Hypnosis In Obstetrics And Gynecology

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X Aypnosis has been widely used in obstetrical care, particularly in hypnotic childbirth training. August (1960a), for example, performed more than 1,000 deliveries using hypnosis as the sole anesthetic. There are a variety of advantages that may result from the use of hypnosis in obstetrics. Hypnosis may be successfully used to reduce pain in delivery, reducing the need for medications and chemo-anesthesia, thereby eliminating its risks and post-delivery effects for both mother and child. It may additionally facilitate comfort in suturing the episiotomy. Hypnosis has proven successful as the sole anesthetic for childbirth in between 58% and 79% of cases (August, 1960, 1961; Fuchs, Marcovici, Peretz, & Paldi, 1983; Mody, 1960; Mosconi & Starcich, 1961), with an average among studies of 69%. Another potential advantage of hypnosis is seen in the widespread reports suggesting that it may reduce the average duration of labor by two to four hours (Abramson & Heron, 1950; Callan, 1961; Davidson, 1962; Fuchs et al., 1983; Mellegren, 1966).

Hypnosis has also proven extremely effective in the treatment of hyperemesis gravidarum, vomiting in the early stages of pregnancy. Success rates of 75% and greater are common with this problem (Fuchs, 1983; Fuchs, Brandes, & Peretz, 1967; Fuchs, Paldi, Abramovici, & Peretz, 1980; Henker, 1976).

Another important area of hypnosis application is in the care of patients with problems of premature labor. The incidence of premature labor has not decreased significantly in recent years (Caritis, Edelstone & Mueller-Heubach, 1979), despite advances in technology; hypnosis has the potential to enhance patient care and minimize risks and expenses for such patients. Hypnosis and self-hypnosis training may modify negative attitudes, anxi-

eties and fears concerning childbirth. Zimmer, Peretz, Eyal and Fuchs (1988) recently found that mothers who used hypnosis for anxiety and stress management had fetuses who moved in a much more active manner than a control group.

More impressively, Omer (1987) and Omer, Friedlander and Palti (1986) have documented that brief hypnotic interventions produced significantly greater prolongation of pregnancy in women with premature labor than a medication treatment group, confirming earlier case reports (Lugan, 1963; Schwartz, 1963). Omer's approach to managing premature labor is presented later in this chapter.

Finally, it should be noted that hypnosis has also been used to promote and to suppress lactation (August, 1961; Cheek & LeCron, 1968; Kroger, 1977) in obstetrical patients.

Like any other therapeutic method, hypnosis has limitations. Obstetrical hypnosis requires that the patient have some hypnotic training prior to delivery, and, of course, not all patients will be adequately responsive to hypnosis. However, group hypnotic training is often conducted in a way that enhances rapport and satisfaction with patients and requires minimal time.

Hypnosis has also been used to treat a variety of gynecologic complaints. I have personally found hypnosis to be of considerable benefit in evaluating and treating dyspareunia (painful intercourse), and I have successfully treated (with long-term follow-ups) several chronic and resistant vaginitis (vaginal infection) cases. Hypnosis has been successfully used in the treatment of dysmenorrhea (painful menstruation) (Leckie, 1964), amenorrhea (Crasilneck & Hall, 1985; Erickson, 1960; Van der Hart, 1985), leukorrhea (vaginal discharge) (Leckie, 1964), pseudocyesis (false pregnancy), and post-menopausal symptoms (Crasilneck & Hall, 1985).

In approximately 50% of infertility cases the cause cannot be determined. It is widely believed that a proportion of these cases result from psychological factors — a belief that is reinforced by the common experience of couple's finally adopting a child out of frustration, only to conceive a child of their own a few months later. Unfortunately, we only have uncontrolled and anecdotal case reports (e.g., August, 1960b; Leckie, 1965; Muehleman, 1978; Wollman, 1960) of the potentially positive impact of hypnosis with resistant infertility. This is an area of potentially fruitful research.

We should also be aware that there is a variety of painful gynecologic procedures for which hypnotic analgesia may be helpful. Finally, there are several well-done investigative reports (Stalb & Logan, 1977; Willard, 1977; Williams, 1973) documenting that hypnosis may be used to induce breast growth. We do not yet know whether this phenomenon is mediated through vascular flow changes, endocrine effects, or a combination of the two, but it illustrates the power of mind-body interaction.

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