Key learning points:
– Why are women choosing hypnobirthing and what are the origins?
– What do hypnobirthing women learn and what effect does it have?
– How can community midwives support hypnobirthing couples?
The current focus in best practice guides is on reducing the number of interventions and ensuring optimal outcomes for all women and babies, with a positive drive towards normalising birth.1,2,3
Many are now seeking ways to help women prepare for birth in a realistic, positive manner where the expectation is a ‘normal’ birth, with medicalisation being reserved for those who need it.
Over the last 10 years hypnobirthing has increased in popularity with women and midwives with some trusts now providing their own hypnobirthing services. The focus on birth as a natural process, substantiated with irrefutable physiological logic, and education surrounding childbirth choices makes it an attractive programme for those wishing to prepare fully for birth.
History and origins
Despite misconceptions about the word, hypnobirthing is “based on sound and irrefutable logic”.4
Grantly Dick Read5 observed that while most women he cared for as a physician had traumatic, agonising births, a few seemed to have seemingly painless, easy births. He hypothesised that the differences could be attributed to levels of fear, which led him to conclude that fear leads to tension, and that tension then inhibits the natural working of the muscles that leads to pain.4
These theories were supported with the discovery of the hormone oxytocin and the link between its production and the contractions of the uterus during labour and birth.6 It is known that triggering the sympathetic nervous system releases adrenaline, which actively counteracts oxytocin production.7
Michel Odent8 states that for women to birth easily “the neocortex… must not be stimulated” and that the “birth process must be protected… from all attention-enhancing situations, such as being exposed to language, feeling observed, or perceiving a possible danger”. The basis of hypnobirthing is that if fear surrounding childbirth can be reduced, the body is able to optimise the hormone production leading to an easier, ‘normal’ birth.
What does hypnobirthing entail?
Hypnobirthing provides education about the physiology of birth and how women can utilise that information to allow their body to work optimally in childbirth. It is not, as many believe, a form of pain relief because hypnobirthing works on the premise that when the body and hormones are working as nature intended, pain is unnecessary in birth. Couples are introduced to and encouraged to practice techniques that will allow them to achieve a deep state of relaxation easily.
During second stage labour women are encouraged to wait for passive descent rather than use the valvasa manoeuvre in accordance with the World Health Organization’s2 recommendation.
In modern western society our cultural conditioning is particularly negative in regards to childbirth. Media portrayal of birth and shared birth stories are stereotypically painful and traumatic, this often causes deep seated subconscious or conscious fears of birth. Hypnobirthing addresses these apprehensions using traditional hypnotherapy techniques similar to those used for reduction of anxiety or phobias. A number of programmes are available that provide basic principles of relaxation for labour, however others also provide information about choices available to women during pregnancy, birth and postpartum, including benefits and risks of homebirth, induction and augmentation. Parents are encouraged to take responsibility for their birth, build rapport with their caregivers and gather information to make informed choices.4
Hypnobirthing – the evidence
Studies on the use of hypnosis in childbirth have discovered that the benefits are multifaceted. A number of historical studies have shown that the average length of labour, particularly first stage, is significantly reduced in multi and prima gravidas.9,10 Most recent studies focus on the effects of hypnosis on the perception of pain, with significant reduction of the use of chemical analgesia.10,11,15,16
The Royal Wolverhampton Hospitals NHS Trust13 carried out a survey comparing hypnobirthing labours with the general population and found reduced emergency caesarean section rates from 15% to 4%. They also found that the occurrence of non-instrumental births in hypnobirthing mothers was 84% compared with the general population of 64%. A retrospective survey by Gallagher reported significant differences in epidural rates of 18% in hypnosis participants compared to 40 to 95% general rates for the area. Again, caesarean rates were reduced in the experimental group in comparison to the general population (6.7% compared with 20-25%).14
Spontaneous deliveries, higher apgar scores at birth and reduced medication use have been reported by Harmon et al and Vandevusse et al.15,16
Davidson11 claimed that there are greater implications for the use of hypnosis in childbirth than the analgesic reduction, as a significant number (70%) of hypnosis mothers reported to have found labour to be a pleasant experience with 53% reported no pain or only slight pain. This can be contrasted with the control group where 33% reported birth to be a pleasurable experience and 6% claimed to have felt no pain or only slight pain. This is supported by findings in Gallagher’s Retrospective Survey14 that showed 96% were pleased at the use of hypnosis, would use hypnosis as a subsequent birth and would recommend its use to other women. Current studies report similar findings of significant benefits to overall positive perceptions of birthing experiences.11,15,17
Davidson concluded as far back as 1962 that, “hypnosis should be used in obstetrics more widely than it is at present”.
Supporting hypnobirthing
Community midwives are in a prime position to assist couples wishing to use hypnobirthing for the birth of their baby. During antenatal appointments women are able to open dialogue with their midwife, gather information and consider options and preferences in accordance with the National Institute for Health and Care Excellence (NICE) guidelines.17
Birth is an incredible, transformative time and the circumstances surrounding parents during birth will remain with them forever. During an accredited hypnobirthing course couples are encouraged to consider the birth they would prefer, their birthing environment and identify information that will help them make informed choices.
At a hypnobirth, clinical requirements and professional responsibilities can be carried out with minor, if any, alterations to everyday practise.
Many of the suggestions outlined in the Royal College of Midwives’s Normality for Labour and Births1 are particularly useful at a hypnobirth.
Communication is a key factor in all literature regarding supporting women in labour.1,2,3,18 Reading or listening to birth preferences creates a feeling of partnership and confidence between the midwife and parents. Language is an important aspect of hypnobirthing with emphasis on the power of words on the body’s responses.19
Hypnobirthing advocates gentle, vernacular language and it can make an enormous difference. Language such as, ‘failure to progress’ or ‘malpositioned baby’ can bring doubt and fear into a mother’s mind. All hypnobirthing programmes discouraged the word pain as it will often sensitise a woman to the sensations that she is experiencing. The word contraction is also often replaced with a more neutral word, such as surge, wave or tightening.
Non-verbal language is another aspect of communication that labouring women in their ‘primal state’ are particularly sensitive to.
Although hypnobirthing couples will have a focus of a gentle and calm birth they will also be aware that sometimes there may be occasions to reassess their options. Couples who have trained with accredited practitioners will be flexible and accommodating if the need arises. The birthing partner is a crucial link between the midwife and mother, as mother’s advocate if interventions are suggested and assisting in making informed decisions.
A simple environmental factor that can be manipulated is lighting. Melatonin has recently been discovered to be another important hormone in uterine contractions during labour, as well as reducing neocortical activity. It is produced in low light, however light of the blue spectrum, particularly found in computer screens, electronic devices and TV, leads to a decrease in production of this important hormone.20
During labour women will generally use breathing and relaxation to remain calm during contractions and as labour progresses, they may decide to remain in their trance-like state to keep neocortical stimulation to a minimum. As such hypnobirthing women often do not display ‘typical’ characteristics of labouring women, with many midwives commenting on how calm mothers are during labour.
A normal labour unfolds in its own time, and by waiting, using all senses, trusting instinct and bringing a sense of calm confidence a midwife is able to support hypnobirthing mothers and normal birth.1
Conclusion
Michel Odent22 stresses that midwives cannot facilitate birth as it is an autonomic function of the body, but they can reduce the inhibitory factors that can cause a labour to stall or be slow. The main inhibitors to an easy birth are fear, feeling observed and light.
By creating a safe, emotionally quiet, darker environment community midwives are able to help reduce the inhibitory factors that many women face during labour and birth.
Through hypnobirthing, increasing numbers of the population are discovering that a calm, positive, normal birth is possible and by supporting couples who chose to use hypnobirthing, midwives are paving the way to a future where normal birth is expected and is not an exception.
Resources
KG Hypnobirthing – Kghypnobirthing.com
References
1. The Royal College of Midwives. Better Births, Normality for Labour and Births. rcmnormalbirth.org.uk/learn-more-about-normal-births/ (accessed 8 February 2016).
2. World Health Organization. Care In Normal Birth. who.int/maternal_child_adolescent/documents/who_frh_msm_9624/en/ (accessed 22 February 2016).
3. The Maternity Care Working Party. Making Normal Birth a Reality; Consensus statement. normalbirth.org.uk (accessed 5 February 2016).
4. Graves K. The Hypnobirthing Book, 2nd ed. Katharine Publishings, 2012.
5. Read GD. Childbirth Without Fear, 2nd ed. Pinter and Martin, 2005.
6. Moberg KU. The Ocytocin Factor. Pinter and Martin, 2011.
7. Buckley S. Gentle Birth, Gentle Mothering. Celestial arts, 2009.
8. Odent M. Do we need midwives? Pinter and Martin, 2015.
9. Jenkins MW Pritchard MH. Hypnosis: Practical applications and theoretical considerations in normal labour. British Journal of Obstetrics and Gynaecology 2005;100(3):221-226, 1993.
10. Cyna AM, McAuliffe GL, Andrew MI. Hypnosis for pain relief in labour and childbirth: a systematic review. British Journal of Anaesthesia 2004;93(4):505-511.
11. Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Pregnancy and Childbirth Group. DOI: 10.1002/14651858.CD003521.pub2 (accessed February 5 2016).
12. Davidson J. An assessment of the value of hypnosis in pregnancy and labour. British Medical Journal 1962;12:951-953.
13. Lycett A. Hypnosis during pregnancy and birth: The science and clinical applications explained. [Lecture] Royal Society of Medicine, 2012.
14. Gallagher S. Hypnosis for childbirth: prenatal education and birth outcome. Unpublished 2001. childbirthjoy.com/Shawn_Gallagher.html (accessed 5 February 2016).
15. Harmon TM, Hynan M, Tyre TE. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting and Clinical Psychology 1990;58:525-530.
16. Vandevusse L, Irland J, Berner M, Fuller S, Adams D. Hypnosis for Childbirth: A Retrospective Comparative Analysis of Outcomes in One Obstetrician’s Practice. American Journal of Clinical Hypnosis 2007;50(2):109-119.
17. McCarthy P. Hypnosis in Obstetrics. Australian Journal of Clinical and Experimental Hypnosis 1998;26:35-42. hypnosisaustralia.org.au/may-1998-volume-26-number-1-abstract-4/ (accessed 5 February 2016).
18. NICE. Woman centred care and informed decision making NICE guideline, 2014. nice.org.uk/guidance/cg62/chapter/1-Guidance (accessed 19 February 2016).
19. Royal College of Midwives. Evidence based Guidelines for Midwifery-Led Care in Labour: Supporting Women in Labour. rcm.org.uk/sites/default/files/Supporting%20Women%20in%20Labour_1.pdf (accessed 5 February 2016).
20. Hansard K. The Secrets of Birth. Sarakka publishing, 2015.
21. Sharkey JT , Puttaramu R, Word RA, Olcese J. Melatonin Synergizes with Oxytocin to Enhance Contractility of Human Myometrial Smooth Muscle Cells. The Journal of Clinical Endocrinology and Metabolism 2009;94(2):421-427.
22. Odent M. Childbirth and the Future of Homo Sapiens. Pinter and Martin, 2013.
