Rumor has it that Duchess of Sussex Meghan Markle, who gave birth on May 6, used hypnobirthing – a technique that aims to ease the pain and anxiety associated with childbirth by using hypnosis, deep breathing, visualization, meditation and other techniques.

The method, which dates back to the 1950’s but was popularized in the 1980’s, appears to have gained the most traction in the United Kingdom and Europe, according to Dr. Kathleen Beebe, Ph.D., R.N., a professor of nursing at Dominican University of California. Though some evidence suggests it might be catching on in the United States, too. Few studies on hypnobirthing’s popularity exist, but one nationally representative survey of 2,400 American mothers who gave birth between 2011 and 2012 found that slightly more than one-fifth used mental strategies such as relaxation, visualization or hypnosis during childbirth.

What exactly is hypnobirthing, anyway; and how does it work? Does it actually make labor any easier? Although it makes intuitive sense that a woman deeply focused on something else might not experience labor pain as acutely, the research isn’t quite so tidy.

The Power of Hypnobirthing by| Bee Ting Ng

The purported benefits

The term “hypnosis” – first coined in the 19th century and named after Hypnos, the Greek god of sleep – typically describes a state of altered consciousness, similar to daydreaming, in which you’re feeling deeply focused and attentive. When you’re hypnotized by a hypnotist or by yourself (the latter of which is a process known as self-hypnosis), the thinking goes, you become more responsive to guidance or suggestions from within or from others.

Hypnosis has been used for centuries to treat everything from mental illness to pain during surgery, but it wasn’t until the 1950’s when hypnotherapists started promoting its use to ease the pains of labor and birth. In 1989, hypnotherapist Marie Mongan developed a program called HypnoBirthing, which posits that fear and anxiety can heighten the experience of pain; and that techniques such as meditation, guided imagery, deep breathing and hypnosis can plunge you into a state of deep relaxation before and during labor, helping you become less fearful of it. Once women free themselves of this fear, the thinking goes, their bodies will relax and childbirth will be less painful.

To this end, women in HypnoBirthing classes are taught to think of aspects of labor differently. Contractions become “uterine waves,” while pushing becomes “birth breathing.” By re-framing these processes in more pleasant and familiar terms, women may experience them differently — and less painfully.

Women are also taught to imagine scenarios that will help them relax and feel less pain. One such technique is called the “silver glove technique,” in which women imagine donning a silver glove that causes their hand to tingle, go numb and relax. Then they visualize that feeling traveling up their arm. They can also spread the numbness around by envisioning their hand touching other body parts.

Mongan’s HypnoBirthing program involves a series of five, 2.5-hour classes and is available in 45 countries. Other, similar, programs include Hypnobabies and the LeClaire Method. Some women may circumvent these programs altogether by developing individualized labor plans with independent hypnotherapists.

Class packages for the three main programs can range in price from about $250 to $700, and some health insurance providers at least partially reimburse the costs.

But does hypnobirthing actually make birth easier?

On this question, findings are mixed. A 2016 Cochrane review of nine clinical trials involving nearly 3,000 women reported that those who used hypnosis did not report less pain or more satisfaction with their birth experience than women who didn’t.

Some programs claim that self-hypnosis can not only be a panacea for pain and fear, but can also reduce the number of medical interventions needed during labor. The HypnoBirthing Institute reported in 2011, for instance, that those who went through its program were less likely to have C-sections, episiotomies (surgical cuts to enlarge the opening of the vagina) or continuous fetal monitoring during labor when compared to American mothers who hadn’t used hypnobirthing. But this finding wasn’t published in a peer-reviewed journal. And with statistics like these, selection bias can be a problem, too: Women who choose (and can afford) to take these childbirth classes may be healthier or have lower-risk pregnancies than average.

Additionally, the Cochrane review found that women who used hypnosis during labor were no less likely to have C-sections than women who didn’t; and while they were 27 percent less likely to use pain-relieving drugs such as nitrous oxide and narcotics overall, they were just as likely to get epidurals. (Women were randomly sorted into the hypnosis groups or the control groups to prevent selection bias.)

Still, some research suggests that women who used self-hypnosis during labor are happy they did. In a 2015 clinical trial involving 680 women, researchers found that those who self-hypnotized felt less afraid and anxious during labor than they’d expected to. Most also later reported having had positive experiences, saying that hypnosis helped them feel calm, confident and empowered before and during their births. “They had started off as being skeptical, but they ended up being really positive about the technique, as did their partners,” said Dr. Soo Downe, Ph.D., one of the clinical trial’s authors and a professor in midwifery studies at the University of Central Lancashire in the United Kingdom. “Many continued to use it after the births of their babies.”

According to the Cochrane review, however, the existing research on hypnosis during labor is weak and difficult to interpret, so it’s hard to make any clear conclusions without more and better research. It’s also a challenging method to study, since researchers can’t control how effective pregnant women and their instructors are at the technique, and hence how well their self-hypnosis works. A woman’s experience with hypnosis might also be shaped by her environment: Frequent interruptions in a hospital or birthing center, such as hourly check-ins or exams, can hinder her ability to stay focused, which “runs counter to hypnosis success,” Dr. Beebe said.

Additionally, hypnosis may not be for everyone. In rare cases, it can cause headaches and dizziness for unknown reasons; and there’s evidence that among women with a history of mental illness, hypnosis may exacerbate certain symptoms, such as psychosis. Another potential problem is that women using self-hypnosis can be so calm and quiet during labor that doctors and nurses may assume that they’re earlier along in their labor than they actually are. “Staff need to carefully assess labor progress in these women, even if they seem to be very calm and relatively pain free,” Dr. Downe said.

In the end, the decision to try self-hypnosis is an individual one, and it depends on the kind of birth you want and your priorities (though you should always consult with your provider before trying it). Although, of course, births do not always go as planned. If you and your doctor feel it’s safe and you want to try hypnobirthing, why not? And if you want an epidural, that’s O.K. too.