Complementary Therapies in Medicine 25 (2016) 6770

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Complementary Therapies in Medicine

journal homepage: www.elsevierhealth.com/journals/ctim

Short Communication

The characteristics of women who use hypnotherapy for intrapartum

pain management: Preliminary insights from a
nationally-representative sample of Australian women
A. Steel a,b, , J. Frawley a,b , D. Sibbritt b , A. Broom c , J. Adams b
a

Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD 4006, Australia
Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2006, Australia
c
School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia
b

a r t i c l e

i n f o

Article history:
Received 11 August 2015
Received in revised form 9 January 2016
Accepted 11 January 2016
Available online 15 January 2016
Keywords:
Hypnosis
Labour
Birth
Anaesthesia
Health services
Complementary therapies

a b s t r a c t
Objectives: This manuscript presents a preliminary examination of the characteristics of women who
choose intrapartum hypnosis for pain management.
Design: Cross-sectional analysis of 2445 women (3136 years) from a sub-study of the Australian Longitudinal Study on Womens Health (ALSWH), employing Fisher exact tests.
Setting: Australia.
Main outcome measures: Use of intrapartum hypnosis, or hypnobirthing, for pain management during
labour and birth.
Results: Women using hypnobirthing were more likely to have consulted with an acupuncturist or naturopath, or attended yoga/meditation classes during pregnancy (p < 0.0001). Use of CM products such
as herbal medicines, aromatherapy oils, homoeopathy, herbal teas or ower essences (p < 0.001) was
also more common amongst these women. Women choosing hypnotherapy for intrapartum pain management less commonly identied as feeling safer knowing that an obstetrician is providing their care
(p < 0.001), and were more likely to labour in a birth centre or in a community centre (i.e. at home).
Conclusions: This analysis provides preliminary analysis into an as yet unexamined topic in contemporary
maternity health service utilisation. The ndings from this analysis may be useful for maternity health
professionals and policy makers when responding to the needs of women choosing to use hypnotherapy
for intrapartum pain management.
2016 Elsevier Ltd. All rights reserved.

Key message
Women who use hypnosis for intrapartum pain management
are more likely to be consulting with complementary medicine
practitioners and utilising CM products. It is less common that these
women feel safer knowing that an obstetrician is providing their
care.
1. Introduction
There has been a substantial focus from maternity care providers
to the reduction of womens discomfort during childbirth in high

Abbreviations: CM, complementary medicine.

Corresponding author at: Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006,
Australia , Fax: +61 7 3257 1889.
E-mail address: Amie.steel@uts.edu.au (A. Steel).
http://dx.doi.org/10.1016/j.ctim.2016.01.006
0965-2299/ 2016 Elsevier Ltd. All rights reserved.

income countries.1 As a result, existing antenatal preparation and

educational strategies target the pain-management options available to women with particular emphasis placed on pharmacological
interventions.1 However, there is evidence of a strong and growing interest in the community for nonpharmacological intrapartum
pain management choices including those offered by complementary medicine (CM).1
Alongside support for an expansion of choices for women to
manage pain during childbirth, including further integration of
CM, there is an acknowledgement of the importance of psychological outlook in the perception of, and response to, labour pain.
Dr. Grantly DickRead, an obstetrician from the 1950s, described
the feartensionpain syndrome as the underlying cause for
womens experience of pain in childbirth.2 The practice of hypnosis during the antenatal and intrapartum period also known as
hypnobirthing to minimise womens levels of fear and thereby
reduce pain has grown from his work and achieved both interest

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A. Steel et al. / Complementary Therapies in Medicine 25 (2016) 6770

and controversy amongst women, maternity care providers and

researchers.3
Women using hypnosis during the antenatal and intrapartum
periods report lower levels of fear and anxiety during labour compared with levels expected prior to labour; however, no difference
in the use of epidural has been found.4, 5 They also report a more
positive experience of childbirth,6 fewer emergency and more elective cesarean sections.7
There is a dearth of research examining women who are already
actively choosing hypnobirthing to manage pain during childbirth.
In response, this research presents the analysis of a large nationallyrepresentative sample of women to identify the characteristics
of women who report using hypnobirthing as part of their intrapartum pain management.
2. Material and methods
The Australian Longitudinal Study on Womens Health was
established in 1996 and was designed to examine demographic,
social, physical, psychological and behavioural variables and their
effect on womens health and wellbeing. Women from the younger
Australian Longitudinal Study on Womens Health cohort (born
19731978) (n = 8,012) and who identied in the 2009 Australian
Longitudinal Study on Womens Health survey as being pregnant of
having recently given birth were invited to complete a sub-study
in 2010 (n = 2445). The sub-study survey examined demographic
factors, maternity health service use CM use, and attitudes and
perceptions towards maternity care and CM. To determine the
characteristics of women who used hypnobirthing as intrapartum
pain management, Fisher exact tests were used to compare categorical variables. A modied Bonferroni correction was used to
compensate for multiple testing, through which statistical signicance was set at p = 0.001. Missing data resulting from respondents
not answering questions were excluded from the analysis.
3. Results
The survey was completed by 1835 women; a response rate of
79.2%. Of the 1348 women who answered the questionnaire item
regarding the use of hypnobirthing as intrapartum pain management (n = 1348), 54 (4.0%) women indicated using hypnobirthing
for their most recent birth. There were no signicant differences
in socio-demographic prole between women who used hypnobirthing and those who did not (data not shown).
Women who reported using hypnobirthing were more likely
to have consulted with an acupuncturist or naturopath, or to
have attended yoga/meditation classes (p < 0.001) (Table 1). They
were also more likely to have used a range of CM products/treatments including herbal medicines, aromatherapy oils,
homoeopathy, herbal teas, and ower essences, as well as practising yoga/meditation at home (p < 0.001).
Women using hypnobirthing less commonly identied with
feeling safer during birthing knowing that an obstetrician is providing care (p < 0.001). Birthing in a birth centre or at home was
more common, whilst birthing in a private hospital was less common amongst women who used hypnobirthing (p < 0.001). Public
hospital birth rates were no different across the two groups.
4. Discussion
This study presents the rst prole of women who choose to use
hypnobirthing for intrapartum pain management. The characteristics identied through this study indicate women employ a range
of CM during pregnancy and are engaging with CM practitioners
from a range of disciplines. As hypnobirthing principles emphasise

birth as a natural process, it may be that women using hypnobirthing actively seek health professionals with aligned views
towards maternity care. The increased prevalence of consultations
with acupuncturists and naturopaths may also indicate that practitioners from these professions are referring or recommending
hypnotherapy to women in their care. However, despite calls to the
contrary,8 the approach to maternity care taken by CM practitioners
remains unexamined. Alternatively, women choosing hypnotherapy may be more inclined to seek CM therapies as it aligns with
their own concepts of health and personal values.
The women who identied as using hypnobirthing were less
likely to report feeling safer knowing that they have an obstetrician supporting them. The focus of hypnosis-based antenatal
preparation often includes pregnancy and birth as a natural physiological process which should not be approached with fear.2 In
contrast, obstetric physicians have been described as applying a
technocratic paradigm to birth which embraces risk as a dominant
feature.9 with research showing obstetricians prefer pharmacological pain relief methods10 The potential perceived dissonance
between the views of these two groups may result in women who
use hypnotherapy during labour feeling uncertain as to whether
an obstetrician will provide care which respects their choices and
views regarding pregnancy, labour and birth.
The place where women birthed appears to be related to their
use of hypnotherapy for intrapartum pain management. Women
who birthed in a private hospital were much less likely to use hypnotherapy during birth. This nding may be due to the specic
environmental requirements for successful use of hypnotherapy,
including quiet surroundings, dim lights, warm room and privacy,11
which may not be supported in private hospital settings. The model
of care commonly employed in private hospitals in Australia may
also conict with the use of hypnotherapy whereby supporting
the natural physiological mechanisms of birth to avoid additional
intervention is emphasised.11 In contrast, women who birth in
community or through a birth centre were much more likely to use
hypnotherapy. Both of these environments support womens control over their birth environment with features which more readily
facilitate the use of hypnotherapy and a positive birth experience.12
Birth in a public hospital stood apart from the other two birth places
as there was no signicant difference in the use of hypnotherapy. This may be because of the diversity in the characteristics
of women birthing in a public hospital.13 and as such suggests
not only staff and environment but also womens preferences may
underpin the relationship between use of hypnotherapy and birth
place.
The ndings from this analysis need to be interpreted with
caution; despite the nationally representative sample, the crosssectional study design limits the ability to determine causality
between variables. The small number of women who reported
accessing hypnotherapy to manage labour pain is a further limitation, impacting on statistical power and the ability to control
for confounders through logistic regression. However, this limitation has been accommodated in part by the use of the Fisher exact
test. Lastly, the Australian Longitudinal Study on Womens Health
197378 cohort is by denition restricted to a specied age range.
As such, the results from this study may only represent women
aged 3136 years, which is older than the average age of birthing
women in Australia (30 years).13
The ndings from our analysis should not be interpreted as
denitive characteristics but rather a preliminary insight into an as
yet unexamined aspect of contemporary maternity care. Maternity
care practitioners may benet from consideration of some of these
ndings when providing care to women who identify as intending
to use, or are currently using, hypnotherapy for intrapartum pain
management.

A. Steel et al. / Complementary Therapies in Medicine 25 (2016) 6770

69

Table 1
Differences between using hypnobirthing for intrapartum pain management and women who did not use hypnobirthing (n = 1348).

Used hypnobirthing
(%)
(n = 54)

Did not use

hypnobirthing
(%)
(n = 1294)

Antenatal CAM use

Acupuncturist
Naturopath
Aromatherapist
Chiropractor
Massage
Yoga/meditation classes
Osteopath
Herbal medicines
Vitamins/minerals
Yoga/meditation at home
Aromatherapy oils
homoeopathy
Herbal teas
Flower essences

33.3
24.0
1.95
30.2
50.0
48.2
17.3
25.9
69.7
66.1
30.2
16.7
71.4
28.9

7.9
6.3
0.4
15.5
33.0
12.1
5.9
9.0
89.0
16.3
8.0
3.2
27.0
5.5

<0.001*
<0.001*
0.210
0.007
0.012
<0.001*
0.004
<0.001*
0.060
<0.001*
<0.001*
<0.001*
<0.001*
<0.001*

Attitudes to maternity care

I have a more equal relationship with CAM practitioners than with obstetricians
I feel safer during birthing knowing that I have a specialist obstetrician supporting me

50.0
26.3

18.8
72.7

0.007
<0.001*

Intrapartum pain management techniques

Breathing techniques
Bath, birthing pool or shower
Acupuncture/acupressure
Nitrous oxide
Pethidine
Epidural
Local anaesthetic
General anaesthetic

95.7
65.2
18.2
45.5
15.8
26.3
0.0
0.0

67.2
36.9
3.1
49.2
19.7
52.0
7.0
2.3

0.004
0.005
<0.001*
0.730
0.670
0.030
0.220
0.490

Birthplace
Public hospital
Private hospital
Birth centre/community

40.9
13.6
45.5

41.7
54.6
3.7

0.002

Adverse events
Premature birth
Caesarean section after labour started
Induction of labour
Labour lasting more than 36 h
Episiotomy
Vaginal tear (requiring stitches)
Forceps or Ventouse suction
Retained placenta
Excessive blood loss requiring extra blood or uid by IV infusion
Low birth weight baby (<2500 g)
Emotional distress
Baby admitted to special care nursery

6.7
8.3
21.7
1.7
16.7
46.7
10.0
5.0
5.0
3.3
3.3
10.0

7.9
9.6
27.1
2.3
11.9
29.9
11.1
5.9
5.9
3.9
7.8
11.5

1.0
1.0
0.46
1.0
0.31
0.009
1.0
1.0
1.0
1.0
0.32
0.84

Statistically signicant after application of Bonferonni correction.

Funding
This project was funded by the Australian Research Council
via a Discovery Project grant (DP1094765). Professor Jon Adams
is funded via an NHMRC Career Development Fellowship and
Professor Alex Broom via an Australian Research Council Future
Fellowship. Dr. Steel is funded through the Endeavour College of
Natural Health Postdoctoral Fellow program at University of Technology Sydney.
Conicts of interest
None.
Acknowledgements
The Australian Longitudinal Study on Womens Health, which
was conceived and developed by groups of interdisciplinary
researchers at the Universities of Newcastle and University of

Queensland, is funded by the Australian Department of Health and

Ageing. We thank all participants for their valuable contribution to
this project.
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