Hypnosis to Facilitate Uncomplicated Birth

American Journal of Clinical Hypnosis, Apr 2004 by Mehl-Madrona, Lewis E

Prior research by the author showed that psychosocial factors distinguished complicated from uncomplicated birth outcome. The purpose of this study was to determine if prenatal hypnosis could facilitate uncomplicated birth. Following a psychosocial assessment, 520 pregnant women in their first or second trimester of pregnancy were randomized to receiving prenatal hypnosis or attention-only groups. The author provided all of the hypnosis in a manner similar to that taught by David Cheek. The goal was to reduce fear of birth and parenthood; to reduce anxiety; to reduce stress; to identify specific fears that might complicate the labor process (addressing them whenever possible); and to prepare women for the experience of labor. The attention-only group was matched to a no-contact comparison group. Women receiving prenatal hypnosis had significantly better outcomes than women who did not. Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to an complicated birth outcome. Attention only was associated with minimal differences in outcome over the no-contact group. The routine prenatal use of hypnosis could improve obstetric outcome.

Keywords: Anxiety, birth, birth complications, cesarean, hypnosis, fear, social support, stress

In these days of health care reform, an important opportunity exists to explore the utility of psychosocial interventions in improving birth outcome. These interventions are often less expensive than medical procedures and can be provided by nonphysicians. One of these interventions is hypnosis.

Labor length and analgesic use have been reported to be decreased when hypnosis is done during pregnancy (Harmon, Hynan, & Tyre, 1990). Anxiety about and during birth is decreased (Mairs, 1995). The incidence of postpartum depression is lessened (McCarthy, 1998; Harmon et al., 1990). Increased self-confidence, increased calmness during labor, and easier transition into breast feeding have been described (Sauer & Oster, 1997). Decreased pain sensation has been reported (Dillenburger & Keenan, 1996; Barber, 1996; Oster, 1994; D'Eon, 1989; South, 1988; Mairs, 1995). Reductions have occurred in the number of complicated births (Rossi & Cheek, 1988; Schauble, Werner, Rai, & Martin 1998). Babies born have had higher Apgar scores (Harmon et al., 1990). Hypnosis subjects experienced greater belonging and security during labor, were less afraid of birth, and perceived birth more as a positive event (Tiba, Prater, Balogh, & Bognarne-Varfalvi, 1985). Hypnosis helped women to be more relaxed during labor and birth, reduced hyperventilation, and increased feelings of participation and mastery (Wormnes, 1984). A psychosocial intervention program that included hypnosis reduced the number of cesarean deliveries and oxytocin augmentations or inductions (Mehl, Donovan, & Peterson, 1990). Among anxious parturients, fetuses moved into a more active state when maternal relaxation was achieved with hypnotherapy (Zimmer, Peretz, Eyal, & Fuchs, 1998).

Case reports have suggested effectiveness of hypnosis for secondary arrest of labor with preeclampsia (Smith, 1989) and hyperemesis gravidarum (Poliakov, 1989). Only one published report showed no improvement over Lamaze technique from the addition of hypnosis, though both LaMaze and hypnosis alone lessened pain equally during labor (Venn, 1987). Hypnosis has been reported helpful in the conversion of the breech presentation to vertex (Mehl, 1994) and in the treatment of premature labor (Mehl, 1988; Cheek, 1996).

The purpose of this research was to determine if a program of prenatal hypnosis could reduce birth complications and reduce labor length. It was also hypothesized that adverse psychosocial factors would be associated with increased risk for birth complications and that prenatal hypnosis could reduce their impact, protecting women against complicated births.

Methods

Settings and sources of subjects

We recruited 520 pregnant women in their first or second trimester for a study on psychosocial factors affecting prenatal risk. Women were recruited in San Francisco, California; Tucson, Arizona; and Burlington, Vermont over a period of 10 years (the amount of time required to complete the study). When all necessary data was collected for the risk prediction study, women were randomly offered the opportunity to receive hypnosis to help them better prepare for childbirth. Referrals of subjects came from family physicians, obstetricians, naturopathic physicians, and midwives practicing in these areas. Patients in the third trimester of pregnancy were excluded because of the author's fear that insufficient time existed to conduct a thorough evaluation and provide sufficient hypnosis to enhance the birth process. (Challenging this belief should be the topic of another study.) Informed consent was obtained and the author's Institutional Review Board (Resources for World Health, Inc.) approved the study for all locations. Because the author did all the hypnosis at no charge, 10 years were required to recruit and treat 520 subjects (because of the limitations of how many patients could be treated at one time for free).