Effectiveness of Lemon Aromatherapy-Enhanced Health Belief Model Counseling in Reducing Labor Pain

Eka Ristin Tarigan; Siti Nurul Fadhilah Sari; Adriana Bangun; Adelina Fitri Tanjung; Putri Nadilla; Jihan Anggraini

doi:10.70716/mohr.v3i3.746

Authors

Eka Ristin Tarigan Lecturer, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia
Siti Nurul Fadhilah Sari Lecturer, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia
Adriana Bangun Lecturer, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia
Adelina Fitri Tanjung Lecturer, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia
Putri Nadilla Undergraduate Student, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia
Jihan Anggraini Undergraduate Student, Sekolah Tinggi Ilmu Kesehatan Mitra Sejati, Medan, Indonesia

DOI:

https://doi.org/10.70716/mohr.v3i3.746

Keywords:

lemon aromatherapy, Health Belief Model, labor pain, childbirth coping self-efficacy, midwifery care

Abstract

Background: Labor pain is a complex sensory-emotional experience that may lead to maternal exhaustion and prolonged labor if inadequately managed. Health Belief Model (HBM)-based antenatal counseling may improve coping self-efficacy, while inhaled lemon (*Citrus limon*) aromatherapy may reduce pain perception. **Objective:** To evaluate the effectiveness of lemon aromatherapy-enhanced HBM counseling in reducing labor pain and distinguish the effects of counseling from aromatherapy. Methods: A three-arm quasi-experimental study was conducted among 135 low-risk laboring women in Medan, Indonesia. Participants received HBM counseling plus lemon aromatherapy (n=45), HBM counseling only (n=45), or routine care (n=45). Pain intensity was measured at cervical dilatations of 4, 6, and 8 cm using the Numeric Rating Scale. Data were analyzed using ANOVA, post-hoc tests, relative risk, and generalized estimating equations. Results: At 8 cm dilatation, mean pain scores were 6.5±1.4, 7.8±1.3, and 8.3±1.2 in Groups A, B, and C, respectively. Aromatherapy significantly reduced pain compared with counseling alone (p<0.001). Group A also demonstrated lower severe pain risk (adjusted RR=0.38; 95% CI: 0.22–0.66), shorter active labor, and higher birth satisfaction, while neonatal outcomes were comparable. **Conclusion:** HBM-based antenatal counseling combined with lemon aromatherapy is an effective, safe, and low-cost strategy for improving labor pain management in primary midwifery care.

Downloads

Download data is not yet available.

References

Alizadeh-Dibazari, Z., Abdolalipour, S., & Mirghafourvand, M. (2023). The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: A scoping review using systematic approach and meta-analysis. BMC Pregnancy and Childbirth, 23, 541. https://doi.org/10.1186/s12884-023-05867-0

Alizadeh-Dibazari, Z., Maghalain, M., & Mirghafourvand, M. (2024). The effect of non-pharmacological prenatal interventions on fear of childbirth: An overview of systematic reviews and meta-analysis. BMC Psychiatry, 24, 415. https://doi.org/10.1186/s12888-024-05870-5

Alyafei, A., & Easton-Carr, R. (2024). The Health Belief Model of behavior change. In StatPearls. StatPearls Publishing.

Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman.

Boaviagem, A., Melo Junior, E., Lubambo, L., Sousa, P., Aragão, C., Albuquerque, S., & Lemos, A. (2021). The effectiveness of aromatherapy in reducing pain and anxiety during labor: A systematic review and meta-analysis. Journal of Alternative and Complementary Medicine, 27(3), 197–208.

Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 45–65). Jossey-Bass.

Çankaya, S., & Şimşek, B. (2021). Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: A prospective randomized controlled study. Clinical Nursing Research, 30(6), 818–829. https://doi.org/10.1177/1054773820916984

Huang, Y., Zhong, Y., Chen, Q., Zhou, J., Fu, B., Deng, Y., Tu, X., & Wu, Y. (2024). A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: A cross-sectional study. BMC Pregnancy and Childbirth, 24, 397. https://doi.org/10.1186/s12884-024-06571-3

Karaahmet, A. Y., & Bilgiç, F. Ş. (2023). The effect of aromatherapy on labor pain, duration of labor, anxiety and Apgar score outcome: A systematic review and meta-analysis. The European Research Journal, 9(5), 1258–1270.

Kaya, A., Yeşildere Sağlam, H., Karadağ, E., & Gürsoy, E. (2023). The effectiveness of aromatherapy in the management of labor pain: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 20, 100255. https://doi.org/10.1016/j.eurox.2023.100255

Kissler, K., & Hurt, K. J. (2023). The pathophysiology of labor dystocia: Theme with variations. Reproductive Sciences, 30(3), 729–742. https://doi.org/10.1007/s43032-022-01018-6

Lestari, C. I., Amilia, R., & Rospia, E. D. (2022). Comparison of the effectiveness of lavender and lemon aromatherapy toward reducing pain labor during active phase of first stage. Jurnal Kebidanan, 11(1), 79–88. https://doi.org/10.26714/jk.11.1.2022.79-88

Liao, C. C., Lan, S. H., Yen, Y. Y., Hsieh, Y. P., & Lan, S. J. (2021). Aromatherapy intervention on anxiety and pain during first stage labour in nulliparous women: A systematic review and meta-analysis. Journal of Obstetrics and Gynaecology, 41(1), 21–31. https://doi.org/10.1080/01443615.2019.1673707

Lowe, N. K. (1993). Maternal confidence for labor: Development of the Childbirth Self-Efficacy Inventory. Research in Nursing & Health, 16(2), 141–149. https://doi.org/10.1002/nur.4770160209

Manning, M. M., & Wright, T. L. (1983). Self-efficacy expectancies, outcome expectancies, and the persistence of pain control in childbirth. Journal of Personality and Social Psychology, 45(2), 421–431. https://doi.org/10.1037/0022-3514.45.2.421

Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971–979. https://doi.org/10.1126/science.150.3699.971

National Institute for Health and Care Excellence. (2023). Intrapartum care for healthy women and babies (Clinical guideline CG190). NICE.

Rivaz, M., Rahpeima, M., Khademian, Z., & Dabbaghmanesh, M. H. (2021). The effects of aromatherapy massage with lavender essential oil on neuropathic pain and quality of life in diabetic patients: A randomized clinical trial. Complementary Therapies in Clinical Practice, 44, 101430. https://doi.org/10.1016/j.ctcp.2021.101430

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203

Scandurra, C., Mezzalira, S., Cutillo, S., Zapparella, R., Statti, G., Maldonato, N. M., Locci, M., & Bochicchio, V. (2022). The effectiveness of neroli essential oil in relieving anxiety and perceived pain in women during labor: A randomized controlled trial. Healthcare, 10(2), 366. https://doi.org/10.3390/healthcare10020366

Şenol, D. K., Aydın Özkan, S., & Ağralı, C. (2024). The effect of the training provided to primiparous pregnant women based on the Health Belief Model on pregnancy risk perception and health literacy. Women & Health, 64(3), 283–293. https://doi.org/10.1080/03630242.2024.2322130

Sirkeci, I., Cagan, O., & Koc, S. (2023). The effect of ylang oil and lemon oil inhalation on labor pain and anxiety pregnant women: A randomized controlled trial. Complementary Therapies in Clinical Practice, 52, 101748. https://doi.org/10.1016/j.ctcp.2023.101748

Tabatabaeichehr, M., & Mortazavi, H. (2020). The effectiveness of aromatherapy in the management of labor pain and anxiety: A systematic review. Ethiopian Journal of Health Sciences, 30(3), 449–458. https://doi.org/10.4314/ejhs.v30i3.16

World Health Organization. (2023). Toolkit for implementation of the WHO intrapartum care and immediate postnatal care recommendations in health-care facilities. World Health Organization. https://iris.who.int/handle/10665/373263

Zhou, J., Zhu, Z., Li, R., Guo, X., & Li, D. (2025). Comparative efficacy of non-pharmacological interventions on fear of childbirth for pregnant women: A systematic review and network meta-analysis. Frontiers in Psychology, 16, 1530311. https://doi.org/10.3389/fpsyg.2025.1530311