Original Article

Effects of Lavender Tea on Fatigue,

Depression, and Maternal-Infant Attachment
in Sleep-Disturbed Postnatal Women
Shu-Lan Chen, RN, MSN Chung-Hey Chen, RN, PhD

ABSTRACT
Keywords
lavender tea,
postpartum fatigue,
depression,
maternal-infant
attachment

Background: Lavender inhalation aromatherapy is widely believed to impart a hypnotic effect, act
as a mood stabilizer, and enhance the positive feelings of mothers toward their infants. However,
research into these and other potential therapeutic effects of lavender tea has been limited.
Aims: This study was conducted in Taiwan to evaluate the effectiveness of lavender tea in
relieving sleep quality, fatigue, and depression; and in improving maternal-infant attachment
during the early postpartum period.
Methods: A total of 80 Taiwanese postnatal women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score 16) and with no history of allergy to herbal
teas, foods, or medicines were assigned systematically to either the experimental group
(n = 40) or the control group (n = 40). The participants in the experimental group were instructed
to drink one cup of lavender tea after spending time to appreciate and smell the aroma each
day for a period of 2 weeks, whereas their control group peers received regular postpartum
care only. The PSQS, Edinburgh Postnatal Depression Scale, Postpartum Fatigue Scale, and
Postpartum Bonding Questionnaire were used to assess outcomes.
Results: ANCOVA analyses using education level and pretest scores as covariates showed that
experimental group participants perceived less fatigue (F = 6.281, p = .014) and depression
(F = 4.731, p = .033) and showed greater bonding with their infant (F = 4.022, p = .049)
compared with the control group. However, the scores for all four instruments were similar for
both groups at the 4-week posttest, suggesting that the positive effects of lavender tea were
limited to the immediate term.
Linking Evidence to Action: Healthcare researchers assume accountability for integrating
research results into clinical practice. The findings in this study can gain greater attention
among healthcare practitioners and encourage the correct and positive use of herbal therapy in
postpartum health care.

BACKGROUND AND SIGNIFICANCE

Sleep is a basic human physiological need and a complex
physiological process that is essential to restoring physical
agility and energy. Poor sleep quality has been associated
with sympathetic nervous system stress response, increased
susceptibility to infection, tiredness, fatigue, daytime function problems, and depression (Ko, Chang, & Chen, 2010;
Munguia-Izquierdo & Legaz-Arrese, 2012). The postpartum
period is an important transitional phase for women. Sleep
disturbance during this period is of particular concern because
new mothers typically sleep less than normal and often
experience fragmented sleep (Lee, Zaffke, & McEnany, 2000).
Untreated sleep problems not only adversely affect a postnatal
woman mentally and physically but may also affect adaptation
to her new life role as a mother and her relationship with her
infant (Lee & Zaffke, 1999). Prior research has found that 95%

370

of postpartum women experience postpartum fatigue (Milligan, Parks, Kitzman, & Lenz, 1997) and that 15% to 20% suffer
from postpartum depression (Guille, Newman, Fryml, Lifton,
& Epperson, 2013). However, despite their frequent occurrence
and severity, sleep quality and fatigue are not acknowledged as
serious problems or as issues that require nursing intervention.
According to the World Health Organization (WHO, 2003),
in Europe, North America and other industrialized regions,
over 50% of the population and in Africa 80% uses some form
of herbal medicine (Cass, 2004). Nonmedical methods that
are used to improve sleep quality include massage, exercise,
yoga, acupuncture, music therapy, and herbal tea (Hollenbach,
Broker, Herlehy, & Stuber, 2013). The various aromatic plants
used as sleep aids include St Johns Wort, passionflower, German chamomile, lavender, valerian, and kava (Jacobs, Bent,
Tice, Blackwell, & Cummings, 2005). Several biochemical

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Original Article
constituents of essential oils, including acids, esters,
coumarins, and monoterpenols, have been reported to
produce hypnotic, sedative, or antianxiety effects. These constituents act on nerve cell function by antagonizing specified
neuronal receptors or binding to other receptors (Bowles,
2003). Anecdotally, lavender oil has been offered in support
of the analgesic and sedative properties and is believed to have
minimal side effects (Fismer & Pilkington, 2012). Lavender
was originally cultivated in the Mediterranean region, where
it is known as the queen of the garden fragrances because
of its distinctive aroma. Lavender tea contains linalyl acetate
and linalool, which reduce depression and insomnia, calm
the mind, and relieve anxiety (Gyllenhaal, Merritt, Peterson,
Block, & Gochenour, 2000; Hoya, Matsumura, Fujita, &
Yanaga, 2008). However, a systematic review of the evidence
on lavender and sleep concluded that additional well-designed
trials are needed to establish the specific causal implications
of the observed effects of lavender oil aroma inhalation on
sleep problems (Fismer & Pilkington, 2012).

POSTPARTUM FATIGUE, DEPRESSIVE

SYMPTOMS, AND MATERNAL-INFANT
ATTACHMENT
Fatigue is a subjective experience that may cause a range of
unpleasant symptoms from feeling tired to exhaustion, which
affect the individuals physical and psychological health (Ream
& Richardson, 1996). Research has shown that 90-96% of
postpartum mothers in Taiwan experience postpartum fatigue,
mostly in the form of a physical-mental mix (Ko & Lu, 2003).
One study found that postnatal women (n = 68) perceived
greater evening fatigue than morning fatigue, with potential
sources of postpartum fatigue including lack of rest during the
day, interruptions in nighttime sleep, stress associated with
new roles, and pain (Troy & Dalgas-Pelish, 2003). Many others have further confirmed postpartum fatigue as a very common and annoying health problem as well as its role as a
significant predictor of depressive mood (Bozoky & Corwin,
2002; McQueen & Mander, 2003). Postpartum fatigue is progressive in nature, continues beyond the 6-week postpartum
period, reduces the quality of mother-infant interactions, and
impairs relations with other family members (Elek, Hudson,
& Fleck, 2002; Lee & Zaffke, 1999; Ruchala & Halstead, 1994;
Troy, 1999). A Taiwan-based study found that a 6-session,
low-intensity exercise program that incorporated Pilates, yoga
movements, and music significantly reduced fatigue in postpartum women during the 3-week postpartum period, but did
not have a significant impact on depressive symptoms (Ko,
Yang, & Chiang, 2008). Using the Yoshitake Fatigue Symptom Checklist to measure levels of fatigue in new mothers, that
study found a significant mean change in the control group only
in physical fatigue (mean difference .77) and significant mean
changes in the intervention group in physical fatigue (1.39),
psychological fatigue (.96), and fatigue symptoms (1.00).
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Most women experiencing postpartum depression develop

related symptoms at 6 to 8 weeks postpartum (Weier & Beal,
2004). Emotional stress, alcohol, substance abuse, long-term
sleep deficiency, and the side effects of certain medications
are factors that have been associated with depression, which
is sometimes expressed as chronic fatigue (Castro, 1997). One
previous study related depression to increased limbic system
activity (Drevets et al., 1992). Mothers who frequently perceived
their daytime sleepiness to be affected by infant-care performance have been shown to be more likely to be depressed
(Huang, Carter, & Guo, 2004). Cheng and Pickler (2014)
found that stress, fatigue, and depression were experienced at
moderately high levels during the postpartum period and that
childcare responsibilities may partially explain the effect of
postpartum fatigue on postpartum depressive symptoms. Dennis and Ross (2005) demonstrated that the onset of depressive
symptoms during the first 8 postpartum weeks is strongly associated with frequent infant night waking, maternal fatigue, and
sleep deprivation. Weier and Beal (2004) reported that the essential oils most consistently used for depression include lavender, jasmine, ylang-ylang, sandalwood, bergamot, and rose.
The feelings of a mother for her baby, often described as
bonding or attachment, stimulate affection and protective feelings (OHiggins, Roberts, Glover, & Taylor, 2013). Attachment
is an emotional connection between parent and child that
profoundly affects the personality and social development of
the child (Broberg, 2000). Bonding disorders describe situations in which this attachment is deprived or weak. Bonding
disorders that occur during the early postpartum period may
cause a mother to be indifferent, disinterested in, or even
abusive toward her child, which will negatively affect her
future caring attitude toward her child (Brockington, Fraser, &
Wilson, 2006; Rutter, 1995). Brockington (1996) reports that
bonding disorders are prominent in 1025% of mothers who
are referred to psychiatrists after childbirth (OHiggins et al.,
2013). Shieh et al. (2012) interviewed 68 Taiwanese postnatal
women to explore the experience of maternal links and found
that concerns about breastfeeding, lack of sleep, and low confidence in the skills of caring were the major sources of anxiety
and worry for postpartum women. Lack of sleep may lead to
negative emotional experiences that hinder the maternal link.
The physical and mental health of the mother has a profound
effect on children during the early postpartum period.
Moehler, Brunner, Wiebel, Reck, and Resch (2006) pointed
out that postpartum women should receive especially strong
protection and support during the first postpartum month.

LAVENDER AND SLEEP, DEPRESSIVE

SYMPTOMS, AND MATERNAL-INFANT
ATTACHMENT
Lavender covers about 28 native species and 300 hybrids in
the Lamiaceae family of herbaceous plants (Buckle, 2003).
Although all lavenders share similar ethnobotanical properties
and major chemical constituents, there are some differences

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Lavender Tea on Postnatal Fatigue, Depression, and Maternal-Infant Attachment

in the reported therapeutic uses for different species. Lavender

oil is traditionally believed to be an antibacterial, antifungal,
carminative (smooth muscle relaxing), sedative, and antidepressive agent; and an effective treatment for burns and insect
bites (Buckle, 2003; Cavanagh & Wilkinson, 2002). The active
ingredients of lavender are linalool and linalylacetate, which
are rapidly absorbed through the skin and reach peak plasma
levels after approximately 19 minutes (Jager, Buchbauer,
Jirovetz, & Fritzer, 1992). The metabolic time for using
essential oils is about 2 hours (Wen, 2009). Linalyl acetate has
narcotic actions, and linalool acts as a sedative. Linalool has an
effect that is similar to phenobarbital (Elisabetsky, Coelho de
Souza, Dos Santos, Siqueira, & Amador, 1995; Re et al., 2000).
However, caution has been advised in the selection of lavender
species because one case report noted that drinking Lavender
stoechas (Buckwheat grass) tea triggered anticholinergic syndrome and supraventricular tachycardia (Acikalin et al., 2012).
The literature on nonpharmacological interventions indicates that lavender oil may have greater acceptability and be
safe for treating mild to moderate sleep disturbances (Edinger
& Sampson, 2003; Lillehei & Halcon, 2014). Most studies
on lavender focus on its aroma-therapeutic effect in terms
of facilitating sleep. Some positive objective outcomes for
lavender inhalation have been reported. Pleasant lavender
odorant-modified respiration during sleep has reportedly
improved sleep quality in younger people with mild insomnia
(Arzi et al., 2010; Lewith, Godfrey, & Prescott, 2005), in adult
or midlife women with insomnia (Chien, Cheng, & Liu, 2012;
Lewith et al., 2005), and in young healthy sleepers (Goel,
Kim, & Lao, 2005). Lavender increased stage 2 sleep and
decreased rapid-eye movement sleep in women and had the
opposite effect in men (Goel et al., 2005). Hudson (1996) also
found that lavender was effective in helping the long-term
hospitalized elderly people to achieve better nighttime sleep
quality and better alertness during the daytime. However, one
study reported that administering lavender odorant during
sleep successfully elevated mood, but had no other effects on
sleep quality, cognitive function, or alertness (Raudenbush,
Koon, Smith, & Zoladz, 2003).
Lavender is a traditional herbal remedy that is believed to
"strengthen the nervous system" (Akhondzadeh et al., 2003).
A pilot study reported that lavender aromatherapy had a
positive effect on mood disorders and decreased psychological
distress on long-stay neurology inpatients (Walsh & Wilson,
1999). Clinical trials that compared the effect of lavender and
antidepressants in the treatment of mild to major depression
found that the combination of antidepressant and lavender
(taken as a tincture, oil capsule, or mill infusion) was significantly more effective than using antidepressant alone, with no
side effects reported among participant cases (Akhondzadeh
et al., 2003; Fibler & Quante, 2014; Nikfarjam, Parvin,
Assarzadegan, & Asghari, 2013). Postpartum depression in
mothers has been shown to negatively impact parent-infant
bonding for up to 1 year postpartum (OHiggins et al., 2013).
Imura, Misao, and Ushijima (2006) reported that lavender

372

aromatherapy massage in healthy postpartum mothers had an

antidepressant effect and significantly increased vigor as well
as the approach feeling toward the infant. One study found
the mothers with very young infants in the lavender-scented
bath oil group were more relaxed, smiled more, and touched
their infants more during bathing (Field et al., 2008).
However, essential oils contain chemicals that may harm
physical functions if used improperly. These chemicals include
ketones, a nerve toxin; phenols, a liver toxin; coumarin, a liver
and kidney toxin as well as skin allergen; furocoumarin, a
skin allergen; aldehydes; and esters (Tseng, 2005). Although
it contains the same ingredients, herbal tea has milder effects
than essential oil. Therefore, herbal tea carries a lower risk as
a stimulant and as a cause of allergic reactions. For healthcare
professionals, integrating scientific research results into clinical practice offers an effective method for resolving dilemmas
in health care (Maddocks-Jennings & Wilkinson, 2004). The
therapeutic effects of lavender tea have not previously been
tested scientifically in health care, nursing, or epidemiological
studies. This study tests the effects of single-ingredient lavender tea on postpartum fatigue, depression, maternal-infant
attachment, and sleep quality. We hope this herbal treatment
will gain greater attention among nursing and healthmanagement practitioners and encourage the development of
a proper scheme for using herbal tea in health care.

METHODS
A pretest-posttest randomized controlled group design was
implemented to examine the effects of lavender tea on
postpartum fatigue, depression, maternal-infant attachment,
and sleep quality.

Participants
Participants for this study were recruited from the postnatal
clinic of a medical center in southern Taiwan. The inclusion
criteria were (a) uncomplicated childbirth, (b) no postnatal
complications, (c) Postpartum Sleep Quality Scale (PSQS)
score 16, and (d) informed consent to participate. Postnatal
women who had a history of allergy to any herbal tea, food, or
medicine were excluded.

Intervention
At 6 weeks after childbirth, participants in the experimental
group were instructed to drink one cup of lavender tea after
smelling (appreciating) its aroma 1 hour before bedtime for a
period of 2 weeks. Each cup of tea was made from one teabag
(origin: France; 2 g of dried lavender flowers) that was steeped
for 1015 minutes in 300 mL of hot water. This study provided
14 teabags to each of the experimental group participants. The
women in the control group received regular postpartum care
only.

Instruments
In addition to demographic data, four instruments, PSQS,
Edinburgh Postnatal Depression Scale (EPDS), Postpartum
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Original Article
Fatigue Scale (PFS), and Postpartum Bonding Questionnaire
(PBQ), were used to measure the outcome variables. Experimental group members received one additional open-ended
question about their current experience with drinking lavender
tea.

Ko and Lu (2003), this scale earned an internal consistency of

.85 and a score for relationship significance with the Yoshitake
Fatigue Symptom Checklist of r = .7, which indicates criterion
validity. Cronbachs for the PFS was .93 in this study.

The PSQS

The PBQ is a 25-item, self-rating questionnaire with four scales

designed to detect discrete mother-infant relationship impairments as perceived by the mother (Brockington et al., 2001).
The 12-item Scale 1 is a general factor for the identification
of some kind of mother-infant relationship impairment. The
seven-item Scale 2 is designed to detect severe mother-infant
relationship impairment in which the mother feels rejection
of or pathological anger toward the infant. The four-item
Scale 3 is used to identify infant-focused anxiety. The twoitem Scale 4 is used to detect incipient abuse (Brockington
et al., 2006). The response to each item is given on a six-point
Likert scale ranging from 0 = always to 5 = never. Higher
scores indicate more pathological responses. In this study,
only the 12-item general factor subscale (e.g., I feel close
to my baby; I wish I could return to a time before I had my
baby) with a maximum score of 60 was employed to assess
maternal-infant attachment. The cut-off point for scale 1 was 11
= normal and 12 = high (Brockington et al., 2006). Cronbachs
for the general factor subscale in this study was .85.

The Chinese version of PSQS was developed by Yang, Yu, and

Chen (2013) to measure postpartum sleep quality. The PSQS
consisted of 14 items and showed good internal consistency
( = .81) and acceptable 5-day test-retest reliability (r = .81).
Construct validity was confirmed using exploratory factor
analysis, which extracted and defined infant night care-related
daytime dysfunction and physical symptoms-related sleep
inefficiency as the two main categories of postpartum sleep
quality. The two factors explained 44.49% of total variance.
The questions were designed to assess the postnatal sleep
quality of participants during the previous 2 weeks, and items
were scored on a five-point Likert scale (0 = never, 1 = few, 2
= sometimes, 3 = often, 4 = almost always). PSQS scores were
computed by first reversing the scores on the three positively
worded items and then summing across all 14 items. Higher
scores indicated poorer postpartum sleep quality. Significant
correlation (r = .67) with the Pittsburgh Sleep Quality Index
(Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) showed
convergent validity (Yang et al., 2013). The PSQS was found to
have adequate internal consistency for the participants in this
study (Cronbachs = .78).

The Edinburgh Postnatal Depression Scale

The 10-item EPDS is a screening tool for detection of postnatal
depression. This scale was initially developed for use in a
postnatal female population to measure the mood of women
after delivery and is a useful indicator for people who may be
suffering from depression (Cox, Holden, & Sagovsky, 1987).
The statements are designed to assess postpartum depressive
symptoms during the previous 7 days, with answers rated
from "not at all" (0) to "yes, most of the time" (3). Total possible
scores for the EPDS range from 0 to 30. A cut-off 9/10
is recommended to screen for postnatal depression. The
sensitivity of the EPDS was assessed as 86%, with a specificity
of 78%; Cronbachs was .87 (Cox et al., 1987). The Chinese
version of the EPDS has been likened to language and cultural
identity in the process of translation. Heh (2001) used the
Chinese-version EPDS to assess maternal postpartum depression and achieved an internal consistency Cronbachs of .87
and concurrent validity with the Beck Depression Inventory
(r = .79). Cronbachs for the EPDS in this study was .83.

The Postpartum Fatigue Scale

The PFS, derived from the Piper Fatigue Scale by Yang (1998),
includes 14 items. Symptoms are scored from 0 to 3 (0 = none;
1 = mild; 2 = moderate; 3 = severe) according to the intensity
experienced by the respondent, with higher scores reflecting a
greater severity of postpartum fatigue. According to the work of
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The Postpartum Bonding Questionnaire

Procedure and Ethical Considerations

This study was carried out from November 2012 to August
2013 after obtaining approval from the research ethics committee of the participating institution. All participants who
provided informed consent received a complete explanation
of the objectives of the study and of their rights. Participation
was voluntary, and refusal to participate had no impact on
an individuals access to care or quality of care.
Eighty women who met the inclusion criteria and returned
their consent documents were assigned systematically from
a random starting point to either the experimental group
(n = 40) or the control group (n = 40). The two groups were
asked to complete the Demographic Data Form, PSQS, EPDS,
PFS, and PBQ questionnaires at three time periods: before the
intervention and at 2 and 4 weeks postintervention. All participants in both groups were given a gift after completing the
pretests. The latter two sets of questionnaires were mailed with
postage-paid, preaddressed envelopes to all the participants
to be filled out and returned. Thirty-eight in the experimental
and 38 in the control group completed the 2-week posttests
(immediate effect); 34 in the experimental and 37 in the control
group completed the 4-week posttests (longer term effect).
The participant flow diagram (Fig. 1) presents the numbers
and timing of randomization assignment, interventions and
measurements for both groups.

Data Analysis
The SPSS (version 17.0 for Windows, SPSS Inc., Chicago, IL,
USA) statistical software package was used to analyze the data.

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Lavender Tea on Postnatal Fatigue, Depression, and Maternal-Infant Attachment

Table 1. ANCOVA for Outcome Variables, Experimental and Control Groups

Scales

Experimental

Control

M (SD)

M (SD)

t/F

Table 2. Demographic and Obstetric Characteristics

of the Experimental and Control Groups

Variable

Experimental

Control

(n = 38)

(n = 38)

Education level

PSQS
22.53 (5.092) 25.63 (5.687) 2.507 .014

Pretest
a

2-week posttest 22.89 (6.600) 26.16 (6.832)

4-week posttest 20.97 (6.735) 22.86 (6.156)

High school

5 (13.2%)

2 (5.2%)

.551 .460

College

19 (50.0%)

31 (81.6%)

.015 .901

Graduate

14 (36.8%)

5 (13.2%)

Occupation

PFS
Pretest

13.05 (6.505) 14.74 (7.748) 1.026 .308

Housewife

17 (44.7%)

10 (26.3%)

21 (55.3%)

28 (73.7%)

2-week posttest 11.61 (5.582) 15.58 (8.265)

6.281 .014

Employed

4-week posttestb 10.91 (6.482) 12.95 (7.524)

2.079 .154

Social class
High

19 (50.0%)

18 (47.4%)

Middle

12 (31.6%)

17 (44.7%)

4.022 .049*

Low

7 (18.4%)

3 (7.9%)

3.748 .057

Type of delivery

PBQ
7.74 (4.769) 9.08 (6.470) 1.029 .307

Pretest

2-week posttestb 6.61 (4.143) 9.66 (7.954)

b

4-week posttest

4.74 (4.316)

7.60 (6.97)

Vaginal

28 (73.7%)

25 (65.8%)

Cesarean

10 (26.3%)

13 (34.2%)

4.731 .033

Parity

1.037 .312

Primiparous

23 (60.5%)

23 (60.5%)

Multiparous

15 (39.5%)

15 (39.5%)

EPDS
7.50 (4.196) 9.71 (4.274) 2.275 .026

Pretest
a

2-week posttest

7.37 (3.590) 10.47 (4.560)

4-week posttest 7.68 (4.676) 9.51 (4.154)

Note. a ANCOVA covariates were education level and pretest score.

b
ANCOVA covariate was education level. * p < .05

Tests for differences in baseline characteristics between the

two groups included the X2 test for categorical variables and the
t test for continuous variables. A one-way analysis of covariates
(ANCOVA) using education level and pretest scores as covariates was used to compare the groups for outcome variables. All
results with p < .05 were considered statistically significant.

Male

15 (39.5%)

20 (52.6%)

Female

23 (60.5%)

18 (47.4%)

Gestational age of
newborn

Preterm

32 (84.2%)

30 (78.9%)

6 (15.8%)

8 (21.1%)

RESULTS

Type of feeding

A total of 80 postnatal women were enrolled in the study. As

noted previously, a total of 38 experimental and 38 control
subjects completed the 2-week posttests and a total of 34
experimental and 37 control subjects completed the 4-week
posttests. The mean age of the experimental group was 32.05
4.01 years (range: 2642 years) and of the control group
was 32.68 3.88 years (range: 2540 years). The mean ages
did not significantly differ between the two groups. The other
demographic and obstetric characteristics of the participants
are presented in Table 1. The Index of Status Position was
used to determine the social class of participants (Lin, 1978).
With the exception of education level, no significant difference
in characteristics was identified between the two groups.

Breast

20 (52.6%)

16 (42.1%)

Bottle

1 (2.6%)

3 (7.9%)

Mixed

17 (44.8%)

19 (50.0%)

374

8.429

.015

2.815

.093

2.489

.288

.561

.454

.000 1.00

Gender of
newborn

Term

x2

1.324

.250

.350

.554

1.556

.459

The PSQS, PFS, PBQ, and EPDS were used to measure

outcome variables. Table 2 presents a comparison of the
means for each of the measures at pretest, 2 weeks posttest,
and 4 weeks posttest. Two sample t tests exhibited significant
differences in the PSQS pretest (p = .014) and the EPDS pretest
(p = .026) values. A key component of the evaluation focused
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Assessed for eligibility (n= 80)

(N=80)

Randomized (n = 80)

Initial test
Allocated to lavender tea (n = 40)
group

Allocated to routine care (n= 40)

Two-week follow-up test

Lost to follow-up (n = 2)

Lost to follow-up (n = 2)

Mastitis (n = 1)
Mailing loss (n = 1)

Incorrect contact details (n = 1)

Mailing loss (n = 1)

Analyzed (n = 38)

Analyzed (n = 38)

Four-week follow-up test

Lost to follow-up (n = 4)

Lost to follow-up (n = 1)

Incorrect contact details (n = 2)

Mailing loss (n = 2)

Mailing loss (n = 1)

Analyzed (n = 34)

Analyzed (n = 37)

Figure 1. Flow Diagram of Participant Progress Through the Phases of the Randomized Trial.
on whether the experimental group earned significantly lower
scores than the control group. A one-way between-group
analysis of covariance (ANCOVA) was conducted to compare
the effectiveness of the lavender tea therapy. For the PFS and
PBQ test, ANCOVA demonstrated a significant difference in
mean scores between the two groups when the means were
adjusted using education level as the covariate (PFS, p = .014;
PBQ, p = .049). For the EPDS test, ANCOVA demonstrated a
significant difference in mean scores between the two groups
when the means were adjusted using education level and
pretest results as covariates (p = .033). However, there were

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no significant differences between the groups on the 4-week

posttest in terms of scores for the four indices.
The participants reported no side effects from the treatment. In response to the open-ended questions, those who
drank lavender tea reported that it effectively promoted
relaxation (50%), sleep quality (26.3%), and emotional stability
(18.4%); and that it had a fragrant aroma (15.8%).

DISCUSSION AND IMPLICATIONS

The results of this randomized trial suggest that lavender tea
may be an effective nonpharmacologic alternative for postnatal

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Lavender Tea on Postnatal Fatigue, Depression, and Maternal-Infant Attachment

women with poor sleep quality because consumption was

found to improve fatigue, depression, and maternal-infant
attachment 2 weeks after beginning the treatment. However,
these effects were short-lived, with no effects found over the
longer term, after the tea-drinking intervention had ceased.
Inconsistent with previous studies that indicated that
lavender essential oil aromatherapy effectively improves sleep
quality (Arzi et al., 2010; Chien et al., 2012; Goel et al., 2005;
Hudson, 1996; Lewith et al., 2005), we found that lavender tea
does not significantly improve sleep quality in sleep-disturbed
postnatal women. This disparity in results may be attributable
to the sleep-quality measurement tools used, research subjects
enrolled, intervention measures used, or dosage value of
lavender used. A further reason may be that although herbal
tea is made with natural herb ingredients, the fragrance composition in the dose may be insufficient to modify respiration
during sleep and to show its hypnotic effect. Wen (2009)
pointed out that fragrant ether plants such as basil deliver the
best improvements in the sleep quality of postpartum women
when poor sleep quality is induced by life pressures or stress
from chores. Based on the results of this study and findings
in the literature, lavender aromatherapy may be a better
treatment for poor sleep quality than drinking lavender tea.
Postpartum fatigue is a frequently reported symptom in
postnatal women that may affect the recovery of the mother
and interfere with her performance of maternal tasks (Pugh
& Milligan, 1993). This study supports the finding of positive
association of lavender tea on fatigue by Kohara et al. (2004),
who found that using 1% lavender essential oil in a foot soak
and reflexology regimen to be effective in alleviating fatigue
in terminally ill cancer patients. Postpartum fatigue may be
viewed as a natural physiological and psychological response to
childbirth and an unavoidable burden of motherhood. Buckle,
Ryan, and Chin (2014) mention that lavender aromatherapy is
said to have several therapeutic uses that include relaxation and
peace, relieve pain, and to create a calm healing environment.
This study also found that although drinking lavender tea
for 2 consecutive weeks had an immediate effect on alleviating
postpartum depression, the effect did not last long after the
intervention ceased. This finding echoes Itai et al. (2000) and
Imura et al. (2006), who reported that lavender aromatherapy
had an antidepressant effect in chronic hemodialysis patients
and healthy postpartum mothers. The effects of lavender on
depression may be explained in light of the multiple chemical
constituents of this herb, which include linalool, linalyl acetate,
and flavonoids; as well as its demonstrated effect on a variety of
neurotransmitters such as serotonin, Gamma amino bootiric
acid, and dopamine, which are involved in the pathophysiology
of depression (Nikfarjam et al., 2013). Although the mechanism of action of fragrance on psychological status has not
yet been clarified, one study demonstrated that lavender scent
induces a state of alertness, improves feelings of wellbeing, and
decreases anxiety (Cavanagh & Wilkinson, 2002). Lavender
is a perennial shrub that can thrive in harsh and otherwise
adverse environments (Mojay, 1996). Perhaps this aspect of

376

lavender embodies the spirit that postpartum women need to

regain their energy and recover from the stress of childbirth.
Interestingly, this study supported the positive effect
of lavender tea on mother-infant attachment. A possible
explanation is that smelling (appreciating) the aroma of the
lavender tea positively influences the mood, relaxation, and
clarity of mind of the recipient and strengthens her positive
perception of her maternal responsibilities (Field et al., 2008;
Imura et al., 2006).
The experimental group subjectively perceived that drinking lavender tea is relaxing, induces sleep, and promotes
emotional stability. Herbal tea is thought to be therapeutically
effective because of both the psychological effects of the aroma
and the physiological effects of the inhaled volatile compounds, which are believed to act on the limbic system (on the
amygdala and the hippocampus in particular). The amygdala
has a role in controlling emotional reactions, whereas the
hippocampus has a role in memory recall. However, although
lavender flavor or fragrance influences emotional reactions
and memory (Itai et al., 2000; Nikfarjam et al., 2013), the exact
cellular mechanism of this action remains unknown.
This study found that the participants who consumed lavender tea for 2 consecutive weeks showed significant improvement in postpartum fatigue, depression, and mother-infant
relationships. However, after stopping the treatment, these
positive effects did not last long enough to have a detectable
effect at the 4-week follow-up (10 weeks postpartum). Lavender
is absorbed into the body via the skin and the olfactory system.
The aromatic molecules of lavender oil are detectable in the
blood plasma in about 19 minutes and fall to undetectable
levels within 90 minutes of application (Jager et al., 1992).
Herbal tea contains only trace amounts of aromatic molecules.
Thus, the metabolic effect of this tea is likely significantly
shorter than lavender essential oil, making multiple daily consumptions necessary to achieve lasting effect. Another possible
reason for the lack of a longer term effect is that at 2-weeks
posttest (8 weeks postpartum), the employed women had
completed their 2-month maternity leave and returned to their
regular jobs. Therefore, additional measurement points with
shorter intervals between each point are necessary to confirm
the actual duration of the therapeutic effects of lavender.
Because this study used single-ingredient lavender tea that
was brewed from dried lavender flowers, results cannot be
generalized to the use of the compound-ingredient lavender
teas that are widely available commercially. There were no
inclusion or exclusion criteria for whether participants had a
history of postpartum depression, or used or were currently
taking antidepressants, hypnotics, or over-the-counter drugs;
these factors might be potential confounders to our results.
In addition, we could not exclude the possibility of contamination: Participants in the control group may have known about
this form of herbal medicine and used lavender tea during
the follow-up period. It is recommended that future studies
address the following potentially confounding factors before
making inferences about the therapeutic effects of lavender tea:
Worldviews on Evidence-Based Nursing, 2015; 12:6, 370379.

C 2015 Sigma Theta Tau International

Original Article
(a) because lavender is widely believed to have healing effects,
future research should work to effectively exclude the placebo
effect; (b) because of the wide variety of lavender tea products
on the market, analytical techniques such as gas chromatography and mass spectrometry should be used to assess the
chemical composition of specific products prior to their use in
research; and (c) the currently small number of extant articles
that address the pharmacological properties of lavender makes
obtaining empirical data on the absorption and metabolism
of lavender and its effects on the central nervous system
difficult. Finally, this study included only Taiwanese postnatal
women, who may share a cultural predisposition to drinking
lavender tea. Therefore, this study should be duplicated in
other countries to confirm the feasibility and effectiveness of
the lavender tea therapy in different cultural settings.

CONCLUSIONS
This study supports the popular claim for the beneficial effects
of lavender tea on fatigue, depression, and maternal-infant
attachment in postpartum women. The lack of reported side
effects further supports lavender tea consumption as an
alternative therapy that is safe, simple, cost-effective, and
viable for all clients.
The tremendous physical and mental changes that
postpartum women face in the process of assuming the responsibilities of motherhood make their physical and mental
health important issues of concern to both the healthcare community and the society at large. Therefore, this study suggests
that clinical healthcare professionals implement postpartum
holistic assessments and design various health promotion
protocols to assist postnatal women to cope with early postpartum stressors and to fulfill their responsibilities and realize
their full potential as new mothers. We hope that healthcare
professionals will reference these findings to make correct and
positive use of herbal therapy in postpartum health care. WVN

ACKNOWLEDGEMENTS
The National Science Council, Taiwan financially supported
this work. The authors thank all the participants for their
support and participation.

LINKING EVIDENCE TO ACTION

r Implement postpartum holistic assessments and
design various health promotion protocols to assist
postnatal women to fulfill their responsibilities as
new mothers.

r Single-ingredient lavender tea may be recommended to postpartum women as a supplementary

approach to alleviating fatigue and depression.

Worldviews on Evidence-Based Nursing, 2015; 12:6, 370379.


C 2015 Sigma Theta Tau International

r Drinking lavender tea has a positive effect on

maternal-infant attachment in postpartum women
with poor sleep quality.

r Explore other nonpharmacologic options for postnatal women with fatigue or depression.

Author information
Shu-Lan Chen, Lecturer, Department of Nursing, Fooyin
University, Kaohsiung, Taiwan; Chung-Hey Chen, Professor,
Institute of Allied Health Sciences & Department of Nursing,
College of Medicine, National Cheng Kung University, Tainan,
Taiwan
This study was funded by Grant NSC 99-2628-B-006-035MY3 from the Taiwan National Science Council.
Address correspondence to Dr. Chung-Hey Chen, Institute
of Allied Health Sciences & Department of Nursing, College of
Medicine, National Cheng Kung University, 1 University Road,
Tainan (70101), Taiwan, ROC; chunghey@mail.ncku.edu.tw
Accepted 24 May 2015
C 2015, Sigma Theta Tau International
Copyright 

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