RESEARCH FINDINGS USING GUIDED IMAGERY FOR
Childbirth

July, 2006

The Value of Childbirth Preparation
About four million births take place annually in the United States (Hamilton, Ventura, et al, 2005). Many of the mothers involved are looking for ways to participate more actively in preparation for delivery and in the process of labor, and to avoid “medicalized” births.

A search for books on “natural childbirth” on Amazon.com, conducted on June 29, 2006, yielded 431 titles, up from 309 titles just three years earlier. Another indicator of this trend is the rise in the use of midwives, which rose from 0.9% in 1975 to nearly 8% of vaginal deliveries in 2001 (Martin and Hamilton, 2005). A recent survey of nurse midwives revealed that 48.8% of CNM’S recommend mind-body techniques for the birthing process (Gentz, 2001).

Although the programs of Lamaze and Dick-Read are the most widely used forms of childbirth preparation in this country, psychological and educational preparation with self-hypnosis and guided imagery have proven effective in several studies (Harmon, Hynan & Tyre, 1990; Martin, Schauble, et al, 2001; Oster 1994; Schauble, Werner, et al, 1998).

Self-hypnosis and guided imagery – the terms are used interchangeably in the literature – combinee deep relaxation with positive suggestion for a normal, comfortable birth. Relaxation and breathing techniques can also reduce anxiety in laboring women (Almeida and de Sousa, 2005).

In one study, a group of 22 women who learned self-hypnosis in a four-session program had shorter hospital stays and fewer surgical interventions than a matched control group who received psychosocial counseling sessions (Martin, Schuable, et al, 2001). Harmon, Hynan, and Tyre (1990) studied 60 pregnant women, half of whom received hypnotic suggestions for an enjoyable childbirth, deep relaxation, and glove anesthesia. The treatment group had quicker progress through Stage 1 of labor, less reported pain, less use of medication, and their babies had higher Apgar scores at 1 and 5 minutes.

Imagery and self-hypnosis have also demonstrated effectiveness in reducing complications of pregnancy (Mehl, 1994; Torem, 1994). For example, Mehl used guided imagery with 100 women whose babies were in breech positions at 37 to 40 weeks' gestation. He compared them with a matched comparison group. In the hypnosis group, 81% of the babies spontaneously "turned" to the proper position, compared with 48% of the comparison group.

Mind-body techniques can also be used for reducing women’s anxiety and stress during pregnancy; these techniques are effective across cultural lines, as well, as illustrated by a 2006 study, where Iranian women using relaxation techniques had significantly reduced low-weight births, cesarean sections, and/or instrumental extractions (Bastani F, Hidarnia, et al, 2006).

Gentz, in her 2001 review of the literature, concluded that hypnosis is “a helpful adjunct” for women during the birthing process.

Authors of a 2003 review found that women using hypnosis were more satisfied with the management of their labor pain when compared with women using other forms of alternative and complementary methods of pain management (Smith, Collins, et al, 2003). More recently, authors of a 2004 review reported that women using hypnosis needed less analgesia and rated their pain as less severe than those in the non-hypnosis groups (Cyna, McAuliffe & Andrew, 2004).

Guided imagery with relaxation has also been used effectively in improving post-partum anxiety, depression, and self-esteem (Rees, 1995).


Potential Cost Savings
The 2004 national cesarean section rate climbed another 6% to an all-time high of 29.1% (Martin, Hamilton et al. 2005), with individual hospital's rates approaching a staggering 57% (Goldstein, 2005). These numbers far exceed The World Health Organization's call for a rate no higher than 15% (WHO, 1985). Clearly there is a need for greater education of the benefits to both mother and baby of natural childbirth and the potential complications of medically unnecessary interventions of "managed" birth.

Reduction of cesarean birth rates to European levels would save approximately $1.5 billion per year in the U.S. (Sachs and Kobelin, 1999). Whatever the method of birth, reduction of hospital stays and complications, like those demonstrated in the studies mentioned above, would save additional resources, although the amount has not been calculated.


Conclusion
Guided imagery can increase women’s feelings of control and confidence in the labor process, significantly reduce their perception of pain, help them handle complications that might arise, and reduce costs by shortening hospital stays and lowering the frequency of surgical interventions.


References
Almeida NA, de Sousa JT, Bachion MM, Silveira Nde A. [The use of respiration and relaxation techniques for pain and anxiety relief in the parturition process] [Article in Portuguese] Rev Lat Am Enfermagem. 2005 Jan-Feb;13(1):52-8. Epub 2005 Mar 3.

Bastani F, Hidarnia A, Montgomery KS, Aguilar-Vafaei ME, Kazemnejad A. Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial. J Perinat Neonatal Nurs. 2006 Apr-Jun;20(2):138-46.

Cyna AM, McAuliffe GI, Andrew MI. Hypnosis for pain relief in labour and childbirth: a systematic review. Br J Anaesth. 2004. Oct;93(4):505-11. Epub 2004 Jul 26.

Gentz BA. Alternative therapies for the management of pain in labor and delivery. Clin Obstet Gynecol. 2001 Dec;44(4):704-32.

Goldstein J. C-sections: Why are so many South Florida babies born this way. Miami Herald, 2005 Nov. 29. Pg. 10E.

Hamilton BE, Ventura SJ, Martin JA, Sutton PD. Preliminary Births for 2004: Infant and Maternal Health. Health E-Stats. National Center for Health Statistics. 2005.
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelim_births/prelim_births04.htm
Accessed June, 2006.

Harmon TM, Hynan MT, Tyre TE. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. J Consult Clin Psychol. 1990 58:525-30.

Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2003. National vital statistics reports; vol 54 no 2. Hyattsville, MD: National Center for Health Statistics. 2005. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf
Accessed June, 2006

Martin, AA, Schauble PG, Rai SH, Curry RW Jr. The Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents. The Journal of Family Practice. 2001 May Vol. 50, No. 5.

Mehl LE. Hypnosis and conversion of the breech to the vertex presentation. Arch Fam Med. 1994 3:881-87.

Oster MI. Psychological preparation for labor and delivery using hypnosis. Am J Clin Hypnosis. 1994 37:12-21.

Rees BL. Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. J Holist Nurs. 1995 Sep;13(3):255-67.

Schauble PG, Werner WEF, Rai SH, Martin A. Childbirth preparation through hypnosis: the hypnoreflexogenous protocol. Am J Clin Hypnosis. 1998 40:273-83.

Sachs BP, Kobelin C, Castro M A, Frigoletto F. The Risks of Lowering the Cesarean-Delivery Rate. N Engl J Med. 1999 Jan. 7; 340:54-57.

Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev. 2003;(2):CD003521.

Torem MS. Hypnotherapeutic techniques in the treatment of hyperemesis gravidarum. Am J Clin Hypnosis. 1994 37:1-11.

World Health Organization. Joint Interregional Conference on Appropriate Technology for Birth. Apr,1985. Qtd on Choices in Childbirth. http://www.choicesinchildbirth.org/who.htm
Accessed June, 2006.