Home Birth

The hypnosis for Childbirth is as much a philosophy as it is a technique. Dr. Grantly Dick-Read, a British physician, was the first to propose the “fear-tension-pain” syndrome in his work Natural Childbirth (1933) and he therefore recommended childbirth preparation as a means to prepare for birth.

While midwives and physicians recommend natural childbirth preparation, hypnosis is an extremely effective way to eliminate the fear-tension cycle. Hypnosis applies the theory on the subconscious level, which at the same time allows your physical body to deeply relax, not only during the sessions, but also during the birth.

The Royal College of Midwives also admits that hypnotherapy can help some women, and says that any methods that can help calm women’s labour fears” are beneficial.

Research studies from around the world show that the use of hypnosis for childbirth results in:

• * shorter labours
• * reduced use of pain medication
• * higher Apgar scores (measurement of the baby’s well being at the birth)
• * reduced surgical delivery (Caesarian delivery and forceps)

Jenkins and Pritchard found a reduction of 3 hours for primigravid women (from 9.3 hours to 6.4 hours, p<0.0001) and 1 hour for multigravid women (from 6.2 hours to 5.3 hours, p<0.01) for active labour (262 subjects and 600 controls). Pushing was statistically shorter for first time mothers (from 50 min to 37 min, p<0.001).

A British study found a statistically significant reduction (p<0.001) in the length of labour of first and second time mothers: 70 hypnosis patients (6 h 21 min) compared to 70 relaxation patients (9 h 28 min) and 70 control group (9 h 45 min).

Hao et al in China measured the effect of nursing suggestions to labouring women and recommends that the conversation of the nurses be “controlled carefully for the purpose of advancing the birth process”. This randomized control trial examined 60 first time mothers with a matched control group of 60 first time mothers and found a statistically significant reduction (p<0.01) in the lengths of the first and second stages of labour.

In a study that compared hypnosis and Lamaze training, 96 women chose between hypnosis (n=45) and Lamaze (n=51). The first stage of labour was shortened in the hypnosis group by 98 minutes for first time mothers and by 40 minutes for second time mothers. These women were more satisfied with labour and reported other benefits of hypnosis such as reduced anxiety and help with getting to sleep.

Mellegren, noted a reduction of two to three hours of labour.

Abramson and Heron found a shorter first stage of labour for 100 women trained with hypnosis (by 3.23 hours) compared to a control group of 88 women.

Forty-five Hypnosis for Childbirth clients (first time mothers) had an average of 4.5 hours for the active labour, a significant reduction compared to the usual 12 hours.

In a British study, 55% of 45 patients (first and second time mothers) required no medication for pain relief. In the other non-hypnosis groups, only 22% of 90 women required no medication.

Two research pieces reported on 1,000 consecutive births: 850 women used hypnotic analgesia resulting in 58 percent rate of no medication.

Five other research pieces reported an incidence of 60 to 79 percent non-medicated births.

My retrospective survey notes an epidural rate of 18 percent in Southern Ontario, where the epidural rate in most hospitals is 40 to 95 percent (depending on the setting) for first time mothers.

Rates of Intervention:

In a randomized control trial of 42 teenagers in Florida, none of the 22 patients in the hypnosis group experienced surgical intervention compared with 12 of the 20 patients in the control group (p=.000). Twelve patients in the hypnosis group experienced complications compared with 17 in the control group (p=.047).

Harmon, Hynan and Tyre reported more spontaneous deliveries, higher Apgar scores and reduced medication use in their study of 60 women.

Of the 45 Hypnosis for Childbirth clients, 38 delivered without the use of caesarian, forceps or vacuum, a rate of spontaneous birth of 84%. This is a higher than average rate of normal birth for the general population of first time mothers.

In a randomized control trial of 42 teenagers in Florida, only 1 patient in the hypnosis group had a hospital stay of more than two days compared with 8 patients in the control group (p=.008).

McCarthy provided five 30-minute sessions to 600 women and found a virtual absence of postpartum depression, compared to the typical rates of 10 to 15 percent. Women with a history of postpartum depression did not develop this condition, even though an estimated 50 percent eventually do.

Harmon et al also reported lower depression scores in the hypnotically treated group.

It appears that a simple intervention, hypnotherapy, has far-reaching effects both medically and socially. Some, but not all, of the above studies are randomized, have large numbers, include control groups and demonstrate statistical significance. There remains, therefore, a clear need for more research, especially Canadian based, in the use of hypnosis for childbirth preparation.

Jenkins, MW, Pritchard MH, Aberdare District Maternity Unit, Mid Glamorgan, Wales. Br J Obstet Gynaecol 1993 Mar; 100(3): 221-6

OBJECTIVE: To assess the designs of hypnotherapy on the first and second stages of labour in a large group of pregnant women.

DESIGN: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy.

SUBJECTS: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included.

INTERVENTION: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy.

OUTCOME MEASURES: Analgesic requirements, duration of first and second stages of labour.

RESULTS: The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group (P<0.0001); the mean lengths of the second stage were 37 min and 50 min, respectively (P<0.001). In the parous women the corresponding values were 5.3 h and 6.2 h (P<0.01); and 24 and 22 min (ns). The use of analgesic agents was significantly reduced (P<0.001) in both hypnotized groups compared with their controls.

CONCLUSION: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.

Shawn Gallagher, B.A., R.M., C.Ht

Objective: To assess the effects of prenatal hypnotherapy classes on the length of labour, use of pain medication, intervention rates, maternal pain perception and maternal satisfaction.

Design: Retrospective survey completed by the woman and her partner.

Subjects: Self-referred clients, nulliparous (first baby) and low risk.

Setting: Toronto, Canada

Intervention: Three sessions of 2.5 to 3 hours in length in a group setting in mid-pregnancy, plus one session of 2.5 hours in length in late pregnancy. The sessions were provided by a Certified Hypnotherapist. The woman’s partner was trained to provide additional hypnosis support during the birth as needed (the hypnotherapist did not attend the births).

Outcome Measures: Anesthetic and analgesic requirements, duration of the early, active and second stages, planned place of birth and actual place of birth, interventions required, pain scale of 0-10 as reported by the mother post-delivery, breastfeeding rates and reported maternal satisfaction.

Results:

Participants: 45 nulliparous women

Control group: none

Planned home birth: 16

Actual home birth: 15 A

Primary care midwife: 29

Primary care physician:16

Averages of:

Length of early labour: 10.7 hours (range: 45 min to 3 days)

Length of active labour: 4.5 hours (range: 54 min to 14 hours)

Length of pushing: 1.2 hours (range: 15 min to 4.5 hrs)

Newborn weight: 7.68 lbs (range: 5 lbs 6 oz to 10 lbs)

Maternal pain perception: “6” on a self-scoring scale of 0-10

Pain medication rate:

Epidural x 8 (18%) B

Nitrous oxide x 1 (3%)

Narcotics x 2 (4.4%)

Interventions:

• Caesarian x 3 (6.5%) C

• Forceps x 3 (9.7%) D

• Vacuum x 1 (3%)

• Pitocin augmentation x 2 (4.4%)

• Pitocin/gel induction x 8 (18%) E

The total number of participants who received an intervention was 8 for a rate of 18%. (Some women received more than one intervention.)

Breastfeeding without formula supplementation: 42 (93%)

Women who would use this method again: 43 (96%)

Length of labour:

The average length of active labour for nulliparous women is 12 hours. Participants in the Hypnosis for Childbirth series averaged 4.5 hours of active labour. The average length of pushing for nulliparous women is about 2 hours. Participants in the Hypnosis for Childbirth series averaged just over 1 hour. Hypnosis is associated with faster births (statistically significant) throughout the research for both the first and second stages of labour.

Medication rates:

The epidural rate in Toronto and Mississauga ranges from 40 to 95% for nulliparous women. This survey notes an 18% epidural rate for Hypnosis for Childbirth participants (11% for caesarians and forceps, 7% for maternal request). This survey’s reduction in medication use is supported by statistically significant reductions in other research for women using hypnosis preparation for birth.

Caesarean rates:

The caesarean section rate in Toronto ranges from 20 to 25%, depending on the institutional setting. This survey notes a caesarian section rate of 6.7% for Hypnosis for Childbirth participants. Other research also notes the reduction of birth interventions with the prenatal use of hypnosis.

A. The one planned homebirth delivered in the hospital was a change of plans in late pregnancy based on a poor biophysical profile (94% successful homebirth rate). Of the 15 planned homebirths at the onset of labour, 100% delivered at home. All planned hospital births delivered in the hospital.

B. The three maternal requests for epidurals were highly correlated to unfavourable fetal positioning (ie. posterior presentation). The other five epidurals were for caesarians (3) and forceps (2).

C. Breech presentation (n=1) at term; fetal distress/prolonged labour/posterior (n=1); fetal distress and poor descent in second stage (n=1).

D. Fetal distress (n=2); poor descent (n=1).

E. Three of the eight had no additional interventions; five of the eight had epidurals (3), forceps (2) and nubaine (1). An additional four were midwifery clients who induced at home using either homeopathy or castor oil (9%). No additional interventions were noted with this group.

As a result of the Hypnosis for Childbirth series a very high percentage of women reported an increased sense of self-confidence prior to the onset of labour. In addition, 96% were pleased at the use of hypnosis, would use hypnosis in a subsequent birth and recommend its use to other women planning natural childbirth

Alice A. Martin, PhD; Paul G. Schauble, PhD; Surekha H. Rai, PhD; and R. Whit Curry, Jr, MD Gainesville, Florida The Journal of Family Practice • MAY 2001 • Vol. 50, No. 5 General

We evaluated how childbirth preparation incorporating hypnotic techniques affected the labor processes and birth outcomes of pregnant adolescents. The study included 42 teenaged patients receiving prenatal treatment at a county public health department before their 24th week of pregnancy. They were randomly assigned to either a treatment group receiving a childbirth preparation protocol under hypnosis or a control group receiving supportive counseling. When labor and delivery outcome measures were compared in the 2 groups, significant differences favoring the hypnosis intervention group were found in the number of complicated deliveries, surgical procedures, and length of hospital stay. Larger studies in different populations are needed.

Hypnosis has been used to control pain during labor and delivery for more than a century, but the introduction of chemo-anesthesia and inhalation anesthesia during the late 19th century led to the decline of its use. Recently there has been a resurgence of this technique in obstetrics. Hypnotherapy has been found to be effective in providing pain relief, reducing the need for chemical anesthesia, and reducing anxiety, fear, and pain related to childbirth. Hypnosis has also been helpful in both managing various complications of pregnancy (such as premature labor) and reducing the likelihood of premature labor and birth in high-risk patients. It has also has been effective in the treatment of hyperemesis gravidarum, acute hypertension associated with pregnancy and conversion of breech to the vertex presentation.

One promising application of hypnosis is in the area of labor and delivery. The use of hypnosis in preparing the patient for labor and delivery is based on the premise that such preparation reduces anxiety, improves pain tolerance (lowering the need for medication), reduces birth complications, and promotes a rapid recovery process. The key aspect of this treatment is involvement of the patient before labor begins, to promote her active participation and sense of control in the labor and delivery process. This is accomplished through educating the patient about this process and teaching her alternate ways to produce hypno-analgesia and anesthesia. Hypnotic preparation thus provides the expectant mother with a sense of control for managing her anxiety and physical discomfort.

Although there have been numerous reports suggesting the value of hypnosis in obstetrics, our study is one of the first to report a randomized controlled evaluation of childbirth preparation incorporating hypnotic techniques on labor processes and birth outcomes. Study design

Both groups of patients received the standard prenatal treatment protocol from the medical staff, nurse practitioners, and hospital staff, all of whom were blind to group assignments. All patients were delivered at the local teaching hospital by obstetrics department staff who were blind to the study. The study interventions were begun with individual meetings with patients during regular clinic visits between 20 and 24 weeks’ gestation. Continuing clinic visits were scheduled for all patients on a biweekly basis, making the time span of the 4-session experimental conditions approximately 8 weeks. The study counselor (the primary author) provided hypnosis preparation training for the treatment group; a nurse midwife provided the supportive contact with the control group. Both interventions were completed before delivery; no prompting occurred during the labor and delivery process.

The 2 groups of patients were compared on medication use (Pitocin, anesthetic, and postpartum medication), complications and surgical intervention during delivery, and length of hospital stay for mothers and neonatal intensive care unit (NICU) admission for the infants. Complications fell into 36 categories of events (eg, multiple pregnancies, preeclampsia, vacuum-assisted delivery) that were entered in subjects’ records by obstetric staff who were unaware of the study. Statistical analysis was based on a simple count of the presence or absence of complications in the medical record by researchers (the researchers were not blinded to the patient’s study assignment). Results

Of the 47 patients, 3 moved out of the geographic area before delivery, and 2 patients (1 in each group) did not complete the research protocol and were not included in the research. Results were thus obtained for 22 patients in the hypnosis group and 20 in the control group, resulting in a total of 42 subjects. A two-tailed Fisher exact analysis at the .05 level was used to test for significance.

Only one patient in the hypnosis group had a hospital stay of more than 2 days compared with 8 patients in the control group (P=.008). None of the 22 patients in the hypnosis group experienced surgical intervention compared with 12 of the 20 patients in the control group (P=.000). Twelve patients in the hypnosis group experienced complications compared with 17 in the control group (P=.047). Although consistently fewer patients in the hypnosis group used anesthesia (10 vs 14), Pitocin (2 vs 6), or postpartum medication (7 vs 11), and fewer had infants admitted to the NICU (1 vs 5), statistical analysis was nonsignificant.

Discussion

We focused on the educational preparation of the patient while in hypnosis to create the expectation of a normal labor and delivery, develop a conditioned response of comfort and confidence, and facilitate an increased sense of control in achieving a healthy delivery.

The subjects in the treatment group received a 4-session sequence of standard hypnotic interventions incorporating childbirth preparation information (ie, the hypnoreflexogenous method) in which they were instructed in the methods and benefits of focused relaxation and imagery to increase the likelihood of a safe and relatively pain-free delivery. The sessions provided an opportunity to experience and practice hypnotic induction and deep relaxation. The suggestions directed toward the expectant mothers during the hypnotic state focused on the conceptualization of pregnancy and childbirth as a healthy natural process.

Conclusions

Our study provides support for the use of hypnosis to aid in preparation of obstetric patients for labor and delivery. The reduction of complications, surgery, and hospital stay show direct medical benefit to mother and child and suggest the potential for a corresponding cost-saving benefit.

Harmon TM, Hynan MT, Tyre TE, The University of Wisconsin, Milwaukee J Consult Clin Psychol 1990 Oct; 58(5):525-30

The benefits of hypnotic anlagesia as an adjunct to childbirth education were studied in 60 nulliparous women. Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task. Half of the subjects in each group received a hypnotic induction at the beginning of each session; the remaining control subjects received relaxation and breathing exercises typically used in childbirth education.

Both hypnotic subjects and highly susceptible subjects reported reduced pain. Hypnotically prepared births had shorter Stage one labours, less medication, higher Apgar scores and more frequent spontaneous deliveries than control subjects’ births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other three groups.

We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study.

The above is classified as both a Clinical trial and Randomized controlled trial.

Schauble PG, Werner WE, Rai SH, Martin A. Counseling Center, University of Florida, Gainsville, Florida. American Journal of Clinical Hypnosis 1998 Apr; 40(4):273-83

(c) Reproduced with permission of Natal Hypnotherapy

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