Self-hypnosis for pain relief in labour
Evaluated properly; doesn’t work
People have been banging on for years about hypnosis for pain relief in labour. Since few can afford their own hypnotist, interest has centred on antenatal training to self-hypnotise. But despite thousands of papers, there have been few randomised trials and, according to Cochrane, the quality of them all was low, until now.
This lovely trial, led by Ellen Nohr, a midwife and epidemiologist from Aarhus in Denmark, appeared in BJOG in February (click here). Ripe-tomato.org often finds discrepancies between registration and publication, but not this time.
The trial was registered here in June 2009. Healthy women having their first baby were allocated to one of three treatment arms: 1 – three extra hour-long antenatal classes teaching self-hypnosis, 2 – the same number of extra classes teaching relaxation, 3 – controls getting no classes, over and above usual midwifery visits and a tour of the birth unit. Randomisation was in the ratio 2: 2: 1. The primary endpoint was use of epidural analgesia for pain relief – if the self-hypnosis or relaxation were effective, fewer women would need to resort to epidural. The original planned sample size was 328: 328: 152, which with 10% inflation made a total of 890 participants. However, in 2010 the frequency of epidural in Aarhus had fallen to such an extent that the trial would no longer have had sufficient power to rule out worthwhile small effects. So the sample size was increased to 446: 446: 226. With 10% inflation that made a planned total of 1208 participants.
The achieved sample size was 1220, with 487, 495, and 230 in each group. Importantly participants complied well; 85% of the hypnosis group and 80% of the relaxation one attended all three of the special classes. Obviously the women themselves knew whether they had been taught self-hypnosis, but the midwives and doctors who cared for them in labour weren’t told. Apart from five post-randomisation exclusions, follow-up for the primary endpoint was 100%, and analysis was by intention to treat.
The result
Neither the hypnosis nor the relaxation were effective. The rate of epidural use was 154/493 (31%) in the hypnosis group, 147/494 (30%) relaxation group, and 69/230 (30%) among controls. Lots of secondary outcomes, including pain scores, were reported but there were no differences in any.
Hypnosis is probably safe, so it would have been good if it worked. But it didn’t. The researchers were disappointed, and are considering trials of different regimes. The rest of us should divert our energies elsewhere.
Jim Thornton
Ripe-tomato.org 
I attempted to use hypnosis with my second baby but it was not helpful. It wasn’t until I understood the importance of natural birth and the environment in which it took place that I was able to give birth without analgesia or intervention and in an ecstatic state. Fifty years later, I still feel that ecstasy when I think about that birth and the one that followed. The best birthing video to date, “Birth As We Know It,” can be found at http://www.birthintobeing.com. In this video, eleven women give birth naturally, beautifully, magnificently. Filmmaker Elena Tonetti-Vladamirova explains the importance of clearing one’s own birth trauma prior to giving birth so that birth will be experienced without repeating earlier trauma. Prior to birth, the images in this documentary will help women learn that they are programmed to give birth normally and that birth can be, should be, a joyous event!
I have to say that it may say more about the women who deliver inside a hospital, or the way that the care is delivered. I deliver babies in an out of hospital birth center. For some women, Hypnobabies is amazing. Just helped a lady who was so calm, that her baby’s head was half out and she was sitting there quietly- we had to direct her to give us a push. Also, learning self-hypnosis is more than 3 classes. It requires lots of effort from the mothers at home.
It is good to see a well conducted trial and it has been published in BJOG during the editorship of a true scientist, lets hope that his successor is as rigorous. Sadly however people will continue to believe what they want to believe and the disappointment of the authors suggest that they were not in ‘equipoise’ when they started. The test will be, in the light of this paperf whether hypnosis or antenatal classes will be scaled down and the resources diverted elsewhere – do not hold your breath. Jeremy
— and how many women will be saying thank goodness for that so that they can get on with knowing that labour is painful but put their trust in the midwife caring from them to provide the safe, calming atmosphere that assists alongside any medical pain relief. I cannot be the only midwife who has cared for women who want a very natural hypno birth who get to 1cm, demand an epidural then berate themselves for not having a natural pain free birth!
It is amazing how the mind can work but I understand that self hypnosis isn’t everyones cup of tea. I think just having support and the right tools for the job should be enough, no?