Indications and advantages of hypnosis in obstetrics

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The induction of hypnosis in a patient is a very simple procedure; only a moderate amount of skill is needed to produce the trance state. Consequently, the physician can use it on almost all obstetrical patients. He needs to understand, however, that psychodynamtic orientation is important because the constant interpersonal relationship between physician and patient is such that there is a marked emphasis of it in the hypnotic state.

One of the indications for using hypnosis is the understanding that respiratory and circulatory infection in the mother and baby with resulting anoxia is markedly decreased, perhaps even avoided altogether by the reduction or elimination of chemical anesthesia. Hypnosis also raises the resistance to muscular efforts. The fatigue that one frequently sees in the obstetrical patient in labor is therefore markedly minimized.

Whenever use of a chemical agent is contraindicated by virtue of a cardiac condition, tuberculosis, prematurity, etc., hypnosis may be used without fear of anesthetic danger to either the mother or the baby. It is generally accepted that any of the anesthetic agents used retard uterine activity; hypnosis does not. Another indication of the usefulness of hypnosis is that it can be controlled; if the hypnoanesthesia needs to be lightened or deepened, it can be readily accomplished by a simple suggestion on the part of the physician. When chemical or anesthetic: agents are used, one can only counteract them by other drugs, by oxygen, or by tune,

It is believed that capillary blood loss is diminished by hypnosis. This is probably due to a vasospasm or to some unknown effect on the coagulation time. Some experimental work has investigated this subject, but no definitive results have yet been attained. It is sometimes stated that bleeding can be stopped by use of hypnosis. This is questionable. The most one can expect is some sort of vasospasm, owing perhaps to a contracting of muscles along the capillaries and thus a diminishing of the bleeding in those areas. The claim has been made that bleeding in the sockets of the teeth can be stopped, but there again, it is probably by one of the two means mentioned above.

Another indication for the use of hypnosis is the reduced time element affecting both physician and patient. Previous antiquated methods used to induce hypnosis in obstetrics required the obstetrician to spend an excessive amount of time with the patient. He spent many hours training his patient to be a somnambulistic subject and developing anesthesia. When she went into labor, he had to hurry to the hospital to reinduce both the trance state and the anesthesia and remain with his patient all during her labor. It is understandable that obstetricians were not willing to use such a time-consuming method.

Changes in hospital attitudes and achievements by contemporary workers in the field have made the situation different today. Some hospitals, fearing legal difficulties, have prohibited the use of hypnosis. They have not been able to legislate against using hypnosis in the office, however. A use of posthypnotic suggestion and autohypnosis has therefore been evolved. The patient does her own hypnotizing in the hospital.

Actually, of course, using the recent techniques that have been devised, the time is considerably shortened. For example, the patient is comfortable during labor and therefore does not require the constant attention of her physician. Labor in primiparae is shortened by an average of two hours in the first stage; during the second stage, the patient is able to bear down more readily without extreme discomfort and expulsion can be augmented.

One other valuable indication is that with hypnosis there have been no reports of an increase in operative interference or of danger either to the mother or baby because of increased instrumental manipulation. These facts differ from the reports on almost all the other anesthetic agents.

An important point to bear in mind is that complete hypnoanesthesia may not be obtainable in a great many patients. But where a lesser amount of hypnoanesthesia is produced, as in light or medium hypnosis, there is still a marked reduction in the quantity of chemical anesthetics required, In every patient, therefore, in whom even a light or medium trance is produced, beneficial effects may be produced. This should include 95 to 100 percent of the obstetrical patients, At the very least, the amount of chemical anesthetic agent the patient needs during labor is diminished wit it hypnosis.

Another good reason for using hypnosis is the postoperative comfort the mother is able to attain. She may be totally free of pain and, through this added comfort, the possibility of atelectasis and other dangers is also minimized or avoided

Some obstetricians have reported that they can increase the secretion of milk in parturient patients by utilizing hypnosis and directly suggesting the filling of the breasts, or even better, by indirectly suggesting the feeling of well, being in the patient, with the mother looking forward expectantly to the wonderful child that she will be able to hold in her arms. Psychologically, this seems to cause an increase in the milk secretion.

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