CNE

Hypnotherapy for
Labor and Birth
Kathleen R. Beebe

Objectives
Upon completion of this activity, the learner will
be able to:
1. Define and describe hypnosis and
hypnotherapy, and describe different types of
hypnosis.
2. Describe research findings on hypnotherapy
for labor and birth.
3. List and describe actions nurses can take
when preparing to care for women who wish
to use hypnotherapy during labor and birth.
Continuing Nursing Education (CNE) Credit
A total of 1 contact hour may be earned as CNE
credit for reading “Hypnotherapy for Labor and
Birth ” and for completing an online post-test and
participant feedback form.
To take the test and complete the participant
feedback form, please visit http://JournalsCNE.
awhonn.org. Certificates of completion will be
issued on receipt of the completed participant
feedback form and processing fees.
Association of Women’s Health, Obstetric and
Neonatal Nurses is accredited as a provider of
continuing nursing education by the American
Nurses Credentialing Center’s Commission on
Accreditation.
Accredited status does not imply endorsement by
AWHONN or ANCC of any commercial products
displayed or discussed in conjunction with an
educational activity.
AWHONN is approved by the California Board of
Registered Nursing, provider #CEP580.
Kathleen R. Beebe, PhD, RNC-OB, is an associate professor of nursing
at Dominican University of California in San Rafael, CA. The author
and planners of this activity report no conflicts of interest or relevant
financial relationships. The author discloses that she is certified as a
trainer by HypnoBirthing® – The Mongan Method, which is mentioned
in this article, but that she has no financial stake in that organization.
No commercial support was received for this learning activity. Address
correspondence to: kathleen.beebe@dominican.edu.
50 © 2014, AWHONN
INTRODUCTION
There is no published estimate of the numbers of women
currently using hypnosis for childbirth; however, it is likely to
be a small minority in the United States. The reasons for this
are unknown, but are possibly owing to a combination of poor
access to perinatal hypnosis training, lack of knowledge about
its utility and negative attitudes toward the practice. Detailed
demographic data for women selecting hypnosis are also
limited. Systematic analyses on the efficacy of hypnotherapy
for applications in maternity care conclude that there may be
benefits, but contradictory findings prevail.
This article will describe the features of hypnosis and
hypnotherapy. Background literature on the effectiveness of
this technique during childbirth will be reviewed along with
implications for nursing practice. Barriers to hypnotherapy in
the clinical setting along with strategies for overcoming them
will also be addressed. Box 1 provides a case example of labor
and birth with hypnotherapy.
DEFINITIONS
Hypnosis is “a procedure during which a person experiences
suggested changes in sensation, perception, thought or
behavior” (Kirsch, 1994, p. 142). It is a condition of “intense
inner absorption, concentration and focus” (American Society
of Clinical Hypnosis, 2010), wherein the person experiencing
it is fully conscious. Hypnosis is likened to states such as
daydreaming or fascination with a riveting movie. In these
circumstances, the individual chooses to “tune-out” or to
reappraise certain stimuli in order to focus more completely
on the object of attention. Theoretically, this entrancement
permits an activation of the subconscious mind, allowing it
to override prior habitual or patterned behavior governed by
conscious thought (Hypnosis Motivation Institute, 2010).
Hypnosis is a voluntary state, wherein one chooses to
become receptive to entering the hypnotic state, whether or
not a hypnotist is directly involved. At any time, the person
could choose to disengage from that state and broaden his/
her sphere of awareness. Unfortunately, misconceptions
about hypnosis as a form of “mind control,” which have
Abstract: Hypnotherapy is an integrative mind-body technique with ther-
apeutic potential in various health care applications, including labor and
birth. Evaluating the efficacy of this modality in controlled studies can be
difficult, because of methodologic challenges, such as obtaining adequate
sample sizes and standardizing experimental conditions. Women using
hypnosis techniques for childbirth in hospital settings may face barriers
related to caregiver resistance or institutional policies. The potential an-
xiolytic and analgesic effects of clinical hypnosis for childbirth merit fur-
ther study. Nurses caring for women during labor and birth can increase
their knowledge and skills with strategies for supporting hypnotherapeutic
techniques. DOI: 10.1111/1751-486X.12093
Keywords: childbirth | HypnoBirthing | hypnosis | hypnotherapy |
intrapartum nursing care
http://nwh.awhonn.org

been promoted by stage acts exemplifying
“involuntary” and sometimes embarrassing
behavior, tend to undermine the therapeutic
potential of hypnosis by reinforcing a stigma
that it holds some dangerous or magical
power. Misperceptions have the consequence
of breeding suspicion, apprehension and
mistrust in hypnosis. Accurate beliefs about
hypnosis contribute to more positive attitudes
about its use and more effective results with
the techniques (Capafons et al., 2008). Box
2 lists some common misconceptions about
hypnosis.
Hypnosis and hypnotherapy are terms
that are often used interchangeably; however,
there is an important distinction in that
hypnotherapy uses hypnosis techniques
with specific intent. Hypnotherapy or clinical
hypnosis is an integrative mind-body technique
using hypnotic suggestions for a specified,
therapeutic purpose mutually identified
between a hypnotherapist and a client. Medical
and nonmedical indications for hypnosis are
numerous and include a variety of applications,
such as alleviating phobias, building better
time management skills, medical and surgical
analgesia, symptom management and many
more (Montgomery, Schnur, & Kravits, 2012).
A hypnotherapist is a trained mental health
or medical professional who has expertise in
the treatment condition as well as in hypnosis
techniques. Although nearly anyone can be
taught how to induce hypnosis, only trained
health care professionals should be directing
clinical hypnosis (hypnotherapy), as the ability
for the techniques to be optimally safe and
efficacious depends on the hypnotherapist’s
skill, experience, knowledge about the client,
and the therapeutic objective. Given that
there is little formal regulation of hypnosis
practice in the United States (only three states
require mandatory licensure), consumers
need to carefully evaluate the qualifications
and certifications of selected hypnotherapy
programs and practitioners (Hypnotherapist’s
Union, Local 472, 2013).
Hypnotizability (also known as hypnotic
susceptibility or suggestibility) is defined as a
trait-like ability, which determines how much
an individual experiences or benefits from
hypnosis, independent of attitudes or expecta-
tions (Barabasz & Perez, 2007). Most experts
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BOX 1 CHILDBIRTH USING HYPNOTHERAPY:
A CASE STUDY
Evidently Beth, the pregnant woman presenting at the admissions
desk of the labor and delivery unit, was not in active labor. Despite
reporting what she called “uterine surges” for the past several
hours, she was calm, with a serene facial expression and body
posture. She had a quiet demeanor and exhibited a subtle pattern
of altered breathing.
Because this was Beth’s first pregnancy, her assigned nurse
suspected that this was early labor, if it was labor at all. In the triage
area, the nurse began taking a history. Beth’s husband, Jack, an-
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swered most of the questions and provided a recounting of Beth’s
health history, which included an uncomplicated pregnancy with no
identified medical risk factors, and comprehensive prenatal care. The
nurse was curious about the fact that Jack did all the talking and she
attempted to engage Beth in conversation directly. At this point, Jack
explained that Beth was in a state of conditioned self-hypnosis and
that he was advocating for her to focus on using her learned skills
to complete the plan they had made for a safe and satisfying birth.
He said that Beth was “under” hypnosis even when her eyes were
open. Between “surges” (the term used in place of “contractions” or
“pains”), Beth verified Jack’s role as her spokesperson, and helped
answer questions when needed.
The nurse then recalled that many women using hypnosis for
birth presented to the hospital in advanced labor and without the
usual affective signs noted in the active or transitional phases. After
verifying a category 1 fetal heart rate pattern, the nurse removed
the fetal monitor and used intermittent auscultation of the fetal
heart rate (IA) for the duration of Beth’s labor. Cervical examination
revealed a dilation of 8 cm complete effacement, a bulging bag of
water, and fetal descent to a +1 station. The certified nurse-midwife
was notified, and the staff prepared for the birth.
Meanwhile, using headphones Beth listened to a prerecorded
hypnosis script while remaining focused and relaxed. Despite the
need to quickly complete admission procedures and to comply with
safe inpatient care standards for Beth and her baby, the nurse also
ensured that Beth’s request for a low-stimulation environment were
accommodated wherever possible. She kept the couple informed
about their progress and encouraged their efforts. Jack provided
Beth with continual reassurances, verbal prompts for deepening
hypnosis, and light-touch massage. Beth declined intravenous
fluids, and preferred to labor in a semi-recumbent position. Both
Beth and Jack expressed a desire to be kept informed about any
necessary invasive procedures during birthing, and to have as few
interruptions as possible.
When Beth entered the second stage of labor soon afterward, she
modified her breathing technique to “breathe the baby” to birth, us-
ing an open-glottis bearing down technique that she and Jack had
learned during the particular hypnosis training program they had
chosen (Mongan, 2005). The term “pushing” was not mentioned
by the couple, but rather, terms such as “opening” and “breathing
down” were emphasized (Mongan, 2005). Two hours after admis-
sion, Beth and Jack became the proud parents of an 8 pound, 1
ounce, healthy baby boy.
Nursing for Women’s Health 51
contend that there are degrees of suggestibility (e.g., low, me-
dium and high), and that various therapeutic approaches ex-
ist to enable hypnotizability along this continuum in all but a
very few cases (Barrett, 2010; Dienes & Hutton, 2013; Jaret &
Martin, 2004). One study (Alexander, Turnbull, & Cyna, 2009)
suggests that women become more hypnotizable during preg-
Hypnosis and hypnotherapy are terms
that are often used interchangeably;
however, there is an important distinction
in that hypnotherapy uses hypnosis
techniques with specific intent
nancy, leading to the hypothesis that pregnancy represents a
potentially sensitive period of receptivity to the practice. Preg-
nant women might, therefore, be uniquely suited to benefit
from the therapeutic effects of hypnotic suggestion.
COMPONENTS OF HYPNOSIS
FOR LABOR AND BIRTH
Implementation of hypnosis during childbirth usually involves
three components: (1) preparation and conditioning in the pre-
natal period, (2) inducing, deepening and sustaining hypnosis
during labor and birth, and (3) the presence of a supportive
advocate throughout the experience.
Preparation and Conditioning in the Prenatal Period
The first component often involves a reframing of the birth-
ing process from one that is necessarily painful, long, difficult
and dangerous to one that can be safe, easy and satisfying. This
component includes education that uses different terminology
applied to the mechanics of birth, often softening traditional,
BOX 2 COMMON MISCONCEPTIONS ABOUT HYPNOSIS
MISCONCEPTION
Hypnosis is a state of unconsciousness
Hypnosis is mind-control and forces
one to behave against her will
Those who can be hypnotized have weak minds
Hypnosis doesn’t really work
52 Nursing for Women’s Health
medicalized and sometimes frightening language. For example,
substitution of the terms “uterine surges” or “waves” for “labor
pains” or “contractions” may reframe the experience for wom-
en and reinforce the physiologic and nonthreatening nature of
progressive labor sensations. Should the necessity arise for in-
creased medical surveillance or intervention during birthing,
the woman is conditioned to remain in hypnosis and to use the
“turn” in conditions (a term to describe an unexpected event or
complication) as a signal to further relax and trust in her body
and in the process of birth (Mongan, 2005).
The choice of words in medical care is thought to contribute
to patient perceptions and responses. A recent study of word
selection in the management of pain after cesarean birth
compared positive and negative language use by caregivers
in two experimental patient groups. The findings suggested
that the use of negative words to assess pain may magnify
the perception, appraisal and incidence of pain reporting
(Chooi, Nerlekar, Raju, & Cyna, 2011). Likewise, persistent
media representations of birthing as dramatically dangerous
and agonizingly painful offer vicarious exposure to examples
that reinforce distorted representations of women’s capacity
for birthing (Morris & McInerney, 2010). Positive effects of
conditioned hypnosis for birthing support the mid-range
nursing theory of symptom management, which maintains
that altering one’s perception or appraisal of a physical,
psychological or environmental condition influences one’s
reaction or response to that condition (Dodd et al., 2001).
Part of the conditioning component in the prenatal period
includes developing body awareness as well as awareness and
attachment to the developing baby. This level of preparation
is designed to empower women to respect their innate ability
to birth. Additionally, the focus on connecting with the fetus
fosters a link that provides purpose and motivation for the pro-
cess of labor and birth (Mongan, 2005). This element takes the
form of education about pregnancy, labor and birth processes,
as well as exercises fostering introspection, visualization and
ACCURATE STATEMENT
Hypnosis is a state of hyper-consciousness
Hypnosis is a voluntary activity; hypnotic
suggestions can be refused, because those
undergoing hypnosis are fully conscious
Hypnotizability is not a negative personality trait;
most people can be hypnotized to some degree, if
they so choose
Many studies over the last century support the
efficacy of hypnosis in various applications
Volume 18 Issue 1

self-affirmation. Coupled with hypnotherapy for birth prepa-
ration, these interventions can become powerful forces for re-
ducing anxiety and counteracting fearful messages about the
birth process. When labor begins, activating a preconditioned
response of calm relaxation may reduce catecholamine release
and enhance uterine contractility and labor progress.
Inducing, Deepening and Sustaining
The second component of hypnotherapy for birthing continues
to emphasize the positive aspects of the birthing experience as
it unfolds, while expanding to include deepening techniques,
which permit varying degrees of hypnoanalgesia (American
Psychological Association, 2004). Alterations in physical
sensations are enabled through practice and conditioning over
time before onset of labor. Some laboring women are able to
achieve a high level of analgesia through subconscious rendering
of birth sensations into other sensations (such as numbness).
One method of accomplishing this under hypnosis is
training the mind to “make” a part of the body become
insensible, and then using that part of the body (usually a hand
or arm) to transfer or extend its insensibility to another body
area. Other women can attenuate nociception (pain sensation)
through a combination of focused reappraisal and altered
sensation. An example of focused reappraisal is reconditioning
one’s belief that uterine contractions are painful by offering
an alternative positive consideration that the contraction of
other muscles (such as the biceps) are not painful, and that the
uterine muscle fibers are acting in concert to help achieve the
desired goal of birthing the anticipated baby.
One hypothetical explanation for analgesic hypnotic
effects is that a reduction in labor pain simply results from the
natural release of endorphins accompanying any unmedicated
birth. However, this theory does not adequately explain the
phenomenon, since hypnoanalgesia has been successfully
reported in other patient populations undergoing acute medical
or dental treatment (Barrett, 2010).
A Supportive Advocate
The final component of hypnosis for birthing involves the active
presence of a prepared and trusted other to participate through
activities such as reinforcement, encouragement and advocacy.
Because the hypnotic state does not necessarily announce itself
outwardly, the partner often serves as one who “holds space” for
the woman to feel safe and sustain her hypnotic entrancement,
thereby maximizing its efficacy. This person remains present
with the hypnotized woman throughout labor and birth, and
contributes to her sense of security. She is assured that she
can remain under hypnosis while her primary support person
pronounces and protects the plans she has for birthing.
The support person may be an intimate partner, other family
member, friend or a trained doula. The choice of primary support
person rests with the woman, but it is someone who has trained
along with her in techniques of self-hypnosis. In addition, this
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CNE
person has learned strategies for deepening and sustaining the
hypnotic state, such as light-touch massage, specific relaxation
scripting and breathing pattern reinforcement. After hospital
admission, it is often the primary support person who wishes to
interact with providers, in order to permit the laboring woman
to remain under hypnosis undisturbed.
AUTO-HYPNOSIS AND SELF-HYPNOSIS
Two schools of thought exist on the efficacy of auto-hypnosis
(self-induced) versus hetero-hypnosis (that which is hypnotist-
mediated). Hypnosis, as a voluntary state of mind, is subject to
the mindfulness and willing participation of the individual. This
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would seem to make the argument for all hypnosis having a self-
generated component (Mongan, 2005). However, some authors
maintain that a sense of “involuntariness,” or the perception
that one is guided through their hypnosis experience by a
trained other, is an essential component of hypnotherapeutic
effectiveness (Burkhard, 2009; Wegner & Erskine, 2003).
Women using hypnotic techniques for childbirth can
Substitution of the terms “uterine surges”
or “waves” for “labor pains”
or “contractions” may reframe
the experience for women and reinforce
the physiologic and nonthreatening
nature of progressive labor sensations
opt for hypnotist-mediated techniques, self-taught and self-
conditioned hypnosis preparation, or a blended program of
mediated sessions coupled with at-home conditioning. Studies
suggest that, although all methods can be beneficial, clinical
hypnosis is more effective when conducted “live” with a
hypnotherapist compared to methods using audio-taped scripts
(Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002).
It is likely that the effectiveness of self-hypnosis for childbirth
is influenced by the amount and consistency of conditioning
and practice. The research on self-hypnosis for birthing is
lacking in measures of adherence to practice sessions; therefore,
the ability to evaluate its overall effectiveness is limited.
Typically, training programs for birthing-hypnosis begin in
the late second trimester with several hetero-hypnosis sessions,
and include concurrent in-home auto-hypnosis practice
sessions. Thereafter, the auto-hypnosis sessions are continued
daily through birth using an audiotaped script to condition
the patient to entering and deepening the hypnotic state. This
mixed method approach of hetero- and auto-hypnosis sessions
is likely the most practical and cost-effective for pregnancy and
birthing applications.
Nursing for Women’s Health 53
HYPNOTHERAPY IN CLINICAL
AND RESEARCH SETTINGS
Hypnotherapeutic treatment for such health indications as
smoking cessation, weight management, sleep disorders, anxi-
ety, depression, nausea and pain have been used in the general
population and in particular subpopulations, including child-
bearing women (Khianman, Pattanittum, Thinkhamrop, &
Lumbiganon, 2012; Ng & Lee, 2008). In addition, hypnosis has
been evaluated for its effectiveness in addressing childbearing-
related conditions such as hyperemesis, pregnancy termina-
tion, preterm labor, fetal movement, external breech version,
post-date pregnancies, breastfeeding difficulties, postpartum
depression and infertility (Dufresne et al., 2010; James, 2009;
Reinhard, Huesken-Janßen, Hatzmann, & Schiermeier, 2009;
Typically, training programs for birthing-
hypnosis begin in the late second
trimester with several hetero-hypnosis
sessions, and include concurrent in-home
auto-hypnosis practice sessions
Reinhard et al., 2012; Shah, Thakkar, & Vyas, 2011). A number
of investigations into perinatal hypnosis have focused on labor
and birth variables, particularly with respect to the variable of
pain control, but also include related outcomes such as labor
duration, anxiety levels, neonatal Apgar scores, incidence of ce-
sarean surgical birth, analgesia use, oxytocin use and childbirth
satisfaction (Cyna, McAuliffe, & Andrew, 2004; Cyna, Andrew,
& McAuliffe, 2006; Cyna, et al., 2006; Werner, Uldbjerg, Zacha-
riae, Rosen, & Nohr, 2012). While many of these investigations
show positive effects of hypnosis on the outcomes studied,
there are conflicting findings in others showing no statistically
significant benefit.
RESEARCH RESULTS ON EFFICACY
Four systematic reviews on hypnosis for birthing have been
completed, with contradictory findings (Cyna et al., 2004;
Landolt & Milling, 2011; Jones et al., 2012; Madden, Middle-
ton, Cyna, Matthewson, & Jones, 2012). Interpretation of the
findings regarding hypnosis for childbirth are complicated by
the variations in study design. These methodologic factors in-
clude the “doses” and types of hypnosis regimens, sample sizes,
selection and definition of outcome variables, randomization
procedures, measures of participant adherence and inclusion of
appropriate control groups. It is no surprise that the overarch-
ing conclusion of systematic analyses of hypnosis for childbirth
pain control show some, none or only modest beneficial effects
54 Nursing for Women’s Health
(Cyna et al., 2004; Simkin & Bolding, 2004; Landolt & Mill-
ing, 2011; Jones et al., 2012; Madden et al., 2012). This “apples
and oranges” comparison of studies complicates a clear deter-
mination of the degree to which hypnosis in maternity care is
beneficial.
METHODOLOGIC CHALLENGES
Two of the consistent critique points made by authors who have
attempted to draw conclusions from published research on the
value of hypnosis for childbirth are (1) lack of standardization
of the “treatment” conditions and (2) small, nonrepresentative
sample sizes. Prior work contains variations in number of hyp-
nosis training sessions, duration of those sessions, qualifica-
tions of the hypnotherapists, quality of the hypnosis sessions
themselves, and between-session “practice” times required of
and performed by the participants (Landolt & Milling, 2011;
Ng & Lee, 2008). These factors account for differences in the
effectiveness of the treatment.
For example, a recent randomized controlled trial in
Denmark evaluating the effect of self-hypnosis on labor
pain and epidural use showed no significant improvement
compared to controls, while an earlier published study showed
significant improvements when hypnotherapy was used (Cyna,
Andrew, & McAuliffe, 2006; Werner et al., 2012). Each study
used a different number of class sessions and protocols for their
hypnosis intervention.
One solution to this limitation is to launch comparative
investigations using standardized protocols for hypnotherapy
interventions across studies. There are a number of established
programs using hypnosis for childbirth such as Hypnobabies®,
the LeClaire Hypnobirthing Method and HypnoBirthing®: The
Mongan Method. The Mongan Method has been implemented
internationally, which permits application in research studies
abroad. Using one of these types of programs as a consistent
interventional package upon which to design future large-scale
studies may offer better control over the treatment conditions,
and hence, more interpretable and comparable results. To
date, the “best dose” of hypnotherapy for childbirth has not
been determined.
The HypnoBirthing® website has published its statistics
collected from 2,001 women between 2005 and 2010 (Dolce,
2010). The women voluntarily self-reported on their birth
outcomes after using hypnosis for childbirth. These data were
compared to the data from the Center for Disease Control and
Prevention’s (CDC) 2007 Birth Statistics report (a national
database of birth outcomes from all recorded births in the
United States in 2007) and the Listening to Mothers II survey
(a national telephone or online survey of the birth experiences
1,573 women who delivered in 2005) (Declercq, Sakala, Corry,
& Applebaum, 2006; Martin et al., 2010).
Women in the hypnosis group reported higher levels of birth
over 37 weeks gestation, fewer low birth weight infants and
Volume 18 Issue 1

fewer cesarean births (17 percent vs. 31.8 percent) compared
to U.S. statistics at the time of data collection (Dolce, 2010).
In addition, these women reported fewer medical interventions
such as pharmacologic analgesia/anesthesia, oxytocin use, con-
tinuous fetal monitoring, artificial rupture of membranes, and
perineal suturing than those polled in the Listening to Mothers
II survey (Dolce, 2010). These data are limited by the voluntary
and anonymous nature of online reporting and may not be rep-
resentative of the experience of all women using hypnosis for
birthing. There are few data on the demographic characteristics
of women selecting hypnosis (and none reported in the Dolce
2010 report), and it is possible that this group may be more
homogenous, and therefore not representative of the birthing
population in general.
One study on the impact of hypnosis on reducing preterm
birth showed a positive effect, but the researchers did not
randomly allocate their participants into the treatment and
control groups. The self-selected hypnosis participants were more
advantaged socioeconomically, reducing the comparability of
the groups and weakening the validity of the findings (Reinhard
et al., 2009). The few randomized studies that control for these
factors continue to demonstrate mixed results.
ADVERSE EFFECTS
Despite variances in the findings on the effectiveness of
hypnotherapy to achieve its intended goals in statistical
analyses, it is considered to be an integrative intervention
that has a consistently low-risk index along with a generally
high level of acceptability by participating women. No recent
published studies were found noting medical or psychological
complications resulting from the use of hypnosis for childbirth
preparation. However, there have been reports of unintended
negative effects resulting from hypnosis (Gruzelier, 2000).
These are usually minor and of short duration, including,
headache, anxiety and/or amnesia. There are increased risks for
severe side effects among those with existing psychopathology,
including an exacerbation of psychoses; therefore, the use of
hypnosis use among groups of women with certain preexisting
mental health conditions may require the consultation with a
mental health professional, or be contraindicated.
A LESS INVASIVE OPTION
Because of its less invasive nature, hypnosis offers birthing
women an alternative to pharmacologic interventions, which
they may need to, or wish to, avoid. The reappraisal of the
birthing process in a wellness paradigm, which emphasizes
women’s capabilities to use the mind-body connection to its best
advantage, may have the potential to improve obstetric outcomes
when used as a replacement for or an adjunct to increasingly
common interventions such as intravenous narcotics, oxytocin
use or epidural anesthesia. More well-designed and controlled
studies are needed to examine these effects.
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OPPORTUNITIES AND BARRIERS
FOR HYPNOTHERAPY DURING LABOR
AND BIRTH
Individualized Nursing Care and Institutional Policies
Hypnotherapy is an attractive and empowering modality
for some women. But what is less certain is the level of
acceptability by physicians, nurses and other clinicians, upon
whom the future potential of hypnotherapy utilization, at least
in the inpatient setting, may rest. Institutional barriers to using
hypnosis for childbirth may include protocols that require
even low-risk birthing women to be interrupted by continuous
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electronic fetal monitoring, routine IV placement, activity
restrictions, inflexible vital sign measurement intervals and
regular requests to “rate their pain.” All of these distract from a
woman’s ability to remain in a focused state within her birthing
body. Low-technology nursing care suggestions for low-risk
birthing women using hypnosis include offering oral fluids
as tolerated during labor, intermittently auscultating the fetal
heart rate, encouraging freedom of movement, minimizing
cervical exams and utilizing ratings of comfort levels rather
than pain levels (Romano & Lothian, 2008). Box 3 describes
some nursing approaches that may be most effective in working
with hypnosis-trained women and their support persons.
Resolving Conflicts in Care Philosophies
Health care providers may not understand or accept the
utilization of hypnotherapy in the birth setting, and may
disapprove of or undermine its use. Conversely, women and
Because of its less invasive nature,
hypnosis offers birthing women
an alternative to pharmacologic
interventions, which they may need to,
or wish to, avoid
their partners may take a hard line in refusing medically-
indicated interventions if they are perceived as unnecessary
or intrusive to the desired birthing experience. In these cases,
the shared goal between health care providers and birthing
women for a safe and satisfying outcome can be thwarted by
this intersection of competing priorities, expectations and
demands. Areas of conflict in this regard need to be carefully
scrutinized with regard to examining standards of practice for
safe, effective and ethical nursing care.
When routine or recommended interventions are ques-
tioned for their necessity during an uncomplicated birth, the
potential for power struggles between patients, their part-
ners and hospital staff arises. Hypnosis-trained and prepared
Nursing for Women’s Health 55
mothers-to-be are conditioned and oriented toward normalcy
in birthing, and may require explanation and justification for
staff-recommended interventions. It is no surprise, then, that
a larger proportion of women who desire birth using hypno-
sis also seek to birth outside of the hospital setting (1 percent
for the general U.S. population vs. 13 percent for HypnoBirth-
ing® women), thereby avoiding the potential for these conflicts
(Dolce, 2010). Interestingly, however, this same report showed
that most women (86 percent) who used hypnosis for birthing
in the hospital or in a free-standing birth center reported a high
degree of satisfaction with the level of support they received
from the nursing staff. This could imply that nurses are aware of
The role of nurses in reinforcing or
inhibiting hypnosis techniques during
pregnancy and birth has not been studied.
Open communication between women,
their partners and their nurses about
needs and expectations will improve
understanding and the ability for all
parties to collaborative effectively
the need to accommodate women’s birthing preferences while
balancing the requirement to meet institutional standards, re-
inforcing the natural partnership between patients and their
nurses. Further investigation is needed to explore hypnosis
awareness and advocacy from a nurse’s perspective.
The role of nurses in reinforcing or inhibiting hypnosis
techniques during pregnancy and birth has not been studied.
Open communication between women, their partners and
their nurses about needs and expectations will improve
understanding and the ability for all parties to collaborative
effectively (see Box 3). Non-judgmental approaches by nurses
and other health care providers makes women feel able to
honestly and clearly state their needs, and simultaneously
builds rapport and trust. Also, active listening provides women
and their nurses the chance to negotiate creative solutions to
meet needs for safe and effective care while honoring patient
preferences. For example, if a woman does not want to be asked
to rate her pain each hour during active labor, she and her nurse
might agree on different language to elicit this information
or, perhaps the woman would agree to this assessment, but
less frequently. Respecting patient autonomy and supporting
patient rights to approve of and participate in their plan of
care is a central precept of ethical nursing practice (American
Nurses Association, 2010).
56 Nursing for Women’s Health
BOX 3 NURSING ACTIONS TO SUPPORT
FAMILIES USING HYPNOTHERAPY FOR
CHILDBIRTH
• Maintain a low-stimulation environment.
• Provide high-touch, low-tech interventions for
labor and birth (e.g., intermittent auscultation)
based on risk status and patient preference.
• Anticipate a woman’s reduced desire for activity
and repositioning during active labor.
• Prepare to answer questions and entertain
challenges to medical/institutional protocols in
an open and nonjudgmental fashion.
• Explain rationale for invasive interventions (e.g.,
prophylactic antibiotic therapy) and respect
woman’s autonomy in decision-making.
• Include the woman’s primary support person in
caregiving activities.
• Remain open to using creative strategies for
enabling hypnosis-mediated birthing.
• Advocate for the woman’s birth preferences with
other providers.
• Assess for objective indicators of advancing
labor (e.g., bloody show, spontanteous rupture
of membranes and/or open-glottis bearing
down), because typical affective cues of labor
progress may not be apparent.
• Be prepared for unexpected progression in
cervical dilation and fetal descent.
• Encourage the use of complementary hypnosis
techniques if pharmacologic and/or surgical
intervention become necessary.
• Emulate the language used by the patient to
refer to the various components of the birthing
process.
• Reinforce the use of hypnotherapy techniques
into the postpartum period.
• Seek ongoing educational and practice
opportunities to expand one’s nursing skill set
to include hypnotherapeutic techniques.
Access to Services
Disadvantages of hypnosis for childbirth are few, but further
barriers exist. Although prices for hypnosis training and audio-
taped scripts vary among programs and practitioners, the fees
for these services and materials are in the typical range of $250
to $500 (Hypnosis for Change, 2011; Your Birthing Journey,
2013). Costs may limit access for low-income women. Like-
Volume 18 Issue 1

wise, availability for non-English-speaking women, those with
sensory deficits, those with limited support systems and/or
those of low literacy may also be limited. These barriers could
be overcome if hypnosis programs were developed specifically
to target these populations.
CONCLUSION
Beth and Jack, the couple whose experience is described in Box 1,
were able to receive supportive care from an experienced
nurse who matched her assessment and care activities to their
individual wishes. After listening to the couples’ needs and
preferences, the nurse minimized distractions and reduced
the use of technological interventions where possible. This
included the use of intermittent auscultation, oral rather than
intravenous fluids and low lighting and sound levels. The
nurse met safe standards of practice while simultaneously
individualizing care, building a therapeutic relationship with
the couple and giving Beth the space to utilize her hypnosis
techniques effectively. This successful partnership may have
been influenced by the culture of the birthing unit as well as
by the knowledge, expertise and flexibility of the nurse. Culti-
vating these qualities across groups of nursing providers and
perinatal units may improve the ability for low-risk women to
make use of integrative techniques that promote physiologic
labor and birth.
Beth’s birth story illustrates an exception to the “rule” we
have come to recognize as the somatic and affective progression
of so many labors and births (fear, tension, pain), while
also posing the proposition that hypnotherapy could be an
underutilized resource for better childbirth preparation and
management—one that could improve comfort and satisfaction
during this significant life event Expanding opportunities for
women to access and utilize hypnosis for childbirth will give
clinicians and scientists more chances to evaluate its effects.
Nurses are well-positioned to develop their knowledge and
skill toward becoming more deliberate, and hence, effective
participants in hypnotherapies. In observing nurses who work
with birthing women, an intriguing prospect arises—could the
gentle stroking massages, the soothing, low-pitched, repetitive
affirmations murmured to patients, the deliberately calming
movements, and the encouraging suggestions that “the baby
is nearly here” actually be generating some unintentional,
but nonetheless beneficial, hypnotherapeutic effects? This
possibility calls for further investigation into the mechanisms
of mind-body interventions during labor and birth, as well as
the role of nurses in facilitating any beneficial effects.
As maternity nurses rise to the challenge of operating in
both a high-tech and a high-touch environment, developing
a working knowledge of ways to support women and their
partners in achieving their goal of using clinical hypnosis for
birthing strengthens the therapeutic relationships formed
between nurses and the women they care for. Developing
February March 2014
CNE
skills in utilizing integrative techniques increases perinatal
nurses’ breadth of expertise and augments their collection of
available strategies to meet women’s needs during the experi-
ence of childbirth. NWH
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58 Nursing for Women’s Health Volume 18 Issue 1

 CNE
Post-Test Questions
Instructions: To receive contact hours for this learning
activity, please complete the online post-test and participant
feedback form at http://JournalsCNE.awhonn.org. CNE
for this activity is available online only; written tests submit-
ted to AWHONN will not be accepted.

1. Which of the following is true about hypnosis? 8. Which of the following is true of a woman’s support
a. It can only be achieved in the presence of a hypnotist. person when she is using hypnotherapy during labor and
b. It is an involuntary state. birth?

c. It is a voluntary state.
2. Which of the following is a common misconception about
hypnosis?
a. Hypnosis is a state of hyper-consciousness.
b. Hypnosis only works on people with weak minds.
9.
c. Hypnotic suggestions can be refused.
3. Which of the following is a therapeutic aspect of hypnosis
during labor and birth?
a. It ensures a shorter labor.
b. It helps a woman reframe her perception of birth
from difficult and scary to easy and satisfying.
c. It makes pain analgesia unnecessary.
http://JournalsCNE.awhonn.org
a. The support person is hypnotized during the birth.
b. The support person lets the laboring woman do most
of the talking during the history and exam.
c. The support person provides verbal prompts to
deepen the woman’s hypnosis.
Which hypnosis method is considered the most practical
and cost-effective for pregnancy and birthing applications?
a. A combination of hypnotist-mediated hypnosis and
self-induced hypnosis sessions.
b. A series of one-on-one “live” hypnotist-mediated
sessions.
c. A series of sessions listening to a recording of a
hypnotist.

4. What is auto-hypnosis? 10. Which of the following is something nurses can do when
caring for a woman using hypnotherapy during labor and
a. Group-mediated hypnosis
birth?
b. Hypnotist-mediated hypnosis
a. Ask the woman to rate her pain every hour.
c. Self-induced hypnosis
b. Expect normal progression in cervical dilation and
5. What is the current state of scientific evidence for fetal descent.
hypnotherapy as a therapeutic intervention during labor c. Provide a low-stimulation environment as much as
and birth? possible.
a. Evidence clearly indicates benefits.
11. Which nursing care practice during labor could be
b. Evidence clearly indicates harm. researched to explore the potential for its hypnotic-like
c. Evidence is mixed. effects?
a. Aromatherapy
6. According to a report published by the HypnoBirthing®
Institute, birth outside the hospital setting is desired b. Gentle massage
by what percentage of women who desire birth using c. Hydrotherapy
hypnosis, compared to 1 percent of women in the general
U.S. population.
a. 7 percent
b. 13 percent
c. 20 percent

7. What is a possible contraindication to hypnosis?

a. Existing psychopathology
b. History of anxiety
c. History of a sleep disorder

February March 2014 Nursing for Women’s Health 59