Hypnosis to Facilitate Uncomplicated Birth

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

Treatment

If hypnosis were successful it would be expected to prevent patients with many adverse factors from having birth complications. If hypnosis were not successful it would be expected to have no impact on outcome.

The general approach used for prenatal hypnosis was oriented toward problem-solving and was perceived as brief, not as insight-oriented nor psychoanalytically based psychotherapy. Goals included increased relaxation, decreased anxiety, increased sense of trust of social support, realistic fear and a feeling of confidence that the woman could cope adequately with the pain of labor. Visualization was used to guide the woman through an imaginary experience of giving birth, thereby decreasing fear and anxiety. Audio and videotapes of representative hypnosis sessions are available upon request.

Randomization

Following an initial psychosocial assessment by the author, patients were randomly assigned (in accordance with a random number generator) to be either offered hypnosis with the author or further discussion of issues that arose during the assessment with the author's graduate psychology intern. At all times, this intern was a female Ph.D. candidate who had completed all requirements for her degree in clinical psychology except her internship. Her role was to provide supportive psychotherapy to any women randomized to this condition. For either hypnosis or supportive psychotherapy, subjects could come as often as desired at their preference for frequency (within the constraints of the practitioners' calendars). The goal was to mimic a real world, managed care, or National Health Insurance situation. Thus comparisons are between readily available supportive psychotherapy by a female counselor and prenatal hypnosis by a male therapist.

A comparison group was developed to benchmark the level of complications without any intervention. Women were selected at random from the practices contributing patients and were matched to women in the supportive psychotherapy group who had the same age, parity, socioeconomic status, race, and birth risk status. These women had no contact at all with the research.

All subjects received one or two visits for psychosocial assessment. The mean number of hypnosis visits was five. Nineteen subjects refused hypnosis, but were included in the hypnosis group anyway, under an intention to treat design. The interpretation was that an offer to treat with hypnosis constituted enrollment in the study even if the subject chose not to have hypnosis. The mode for number of hypnosis sessions was three. The minimum number was one, and the maximum, 60. Ninety-nine subjects declined an additional interview with the graduate intern. The mean number of interviews with the graduate student was 1.9. The mode for number of graduate student interviews was 1. The range was from 1 to 12.

Outcome variables

An uncomplicated birth was defined as one without obstetrical intervention (no Cesarean, no uterine dysfunction, no fetal distress, no fetal distress diagnosed, no infant resuscitation required, etc). Uterine dysfunction was diagnosed when treated by the doctor or midwife with oxytocin augmentation during labor or with induction. Fetal distress was noted when it was recorded as a diagnosis on the labor and delivery record. Apgar scores were recorded on the labor and delivery record. Infant resuscitation efforts were described on the labor and delivery record. all of these were obtained from the hospital records, or, for home birth, from the midwife's birth records.