Comparison of the Effect of Chamomile Matricaria and Mefenamic Acid capsules on postpartum hemorrhage in women with postpartum Pain

Document Type : Original Article


1 Instructor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

2 M.Sc. Student of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate Professor, Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Professor, Department of Biostatistics, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Assistant Professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Postpartum hemorrhage is one the most common causes of maternal mortality in the world. Nonsteroidal anti-inflammatory drugs which are routinely used for postpartum pain, due to inhibitory effect on cyclooxygenase 1 pathway leads to increasing the volume of postpartum hemorrhage. Therefore, this study was performed with aim to compare the effect of chamomile capsule and mefenamic acid on postpartum hemorrhage in women with postpartum pain.
Methods: This double-blind clinical trial study was performed on 70 multiparous women with vaginal delivery. At the end of the third stage of labor and uterine compress, within 2 to 4 hours after delivery, if the subjects had pain scores of≥ 40 mm based on analog scale pain were randomly divided into two groups: A (250 mg mefenamic acid) and B (1000 mg chamomile capsule); then, bleeding was hourly measured up to 6 hours. Data collection tools were Pain Visual Analogue Scales (VAS), Digital scale and questionnaire, observation forms. Data were analyzed using SPSS software (version 16) and Chi-square, Fisher, independent t-test, Mann-Whitney tests and repeated measures test. PResults: The bleeding rate decreased after invention in both groups, but there was no significant difference between two groups (P>0.05). The bleeding rate in first (P=0.38), second (P=0.46), third (P=0.47), fourth (P=0.19), and fifth (P=0.15) hour was llower in chamomile group than mefnamic acid group, but the difference was not significant. The bleeding rate in the sixth hour was more in chamomile group than mefnamic acid group, but the difference was not significant (P=0.97).
Conclusion: Chamomile and mefnamic acid capsules both have the same effect on postpartum hemorrhage in women with postpartum pain, but Chamomile is most effective than mefnamic acid in reducing postpartum pain. Chamomile is a suitable alternative to mefnamic acid for reducing postpartum pain in women with postpartum pain.


  1. Kuhn KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367(9516):1066-74.
  2. Scott JR. Clinical obstetrics and gynecology. Philadelphia: Lippincott Williams & Wilkins; 2002. P. 330-40.
  3. Kordi M, Rashidi Fakari F, Mazlom SR, Khadivzadeh T, Akhlaghi F. Comparison between the efficacy of web-based, simulation and conventional training on knowledge and skills retention of midwifery students in management of postpartum hemorrhage. Iran J Obestet Gynecol Infertil 2014; 16(89):8-14. (Persian).
  4. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
  5. Gharekhani P, Sadatian SA. Principles of pregnancy and Obstetrics (CMMD). 2nd ed. Tehran: Sahreab, Ayandesazan; 2005. (Persian).
  6. Tara F, Davoodi R, Saghafi N, Mirteimouri M, Ghooshkhanei, Soltanifar A, et al. Management of post-partum hemorrhage (Clinical Guideline). Iran J Obestet Gynecol Infertil 2013; 16(62):11-7. (Persian).
  7. Ward EM, Dick J, Greenweell S, Sullivan E, Verma R, Whitaker DK. Management of anaesthesia for Jehovah’s witnesses. 2nd ed. London: The Association of Anaesthetists of Great Britain and Ireland; 2005.
  8. Fuentes A, Rojas A, Porter KB, Saviello G, O'Brien WF. The effect of magnesium sulfate on bleeding time in pregnancy. Am J Obstet Gynecol 1995; 173(4):1246-9.
  9. Ramanathan G, Arulkumaran S. Postpartum hemorrhage. J Obstet Gynaecol Can 2006; 28(11):967–73.
  10. Pourmaleky S, Najar S, Montazery S, Haghighizadeh MH. Comparison between the effects of Zintoma (Ginger) and Mefenamic acid on after pain during postpartum in multiparous women. Iran J Obestet Gynecol Infertil 2013; 16(79):18-25. (Persian).
  11. Deussen AR, Ashwood P, Matis R. Analgesia for relief of pain due to uterin cramping/involution after birth. Cochrane Database Syst Rev 2011; 5:CD004908.
  12. Roberts LJ, Morrow JD. Analgesic–antipyretic and anti–inflammatory agents and drugs employed in treatment of gout. In: Hardman JG, Limbird LE, editors. The pharmacologic basis of therapeutics. 10th ed. New York: McGraw Hill; 2001; P. 687-715.
  13. Huang YC, Tsai SK, Huang CH, Wang MH, Lin PL, Chen LK, et al. Intravenous tenoxicam reduces uterine cramps after cesarean delivery. Can J Anesth 2002; 49(4):384-7.
  14. Yaghmaei M, Mokhtari M, Mohammadi M. The comparison of the therapeutic effect of Mefenamic acid and Mefenamic acid plus vitamin E on severity of pain in primary dysmenorrhea. J Reprod Infertil 2005; 6(2):187-93 (Persian).
  15. Jahan M, Koocheki A. Effect of organic production of german chamomile (Maricaria chamomilla L.) on it is chemical composition. Pajouhesh Sazandegi 2004; 61:87-95.
  16. Vahidi A, Dashti M. A comparison between the analgesic effect of chamomile extract and morphine in Syrian mice. J Ardabil Univ Med Sci 2007; 7(4):409-17.
  17. Masoumi AY, Abbasnejad M, Derakhshanfar A, Esmaeilpour BK, Mostafavi SA. Effect of Matricaria recutita L. aqueous extract on acetic acid-induced ulcerative colitis in adult male rats. Physiol Pharmacol 2010; 14(3):268-80.
  18. Vahidi A, Dashti MH, Jamaladdini SH. Antinociceptive effect of chamomill on formalin induced pain in rat. J Shahid Sadoughi Univ Med Sci Health Ser 2001; 9(2):60-5. (Persian).
  19. Stokker K. Remedies and rituals: folk medicine in Norway and the New Land. St Paul, US: Minnesota Historical Society; 2007. P. 26.
  20. Srivastava JK, Pandey M, Gupta S. Chamomile, a novel and selective cox-2 inhibitor with anti-inflammatory activity. Life Sci 2009; 85(19):663-9.
  21. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea (Matricaria recutita L.). Phytother Res 2006; 20(7):519-30.
  22. Pirre S, Crosbie L, Duttaroy AK. Inhibitory effect of aqueous extracts of some herbs on human platelet aggregation in vitro. Platelets 2005; 16(8):469–73.
  23. Yazdani M, Shahrani M, Hamedi B. Comparison of Fennel and Chamomile extract and placebo in treatment of premenstrual syndrome and dysmenorrheal. Bim J Hormozgan Univ Med Sci 2004; 8(1):57-61. (Persian).
  24. Modarres M, Mirmohhamad AM, Oshrieh Z, Mehran A. Comparison of the effect of mefnamic acid and matricaria chamomile capsules on primary dysmenorrhea. J Babol Univ Med Sci 2011; 13(3):50-8. (Persian).
  25. Karimian Z, Sadat Z, Bahrami N, Kafaie M. Comparison of chamomile and mefnamic acid capsules in hemorrhage of menstruation. Iran J Obestet Gynecol Infertil 2015; 18(157):11-7. (Persian).
  26. Baharara J, Rostampour VM. Evaluation of tratogenic effects of matricaria chammomilla in Balb/C mouse. Iran J Obestet Gynecol Infertil 2006; 9(2):33-8. (Persian).
  27. Saeedi M, Azadbakht M, Semnani K, Khandan M. Formulation of herbal toothpaste from chamomile and myrrh, a preliminary clinical evaluation on bleeding gum. J Mazandaran Univ Med Sci 2003; 13(40):61-9.
  28. Sadighara P, Barin A, Jahed G, Farjadmand F. Assessment of antioxidantcapacity and anti-inflammatory of alcoholic extraction of chamomile morus marshmallow borage and rosemary. Knowledge Health 2013; 8(1):31-4. (Persian).
  29. Tafazoli M, Khadem Ahmadabadi M, Asili J, Esmaeili H. Comparison of the effect of cuminum and mefnamic acid on after pains in multiparous women. Iran J Obestet Gynecol Infertil 2013; 16(75):1-11. (Persian).
  30. Mills S, Bone K. The essential guide to herbal safety. New York: Elsevier Churchill Livingstone; 2005. P. 52.
  31. Hammod N, Latifnegad R, Khadem N, Hadad MN, Mazlum SR. Comparison of date and oxytocin in the management of postpartum hemorrhage. [Master Thesis]. Mashhad, Iran: Nursing and Midwifery School, Mashhad University of Medical Sciences; 2000. (Persian).
  32. Mahdavian M, Golmakani N, Manssori A, Hosseinzade H, Afzalaghaee M. An investigation of effectiveness of oral dill extracts on postpartum hemorrhage. Iran J Obestet Gynecol Infertil 2001; 4(7-8):19-25. (Persian).
  33. Mesgarpour B. A comprehensive textbook of drug information. 2nd ed. Tehran: Teimourzadeh Press; 2008.
  34. Jenabi E, Ebrahimzadeh S. Chamomile tea for relief of primary dysmenorrhea. Iran J Obstet Gynecol Infertil 2010; 13(1):39-42. (Persian).
  35. Emami A, Faseehy S, Mehregan E. Handbook of medicinal herbs Institute of Historical medicine studies Islamic and Complementary Medicine Iran University of Medical sciences. 1st ed. Tehran: Aaj Publication; 2010; 863-7. (Persian).