When I initially began using hypnosis, I treated patients on an individual basis. But after the original fascination wore off, I discovered that I was using up too much time. Therefore, I adopted a group training model with which I have been very pleased.
I consider the following aspects most important:
2. I spend one and a half hours twice a month with the group and this allows a larger number of patients to achieve a greater depth in the hypnosis and to be exposed to a greater variety of techniques.
3. The patients are able to exchange experiences in the group.
4. The answers to questions by any member of the group help the entire group.
5. The spirit of competition helps some patients to attain a greater depth.
6. Group preparation is stressful for some patients. However, if patients who are rather anxious in groups are still able to achieve a hypnotic state under these conditions, they will have a better chance of achieving it in labor, which is another stressful condition.
7. The classes give a much better chance to educate the patient about the misconceptions that make labor and delivery such an ordeal.
problems amenable to hypnosis. If I were to take time with each patient referred or asking for help with hypnosis, I would have to give up obstetrics and gynecology. However, I can accommodate a great number of these patients by teaching them hypnotic techniques in the group situation and then spending a short period of time with them on an individual basis.
I make no effort to induce my patients to use hypnosis. However, because of past patients who have used hypnosis and referrals for hypnosis, I still have a great many who choose this modality. Because of the understanding of hypnosis that the teachers of Lamaze have in our area, they no longer resist the use of hypnosis. At one time they felt that if a woman was using Lamaze she was controlling the situation, but if she was using hypnosis she was under someone else's control. I was able to demonstrate to them that their use of methods like eye fixation and breathing and counting were actually self-hypnosis. I helped them realize that no one actually hypnotizes a patient, but that we are teaching women how to go into a hypnotic state and use it for their own benefit.
I use a permissive approach with my patients. They are invited to come in and observe at least one class. At this time every effort is made to correct any misconceptions they may have concerning hypnosis and to give them a basic understanding of how hypnosis can be beneficial for them. It is explained that only 20%-35% of patients are able to go through labor and delivery using hypnosis alone. However, it is explained that, if they do need medication or anesthesia, less will be required than without hypnosis. They are informed that if they do not feel completely relaxed they may ask for medication to help them. They are told that they never have to feel that they are letting me down if they do not use hypnosis all through the delivery. After all, they are using hypnosis for their benefit, not mine.
I no longer use any one particular induction technique; rather, I seek to fit the technique to the individual. But, since I am using a group approach with about 20-25 patients, I have them close their eyes and I tend to use a counting technique, counting backwards from 100 to 0.1 go from 100 to 80 in increments of 1, and then from 80 to O in increments of 5.1 also offer suggestions after each count of 20. After counting down to 0, I ask them to picture themselves doing something they would find particularly enjoyable. It is suggested that, as this becomes more and more vivid, they can go deeper and deeper.
I no longer use dissociation to imaginal scenes during delivery. I used that technique in the very beginning. However, it seems silly to me to have a woman taking an imaginal trip 1,000 miles away on a beach, or even imagining sitting in a chair observing the birth process, while she is delivering. I believe that she should know that she is having a baby but that it does not have to be painful. Nevertheless, dis-sociational procedures are valuable when repairing an episiotomy, although even in this situation I give patients a choice of technique. I ask, "Do you want to simply picture yourself doing something enjoyable or do you want me to use a local anesthetic?"
The verbalizations I use for obstetrical patients vary with the problems. I usually give the following suggestions at every 20 number interval (e.g., at 80, 60, 40, 20, and 0) during the counting technique.
"The remainder of your pregnancy will be so much better. Your labor will be shorter, easier and safer. Your stay in the hospital will be so much better. When you are in labor and when you are in the hospital, you can use your contractions to get more and more relaxed, and to make every muscle in your bottom nice and numb, loose and relaxed. [These are the muscles that have to relax when the head is coming down and delivering.] If I put my hand (or if the nurse or your husband puts a hand) on your shoulder, you can use this as a signal to go deeper and deeper."
While the patients are deeply relaxed they are told about the "breakthrough periods," and how to use them to their advantage. First, when they are 6-7 cm. dilated, they may feel discouraged and that they are not getting anywhere or that no one is paying much attention to them. They may even feel nauseated. It is explained that if they are checked at this time and found to be 6-7 cm. dilated, then they should know that within a half an hour or less they will be completely dilated.
The second "breakthrough period" is just before they are completely dilated. They feel like pushing and if they push they feel uncomfortable because they are pulling down the whole uterus. It is not helpful to tell them not to push; instead they are told to take in a big breath and let it all out, or pant like a puppy, and then they cannot push. The last "breakthrough" is when the head comes through the cervix. Sometimes this occurs suddenly and with great force. They are told that this is what they were waiting for. If they have had a baby before, they will be ready to deliver in three or four contractions. If this is their first baby, they can use the contractions. "By pushing down, the more you push, the better it feels. And with each contraction, you can relax more and more, and make all the muscles in your bottom nice and numb, and loose and relaxed."
Patients are also told that when their contractions are 10 minutes or less apart, they should get ready to go to the hospital. "And when you get in the car, you can feel just as if you are sitting in this chair. And by merely putting your right hand on your left shoulder, and closing your eyes, picturing a color, and taking a deep breath, as you gradually let that breath out, and that hand sinks all the way to your side, you will be deeply relaxed." Patients are told to repeat the self-hypnotic induction again in the prep room to make the prepping and examination comfortable. "And each contraction and each background sound or noise will simply help you stay more relaxed." They are further told, "The remaining part of your pregnancy will be so much better. Your labor will be shorter, easier and safer, and your stay in the hospital will be so much better." They are also instructed to practice self-hypnosis.
I stress relaxation primarily, but glove anesthesia may be produced during a group session and transferred to the chin with suggestions to keep the numbness in the chin for five minutes after alerting from trance. This serves the purpose of providing trance ratification. It is pointed out that they can transfer the numbness anywhere.
I seek to see the patient in labor when she is 2V2-3 cms. dilated. If I am delayed, however, our nurses and residents are familiar with supportive measures and are very helpful. If the patient is having difficulty relaxing, the resident usually asks what method she uses to relax, and during the process of explaining her self-hypnotic technique, the patient will usually induce a hypnotic state. If the patient needs medication it will usually not be until shortly before delivery, and then in most cases she will only require 25 mg. IV of Demerol.
suggestions for hyperemesis. "You can replace the dirty metallic taste in your mouth with a minty taste or the taste of your favorite toothpaste. And as you relax more and more, all your muscles will be twice as relaxed and your circulation improves on the inside and outside of your body, especially through your intestinal tract. As the circulation improves, all the peristaltic waves, the waves that move the food along the intestine, will be nice and smooth, beginning with the esophagus, the tube from the back of your throat to your stomach. And the food will go down nice and easy, and be broken up in the stomach and passed to the small bowel to be digested and absorbed. All the peristaltic waves will be nice and smooth. Each time you brush your teeth, you will reinforce the nice relaxed feeling and have this pleasant taste in your mouth."
excess fluids. "As the muscles relax more and more, the circulation improves on the inside and outside of the body, bringing the fluid back into circulation from the tissues, and helps the kidneys to work more effectively."
headaches. "As the muscles relax, the circulation improves on the inside and outside of the body, especially through the brain. And since the circulation is normal, the vessels will not dilate or constrict; therefore, there should be no headaches."
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Hypnosis is a capital instrument for relaxation and alleviating stress. It helps calm down both the brain and body, giving a useful rest. All the same it can be rather costly to hire a clinical hypnotherapist, and we might not always want one around when we would like to destress.