Hypnosis to Facilitate Uncomplicated Birth

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

These interviews represented different experiences to different patients. To most, they gave a needed feeling of being an individual in whom others were interested. To a few, the interviews were simply an opportunity to be a part of a study, and to a couple of women, the interviews provided a serious threat. Most of the patients, however, soon came to regard the interview as a helpful experience-an opportunity to talk about anxieties and problems.

Observations of the prenatal-care provider were elicited by telephone interview or a data form sent in the mail. Obstetric data and all physical examination findings during the course of pregnancy and childbirth were abstracted from prenatal care records, requested after delivery (the woman signed a records release form during the initial interview). Every effort was made to learn as much as possible about the patients in terms of their psychological functioning, cultural background, and life experiences.

Interview records were examined in accordance with Glaser's (1977) method of grounded theory. In this method, qualitative data is examined with an eye toward data reduction. all possible categories, which make sense clinically and theoretically, are applied to the data. Categories are tabulated and reviewed. Categories are collapsed and combined when possible and logical to obtain a limited and manageable number of variables. A continued coding, sorting, and evaluating process eventually results in a data reduction scheme, which is logical and represents what is available in the data. For example, the statement, "I am afraid of pain in childbirth," was coded as a fear response. Initially it was called "personal fear of birth," then "fear of birth," and finally, "fear," as categories were combined. By taking the verbal statements, reviewing any descriptions of associated affective expression, a statement could be made about the intensity of the fear. Statements made were rated on a 3 to -3 scale. "I am afraid of pain in childbirth" became a "Fear" statement, with a numeral rating assigned to represent its intensity. The final coding format developed through the grounded theory process is available upon request.

The final seven categories to arise from the coding process included:

(1) Fear;

(2) Anxiety-Stress;

(3) Maternal Self-Identity;

(4) Beliefs;

(5) Psychosocial Support from the Partner;

(6) Psychosocial Support from the Mother's Mother; and

(7) Psychosocial support from friends.

A team of three clinicians assigned responses to the appropriate category and rated the response for intensity. The frequency of occurrence of a specific response and the magnitude or intensity of the responses was sufficient for clinicians to grade responses from -3 to 3 according to the strength of the statement. Comparative adverbs of "very," "mildly," etc., were included as indicators of the magnitude of the psychological state. The verbal responses of the women were differentially weighted in the specific content categories in proportion to the assumed intensity represented by statements made and interviewer notes. Values were assigned to all the verbal responses made. One type of direct verbal report of the subjective affective experience, such as, "I am anxious," would be classified in the "anxiety-stress" category, and have a weighted value of a -2, while the same statement with a greater intensity, " I am very anxious," could be weighted -3. Each of the women's responses was assessed with the value weighted on each variable to develop a profile of her psychological attitude during pregnancy. The sign of the rating ( or -) was in accordance with the hypothesized relationships of how this factor would affect the birthing process. The descriptors provided were those which worked for the raters to achieve over 85% agreement. They were developed through rating patients together prior to beginning the study. If the raters could not agree through consensus, the average of their ratings was taken and rounded. The interrater reliability was checked on every fifth patient and remained above 0.85.