Wednesday, 4 November 2015

Research into hypnobirthing methods to reduce labour pain.

Downe S. et al (2014) set out to discover if teaching women hypnobirthing relaxation techniques could lead to less use of epidurals. Their findings are available in full from the Wiley Online Library. 

At last, I thought, evidence that labour does not have to be the trauma seen every day by hospital midwives world wide. How disappointed I was.

I read it with a sinking feeling. It was as a whole a very well thought out study with 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.

I could not find anywhere in the study where positions in labour were even considered when every midwife worth her salt knows that keeping women off the bed leads to less pain relief needed. The primary outcome was if a woman had epidural analgesia or not with secondary outcomes of how women measured their fear levels looking back on their labour.

Margaret Jowitt (2014) has written an entire book on how positions in labour can influence the success rate of normal births. “Women were not designed by evolution to labour and give birth propped up semi-sitting or lying on their backs. The hospital bed can turn a healthy active woman who is quite capable of trusting her body to give birth by itself to a passive patient hooked up to machines which immobilise her and increase her pain.” If the women in the intervention group were not advised to keep mobile or upright on comfy chairs or birth balls during their first stage of labour then no wonder the same amount of them needed epidurals as in the usual care group.

There was no mention of how many of the women in either group went into labour spontaneously or had to be induced. Does relaxation/hypnobirthing make a difference in delaying labour if fear is a factor? Also a massive 75% delivered in an obstetric unit where the main object that you see when entering a room is the bed. I often have to stand in front of the bed when a woman enters a delivery room and guide her towards some of our comfy chairs much to her surprise. She has watched One Born Every Minute and is convinced that labouring women are ill and should be tucked up in bed like a patient with doctors on hand to heal them.

This piece of research was a lost opportunity to turn the tide against the ever rising amount of women who see birth as a terrible ordeal to be got through with as many drugs and interventions as possible. The conclusions of the study were that the hypnobirthing teaching sessions and CDs were no better at avoiding epidurals than usual ante natal care. If the women in the intervention group had also been given the advice not to lie down in labour, as many seem to want to, then the outcome may have been very different.

Downe S et al (2014) Self-hypnosis for intrapartum pain management (SHIP) in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG available on line at Wiley Online Library.

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