Self‐hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness

Abstract

Objective(Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use.DesignMulti-method randomised control trial (RCT).SettingThree NHS Trusts.PopulationNulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness.MethodsRandomisation at 28–32 weeks’ gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks’ gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal.Main outcome measuresPrimary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis.ResultsSix hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64–1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference −0.72, 95% CI −1.16 to −0.28, P = 0.001); fear (mean difference −0.62, 95% CI −1.08 to −0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: ‘Mean difference’ replaced ‘Odds ratio (OR)’ in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI −£257.93 to £267.59).ConclusionsAllocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation.Tweetable abstractGoing to 2 prenatal self-hypnosis groups didn't reduce labour epidural use but did reduce birth fear & anxiety postnatally at < £5 per woman.

The Complementary Therapies for Labour and Birth Study making sense of labour and birth – Experiences of women, partners and midwives of a complementary medicine antenatal education course

“…Medical management of labour and birth are now part of the childbirth education teaching curriculum and accepted as part of normal birth (Ferguson et al, 2013;Lothian, 2007Lothian, , 2008aWalker, Visger, & Rossie, 2009). The literature supports the notion that antenatal educational interventions, including psychoprophylaxis and hypnosis, increases feelings of confidence and agency, but demonstrate little impact on reducing interventions and associated morbidity (Bergström, Kieler, & Waldenström, 2009;Byrne, Hauck, Fisher, Bayes, & Schutze, 2014;Cyna et al, 2013;Downe et al, 2015;Gagnon & Sandall, 2007;Koehn, 2002;Madden, Middleton, Cyna, Matthewson, & Jones, 2012).…”

Experiences of early labour management from perspectives of women, labour companions and health professionals: A systematic review of qualitative evidence

“…An RCT by Werner et al (2013) reported that a brief antenatal intervention in self-hypnosis improved nulliparous women's experiences of childbirth compared with outcomes of women randomised to a relaxation and mindfulness group or usual care. Downe et al (2015) in their RCT of self-hypnosis training in pregnancy to better manage labour pain in nulliparous women showed as a secondary outcome that women in the intervention group had lower actual than anticipated levels of anxiety and fear between baseline (around 27 weeks gestation) and two weeks postnatally. Although a response rate of 67% limits the generalisability of this finding, it is nevertheless important to consider approaches to prevent and/or minimise maternal anxiety and fear at the onset of labour.…”

Os Impactos Da Hipnose Durante a Gravidez E Trabalho De Parto

“…Em resposta a essa crescente demanda, os prestadores de serviços públicos e privados estão oferecendo técnicas alternativas para o parto e para o alívio da dor, incluindo programas focados na prática de hipnose. (3) Waisblat et al, testou a hipnose em mulheres que solicitaram a anestesia epidural com intuito de reduzir a ansiedade e medo durante o processo.5 Com uma abordagem cega, contou com uma equipe de anestesistas treinados em hipnose clínica que, durante a aplicação da anestesia, utilizou uma estratégia de comunicação positiva e sugestiva. Foi observada uma redução de até 20% no estresse ao longo de todas as fases do trabalho de parto e também na intensidade da dor das contrações.…”

“…(6) Na terceira e quarta sessões incorporaram sugestões sobre uma experiência positiva de trabalho de parto e pós-parto visando menor desconforto durante o parto e vínculo positivo das mulheres com seus bebês recém-nascidos, (incluia orientar os participantes para o futuro, pedindo-lhes para imaginar estar em trabalho no hospital e o tempo após a conclusão do trabalho de parto).6 Nesse contexto, no momento do parto, observou-se que a solicitação por anestesia epidural foi significativamente menor naquelas mulheres que haviam sido submetidas à prática de hipnose (4,3% versus 0% de mulheres submetidas). (6) Essa redução na solicitação por anestesia epidural foi o resultado mais consistentemente observado nos estudos avaliados: 28% versus 31% de mulheres submetidas em Downe et al, 72% versus 81% em Finlayson et al e 30% versus 12,5% em Beevi et al (2,3,4) Ademais, em relação aos sintomas psicológicos ao longo dos trimestres…”