What is the issue?

Women’s experiences of pain in labour are variable and complex. Techniques such as hypnosis have been proposed as ways to help women cope with pain during labour. Hypnosis represents an aspect of conscious awareness similar to daydreaming and involves focusing attention inwards and increased responsiveness to suggestions. Suggestions are verbal and non-verbal communications, that may influence perceptions (such as the way contractions are experienced), mood or behaviour. During childbirth women may use hypnosis in a range of ways; to promote relaxation, as a means of dissociating from pain or to change their perceptions, for example, perceIving contractions as a way to get closer to birthing their baby rather than an experience of pain and suffering more usually associated with injury and disability. Women can be guided into hypnosis by a practitioner during labour or individuals can learn self-hypnosis during pregnancy, for subsequent use during labour. This training on how to use hypnosis during the pregnancy is sometimes supplemented by audio recordings of hypnotic suggestions.

Why is it important?

Childbirth is a major physical, emotional and social event in a woman’s life. The experience and management of pain during labour are important issues for many women.

What evidence did we find?

We included nine trials that randomised 2954 women to hypnosis or to control groups receiving; standard care, relaxation training or supportive counselling. In eight trials the women were trained in self-hypnosis during pregnancy for later use during labour. In the other trial, the hypnotherapist was present during the woman’s labour.

There were no clear differences between women in the hypnosis group and those in the control groups in terms of the number of normal deliveries, women’s satisfaction with the method of pain relief or women’s sense of coping with labour. However, fewer women in the hypnosis group used pain relief medication for labour. Epidural use did not differ between the groups. All the evidence for these outcomes was found to be of low quality. The studies measured a range of other outcomes and no consistent differences were found.

What does this mean?

Hypnosis may reduce the overall use of pain medication during labour, but does not seem to reduce the use of epidurals. Women using hypnosis are no more likely to have a normal vaginal birth. There is currently not enough evidence to say whether hypnosis helps women feel more satisfied about their pain relief in labour, nor whether it improves their sense of coping with labour. Further high-quality research is needed and should include assessment of women’s satisfaction with pain relief and sense of coping in labour. Our conclusions about the impact hypnosis has on pain during labour and childbirth may change with future, high-quality research.