How might hypnotherapy work to relieve or even eliminate pain during labor?
Researchers think that hypnotherapy works by changing how you perceive pain. The theory is that using hypnosis for pain relief alters the higher centers of your central nervous system. This means that entering into a state of self-hypnosis during labor may activate certain mental processes that make potentially painful sensations less unpleasant or even non-painful.
What is the evidence specifically on using hypnosis for pain relief during labor?
Well, in 2016, Madden et al. published a Cochrane review and meta-analysis. The review included nine randomized, controlled trials with a total of nearly 3000 participants. The studies ranged in size from as small as 38 participants and as large as about 1200 participants. In eight trials, the hypnotherapy began during pregnancy and was taught in group classes. In four trials, women were given audio tracks and told to practice daily at home. And in one study, hypnotherapy wasn’t introduced until the participants were in labor- so that was the first time they got any hypnotherapy.
One of the problems with these studies is that they may have used ineffective ways to prepare people to use hypnotherapy. For example, in some of the studies, they may have only had one or two sessions. And only learning about self-hypnosis one or two times and then not practicing, does not effectively prepare someone to use the technique. People in the control groups in these studies received standard care which may have included regular childbirth education, supportive counseling, and relaxation practices. Some participants in the study used epidurals, nitrous oxide, and injectable opioids such as Demerol. “Blinding” was attempted in four studies where they didn’t tell women which group they ended up in, but the researchers didn’t measure if the blinding was actually successful (the women were truly blinded) or not.
They found that people who received hypnosis were 27% less likely to have any drugs for pain relief overall. This could have included epidurals, or injectable opioids, or nitrous oxide gas. However, when they looked specifically at epidural use, they did not see any difference between epidural rates in the hypnosis group and in the standard care group. One analysis that the Cochrane researchers did showed that there might be an interaction between when you started the hypnosis training and how much pain medication you needed. In other words, they found that the earlier you started the hypnosis training – giving you more time to practice- the less likely you were to need pain medication during labor.
After the births, there were no clear differences between the hypnosis and control groups with their reports of how they felt like they coped during labor or their satisfaction with their pain relief. However, the researchers did find a slight benefit in satisfaction levels in the hypnosis group when hypnosis was combined with being immersed in a tub of warm water. They did not find any reports of bad side effects from using hypnosis. The researchers concluded that the quality of the studies in their review ranged from low to very low quality because of concerns they had about the methods of the studies.