Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: A systematic review and meta-analysis

[[abstract]]背景與目的： 分娩過程既充滿期待，卻又夾雜恐懼和焦慮的情緒。生產疼痛是導致焦慮和恐懼的因素之一，進而可能會影響她們的分娩方式選擇和分娩經歷，在安全範圍內合理降低疼痛強度和焦慮感，是產期護理的主要目標。過去甚少有系統性研究，關於芳香療法是否能減輕婦女生產時的疼痛與焦慮感，本研究希望收集隨機臨床試驗（RCT）的證據，透過整合分析，探討芳香療法介入對初產婦在第一產程焦慮與疼痛之效果。 材料與方法： 運用系統性回顧與整合分析在嚴格評估下，從收集隨機臨床試驗（RCT），以獲得所有有關芳香療法對分娩疼痛和焦慮緩解的證據。文獻檢索自MEDLINE / PubMed，Cochrane圖書館，Cochrane對照試驗中心登記冊和Scopus資料庫，收集時間至2019年1月。另外，也對Google Scholar進行了檢索，將符合條件的隨機臨床試驗（RCT） 納入系統審查。使用搜索的關鍵字為：（懷孕或孕婦或產前或初產或周產期或母親）和（芳香療法或精油或芳療法）。根據PRISMA研究指南，設定納入和排除標準，系統評價分析後有9個RCT納入整合分析。根據系統評價和整合分析指南，將數據輸入到Rev Man 5.3中進行分析與判讀。 結果： 9個隨機對照試驗的結果表明，芳香療法可以減輕初產婦女在其第一產程分娩中所有階段的疼痛：潛伏期（MD：-1.88 [-2.98，-0.78]，p = .0008）；活躍期（MD：1.78 [-2.83，-0.72]，p = .001）; 和過渡期（MD：-1.72 [-2.69，-0.76]，p = .0004）。進一步發現焦慮評分的測量具有統計學意義（MD：-9.29 [-15.88，-2.69]，p = .006）。從新生兒(APGAR scores)出生後一分鐘和五分鐘的得分，證明芳香療法對新生兒的健康沒有負面影響。 結論： 芳香療法經證實可有效減輕初產婦女生產的痛苦和焦慮。 此外，一發現發現芳香療法對產婦及其新生兒都是安全的。 Background and Aim: During labour, conflicting emotions are present: fear and anxiousness on the one hand, coupled with anticipation and gladness on the other hand. Anxiety and fear are factors contributing towards women’s perception of pain and in turn may affect their labour and birth experience. As such, a reasonable reduction of pain intensity and anxiety level within a manageable safe range is necessary and the main goal of intrapartum care. Little is known regarding the presumed health benefits of aromatherapy on reducing women’s labour pain and anxiety. This study aims to critically evaluate and summarize all available evidences derived from randomized clinical trials (RCTs) regarding aromatherapy’s effects on anxiety and pain during first stage labour in nulliparous women. Materials and Methods: This systematic review and meta-analysis aimed to critically evaluate and summarize all available evidences derived from randomized clinical trials (RCTs) regarding aromatherapy’s effects on labor pain and anxiety relief. Literature search was performed in MEDLINE/PubMed, Cochrane library, Cochrane Central Register of Controlled Trials and Scopus since their respective inception to January 2019. Additionally, Google Scholar was also searched to explore citations of eligible final studies which were subsequently included in the systematic review. The search strategy used was: (pregnancy or pregnant or prenatal or antenatal or perinatal or maternal) AND (aromatherapy or essential oils or aroma therapy). Per inclusion and exclusion criteria established by the current study, 9 RCTs were included in the systematic review. Data were entered into Rev Man 5.3 for meta-analyses, in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Main results： Results from the 9 included RCTs indicated that aromatherapy has reduced labour pain for women throughout all phases of their first stage labour : latent phase (MD: -1.88 [- 2.98, - 0.78], p = .0008); early active phase (MD: 1.78 [- 2.83, - 0.72], p = .001); and late active phase (MD: -1.72 [- 2.69, - 0.76], p = .0004). Anxiety score measurements were further found to be statistically significant (MD: - 9.29 [- 15.88, - 2.69], p = .006). Systemic review and meta-analysis results found that aromatherapy has not negatively impacted newborns’ health, as demonstrated by newborns’ APGAR scores of one-minute and five-minute after birth. Conclusions： Aromatherapy was validated to be effective in reducing labour pain and anxiety of labouring women. Additionally, aromatherapy was found to be safe both to labouring women and their new