*3.4. Effect of Neroli Oil Aromatherapy on Anxiety*

The results relating to anxiety assessed through the VAS-A were similar to those obtained for pain. Indeed, they showed that participants undergoing aromatherapy perceived lower levels of anxiety than participants in the control group at all stages of labor (Table 3).

Repeated measures ANOVA revealed that the main effect of the "Study Group" (experimental vs. control) was significant (*F* = 11.41, *p* = 0.004, *η* <sup>2</sup> = 0.42), indicating that there was an overall difference in mean anxiety scores reported by the experimental group compared to those of the control group, with a large effect size. Similarly, the "Time" effect (i.e., the three phases of labor) was also significant and with a large effect size (*F* = 7.66, *p* = 0.014, *η* <sup>2</sup> = 0.32). However, as opposed to the results concerning pain intensity, in this case even the effect of the "Childbirth Group" (primiparas vs. multiparas) on anxiety was significant and with a large effect size (*F* = 16.19, *p* = 0.001, *η* <sup>2</sup> = 0.50). Specifically, the multiparas

showed higher average anxiety scores than the primiparas in all phases of labor, as follows: latent phase (primiparas: *M* = 2.91, *SD* = 2.12; multiparas: *M* = 5.87, *SD* = 1.12; *t* = −3.59, *p* = 0.002), early active phase (primiparas: *M* = 4.09, *SD* = 2.47; multiparas: *M* = 7.00, *SD* = 1.07; *t* = −3.11, *p* = 0.006), and late active phase (primiparas: *M* = 5.00, *SD* = 2.65; multiparas: *M* = 8.25, *SD* = 1.67; *t* = −3.05, *p* = 0.007). Again, as shown in Figure 3, with the progress of labor, anxiety increased in all participants, but the increase was milder in the experimental group than in the control group. *Healthcare* **2022**, *10*, x 7 of 11

**Figure 2.** Changes in pain intensity scores along the stages of labor in experimental and control **Figure 2.** Changes in pain intensity scores along the stages of labor in experimental and control group.

group. *3.4. Effect of Neroli Oil Aromatherapy on Anxiety*  **Table 3.** Comparisons between experimental and control groups on anxiety measured with VAS-A during the stages of labor.


during the stages of labor. Notes: VAS-A = Visual Analogue Scale for Anxiety; *M* = mean; *SD* = standard deviation; *t* = Student's *t*-test; CI = confidence intervals; *d* = Cohen's d. \* *p* < 0.05.

case even the effect of the "Childbirth Group" (primiparas vs. multiparas) on anxiety was significant and with a large effect size (*F* = 16.19, *p* = 0.001, *η2* = 0.50). Specifically, the mul-**Figure 3.** Changes in anxiety scores measured with the Visual Analogue Scale for Anxiety along the stages of labor in experimental and control group. **Figure 3.** Changes in anxiety scores measured with the Visual Analogue Scale for Anxiety along the stages of labor in experimental and control group.

tiparas showed higher average anxiety scores than the primiparas in all phases of labor, as follows: latent phase (primiparas: *M* = 2.91, *SD* = 2.12; multiparas: *M* = 5.87, *SD* = 1.12; *t* = −3.59, *p* = 0.002), early active phase (primiparas: *M* = 4.09, *SD* = 2.47; multiparas: *M* = 7.00, Finally, with regard to state anxiety assessed through the STAI-Y, it clearly emerged that the average anxiety scores measured before labor did not differ between the experi-Finally, with regard to state anxiety assessed through the STAI-Y, it clearly emerged that the average anxiety scores measured before labor did not differ between the experimental

tiparas: *M* = 8.25, *SD* = 1.67; *t* = −3.05, *p* = 0.007). Again, as shown in Figure 3, with the progress of labor, anxiety increased in all participants, but the increase was milder in the

**Table 4.** Comparisons between experimental and control groups on anxiety measured with STAI-Y

Before the childbirth 2.07 (0.15) 2.08 (0.18) −0.04 −0.16, 0.16 1.09 After the childbirth 2.01 (0.06) 2.32 (0.19) −4.69 \*\*\* −4.44, −0.17 1.23 Notes: STAI-Y = State–Trait Anxiety Inventory Form Y; *M* = mean; *SD* = standard deviation; *t* =

The current randomized controlled study was aimed at evaluating the effectiveness of neroli essential oil aromatherapy in relieving anxiety and perceived pain in women in labor. Results showed that neroli oil aromatherapy significantly and positively impacts women's experience of perceived pain and anxiety during labor, representing a further confirmation of the effectiveness of non-pharmacological methods in making the child-

Specifically, our findings showed that neroli oil reduced women's perception of pain and anxiety, which appeared less intense than in the women that did not receive aromatherapy treatment. Specifically, as the labor progressed, pain and anxiety increased in all participants, but the increase was milder in the experimental group when compared to the control group. Furthermore, since the average anxiety and perceived pain scores measured before labor did not differ between the experimental and control groups, while differed significantly after childbirth, we can conclude that neroli oil aromatherapy had a positive effect on anxiety and perceived pain. These findings confirm the results obtained in previous studies using other essential oils [16,28,38,39]. For instance, the use of essential oils in aromatherapy, thanks to their validated analgesic, anti-inflammatory, calming, and relaxing effects, has been proven to alleviate physical and emotional disorders in cancer patients [40]. This makes it reasonable to infer that aromatherapy represents a helpful al-

**Control Group (***n* **= 44)**  *M* **(***SD***)** 

*t* **95% CI** *d*

**Experimental Group (***n* **= 44)**  *M* **(***SD***)** 

Student's *t*-test; CI = confidence intervals; *d* = Cohen's d. \*\*\* *p* < 0.001.

ternative method for anxiety and pain control [41–43].

experimental group than in the control group.

before and after the childbirth.

birth a less stressful experience.

**4. Discussion** 

and control groups, while differed significantly after childbirth, indicating that neroli oil aromatherapy had a positive effect on anxiety (Table 4).


After the childbirth 2.01 (0.06) 2.32 (0.19) −4.69 \*\*\* −4.44, −0.17 1.23

**Table 4.** Comparisons between experimental and control groups on anxiety measured with STAI-Y

Notes: STAI-Y = State–Trait Anxiety Inventory Form Y; *M* = mean; *SD* = standard deviation; *t* = Student's *t*-test; CI = confidence intervals; *d* = Cohen's d. \*\*\* *p* < 0.001.
