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Self-hypnosis fails to reduce epidural use during labor

By Andrew M. Seaman

NEW YORK (Reuters Health) - A few brief self-hypnosis classes may not persuade women to skip epidural painkillers while giving birth, according to a new Danish study.

Researchers found that a group of women who had three one-hour self-hypnosis classes used epidurals during labor just as often as women who practiced relaxation techniques or just got standard care.

"What was done in this particular study was a fairly brief preparation. So it's not surprising that they didn't see any differences in the use of epidurals," said Dr. Bill Camann, director of obstetric anesthesiology at Brigham and Women's Hospital in Boston.

"There is a lot of interest in hypnotic or mind control techniques for labor pain, but in general the ones that are most effective are ones that take a lot of preparation," said Camann, who was not involved with the new research.

Hypnosis has been used to control pain for over a century, the study's authors point out in BJOG: An International Journal of Obstetrics and Gynaecology. And several past studies showed a benefit from self-hypnosis for expectant mothers during labor pains.

Epidural - meaning delivered into the spine - painkillers have been linked with negative effects, including longer labor duration, higher likelihoods of instruments being used during delivery and disturbances in the newborn's basic body functions.

Although hypnosis is typically done under the guidance of a hypnotist, the researchers say women can be taught to self-hypnotize.

The goal of the new study was to see if teaching pregnant women self-hypnosis would limit their use of epidurals - currently the preferred pain relief method during labor - and reduce some of their pain.

For the new study, Anette Werner, the study's lead author from Aarhus University in Denmark, and her colleagues recruited 1,222 pregnant women from their hospital who were randomly assigned to one of three groups.

One group of 497 women went through three one-hour self-hypnosis training classes, another group of 495 went through three one-hour relaxation training classes and the rest got routine prenatal care.

Overall, about 30 percent of women had an epidural injection during their labor regardless of which group they were in. There were also no differences in the amount of pain they reported experiencing.

Werner told Reuters Health in an email that she was surprised there were no differences between the groups.

"When I have provided hypnosis to women on an individual (basis), I always have an agreement with them that they return after the birth and tell me about their experience - and it seemed that they benefitted from the hypnosis," said Werner.

But she added that past studies using more intensive interventions showed a benefit, while research using brief training sessions - such as the ones used in this study - hadn't.

"We need to look further into what happens if we tailor the training for more specific needs, start earlier in pregnancy and intensify the intervention," said Werner.

Chris Just, executive director of prenatal education at Isis, a Boston-area company that offers classes to parents and expectant parents, told Reuters Health that the new study seemed to use less intense methods than what they offer.

Just, who was not involved with the new research, told Reuters Health that her locations offer five two-and-a-half hour Mind Body Birth classes for between $200 and $250, which includes a class focused on self-hypnosis.

Camann, who authored Easy Labor, a book that explains available labor pain relief methods, said that it's also important for women to know that they don't have to choose between self-hypnosis and epidurals.

"You can still use some of these mental imagery and relaxation techniques in the presence of an epidural," he said. "I don't think it needs to be an either/or decision. They're completely compatible."

SOURCE: http://bit.ly/QJZoft BJOG: An International Journal of Obstetrics and Gynaecology, online November 27, 2012.

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