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© 2016 Iranian Journal of Nursing and Midwifery Research | Published by Wolters Kluwer - Medknow 197
Effect of lavender scent inhalation on prevention of
stress, anxiety and depression in the postpartum period
Maryam Kianpour1, Akram Mansouri1, Tayebeh Mehrabi2, Gholamreza Asghari3
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 specic
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 signicance 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 signicantly 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
1Nursing and Midwifery Care Research Center, Faculty of Nursing
and Midwifery, Isfahan University of Medical Sciences, Isfahan,
Iran, 2Student Research Center, Faculty of Nursing and Midwifery,
Isfahan University of Medical Sciences, Isfahan, Iran, 3Student
Research Center, School of Pharmacy, Isfahan University of Medical
Sciences, Isfahan, Iran
Address for correspondence: Ms. Maryam Kianpour,
Nursing and Midwifery Care Research Center, School of Nursing
and Midwifery, Isfahan University of Medical Sciences,
Isfahan, Iran.
E‑mail: kianpour@mail.mui.ac.ir
Submitted: 21‑Nov‑14; Accepted: 20‑Sep‑15
IntroductIon
Pregnancy and delivery are pleasant physiological
phenomena, but at times, changes occur in pregnant
women’s mood that make them so sensitive
Original Article
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DOI:
10.4103/1735-9066.178248
How to cite: Kianpour M, Mansouri A, Mehrabi T, Asghari G. Effect
of lavender scent inhalation on prevention of stress, anxiety and
depression in the postpartum period. Iranian J Nursing Midwifery
Res 2016;21:197-201.
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to psychological stimulants and lead to their mental
problems.[1,2] After delivery, women start losing self‑control
on the events and feel helpless, and are involved in
confusion and manifest signs such as depression, anxiety,
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
influences 5–20% of the mothers.[5] Eventually Postpartum
depression (with a variant prevalence of 5–40% in different
societies) accounts for 12.5% of the women’s hospital
admissions due to psychological problems.[6] Postpartum
depression is among the most important complications
of postpartum stress, which increases mothers’ and
infants’ vulnerability.[4] Stress can lead to anxiety which
is a mental reaction to a real or mentally made threat.
Lack of sleep, poor nutrition, high consumption of
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Kianpour, et al.: The eect of the fragrances lavender on the prevenon of stress, anxiety and depression in the postpartum period
caffeine, smoking, and physical diseases are among the
manifestations of anxiety.[7] Anxiety in mothers decreases
oxytocin secretion and milk production. A study in Japan
showed that postpartum anxiety and depression led to
lower self‑confidence and, consequently, decreased breast
feeding.[8] Although minor anxiety can somehow encourage
the individuals to take charge of their responsibility properly
or to learn how to modify their lifestyle and habits, severe
anxiety can be very disabling. Anxiety increasing as much
as a panic disorder can cause disability.[9] Postpartum
depression can have negative effects on mothers’ role
and, in some cases, impair maternal interest to infant and
family members. As birth is considered a pleasant event,
mothers’ mental suffering can be very confusing for the
family members. It also negatively affects their sexual desire
and, consequently, their marital relationship. Postpartum
depression is a major health problem that impairs healthy
mother–infant relationship.[10] If not treated, depression
gradually subsides normally 6 months after delivery, while a
longer period of time increases the number of complications
and their severity.[11] The first step in treatment of such
disorders is prevention. Recent studies show that treatment
interventions before and after delivery act very successfully
in reduction of risk among the women with severe
delivery‑related disorders.
Preventive treatments during delivery and immediately
after that include supportive psychotherapy, interpersonal
psychotherapy, and medication. Prophylactic medication
is recommended for high‑risk mothers immediately after
delivery.[12] Since use of psychotropic drugs by breast
feeding mothers causes problems such as severe drowsiness
and diminished response of mothers to the cries of infants
during sleep, changes in sexual function, fatigue, changes
in role, confusion, hypotension, tachycardia, etc., and also
due to their tranquilizing effect on the infant through the
milk they receive, these medications are limited during
breast feeding.[13] Research shows that one of the existing
treatments to reduce stress, anxiety, and depression is
aromatherapy.[14,15] Sahebalzamin et al. reported that
aromatherapy inhalation of lavender and rose essence
combination significantly decreased the level of anxiety
and depression among the students residing in hostels.[9]
A significant decrease in cortisol release from the adrenal
gland, a significant increase in secretion of serotonin from
the digestive system, and a significant reduction of anxiety
during delivery have been all reported after inhalation of
lavender in Mirzaei et al. ’s study.[16] Pemberton and Turpin
reported the effect of lavender and sage on the reduction of
stress resulting from working in ICU among the nurses.[17]
There are some studies on aromatherapy in postpartum
period, including Imura et al. in which mothers’ and infants’
physical and mental status improvement and facilitation of
mother–infant interaction have been reported.[18] Conrad
and Adams conducted a comparative study on the effects of
inhalation and massage aromatherapy using a combination
of lavender rose essentials and reported that both methods
significantly reduced depression and anxiety although
massage aromatherapy was more effective.[15] One of the
scented essential oils used in aromatherapy is lavender
oil. Its scientific name is Lavandula angustifolia from the
group of mints with the English name of lavender. Among
the effective ingredients is a combination of linalool and
linalyl acetate. Linalool acts as a tranquilizer by affecting
aminobutyric acid receptors in the central nervous
system.[19] Oil essence of this plant contains phenol aldehyde
or alcohol with the highest germicidal effect.[20] With regard
to the high prevalence of stress, anxiety, and postpartum
depression and lack of adequate research on the effect of
inhalation aromatherapy on prevention of stress, anxiety,
and postpartum depression, the present study aimed to
investigate the effect of lavender on the prevention of stress,
anxiety, and postpartum depression in women.
MAterIAls And Methods
This is a clinical trial (No. 392556) that was conducted
after obtaining permission from the ethics committee of
Isfahan and Lorestan universities of medical sciences. In
this study (2014), 171 women hospitalized in the midwifery
and gynecology ward of Charity Hospital of Asali in
Khorramabad, Iran were selected through convenient
sampling based on the inclusion criteria after delivery and
they were explained about Golkaran the goals of study
and asked to sign a written consent form. Inclusion criteria
were being literate, having Iranian nationality, a single
tone pregnancy, termination of pregnancy between 37
and 42 weeks of gestational age, birth of a healthy infant,
no postpartum complications such as acute hemorrhage
and infection, no maternal problems such as preeclampsia
during their current pregnancy, no congenital abnormality in
infants or not being hospitalized in ICU, no drugs or alcohol
consumption by the mother, mother not being affected by
known chronic or systemic diseases, no consumption of
anti‑depressant, anti‑anxiety, or anti‑stress medications
in their recent pregnancy, no history of asthma, allergy,
or dermatitis diagnosed by a physician, no history of
eczema and allergy to flowers and plants diagnosed by a
physician, and no disorder in olfactory sense. Exclusion
criterion was appearance of signs of allergy to lavender
essential in the subjects or their family members. Firstly,
the subjects’ background characteristics questionnaire
was filled. Then, the subjects were randomly assigned
to study (aromatherapy) and control (no aromatherapy)
groups by picking up the cards of the related groups.
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Kianpour, et al.: The eect of the fragrances lavender on the prevenon of stress, anxiety and depression in the postpartum period
One subject in the aromatherapy group in the first stage of
sampling and two subjects in the control group (one in the
first stage and the other in the second stage of sampling)
were left out of the study as they developed acute anxiety.
Also, 27 subjects were excluded in the first stage of sampling
as they were not willing to continue in the study. One
subject was excluded due to her claim that lavender was
unpleasant. Intervention in the study group consisted of
inhalation of lavender essential (prepared from the leaves
of lavender plant) manufactured by Golkaran company
(Kashan, Isfahan). Firstly, The mothers were trained
how to inhale the aroma, subsequently administered the
process once Under supervision of the researcher. In the
study group, the subjects took three drops of lavender
essential on their palms, rubbed them together three times
a day (with an 8 h interval), and continued the intervention
for 4 weeks after discharge from the hospital. The subjects
were followed up through phone calls to find out if they did
the intervention and had no allergy to the lavender essential.
The subjects in both groups filled the Edinburg stress,
anxiety, and depression scale and the 21‑item Depression,
Anxiety, and Stress Scale (DASS‑21) questionnaire 2 weeks,
1 month, and 3 months after intervention. During the
follow‑up period, the women receiving high scores of stress,
anxiety, and acute depression were excluded and referred
to a psychiatrist. Data collection tools were demographic
characteristics questionnaire and a checklist including
standard Edinburg test and DASS‑21. Edinburg standard
test includes 10 four‑option questions, each scored between
0 and 3. Based on Edinburg questionnaire, the subjects
with scores less than 13 were not depressed and those
with scores equal to or higher than 13 were counted as
depressed. Edinburg 10‑item standard questionnaire was
designed by Cocks et al. in 1978 and has been frequently
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
stress is a self‑reporting 21‑item questionnaire that is capable
of evaluating depression, anxiety, and stress concurrently.
Each of the three subscales of depression, anxiety, and
stress contains seven questions. The subjects’ score in each
subscale is calculated by adding up all subscale scores. In
this questionnaire, the items are scored between 0 and 3.
DASS‑21 has been investigated in some studies; Among
them is a study of Honari and Vekraford (2005), which was
conducted with a large sample size in England (1794).[21]
In their study, Cronbach alpha values for the scale overall
and the three subscales of depression, anxiety, and stress
were reported as 0.93%, 0.88%, 0.82%, and 0.90%,
respectively.
Factor analysis also confirmed the subscales of depression,
anxiety, and stress (each with seven items). Validity and
reliability of DASS‑21 have been frequently investigated
and established.[22] The resultant data of study were
analayzed by SPSS19, ANOVA, Mann–Whitney, t‑test, and
post hoc tests. P < 0.05 was considered significant.
results
In the present study, 140 women who were hospitalized
in the maternity unit were studied after delivery. The
background characteristics of both groups have been
presented in Table 1 (there was no significant difference
in the background characteristics). Variance analysis
results showed a significant difference in depression
scores between the study and control groups at 2 weeks,
1 month, and 3 months after delivery (P < 0.0004).
Mean score of depression was lower in the study
group in different time points, compared to the control
group (P < 0.0001) [Table 2]. Variance analysis results
showed a significant difference in the mean scores of anxiety
between the study and control groups at 2 weeks, 1 month,
and 3 months after delivery (P < 0.0001).
Mean scores of anxiety were lower in the study group
in different time points, compared to the control
group (P < 0.0001) [Table 2]. Variance analysis results
showed a significant difference in the mean scores of
stress between the study and control groups at 2 weeks,
1 month, and 3 months after delivery (P < 0.0001).
It was less in the study group compared to control
group (P < 0.0001) [Table 2]. As observed in Table 3,
Chi‑square test showed a significant difference in the
level of depression in the two groups of study and control
at 2 weeks (P = 0.023), 1 month (P < 0.0001), and
3 months (P < 0.0001) after delivery.
dIscussIon
This study was conducted to investigate the effect
of lavender on the prevention of stress, anxiety, and
postpartum depression in women. The obtained results
showed that mean differences of stress, anxiety, and
postpartum depression scores and incidences of their
signs were significantly lower at the time point of 2 weeks
after delivery in the study group compared to the control
group. Mean differences in the scores of stress, anxiety,
and depression at time points of 1 month and 3 months
after delivery were significantly different in the study and
control groups; therefore, aromatherapy with lavender had
a positive effect on reducing their signs. Mean scores of
stress, anxiety, and postpartum depression had a higher
reduction in the study group compared to control at
2 months after the intervention, indicating the longevity
of lavender aromatherapy effect. Mean differences in
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Iranian Journal of Nursing and Midwifery Research | March-April 2016 | Vol. 21 | Issue 2 200
Kianpour, et al.: The eect of the fragrances lavender on the prevenon of stress, anxiety and depression in the postpartum period
the scores of stress, anxiety, and postpartum depression
were significantly different at 2 weeks, 1 month, and
3 months after delivery between the study and control
groups. Meanwhile, mean differences in the scores of
stress, anxiety, and postpartum depression were different
between the study and control groups at time points of
2 weeks, 1 month, and 3 months after delivery. So, the
mean scores of stress and postpartum depression decreased
through time in women after delivery. Therefore, although
they normally decrease through time, this decrease was
higher with lavender aromatherapy, which prevents or
reduces the complications resulting from stress, anxiety,
and postpartum depression.
Our results are in line with Sahebalzamin et al., who
reported a significant reduction of anxiety and depression
of the students residing in a hostel after lavender and
rose essential aromatherapy,[9] and Mirzaei et al., who
reported a significant reduction in cortisol release from
the adrenal gland, an increase in serotonin secretion
from the digestive system, and reduction of anxiety level
during delivery after aromatherapy with lavender.[16] Our
obtained results are also consistent with the study results
of Imura et al. on the application of aromatherapy after
delivery, reporting an improvement in mothers’ and infants’
physical and psychological conditions as well as facilitation
of maternal–infant interaction,[18] and Conrad and Adams
on the effect of inhalation and hand aromatherapies
with a combination of lavender and rose essentials, in
which hand massage aromatherapy was more effective.
[15] It should be noted that in all conducted researches,
the goal was reduction of stress, anxiety, and diagnosed
depression, while the present study was conducted to
prevent these disorders and also investigate the longevity of
aromatherapy, which had been ignored in previous studies.
The present study faced limitations such as studying the
subjects immediately after delivery. Especially those who
have underwent CS, were reluctant to fill the psychological
status questionnaire due to unappropriate physical and
psychological conditions. The questionnaires were not also
completed before intervention. In order to overcome this
limitation and having two identical groups with regard to
psychological conditions.
• Conducting random sampling, meeting the inclusion
criteria, investigating any diagnosed incidence or history
Table 1: Background characteristics of subjects in the study
and control groups
Descriptive statistics Test
No. (%)
Test
No. (%)
Total
No.(%)
P, t
Education
Under diploma 26 (44.1) 33 (55.9) 59 (100) P=0.599
t=1.873
Diploma 32 (55.2) 26 (44.8) 58 (100)
University education 12 (47.8) 11 (52.2) 23 (100)
Delivery mode
Natural 29 (53.7) 25 (46.3) 54 (100) P=0.487
t=0.482
Occupation
Homemaker 67 (50) 67 (50) 134(100) P=10.00
Type of pregnancy
Unwanted 8 (57.1) 6 (42.9) 14 (100) P=0.573
t=0.317
Child’s gender
Unwanted 12 (46.2) 14 (53.8) 26 (100) P=0.664
t=0.189
Social satisfaction
None 4 (36.4) 7 (63.6) 11 (100) P=0.346
t=0.888
Marital satisfaction
None 3 (37.5) 5 (62.5) 8 (100) P=0.466
t=0.530
Economic status satisfaction
None 10 (55.6) 8 (44.4) 18 (100) P=0.614
t=0.255
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, tMean (SD) P value, t
Two weeks after intervention Study 5.31 (4.42) 0.012 2.19 (2.42) P=0.001
t=−4.466
3.39 (2.78) P=0.003
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
t=26.274
2.21 (2.4) P=0.001
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
t=−5.877
2.13 (2.44) P=0.001
t=−5.287
Control 7.27 (5.11) 4.13 (3.43) 5.07 (3.97)
ANOVA signicance level to investigate
the effect of time
0.001 0.001 0.001
ANOVA signicance level to investigate
the effect of group
0.001 0.001 0.004
*Mann-Whitney test. SD: Standard deviation
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Iranian Journal of Nursing and Midwifery Research | March-April 2016 | Vol. 21 | Issue 2 201
Kianpour, et al.: The eect of the fragrances lavender on the prevenon of stress, anxiety and depression in the postpartum period
of mood and psychological disorders before entering the
study
• Although the subjects were randomly selected and
aromatherapy was conducted in two phases of “at
home” and “in hospital,” where the study and control
subjects could be hospitalized on the beds next to each
other and could distinguish the difference between
lavender essential from placebo making a bias in
the study, no intervention except routine care was
administered in the control group.
conclusIon
As inhalation of lavender can lead to prevention of stress,
anxiety, and postpartum depression, it can be used as a
complementary method to prevent these disorders.
Acknowledgment
This article was derived from a master thesis of akram mansuori
with project number 392556 Isfahan University of Medical
Sciences, Isfahan, Iran. We appreciate Clinical Research
Development Center of Charity Hospital Haji Karim Asli. We
greatly appreciate the authorities of Isfahan University of Medical
Sciences and the staff of Asali Charity Hospital, as well as all those
who helped us in this research (No. 392556).
Financial support and sponsorship
Isfahan University of Medical Sciences, 392556
Conflicts of interest
There are no conflicts of interest.
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Table 3: Comparison of frequency distribution of depression
between the two groups in different time points
Time Group No. (%) P value*
Study Control
Two weeks
after intervention
Depressed 13 (18.6) 25 (35.7) 0.023
One month
after intervention
Depressed 2 (2.9) 21 (30.0) 0.001
Three months
after intervention
Depressed 3 (4.3) 17 (24.3) 0.001
*Chi-square
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