KALOJI NARAYANA RAO UNIVERSITY OF HEALTH AND SCIENCE,

WARANGAL, TELANGANA.

PROFORMA FOR THE SUBMISSION OF SYNOPSIS

Ms. SALEHA BANU

NAME OF THE
1. OWAISI COLLEGE OF NURSING, SANTOSH
CANDIDATE
NAGAR, HYDERABAD, TELANGANA

OWAISI COLLEGE OF NURSING, SANTOSH

NAME OF THE
2.
INSTITUTION NAGAR, HYDERABAD, TELANGANA

COURSE OF M.Sc. NURSING Ist YEAR

3. THE STUDY
AND SUBJECT OBSTETRIC AND GYNECOLOGICAL NURSING

YEAR OF
4. 2017
ADMISSION

A STUDY TO ASSESS THE EFFECTIVENESS OF AROMATHERAPY IN

TITLE OF THE REDUCTION OF BACK PAIN AMONG POSTNATAL MOTHERS AT

5.
TOPIC
SELECTED HOSPITALS, HYDERABAD.

SIGNATURE OF
6 THE
CANDIDATE

SIGNATURE OF
7
THE GUIDE

SIGNATURE OF
8
THE PRINCIPAL

1
 INTRODUCTION:

The mothers who give birth in maternity wards are under the

supervision of skilled personnel in the immediate postnatal period and are monitored

regarding the life-threatening conditions, such as bleeding, hypertension, and infection,

in addition to fatal complications, mothers in the immediate postpartum period may

suffer from some problems, such as perineal pain, back pain, uterine cramps, and

fatigue. Busy care providers focus on the serious complications of postpartum period.

This issue causes the seemingly trivial complications, such as

mother's perineal pain, back pain, and psychological status, to be less taken into

account. In addition, mothers may consider these problems as the natural consequences

of labour and speak less about them. Physical pain in the postpartum period can lead to

insomnia, fatigue, confusion, anxiety, delay in the formation of relationship between

the mother and her baby, disability in caring about the new-born, and inappropriate

body position during breastfeeding.

Back pain can be treated by a pharmacological pain relief method

include non-steroidal anti-inflammatory drugs, variety of oral analgesics, and topical

anaesthetics. But this method is associated with serious adverse effects like

constipation, gastric irritation, passage of drugs to the maternal milk and prolonged

bleeding time. With regard to non-pharmacological method, common practice is the

use of aromatherapy after the first 24 hours, postpartum is a traditional method used

2
for the immediate symptomatic relief of pain. It should be noted that, in most cases in

Iran, mediolateral incision is made for episiotomy and catgut thread is used for its

repair, resulting in more perineal pain. Therefore, a lot of women in Iran and other

countries (with similar above-mentioned midwifery background) need to be relieved

from perineal pain during the first 24 h postpartum.

Lavender is an aromatic plant that is widely used in

aromatherapy. Researches have indicated that aromatherapy with lavender has

anti-inflammatory, hypnotic, sedative, muscle-relaxant, antibacterial, and

anti-spasmodic effects. Aromatherapy with lavender oil has been used to reduce pain

and anxiety during labour, and mothers have generally evaluated this approach as an

appropriate method.

Considering the implementation of rooming-in method in most

maternity wards, it is important that mothers experience less pain, have a good mood

to establish an appropriate emotional relationship with their infants in the early days of

postpartum period, and can breastfeed and take care of their infants. Obviously,

supportive efforts from care providers result in a successful initiation of breastfeeding

that causes it to be continued after release from hospital.

3
 NEED FOR THE STUDY

Childbirth is one of the most marvelous and memorable segment in a

woman’s life. It does not really matter if the child is the first, second or the third one.

Each experience is unique and calls for a celebration​. One of the most beautiful time

periods during a women’s life is the pregnancy period. Because her life will be satisfied

by giving birth to her baby. For that she will be ready to suffer all the pains with full

happiness​.

Even though the labor event gives pleasure for the mother it also

gives severe pain. Most of the mother will experience some amount of discomfort after

the delivery. Some common discomforts are pain in the episiotomy site, breast

engorgement, after pain, back pain etc.…Among this, back pain is very common during

pregnancy and postpartum period and is a serious cause of morbidity​.

Postnatal is the period beginning immediately after the birth of a

child and extending for about six weeks. Biologically, it is the time after birth, a time in

which the mother's body, including hormone levels and uterus size, return to

pre-pregnant states. The major focus of postnatal care is ensuring that the mother is

healthy and capable of taking care of her new born; equipped with all the information

she needs about breast feeding, reproductive health and the immanent life adjustment.

In some case this adjustment is not made easily and women may suffer from

postpartum depression, post-traumatic stress disorder or even puerperal psychosis. So,

4
the women need to be taken care properly during period. Most postnatal women

experience relatively little discomfort related to physical changes.

During postnatal period 68% of women are affected with back pain in 8

weeks and 60% in 8 months. Neither elective caesarian section nor assisted vaginal

delivery increase the risk of postnatal back pain compared with spontaneous delivery.

Most of the time analgesic is given to the postnatal mothers in order to reduce the pain.

The action of analgesic is temporary which helps to reduce pain for very short period

but the aromatherapy plays very important role in minimizing pain, disability and

speedy recovery to normal condition​3​.

Aromatherapy may be an effective solution for the mothers during

postnatal period. The top 6 benefits of aromatherapy for mothers: are Relaxation, Stress

Relief, back aches, neck and Shoulders pain, Reduction of fluid retention, help uterus to

return to original size, reduction of cellulite and helps to tone up the body.

Aromatherapy also provides an important sense of continuing comfort for the new

mother. The aim of this therapy is to give nurturing and emotional support as well as

alleviate the muscle aches from the strain of labor and childbirth.

A study conducted on “massage therapy during early postnatal life

promotes greater lean mass bone growth and mineralization”. The massage therapy was

performed daily from day 6 to day 10 of postnatal life, body composition, bone area,

mineral content, bone mineral density was measured by Dual Energy X-ray

absorptiometry (DXA). Massage therapy during early life elicited immediate and

prolonged anabolic effect on postnatal growth. On day 21 body weight, lean mass, bone

mineral and bone area were significantly found greater.

5
 Lavender is an aromatic plant that is widely used in aromatherapy.

Researches have indicated that aromatherapy with lavender has anti-inflammatory,

anti-depressant, hypnotic, sedative, muscle-relaxant, antibacterial, and anti-spasmodic

effects Aromatherapy with lavender oil has been used to reduce pain and anxiety

during labour, and mothers have generally evaluated this approach as an appropriate

method.

Considering the implementation of rooming-in method in most

maternity wards, it is important that mothers experience less pain and fatigue, have a

good mood to establish an appropriate emotional relationship with their infants in the

early hours of postpartum period, and can breastfeed and take care of their infants.

Obviously, supportive efforts from care providers result in a successful initiation of

breastfeeding that causes it to be continued after release from hospital. Discharge with

better physical and mental conditions in turn improves women's quality of life. Thus,

the present study aims to assess the effect of aromatherapy with lavender oil in

postnatal period with back pains.

6
 REVIEW OF LITERAURE

A review of literature on the research topic makes the researcher familiar with the

existing studies and provides information, which helps focus on a particular problem

lay a foundation upon which to base new knowledge. it creates accurate picture of the

information found on the subject.

I. STUDIES RELATED TO BACKPAIN AMONG POSTNATAL

MOTHERS

II. STUDIES RELATED TO AROMATHERAPY

III. STUDIES RELATED TO EFFECTIVENESS OF AROMATHERAPY ON

BACK PAIN

STUDIES RELATED TO BACKPAIN AMONG POSTNATAL MOTHERS:

A study was conducted on “Long term back aches after

childbirth: prospective search for causative factors” in US. In this study 599 women

were recruited, of whom 450 (75%) replied to a follow up questionnaire. 152 women

(33.8% of responders) reported backache lasting three months after delivery and, of

7
these, 33 (7.3%) had not previously suffered with backache. There was no significant

differences between the treatment groups in the incidence of postnatal backache overall

or of new backache or any symptoms after childbirth. Among all demographic,

obstetric, and epidural variables examined the only factors significantly associated with

backache after childbirth was backache before and during pregnancy​8​.

A study was conducted on “physical activity and persistent low back

pain and pelvic pain postpartum” in Umea University, Sweden. In this descriptive

study they studied 639 women. These women were sent a questionnaire at

approximately six months after delivery. Study concludes almost half of women who

had experienced LBPP during pregnancy reported PA at six months post-partum. The

number of years of pre-pregnancy PA did not influence the risk of persistent LBPP.

Obesity was a risk factor for not practicing PA.

A study was conducted on “persistence of back pain symptoms after

pregnancy and bone mineral density changes”. In this cohort study they studied 60

women. Result shows women had higher BMD loss during pregnancy compared to

those without further pain. Study concludes Persistence of back pain symptoms after

pregnancy could be related to an inability to recover fully from BMD loss during the

index pregnancy

​STUDIES RELATED TO AROMATHERAPY

In a randomized controlled trial to investigate the effect of combining

acupressure with lavender essential oil for pain relief of subacute and chronic lower

back pain, participants who received a 3-week course of eight sessions of treatment

showed a significant reduction in subjective pain intensity and an improvement in

8
objective measures of physical functional performance, including lateral spine flexion

and walking time. The results of the study support that acupressure type massage with

lavender oil may help improve subacute lower back pain. However, there was no group

that received acupressure without lavender oil, so it is not possible to say definitively

whether the improvement came from the aromatherapy or the massage intervention

alone. The researchers recommend that the combined treatment be used along with

mainstream medical treatment, as an add-on therapy in reducing lower back pain in the

short term

A separate randomized control trial compared participants who

received Swedish massage using ginger oil with a control group who received

traditional Thai massage through clothes with no oil. In this trial, participants were

assessed 15 months after treatment to determine the long-term effects of aromatherapy.

The researchers found that both massage groups experienced a significant improvement

in pain and mobility. However, the patients whose massage contained ginger oil

experienced better outcomes across categories for longer periods of time

An experimental study compared the results of patients who

received acupoint electrode stimulation combined with aromatherapy acupressure in

addition to conventional treatment versus conventional treatment alone for neck pain.

After eight lavender acupressure and acupoint stimulation sessions, the increased

intervention group reported an improved range of motion, reduced pain, reduced

stiffness, and reduced stress a month after treatment compared to those receiving usual

treatment. These results indicate that aromatherapy is a viable option for a

complementary treatment in addition to conventional treatment

9
 Experimental study, massage with ginger oil was compared to a

massage only and a treatment as usual group. At one-week follow-up, knee pain and

stiffness were similar among the three groups. At the four-week follow-up, the

aromatherapy intervention group reported a reduction in knee pain rating. This

intervention group also demonstrated an improvement in physical function compared to

the control groups. Interestingly, there was no significant change in report of overall

quality of life for any of the three groups. Although the results were inconclusive, they

suggest that aromatherapy has potential to treat knee pain in addition to standard care

Menstrual pain is extremely common, affecting 25–97% of women

worldwide. In about 15% of adolescents and young women, menstrual pain is severe

and may impair women from attending work, school, playing sports, or enjoying other

activities. In one study, the menstrual pain of women being treated with aromatherapy

abdominal massage was compared with a control group of women treated with

acetaminophen. The aromatherapy group reported a significantly higher rate of relief

than the acetaminophen group. The results, however, are unclear because it is possible

that massage alone could alleviate menstrual pain. A later randomized blind placebo

clinical trial remediated this by comparing an aromatherapy group with a placebo

group, receiving massage with no therapeutic oil. In this study, the aromatherapy group

reported a considerable improvement in pain compared to the control..

Using aromatherapy to manage pain related to childbirth has been

researched more than any other specific type of pain. Despite the availability of data,

results are inconclusive. A review of two randomized controlled trials involving more

than 500 women found no difference in pain intensity, rate of caesarean section, or

frequency of requests for pharmacological intervention for women being treated with

10
clary sage, chamomile, lavender, ginger oil, or lemongrass compared to women

receiving standard care. A semi-experimental clinical trial found that women who were

treated with lavender aromatherapy during labour reported a lower intensity of pain

than women in a control group. Unfortunately, the aromatherapy group did not

experience a reduced duration of labour or improved Apgar scores of their infants A

similar study using orange oil for pain management during labour and delivery reported

comparable results Although conflicting reports exist, the low cost, ease of use, and

non-invasive approach makes aromatherapy a viable option for complementary care

during labour and childbirth.

STUDIES RELATED TO EFFECTIVENESS OF AROMATHERAPY ON BACK

PAIN

Effective and satisfactory pain management needs to individualized for

each woman. This can be influenced by two mechanisms: working with pain or pain

relief. The working with pain paradigm includes the belief for long-term benefits to

promoting normal birth and pain plays an important role in the process. This approach

offers support and encouragement to women and self-help techniques to cope with

normal labour pain. The pain relief paradigm, other note, is characterized by the use

of pharmacological intervention in order for women not to suffer pain. (Smith, Collins

and Crowther, 2011)

The use of complementary therapies and medicines has gained its

popularity among consumers across the world. Studies suggests that between 36% to

62% of adults from industrialized nations adopted some forms of these alternative

11
methods to prevent or treat health problems. (Barnes, 2004) Complementary therapies

are commonly used among women of reproductive age. It is also possible that a

significant proportion of women use these during pregnancy. One of the

complementary approaches mentioned includes aromatherapy. (Smith, Collins and

Crowther, 2011)

The use of complimentary non-pharmacological adjuvant therapies are

advocated as part of multimodal approach to reducing pain, anxiety, and emetic

symptoms in postpartum period. The Acute Pain Management Guideline Panel of the

American Society of Anaesthesiologists Task Force on acute pain management in the

postpartum setting: an updated report by the American Society Anaesthesiologists Task

Force on Acute Pain Management. Anaesthesiology 2004; 100: 1573-81 specifically

states that nonpharmacological therapies should be considered for any patient with an

interest or acceptance of these techniques as a pain management strategy.

Use of essential oils is one of the fastest growing complimentary

therapies. (Buckle, 2001) Numerous reports showed the usefulness of essential oils in

various clinical settings. (Ching, 1999) There have been no studies or published

anecdotal evidence that demonstrate harm from essential oils to mother and foetus,

(Tillett, 2010; Burns, 2 Essential oils are concentrated substances and can cause skin

irritation. (Tillett, 2010)

Essential oils stimulate the release of brain neurotransmitters which

reduce pain by producing euphoric sensation and pleasant feelings. Adrenaline levels,

anxiety and fear are reduced which resulted to natural oxytocin production and to a

normal physiological labour process.

12
(Burns et. al., 1999)

A ground breaking evaluative study of the use of aromatherapy in

intrapartum midwifery was conducted. With a sample size of 8058 mothers between the

spectrum of1990 to 1998, it was identified that aromatherapy has the capacity to

alleviate anxiety and fear and appeared to reduce the need for additional pain relief

resulting to decrease in the need of epidural medication. (Burns et. al,1999; Nottingham

University Hospital, 2012) The use of essential oils has been one of the fastest growing

trend in natural health care. The molecules of the essential oils interact with the body to

promote wellness through receptor sites that accept plant molecules and use them to fire

responses to the brain, just as the body would use its own molecules for healing

process. (Raybern, 2010)

According to International Federation of Professional Aromatherapists,

essential oils are currently under worldwide medical research and being used in

hundreds of hospitals in America. Essential oils are safe for consumption for pregnant

patients since they have developed a thicker layer of fat underneath the skin which acts

as a safety area between the baby and essential oil. The oil dissolves in fat and more

likely rest in the fatty layers giving a slow-release treatment. Essential oils by their very

nature, being organic substances, will cross the placental barrier and have the potential

to affect the foetus. However, the amount of essential oil that actually accesses the

mother’s skin is very tiny and therefore the amount that reaches the placenta minuscule

if proper dilutions are being used.

Aromatherapy is “the science of using highly concentrated essential oils or

essences distilled from plants in order to utilize their therapeutic properties.”

Aromatherapy is a modality that uses essential oils, which are as potent

13
as pharmacological drugs. (Simkins and bolding, 2004)

Aromatherapy is one of the potential methods of reducing postpartum pain

and improving patients’ satisfaction. Lavender oil aromatherapy, in particular, has been

credited with mood-enhancing and analgesic properties by aromatherapists, in a study

done by Stevenson C. Nonpharmacologic aspects of acute pain management.

ComplTher Nurs 1995; 1: 77-85.

Aromatherapy involves the use of essential oils which are volatile, fragrant

organic compounds obtained predistillation for plant material. The mechanism of action

for aromatherapy is still unclear yet studies revealed no significant changes on

physiological parameters such as blood pressure or heart rate. On a significant note,

aromatherapy produces psychological improvement in mood and anxiety levels.

(Stevenson, 1995)

In the study entitled as “Treatment with lavender aromatherapy in the post

anaesthesia care unit reduces opioids requirements of morbidly obese patients

undergoing laparoscopic adjustable gastric banding”, patients in the study group were

treated with lavender oil, which was applied to the oxygen face mask, the control group

patients received non-scented baby oil. Post-operative pain was treated with morphine.

Numerical rating scores (0-10) were used to measure the level of pain at 5, 30 and 60

minutes. This study showed a reduction in opioid consumption after post-operative

lavender aromatherapy.

The effectiveness of the aromatherapy treatment in reducing

postoperative perception of pain without evidence of adverse effects, supports the

interest for potential use of aromatherapy in perioperative care. (Kim et. al., 2007)

Meticulous records were kept regarding the oils used, the mode and timing of

14
administration, and rea-​ sons for use. Mothers and midwives reported on the effectiveness of

the oils in accomplishing the purpose for which it was given. Sixty-one percent of the women

received aromatherapy (lavender, rose, or frankincense) to relieve anxiety and fear. Fifty

percent of both mothers and midwives found it helpful, and 13% found it unhelpful. Rosé oil

was rated helpful by most (71%), followed bylavender (50%). Lavender and frankincense were

used for pain by 537 women, of whom 54% found lavender helpful and 64% found

frankincense helpful. (Simkins and bolding,2004)

STATEMENT OF PROBLEM
. “​A STUDY TO ASSESS THE EFFECTIVENESS OF AROMATHERAPY IN

REDUCTION OF BACK PAIN AMONG POSTNATAL MOTHERS AT SELECTED

HOSPITALS, HYDERABAD.”

OBJECTIVES
1. To assess the level of back pain among control group and experimental group.

2. To assess the effectiveness of aromatherapy on backpain among postnatal

mother.

3. To find the association between back pain scores of postnatal mothers with
selected demographical variables.

15
OPERATIONAL DEFINITION
1. Effectiveness: ​effectiveness refers to the extent to which the aromatherapy has

an effect on the reduction of backpain perception shown by postnatal mother.

2. Back pain: It refers to mild, moderate or severe discomfort in the back pain

experienced by mother after child birth.

3. Aromatherapy: it refers to the therapeutic use of essential oil absorbed through

the skin.

4. Lavender oil: ​lavender oil is aromatic oil has anti-inflammatory,

anti-spasmodic, muscle relaxant effect.

5. Postnatal mothers:​ It refers to the mothers after delivery with back pain.

ASSUMPTION
1. The postnatal mothers with backpain will co-operate and be willing to

participate in the study

2. The items included in the tool will be adequate

3. Aromatherapy may alter the back pain

HYPOTHESIS

H​1​: There will be a significant difference in back pain among postnatal mothers

between pre and post test

H​2​: There will be a significant association between pre-test scores and their selected

demographic variables among postnatal mothers with back pain.

16
DELIMITATIONS
1. Postnatal mothers those who are having back pain.

2. Back pain will be measured by visual analog scale.

3. The study sample size will be delimited to 30 post-natal mothers with pregnancy

backpain.

VARIABLES
Variables included in the study were

​Dependent Variables : back pain.

​Independent Variables : aromatherapy

​Attributed Variables : Age, Occupation, Sleep, Diet, Exercise

Drug

MATERIALS AND METHODS

SOURCE OF DATA

Postnatal mothers with back pain who are registered in selected hospitals at

Hyderabad.

METHOD OF DATA COLLECTION

RESEARCH DESIGN

The research design selected for the present study will be a pre-experimental

design (one group pre-test and post-test design). The intention of study will be to

evaluate the effect of aromatherapy among postnatal mothers with backpain.

17
SETTING OF THE STUDY

The study will be conducted in selected hospital in Hyderabad.

POPULATION

Postnatal mothers with backpain will be the population of the study.

SAMPLE
The sample will be post-natal mothers with at selected hospitals at Hyderabad.

SAMPLE SIZE
The sample size will be 60 (30 experimental and30 control).

TOOL OF THE RESEARCH:​ Structured interview schedule

Visual analogue pain scale.

SAMPLING TECHNIQUE
Non-probability, purposive sampling technique will be used to select subject.

SAMPLING CRITERIA
In sampling criteria, the researcher specifies the characteristics for the population under

the study by dealing the inclusion and exclusion criteria.

a. Inclusion Criteria

postnatal mothers suffering from mild, moderate and severe back pain.

18
 Postnatal mothers who are willing to participate in the study.

Postnatal mothers with assisted or normal vaginal delivery.

b. Exclusion criteria

Postoperative mothers.

Postnatal mothers with high-risk group.

LIMITATIONS
➢ The samples will be selected by purposive sampling method

➢ The intervention will be given for 3 days.

➢ The pharmacological management for backpain will be beyond the control of

investigator.

PLAN FOR DATA ANALYSIS

For the present study the researcher will collect the data from the postnatal mothers

with backpain and this data will be analysed by using both descriptive and inferential

statistics.

DATA ANALYSIS AND INTERPRETATION

The analysis and interpretation of data in this study will be based on data collected by

interview observation schedule. The results will be computed using descriptive and

inferential statistics.

Does the study require any investigation to be conducted on patient or other humans or

animals, if so please describe briefly?

Ans: Yes, in this study aromatherapy with lavender oil is given for postnatal mothers

for 2 days.

19
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