Self‐hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. (11th May 2015)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: BJOG. Volume 122:Number 9(2015:Sep.)
• Page Start: 1226
• Page End: 1234
• Publication Date: 2015-05-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13433
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13433-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13433-sec-0001" sec-type="section"> <title>Objective</title> <p>(Primary) To establish the effect of antenatal group self‐hypnosis for nulliparous women on intra‐partum epidural use.</p> </sec> <sec id="bjo13433-sec-0002" sec-type="section"> <title>Design</title> <p>Multi‐method randomised control trial (RCT).</p> </sec> <sec id="bjo13433-sec-0003" sec-type="section"> <title>Setting</title> <p>Three NHS Trusts.</p> </sec> <sec id="bjo13433-sec-0004" sec-type="section"> <title>Population</title> <p>Nulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness.</p> </sec> <sec id="bjo13433-sec-0005" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="bjo13433-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p> <italic>Primary:</italic> epidural analgesia. <italic>Secondary</italic>: associated clinical and psychological outcomes; cost analysis.</p> </sec> <sec id="bjo13433-sec-0007" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> = 0.001); fear (mean difference −0.62, 95% CI −1.08 to −0.16, <italic>P </italic>=<italic> </italic>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).</p> </sec> <sec id="bjo13433-sec-0008" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>