Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum-A randomized controlled trial

PLoS One. 2020 May 1;15(5):e0230704. doi: 10.1371/journal.pone.0230704. eCollection 2020.


Background: Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum.

Methods: In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test.

Findings: During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96).

Conclusion: Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.

Publication types

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

MeSH terms

  • Adult
  • Analgesia, Obstetrical / adverse effects
  • Delivery, Obstetric
  • Female
  • Humans
  • Hydrocortisone / metabolism
  • Hypnosis / methods*
  • Labor Pain / metabolism
  • Labor Pain / physiopathology
  • Labor Pain / therapy*
  • Labor, Obstetric / physiology
  • Parturition / metabolism*
  • Parturition / physiology
  • Patient Satisfaction
  • Postpartum Period / metabolism
  • Postpartum Period / physiology
  • Pregnancy
  • Prenatal Care
  • Relaxation Therapy*
  • Saliva / metabolism


  • Hydrocortisone

Grant support

•Nordea Fonden: https://nordeafonden.dk/ (Recieved 2008) •Aase og Ejnar Danielsen’s foundation: https://danielsensfond.dk/ (Grant number:10- 000395 and 10-000166) •The Danish Society for Clinical Hypnosis: https://hypnoseselskabet.dk/ (Recieved 2009) •VIFAB (Knowledge and Research Center for Alternative Medicine): https://stps.dk/da/ansvar-og-retningslinjer/alternativ-behandling/ (Grant number: 802-44-2009) •King Christian X’s foundation: http://kongehuset.dk/node/5556 (Grant number 117/2009) •The Danish Association of Midwives: http://www.jordemoderforeningen.dk/fagforskning/forsknings-og-udviklings-beholdningen/ (Grant number:56-089-MHJ) The following authors took part in all funding acquisitions: Anette Werner, Robert Zachariae, Ellen A Nohr, Niels Uldbjerg, Åse Marie Hansen The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The researchers acted independently from the study sponsors in all aspects of this study.