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.
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. (Perhaps a
bigger study is needed.)
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.
