Summary of findings for the main comparison. Self‐hypnosis or hypnotherapy versus all for management of pain during labour and childbirth.
| Self‐hypnosis or hypnotherapy versus all for management of pain during labour and childbirth | ||||||
| Patient or population: pregnant women Setting: Australia, Denmark, UK, USA Intervention: self‐hypnosis or hypnotherapy Comparison: standard care (including supportive counselling, relaxation) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with all | Risk with Self‐hypnosis or hypnotherapy | |||||
| Use of pharmacological pain relief/anaesthesia | Study population | average RR 0.73 (0.57 to 0.94) | 2916 (8 studies) | ⊕⊝⊝⊝ very low1, 2 | ||
| 608 per 1000 | 444 per 1000 (347 to 572) | |||||
| Moderate | ||||||
| 673 per 1000 | 491 per 1000 (384 to 633) | |||||
| Satisfaction with pain relief (number of women who reported that they felt they had adequate pain relief) |
Study population | RR 1.06 (0.94 to 1.20) | 264 (1 study) | ⊕⊕⊝⊝ low3,4 | ||
| 773 per 1000 | 820 per 1000 (727 to 928) | |||||
| Satisfaction with pain relief (reported 2 weeks postnatal) ‐ Pethidine Seven‐point scale: 7 = most satisfaction |
The mean satisfaction with pain relief score was 4 in the control group | The mean satisfaction with pain relief score in the hypnosis group was 0.41 points more (1.27 higher to 0.45 lower) | 72 (1 study) | ⊕⊕⊝⊝ low3,4 | Higher score indicates more satisfaction with pain relief | |
| Satisfaction with pain relief (reported 2 weeks postnatal) ‐ Entenox Seven‐point scale: 7 = most satisfaction |
The mean satisfaction with pain relief score was 4.07 in the control group | The mean satisfaction with pain relief score in the hypnosis group was 0.19 points more (0.57 higher to 0.19 lower) | 357 (1 study) | ⊕⊕⊝⊝ low3,4 | Higher score indicates more satisfaction with pain relief | |
| Satisfaction with pain relief (reported 2 weeks postnatal) ‐ Self‐hypnosis Seven‐point scale: 7 = most satisfaction |
The mean satisfaction with pain relief score was 4.04 in the control group | The mean satisfaction with pain relief score in the hypnosis group was 0.28 points more (0.88 higher to 0.32 lower) | 160 (1 study) | ⊕⊕⊝⊝ low3,4 | Higher score indicates more satisfaction with pain relief | |
| Satisfaction with pain relief (reported 2 weeks postnatal) ‐ Epidural Seven‐point scale: 7 = most satisfaction |
The mean satisfaction with pain relief score was 6.55 in the control group | The mean satisfaction with pain relief score in the hypnosis group was 0.03 points lower (0.34 higher to 0.40 lower) | 127 (1 study) | ⊕⊕⊝⊝ low3,4 | Higher score indicates more satisfaction with pain relief | |
| Satisfaction with pain relief (reported 2 weeks postnatal) ‐ Water immersion Seven‐point scale: 7 = most satisfaction |
The mean satisfaction with pain relief score was 4.94 in the control group | The mean satisfaction with pain relief score in the hypnosis group was 0.52 points higher (1.00 higher to 0.04 higher) | 174 (1 study) | ⊕⊕⊝⊝ low3,4 | Higher score indicates more satisfaction with pain relief | |
| Coping in labour | The mean coping in labour score was 5.29 in the control group | The mean coping in labour score in the hypnosis group was 0.22 points higher (0.14 fewer to 0.58 more) | 420 (1 study) | ⊕⊕⊝⊝ low3,4 | Coping in labour was measured on a seven‐point scale where 0 = extremely dissatisfied and 7 = extremely satisfied | |
| Spontaneous vaginal birth | Study population | average RR 1.12 (0.96 to 1.32) | 2361 (6 studies) | ⊕⊕⊝⊝ low5, 6 | ||
| 619 per 1000 | 693 per 1000 (594 to 817) | |||||
| Moderate | ||||||
| 560 per 1000 | 627 per 1000 (538 to 739) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Inconsistency: considerable heterogeneity evident ‐ I2 = 91% (‐2)
2 Design limitations: four of eight studies are at high/unclear risk for selection bias (‐1)
3 Design limitations: the one study contributing data had design limitations to do with lack of blinding of participants for this subjective outcome (‐1)
4 Imprecision: only one study with a small sample size (‐1)
5 Inconsistency: substantial heterogeneity evident ‐ I2 = 73% (‐1)
6 Design limitations: three of six studies are at high/unclear risk for selection bias; three of six studies are at high risk for detection bias (‐1)