Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness
Downe, Soo; Finlayson, Kenneth; Melvin, C.; Spiby, Helen; Ali, A.; Diggle, P.; Gyte, G.; Hinder, S.; Miller, V.; Slade, P.; Trepel, D.; Weeks, A.; Whorwell, Peter
Professor HELEN SPIBY Helen.Spiby@nottingham.ac.uk
Professor of Midwifery
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.
|Journal Article Type||Article|
|Journal||BJOG: An International Journal of Obstetrics and Gynaecology|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||Downe, S., Finlayson, K., Melvin, C., Spiby, H., Ali, A., Diggle, P., …Whorwell, P. (in press). 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, 122(9), https://doi.org/10.1111/1471-0528.13433|
|Keywords||Cost-analysis, epidural, group antenatal training, hypnosis, labour pain, psychological outcomes, randomised trial|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0|
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0
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