For statistical information about HypnoBirthing outcomes in the USA see here: HypnoBirthing Outcomes 2006
Clinical studies Supporting Hypnosis in Birth:
Hypnosis: practical applications and theoretical considerations in normal labour.
Jenkins MW, Pritchard MH. Br J Obstet Gynaecol 1993 Mar;100(3):221-6
OBJECTIVE: To assess the effects of hypnotherapy on the first and
second stages of labour in a large group of pregnant women.
DESIGN: A semi-prospective case control study in which women attending
antenatal clinics were invited to undergo hypnotherapy.
SUBJECTS: One hundred twenty-six primigravid women with 300 age
matched controls, and 136 parous women having their second baby with 300 age matched
controls. Only women who had spontaneous deliveries were included.
SETTING: Aberdare District Maternity Unit, Mid Glamorgan, Wales.
INTERVENTION: Six sessions of hypnotherapy given by a trained medical
hypnotherapist during pregnancy.
OUTCOME MEASURES: Analgesic requirements, duration of first and
second stages of labour.
RESULTS: The mean lengths of the first stage of labour in the primigravid
women was 6.4 h after hypnosis and 9.3 h in the control group (P < 0.0001); the
mean lengths of the second stage were 37 min and 50 min, respectively (P < 0.001).
In the parous women the corresponding values were 5.3 h and 6.2 h (P < 0.01);
and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P
< 0.001) in both hypnotised groups compared with their controls.
CONCLUSION: In addition to demonstrating the benefits of hypnotherapy,
the study gives some insight into the relative proportions of mechanical and psychological
components involved in the longer duration of labour in primigravid women.
PMID: 8476826 [PubMed – indexed for MEDLINE]
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Hypnosis for Childbirth: A retrospective
survey of birth outcome using prenatal self-hypnosis, Retrospective Survey 2001
Shawn Gallagher, B.A. C.Ht www.midwiferyconsulting.com
Objective: To assess the effects of prenatal hypnotherapy classes on the length of labour,
use of pain medication, intervention rates, maternal pain perception and maternal
satisfaction.
Design: Retrospective survey completed by the woman and her partner.
Subjects: Self-referred clients, nulliparous (first baby) and low
risk.
Setting: Toronto, Canada
Intervention: Three sessions of 2.5 to 3 hours in length in a group setting in mid-pregnancy,
plus one session of 2.5 hours in length in late pregnancy. The sessions were provided
by a Certified Hypnotherapist. The woman’s partner was trained to provide additional
hypnosis support during the birth as needed (the hypnotherapist did not attend the
births).
Outcome Measures: Anesthetic and analgesic requirements, duration
of the early, active and second stages, planned place of birth and actual place
of birth, interventions required, pain scale of 0-10 as reported by the mother post-delivery,
breastfeeding rates and reported maternal satisfaction.
Results:
Participants: 45 nulliparous women
Control group: none
Planned home birth: 16
Actual home birth: 15 A
Primary care midwife: 29
Primary care physician:16
Averages of:
Length of early labour: 10.7 hours (range: 45 min to 3 days)
Length of active labour: 4.5 hours (range: 54 min to 14 hours)
Length of pushing: 1.2 hours (range: 15 min to 4.5 hrs)
Newborn weight: 7.68 lbs (range: 5 lbs 6 oz to 10 lbs)
Maternal pain perception: “6” on a self-scoring scale of 0-10
Pain medication rate:
Epidural x 8 (18%) B
Nitrous oxide x 1 (3%)
Narcotics x 2 (4.4%)
Interventions:
• Caesarian x 3 (6.5%) C
• Forceps x 3 (9.7%) D
• Vacuum x 1 (3%)
• Pitocin augmentation x 2 (4.4%)
• Pitocin/gel induction x 8 (18%) E
The total number of participants who received an intervention was 8 for a rate of
18%. (Some women received more than one intervention.)
Breastfeeding without formula supplementation: 42 (93%)
Women who would use this method again: 43 (96%)
Length of labour:
The average length of active labour for nulliparous women is 12 hours. Participants
in the Hypnosis for Childbirth series averaged 4.5 hours of active labour. The average
length of pushing for nulliparous women is about 2 hours. Participants in the Hypnosis
for Childbirth series averaged just over 1 hour. Hypnosis is associated with faster
births (statistically significant) throughout the research for both the first and
second stages of labour.
Medication rates:
The epidural rate in Toronto and Mississauga ranges from 40 to 95% for nulliparous women.
This survey notes an 18% epidural rate for Hypnosis for Childbirth participants (11% for caesarians and forceps,
7% for maternal request). This survey’s reduction in medication use is supported
by statistically significant reductions in other research for women using hypnosis
preparation for birth.
Caesarian rates:
The caesarian section rate in Toronto ranges from 20 to 25%, depending on the institutional setting.
This survey notes a caesarian section rate of 6.7% for Hypnosis for Childbirth participants. Other
research also notes the reduction of birth interventions with the prenatal use of hypnosis.
A. The one planned homebirth delivered in the hospital was a change of plans in
late pregnancy based on a poor biophysical profile (94% successful homebirth rate).
Of the 15 planned homebirths at the onset of labour, 100% delivered at home. All
planned hospital births delivered in the hospital.
B. The three maternal requests for epidurals were highly correlated to unfavourable
fetal positioning (ie. Posterior presentation). The other five epidurals were for
caesarians (3) and forceps (2).
C. Breech presentation (n=1) at term; fetal distress/prolonged labour/posterior
(n=1); fetal distress and poor descent in second stage (n=1).
D. Fetal distress (n=2); poor descent (n=1).
E. Three of the eight had no additional interventions; five of the eight had epidurals
(3), forceps (2) and nubaine (1). An additional four were midwifery clients who
induced at home using either homeopathy or castor oil (9%). No additional interventions
were noted with this group.
As a result of the Hypnosis for Childbirth series a very high percentage of women
reported an increased sense of self-confidence prior to the onset of labour. In
addition, 96% were pleased at the use of hypnosis, would use hypnosis in a subsequent
birth and recommend its use to other women planning natural childbirth.
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Teenagers - The Effects of Hypnosis
on the Labor Processes and Birth Outcomes of Pregnant Adolescents
Alice A. Martin, PhD; Paul
G. Schauble, PhD; Surekha H. Rai, PhD; and R. Whit Curry, Jr, MD Gainesville, Florida
The Journal of Family Practice • MAY 2001 • Vol. 50, No. 5
GENERAL
We evaluated how childbirth preparation incorporating hypnotic techniques affected
the labor processes and birth outcomes of pregnant adolescents. The study included
42 teenaged patients receiving prenatal treatment at a county public health department
before their 24th week of pregnancy. They were randomly assigned to either a treatment
group receiving a childbirth preparation protocol under hypnosis or a control group
receiving supportive counseling. When labor and delivery outcome measures were compared
in the 2 groups, significant differences favoring the hypnosis intervention group
were found in the number of complicated deliveries, surgical procedures, and length
of hospital stay. Larger studies in different populations are needed.
Hypnosis has been used to
control pain during labor and delivery for more than a century, but the introduction
of chemo-anesthesia and inhalation anesthesia during the late 19th century led to
the decline of its use. Recently there has been a resurgence of this technique in
obstetrics. Hypnotherapy has been found to be effective in providing pain relief,
reducing the need for chemical anesthesia, and reducing anxiety, fear, and pain
related to childbirth. Hypnosis has also been helpful in both managing various complications
of pregnancy (such as premature labor) and reducing the likelihood of premature
labor and birth in high-risk patients. It has also has been effective in the treatment
of hyperemesis gravidarum, acute hypertension associated with pregnancy and conversion
of breech to the vertex presentation.
One promising application
of hypnosis is in the area of labor and delivery. The use of hypnosis in preparing
the patient for labor and delivery is based on the premise that such preparation
reduces anxiety, improves pain tolerance (lowering the need for medication), reduces
birth complications, and promotes a rapid recovery process. The key aspect of this
treatment is involvement of the patient before labor begins, to promote her active
participation and sense of control in the labor and delivery process. This is accomplished
through educating the patient about this process and teaching her alternate ways
to produce hypno-analgesia and anesthesia. Hypnotic preparation thus provides the
expectant mother with a sense of control for managing her anxiety and physical discomfort.
Although there have been
numerous reports suggesting the value of hypnosis in obstetrics, our study is one
of the first to report a randomized controlled evaluation of childbirth preparation
incorporating hypnotic techniques on labor processes and birth outcomes.
STUDY
DESIGN
Both groups of patients received the standard prenatal treatment protocol from the
medical staff, nurse practitioners, and hospital staff, all of whom were blind to
group assignments. All patients were delivered at the local teaching hospital by
obstetrics department staff who were blind to the study. The study interventions
were begun with individual meetings with patients during regular clinic visits between
20 and 24 weeks’ gestation. Continuing clinic visits were scheduled for all patients
on a biweekly basis, making the time span of the 4-session experimental conditions
approximately 8 weeks. The study counselor (the primary author) provided hypnosis
preparation training for the treatment group; a nurse midwife provided the supportive
contact with the control group. Both interventions were completed before delivery;
no prompting occurred during the labor and delivery process.
The 2 groups of patients
were compared on medication use (Pitocin, anesthetic, and postpartum medication),
complications and surgical intervention during delivery, and length of hospital
stay for mothers and neonatal intensive care unit (NICU) admission for the infants.
Complications fell into 36 categories of events (eg, multiple pregnancies, preeclampsia,
vacuum-assisted delivery) that were entered in subjects’ records by obstetric staff
who were unaware of the study. Statistical analysis was based on a simple count
of the presence or absence of complications in the medical record by researchers
(the researchers were not blinded to the patient’s study assignment).
RESULTS
Of the 47 patients, 3 moved out of the geographic area before delivery, and 2 patients
(1 in each group) did not complete the research protocol and were not included in
the research. Results were thus obtained for 22 patients in the hypnosis group and
20 in the control group, resulting in a total of 42 subjects. A two-tailed Fisher
exact analysis at the .05 level was used to test for significance.
Only one patient in the
hypnosis group had a hospital stay of more than 2 days compared with 8 patients
in the control group (P=.008). None of the 22 patients in the hypnosis group experienced
surgical intervention compared with 12 of the 20 patients in the control group (P=.000).
Twelve patients in the hypnosis group experienced complications compared with 17
in the control group (P=.047). Although consistently fewer patients in the hypnosis
group used anesthesia (10 vs 14), Pitocin (2 vs 6), or postpartum medication (7
vs 11), and fewer had infants admitted to the NICU (1 vs 5), statistical analysis
was nonsignificant.
DISCUSSION
We focused on the educational preparation of the patient while in hypnosis to create
the expectation of a normal labor and delivery, develop a conditioned response of
comfort and confidence, and facilitate an increased sense of control in achieving
a healthy delivery.
The subjects in the treatment
group received a 4-session sequence of standard hypnotic interventions incorporating
childbirth preparation information (ie, the hypnoreflexogenous method) in which
they were instructed in the methods and benefits of focused relaxation and imagery
to increase the likelihood of a safe and relatively pain-free delivery. The sessions
provided an opportunity to experience and practice hypnotic induction and deep relaxation.
The suggestions directed toward the expectant mothers during the hypnotic state
focused on the conceptualization of pregnancy and childbirth as a healthy natural
process.
CONCLUSIONS
Our study provides support for the use of hypnosis to aid in preparation of obstetric
patients for labor and delivery. The reduction of complications, surgery, and hospital
stay show direct medical benefit to mother and child and suggest the potential for
a corresponding cost-saving benefit.
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Improved obstetric outcomes using
hypnotic analgesia and skill mastery combined with childbirth education.
Harmon TM,
Hynan MT
,
Tyre
TE, The
University of Wisconsin
,
Milwaukee
J Consult Clin Psychol 1990 Oct; 58(5):525-30
The benefits of hypnotic
anlagesia as an adjunct to childbirth education were studied in 60 nulliparous women.
Subjects were divided into high and low hypnotic susceptibility groups before receiving
6 sessions of childbirth education and skill mastery using an ischemic pain task.
Half of the subjects in each group received a hypnotic induction at the beginning
of each session; the remaining control subjects received relaxation and breathing
exercises typically used in childbirth education.
Both hypnotic subjects and
highly susceptible subjects reported reduced pain. Hypnotically prepared births
had shorter Stage one labours, less medication, higher Apgar scores and more frequent
spontaneous deliveries than control subjects’ births. Highly susceptible, hypnotically
treated women had lower depression scores after birth than women in the other three
groups.
We propose that repeated
skill mastery facilitated the effectiveness of hypnosis in our study.
The above is classified
as both a Clinical trial and Randomized controlled trial.
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Childbirth preparation through hypnosis: the hypnoreflexogenous protocol.
Schauble PG, Werner WE,
Rai SH,
Martin A. Counseling Center
,
University of Florida
,
Gainsville, Florida
. American Journal of Clinical Hypnosis 1998 Apr; 40(4):273-83
A verbatim protocol for the “Hypnoreflexogenous” method of preparation for childbirth
is presented wherein the patient is taught to enter a hypnotic state and then prepared
for labour and delivery. The method provides a “conditioned reflex” effect conducive
to a positive outcome for labour and delivery by enhancing the patient’s sense of
readiness and control. Previous applications of the method demonstrate patients
have fewer complications, higher frequency of normal and full-term deliveries, and
more positive postpartum adjustment. The benefit and ultimate cost effectiveness
of the method are discussed.
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Suggestion Therapy - Clinical study on shortening the birth process using psychological suggestion therapy.
Hao TY, Li YH,
Yao
SF. Zhonghua Hu Li Za Zhi. 1997 Oct; 32(10):568-70. (General Military Hospital of
Jinan, P.R. China.)
This randomized control
trial investigated the effect of psychological suggestion therapy on the birth process.
A specially designed, prospective study of psychological suggestion recruited 120
healthy, full-term primipara (first baby) with singleton pregnancies and cephalic
presentation (head first). All cases were randomly divided into 2 groups, the birth
processes and final modes of delivery were analyzed in 60 cases interfered with
the psychological suggestion therapy and 60 cases with spontaneous birth processes
as control group.
The results showed that
a significant shorter time of the first and second stages of labour in the study
group than in the control group (P<0.01). Based on this study, it is suggested
that the conversation concerning the evaluation of individual birth process between
the mother-to-be and nurse should be controlled carefully for the purpose of advancing
the birth process (my italics SG), especially when answering the question raised
by mother-to-be about the quantity of the cervical dilatation.
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