Congress of Iranian Society for Reproductive Medicine. Tehran: Iran; 2012.
  9. Marcus SM. Depression during pregnancy: rates, risks and consequences—Motherisk Update 2008. Can J Clin Pharmacol 2009; 16(1):e15-22.
  10. Ebrahimi Hoshyar A, Rezai HH, Jahani Y, Kazemi M , Monfared S. Comparison of two methods of aromatherapy with lavender essence and Transcutaneous Electrical Nerve Stimulation (TENS) on cesarean postoperative pain. Iran J Obstet Gynecol Infertil 2015; 18(146):6-12. (Persian).
  11. Khoshtarash M, Ghanbari A, Yegane M, Kazemnejhad E, Rezasoltani P, Massahnia S. Effects of foot reflexology on pain and physiological parameters after cesarean section. Koomesh 2012; 14(1):109-16.
  12. Olapour A, Behaeen K, Akhondzadeh R, Soltani F, Al Sadat Razavi F, Bekhradi R. The effect of inhalation of aromatherapy blend containing lavender essential oil on cesarean postoperative pain. Anesth Pain Med 2013; 3(1):203-7.
  13. Kim YJ, Lee MS, Yang YS, Hur MH. Self-aromatherapy massage of the abdomen for the reduction of menstrual pain and anxiety during menstruation in nurse: a placebo-controlled clinical trial. Eur J Integrat Med 2011; 3(3):165–8.
  14. 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. Evid Based Complement Alternat Med 2013; 2013:1-6.
  15. Wolfgang S, Michaela S. Clinical aromatherapy. J Men Health 2008; 5:74-85.
  16. Abbasnejad M, Keramat B, Mahani E, Rezaeezade-Roukerd M. Effect of hydro-methanolic extract of sour orange flowers, citrus aurantium on pentylentetrazole induced seizure in male rats. J Babol Univ Med Sci 2012; 14(5):20-8.
  17. Zargari A. Medicinal plants. 7th ed. Tehran: University of Tehran Press; 2005. P. 483-5.
  18. Shabanian G, Pooria Mofread A, Akhlaghi M. Comparison of Citrus (Citrus aurantium) and diyazpam in reducing anxiety before surgery. J Shahrekord Univ Med Sci 2008; 4:13-8. (Persian).
  19. Pultrini Ade M, Galindo LA, Costa M. Effects of the essential oil from Citrus aurantium L. in experimental anxiety models in mice. Life Sci 2006; 78(15):1720–5.
  20.  Babashahi M, Fayazi S, Aghel N, Haghighizadeh MH. Effect of aromatherapy on anxiety level among preoperative patients. Jundishapur Sci Med J 2010; 9(5):507-16.
  21. Namazi M, Amirali Akbari S, Mojab F, Talebi A, Alavi Majd H, Jannesari S. The effect of Citrus Aurantium (Bitter Orange) on severity of first-stage labor pain. Iran J Obstet Gynecol Infertil 2014; 17(111):12-9. (Persian).
  22. Spielberger CD. STAI manual for the state-trait anxiety inventory. California: Palo Alto, Consulting Psychologist Press Inc; 1983.
  23. Good M, Stiller C, Zauszniewski JA, Anderson GC, Stanton-Hicks M, Grass JA. Seneation and Distress of Pain Scales: reliability validity and sensitivity. J Nurs Meas 2001; 9(3):219-38.
  24. Abrosh Z, Rezai M, Ashrafi F. Effect of antibacterial activity of Salvia officinalis essence. J Med Aromatic Plants 2004; 20(4):457-68.
  25. Mohseni M, Ibn al-Shahidi A, Yazdkhasti P. Effect of music on pain, anxiety and hemodynamic of patients in post-cesareanpain and vital signs. J Anesthesiol Pain 2013; 2(7):88-94.
  26. Lehrner J, Eckersberger C, Walla P, Potsch G, Deecke L. Ambient odor of orange in a dental office reduces anxiety and improves mood in female patients. Physiol Behav 2000; 71(1-2):83-6.
  27. Graham PH, Browne L, Cox H, Graham J. Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 2003; 21(12):2372-6.
  28. Mahmoodi M, Shamsi Meimandi M, Foroumadi AR, Raftari S, Asadi Shekari M. Antidepressant effect of sour orange flowers extract on lipopolysaccharide. J Kerman Univ of Med Sci 2005; 4(12):244-51.
  29. Hwang JH. The effects of the inhalation method using essential oils on blood pressure and stress responses of clients with essential hypertension. Taehan Kanho Hakhoe Chi 2006; 36(7):1123-34.
  30. Akhlaghi M, Shabanian G, Rafieia-Kopaei M, Parvin N, Saadat M, Akhlaghi M. Citrus aurantium blossom and preoperative anxiety. Rev Bras Anestesiol 2011; 61(6):702-12.

Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy-massage in healthy postpartum mothers. J Midwifery Womens Health 2006; 51(2):e21-7.