title: Hypnosis for pain management during labour and childbirth.
abstract: BACKGROUND
  This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review.
  
  
  OBJECTIVE
  To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 January 2012) and the reference lists of primary studies and review articles.
  
  
  METHODS
  Randomised controlled trials and quasi-randomised controlled trials comparing preparation for labour using hypnosis and/or use of hypnosis during labour, with or without concurrent use of pharmacological or non-pharmacological pain relief methods versus placebo, no treatment or any analgesic drug or technique.
  
  
  METHODS
  Two assessors independently extracted data and assessed trial quality. Where possible we contacted study authors seeking additional information about data and methodology.
  
  
  RESULTS
  We included seven trials randomising a total of 1213 women. All but one of the trials were at moderate to high risk of bias. Although six of the seven trials assessed antenatal hypnotherapy, there were considerable differences between these trials in timing and technique. One trial provided hypnotherapy during labour. No significant differences between women in the hypnosis group and those in the control group were found for the primary outcomes: use of pharmacological pain relief (average risk ratio (RR) 0.63, 95% confidence interval (CI) 0.39 to 1.01, six studies, 1032 women), spontaneous vaginal birth (average RR 1.35, 95% CI 0.93 to 1.96, four studies, 472 women) or satisfaction with pain relief (RR 1.06, 95% CI 0.94 to 1.20, one study, 264 women). There was significant statistical heterogeneity in the data for use of pharmacological pain relief and spontaneous vaginal birth. The primary outcome of sense of coping with labour was reported in two studies as showing no beneficial effect (no usable data available for this review).  For secondary outcomes, no significant differences were identified between women in the hypnosis group and women in the control group for most outcomes where data were available. For example, there was no significant difference for satisfaction with the childbirth experience (average RR 1.36, 95% CI 0.52 to 3.59, two studies, 370 women), admissions to the neonatal intensive care unit (average RR 0.58, 95% CI 0.12 to 2.89, two studies, 347 women) or breastfeeding at discharge from hospital (RR 1.00, 95% CI 0.97 to 1.03, one study, 304 women). There was some evidence of benefits for women in the hypnosis group compared with the control group for pain intensity, length of labour and maternal hospital stay, although these findings were based on single studies with small numbers of women. Pain intensity was found to be lower for women in the hypnosis group than those in the control group in one trial of 60 women (mean difference (MD) -0.70, 95% CI -1.03 to -0.37). The same study found that the average length of labour from 5 cm dilation to birth (minutes) was significantly shorter for women in the hypnosis group (mean difference -165.20, 95% CI -223.53 to -106.87, one study, 60 women). Another study found that a smaller proportion of women in the hypnosis group stayed in hospital for more than two days after the birth compared with women in the control group (RR 0.11, 95% CI 0.02 to 0.83, one study, 42 women).
  
  
  CONCLUSIONS
  There are still only a small number of studies assessing the use of hypnosis for labour and childbirth. Although the intervention shows some promise, further research is needed before recommendations can be made regarding its clinical usefulness for pain management in maternity care.
authors.affiliation: School of Psychology, University of Tasmania, Hobart, Australia. klmadden@utas.edu.au
authors.forename: Kelly
authors.initials: K
authors.lastname: Madden
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.forename: Allan M
authors.initials: AM
authors.lastname: Cyna
authors.forename: Mandy
authors.initials: M
authors.lastname: Matthewson
authors.forename: Leanne
authors.initials: L
authors.lastname: Jones
mesh_terms: D016362:Analgesia, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D006990:Hypnosis / Q000379:methods*; D048949:Labor Pain / Q000523:psychology / Q000628:therapy*; D007743:Labor, Obstetric / Q000523:psychology; D007902:Length of Stay; D017060:Patient Satisfaction; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors