Hypnosis to Facilitate Uncomplicated Birth

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

Discriminant function analysis was used to correctly classify 91% of the cases correctly into the uncomplicated birth outcome group (group N) or the complicated birth outcome group (group A). Women having uncomplicated deliveries were classified correctly with 90.2% accuracy, compared to 92.1% for women having uncomplicated births. The canonical correlation was 0.7808 meaning that about eight times out of 10, correct classification occurred. The most significant psychosocial factors were fear and support from the baby's father and drug use. Hypnosis was significantly associated with uncomplicated outcome.

Discussion

The advantage of this study lies in its duplication of a clinical setting in which patients decide whether or not to take advantage of an offered preventive service. The lack of payment in the study would resemble what is typically found in a managed care environment (U.S.) or a National Health Service/Insurance environment (Canada, Europe), or a private office with high quality health insurance (U.S.). In this study, we were able to see what women would do when offered prenatal hypnosis or supportive psychotherapy in an environment in which using the services posed no financial hardship. In the study as in clinical care, the women were free to accept or not accept the service and to pick their own level of intensity and duration of care. Given this freedom, women did come sufficiently often for prenatal hypnosis to make significant reductions in birth complications and epidural use. Hypnosis was associated with improved obstetrical outcome. Psychosocial variables were related to complicated birth outcome, and hypnosis appeared to protect against those effects.

Common and easily measured (during a clinical interview) psychosocial variables were associated with birth complications. These included maternal anxiety, fear, negative beliefs about birth, negative maternal self-identity, low social support from the baby's father, from friends and parents (mother), and poor marital satisfaction (as measured with the Dyadic Adjustment Scale). Depression as measured by the Beck Depression Inventory was associated with complicated birth as was manifest anxiety (Taylor Manifest Anxiety Scale), and Life Stress over the past three years (Holmes-Rahe Life Stress Inventory).

Providing hypnosis to women at psychosocial risk (as judged by the above criteria) appeared to improve the likelihood of uncomplicated birth. The exclusion criteria prevented severely disturbed patients from being included in the study. The author believes that these patients would have been helped even more (those with diagnosable anxiety disorders, dysthymic disorder, major depressive histories), and that even stronger results would have been seen in a regression to the mean effect. He hopes this will be the subject of future research.

Di Bernardo (1975) states that, "There is a present need for the insertion of psychology in teaching and medical practice so that full value and respect can be given to the patient's human side." This study shows that a psychosocial intervention program can have a positive effect on birth outcome among women who are having full-term labors. Prenatal providers might do well to incorporate a consideration of psychosocial risk factors during prenatal care and to utilize methods such as hypnosis (or others that may prove effective) to help reduce psychosocial risk during routine prenatal care. This can be done cost effectively, through utilization of a trained mental health professional. This practitioner can interact with nurses and childbirth educators to improve coordination of patient care and provide attention to psychosocial risk. Specifically, psychosocial risk reduction involves: