Hypnosis Antenatal Training for Childbirth (HATCh): a randomised controlled trial [NCT00282204]

BACKGROUND: Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth. This may increase the risk of associated complications and a less satisfactory birth experience. Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth. This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy. METHODS/DESIGN: A single centre, randomised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia. Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy; Group 3 participants continue with their usual preparation for childbirth with no additional intervention. Women > 34 and < 39 weeks gestation, planning a vaginal birth, not in active labour, with a singleton, viable fetus of vertex presentation, are eligible to participate. Allocation concealment is achieved using telephone randomisation. Participants assigned to hypnosis groups commence hypnosis training as near as possible to 37 weeks gestation. Treatment allocations are concealed from treating obstetricians, anaesthetists, midwives and those personnel collecting and analysing data. Our sample size of 135 women/group gives the study 80% power to detect a clinically relevant fall of 20% in the number of women requiring pharmacological analgesia – the primary endpoint. We estimate that approximately 5–10% of women will deliver prior to receiving their allocated intervention. We plan to recruit 150 women/group and perform sequential interim analyses when 150 and 300 participants have been recruited. All participant data will be analysed, by a researcher blinded to treatment allocation, according to the "Intention to treat" principle with comprehensive pre-planned cost- benefit and subgroup analyses. DISCUSSION: If effective, hypnosis would be a simple, inexpensive way to improve the childbirth experience, reduce complications associated with pharmacological interventions, yield cost savings in maternity care, and this trial will provide evidence to guide clinical practice

Psychological trauma following childbirth

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Post-traumatic stress following childbirth: a review of the emerging literature and directions for research and practice

Abstract The aim of this paper is to provide a review of the emerging literature on the relationship between the experience of difficult childbirth and the development of post-traumatic stress disorder (PTSD). First, we discuss the criteria for diagnosis of PTSD and the implications that changes in these criteria over the past decade have had for women who experience a traumatic childbirth. Although the literature is limited, it can be concluded that women who experience traumatic childbirth may go on to develop clinically significant symptoms of PTSD in the postnatal period. Second, we discuss the clinical presentation of PTSD in women who undergo childbirth. Sexual avoidance and parenting problems may be features particular to women who experience difficult and traumatic childbirth. Third, we review the empirical evidence for risk factors to the development of PTSD including childbirth related, personality and individual difference factors, and social psychological factors. Recommendation for investigation into the clinical effectiveness of social support provision for women who have experienced traumatic childbirth is made, along with recommendations for investigation into the usefulness of routine screening for PTSD