The HATCh Trial: hypnosis antenatal training for childbirth.

Abstract

The evidence appeared to suggest that the use of hypnosis in childbirth: decreases analgesia requirements during labour; decreases oxytocin requirements during labour and, increases the incidence of spontaneous vaginal birth. A research gap was identified that the Hypnosis Antenatal Training for Childbirth (HATCh) Trial was designed to fill. The HATCh Trial was a comprehensive, high-quality, randomised trial that included 448 pregnant women in late pregnancy. It was designed to assess the efficacy of a short, three-session, standardised hypnosis intervention in late pregnancy. The HATCh study findings show that, unlike in all but one previous study, this hypnosis intervention in the third trimester was ineffective in reducing analgesia requirements during childbirth. The increased incidence of induction required in hypnosis groups when compared with controls was unexpected and suggests that hypnosis may have an effect in the non-pharmacological inhibition of spontaneous labour. Subgroup analysis suggested that hypnosis may reduce analgesia requirements when supplemented by yoga. The addition of the HATCh Trial results has substantially increased the heterogeneity of the systematic review. Systematic review sub-group analyses, according to the timing of the hypnosis training during pregnancy, suggest that training in the third trimester is ineffective in reducing analgesia requirements during labour and childbirth. However hypnosis training commencing early in pregnancy, either in the first or second trimester, may decrease pharmacological analgesia use during childbirth. Further research is required to investigate why hypnosis might inhibit the spontaneous onset of labour and how this effect might be negated, minimised or utilised. Further research is also required to investigate the optimal timing to commence antenatal hypnosis training, the number of sessions and the types of suggestions that might be most effective. Yoga may be a useful adjunct to the hypnosis intervention and should be researched further as a sole technique and together with antenatal hypnosis training during pregnancy. There is a clear need for high quality trials where hypnosis training occurs before the 3rd trimester. Ideally, training after the 3rd trimester should be compared with antenatal hypnosis training before the 3rd trimester.