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

S. Downe, K. Finlayson, C. Melvin, H. Spiby, S. Ali, P. Diggle, G. Gyte, S. Hinder, V. Miller, P. Slade, D. Trepel, A. Weeks, P. Whorwell, M. Williamson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1226-1234
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume122
Issue number9
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Hypnosis
Pain Management
Pregnant Women
Randomized Controlled Trials
Confidence Intervals
Psychology
Fear
Epidural Analgesia
Anxiety
Odds Ratio
Costs and Cost Analysis
Pregnancy
Third Pregnancy Trimester
Random Allocation
Publications
Outcome Assessment (Health Care)
Parturition
Hypertension
Population

Keywords

  • Cost-analysis
  • epidural
  • group antenatal training
  • hypnosis
  • labour pain
  • psychological outcomes
  • randomised trial

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Self-hypnosis for intrapartum pain management in pregnant nulliparous women : A randomised controlled trial of clinical effectiveness. / Downe, S.; Finlayson, K.; Melvin, C.; Spiby, H.; Ali, S.; Diggle, P.; Gyte, G.; Hinder, S.; Miller, V.; Slade, P.; Trepel, D.; Weeks, A.; Whorwell, P.; Williamson, M.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 122, No. 9, 01.08.2015, p. 1226-1234.

Research output: Contribution to journalArticle

Downe, S, Finlayson, K, Melvin, C, Spiby, H, Ali, S, Diggle, P, Gyte, G, Hinder, S, Miller, V, Slade, P, Trepel, D, Weeks, A, Whorwell, P & Williamson, M 2015, 'Self-hypnosis for intrapartum pain management in pregnant nulliparous women: A randomised controlled trial of clinical effectiveness', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 122, no. 9, pp. 1226-1234. https://doi.org/10.1111/1471-0528.13433
Downe, S. ; Finlayson, K. ; Melvin, C. ; Spiby, H. ; Ali, S. ; Diggle, P. ; Gyte, G. ; Hinder, S. ; Miller, V. ; Slade, P. ; Trepel, D. ; Weeks, A. ; Whorwell, P. ; Williamson, M. / Self-hypnosis for intrapartum pain management in pregnant nulliparous women : A randomised controlled trial of clinical effectiveness. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2015 ; Vol. 122, No. 9. pp. 1226-1234.
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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.",
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AU - Spiby, H.

AU - Ali, S.

AU - Diggle, P.

AU - Gyte, G.

AU - Hinder, S.

AU - Miller, V.

AU - Slade, P.

AU - Trepel, D.

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N2 - 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.

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