International Hypnosis Research Institute - Child Birth

Hypnosis for induction of labour.

Tue, 04 Nov 2014 12:02:00 -0500

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handsearched relevant conference proceedings, contacted key personnel and organisations in the field for published and unpublished references. SELECTION CRITERIA: All published and unpublished randomised controlled trials (RCTs) and cluster-RCTs of acceptable quality comparing hypnosis with no intervention or any other interventions, in which the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 for labor and birth.

Thu, 21 Aug 2014 18:55:00 -0500

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.

The effect of hypnosis on dysmenorrhea.

Thu, 26 Jun 2014 18:41:00 -0500

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.

Non-hormonal methods for induction of labour.

Tue, 18 Feb 2014 18:17:00 -0500

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.

Clinical hypnosis for labour and birth: a consideration.

Thu, 21 Nov 2013 16:21:00 -0500

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.

Hypnosis versus diazepam for embryo transfer: a randomized controlled study.

Mon, 26 Aug 2013 16:05:00 -0500

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

Clinical hypnosis for labour and birth: a consideration.

Mon, 19 Aug 2013 16:05:00 -0500

Effect of self-hypnosis on duration of labor and maternal and neonatal outcomes...

Thu, 15 Aug 2013 16:38:00 -0500

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.

Hypnosis Antenatal Training for Childbirth: a randomised controlled trial.

Thu, 08 Aug 2013 16:37:00 -0500

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.

When the bough breaks: rethinking treatment strategies for perinatal depression.

Tue, 25 Jun 2013 16:04:00 -0500

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

Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial.

Thu, 07 Mar 2013 14:18:00 -0500

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.

Clinical hypnosis before external cephalic version.

Thu, 21 Feb 2013 14:10:00 -0500

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

Self-hypnosis for coping with labour pain: a randomised controlled trial.

Tue, 19 Feb 2013 14:50:00 -0500

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.

Hypnosis for pain management during labour and childbirth.

Tue, 29 Jan 2013 14:43:00 -0500

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.

Non-opioid drugs for pain management in labour.

Mon, 24 Dec 2012 16:18:00 -0500

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.