The effect of mint chewing gum on salivary cortisol the first stage of labor in nulliparous women

Document Type : Original Quantitative and Qualitative Research Paper


1 Instructor of midwifery, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, Iran

2 Post graduate of Midwifery, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate Professor of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-e-Sina Hospital, Faculty of Medicine , Mashhad University of Medical Sciences, Mashhad, Iran

4 Assistant professor of Biochemistry, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Delivery is one of the critical stressful incidents in lives of most women and its associated complications can disturb the progress of labor and exacerbate post partum problems. Chewing gum is one of the new non-pharmacological methods to reduce stress. So far no study has been conducted to investigate the effect of chewing gum on the stress of labor.
Aim: To determine the effect of mint chewing gum on salivary cortisol in nulliparous women in the first stage of labor.
Methods: The study was a randomized, single-blind, controlled clinical trial in which 60 nulliparous women, who admitted at the first stage of labor in Omolbanin Hospital in Mashhad in 2012, were allocated to two experimental and control groups. The experimental group was asked to chew mint gum (1 gr) for 20 minutes and then their saliva sample were taken to measure cortisol level. Data were analyzed by independent and paried t-test in 5 percent level of significance with SPSS software version 11.5.
Results: The mean salivary cortisol levels at the first and second measurement were respectively 44/9 ± 12/7 and 41/4 ± 13/0 in experimental and also 39/3 ± 10/3 and 42/8 ± 11/0 nmol in control group.  The salivary cortisol level showed a significant increase from the first to the second measurement in control group(p <0.009), whereas a significant decrease was seen in these two measurments in experimental group (p <0.014).Two groups were significantly different in terms of the changes in stress levels between two measurements (P>0/001).
Conclusion: Mint chewing gum reduces salivary cortisol level at the first stage of labor in nulliparous women, which is an evidence for reducing stress. Although careful judgment aboute the exact changes in stress level are needed both laboratory and clinical studies.


1. Fajardo M, Florida J, Villaverdeb C, Oltrasb M, GonzBlez A, Ramirez F. Plasma Lvels of P-endorphin and ACTH Puerperium During Labor and Immediate. Eur J Obstet Gynecol Reprod Biol. 1994;55:105-8.
2. Jannati I, Khaki N.Psychologyi midwifery, Tehran: Jameenegar, 1384:1468-124-47(Persian).
3.Benjamin J, Sodack M.Comperhensive text book of psychiatry. 8rd Edition, New York: Lippincott; 2010:1729.
4. Antooni F.Harisson 2008. Translator of Khosroo Sobhanian.Tehran: Arjmand; 1387:254-8. (Persian)
5. Kirschbaums C, Kudielka B, Gaab J. Impact of Gender-Mensturation Cycle Phase and Contraceptives on Activity HPA Axis. Pychosom Med. 1999;61(2):154-62.
6. Luoien S, Fioccoa S. Stress Hormone and Human Memory Function Across Lifespan. Pcychoneroendocrinology. 2005;30(30):225-42.
 7. Harper AH. Harper biochemectery2000. Translator of Elahe Noroozi. tehran: Teimoor Zade; 1379. 224-33. (Persian)
8. Nancy K, Elizabeth A. Proposed Biological Linkages Between Obesity, Stress and Inefficient Uterinecontractility During Labor in Humans. Med Hypotheses. 2011;76:755–60.
 9. Ruben G, Rafael P. Stress During Labor and Delivery Is Associated with Delayed Onset of Lactation Among Urban Guatemalan Women. Nutrition J. 2002;28:3055-60.
10. Murray S. Foundation of mental newborn nursing  Philadelphia: ST Louis; 2002: 364
11. Parsons M. Midwifery Dilemma: to Fast or Feed the Labouring Woman. Part 2: The Case Supporting Oralintake in Labour. Aust J Midwifery. 2004;17(1):5-9.
12. Ghooshchian S, Dehghani M, Khorsandi M, Farzad V. The Role of Fear of Pain and Related Psychological Variables in Prediction Ofcesarean Labor. AMUJ. 2011;14(56):45-54. (Persian)
13. Mirzaei F, Kaviani M, Jafari P. The Effect of Reflexology on Anxiety in Primiparous Women. IJNMR. 2011;16(1):65-71. (Persian)
14. Cunningham F LK, Bloom S,  Hauth J, Rouse D,  Spong C. Williams Obstetrics. Edition r, editor. New York: Mc Graw Hill Medical; 2010:374
15. Kooshan M Vagheie S. Nursing psychology2. Tehran: Andisheh rafie; 1386:102. (Persian)
16. Moaied Hoseini, S Sohrabi S. Is True that Cesarean Increased  in Iran. Paiesh. 2011;10(2):261-4. (Persian)
17. Laura K, Torney A, Andrew J, Johnson A, Christopher M. Chewing Gum and Impasse-Induced Self-reported Stress. Appetite. 2009;53:414-7.
18. Tahara Y, Sakurai K, Ando T. Influence of Chewing and Clenching on Salivary Cortisol as Indicatore of Stress. Prosthodontics J. 2007;16(2):129-35.
19. Momose T, Nishikami J, Sasaki Y. Effect of Mastication on Regional Cerebral Blood Flow      Examined by Positron Emission Tomography with O-labelled Water and Magnetic Resonance Imaging. Arch Oral Biol. 1997; 7: 5761.
 20. Hollingworth H. Chewing as a Technique of Relaxation. Science. 1939;90:385-7.
21. Johnson Aj, Jenks R, Miles C, Albert M, Cox M. Chewing Gum Moderates Multi-task Induced Shifts in Stress, Mood, and Alertness. A Re-examination. Appetite. 2011 Apr; 56(2):408-11
22. Masahiro T, Kanehisa M. Evaluation of Effects of Lavender and Peppermint Aromatherapy Using Sensitive Salivary Endocrinological Stress Markers. Stress Health. 2011;27:430-5.
23. Doulatabad SN, Hashemi N, Mohebi Z, Sadaghi H. The Effect of Hydroalecolic Extract of Menthe Piperita Complement Treatment on Severity on Depressed Patients. Armaghan danesh. 2010;14(3):83-91. (Persian)
24. Norrish M, Dwyer K. Preliminary Investigation of the Effect of Peppermint Oil on an Objective Measure of Daytime Sleepiness. Int J Psychophysiol. 2005;55:291-8.
25. Scholey A, Crystal H, Bernadette R, David K, Anthea M, Mark W. Chewing Gum Alleviates Negative Mood and Reduces Cortisol During Acute Laboratory. Physiology & Behavior. 2009;97:304-12.
26. Monica C, Lee M, Joseph W, Vander V, Katrina C. The Effect of Chewing Gum on Self-Reported Nicotine Withdrawal: Is It the Flavor,the Act of Chewing, or Both. Addict Behav. 2010;35:224-8.
27. Gray G, Christopher M, Nigel W, Rebecca J, Martin C, Andrew J. The Contrasting Physiological and Subjective Effects of Chewing Gumon Social Stress. Appetite. 2010;554-8.
28. Salehi J. Relationship Between multiple roles and the satisfaction of it on wemens stress and self steem: (Thesis MSC ) Tarbiat modares:1994. (Persian)
29. Bastani F, Rahmatnejad L, . HH. Breast Feeding Self Efficacy and Perceived Stress. IJN. 2008;21(54):9-22. (Persian)
30. Phumdoung S, Good M. Music Reduces Sensation and Distress of Labor Pain. Pain Manag Nurs. 2003;4(2):54-61.
31. Lee K, Hicks G, Nino-Murcia G. Validity and Reliability of a Scale to aAssess Fatigue. Psychiatry Research. 1991;36:291-8.
32. Khalilzadeh M, Alamdari KA, Choobineh S, Shirmard BE, Ghahramani M. Effects of Aerobic Training with Low and Intermediate Intensity on Appetite, Body Weight, Exercise Energy Expenditure and Plasma Ghrelin Level in Relatively Thin and Obese Sedentary Wemon. Int J Prev Med. 2011;6(11):1-10. (Persian)
33. Mirzaie F, Keshtgar S, Kaviani M, Rajaiefard A. The Effect of Lavender Essence Smelling During Labor on Cortisol and Serotonin Plasma Levels and Anxiety Reduction in Nulliparous Women. Journal of Kerman University of Medical Sciences.16(3):245-54. (Persian)