Full title: The efficacy of hypnosis as an intervention for labor and delivery pain: a comprehensive methodological review.

This paper presents a comprehensive methodological review of research on the efficacy of hypnosis for reducing labor and delivery pain. To be included, studies were required to use a between-subjects or mixed model design in which hypnosis was compared with a control condition or alternative intervention in reducing labor pain. An exhaustive search of the PsycINFO and PubMed databases produced 13 studies satisfying these criteria. Hetero-hypnosis and self-hypnosis were consistently shown to be more effective than standard medical care, supportive counseling, and childbirth education classes in reducing pain. Other benefits included better infant Apgar scores and shorter Stage 1 labor. Common methodological limitations of the literature include a failure to use random assignment, to specify the demographic characteristics of samples, and to use a treatment manual.

Clin Psychol Rev. 2011 Aug;31(6):1022-31. Landolt AS, Milling LS. University of Hartford, West Hartford, CT, USA.

Hyperemesis gravidarum--severe and persistent nausea and vomiting during pregnancy--can lead to serious negative health consequences for both mother and fetus. Appropriate evidence-based treatment for this illness is paramount. Studies describing hypnosis in the treatment of hyperemesis gravidarum (HG) were reviewed. A literature search was carried out using Cochrane, PsycINFO, PsycARTICLES, and Web of Knowledge databases. A total of 45 studies were identified by the search. Six studies fulfilled the inclusion criteria. Studies were reviewed in terms of study design, methodological quality, intervention and outcomes. Methodology between the studies differed but all reported encouraging positive outcomes. However, the quality of current evidence, based on the studies reviewed in this study, is not sufficient to establish if hypnosis is an effective treatment for HG. To be able to accurately assess the efficacy of hypnosis for HG, it is recommended that well-designed studies, e.g. randomised control trials, be carried out.

J Obstet Gynaecol. 2010;30(7):647-53. McCormack D. Department of Perinatal Clinical Psychology, Royal Jubilee Maternity Hospital and School of Psychology, The Queen's University of Belfast, Northern Ireland. dmccormack04@qub.ac.uk

PURPOSE: This study examines whether or not those women who have participated in a hypnoreflexogenous birth preparation course have a lower incidence of preterm labour and higher gestational age. MATERIAL AND METHODS: 101 women participated in the birth preparation hypnosis course (hypnomental birth preparation) and were evaluated against a parallelised control group. The following parameters were evaluated: education, number of previous pregnancies and live births, average number of cigarettes smoked per day and age of the mother. The control group was selected out of the hospital birth register from 2001 to 2008 (n=10 812). RESULTS: In the hypnosis group (n=101) there were six late preterm deliveries (5.49%) whereas in the parallelised control group there were significantly more preterm deliveries (n=11; 11.3%; p=0.02). There was also a statistically significant correlation between gestational age and maternal participation in the hypnomental birth preparation. CONCLUSION: In the hypnosis group there were significantly less preterm deliveries after parallelising the socio-economical demographics. A planned randomised controlled study of preterm labour should identify whether clinical hypnosis can reduce the incidence of preterm labour. Georg Thieme Verlag KG Stuttgart, New York.

Z Geburtshilfe Neonatol. 2010 Jun;214(3):82-7. Epub 2010 Jun 23. Reinhard J, Hüsken-Janssen H, Hatzmann H, Schiermeier S. Frauenklinik der Universität Witten/Herdecke, Akademisches Lehrkrankenhaus der Ruhr-Universität Bochum, Witten. j.reinhard@marien-hospital-witten.de

Full Title: Changes in resistance of the umbilical artery, foetal movements and short time variation through clinical hypnosis--preliminary results

BACKGROUND: The aim of this study was to determine whether there are any changes in short time variation (STV), foetal movements, and blood flow in the umbilical artery in the trance state. METHODS: Six pregnant patients who had already attended two hypnoreflexogenous birth preparation course units had a standardised hypnosis intervention under cardiotocography (CTG). Using the CTG-Player ((R)) STVs and foetal movements were calculated from the electronically saved CTG traces and evaluated against control CTGs recorded before and after hypnosis. Before and after the induction of hypnosis, blood flow in the umbilical artery was measured. RESULTS: Using the Wilcoxon test there is a significant lowering of blood flow resistance in the umbilical artery after hypnosis (p=0.042). There was a trend that the foetal movements increas at the beginning of the trance (Wilcoxon test, p=0.075). There was no significant difference in the STVs before, during and after trance. CONCLUSIONS: Preliminary results showed that blood flow of the umbilical artery can be improved by hypnosis. Further clinical studies are required to verify this hypothesis. The subjective impression of participants that foetal movements increase at the beginning of the trance seems to be correct.

Z Geburtshilfe Neonatol. 2009 Feb;213(1):23-6. Epub 2009 Mar 3. Reinhard J, Hüsken-Janssen H, Hatzmann H, Schiermeier S. Universität Witten/Herdecke, Frauenheilkunde, Marien Hospital Witten. J.Reinhard@Marien-Hospital-Witten.de

Hypnosis during pregnancy and childbirth has been shown to reduce labor analgesia use and other medical interventions. We aimed to investigate whether there was a difference in hypnotizability in pregnant and nonpregnant women. Study participants had hypnotizability measured by the Creative Imagination Scale (CIS) in the third trimester of pregnancy and subsequently between 14 and 28 months postpartum and when not pregnant. The 37 participants who completed the study gave birth in the largest maternity unit in South Australia between January 2006 and March 2007. CIS scores were increased in women when pregnant (Mean 23.5, SD 6.9) compared to when they were not pregnant (Mean 18.7, SD 6.6), p < 0.001. The mean effect size was 0.84 suggesting that the hypnotizability change was both statistically significant and clinically meaningful. Our study findings support previous evidence showing that women are more hypnotizable when pregnant than when not pregnant.

Am J Clin Hypn. 2009 Jul;52(1):13-22. Alexander B, Turnbull D, Cyna A. Department of Women's Anaesthesia Women's & Children's Hospital, 72 King William Road Adelaide, S.A. 5006, Australia.

Full Title: Clinical indications and perceived effectiveness of complementary and alternative medicine in departments of obstetrics in Germany: a questionnaire study

OBJECTIVE: Our earlier study on complementary and alternative medicine (CAM) methods showed that acupuncture, homeopathy, and aromatherapy are available in most obstetrics departments in Germany but it did not evaluate the clinical indications for using CAM. The present study aimed to explore further the effectiveness of CAM use in obstetrics. STUDY DESIGN: We sent all departments of obstetrics in North Rhine-Westphalia a questionnaire designed to delineate their use of acupuncture, homeopathy, and aromatherapy during childbirth. It sought details on who provided the CAM therapy (midwife or physician). We asked respondents to indicate on a five-point scale how reasonable or otherwise they would consider the provision of CAM in each of six common problem situations and to estimate for each the proportion of patients given the CAM treatment. Respondents were also asked about the rationale for offering CAM, quality assurance and side effects. Spearman's bivariate correlation, cross-tabulation and Pearson's chi(2) test were used for statistical analysis. RESULTS: About 73.4% (138/187) of the departments responded. Acupuncture and homoeopathy were most widely used. Although obstetricians are responsible for patient care, decisions to provide CAM were largely taken by midwives, and the midwives' belief in the methods' effectiveness and patient demand were the principle motivating factors. Rates of CAM use in the six problem scenarios evaluated were directly related to practitioners' perceptions of the methods' therapeutic effectiveness. CONCLUSIONS: CAM methods were widely offered despite the lack of evidence of effectiveness or information on adverse consequences. In Germany, including CAM in the mandatory national quality assurance measures and perinatal surveys would provide valuable information; CAM use elsewhere merits further study.

Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):50-4. Münstedt K, Brenken A, Kalder M. Department of Obstetrics and Gynaecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de

OBJECTIVE: To describe levels of anxiety and self-efficacy for childbirth in nulliparous women during the late third trimester and to identify relationships among those variables, prehospitalization labor pain, management strategies, and hospital admission status. DESIGN: A longitudinal, descriptive study. PARTICIPANTS: Thirty-five English-speaking nulliparous women, 18 to 40 years of age, more than or equal to 38 week's gestation, with uncomplicated pregnancies. All participants had a significant other (husband or partner) and attended childbirth education programs. MAIN OUTCOME MEASURES: Spielberger Trait Anxiety Inventory, Prenatal Self-Evaluation Questionnaire, Childbirth Self-Efficacy Inventory, McGill Pain Questionnaire-Short Form, postpartum interviews, and medical records review. RESULTS: Prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor, and admitting cervical dilation. The number of management strategies used was related to pain scores during labor before hospital admission. Women who spent longer periods of time at home in labor arrived at the hospital with a greater cervical dilation. CONCLUSIONS: Antenatal characteristics influence intrapartal outcomes in nulliparas. Labor environment, at home and in the hospital, is recognized as an important component of the first childbirth experience.

J Obstet Gynecol Neonatal Nurs. 2007 Sep-Oct;36(5):410-8. Beebe KR, Lee KA, Carrieri-Kohlman V, Humphreys J. Dominican University of California, San Rafael, CA 94901, USA. kbeebe@dominican.edu

by Pauline Rzepecki, BSN, MSN, CHT

The answer to that question is ABSOLUTELY! Clients who are using hypnosis are achieving their goal of conception, carrying a pregnancy to term and giving birth to their beautiful bundle of joy. Countless women are enhancing their fertility while enjoying the beneficial side effects of relaxation and stress reduction. We all know that stress, tension and anxiety are harmful to our heart, joints, and stomach so it makes sense that it is also harmful to our fertility. Stress can cause the fallopian tubes and uterus to spasm, creating a harsh fertilization environment. Stress can throw off the delicate hormonal balance needed for conception and pregnancy to take place. Stress can even decrease sperm count dramatically. When the client learns how to effectively reduce and release the stress in their lives, they automatically enhance their fertility.

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The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Marc I, Rainville P, Masse B, et al. Hypnotic analgesia intervention during first-trimester pregnancy termination: an open randomized trial. Am J Obstet Gynecol 2008;199:469.e1-469.e9. The full discussion appears at www.AJOG.org, page e1-e5.

Am J Obstet Gynecol. 2008 Nov;199(5):579-80. Comment on: Am J Obstet Gynecol. 2008 Nov;199(5):e1-5. Macones GA, Tuuli M, Houser M, Nicholas S, Kurnit K. Washington University School of Medicine, Department of Obstetrics and Gynecology, St Louis, MO, USA.