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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