February 04, 2004

More questions about hypnobirthing

Those of you who have read my previous entries on hypnobirthing will know that I am not a fan of this approach to childbirth preparation, because it encourages the woman into a deep meditative state that “removes” her from the birth process. I accept that many women have used it with success and that it may have a place for women who are phobic about labour pain, but I still question its evidence base and the psychological implications of it as a practice.

An independently practising midwife colleague was telling be about a birth she attended (at home) just before Christmas where the mother utilised hypnobirthing. She reached such a stage of disassociation from the labour pain that she was unaware that the baby was about to be born, and that it was coming breech. The midwife was called but was too far away to get there in time and the woman and her parents (who were supporting her) were left to deal with the unexpected breech birth, with tragic results - the baby died.

The midwife told me that she discussed this event with other independent practitioners and two of them had also been involved with births where hypnobirthing left the mothers completely unaware of what was happening in their bodies, especially the imminent arrival of the baby. If a woman is so out of touch with what it going on that she fails to recognise the signs of advancing labour there is a real risk that the midwife may not arrive in time. For some women this will just mean an unattended birth, but as birth always carries an element of unpredictability, having professional help at hand in case of need is a sensible and desirable precaution.

I understand that these three local independent midwives will be reviewing their advice to women who want to use hypnobirthing, so that they are called as soon as labour starts.

I think that one of the most useful aspects of an unmedicated labour is that a woman is able to stay much more closely in touch with her labour and can often tell the midwife what is happening during the birth. One of the main functions of labour pain is to give the woman (and midwife) a biofeedback mechanism that can often be diagnostic, especially when problems are developing. For example, a woman may be able to tell the midwife that she cannot feel any descent of the baby in second stage, or alternatively, that the baby is coming.

If hypnobirthing removes or diminishes this biofeedback mechanism this is a disadvantage that women need to be made aware of and midwives also need to recognise. These stories from my midwifery colleagues only reinforce my own doubts about the widsom of encouraging women to disengage from their labour and I will continue to be sceptical about the necessity (and now safety) of hypnobirthing.

Posted by andrea at February 04, 2004 03:56 PM

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I am appalled at your obvious lack of understanding about a birthing method which you have no problem attacking. HypnoBirthing mothers are absolutely not in any kind of vegetative state and they are not disassociated from their birth. HypnoBirthing mothers are ultra-aware of what their body is doing and calm because they trust and have faith...not because they are "out of it." I have given birth twice using HypnoBirthing and I was conversant and in complete control with both babies. I have been teaching HypnoBirthing for over 2 years and have yet to have a mother that didn't know her baby was coming.

Have you read the HypnoBirthing book? If you had, you would know that our moms are encouraged to become familiar with and communicate with their babies prenatally, as well as during labor and birth. They are educated about how their bodies work, why labor hurts, and why it doesn't have to hurt. After my own two painless labors I can tell you with complete confidence that HypnoBirthing works and is the safest way to have a natural birth.

The only thing I can possibly think would cause you to have such feelings is if you have witnessed a birth by hypnosis, that is, a mom that has used hypnosis for birth rather than the HypnoBirthing method. Hypnosis for birth is about disassociating yourself from the birth, because many of the practitioners that teach hypnosis for birth believe that pain is an inevitable part of the birth process. This is not HypnoBirthing.

I encourage you to research and read more on HypnoBirthing, so that you are fully educated on what you are puting out there for future moms to read.

Posted by: Heather Hilton on February 13, 2004 08:36 AM

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Dear Andrea
I am a hypnotherapist, licensed clinincal social worker, and HypnoBirthing® practioner. Most importantly, I had both of my children using the practices of HB. Both labors were about 6 hours. Both were unmedicated, joyful and empowering. And during both, I was totally in tune with my body and my baby.
I wonder what you really know about HB and its philosophy, and hypnosis in general. As a psychotherapist, I saw dissociation on a regular basis. It is a powerful mechanism used to escape, to disconnect, often due to trauma, fear, or some type of psychic overload. Hypnotherapists may also teach dissociation to clients as a way to deal with severe pain, as has been used very successfully with burn victims. Quite simply, HB does not teach dissociation, but the opposite process. It is about completely focusing on the birthing body and the baby inside, during pregnancy and birthing
The beauty of HB is that is offers a woman two things: a calm confidence in her body's ability to birth, and the often surprising but extremely comforting knowledge that birth does not have to be a painful and agonizing ordeal. HB moms, myself included, feel no need to escape this natural, magnificent process. In fact, in the context of calmness and confidence, healthy moms birth healthy babies everyday, in peace, all over this planet.
Sadly, misconceptions about birth and its dangers are everywhere. Women enter pregnancy joyful they are to be mothers but terrified they will have to birth. How sad. And how sad that such fears and committment to the pain and dangers of birth are being perpetuated by members of the very profession that espouse to empower women and provide an alternative to current overmedicalized OB practices. ( In the US, 91% of women use medication to birth...a chemical dissociation from one's body that has been become the norm.)
Have you read Marie Mongan's book? Have you ever talked to a HB practioner in detail about HB?
I remember when I would tell people I was using a midwife as my caregiver. Some would respond, "Oh I would never use a midwife, only a doctor. I want someone with training." As much as midwives have been maligned and misperceived, it is sad that the spreading of such uninformed misrepresentation would now be a part of their birthing practice as well.
Please, before you and your midwife friends continue to attack HypnoBirthing®, take the time to truly learn what is about. Any unwillingness to do so is akin to perpetuating the bashing that midwifery has endured by those that are threatened and ignorant of the facts.
Respectfully,
Lynn Lyons, LICSW

Posted by: Lynn Lyons on February 13, 2004 09:04 AM

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I am very concerned with the lack of understanding of hypnosis of any kind, much less HypnoBirthing, that is expressed here. As a practicing hypnotherapist, I have never had a client so dissociated from their bodies as to not know what is going on. There is no such state. In a hypnotic state, in fact, one is hypersensitive. With HypnoBirthing, this hyper-awareness is used in the management of uterine surges, NOT in dissociation from them. Nor does conventional hypnosis for childbirth put people in some sort of disconnected state. I am shocked hat such an uninformed opinion is so fociferously put forth here but such a reputable writer.

Posted by: Kerry Skiffington, PhD, DHyp on February 13, 2004 09:21 AM

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Whoa! This is narrow-minded, if I ever saw it. I would advise looking at the whole situation, say what else was going on in the home/ward at the time, etc. If this mother was an incest (or other abuse) survivor would make a major impact on how she experiences childbirth, as would a million other things. When one is so quick to blame HypnoBirthing or any other single cause of a poor outcome, it reflects nothing so much as a fear of the unknown. The speaker would do well to do some self-examination, as well as some research on HypnoBirthing as it is practiced in reality, not in your imagination.

Posted by: Katie MacAusland on February 13, 2004 09:34 AM

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I think it is very important that we clarify a few things about hypnosis and birth. Hypnobirthing is not a generic term, it is a trade mark name. HypnoBirthing®: The Mongan Method does NOT in any way teach dissociation. If you read the book, website, testimonials, in none of this will you find stories of women cut off from feelings or women who have dissociated. Please refrain from slapping the label "hypnobirthing" onto any birth where the woman happens to use hypnosis. This is not HypnoBirthing®. HypnoBirthing® promotes a calm, comfortable birth where the mother is fully alert and participatory. She just happens to be enjoying her birth experience!

I cannot speak to other hypnosis for birth methods, but I can say that as a midwife I have attended dozens of HypnoBirthing® births and had one myself. I received my son into my own hands at home in water - it was the most fabulous moment of my life! I was smiling and very aware! I could feel him moving down, I felt as he came out. I certainly would not have described it as painful but I could feel it and I was fully aware.

A woman certainly can feel surges enough to time them and therefore give her practitioner enough time to arrive or herself enough time to get to her intended birth place. It is ridiculous to assume that a woman has no biofeedback mechanism during birth if she is using hypnosis or more specifically HypnoBirthing®. It is equally ridiculous to assume there "needs" to be pain. Pain is present in the event of something pathological happening. The mother will certainly tell you if she has pain.

Whenever a baby dies there are always people who want to place blame. It's human nature in tragic circumstance. This birth had no trained attendant and even if she had arrived in time, if she was not skilled in breech, the baby may still have died!

My question would be, why was the baby's position not caught at a prenatal visit? Is this too the fault of hypnosis? See, there are a myriad of fingers we could point in numerous directions. But the fact remains that we do not know all the particulars about everything that happened and it's all only conjecture. Blaming HypnoBirthing®, or homebirth, or the full moon really does nothing to help the parents in this most tragic of circumstances. If this were you, would you want your birth story plastered all over the Internet for people to debate and second guess? Let's refrain from airing publically peoples most private and painful moments. We can still debate hypnosis and it's use in the birth setting but we don't need to add insult to injury when people are already suffering.

My most heartfelt condolences to this family in their time of grief.
Sincerely,
Francesca

Posted by: Francesca on February 13, 2004 11:21 AM

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Dear Andrea,

As a practicing HypnoBirthing® Practitioner and Professional Labor Companion I can honestly say that with this method the woman is never disassociated from her body or baby - just the opposite; she is looking within and totally focused and working with her body and baby. In the births I have attended, the woman always knows when the baby is descending and eventhough comfortable can vocalize that this is happening. Also the births, because the body is working in harmony, without the fear that causes pain in normal birthing, do progress quicker. But this progression is not without the mother's knowledge. It is trully a shame that HypnoBirthing® would be blamed for the tragic outcome of this breech birth. I do agree that midwives and other health care providers do need to be educated though, that this method does promote easier, faster and gentle birthing but again, I repeat, does not disassociate the woman from her birthing body but rather focuses the woman on her body and baby and what they are doing in order to have mind, body and baby in working together.

Respectfully,

Gisela Llorens, CH, HBCE

Posted by: Gisela Llorens on February 13, 2004 12:47 PM

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I used HypnoBirthing with my second son and was NOT removed from the experience in the least. I was incredibly "in-tune" with exactly what was going on with my body and baby. It was an amazing experience and one I did not expect considering I had an epidural in place with the birth of my first son without the benefit of HypnoBirthing. I suffered severely from my ignorance and didn't fully understand the consequences of my choice. Now, as a Certified HypnoBirthing Practitioner, I not only teach deepen techniques with hypnosis, ALWAYS WITH THE BABY AND BIRTH PROCESS IN THE FOREFRONT OF THE MOMS AWARENESS, but that understanding the science and physiology of birth is what makes the experience so successful. HypnoBirthing engages a women with her birth. It does not "disengage" her. I hope that you do a bit more research into HypnoBirthing-The Mongan Method. You will learn that you are way off base and may need to retract your comments.
With Peace and Respect,
Catherine Angell McCabe

Posted by: Catherine Angell McCabe on February 13, 2004 01:06 PM

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Re: More Questions About HypnoBirthing

I was horrified to read your article on HypnoBirthing posted 4th February, 2004. I am a practicising midwife and teach HypnoBirthing in my area.

I would like to ask these independent midwives if they are sure that HypnoBirthing was the method used for their ladies deliveries? Or, have they been given hypnosis for birth - provided by someone who is not a certified HypnoBirthing practitioner?

HypnoBirthing does NOT dis-associate a women from her labour, indeed, it does just the opposite!!!
Women are encouraged to bond with their babies very early in their pregnancy,they are taught exactly what happens to their bodies during labour and are taught methods of relaxation that take them inside themselves to understand and FEEL what is happening to their bodies as they labour.

They are definitely not "removed" from the birth process, if anything they are shown how to understand the birth process and know exactly what phase of labour they are in!!

I would also question why a woman needs to feel "pain" to make this biofeedback mechanism work - if a woman is in touch with her body and her baby - which is one of the main philosophies of HypnoBirthing - the biofeedback mechanism of knowing what is happening can work perfectly without "pain".

You state that

"one of the most useful aspects of an unmedicated labour is that a woman is able to stay much more closely in touch with her labour and can often tell the midwife what is happening during the birth." -

What do you think HypnoBirthing is? It is an unmedicated labout where a women IS in touch with her labour - most HypnoBirthing mums need none, or very little, medication during their labour as they are not fixated on this myth that childbirth NEEDS to be painful!!

HypnoBirthing certainly does not teach women to detach themselves from the labour and take themselves away to some other place - they are aware of their surroundings, aware of what is happening to them - in fact in many cases - are more aware of what is happening to them as they are not distracted by the fear or the so called "pain" of labour.

Before you put HypnoBirthing down completely, please at least find out exactly what it is about, what it teaches and the methods that are used - you may be surprised!

Posted by: Marian Nisbet on February 13, 2004 07:25 PM

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My heart goes out to the woman and her family. The loss of a life is devastating. I've miscarried twice and just in the last 18 months have buried 7 relatives. I hope they attend grief counseling soon.
BTW, there is a hypnosis script for turning breech babies.I wonder if they used it.
I think what happened and the use of HypnoBirthing® is getting collasped in the story.
The facts are:
this woman used HypnoBirthing®
her baby was breech
her midwife was not there
her baby died
The way you are viewing the facts and relating them is your point of view but not necessarily the truth. The baby died. If you say it was due to being born breech or because the midwife was not there you'd have to place 'the blame' on the baby or the midwife and no one wants to go there because it makes it personal! If you say it was because of a technique that you are slightly familar with it isn't personal thus easy to attack. The choice of learning and applying HypnoBirthing® and the choice of hiring a midwife and contacting them at whatever time the mom chooses is the mom's choice.I am NOT suggesting the mom is responsible for her baby's death. I am saying that when human beings are responsible for their actions what is left is what happened.

We used HypnoBirthing® for the birth of our first baby 3 years ago [our story is on the my web site].The experience of tuning into my body and letting our baby direct the birthing in partnership with my uterus was so wonderful compared to most of my friends that I was shy at first to share about it. I felt so empowered as a woman to birth my daughter from first active surge to crowning in less than 6 hours and with no medical intervention or drugs! My midwife said I could be the "poster mom" for HB. Not only was I intimately in touch with my birthing experience [aka labor] I was calm, rested and responsive to provide biofeedback to my nurse and midwife.I was completely aware of where my baby was however I didn't have the fear, tension and pain so my nurse [not familiar w/ HB] relied on my direction. When my daughter was 6 months old I found out I could be certified to instruct other moms & dads to have the incredible experience we had in welcoming in our daughter in such a natural and calm way. I have now taught over a dozen moms & dads how to prepare for and birth their babies the way they want to and not turn themselves over to their OB docs to'deliver' their babies but instead birth them and many with the calming support of midwives nearby. HypnoBirthing® education is not just about the birth but about becoming parents and prenatal bonding and prenatal parenting in ways that most 'childbirth' classes just do not touch
upon. The exercises and questions addressed the emotional, physical and financial well being of our family unit not just the baby. Also, learning the relaxation techniques and self-hypnosis [which all hypnosis is self-hypnosis] helped greatly when I had only 20 minutes to catch up on some much
needed sleep once my daughter arrived!

Posted by: Debi Tracy, CHBCE on February 14, 2004 03:41 AM

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I'd like to point out that there are many different forms of hypnosis for childbirth. While dissociation was popular in the 70s, and may still be practiced by some uninformed hypnotherapists today, the actual HypnoBirthing programme - which is a strictly regulated specific childbirth education programme enhanced by hypnosis - teaches relaxation coupled with a deep awareness of what is going on in your body and with your baby. In fact I was much more aware of what was going on when I had my second child with HypnoBirthing than when I had my first without - mostly because I was not in severe pain. HypnoBirthing mums can experience discomfort - certainly enough to be able to communicare to their midwives that something is wrong.

I do think it's a good idea that midwives should go early to a HypnoBirth as research has shown that birthing is an average of three hours shorter when using hypnosis.

Perhaps more of an issue is that midwives have to get used to attending shorter, easier births. Or are you suggesting that women should stick to painful, longer births because that's what midwives are accustomed to?

My second baby was an undetected breech - we were at home. I had no idea she was breech until a foot popped out - although I did feel discomfort in my back, but only for about 20 mins before the foot appeared. Without HypnoBirthing there is no way I would have remained calm enough to resist bearing down until I was fully dilated and had transferred to hospital - just in case there was a problem. In fact she was born safely and easily. I was certainly aware of all that was going on in my body (particularly the instinct to bear down) but did not know there was a way for a labouring Mum to know her baby was breech other than perhaps back labour. (And an uninformed Mum would not even know this, or might think baby was posterior.) Also, isn't it also the case that some Mums do not experience as much of a bearing down instinct with a frank breech? (I'm not sure, so do correct me if I remember wrongly.) So perhaps she wouldn't have had the sensation to be aware of in the first place?

It is tragic that a baby died, but please don't write off all hypnosis for birth. It can be an extremely useful tool in the hands of a trained and informed person. Women considering hypnosis for birth (I personally highly recommend it) should check on the practitioner's training - especially if they are a hypnotherapist without specific training in hypnosis for birth. It is also becoming popular for midwives to use hypnosis. Again - do check the training you are being given is from a reputable source. The actual HypnoBirthing programme has been going for over 15 years and is widely used internationally, both for hospital and home births.

Posted by: Moira Campbell on February 14, 2004 04:31 AM

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I do think it's a good idea that midwives should go early to a HypnoBirth as research has shown that birthing is an average of three hours shorter when using hypnosis.

Posted by: Moira Campbell on February 14, 2004 04:49 AM

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As a fellow midwife, I am overwhelmed by the loss of dignity displayed by this presentation about HypnoBirthing® and the attempt to drag ‘fellow midwives’ into this misconception-filled attack on the parents that chose this birthing method. The ability to accept what is often considered ‘against the norm’ is what midwives are supposed to do best. Allowing each birthing Mother’s own personal forte to be the clue or information we take from that birthing Mother and allow ourselves to follow as the ‘keeper of normal birth’. I’m so distressed to see more and more frequent attempts to keep a lid on things, to discount and discredit, to attempt to conveniently categorize anything that doesn’t fall into that carefully fabricated circle of comfort that we as midwives believe is our safety net. Believe is the operative word here. A word used in the HypnoBirthing® Method-notice the Registered mark-a complete philosophy, an incredibly effective technique, embraced by thousands of birthing women around the world, not just the latest childbirth education fad. A sadly misplaced belief that “as a midwife, I know how birth works” therefore I can dispose of anything that challenges my current belief system about birthing. HypnoBirthing® does tend to challenge some of the beliefs the midwifery model has become comfortable with. However, I ask you to embrace all this program has to offer that TRULY supports the midwifery model. So many of the very things we strive to have our birthing clients connect to, to learn to trust, to realize that their bodies do know exactly what to do and that the baby they are carrying knows exactly what to do, as well. As midwives, we also recognize that every baby has it’s own journey, it’s own agenda. And when the birth is just fine and wonderful, we all nod our heads and agree that the birthing body and baby work just fine. It’s only when births unravels and special circumstances develop, do we doubt ourselves and attempt to lay blame, to make it all make sense. Wasting valuable time and energy when we all know that birth is not in our control. Belief, skills, knowledge and the ability to trust our clients IS in our control.
I was so relieved to find HypnoBirthing® as a tool to provide the very joy and pride we hope every woman, every birthing companion gets to experience at this time of making a life-time memory. I urge you to explore all the options that are available to you through the HypnoBirthing® Method. Evaluate what might make you feel doubt or discomfort, gain enough information to truly decide what you believe, not just what you think you know.

Jennifer L. West,LM,CPM,HBCE
www.albuquerquehomebirth.com
info@tubsntea.com

Posted by: Jennifer L. West, LM,CPM,HBCE on February 14, 2004 06:15 AM

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Andrea, I have attended your Active Birth Seminar.
I have been an midwife for 28 yrs and am extremely disappointed to read your diary entry of 4/2/04 re HypnoBirthing. To say HypnoBirthing encourages a deep meditative state that "removes" a woman from the birth process or leaves them "completely unaware of what is happening in their bodies" is not only very inaccurate, it is frightening. HypnoBirthing does not teach this.
One does not need to have a phobia about labour pain to prefer not to have it. There is evidence out there re hypnotherapy and the psychological implications of a painful labour complete with the all too often cycle of intervention and assisted delivery is more worrying.
HypnoBirthing is an asset to midwifery practice and thankfully the more informed midwives and obstetricians are, the more supportive they are of it. I'm sure we all want the safest, most satisfying and enjoyable experience for our mums and babies.

Posted by: June Poole on February 15, 2004 02:50 AM