Scientific Research

1. Integrative Oncology: Complementary Therapies for Pain, Anxiety, and Mood Disturbance
Researchers Gary Deng, MD, PhD and Barrie R. Cassileth, PhD found that many people with cancer experience pain, anxiety, and mood disturbance. Conventional treatments do not always satisfactorily relieve these symptoms, and some patients may not be able to tolerate their side effects. Complementary therapies such as acupuncture, mind-body techniques, massage, and other methods can help relieve symptoms and improve physical and mental well-being. Self-hypnosis and relaxation techniques help reduce procedural pain. Acupuncture is well documented to relieve chronic cancer pain. Massage and meditation improve anxiety and other symptoms of distress.

Source: CA Cancer J Clin 2005; 55:109-116

2. Hypnosis and Headache Pain
In a study conducted by Anderson (1975), migraine patients treated with hypnosis had a significant reduction in the number of attacks and in their severity compared to a control group who were treated with traditional medications. The difference did not become statistically significant until the second six-month follow-up period. In addition, at the end of one year, the number of patients in the hypnosis group who had experienced no headaches for over three months was significantly higher.

In a controlled trial conducted by Olness (1987), self-hypnosis was shown to be significantly more effective than either propranolol or placebo in reducing the frequency of migraine headaches in children between the ages of six and twelve years of age.

In a research conducted by Schlutter (1980), hypnosis was also found to be effective in dealing with the relief of tension headache.

Alladin (1988) reviewed the literature on hypnosis, identifying fully a dozen different hypnotic techniques that have been used in the treatment of chronic migraine headaches. Of these, hypnotic training emphasizing relaxation, hand warming (which, according to Anderson, 1975) seems the simplest method of establishing increased voluntary control of the sensitive vasomotor system) and direct hypnotic suggestions of symptom removal have all been shown to be effective in reducing the duration, intensity and frequency of migraine attacks during a ten-week treatment course and at thirteen-month follow-up when compared to controls.

A study (Gutfeld, G. and Rao, L., 1992) was conducted on 42 patients suffering from chronic headaches. These patients, all of whom had responded poorly to conventional treatments, were split into two groups. One received hypnotherapy to relieve their daily headaches; the rest acted as a comparison group. The hypnotherapy group experienced reduced frequency and duration of headaches, cutting the intensity by about 30%. “These results are impressive in such a difficult, hard-to-treat group of patients,” commented Egilius Spierings, M.D., Ph.D. director of the headache section, division of neurology at Brigham and Women’s Hospital.

Sources:

Pregnancy and Childbirth

Link to the study: http://www.hypnobirthingglasgow.co.uk/research1.pdf

2. Self-Hypnosis: Alternative Anesthesia for Childbirth
MCN, American Journal of Maternal Child Nursing. 27(6):335-340, November/December 2002.

Ketterhagen, Debra MSN, RNC, CNM; VandeVusse, Leona PhD, RN, CNM, FACNM; Berner, Margaret Ann MSN, RN, CNM, HBCE

This study showed that when used for childbirth pain, self-hypnosis helped the women maintain control by managing anxiety and discomfort though the process of inducing a focused state of relaxation. The study notes that before the widespread use of drugs for pain, hypnosis was one of the few pain relief methods available for labor. “However, as new technologies for pain relief emerged, hypnosis received less attention.” The researchers felt that it is “important that nurses learn about self-hypnosis to be able to inform pregnant women fully about all pain control options and to maximize the benefits for the woman choosing hypnosis.” http://www.mcnjournal.com/

Additional view of the study: http://www.hypnobirthingglasgow.co.uk/research2.pdf

3. The effects of hypnosis on the labor processes and birth outcomes of pregnant adolescents.
In another study, women who used self-hypnosis for their labors had shorter hospital stays (p<0.005) and fewer surgical interventions (p<0.001) than a matched control group who received psychosocial counseling (Martin, Schauble et al. 2001).

http://www.ncbi.nlm.nih.gov/pubmed/11350710

Older studies:
Researchers Harmon, Hynan, and Tyre studied 60 pregnant women, half of whom received hypnotic suggestions for a comfortable labor, deep relaxation, and glove anesthesia.

Those using hypnosis had shorter Stage 1 of labor, reported less pain, and used less medication than the control group. The babies of the treatment group had higher Apgar scores at 1 and 5 minutes.

Pregnancy and Depression

http://www.greenjournal.org/ cgi/content/ abstract/ 110/5/1102

NEW FINDINGS ON ANXIETY & DEPRESSION DURING PREGNANCY
More research is pointing to anxiety and depression during pregnancy as a pervasive problem affecting the health and wellbeing of both women and their babies. New findings published in the November issue of the journal Obstetrics and Gynecology suggest that anxiety and depression during pregnancy are both “highly prevalent” and a strong predictor of postpartum depression (PPD). The study found that anxiety and depression are most prevalent and most severe during the first and third trimesters of pregnancy, and that strong risk factors for anxiety or depression during pregnancy include younger age and a history of alcohol use.

Other studies:

1. Behavior Therapy, Psychoanalysis and Hypnotherapy
In a comparative study of Behavior Therapy, Psychoanalysis and Hypnotherapy published by American Health Magazine, the 2000 study reveals that hypnotherapy is highly effective in the treatment of people who have mental health issues.

Furthermore, with the use of hypnotherapy patients saw a 93% recovery after 6 sessions: http://ezinearticles.com/?Antidepressants—Research-Study&id=1016070

2. A comparative study of hypnotherapy and psychotherapy in the treatment of methadone addicts. Manganiello AJ. American Journal of Clinical Hypnosis 1984; 26(4): 273-9.
Dr. Gayle Peterson: http://www.insightofnc.com/articles48.htm

3. Additional studies:

Significant differences were found on all measures. The experimental group had significantly less discomfort and illicit drug use, and a significantly greater amount of cessation. At six month follow up, 94% of the subjects in the experimental group who had achieved cessation remained narcotic free.

Treatment was given to 18 clients over 7 years. A 77 per cent success rate was maintained at the 1-year follow-up. 15 were treated for alcoholism or alcohol abuse, 2 were treated for cocaine addiction, and 1 client was treated for marijuana addiction.

This research study on Self-hypnosis for relapse preventing training with chronic drug-/alcohol users showed raised Self-esteem & Serenity. Lowered Impulsivity and Anger Participants were 261 veterans admitted to Substance Abuse Residential Rehabilitation Treatment Programs (SARRTPs). Individuals who used repeated self-hypnosis, “at least 3 to 5 times a week,” at 7-week follow-up, reported the highest levels of self-esteem and serenity, and the least anger/impulsivity, in comparison to the minimal-practice and control groups.

The subject was a female in her twenties. Hypnosis was successfully used to overcome a five gram per day cocaine addiction of approximately eight months. She decided to use hypnosis. She used hypnosis three times a day for four months, her addiction was eliminated. She has been drug free for nine years. Hypnosis was the only intervention.

90.6% Success Rate Using Hypnosis. Of 43 consecutive people undergoing this treatment protocol, 39 reported remaining abstinent at follow-up (6 months to 3 years post-treatment).

Thirty smokers enrolled in an HMO were referred by their primary physician for treatment. Twenty-one patients received hypnosis for smoking cessation. At the end of treatment, 81% reported that they had stopped smoking, and 48% reported abstinence at 12 months post-treatment.

Hypnosis Subjects Lost More Weight Than 90% of Others and Kept it Off – Researchers analyzed 18 studies comparing a cognitive behavioral therapy – relaxation training, guided imagery, self monitoring or goal setting with the same therapy supplemented by hypnosis. Those who received the hypnosis lost more weight than 90 percent of the non hypnosis, and maintained the weight loss two years after treatment ended.

Hypnosis Lowered Post-treatment Pain in Burn Injuries. Participants in the hypnosis group reported less post treatment pain than did patients in the control group.

Hypnosis Useful in Hospital Emergency Rooms – Hypnosis can be a useful adjunct in the emergency department setting. Its efficacy in various clinical applications has been replicated in controlled studies. Application to burns, pain, pediatric procedures, surgery, psychiatric presentations – coma, somatoform disorder, anxiety, and posttraumatic stress), and obstetric situations – hyperemesis, labor, and delivery are described.

Breech Birth

A study from the Archives of Family Medicine Journal, (Vol. 3, Oct. 1994) showed the following:

Objective: To evaluate the effectiveness of hypnosis to convert a breech presentation to a vertex presentation.

Design: Prospective case series compared with historical, matched comparison group.

Subjects: One hundred pregnant women whose fetuses were in breech position at 37 to 40 weeks’ gestation and a matched comparison group of women with similar obstetrical and sociodemographic parameters derived from databases for other studies from the same time period and geographical areas.

Intervention: The intervention group received hypnosis with suggestions for general relaxation with release of fear and anxiety. While in the hypnotic state women were asked for the reasons why their baby was in the breech presentation. As much hypnosis was provided as was convenient and possible for the women until they were delivered of the baby or the baby converted to the vertex position.

Main Outcome Variables: A successful conversion for the intervention group was scored when the baby spontaneously converted to the vertex position before delivery or successful cephalic version. The conversion rate of the intervention group was compared with the comparison group who received standard obstetrical care without the opportunity for hypnosis.

Data Analysis: Parametric testing of statistically significant differences in the rate of conversion between the two groups.

Results: Eighty-one percent of the fetuses in the intervention group converted to vertex presentation compared with 48% of those in the comparison group. This difference was statistically significant.

Conclusions: Motivated subjects can be influenced by a skilled hypnotherapist in such a manner that their fetuses have a higher incidence of conversion from breech to vertex presentation. Psychophysiological factors may influence the breech presentation and may explain this increased frequency of conversion to vertex presentation.

Source: Lewis E. Mehl, MD, PhD
Dept. of Psychiatry
Univ. of Vermont College of Medicine, Burlington
(Arch Fam Med. 1994;3:881-887)

The Negative Side of C-Sections

Studies

1. British Medical Journal
October 30, 2007
http://www.bmj.com/cgi/content/abstract/335/7628/1025

Results of the study: Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective.

Conclusions: Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.

2. Is delivery by cesarean section a risk factor for food allergy?
Eggesb� M, Botten G, Stigum H, Nafstad P, Magnus P.

Norwegian Institute of Public Health, Division of Epidemiology, Oslo, Norway.

BACKGROUND: Cesarean delivery might delay the colonization of the newborn intestine. A delayed or aberrant colonization process has been offered as an explanation for the increase in allergic diseases. OBJECTIVE: The aim of this study was to examine whether cesarean delivery and the use of antibiotics were associated with subsequent food allergy.

METHODS: In a population-based birth cohort of 2803 children, information regarding mode of delivery, maternal or infant use of antibiotics, and information on potential confounders was obtained prospectively from parental reports and the Norwegian Birth Registry. Parentally perceived reactions to egg, fish, or nuts, as well as objectively confirmed reactions to egg at the age of 2 1/2 years, were chosen as outcomes. RESULTS: Among children whose mothers were allergic, cesarean section was associated with a 7-fold increased risk of parentally perceived reactions to egg, fish, or nuts (odds ratio, 7.0; CI, 1.8-28; P =.005) and a 4-fold increased risk of confirmed egg allergy (odds ratio, 4.1; CI, 0.9-19; P =.08) in a logistic regression analysis, adjusting for pregnancy complications, birth weight, gestational length, and socioeconomic factors. Among children whose mothers were not allergic, the association was much weaker and not significant. Maternal or infant use of antibiotics was not associated with an increased risk of food allergy. CONCLUSION: The results indicate that in predisposed children cesarean section might increase the risk of development of food allergy, which supports the theory that factors interfering with the colonization process might play a role in the development of food allergy.

PMID: 12897751 [PubMed - indexed for MEDLINE]

3. Cesareans tied to strokes
A new study from the American Journal of Obstetrics & Gynecology 2008; 198: 391.e1-391.e7

MedWire News: Cesarean section (CS) delivery is an independent risk factor for stroke, a study of almost a million births has revealed.

Current strategies for preventing stroke rely mainly on controlling inherent risk factors in daily life, such as hypertension, smoking, and obesity, say the Taiwanese researchers.

They examined whether stroke risk could also increase after CS among 987,010 women who had singleton deliveries in their country between 1998 and 2002.

The team from the University of Taipei found that women who delivered by CS had significantly higher stroke rates within 3 months postpartum than those who delivered vaginally, at 0.03 percent versus 0.02 percent, respectively.

The same was true within 6 months after delivery, at 0.05 percent versus 0.03 percent, and at 12 months, at 0.08 versus 0.05 percent, respectively.

Hazard ratios for stroke with CS compared with vaginal delivery were 1.67 within 3 months of delivery, dropping to 1.61 within 6 months, and 1.49 within 12 months.

Shiyng-Yu Lin and co-workers suggest CS delivery could alter hemodynamic and coagulation status, thereby predisposing to stroke.

“Based on the results of this study, a reduction in the CS delivery rate should prove to be beneficial for stroke prevention,” they conclude.

4. Assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions.

Source: Wilson BL. J Nurs Scholarsh 2007;39(3):208- 13.
http://www.jmwh.com/article/S1526-9523%2807%2900485-0/fulltext# bib1

Inductions of labor have increased substantially- 25% between 1989 and 2002. With increased inductions of labor, cesarean rates, longer hospital stays, iatrogenic prematurity and associated neonatal outcomes such as cord prolapse, sepsis, and neonatal pulmonary insufficiency have followed. This study evaluates the effects of age, gestational age, socioeconomic status, and ethnicity on the likelihood of cesarean births among women receiving induction.

This retrospective, descriptive correlational design investigated 1325 women who were scheduled for induction at a large southwestern US tertiary care hospital during 2005. Because a randomized controlled trial would not have been possible, the author increased the strength of design by using a method known as “natural experiment.” Although all women scheduled for induction (electively or medically) were considered, using the natural experiment enabled the outcomes of those scheduled for induction to be compared with those having vaginal births. This enabled comparisons between women scheduled for induction (who instead went on to labor spontaneously and deliver vaginally) with women who were actually induced. According to the author, this design would make for comparable groups, subject to the same sets of risks. Three comparison groups emerged for primaparous and multiparous women: elective inductions, medically indicated inductions, and vaginal births. Race/ethnicity background of women delivering in the institution shows 75.5% non-Hispanic white, 17% Hispanic, 5% Asian, 2% Native American, and 0.5% black.

Wilson notes that, in some cases, criteria required by institutional policy to document a medical indication for induction was not attained. For example, reasons for some medical indications listed were “possible shoulder dystocia,” “history of rapid labors,” and “advanced maternal age.” Gestations less than 41 weeks were sometimes listed for induction as “post-dates. ” In some cases, charts did not clarify elective versus medically indicated. In these cases, the author met with a team of obstetric providers and nursing personnel from the institution to reach consensus on the appropriate designation. Those inductions scheduled as post-dates, but were less than 41 weeks gestational age, were recategorized as elective for purposes of the study. Once the appropriate category of induction was agreed upon, records were later matched to a hospital database containing information on birth outcomes. In developing her tables, Wilson used a propensity score, a statistic to evaluate how randomization affects observed data according to independent variables. Mean differences by type of delivery were calculated among multiparas, and predictors of cesarean delivery were calculated by type of induction and parity.

Primiparas undergoing elective induction were more likely to have cesarean birth than multiparas. Although multiparas experienced higher rates of medical inductions of labor than primiparas, rates of cesarean in multiparas decreased. Wilson deemed this increase in medically indicated inductions of labor among multiparas logical, because medical complications of pregnancy increase as women become older. When calculating differences for predictors of cesarean delivery, maternal age and gestation were factors showing statistical significance for increasing cesarean delivery. Insurance status and ethnicity did not increase the likelihood of cesarean in either primiparas or multiparas, though the percentage of African American women in this study is low (0.5%) and Hispanic women accounted for only 17% of births. As women age, their chance of cesarean birth increases, whether primipara or multipara and whether labor is spontaneous or induced. In this study, the greatest chance of cesarean birth occurred in older primiparas undergoing elective induction.

Elective induction of labor has become common practice, though, as Wilson elaborates, it is fraught with potential adverse consequences for mothers and newborns, increased cost, and has no evidence base to support it. Strengths of this paper include a concise yet excellent literature review and a team process by which consensus was achieved to clarify, as accurately as possible, reasons for induction. The author does not describe how an N of 1325 was determined or whether a power analysis was done. Inclusion/exclusion criteria are not given, and other variables that could affect delivery, such as type of anesthesia, are not included. Though findings from this study are not generalizable, the author’s efforts to strengthen the design and statistical analyses lend credibility to the paper. Midwives can use this information to effectively counsel women about potential risks and increased likelihood of cesarean delivery, particularly older primiparas seeking elective inductions of labor.

The Risks of Pitocin/Oxytocin
Oxytocin/Pitocin is used to strengthen contractions of a slow moving labor. It is also used now to speed things up when labor isn’t going as fast as we would like. It is worth taking a look at some of the documented risks associated with this kind of intervention:

High doses can lead to fetal distress, an increased chance of a c-section

A 1992 study found that Oxytocin induction was associated with an increase in fetal distress and c-section rate when used in high doses (Obstet Gynecol 1992; 80): http://www.greenjournal.org/cgi/content/abstract/80/1/111

A Ruptured Uterus
According to a 1999 study in the American Journal of Obstetrics and Gynecology (Plaut, M.M. Schwartz, M.L. and Lubarsky, S.L.), with labor induction between one and six percent of women end up with ruptured uteruses: http://www.ncbi.nlm.nih.gov/pubmed/10368501

The Curious Link between Autism and Pitocin
Public health authorities have identified an enormous increase in the incidence of childhood autism.

As reported by Newsweek, Dr. Eric Hollander of New York’s Mount Sinai School of Medicine noticed that 60 percent of the autistic patients in his clinic had been exposed in the womb to pitocin, the synthetic version of a brain chemical oxytocin that helps induce labor.

http://www.newsweek.com/id/85572/page/1
http://www.accessmylibrary.com/coms2/summary_0286-10445240_ITM