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

BJOG. 2015 Aug;122(9):1226-34. doi: 10.1111/1471-0528.13433. Epub 2015 May 11.


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.

Keywords: Cost-analysis; epidural; group antenatal training; hypnosis; labour pain; psychological outcomes; randomised trial.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia, Epidural / statistics & numerical data*
  • Analgesia, Obstetrical / statistics & numerical data*
  • Female
  • Humans
  • Hypnosis*
  • Labor Pain / epidemiology
  • Labor Pain / therapy*
  • Pain Management* / methods
  • Patient Compliance / statistics & numerical data*
  • Patient Education as Topic
  • Patient Satisfaction
  • Pregnancy
  • Reminder Systems
  • Self Care / methods*
  • Surveys and Questionnaires
  • Treatment Outcome