Translated by Vincent Chartier
In a time when more and more people are seeing Western medicine as having reached an impasse, many find themselves turning to alternative medicine.
One such alternative practice has made a significant comeback over the last few decades: hypnosis. Although it has been slandered and caricatured by so-called “theatrical” hypnosis (Robin, 2013), this practice has slowly regained its own merit and is becoming more popular in various domains, including obstetrics (Beebe, 2014). The list of autohypnosis programs for childbirth, the names of which I feel all greatly lack in originality (HypnoBirthing®, Hypnobabies®, Hypno-Vie, HypnoNaissance, etc.) has only grown longer over the last couple years. There are increasingly more proponents of this practice, which some still consider controversial.
Even though there exists reliable scientific literature on the subject, many see hypnosis and hypnotherapy as oscillating between science and esotericism.
Hypnotherapy is a misjudged science that could potentially be beneficial for a multitude of patients in various disciplines, particularly in obstetrics; as long as the numerous sceptics can be convinced of the efficacy of this practice, or, at the very least, be more open to it.
Hypnosis is, at once, a psychic state, a therapeutic relationship, a procedure, and a process (Robin, 2013; Beebe, 2014), which is why the concept and its definition can sometimes be confusing. Generally, hypnosis is described as an altered state of consciousness that we call a “trance” (Robin, 2013). This state can help modulate some neurovegetative reactions (Facco, Zanette and Casiglia, 2014) and is characterized by an increased openness to suggestion (Abdeshahi, Hashemipour, Mesgarzdeh, Shahidi Payam and Halaj Monfared, 2013; Allison, 2015). It is comparable to a deep state of concentration in which the hypnotized subject can change the way they perceive things, (Blair Terhune and Cohen Kadosh, 2012; Beebe, 2014; Allison, 2015) and can therefore modify their thoughts, their behaviour and even alter the interpretation of their senses and perceptions (Kirsch, 1994; Robin, 2013). This state of mind can be induced by a third party (primary hypnosis) or be self-imposed (secondary hypnosis, auto-hypnosis). It is important to understand that primary hypnosis does not involve controlling one’s thoughts, because the hypnotized person must be volunteering and agree to enter hypnosis (Robin, 2013; Beebe, 2014). Thus, we are not dealing with mental manipulation or a type of sleep, only a modified state of awakeness (Robin, 2013; Beebe, 2014). Hypnotherapy is simply therapy by means of hypnosis, i.e. the treatment of a physical or psychological disorder using various hypnotic processes (Messinger, 1994; Robin, 2013).
Hypnosis Therapy: A Bit of History
Although it has been around for centuries, “modern” hypnosis was introduced near the end of the 18th century by physicist Franz Anton Mesmer, who practiced animal magnetism. At the time, the concept of hypnosis and the name it was given (induced sleepwalking, lucid dreaming, etc.) was specific to the one that practiced it. The term “hypnosis” was introduced only in 1843, thanks to the research of Dr. James Braid (Allison, 2015), and it was only in 1882 that this phenomenon was recognized as a science in its own right, defined by specific criteria (Bellet, 2002; Robin, 2013). However, hypnosis gradually declined in popularity until the famous American psychiatrist Milton Erickson reignited interest in the practice among the medical community during the 1950s (Bellet, 2002; Robin, 2013). Today, hypnosis is considered to be based on dissociation: the subjects dissociate themselves from the external reality to focus almost exclusively on their internal reality, usually unattainable consciously (Robin, 2013). There are many hypnosis techniques with different results at different levels and in different domains such as medicine, psychology, and dentistry (Messinger, 1994; Allison, 2015). Notwithstanding the different heterogeneous practices of hypnotherapy, the outcome remains the same, that is, a distinct level of attention and concentration that enables the subject to accomplish an objective thanks to an altered state of consciousness (Robin, 2013).
The Science behind the Trance
If, like me, you tend to shamelessly pyrrhonize, you will be glad to hear that there are many neuropsychological indicators of the hypnotic state, which are considered rather irrefutable by the skeptics of this world. The subjects in a state of hypnosis effectively demonstrate certain physiological markers that are distinctive of the trance state and cannot be voluntarily emulated in an awake state (Robin, 2013). First, it has been noticed that the lateral eye movements are excessively slow in hypnotized subjects (Robin, 2013). Secondly, it was also observed with electroencephalography that the theta activity of subjects in deep hypnosis was more predominant than in an awakened state (Robin, 2013), even if this is also the case for subjects in a state of paradoxical sleep, for instance (Basar et al., 2001). Finally, hypnosis causes some distinct variations of cerebral blood flow. Notably, an increase in the activity of the anterior cingulate region (responsible, amongst other things, for hallucinations), the thalamus (one of the main regions targeted by anaesthetics), and even the occipital region (involved in the process of mental images) has been observed (Derbyshire et al., 2004). By contrast, there is a noticeable decrease in the activity of the precuneus and posterior cingulate cortex (involved in the sensation of pain) (Robin, 2013). However, to ensure these markers are considered characteristic of the hypnotic state, they must be taken as a whole, because they are not specific to the trance state individually (Robin, 2013).
A Trance for Your Nuisance?
Hypnotherapy is used to treat various physical or psychological afflictions: anxiety, depression, phobia, addiction (alcohol, tobacco, drug), concentration and motivation problems, stuttering and tics, behavioural problems, self-confidence issues, digestive problems, eating disorders, spasmophilia, insomnia, etc. (Messinger, 1994; Bellet, 2002). Supporters of hypnotherapy seem to believe that everything can be cured, or at least improved with hypnotherapy. Though I am a little doubtful as to the supposed near-limitless powers of the practice, I cannot deny its undeniable analgesic effects. The analgesic powers of hypnosis have been proven time and time again (Montgomery et al., 2000), even though the underlying mechanisms are still only more or less understood (Robin, 2013). Analgesia, by means of hypnosis, helps to modulate pain signals by activating physiological mechanisms that inhibit them (Robin, 2013). In some cases, hypnotherapy can even lead to the total sedation of the subject (Allison, 2015; Franco et al., 2014). Hypnosis was once commonly used as an analgesic in many fields such as surgery, but it was abandoned in favor of modern methods of chemical anesthesia and analgesia (Bellet, 2002; Allsion, 2015). However, it is still widely used in dentistry (Facco et al., 2014; Allison, 2015) and there is abundant research on hypnosis in this field. One study was able to conclude that hypnosis could raise the pain threshold by over 200% and that patients did not need any other anaesthetics during surgery (Abdeshahi et al., 2013; Allison, 2015).
Delivery with Hypnotherapy
For many women, delivery is accompanied by sharp pain and is quite exhausting—both physically and psychologically (Withridge et al., 1985; Werner et al., 2013; Madden et al., 2016). Since hypnotherapy is very safe (Cyna et al., 2004; Kroger, 2008; Beebe, 2014; Facco et al., 2014; Allison, 2015), has very little contraindications (e.g., deafness, mental illness, etc.) (Bellet, 2002), and is particularly effective on pregnant women (Alexander et al., 2009), it seems to be an excellent choice to help women alleviate pain during childbirth. A large number of studies have concluded that hypnosis during childbirth could reduce the need for analgesics (e.g., an epidural) and the use of pharmaceutical products (e.g., synthetic oxytocin), increase women’s satisfaction with pain management, and increase the chances of delivering vaginally (Cyna et al., 2004; Smith et al., 2006; Beebe, 2014; Finlayson et al., 2015). Many studies have reported that women who gave birth under hypnosis were very satisfied with the experience in terms of pain management (Werner et al., 2013; Finlayson et al., 2015).
Therefore, we can conclude that, even though hypnotherapy is still considered marginal in the field of obstetrics (Nishi et al., 2014), it is an excellent alternative to analgesics when it comes to managing the pain of childbirth (Allison, 2015). Indeed, traditional pharmaceutical methods (e.g., epidurals) used to relieve women in active labour is not suitable for every woman (Ullman et al., 2010) and may sometimes be contraindicated in the case of allergies, problems with clotting, spina bifida, obesity, or fever, for instance (Martin et al., 2012).
Hypnotization and Parturition: a Questionable Combination
However, hypnotherapy is far from being a panacea. Many studies have shown that hypnosis had no effect on pain during childbirth (Downe et al., 2015; Werner et al., 2012). For example, according to a meta-analysis done in 2016, on approximately 3,000 women, there was no clear link between vaginal delivery, satisfaction with pain relief, the intensity of said pain, and being in the group of hypnotized subjects versus the control group (Madden et al., 2016; Fisher et al., 2009). We can therefore see that studies on hypnotherapy during childbirth are greatly contradictory. There are many reasons for this. First, the studies considered in the meta-analysis had very different methodologies (dissimilar control groups, various types and techniques of hypnosis, very different criteria for inclusion and exclusion, etc.), which make them difficult to compare (Beebe, 2014). Nevertheless, even if the current data on hypnotherapy during childbirth is not all conclusive (Madden et al., 2016) or simply nearly nonexistent—as in the case of primary hypnosis (which I believe to be the most interesting avenue based on the results obtained with dentistry)— and difficult to prove without a doubt that hypnotherapy has a positive effect on pain relief during childbirth, this method should not be discarded from the outset.
I am not intending to promote hypnotherapy or discredit modern methods of analgesia in the field of obstetrics, quite the contrary. While we may have a long way to go in terms of understanding the methods of hypnosis, I believe it is important to remember that alternative methods, other than the traditional epidural, exist, and could help women in labour.
Far be it from me to make you believe that hypnotherapy is a miracle cure for the pain of childbirth, but it can without a doubt reduce the amount of discomfort by various degrees and can certainly reduce the need for medication (Beebe, 2014).
That said, patients wishing to be hypnotized must often face the negative and close-minded attitudes of hospital staff (Beebe, 2014). Being a skeptic at heart myself, I will not point fingers at anyone. However, as members of the scientific community, we have to keep an open mind. Many health professionals working in obstetrics do not know the potential benefits of primary hypnotherapy during childbirth and will occasionally vilify patients who believe in it (Beebe, 2014).
Say Yes to Hypnosis
Though hypnosis has existed for centuries (Wilson and Dillard, 2012) and is used more and more in various medical fields, hypnotherapy in obstetrics has yet to prove itself as a therapeutic tool in accordance with the rules of science. It is totally normal for health professionals to remain unconvinced of the efficiency of this practice until there are more articles that deal specifically with its use for pain management during childbirth, and until these articles comply with the imposed standards of randomized controlled trials. As scientists, we must encourage research on hypnotherapy (especially primary hypnotherapy, since there are very few studies on the subject) during childbirth to obtain reliable and, hopefully, conclusive data to base ourselves on in terms of recommendations for clinical practice. As individuals, we must demonstrate open-mindedness when faced with the benefits that hypnotherapy can offer, even though the practice may puzzle us at first glance. Hypnosis may indeed be an interesting option for multiple avenues of reproductive health where analgesia is required, like with voluntary termination of pregnancy, with sex-related issues such as premature ejaculation or impotence (when the issue isn’t entirely biological), or even with gyneacological issues such as dyspareunia, vaginismus, vulvodynia etc. (Messinger, 1994; Dufresne et al., 2009). Let’s get started: you are feeling very, very, very sleepy… On three, let’s practice hypnosis.
One… two… three!
Abdeshahi, S.K., Hashemipour, M.A., Mesgarzadeh, V., Shahidi Payam, A. and Halaj Monfared, A. (2013). Effect of hypnosis on induction of local anaesthesia, pain perception, control of haemorrhage and anxiety during extraction of third molars: a case-control study. Journal of Cranio-Maxillo-Facial Surgery, 41(4), p. 310-315. DOI 10.1016/j.jcms.2012.10.009
Alexander, B., Turnbull, D. and Cyna, A. (2009). The effect of pregnancy on hypnotizability. American Journal of Clinical Hypnosis, 52(1), p.13–22. DOI 10.1080/00029157.2009.10401688
Allison, N. (2015). Hypnosis in modern dentistry: Challenging misconceptions. Faculty Dental Journal, 6(4), p. 172-175. DOI 10.1308/rcsfdj.2015.172
Basar, E., Basar-Eroglu, C. Karakas, S. and Schurmann, M. (2001). Gamma, alpha, delta, and theta oscillations govern cognitive processes. International Journal of Psychophysiology, 39(2-3), p.241-248. DOI 10.1016/S0167-8760(00)00145-8
Beebe, K.R. (2014). Hypnotherapy for Labor and Birth. Nursing for Women’s Health, 18(1), p. 48-59. DOI 10.1111/1751-486X.12093
Bellet, P. (2002). L’hypnose. Paris: Odile Jacob.
Blair Terhune, D. and Cohen Kadosh, R. (2012). The emerging neuroscience of hypnosis. Cortex, 48, p.382-386. DOI 10.1016/j.cortex.2011.08.007
Cyna, A.M., McAuliffe, G.L. and Andrew, M.I. (2004). Hypnosis for pain relief in labor and childbirth: A systematic review. British Journal of Anaesthesia, 93(4), p. 505-511. DOI 10.1093/bja/aeh225
Derbyshire, S.W.G., Whalley, M.G., Stenger, V.A. and Oakley, D.A. (2004). Cerebral activation during hypnotically induced and imagined pain. NeuroImage, 23(1), p.392-401. DOI 10.1016/j.neuroimage.2004.04.033
Downe, S., Finlayson, K., Melvin, C., Spiby, H., Ali, S., Diggle, P., Gyte, G., Hinder, S., Miller, V., Slade, P., Trepel, D., Weeks, A., Whorwell, P. and Williamson, M. (2015). Self-Hypnosis for Intrapartum Pain Management in Pregnant Nulliparous Women: a Randomised Controlled Trial of Clinical Effectiveness. International Journal of Obstetrics and Gynaecology, 122(9), p.1226-1234. DOI 10.1111/1471-0528.13433
Dufresne, A., Rainville, P., Dodin, S., Barré, P., Masse, B., Verreault, R. and Marc, I. (2009). Hypnotizability and opinions about hypnosis in a clinical trial for the hypnotic control of pain and anxiety during pregnancy termination. International Journal of Clinical and Experimental Hypnosis, 58(1), p.82-101. DOI 10.1080/00207140903310865
Facco, E., Zanette, G. and Casiglia, E. (2014). The role of hypnotherapy in dentistry. Journal of the Society for the Advancement of Anaesthesia in Dentistry, 30, p.3-6. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24624516
Finlayson, K., Downe, S., Hinder, S., Carr, H., Spiby, H. and Whorwell, P. (2015). Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labor. BMC Pregnancy and Childbirth, 15(229), p.1- 9. DOI 10.1186/s12884-015-0659-0
Fisher, B., Esplin, S., Stoddard, G. and Silver, R. (2009). Randomized controlled trial of hypnobirthing versus standard childbirth classes: patient satisfaction and attitudes towards labor. American Journal of Obstetrics and Gynecology, 201(6), p.61-62. DOI 10.1016/j.ajog.2009.10.140
Kirsch, I. (1994). APA definition and description of hypnosis: Defining hypnosis for the public. Contemporary Hypnosis, 11, p. 142-143. Retrieved from https://psycnet.apa.org/record/1995-22602-001
Kroger, W. (2008). Clinical and Experimental Hypnosis in Medicine, Dentistry, and Psychology. Philadelphia: Lippincott Williams & Wilkins.
Madden, K., Middleton, P., Cyna, A.M., Matthewson, M. and Jones, L. (2016). Hypnosis for pain management during labour and childbirth (Review). Cochrane Database of Systematic Reviews, 5. DOI 10.1002/14651858.CD009356.pub3
Martin, R., Guay, J. and Plaud, B. (2012). Précis d’Anesthésie et de Réanimation. Montréal: Presses de l’Université de Montréal.
Messinger, J. (1994). Les vrais-faux pouvoirs de l'hypnose. Paris : Criterion.
Montgomery, G.H., Duhamel, K.N. and Redd, W.H. (2000). A Meta- Analysis of hypnotically Induced Analgesia: How Effective is Hypnosis? International Journal of Clinical and Experimental Hypnosis, 48(2), p. 138–53. DOI 10.1080/00207140008410045
Nishi, D., Shirakawa, M.N., Ota, E., Hanada, N. and Mori, R. (2014). Hypnosis for Induction of Labour. Cochrane Library, 8. DOI 10.1002/14651858.CD010852.pub2
Robin, F. (2013). Hypnose : processus, suggestibilité et faux souvenirs. Bruxelles: De Boeck.
Smith, C., Collins, C., Cyna, A.M., and Crowther, C.A. (2006). Complementary and alternative therapies for pain management in labor. Cochrane Database of Systematic Reviews, 4. DOI 10.1002/14651858.CD003521. pub2.
Ullman, R., Smith, L.A., Burns, E., Mori, R. and Dowswell, T. (2010). Parenteral opioids for maternal pain management in labor. Cochrane Database of Systematic Reviews, 9. DOI 10.1002/14651858.CD007396.pub2.
Werner, A., Uldbjerg, N., Zachariae, R., Rosen, G. and Nohr, E.A. (2012). Self hypnosis for coping with labour pain: a randomized controlled trial. General Obstetrics, 120(3), p.346-353. DOI 10.1111/1471-0528.12087
Werner, A., Uldbjerg, N., Zachariae, R., Sen Wu, C. and Nohr, E.A. (2013). Issues in Perinatal Care: Antenatal Hypnosis Training and Childbirth Experience: A Randomized Controlled Trial. Birth, 40(4), p. 272-280. DOI 10.1111/birt.12071
Whitridge Williams, J., Pritchard, J.A., MacDonald, P.C. and Grant, N.F. (1985). Williams Obstetrics. Norwalk: Appleton-Century-Crofts.
Wilson, D.R. et Dillard, D.M. (2012). Use of Hypnosis in the Childbearing Year. International Journal of Childbirth Education, 27(3), p.31-36. Retrieved from https://www.researchgate.net/publication/233819003_Use_of_hypnosis_in_the_childbearing_year