Ali B, Al-Wabel NA, Shams S, Ahamad A, Khan SA, Anwar F. Essential oils used in aromatherapy: a systemic review. Asian Pac J Trop Biomed. 2015; 5:(8)601-611

Anita W. Techniques of pain reduction in the normal labour process: a systematic review. J Endur. 2017; 2:(3)

Baljon KJ, Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology, and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones, and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial. BMJ Open. 2020; 10:(6)1-13

Buglione A, Saccone G, Mas M Effect of music on labour and delivery in nulliparous singleton pregnancies: a randomized clinical trial. Arch Gynecol Obstet. 2020; 301:(3)693-698

Critical Skills Appraisal Programme. CASP Randomised controlled trial standard checklist. 2020. (accessed 8 June 2022)

Chaillet N, Belaid L, Crochetière C Nonpharmacologic approaches for pain management during labour compared with usual care: A meta-analysis. Birth. 2014; 41:(2)122-137

Chow J, Ateah CA, Scott SD, Ricci SS, Kyle T. Canadian maternity and pediatric nursing.China: Library of Congress; 2013

Chughtai A, Navaee M, Hadi M, Yaghoubinia F. Comparing the effect of aromatherapy with essential oils of rosa Damascena and lavender alone and in combination on severity of pain in the first phase of labour in primiparous women. Crescent J Med Biol Sci. 2018; 5:(4)312-319

Dengsangluri J. Effect of breathing exercise in reduction of pain during first stage of labour among primigravidas. Int J Heal Sci Res. 2015; 5:(6)390-398

Esmaelzadeh-Saeieh S, Rahimzadeh M, Khosravi-Dehaghi N, Torkashvand S. The effects of inhalation aromatherapy with Boswellia carterii essential oil on the intensity of labour pain among nulliparous women. Nurs Midwifery Stud. 2018; 8:(1)45-49

Gayeski ME, Brüggemann OM, Monticelli M, dos Santos EKA. Application of nonpharmacologic methods to relieve pain during labour: the point of view of primiparous women. Pain Manag Nurs. 2014; 16:(3)273-284

Gokyildiz Surucu S, Ozturk M, Avcibay Vurgec B, Alan S, Akbas M. The effect of music on pain and anxiety of women during labour on first-time pregnancy: a study from Turkey. Complement Ther Clin Pract. 2018; 30:96-102

Hamdamian S, Nazarpour S, Simbar M, Hajian S, Mojab F, Talebi A. Effects of aromatherapy with Rosa damascena on nulliparous women's pain and anxiety of labour during first stage of labour. J Integr Med. 2018; 16:(2)120-125

NANDA International nursing diagnosis: definition and classification, 2015-2017. In: Herdman TH, Kamitsuru S (eds). Oxford: Wiley Blackwell; 2014

Hutchison J, Mahdy H, Hutchison J. Stages of Labor.Treasure Island (FL): StatPearls Publishing; 2022

Indonesian Ministry of Religion. Rumput Fatimah si pelancar kelahiran. 2011. (accessed 13 June 2022)

Joanna Briggs Institute. JBI levels of evidence FAME. 2014. (accessed 8 June 2022)

Jones L. Pain management for women in labour: an overview of systematic reviews. J Evid Based Med. 2012; 5:101-102

Keliat BA. Mental health nursing: group activity therapy.Jakarta: EGC; 2015

Kimber L, McNabb M, McCourt C, Haines A, Brocklehurst P. Massage or music for pain relief in labour: a pilot randomized placebo controlled trial. Eur J Pain. 2008; 12:(8)961-969

Kurniawati A, Dasuki D, Kartini F. Effectiveness of birth ball exercise to decrease labour pain in the active phase of the first stage of labour on the primigravida women. J Kebidanan. 2016; 5:2-3

Liu ZH, Wang DX. Potential impact of epidural labour analgesia on the outcomes of neonates and children. Chin Med J (Engl). 2020; 133:(19)2353-2358

Lowdermilk DL, Perry SE, Cashion K. Maternity nursing.Mosby: Elsevier; 2013

Mansour Lamadah S. The effect of aromatherapy massage using lavender oil on the level of pain and anxiety during labour among primigravida women. Am J Nurs Sci. 2016; 5:(2)

Mori HM, Kawanami H, Kawahata H, Aoki M. The wound healing potential of lavender oil by accelerating granulation and wound contraction through induction of TGF-β in a rat model. BMC Complement Altern Med. 2016; 16:(144)1-11

Reeder SJ, Martin LL, Griffin Deborah K. Maternity nursing for women's health, newborn and family.Jakarta: EGC; 2018

Tingkat nyeri persalinan melalui terapi accupressure metacarpal dan counter-preessure regiosacralis ibu persalinan kala 1. 2017. (accessed 8 June 2022)

Ricci SS, Kyle T, Carman S. Maternity and pediatric nursing.China: Library of Congress; 2013

Sato K, Fukumori S, Matsusaki T Non immersive virtual reality mirror visual feedback therapy and its application for the treatment of complex regional pain syndrome: an open-label pilot study. Pain Med. 2010; 11:(4)622-629

Research overview: self-hypnosis for labour and birth. prep parent birth early parent. 2011. (accessed 8 June 2022)

Shukla D, Shukla S, Patel S, Shah A. Changing trends in rate of cervical dilation in first stage of labor: prospective longitudinal study. Open J Obstet Gynecol. 2020; 10:(9)1176-1186

Simavli S, Gumus I, Kaygusuz I, Yildirim M, Usluogullari B, Kafali H. Effect of music on labour pain relief, anxiety level and postpartum analgesic requirement: a randomized controlled clinical trial. Gynecol Obstet Invest. 2014; 78:(4)244-250

Tanvisut R, Traisrisilp K, Tongsong T. Efficacy of aromatherapy for reducing pain during labour: a randomized controlled trial. Arch Gynecol Obstet. 2018; 297:(5)1145-1150

Tashjian VC, Mosadeghi S, Howard AR Virtual reality for management of pain in hospitalized patients: results of a controlled trial. JMIR Ment Heal. 2017; 4:(1)

Thomson G, Feeley C, Moran VH, Downe S, Oladapo OT. Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: A qualitative systematic review. Reprod Health. 2019; 16:(1)

Türkmen H, Çetinkaya S, Kiliç H Effect of focusing on Maryam’ s flower during the first stage of the labour on the labour pain, labour duration, and levels of comfort and satisfaction. Clin Nurs Res. 2020; 30:(6)780-789

Tzeng YL, Yang YL, Kuo PC, Lin YC, Chen SL. Pain, anxiety, and fatigue during labour: a prospective, repeated measures study. J Nurs Res. 2017; 25:(1)59-67

Vakilian K, Keramat A, Gharacheh M. Controlled breathing with or without lavender aromatherapy for labour pain at the first stage: a randomized clinical trial. 2018; 5:(3)172-175

Wong MS, Spiegel BMR, Gregory KD. Virtual reality reduces pain in labouring women: a randomized controlled trial. Am J Perinatol. 2021; 38:(S01)e167-e172

Xavier T, Viswanath L. Effect of music therapy on labour pain among women in active labour admitted in Tertiary Care Hospital Kochi. Int J Integr Med Sci. 2016; 3:(11)444-453

Yazdkhasti M, Pirak A. The effect of aromatherapy with lavender essence on the severity of labour pain and duration of labour in primiparous women. Complement Ther Clin Pract. 2016; 25:81-86

Yulianingsih E, Porouw HS, Loleh S. Teknik massage counterpressure terhadap penurunan intensitas nyeri kala l fase aktif pada ibu bersalin di RSUD. Gaster. 2019; 17:(2)

Pain management in the first stage of labour using sensory stimulation

02 July 2022
15 min read
Volume 30 · Issue 7



Severe pain during the first stage of labour can harm both the mother and fetus. Previous studies have shown that severe pain in childbirth can cause discomfort, stress, risk of depressive disorders, decreased intestinal motility and prolonged labour for the mother. For the fetus, it can cause hypoxia, metabolic acidosis, cognitive and emotional disorders and even death. Therefore, better management of labour pain during the first stage is needed.


This study aimed to assess the effect of sensory stimulation to reduce pain in the first stage of labour.


Garuda portal, the Perpustakaan Nasional Republik Indonesia e-resource, the Cochrane Central Register of Controlled Trials and Pubmed were used to search for literature. The inclusion criteria were original randomised controlled trials published in English, in 2014–2020, with a minimum sample size of 30 where the study outcome was rated on a pain scale.


Ten randomised controlled trials were included. The primary interventions using sensory stimulation to reduce pain during the first stage of labour were aromatherapy, music therapy, breathing control, focusing, and virtual reality.


Sensory stimulation by aromatherapy, music therapy, breathing control, focusing and virtual reality are effective in reducing pain in the first stage of labour.

Labour pain is a sensory and emotional experience associated with labour and delivery (Herdman and Kamitsuru, 2014). Chow et al (2013) states that pain is a subjective experience, a complex interaction between physiological, spiritual, sensory, behavioural, cognitive, psychological and cultural influences. Labour pain is caused by cervical dilation, uterine muscle hypoxia, which causes decreased perfusion during contractions, pressure on the urethra, bladder, rectum and pelvic floor muscles (Ricci et al, 2013).

During labour, the level of pain experienced is based on the mother's perception (Yulianingsih et al, 2019). A mother's perception of pain is influenced by her experience, fatigue, anticipation of pain, support, environment, cultural expectations, emotional level and anxiety (Lowdermilk et al, 2013).

The labour process consists of four stages, stage I to stage IV. The first stage of labour lasts the longest (Kurniawati et al, 2016) and in a primigravida, lasts for an average of 12 hours, while multigravidas experience labour for half this time on average (Ricci et al, 2013). The first stage of labour is divided into three phases. According to Chow et al (2013), the first is the latent phase, where the cervix dilates up to 3cm and contractions occur every 5–10 minutes, lasting for 30–45 seconds. The next phase is the active phase, where the cervix dilates 4–7cm, contractions occur every 2–5 minutes and last 45–60 seconds. The last phase is the transitional phase, where dilation is between 8–10cm, contractions occur every 1–2 minutes and last 60–90 seconds (Chow et al, 2013). Recent literature and studies have stated that the active phase begins at 6 cm of cervical dilation (Shukla et al, 2020; Hutchison et al, 2022). This change in the definition of the active phase affects labour management and the identification of abnormal labour. For example, the risk of misdiagnosing dystocia and overuse of labour-accelerating interventions is found if the Friedman criteria (cervical dilation occurs at a rate of 1cm or more per hour) are implemented. This can increase the risk of unnecessary intervention for the mother and fetus (Shukla et al, 2020).

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