***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth . This may increase the risk of associated complications and a less satisfactory birth experience . Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth . This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy . Methods / design A single centre , r and omised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia . Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement ; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy ; Group 3 participants  continue with their usual preparation for childbirth with no additional intervention . Women > 34 and < 39 weeks gestation , planning a vaginal birth , not in active labour , with a singleton , viable fetus of vertex presentation , are eligible to participate . Allocation concealment is achieved using telephone r and omisation . Participants assigned to hypnosis groups commence hypnosis training as near as possible to 37 weeks gestation . Treatment allocations are concealed from treating obstetricians , anaesthetists , midwives and those personnel collecting and analysing data . Our sample size of 135 women/group gives the study 80 % power to detect a clinical ly relevant fall of 20 % in the number of women requiring pharmacological analgesia – the primary endpoint . We estimate that approximately 5–10 % of women will deliver prior to receiving their allocated intervention . We plan to recruit 150 women/group and perform sequential interim analyses when 150 and 300 participants have been recruited . All participant data will be analysed , by a research er blinded to treatment allocation , according to the " Intention to treat " principle with comprehensive pre-planned cost- benefit and subgroup analyses . Discussion If effective , hypnosis would be a simple , inexpensive way to improve the childbirth experience , reduce complications associated with pharmacological interventions , yield cost savings in maternity care , and this trial will provide evidence to guide clinical practice BACKGROUND The use of negative words , such as ' sting ' and ' pain ' , can increase patient pain and anxiety . We aim ed to determine how pain scores compare with comfort scores and how the technique of pain assessment affects patient perceptions and experiences after operation . METHODS After Caesarean section , 300 women were r and omized before post-anaesthesia review . Group P women were asked to rate their pain  on a 0 - 10-point verbal numerical rating scale ( VNRS ) , where ' 0 ' was ' no pain ' and ' 10 ' was ' worst pain imaginable ' . Group C women were asked to rate  comfort  on a 0 - 10-point VNRS , where ' 0 ' was ' no comfort ' and ' 10 ' was ' most comfortable ' . All women were asked whether the Caesarean wound was bothersome , unpleasant , associated with tissue damage , and whether additional analgesia was desired . RESULTS The median ( inter-quartile range ) VNRS pain scores was higher than inverted comfort scores at rest , 2 ( 1 , 4 ) vs 2 ( 0.5 , 3 ) , P=0.001 , and movement , 6 ( 4 , 7 ) vs 4 ( 3 , 5 ) , P<0.001 . Group P women were more likely to be bothered by their Caesarean section , had greater VNRS ' Bother ' scores , 4 ( 2 , 6 ) vs 1 ( 0 , 3 ) , P<0.001 , perceived postoperative sensations as ' unpleasant ' [ relative risk ( RR ) 3.05 , 95 % confidence interval ( CI ) 2.20 , 4.23 ] , P<0.001 , and related to tissue damage rather than healing and recovery ( RR 2.03 , 95 % CI 1.30 , 3.18 ) , P=0.001 . Group P women were also more likely to request additional analgesia ( RR 4.33 , 95 % CI 1.84 , 10.22 ) , P<0.001 . CONCLUSIONS Asking about pain and pain scores after Caesarean section adversely affects patient reports of their postoperative experiences British physician , Dr. Grantly Dick-Read , was the first to suggest the “ fear-tension-pain ” cycle in his work Natural Childbirth ( 1933 ) . As a result of his underst and ing of how this cycle affected birthing , he recommended women prepare for childbirth . Research studies from around the world have shown that the use of hypnosis for childbirth results in : ∗ shorter labors ∗ reduced use of pain medication ∗ higher Apgar scores ∗ reduced cesarean and forceps Negative or harsh words such as ‘ pain ’ and ‘ sting ’ used to describe sensations prior to potentially painful procedures have been shown to increase pain . We aim ed to determine whether the reporting of pain and its severity is affected by the way it is assessed during anaesthesia follow-up after caesarean section . Following caesarean section , 232 women were r and omised prior to post-anaesthesia review . Group N participants were asked questions containing the negative word ‘ pain ’ , “ Do you have any pain ? ” and then asked to rate it on a 0 to 10 point Verbal Numerical Rating Scale . Group P participants were asked questions using more positive words , “ How are you feeling ? ” and “ Are you comfortable ? ” . Data are presented as median , interquartile range . In Group N , 63 participants ( 54.3 % ) reported pain compared with only 28 participants ( 24.1 % ) in Group P ( P < 0.001 ) . There were no significant differences between groups for Verbal Numerical Rating Scale at rest : Group N 2 ( 0 to 3 ) vs Group P 1 ( 0 to 4 ) ; P=0.97 , or Verbal Numerical Rating Scale with movement , Group N 5 ( 3 to 6 ) vs Group P 5 ( 3 to 6.3 ) ; P=0.90 . The assessment of pain after caesarean section , using more positive words , decreases its incidence but does not affect its severity when measured by pain scores . Words that focus the patient on pain during its assessment may lead some to interpret sensations as pain which they might not do otherwise . These findings may have important implication s when assessing and research ing postoperative pain The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women . Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task . Half of the Ss in each group received a hypnotic induction at the beginning of each session ; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education . Both hypnotic Ss and highly susceptible Ss reported reduced pain . Hypnotically prepared births had shorter Stage 1 labors , less medication , higher Apgar scores , and more frequent spontaneous deliveries than control Ss ' births . Highly susceptible , hypnotically treated women had lower depression scores after birth than women in the other 3 groups . We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study BACKGROUND Childbirth is a dem and ing event in a woman 's life . The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience . METHOD In a r and omized , controlled , single-blinded trial , 1,222 healthy nulliparous women were allocated to one of three groups during pregnancy : A hypnosis group participating in three 1-hour sessions teaching self-hypnosis to ease childbirth , a relaxation group receiving three 1-hour lessons in various relaxation methods and Mindfulness , and a usual care group receiving ordinary antenatal care only .  Wijmas Delivery Expectancy/Experience Question naire ( W-DEQ ) was used to measure the childbirth experience 6 weeks postpartum . RESULTS The intention-to-treat analysis indicated that women in the hypnosis group experienced their childbirth as better compared with the other two groups ( mean W-DEQ score of 42.9 in the Hypnosis group , 47.2 in the Relaxation group , and 47.5 in the Care as usual group ( p = 0.01 ) ) . The tendency toward a better childbirth experience in the hypnosis group was also seen in subgroup analyses for mode of delivery and for levels of fear . CONCLUSION In this large r and omized controlled trial , a brief course in self-hypnosis improved the women 's childbirth experience & NA ; Sixty‐one patients clearly diagnosed as suffering from Temporo‐M and ibular Pain and Dysfunction Syndrome ( TMPDS ) were r and omly assigned to one of three groups , 1 ) hypnosis and cognitive coping skills , 2 ) relaxation and cognitive coping skills , or 3 ) a no‐treatment control group . All patients were evaluated with a st and ard hypnotic susceptibility scale before treatment . The two treatment groups received four weekly sessions of their respective treatments . Patients in the hypnosis and relaxation groups reported equivalent decrements in pain , abnormal sounds in the temporom and ibular joint , and limitations of jaw mobility . Hypnotic susceptibility was significantly correlated with reductions in reported pain for the treatment groups . Patients ' age and the duration of pain before treatment were not related to treatment outcome . Patients who dropped out of treatment had fewer limitations in jaw movement but did not differ in any other variable from patients who remained in treatment . These findings are discussed in relation to the hypothesis that Temporo‐M and ibular Pain and Dysfunction Syndrome is stress‐related muscular pain and dysfunction Abstract Prior research by the author showed that psychosocial factors distinguished complicated from uncomplicated birth outcome . The purpose of this study was to determine if prenatal hypnosis could facilitate  uncomplicated birth .  Following a psychosocial assessment , 520 pregnant women in their first or second trimester of pregnancy were r and omized to receiving prenatal hypnosis or attention-only groups .  The author provided all of the hypnosis in a manner similar to that taught by David Cheek . The goal was to reduce fear of birth and parenthood ; to reduce anxiety ; to reduce stress ; to identify specific fears that might complicate the labor process ( addressing them whenever possible ) ; and to prepare women for the experience of labor . The attention-only group was matched to a no-contact comparison group . Women receiving prenatal hypnosis had significantly better outcomes than women who did not . Further assessment suggested that hypnosis worked by preventing negative emotional factors from leading to an complicated birth outcome . Attention only was associated with minimal differences in outcome over the no-contact group . The routine prenatal use of hypnosis could improve obstetric outcome Comparaison de 29 primipares preparees avec un entrainement d'auto-hypnose et 36 preparees de facon traditionnelle . Les result ats indiquent que l'hypnose n'est pas significativement efficace en tant que method e d'analgesie , qu'elle donne cependant une amelioration de l'experience de l'accouchement , et qu'elle est peut-etre une cause de prolongement de la 
    Output:
    
There were no clear differences between women in the hypnosis group and those in the control groups for most of the other primary outcomes .
It should be noted that for pharmacological pain relief and spontaneous vaginal birth , there was evidence of considerable statistical heterogeneity , which could not be fully explained by subgroup analysis .For this review 's secondary outcomes , no clear differences were found between women in the hypnosis group and women in the control groups for most outcomes where data were available .
There was mixed evidence regarding benefits for women in the hypnosis group compared with all control groups for pain intensity , satisfaction with childbirth experience and postnatal depression .
Overall these new comparisons displayed much less statistical heterogeneity than the comparison including all control groups .
Hypnosis may reduce the overall use of analgesia during labour , but not epidural use .
No clear differences were found between women in the hypnosis group and those in the control groups for satisfaction with pain relief , sense of coping with labour or spontaneous vaginal birth .