Use of hypnosis in the childbearing year.
The purpose of this paper is to explore the history and contemporary use of hypnosis during pregnancy and childbirth. Research supports the inclusion of hypnosis in childbirth education. Hypnosis, a mainstream complementary and alternative approach, has been endorsed internationally by several organizations including the British Medical Association, the Canadian Medical Association, the American Psychological Association, and the American Psychiatric Association since before the 1960s (American Psychotherapy and Medical Hypnosis Association, 2012). Although many misconceptions about hypnosis persist, usually due to the early use of unethical demonstrations of power through hypnosis on the stage (Society of Psychological Hypnosis, 2012), strong evidence supports the benefits of hypnotherapy as an effective treatment for managing pain, nausea and vomiting, anxiety, and other conditions all common in pregnancy (American Psychiatric Association [APA], 2009). From its historical underpinnings to contemporary clinical applications, hypnosis can be incorporated into childbirth education and shared with the childbearing family.
A Brief History of Hypnosis
Hypnosis is one of the oldest mind-body approaches to healing (Hornyak & Green, 2000). Religious and healing ceremonies of all primitive peoples included a hypnotic trance, which McClenon (1997) proposed may have served as the pathway reinforcing the genetic component of suggestibility. Induction was accomplished with rhythmic chanting, drum beats, and strained fixations of the eyes (Bryan, 1963). The earliest recorded instances of hypnotherapy originated in Egyptian sleep temples in which priests induced sleep and treated their patients with the use of suggestion (Bryan, 1963). These temples spread throughout Greece, Asia, and Rome (Bryan, 1963). Hippocrates, the well-known Greek physician, spoke of the power of hypnosis, stating that "the affliction suffered by the body, the soul sees quite well with the eyes shut"(Bryan, 1963, p. 1). Aesculapius, a Roman physician, induced a "deep sleep" and reduced pain by stroking with his hand (Bryan, 1963, p. 1). Although the benefits of hypnosis were widely regarded, the use of hypnosis declined as Christianity spread; hypnosis was considered to be witchcraft (Bryan, 1963). Oddly, though, hypnosis underwent a rebirth in the early 1770s when a Catholic priest, Father Gassner, used trance states to exorcise disease-causing demons (Bryan, 1963). Franz Anton Mesmer, who observed several of Father Gassner's healings, developed a form of trance induction that he believed occurred because of the magnetic properties of the human body (Bryan, 1963). This process, which Mesmer called animal magnetism, involved patients retreating to a state of quiet relaxation and following a suggestion of reemergence from a crisis state (Bryan, 1963). Mesmerism, though discredited, ignited the curiosity of James Braid (Bryan, 1963). Braid reexamined Mesmer's process and found that suggestion alone was just as effective as mesmerism (Bryan, 1963).
Braid renamed the process hypnosis after Hypnos (Bryan, 1963), the Greek god of sleep (Atsma, 2011). Braid later attempted to change the name to monoideism in order to distinguish hypnosis from a sleep state, but the name had already become too well-known (Bryan, 1963). Braid made several significant contributions to the development of a clinical hypnosis among which were the assertions that the use of hypnosis be limited to the healing professions (Bryan, 1963), that individuals experienced different degrees of suggestibility (Gibson, 1977), and that hypnosis, although capable of curing, should be used in conjunction with other effective treatments (Bryan, 1963). During Braid's time, several other notable physicians and dentists used hypnosis to anaesthetize patients for painless surgeries (Bryan, 1963; Gibson, 1977). However, hypnoanesthesia became less popular as chemoanesthesia became more widely available (Bryan, 1963). Hypnosis, instead, fell under the domain of psychoanalysts, who recognized its use in treating anxiety and trauma (Bryan, 1963).
Research and development of modern hypnosis can be credited to a physician from France, Dr. A. Leibeault, who was the first to recognize that the phenomenon of hypnosis was subjective (Bryan, 1963). World War I brought a new era of hypnosis due to the rise in psychiatric disorders associated with the war and the inadequacy of medical help for the soldiers. The use of hypnosis became more accepted in Western medicine, and its teaching was endorsed in medical schools. The American Institute of Hypnosis was founded in 1955 to serve as the educational body devoted to promotion of hypnosis in medicine and dentistry (Bryan, 1963).
After the Second World War, the work of Milton Erickson in the United States was to have an enormous influence on the practice of hypnosis. Erickson was first and foremost a psychotherapist and a psychiatrist (O'Hanlon, 1987), but he was "probably the most creative, dynamic, and effective hypnotherapist the world has ever seen" (Havens, 1996, p. ix). Erickson displayed his passion for hypnotherapy through his advocacy for its use. Erickson became the founding president of the American Society of Clinical Hypnosis (ASCH, 2010) in 1957, and in 1958, he became the founding editor of the American Journal of Clinical Hypnosis. Despite occasional setbacks, acceptance for clinical hypnosis continues to grow as scientific evidence accumulates.
Certification for hypnosis is legislated state by state in the United States with training from an accredited school generally ranging from 200 to 300 hours (California Institute of the Healing Arts & Sciences, 2012). Accredited schools have different requirements for admittance and acceptance, but licensure for clinicians is limited to health professionals including psychologists, physicians, dentists, and nurses with advanced degrees (ASCH, 2010). The American Council of Hypnotist Examiners (ACHE, 2012) is the largest and most recognized hypnotherapy certification agency in the United States. It is considered the major certifying organization in the United States and requires that its schools are state-licensed (ACHE, 2012). ACHE awards certification at two different levels of training: Certified Hypnotherapist, in which the applicant has completed at least 200 hours of training in a licensed program; and Certified Clinical Hypnotherapist in which the applicant has completed all the requirements of the hypnotherapist and has at least 300 hours of instruction at an approved school. Both certifications require completion of a written and practical skills exam, unless an exemption is granted based upon demonstrated full-time continuous professional practice (ACHE, 2012). ACHE is a state-chartered, non-profit professional organization that maintains standards for education, practice and a code of ethics.
Hypnosis in Childbirth
Hypnosis is a state of intense relaxation where the mind becomes detached from environmental influences and the concerns of everyday life. It is in this relaxed state that the subconscious becomes responsive to suggestion. The impetus for change is easily accessed here at the subconscious because the hypnotized subject is free from anxiety and does not analyze the suggestions. The subject does not lose consciousness during hypnosis; rather, there is heightened consciousness and focus. Awareness is much greater than normal, and the awareness is related to the increased focus. This description of hypnosis may not intuitively mesh with Western notions of childbirth, which is typically portrayed as a painful, terrifying, and drawn-out process fraught with danger for mother and unborn child (Smith, 2008).
Marie Mongan, creator of a hypnosis-in-birthing program, emphasized that a pregnant woman must believe in her own ability to give birth without intervention (Scotland, 2007). Trained deep relaxation stimulates hormonal responses that ease birthing pains and enhance the body's natural abilities to prepare for childbirth (Scotland, 2007). Scotland (2007) emphasized the role of building trust, privacy, and enlightenment through education about the human body. Instead of focusing on risk and complications, birthing is conceptualized as "a loving event" (Scotland, 2007, p. 6).
Induction is the method the hypnotist uses to "transfer the subject from the conscious awareness to the subconscious awareness" (Preston, 2001, p. 87). Hypnotic induction has several general principles. First, anyone can be hypnotized, although people exhibit different degrees of suggestibility (McClenon, 1997). Most people have experienced self-hypnosis to some extent. A common example of this is when you are driving home from work, thinking about the events of the day, and arriving at the driveway without any memory of the actual trip. Erickson believed hypnosis is a natural and common experience that can be induced within the right environment (Havens, 1996).
Hypnosis is a collaborative endeavor and requires cooperation from the subject. Subjects who are comfortable and cooperative will be able to learn to enter a hypnotic trance. Rapport and trust between the hypnotist and the subject are essential (Preston, 2001; Scotland, 2007).
All hypnosis is self-hypnosis, and the hypnotist merely provides instruction and advice in an appropriate setting during a teachable moment (Fredericks, 2001; Havens, 1996). The subject must be able to concentrate and focus (Preston, 2001). Hypnosis must be tailored to meet the expectations, needs, and attitudes of the subject (O'Hanlon, 1987). Erickson criticized standardized approaches to hypnosis and did not think hypnosis lends itself well to quantitative research for this very reason (Havens, 1996).
In Mongan's method, the birthing experience is framed positively in words and actions (Scotland, 2007). For example, water does not break but releases, and contractions are referred to as "surges" (Scotland, 2007, p. 7). By removing negative connotations, anticipation and occurrence of negative events can be reduced (Scotland, 2007). Using hypnosis reframes the childbirth experience (Scotland, 2007; Smith, 2008). Mothers are taught to understand how their bodies were designed for childbirth, and birthing partners are tasked with specific duties to reduce their feelings of helplessness (Scotland, 2007). As Smith (2008) astutely stated, "if we don't allow the association of birthing and pain, we can dissociate ourselves from the negative and work with the positive" (p. 10).
The Placebo Effect
Bausell (2007) asserted that hypnosis shares qualities with placebo, arguing that hypnosis only works because people could be coerced into belief. The placebo effect cannot be ignored. It is responsible for a significant amount of healing. The placebo effect has been used from early shamans, to country doctors, to today's surgeons to potentiate healing. Contrary to Bausell's negative framing, hypnosis has been described as the non-deceptive placebo (Breuer, 2000). Breuer (2000) identified that to enable placebo effectiveness patients must accept their role in their own health care and need to feel that the health care practitioner has a credible approach to treating the illness with hypnosis. Preston (2001) says,
Each of us determines the relevance of incoming information and its importance to our well-being. The most important factor is believability, and one's belief determines one's behavior. If we consciously recognize information as being believable, important, and true, it impacts our behavior (p. 27).
In hypnotherapy, the practitioner must exude confidence about the likelihood of success, be empathetic and motivated to help, and have a positive approach (Breuer, 2000).
Hypnosis in Obstetrics
Numerous studies have been done supporting the use of hypnosis. Table 1 lists the most common uses for hypnosis identified in the literature (Barber, 1996; Lynn, Kirsch, & Rhue, 1996; Breuer, 2000; APA, 2009; Burrows, Stanley, & Bloom, 2001).
Notwithstanding the usefulness of hypnosis in other areas, the largest and earliest body of research on hypnosis has been in the area of obstetrics and child birth preparation. Evidence points to specific benefits in every stage of pregnancy.
Pregnancy Planning and Early Pregnancy
Hypnosis can assist couples facing fertility issues. Levitas et al. (2006) compared a control group 96 couples who underwent 96 cycles of in-vitro fertilization embryo transfer (IVF/ET) treatments with an experimental group of 89 couples who were taught hypnosis and completed 98 IVF/ ET treatment cycles in a fertility treatment center in Israel. Couples who completed hypnosis conceived at a rate of 58.4%, while couples in the control group conceived at a rate of 30.2% (Levitas et al., 2006). Furthermore, couples in the hypnosis group achieved a significantly higher rate of implantation with 28% versus 14.4% in the control group (Levitas et al., 2006). Hypnosis may assist overcoming issues with fertility by assisting with stress reduction and anxiety (Levitas et al., 2006). Preterm labor and miscarriage are additional concerns in early pregnancy for many women. Reinhard, Hesken-Janfien, Hatzmann, and Schiermeier (2009) reported recent rises in the incidence of preterm deliveries, which leads to increased mortality and morbidity for the premature infants. In a study examining the use of hypnosis to stop preterm labor, Reinhard et al. found a significant difference in the rate of preterm deliveries between a hypnosis group (4.7% experienced preterm delivery) and a control group (10.3% experienced preterm delivery), although confounding demographic variables were not fully addressed. Reinhard et al.'s study brings to light the role hypnosis can play in controlling labor progression. Hypnosis has also been used to treat nausea in the first trimester (Torem, 1994). McCormack (2010) reviewed six existing studies on hypnosis and morning sickness and although questioning the quality of the studies, recognized that hypnosis appeared to help resolve morning sickness in each study.
Hypnosis can be used throughout pregnancy, and its role in pain management is most noted during labor. Hypnosis helps allay stress and anxiety about medical procedures, fear, and pain in childbirth (Mairs, 1996). Several studies have shown significant reductions in complications and medical interventions for mothers using hypnosis techniques. In a study of 42 pregnant adolescents, Martin, Schauble, Rai, and Curry (2001) found notable, though not always statistically significant, differences between those who used hypnosis and those who did not. Perhaps most notably, "none of the 22 patients in the hypnosis group experienced surgical intervention compared with 12 of the 20 patients in the control group (P=.000)" (Martin et al., 2001). Harmon, Hynan, and Tyre (1990) reported that women who used hypnotic analgesia and skill mastery during labor progressed more quickly through Stage 1 labor with reduced perceptions of pain, had more spontaneous deliveries, used fewer tranquilizers, narcotics, and oxytocics, and had infants with higher Apgar scores at both one and five minutes. According to Ernst, Pittler, Wider, and Boddy (2007), the weight of evidence clearly and strongly indicates support for the use of hypnotherapy in labor pain management.
The benefits of hypnosis continue beyond delivery. Hypnosis may reduce incidence of postpartum depression. In one hypnosis experimental group, women reported significantly higher wellbeing at two weeks postpartum than a control group, and these differences remained evident and significant at 10 weeks postpartum (Guse, Wissing, & Hartman, 2006). Although evidence of protection against postpartum depression is not as voluminous as in other areas, it merits a closer look and further consideration. This literature review has showed that hypnosis is recognized as evidence-based interventions appropriate for enhancing quality of life in general and certainly the childbearing times.
Hypnosis in Childbirth Education
Childbirth educators are already teaching guided imagery, relaxation techniques, breath work (and much more) to the childbearing families. Hypnosis, trance induction, and self-hypnosis naturally follow as part of our practices as childbirth educators. Investigate local certification programs in your country and consider how this natural, safe, and holistic modality can enhance your work with the childbearing family.
American Council of Hypnotist Examiners. (2012.). Retrieved May 27, 2012, from http://www.hypnotistexaminers.com/index.html
American Psychiatric Association. (2009). Position statement on hypnosis. Retrieved May 27, 2012, from http://www.psychiatry.org/advocacy--newsroom/ position-statements/apa-position-statements
American Psychotherapy and Medical Hypnosis Association. (2012). Important notice regarding hypnosis and the American Medical Association. Retrieved May 27, 2012, from http://apmha.com/amahypnosis.htm
American Society of Clinical Hypnosis. (2010). About the society. Retrieved May 27, 2012, from http://www.asch.net/
Atsma, A. J. (2011). Hypnos. Retrieved May 27, 2012, from http://www. theoi.com/Daimon/Hypnos.html
Barber, J. (1996). Hypnosis and suggestion in the treatment of pain. New York, NY: W. W. Norton.
Bausell, R. B. (2007). Snake oil medicine: The truth about complementary and alternative medicine. New York, NY: Oxford University Press.
Breuer, W. C. (2000). Physically focused hypnotherapy: A practical guide to medical hypnosis in everyday practice. Louisville, KY: S.P.R.F.
Bryan, W. J. (1963). A history of hypnosis. Journal of American Institute of Hypnosis. Retrieved May 27, 2012, from http://www.aspenhypnotherapy. com/HypnoHistory.html
Burrows, G. D., Stanley, R. O., & Bloom, P. B. (2001). International handbook of clinical hypnosis. West Sussex, England: John Wiley & Sons.
California Institute of the Healing Arts and Sciences. (2012). Common questions about hypnotherapy training and certification. Retrieved May 27, 2012, from http://www.californiainstitute.net/licensing_hypnotherapy.htm
Ernst, E., Pittler, M. H., Wider, B., & Boddy, K. (2007). Mind-body therapies: Are the trial data getting stronger? Alternative Therapies in Health and Medicine, 13(5), 62-64. Retrieved from http://www.alternative-therapies. com/
Fredericks, L. (2001). The use of hypnosis in surgery and anesthesiology: Psychological preparation of the surgical patient. Springfield, IL: Charles C. Thomas.
Gibson, H. B. (1977). Hypnosis: Its nature and therapeutic uses. New York, NY: Taplinger.
Guse, T., Wissing, M., & Hartman, W. (2006). The effect of a prenatal hypnotherapeutic programme on postnatal maternal psychological well-being. Journal of Reproductive & Infant Psychology, 24(2), 163-177. doi:10.1080/02646830600644070
Harmon, T. M., Hynan, M. T., & Tyre, T. E. (1990). Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting & Clinical Psychology, 58(5), 525-530. Retrieved from http://psycnet.apa.org/journals/ccp/58/5/
Havens, R. A. (Ed.). (1996). Milton Erickson: Hypnosis & hypnotherapy (Vol. 1). New York, NY: Irvington Publishers.
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Levitas, E., Parmet, A., Lunenfeld, E., Bentov, Y., Burstein, E., Friger, M., & Potashnik, G. (2006). Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization-embryo transfer: A case-control study. Fertility & Sterility, 85(5), 1404-1408. doi:10.1016/j.fertnstert.2005.10.035
Lynn, S. J., Kirsch, I., & Rhue, J. W. (1996). Casebook of clinical hypnosis. Washington, DC: American Psychological Association.
Mairs, D. (1996). Hypnosis and pain in childbirth. Contemporary hypnosis, 12(2), 111-118.
Martin, A. A., Schauble, P. G., Rai, S. H., & Curry, R. W. (2001). The effects of hypnosis on the labor process and birth outcomes of pregnant adolescents. Journal of Family Practice, 50(5), 441-443. Retrieved from http://www. jfponline.com
McClenon, J. (1997). Shamanic healing, human evolution, and the origin of religion. Journal for the Scientific Study of Religion, 36(3), 345-354. Retrieved from http://www.blackwellpublishing.com/journal.asp?ref=0021-8294
McCormack, D. (2010). Hypnosis for hyperemesis gravidarum. Journal of Obstetrics and Gynaecology, 30(7), 647-653. doi:10.3109/01443615.2010.50 9825
O'Hanlon, W. H. (1987). Taproots: Underlying principles of Milton Ericksons therapy and hypnosis. New York, NY: W. W. Norton
Preston, M. D. (2001). Hypnosis: Medicine of the mind. Montreal, Canada: Ulyssian Publications.
Reinhard, J., Huesken-Janien, H., Hatzmann, H., & Schiermeier, S. (2009). Preterm labor and clinical hypnosis. Contemporary Hypnosis, 26(4), 187-193. doi:10.1002/ch.387
Scotland, M. (2007). Why I'm a Hypnobirthing[R] practitioner. Midwifery Matters, 114, 6-7. Retrieved from http://www.nswmidwives.com.au/
Smith, G. (2008). Hypnobirthing[R]: New learned behaviour for an ancient art. Midwifery Matters, 119, 10. Retrieved from http://www.nswmidwives. com.au/
Society of Psychological Hypnosis. (2012.). Hypnosis: What it is and how it can help you feel better [Online Brochure]. Retrieved May 27, 2012, from http://psychologicalhypnosis.com/div30/brochure/
Torem, M. S. (1994). Hypnotherapeutic techniques in treatment of hyperemesis gravidarum. American Journal of Clinical Hypnosis, 37(1), 1-11.
by Debra Rose Wilson, PhD MSN RNIBCLC AHN-BC CHT and Dana M. Dillard, MS
Debra is a professor at Middle Tennessee State University and contributing faculty at Walden University and University of Liverpool. Debra was a L&D nurse, a NICU nurse, and a prenatal educator for much of her career and has been a practicing clinical hypnotherapist for 30 years. She has spent many years training others in hypnobirthing and other holistic interventions for the childbearing years.
Dana has completed a Master's degree in Psychology and is working toward a PhD in Health Psychology at Walden University. Dana plans to continue her study of complementary and alternative therapies.
Table 1. Common Uses for Hypnosis * ADD/ADHD * Muscle Spasm and Muscle Tension * Immune System Disorders * Enuresis * Hernia * Allergy * Blood Sugar Disorder * Analgesia * Indigestion and GERD * Phobias * Fibromyalgia * Sinusitis * TMJ * Sleeping Disorders and Insomnia * Acute and Chronic Pain * Epilepsy * Amnesia and Recovered Memory * Dysphonia * Burns * Eating Disorders * PTSD * Anxiety Disorders * Dental Anxiety and Pain * Claustrophobia * Depression * Memory Improvement * Multiple Sclerosis * Amenorrhea * Dysmennorhea * Nausea and Vomiting * Panic Attack * Smoking Cessation * Alzheimer's * Irritable Bowel Syndrome and Chron's * Chronic Fatigue Syndrome * Neurodermatitis * Essential Hypertension * Headaches and Migraine Headaches * Torticollis * Gagging * Weight Loss and Appetite Management * Postoperative Pain and Recovery * Vertigo * Psychosis and Personality Disorders * Sexual Dysfunction * Dissociation * Dental Anxiety and Pain * Cancer * Calming for Medical Procedures * Improved Exam Performance Note: The use of hypnosis for recovered memory detail for legal evidence is not accepted in the courts in the United States.
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|Author:||Wilson, Debra Rose|
|Publication:||International Journal of Childbirth Education|
|Date:||Jul 1, 2012|
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