BACKGROUND: Induction of labour using pharmacological and mechanical methods can increase complications. Complementary and alternative medicine methods including hypnosis may have the potential to provide a safe alternative option for the induction of labour. However, the effectiveness of hypnosis for inducing labour has not yet been fully evaluated. OBJECTIVES: To assess the effect of hypnosis for induction of labour compared with no intervention or any other interventions. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2014), handsearched relevant conference proceedings, contacted key personnel and organisations in the field for published and unpublished references. SELECTION CRITERIA: All published and unpublished randomised controlled trials (RCTs) and cluster-RCTs of acceptable quality comparing hypnosis with no intervention or any other interventions, in which the primary outcome is to assess whether labour was induced. DATA COLLECTION AND ANALYSIS: Two review authors assessed the one trial report that was identified (but was subsequently excluded). MAIN RESULTS: No RCTs or cluster-RCTs were identified from the search strategy. AUTHORS' CONCLUSIONS: There was no evidence available from RCTs to assess the effect of hypnosis for induction of labour. Evidence from RCTs is required to evaluate the effectiveness and safety of this intervention for labour induction. As hypnosis may delay standard care (in case standard care is withheld during hypnosis), its use in induction of labour should be considered on a case-by-case basis.Future RCTs are required to examine the effectiveness and safety of hypnotic relaxation for induction of labour among pregnant women who have anxiety above a certain level. The length and timing of the intervention, as well as the staff training required, should be taken into consideration. Moreover, the views and experiences of women and staff should also be included in future RCTs.

Cochrane Database Syst Rev. 2014 Aug 14;8:CD010852. doi:10.1002/14651858.CD010852.pub2. Nishi D(1), Shirakawa MN, Ota E, Hanada N, Mori R. Author information: (1)Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashicho, Kodaira, Tokyo, Japan, 187-8553.

Hypnotherapy is an integrative mind-body technique with therapeutic potential in various health care applications, including labor and birth. Evaluating the efficacy of this modality in controlled studies can be difficult, because of methodologic challenges, such as obtaining adequate sample sizes and standardizing experimental conditions. Women using hypnosis techniques for childbirth in hospital settings may face barriers related to caregiver resistance or institutional policies. The potential anxiolytic and analgesic effects of clinical hypnosis for childbirth merit further study. Nurses caring for women during labor and birth can increase their knowledge and skills with strategies for supporting hypnotherapeutic techniques.

Nurs Womens Health. 2014 Feb-Mar;18(1):48-58; quiz 59. doi: 10.1111/1751-486X.12093. Beebe KR.

© 2014 AWHONN.

This randomized control trial studied the effect of hypnosis on dysmenorrhea. Fifty eligible nursing students were randomly divided into 2 groups according to baseline pain scores. One group was given hypnosis and the other given medications for pain relief for 3 menstrual cycles, followed by 3 cycles without any treatment. They were evaluated for functional restriction of activity on a 3-point scale. There was significant improvement in quality of life after the third cycle in both groups compared to baseline. The effect of hypnosis and medications on quality of life was similar in both groups at the third and sixth cycles.

Int J Clin Exp Hypn. 2014;62(2):164-78. doi: 10.1080/00207144.2014.869128. Shah M(1), Monga A, Patel S, Shah M, Bakshi H. Author information: (1)a Medical College, Baroda, Sir Sayaji General Hospital , Gujarat , India.

PURPOSE OF REVIEW: The percentage of induced live birth has more than doubled from the 1990s to 2008. Induction of labour can either be based on medical indications, or performed as an elective procedure. A large range of pharmacological and non-pharmacological modalities are available for the induction of labour and the optimal method for labour induction is unknown. This article is aimed to examine literature on non-hormonal methods for labour induction, published from January 2012 to May 2013. RECENT FINDINGS: Eleven studies were identified in our search and included into the review. Foley balloon catheter appears to be more cost-effective and commonly used non-hormonal technique for induction of labour, although further meta-analysis is required in this area. Currently, there is not enough evidence to support routine use in all women for labour induction among other methods including amniotomy, acupuncture, sexual intercourse, isosorbide mononitrate, hypnosis, castor oil and breast stimulation. The latest three studies suggest that amniotomy may increase need for oxytocin augmentation during labour induction. SUMMARY: Many non-hormonal methods for labour induction still require further evidence to support their use within the clinical setting. Balloon catheter seems to be a more widely accepted non-hormonal method that has been supported by various literatures.

Curr Opin Obstet Gynecol. 2013 Dec;25(6):441-7. Lim CE, Ng RW, Xu K. Faculty of Medicine, University of New South Wales, Sydney Australia.

Labour pain is one of the most important factors in shaping women's experiences of birth. Choice around pharmacological relief can be complex. Clinical hypnosis is a non-pharmacological option which a number of women have chosen to use, often paying privately to do so. Self hypnosis allows women the opportunity to take control of this technique. Research findings relating to the therapy vary; some trials have found positive effects by way of a reduction in use of pharmacological pain relief, oxytocin use and shortened first stage of labour. Inclusion of the therapy as a means to invoke relaxation and counter the effects of stress and anxiety alone may be valid reasons for consideration of its use. This article outlines the framework used in clinical hypnosis and discusses some of the issues relating to the evidence base for it.

Pract Midwife. 2013 May;16(5):10-3. Kenyon C. University of Huddersfield.

Levitas et al. (2006) showed in a cohort study that hypnosis during embryo transfer (ET) increased pregnancy ratio by 76%. In order to evaluate hypnosis during ET in a general population, the authors performed a randomized prospective controlled study comparing diazepam (usual premedication) administered before ET plus muscle relaxation versus hypnosis plus placebo in 94 patients. Additionally, the authors studied anxiety pre and post ET. Anxiety scores were not different in the two groups before and after ET. No difference in pregnancy and birth ratio was found in the two groups. Hypnosis during ET is as effective as diazepam in terms of pregnancy ratio and anxiolytic effects, but with fewer side effects and should be routinely available.

Am J Clin Hypn. 2013 Apr;55(4):378-86. Catoire P, Delaunay L, Dannappel T, Baracchini D, Marcadet-Fredet S, Moreau O, Pacaud L, Przyrowski D, Marret E. Clinique du Mail, Department of Anesthesia, La Rochelle, France. catoire8105@orange.fr

Labour pain is one of the most important factors in shaping women's experiences of birth. Choice around pharmacological relief can be complex. Clinical hypnosis is a non-pharmacological option which a number of women have chosen to use, often paying privately to do so. Self hypnosis allows women the opportunity to take control of this technique. Research findings relating to the therapy vary; some trials have found positive effects by way of a reduction in use of pharmacological pain relief, oxytocin use and shortened first stage of labour. Inclusion of the therapy as a means to invoke relaxation and counter the effects of stress and anxiety alone may be valid reasons for consideration of its use. This article outlines the framework used in clinical hypnosis and discusses some of the issues relating to the evidence base for it.

Pract Midwife. 2013 May;16(5):10-3. Kenyon C. University of Huddersfield.

Full Title: Effect of self-hypnosis on duration of labor and maternal and neonatal outcomes: a randomized controlled trial.

A study conducted with 1,222 women at Aarhaus University Hosital in Denmark showed that self-hypnosis faled to show any effects on duration of childbirth and other birth outcomes. However, fewer emergency and elective cesarean sections occurred in the hypnosis group. There was no difference in the length of the expulsion phase of the second stage of labor.

The hypnosis group received three one-hour self-hypnosis lessons and an additional audio-recording intended to ease childbirth. A second relaxation group was taught mindfulness and provided appropriate audio-recordings. The third group received only the usual antenatal care.

Werner A, Uldbjerg N, Zachariae R, Nohr EA. Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark.

In a randomized controlled clinical trial conducted at the University of Adelaide (Austrialia) between December 2005 and December 2010, it was their objective to see if there was an impact on pharmacologicl analgesia during childbirth when antenatal hypnosis was used. They found that there was no difference when using pharmacological analgesia during labor and childbirth or merely using hypnosis and a CD (by a hypnotherapist).

448 women were included in this study. They were planning a vaginal birth. Excluded from this group were women who needed a translator, had psychiatric illnesses, younger than 18 years, and had previous experience with childbirth.

The method used a combination of three live sessions plus the use of the CD between sessions. There was also a fourth CD that they were to listen to during labor. No information was provided as to the type of induction or suggestions given. That would have been extremely useful as there tends to be a large difference between direct and indirect suggestions when used in such as study. Also, they did not mention the training and experience of the hypnotherapist who conducted the live sessions or the creator of the CDs. Therefore, this study is largely flawed.

BJOG. 2013 Jul 3. doi: 10.1111/1471-0528.12320. Cyna A, Crowther C, Robinson J, Andrew M, Antoniou G, Baghurst P. Department of Women's Anaesthesia, Women's & Children's Hospital, North Adelaide, Australia; Acute Care Medicine, University of Adelaide, Adelaide, Australia.

Awareness of depression among OB-GYN physicians has increased with the result that more than 13% of pregnant women in the United States receive prescriptions for antidepressant medications. But the safety and effectiveness of these compounds has been exaggerated while the effectiveness of psychotherapy has been overlooked and distorted and various medical guidelines for treatment of perinatal depression have been downplayed or ignored. This article addresses the common fears and misconceptions surrounding treatment of depression during pregnancy and after childbirth. The effectiveness of strategic cognitive-behavioral therapy enhanced with hypnosis offers excellent results without the risks associated with these medications. Targets for focused intervention are identified and discussed.

Am J Clin Hypn. 2013 Jan;55(3):291-323. Rosenquist SE. DrSara@DrSara.com

OBJECTIVE: The use of estrogen and progesterone to manage vasomotor symptoms (ie, hot flashes and night sweats) has declined because of concerns about their risks, and there is an increased interest in alternate, effective, and low-risk treatments. This study reports the results of a randomized controlled trial of clinical hypnosis for treating vasomotor symptoms among postmenopausal women.

METHODS: This is a randomized, single-blind, controlled, clinical trial involving 187 postmenopausal women reporting a minimum of seven hot flashes per day (or at least 50 hot flashes a week) at baseline between December 2008 and April 2012. Eligible participants received five weekly sessions of either clinical hypnosis or structured-attention control. Primary outcomes were hot flash frequency (subjectively and physiologically recorded) and hot flash score assessed by daily diaries on weeks 2 to 6 and week 12. Secondary outcomes included measures of hot flash-related daily interference, sleep quality, and treatment satisfaction.

RESULTS: In a modified intent-to-treat analysis that included all randomized participants who provided data, reported subjective hot flash frequency from baseline to week 12 showed a mean reduction of 55.82 (74.16%) hot flashes for the clinical hypnosis intervention versus a mean reduction of 12.89 (17.13%) hot flashes for controls (P < 0.001; 95% CI, 36.15-49.67). The mean reduction in hot flash score was 18.83 (80.32%) for the clinical hypnosis intervention as compared with 3.53 (15.38%) for controls (P < 0.001; 95% CI, 12.60-17.54). At 12-week follow-up, the mean reduction in physiologically monitored hot flashes was 5.92 (56.86%) for clinical hypnosis and 0.88 (9.94%) for controls (P < 0.001; 95% CI, 2.00-5.46). Secondary outcomes were significantly improved compared with controls at 12-week follow-up: hot flash-related interference (P < 0.001; 95% CI, 2.74-4.02), sleep quality (P < 0.001; 95% CI, 3.65-5.84), and treatment satisfaction (P < 0.001; 95% CI, 7.79-8.59).

CONCLUSIONS: Compared with structured-attention control, clinical hypnosis results in significant reductions in self-reported and physiologically measured hot flashes and hot flash scores in postmenopausal women.

Menopause. 2012 Oct 22. Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ. From the 1Mind-Body Medicine Research Laboratory, Baylor University, Waco, TX; 2School of Nursing, Indiana University, Indianapolis, IN; and 3College of Education, University of Texas, Austin, TX.

Three to four percent of full-term singleton pregnancies present themselves as breech deliveries. External cephalic version (ECV) is a procedure to try to turn a breech fetus to cephalic by externally maneuvering the fetus through the maternal abdomen. This trial examines a clinical hypnosis intervention against standard medical care of women before ECV. A total of 78 women, who received a hypnosis intervention prior to ECV, had a 41.6% (n = 32) successful ECV, whereas the control group of 122, who had similar baseline characteristics, had a 27.3% (n = 33) successful ECV procedure (p < 0.05). This trial found that a relaxation technique with the help of clinical hypnosis was successful at increasing the likelihood of a successful ECV procedure.

Am J Clin Hypn. 2012 Oct;55(2):184-92. Reinhard J, Heinrich TM, Reitter A, Herrmann E, Smart W, Louwen F. Department of Obstetrics and Gynaecology, Faculty of Medicine, Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt am Main, Germany. Joscha.Reinhard@kgu.de

OBJECTIVE: To estimate the use of epidural analgesia and experienced pain during childbirth after a short antenatal training course in self-hypnosis to ease childbirth.

DESIGN: Randomised, controlled, single-blinded trial using a three-arm design.

SETTING: Aarhus University Hospital Skejby in Denmark during the period July 2009 until August 2011.

POPULATION: A total of 1222 healthy nulliparous women.

METHOD: Use of epidural analgesia and self-reported pain during delivery was compared in three groups: a hypnosis group receiving three 1-hour lessons in self-hypnosis with additional audiorecordings to ease childbirth, a relaxation group receiving three 1-hour lessons in various relaxation methods and mindfulness with audiorecordings for additional training, and a usual care group receiving ordinary antenatal care only.

MAIN OUTCOME MEASURES: Primary outcome: Use of epidural analgesia. Secondary outcomes included self-reported pain.

RESULTS: There were no between-group differences in use of epidural analgesia-31.2% (95% confidence interval [95% CI] 27.1-35.3) in the hypnosis group, 29.8% (95% CI 25.7-33.8) in the relaxation group and 30.0% (95% CI 24.0-36.0) in the control group. No statistically significant differences between the three groups were observed for any of the self-reported pain measures.

CONCLUSION: In this large randomised controlled trial of a brief course in self-hypnosis to ease childbirth, no differences in use of epidural analgesia or pain experience were found across study groups. Before turning down self-hypnosis as a method for pain relief, further studies are warranted with focus on specific subgroups.

BJOG. 2012 Nov 27. doi: 10.1111/1471-0528.12087. Werner A, Uldbjerg N, Zachariae R, Rosen G, Nohr E. Department of Gynaecology and Obstetrics, Aarhus University Hospital Skejby, Aarhus, Denmark.

BACKGROUND: This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review.

OBJECTIVES: To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 January 2012) and the reference lists of primary studies and review articles.

SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing preparation for labour using hypnosis and/or use of hypnosis during labour, with or without concurrent use of pharmacological or non-pharmacological pain relief methods versus placebo, no treatment or any analgesic drug or technique.

DATA COLLECTION AND ANALYSIS: Two assessors independently extracted data and assessed trial quality. Where possible we contacted study authors seeking additional information about data and methodology.

MAIN RESULTS: We included seven trials randomising a total of 1213 women. All but one of the trials were at moderate to high risk of bias. Although six of the seven trials assessed antenatal hypnotherapy, there were considerable differences between these trials in timing and technique. One trial provided hypnotherapy during labour. No significant differences between women in the hypnosis group and those in the control group were found for the primary outcomes: use of pharmacological pain relief (average risk ratio (RR) 0.63, 95% confidence interval (CI) 0.39 to 1.01, six studies, 1032 women), spontaneous vaginal birth (average RR 1.35, 95% CI 0.93 to 1.96, four studies, 472 women) or satisfaction with pain relief (RR 1.06, 95% CI 0.94 to 1.20, one study, 264 women). There was significant statistical heterogeneity in the data for use of pharmacological pain relief and spontaneous vaginal birth. The primary outcome of sense of coping with labour was reported in two studies as showing no beneficial effect (no usable data available for this review). For secondary outcomes, no significant differences were identified between women in the hypnosis group and women in the control group for most outcomes where data were available. For example, there was no significant difference for satisfaction with the childbirth experience (average RR 1.36, 95% CI 0.52 to 3.59, two studies, 370 women), admissions to the neonatal intensive care unit (average RR 0.58, 95% CI 0.12 to 2.89, two studies, 347 women) or breastfeeding at discharge from hospital (RR 1.00, 95% CI 0.97 to 1.03, one study, 304 women). There was some evidence of benefits for women in the hypnosis group compared with the control group for pain intensity, length of labour and maternal hospital stay, although these findings were based on single studies with small numbers of women. Pain intensity was found to be lower for women in the hypnosis group than those in the control group in one trial of 60 women (mean difference (MD) -0.70, 95% CI -1.03 to -0.37). The same study found that the average length of labour from 5 cm dilation to birth (minutes) was significantly shorter for women in the hypnosis group (mean difference -165.20, 95% CI -223.53 to -106.87, one study, 60 women). Another study found that a smaller proportion of women in the hypnosis group stayed in hospital for more than two days after the birth compared with women in the control group (RR 0.11, 95% CI 0.02 to 0.83, one study, 42 women).

AUTHORS' CONCLUSIONS: There are still only a small number of studies assessing the use of hypnosis for labour and childbirth. Although the intervention shows some promise, further research is needed before recommendations can be made regarding its clinical usefulness for pain management in maternity care.

Cochrane Database Syst Rev. 2012 Nov 14;11:CD009356. doi: 10.1002/14651858.CD009356.pub2. Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. School of Psychology, University of Tasmania, Private Bag 30, Hobart, Tasmania, Australia, 7001.

Labour is a normal physiological process, but is usually associated with pain and discomfort. Numerous methods are used to relieve labour pain. These include pharmacological (e.g. epidural, opioids, inhaled analgesia) and non-pharmacological (e.g. hypnosis, acupuncture) methods of pain management. Non-opioid drugs are a pharmacological method used to control mild to moderate pain. To summarise the evidence regarding the effects and safety of the use of non-opioid drugs to relieve pain in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012). Randomised controlled trials (RCTs) using non-opioid drugs (non-steroidal anti-inflammatory drugs (NSAIDs); paracetamol; antispasmodics; sedatives and antihistamines) in comparison with placebo or standard care; different forms of non-opioid drugs (e.g. sedatives versus antihistamines); or different interventions (e.g. non-opioids versus opioids) for women in labour. Quasi-RCTs and trials using a cross-over design were not included. Cluster-randomised RCTs were eligible for inclusion but none were identified for inclusion. Two review authors independently assessed for inclusion all studies identified by the search strategy, carried out data extraction and assessed risk of bias. We resolved any disagreement through discussion with a third author. Data were checked for accuracy. Nineteen studies randomising a total of 2863 women were included in this review. There were three main comparison groups: 15 studies compared non-opioid drugs with placebo or no treatment (2133 women); three studies compared non-opioid drugs with opioids (563 women); and three studies compared one type of non-opioid drug with a different type or dose of non-opioid drug (590 women). Some of the studies included three or more groups and so have been put in more than one comparison. Overall, there was little difference between groups for most of the comparisons. Any differences observed for outcomes were mainly limited to one or two studies. Non-opioid drugs (sedatives) were found to offer better pain relief (mean difference (MD) -22.00; 95% confidence interval (CI) -35.86 to -8.14, one trial, 50 women), better satisfaction with pain relief (sedatives and antihistamines) (risk ratio (RR) 1.59; 95% CI 1.15 to 2.21, two trials, 204 women; RR 1.80; 95% CI 1.16 to 2.79, one trial, 223 women) and better satisfaction with the childbirth experience (RR 2.16; 95% CI 1.34 to 3.47, one trial, 40 women) when compared with placebo or no treatment. However, women having non-opioid drugs (NSAIDs or antihistamines) were less likely to be satisfied with pain relief compared with women having opioids (RR 0.50; 95% CI 0.27 to 0.94, one trial, 76 women; RR 0.73; 95% CI 0.54 to 0.98, one trial, 223 women). Women receiving the antihistamine hydroxyzine were more likely to express satisfaction with pain relief compared with the antihistamine promethazine (RR 1.21; 95% CI 1.02 to 1.43, one trial, 289 women). Women receiving sedatives were more likely to express satisfaction with pain relief compared with antihistamines (RR 1.52; 95% CI 1.06 to 2.17, one study, 157 women). The majority of studies were conducted over 30 years ago. The studies were at unclear risk of bias for most of the quality domains.Opioids appear to be superior to non-opioids in satisfaction with pain relief, while non-opioids appear to be superior to placebo for pain relief and satisfaction with the childbirth experience. There were little data and no evidence of a significant difference for any of the comparisons of non-opioids for safety outcomes. Overall, the findings of this review demonstrated insufficient evidence to support a role for non-opioid drugs on their own to manage pain during labour.

Cochrane Database Syst Rev. 2012 Jul 11;7:CD009223. Othman M, Jones L, Neilson JP. Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK. mothman12399@yahoo.com.

The morbidity caused by postnatal depression is enormous. Several psychological or psychosocial interventions have appeared to be effective for treating the disorder although they have not shown a clear benefit in preventing the development of PND. As yet however, the effectiveness of hypnosis has not been evaluated in relation to this. To assess the effect of hypnosis for preventing postnatal depression compared with usual antenatal, intranatal, or postnatal care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). Randomised controlled trials comparing hypnosis with usual antenatal, intranatal, or postnatal care, where the primary or secondary objective is to assess whether there is a reduced risk of developing postnatal depression. Two review authors independently assessed trials for inclusion and assessed the one included study for risk of bias. The included study did not contribute any data for analysis. There was one included study (involving 63 women). However, as it did not include the outcomes of interest, no data were available for analysis for this review. There was no evidence available from randomised controlled trials to assess the effectiveness of hypnosis during pregnancy, childbirth, and the postnatal period for preventing postnatal depression. Evidence from randomised controlled trials is needed to evaluate the use and effects of hypnosis during the perinatal period to prevent postnatal depression. Two trials are currently underway which may provide further information in the future.

Cochrane Database Syst Rev. 2012 Jun 13;6:CD009062. Sado M, Ota E, Stickley A, Mori R. Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. mitsusado@nifty.com.

Hyperemesis gravidarum, or pernicious vomiting of pregnancy, is a complication of pregnancy that affects various areas of the woman's health, including homeostasis, electrolytes, and kidney function, and may have adverse fetal consequences. Recent research now provides additional guidelines for protection against and relief from hyperemesis gravidarum. Alterations to maternal diet and lifestyle can have protective effects. Medicinal methods of prevention and treatment include nutritional supplements and alternative methods, such as hypnosis and acupuncture, as well as pharmacotherapy.

Rev Obstet Gynecol. 2012;5(2):78-84. Wegrzyniak LJ, Repke JT, Ural SH.

by Gayle Peterson, LCSW, PhD
The question may be raised... whether the improvement in medical management, in lessening the physical dangers of pregnancy, has contributed to a waning concern with the concomitant psychological changes." Greta Bibring (1959)

The biological processes of pregnancy and childbirth ready a woman for motherhood psychologically as well as physically. The birth of a baby is the birth of family. A myriad of births take place at once: women become mothers, husbands become fathers, and so on. One birth ripples through generations, creating subtle shifts and rearrangements in the family web.

Pregnancy and childbirth presents women with an opportunity for profound insight and self-understanding. Yet this stage of the family life cycle has gone unrecognized and unnamed. The perinatal stage has its own developmental tasks and unique characteristics. Forging an identity as a parent from past experience is one such task that a woman faces as she crosses the threshold to motherhood. The impact of the childbirth process significantly aids or hinders this process. This stage is indeed a critical period of the family life-cycle which deserves attention apart from the stages that follow: rearing young children, raising teenagers, and launching young adults. Pregnancy and giving birth form an extremely fertile time in the family's life cycle, providing an opportunity for needed adjustments in beliefs, attitudes, and family relationships to occur. As most family therapists are fully aware, transitions are periods of tremendous growth and activity, which can either result in new kinds of adjustment in healthy family systems, or in maladjustments that repeat, causing developmental delays and emotional pain.

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Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group. Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 37(0/7) (259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone (n = 122). Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (n = 17), successful ECV, whereas 38 women, who received NLP, had a 44.7% (n = 17) successful ECV (P > 0.05). The control group had similar patient characteristics compared to the intervention groups (P > 0.05). In the control group (n = 122) 27.3% (n = 33) had a statistically significant lower successful ECV procedure than NLP (P = 0.05) and hypnosis and NLP (P = 0.03). Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone.

Evid Based Complement Alternat Med. 2012;2012:626740. Epub 2012 Jun 21. Reinhard J, Peiffer S, Sänger N, Herrmann E, Yuan J, Louwen F. Department of Obstetrics and Gynaecology, Faculty of Medicine, Johann Wolfgang Goethe University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.

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.