title: Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness.
abstract: OBJECTIVE
  (Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use.
  
  
  METHODS
  Multi-method randomised control trial (RCT).
  
  
  METHODS
  Three NHS Trusts.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK.
authors.forename: S
authors.initials: S
authors.lastname: Downe
authors.affiliation: Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK.
authors.forename: K
authors.initials: K
authors.lastname: Finlayson
authors.affiliation: Women & Children's Health Research Team, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK.
authors.forename: C
authors.initials: C
authors.lastname: Melvin
authors.affiliation: Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Spiby
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ali
authors.affiliation: Lancaster Medical School, Lancaster University, Lancaster, UK.
authors.forename: P
authors.initials: P
authors.lastname: Diggle
authors.affiliation: Cochrane Pregnancy and Childbirth Group, Department of Women and Childrens' Health, Liverpool Women's NHS Foundation Trust, University of Liverpool, Liverpool, UK.
authors.forename: G
authors.initials: G
authors.lastname: Gyte
authors.affiliation: RaFT Research, Clitheroe, Lancashire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hinder
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: V
authors.initials: V
authors.lastname: Miller
authors.affiliation: Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Slade
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: D
authors.initials: D
authors.lastname: Trepel
authors.affiliation: Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors.forename: A
authors.initials: A
authors.lastname: Weeks
authors.affiliation: Centre for Gastrointestinal Sciences, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Whorwell
authors.affiliation: Women & Children's Health Research Team, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK.
authors.forename: M
authors.initials: M
authors.lastname: Williamson
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006990:Hypnosis; D048949:Labor Pain / Q000453:epidemiology / Q000628:therapy*; D059408:Pain Management / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy; D017010:Reminder Systems; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cost-analysis; epidural; group antenatal training; hypnosis; labour pain; psychological outcomes; randomised trial