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Randomized Controlled Trial
. 2015 Aug;122(9):1226-34.
doi: 10.1111/1471-0528.13433. Epub 2015 May 11.

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

S Downe  1 , K Finlayson  1 , C Melvin  2 , H Spiby  3 , S Ali  4 , P Diggle  5 , G Gyte  6 , S Hinder  7 , V Miller  8 , P Slade  9 , D Trepel  4 , A Weeks  10 , P Whorwell  11 , M Williamson  2
Affiliations
Randomized Controlled Trial

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

S Downe et al. BJOG. 2015 Aug.

Abstract

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 hypertension 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: mean difference -0.72, 95% CI -1.16 to -0.28, P = 0.001); fear (mean difference -0.62, 95% CI -1.08 to -0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: 'Mean difference' replaced 'Odds ratio (OR)' in the preceding sentence.]. 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.

Keywords: Cost-analysis; epidural; group antenatal training; hypnosis; labour pain; psychological outcomes; randomised trial.

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Figures

Figure 1
Figure 1
CONSORT flow diagram.
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References

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