• S Downe, K Finlayson, C Melvin, H Spiby, S Ali, P Diggle, G Gyte, S Hinder, V Miller, P Slade, D Trepel, A Weeks, P Whorwell, and M Williamson.
• Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK.
• BJOG. 2015 Aug 1;122(9):1226-34.

Objective(Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use.DesignMulti-method randomised control trial (RCT).SettingThree NHS Trusts.PopulationNulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness.MethodsRandomisation at 28-32 weeks' gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks' gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal.Main Outcome MeasuresPrimary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis.ResultsSix hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64-1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference -0.72, 95% CI -1.16 to -0.28, P = 0.001); fear (mean difference -0.62, 95% CI -1.08 to -0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: 'Mean difference' replaced 'Odds ratio (OR)' in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI -£257.93 to £267.59).ConclusionsAllocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation.© 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

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