Tim Brunson DCH

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Self-hypnosis for intrapartum pain management in pregnant nulliparous women...

Full title: Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness.

OBJECTIVE: (Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use. DESIGN: Multi-method randomised control trial (RCT). SETTING: Three NHS Trusts. POPULATION: Nulliparous women not planning elective caesarean, without medication for hype rtension and without psychological illness. METHODS: Randomisation at 28-32 weeks' gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks' gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal. MAIN OUTCOME MEASURES: Primary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis. RESULTS: Six hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64-1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: OR -0.72, 95% CI -1.16 to -0.28, P = 0.001); fear (OR -0.62, 95% CI -1.08 to -0.16, P = 0.009). Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI -£257.93 to £267.59). CONCLUSIONS: Allocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

BJOG. 2015 May 11. doi: 10.1111/1471-0528.13433. Downe S(1), Finlayson K(1), Melvin C(2), Spiby H(3), Ali S(4), Diggle P(5), Gyte G(6), Hinder S(7), Miller V(8), Slade P(9), Trepel D(4), Weeks A(10), Whorwell P(11), Williamson M(2). Author information: (1)Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK. (2)Women & Children's Health Research Team, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK. (3)Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK. (4)Department of Health Sciences, University of York, York, UK. (5)Lancaster Medical School, Lancaster University, Lancaster, UK. (6)Cochrane Pregnancy and Childbirth Group, Department of Women and Childrens' Health, Liverpool Women's NHS Foundation Trust, University of Liverpool, Liverpool, UK. (7)RaFT Research, Clitheroe, Lancashire, UK. (8)University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. (9)Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK. (10)Department of Women's and Children's Health, University of Liverpool, Liverpool, UK. (11)Centre for Gastrointestinal Sciences, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.

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