A pilot study was conducted to investigate whether psychobiosocial intervention could be a useful adjunct to medical management of premature labor. 44 women threatening premature delivery (range of 20 to 34 weeks gestation) were referred by hospital clinicians. Nineteen of these patients were hospitalized, 28 were on tocolytic medication, and 42 on total bedrest. Hypnosis was used with all subjects; 77% also received body awareness techniques designed to decrease autonomic reactivity and muscle tension. Average treatment was seven two-hour sessions over three weeks. Forty women (91%) progressed to term; three who did not had twins and one patient, who was at 4 cm. dilation when diagnosed, received only one hypnosis session. Common issues expressed during hypnosis, their impact on the pregnancy, and how they were modified are discussed. The positive results of this study suggest that a randomized, controlled trial of psychobiosocial interventions during premature labor is warranted.
1. Herron MA, Katz M, Creasy RC. Evaluation of a preterm birth prevention program: Preliminary report. Obstet & Gynecol 1978;59:452-456.
2. Committee to Study the Prevention of Low Birthweight. Preventing Low Birthweight Washington, D.C.: Institute of Medicine, 1986.
3. 1983 United Nations Demographic Yearbook, cited in Preventing Low Birthweight
4. Simon, cited in Preventing Low Birthweight.
5. Goldberg S. Premature birth: Consequences for the parent-infant relationship. In Fitzgerald H., Carr T eds. Human Development 83/84. Guildford, CT: The Dushkin Publishing Group, Inc., 1983.
6. Ferreira R. Emotional factors in the prenatal environment. J. Nervous & Mental Disorders 1965;141:108-114.
7. McDonald RL, Gunther M, Christakes A. Relations between maternal anxiety and obstetrical complications. Psychosom Med 1963;27:383-390.
8. Levinson G, Schnider S. Catecholamines: The effects of maternal fear and its treatment on uterine function & circulation. Birth & the Family J 1979; 6(3):167-174.
9. McDonald RL. Personality characteristics in patients with three obstetrical complications. Psychosom Med 1965;27:383-390.
10. Newton RW, Webster PAC, Sunu PS et al. Psychosocial stress during pregnancy and its relation to the onset of premature labor. British Med J 1979;2:411-414.
11. Gunther LM. Psychopathology & stress in the life experience of mothers of premature infants. Am J Obs & Gynecol 1963;86:333-339.
12. Blau A, Staff B, Easton K et al. The psychogenic etiology of premature birth. Psychosom Med 1963;25:201-210.
13. Klein H, Potter H, & Dyke R. Anxiety in Pregnancy & Childbirth. New York: Hueber, Inc., 1950.
14. Newton N. Maternal Emotions. New York: Hueber, Inc., 1955.
15. Omer H, Barnea T, Elizur Y, et al. in Omer H. Possible psychophysiologic mechanisms in premature labor. Psychosomatics 1986;27:580-584.
16. Omer H, Friedlander D, Palti Z. in Omer H. Possible psychophysiologic mechanisms in premature labor. Psychosomatics 1986;27:580-584.
17. Berkowitz GS, Kassi SV. The role of psychological factors in spontaneous preterm delivery. J Psychosom Res 1983;27:283-290.
18. Berkowitz GS. An epidemiological study of preterm delivery. Am J Epidemiology 1981;113:81-92.
19. Frederick J, Anderson ABM. Factors associated with spontaneous preterm birth. Br J Obstet Gynaecol 1976;83:342-349.
20. Karltreyder DF, Kohl S. Epidemiology of preterm delivery. Clin Obstet Gynecol 1980;23:17-31.
21. Herms V, Gabelman J. Psychosomatische aspekte vorzeitig wehen. Z. Geburtshilfe Perinatal 1982;186:50-54.
22. Mehl LE, Peterson GH, Whitt M, Hawes W (1977). Outcomes of 1146 elective homebirths. J Reprod Med 1977;19(3):281-290.
23. Mehl LE. Psychophysiological aspects of the birth process. In Fehner L. The Psychology of Birth. London: Souvenir Press, 1979.
24. Peterson GH, Mehl LM Pregnancy as Healing Vol I. Berkeley: Mindbody Press, 1985.
25. Peterson GH, Mehl LM Pregnancy as Healing Vol II. Berkeley: Mindbody Press, 1986.
26. Mehl LE, Donavan S, Peterson GH. The role of hypnotherapy in preventing birth complications. In: Fedor-Freyburgh P., ed. Encounter with the Unborn. London: Panteon, 1988.
27. Bickers W. Uterine contraction patterns: Effects of psychic stimuli on the myometrium. Fertil Steril 1956;7:268-275.
28. Frohlich H. Steuermechanismen der motilitat des nichtgraviden uterus in situ. Wein Klin. Wochenscri 1986 (suppl 24):1-28.
29. Birkmayer W. Correlations between muscle tone & psyche. In: Kielholz P, chairman. Anxiety and Tension-New Therapeutic Aspects. An Internal Symposium. Basel: Ciba, 1970;29-35.
30. Mason JW. Clinical psychophysiology: Psychoendocrine mechanisms. In Arieti S (ed) American Handbook of Psychiatry. New York: Basic Books, Vol. 1, 1975, 553-582.
31. Mason JW. A review of psychoendocrine research on the sympathetic-adrenal medullary system. Psychosom Med 1968;30:576-601.
32. Kelly D. Anxiety and Emotions. Springfield, IL: Charles C. Thomas, 1980.
33. Wyatt RJ, Portnoy B, Kupfer DJ et al. Resting polasma catecholamine concentrations in patients with depression and anxiety. Arch. Gen. Psychiatry 1971;24:65-70.
34. Matthew RJ, Ho HBT, Kralik P, et al. Catecholamines and monoamine oxidase activity in anxiety. Acta Psychiatr. Scand. 1981;63:245-252.
35. Danforth, DN. Obstetrics and Gynecology. Philadelphia: Harper and Row, 1982.
36. Omer H. Possible psychophysiologic mechanisms in premature labor. Psychosomatics 1986;27:580-584.
37. Lederman RP, Lederman E, Work BA, et al. The relationship of maternal anxiety, plasma catecholamines, and plasma Cortisol to progress in labor. J. Obstet. Gynecol 1978;132:495-500.
38. Ishikawa M, Fuchs A. Effects of epinephrine and oxytocin on the release of prostaglandin F from the rat uterus in vitro. Prostaglandins 1978;15:89-101.
39. Tothill A, Rathbone L, Willman F. Relation between prostaglandin E2 and adrenaline reversal in the rat uterus. Nature 1971; 233:56-57.
40. Terman GW, Shavit Y, Lewis JW, et al. Intrinsic mechanisms of pain inhibition: Activatino by stress. Science 1986;226:1270-1277.
41. Selye H. Stress in Health and Disease. Boston: Butterworths, 1976.
42. Lang RE, Jurgen WEH, Ganten D, et al. Oxytocin unlike vaspressin is a stress hormone in the rat. Neuroendocrinology 1983;37:314-316.
43. Caldyro-Barcia R, Sica-Bianco Y, Pseiro JJ. A quantitative study of the action of synthetic oxytocin on the pregnant human uterus. J Pharmacol Exp. Ther. 1957;121:18-25.
44. Takahashi K, Diamond F, Bieniarz J, et al. Uterine contractilitly and oxytocin sensitivity in preterm, term, and post-term pregnancy. Am. J. Obstet Gynecol 1980;136:774-779.
45. Eipper H, Konnecke P. Rheobasenmessung bei drohender fruhgeburt. Zentralbl Gynakol 1980;102:1170-1174.
46. Konig U, Seidenschnur G. Der stellenwert der rheobasenmessugn zur erfassugn und kontrolle einer vorzeitigen wehentatigkeit. Zbl Gynakol 1980;102:1362-1371.
47. Nieder VW, Jager KH, Backhaus R. Einfache geratekombination zur objectivierung der rheobasemessung. Zbl Gynakol 1980;102:1372-1374.
48. Kochenstein P. Methodenkritische betrachtung zur rheobasendiagnostik. Geburtsh u Frauenheilk 1982;42:361-366.
49. Herms V. Psychosomatisch aspeckte vorzeitiger wehen. Post-doctoral dissertation, University of Heidelberg, 1980.
50. Peterson GH. Birthing Normally. Berkeley: Mindbody Press, 1984.
51. Mehl LE, Peterson GH. The Language of the Body: Hypnosis, healing, & physical illnesses. New York: Irvington, 1988.
52. Personal communication, Dr. Robert Creasy, 1988.
53. Personal communication, Dr. Marshall Klaus, 1988.
Lewis E. Mehl, M.D., Ph.D.
The author gratefully acknowledges the help of graduate students Michael Rabinoff, Leslie Bowman, and Ann Rawley Karlen, who assisted him with literature review and tracking references. He also acknowledges the involvement of the following clinicians in the clinical treatment that was provided to the patients: Robert Levine, Leslie Bowman, Gayle Peterson, Dr. Gilbert Lanese, Dr. Susan Strong, Wynn Tamura, Angelina Borbon, and Kate Amatruda. This paper was presented at the 4th biennial conference of the Preand Peri-natal Psychology Association of North America, San Francisco, California, July, 1987. Address communication to Dr. Mehl at: Health Resources Group, 3699 Clay Street, Suite 2, San Francisco, CA 94118.
JOURNAL OF PRENATAL AND PERINATAL PSYCHOLOGY AND HEALTH publishes research and clinical articles from the cutting edge of the science of prenatal and perinatal psychology and health. The journal, published quarterly since 1986, is dedicated to the in-depth exploration human reproduction and pregnancy and the mental and emotional development of the unborn and newborn child.