February 15, 2004

"Hypnobirthers" have their say

Once again I am hoeing into the debate about “hypnobirthing”. A number of comments have been posted to my previous entry on this subject (they are an organised group, these hypnobirthers!) which have been welcome.

In reading through this passionate feedback, several facts stand out. First, all these comments have come from those who have used the technique (usually referred to in these comments as a “birthing method”) and found it useful. I have not received any feedback from those who have used it and found it didn’t work, so these comments represent a biassed sample of users.

It is abundantly clear that all of these women had a deep sense of trust and faith that they could give birth without drugs etc. They may have needed the input of the “hypnobirth trainer” to be convinced of this over several sessions prenatally, or they may have used this technique to reinforce a belief they already had but which was being stifled by messages they were receiving from health professionals, the media, friends, family etc. I think it can be very hard to retain a sense of belief in one’s own birth abilities in the current climate of fear being created by the medical professional, drug companies, equipment makers and other vested interests. If “hypnobirthing” has strengthened these women’s belief in themselves and their own capacity, then great - I have no argument with it at all.

However, it seems sad that they have had to go to such lengths to discover what they had within themselves all along. The majority of the world’s women would think that having to learn how to give birth using a method of any kind is crazy - they know that you just get on with when the time comes. The women contributing to this discussion are clearly well educated and articulate and leaning about giving birth may fit comfortably with their attitudes towards learning and education in general. I would just point out that if the survival of our species relied on women learning a technique or adopting prescribed behaviours during labour and birth, we humans would have died out long ago! Women have been managing perfectly well for millions of years, long before hypnobirthing or any other method was invented.

I am amused that many of the comments being made by the “hypnobirthers” could equally be trumpeted by the women who are choosing epidurals - there seems to be a need to justify a need for something to get through labour and birth.

Many of the comments that have been made are reminiscent of the claims and endorsements made for those other great “inventions” for achieving painless labour - psychoprophylaxis and Lamaze - that were made in the 70s. I well remember the passionate statements, the training that women underwent, the almost religious fervour that was reflected in the literature and the classes. No evidence (randomised controlled trials) have been produced to show that these approaches improve birth outcomes, reduce the need for pain killing drugs or that they are even safe. Elizabeth Noble in her pioneering work “Childbirth with Insight” (published in the early 80s and now out of print) pointed out that encouraging women to breathe in any pattern other than her natural rhythm had the potential to alter blood chemistry. Reading this comment was a powerful wake up call to me at that time and was the basis for dropping all forms of “teaching about the breathing” from our educators training course and classes in 1984. My discovery, at about the same time, from observations of women labouring in their own homes, that they didn’t use any “methods” and gave birth really well, was also an important revelation. These two factors formed my underpinning faith in women and that we had the capacity for safe and effective labour all along - we had just forgotten to trust our instincts.

I must also point out that, like the Lamaze business in the USA today, many of the proponents of the hypnobirthing technique have a vested interest too (I notice they have registered it as a trademark!). They need to attract willing clients and promote success stories for their own purposes. It is notable that psychoprophylaxis (the basis of the original Lamaze training) is a very American concept - its techniques were abandoned many years ago in most other countries, if they were every adopted in the first place. Could this new phenomenon be another manifestation of the American way of birth?

In the past 20 years, western cultures seem to have strayed even further from our instinctive natures. As a result pregnant women may well be finding it difficult to find someone or something to use as a foundation to explain/validate/justify their needs and desires for natural birth. Some will choose “hypnobirthing”, others will rely on TENS, some will choose aromatherapy, reflexology, yoga - whatever. If this helps, then wonderful - at least these “birth methods” will not alter blood chemistry, fill the unborn baby with drugs, or compromise their hormonal flow during labour and birth. There is no hard evidence that they work, and if they are effective, it is probably as a placebo. What I do find sad, is that those who choose these strategies place their faith in the method when their success was most likely doe to their own body’s capacity and their natural physiological and biological functions working well.

Please don’t sell yourself short as a woman - you have what it takes to give birth well and, just as millions of women have done before you down the years, you can be successful. Find those who will support your needs and choose a safe and comfortable birthplace. Find a supportive midwife at the hospital and use her to shield you from medical intervention whilst enabling you to give birth yourself. If you can’t find a midwife in the hospital (perhaps you live in the USA) then look outside the hospital system and choose appropriate alternatives. I believe that with a caring midwife and an appropriate environment, women will discover they don’t need props and “birth methods” - they will discover their own power and pleasure in birth all by themselves.

Meanwhile, I expect there will be more comment from readers on this issue and I look forward hearing from those who have tried “hypnobirthing” and found it lacking - some balance will make the claims for this technique more believable.

Posted by andrea at February 15, 2004 10:30 AM

Comments

While I agree with 90% of what you have said Andrea (except that you will, really and truly, find midwives in some hospitals in the USA try the Kaiser Permanente HMO for one group of hospitals)I also think we are selling women short by not talking about breathing during labour to them in antenatal classes. Women do need to know basic relaxation techniques. I am not talking about the hyperventilation: which as we all know(I hope) Lamaze groups STOPPED teaching back in the MID-70's, but simple yoga based breath following techniques to guide women through the pain. Some women are very,very, basic creatures and like a cat going into a slow rhythmic breathing pattern with their contractions, others of us just loose it, hold our breath, cry, panic and that is what the classes helped us avoid, they helped us get in touch with or activate our primal selves. And they put us in touch with like minded women who provided support both before and after the birth. Are there really no studies which support any of the various childbirth education techniques? To be honest I don't know myself.

marilyn

Posted by: Marilyn Kleidon on February 15, 2004 04:05 PM

Comments

Andrea--
I read with interest your response to we HypnoBirthers as we tried honestly and factually to correct and describe the misconceptions of HB as you continue to present them. It's ironic how, in your criticism of HB, you are actually describing the need for women to do exactly what we too feel is the mainstay of a wonderful philosophy....that women can birth, have always been able to birth, and can find it a wonderful, miraculous experience. Please, for all those reading with great interest....we must know...have you ever read/been fully informed of what we espouse? Have you read Marie Mongan's book? Please let your audience know. It feels like you are arguing with a group of vegans that they shouldn't eat animals. How wonderful if your own continuing learning would allow you to recognize that we are, in fact, on the exact same side.
Lynn Lyons

Posted by: lynn lyons on February 16, 2004 08:21 AM

Comments

Andrea

I have read with great interest all of the responses regarding HypnoBirthing.I have two children on was born very medically though that was not my intention. I had high hopes and intentions of having a deep spiritual birth where I tuned into my baby and trusted my body to give birth.I trusted my body and birth. However this was not the birth I experienced. I labored for 30 painful hours before finally breaking down and agreeing to an epidural and a myriad of interventions.I was depressed for a long time about my "failure" to give birth easily and joyfully as I knew other women had.

My second pregnancy I chose to take HypnoBIrthing classes. My daughter then 8 wanted to be at the birth and I hoped after hearing about HB from friends that she would be priveledged to see a beautiful joyful birth. To somehow understand that birth can and should be calm and peaceful, beautiful. To conteract the indelible imprint left in her mind of her own birth.

I loved the classes. We learned how to step into our own relaxation response, that relaxation naturally starts the flow of endorphins in our bodies, the more relaxed the more endorphins, the more endorphins the more relaxed etc.During the exercises I always felt like I was somehow hyperaware of everything yet equally able to tune out anything I chose to.

My birth was a joyful, painless 6 hours attended by my husband, daughter and midwife. I was very aware of what was going on in my body yet able to listen to what I chose and tune out the rest of the hospital.I felt my body opening and my baby moving down. I was aware of each sensation in my body yet I dropped into relaxation with each surge trusting my uterus to do the work. My midwife was in awe of the power of this birth.

What did HypnoBirting teach me that I did not know before? I learned that pain is a signal that something is WRONG. Labor is so right therefore no pain is needed.The uterus can work perfectly when we just relax and allow it to its job.Trusting my body(as I did in my first birth) was not enough for me. I really had to teach my body how to relax something women in many other countries already know how to do. American society does not teach this skill.

In a perfect world women would not be brought up to fear birth and to distrust thier bodies but currently they are raised to these things in America. HypnoBirthing teaches women exactly what you espouse. Do you not teach childbirth education? If women instictively know all they need then why do you teach?

HypnoBirthing is helping women to tap into thier own power something that is long overdue. I encourage you to educate yourself about it. It is obvious you have not.It seems only wise to investigate and to fully understand something before attacking it.

"Meanwhile, I expect there will be more comment from readers on this issue and I look forward hearing from those who have tried “hypnobirthing” and found it lacking"

Why do you seek women who have not been able to tap into thier bodies own natural abilities? You are essentially looking for women who have not tapped into their own body’s capacity and their natural physiological and biological functions. Something you claim that every woman can do all by themselves.

You make no sense.You seek evidence that HypnoBirthing works(studies) and you seek evidence of it's failure.

Perhaps it is time to let go of your deeply seated beliefs about HypnoBirthing and get to the actual information about it. READ THE BOOK as many others have said.

Posted by: Toshia Parker on February 16, 2004 09:08 AM

Comments

"If all an expectant woman hears is "EPIDURAL" every where she turns, is she truly being given choices? Or are her options whittled down to only one?" Judy M. Wimmer, RN, ACCE. This is one of my favorite quotes that I give out to my HypnoBirthing® classes.

The same can be said in regard to pain. If all expectant women hear is "pain in labor" every where she turns, is she truly being given choices? Or are her options whittled down to only one?

I for one among many HypnoBirthing® Practitioners, am thrilled to inform women that there is another choice. That pain is NOT an inherent part of labor and birth. In every other instance of the bodily functions, pain is a red flag warning that something is wrong. Why are we so accepting of pain in regard to the ultimate female bodily function?

This is not to say that there are no sensations in regard to labor and birth. Sensation does not need to equal pain in this experience. We encourage birthing women to tune into the birthing process. These mothers experience as much as they want of these beautiful sensations of the unterine muscles working in harmony, of the baby moving through and out her birthing body, and the rythmic sensation of what is life begetting life.

If so many women have experienced labor and described it as comfortable, little pain or painless, how can this be anything but true?

We (HB Practitioners) are just guides. We point to the path of more comfortable childbirth. We point to the possibility that there is another, better way. We point them inward to the very core of what we are as birthing women. We teach them that all they need to know has always been there and has just been deeply buried by the negative messages of birth by our culture and the expectation that their bodies are doomed to hurt and/or fail by the medical culture.

I am always stunned when people are so protective of the pain factor. When birth is relaxed and every turn is met with calm release, aren't we all thrilled and awed by it? The birthing mother has experienced all that birth is meant to be. I look forward to a time when this beautiful kind of birthing is expected and it is the painful birth that is the unexpected.

Posted by: Erin Kimbell, RN, HBCE on February 17, 2004 08:20 AM

Comments

Yes, HypnoBirthing has worked for me, and yes, I am now a 'biased' HypnoBirthing practitioner, but there is research to support hypnosis for birth - here is a taster.
Obstetrical patients using self-hypnosis have been shown to have
¸ lower McGill Pain Questionnaire (MPQ) scores for pain associated with childbirth
¸ shorter duration of both first and second stage labour
¸ increased number of spontaneous births
¸ decreased use of analgesia, anaesthesia and oxytocics
¸ decreased need for surgical intervention
¸ decreased number of complications
¸ infants with higher average Apgar scores
¸ reduced length of postpartum hospital stay

Abstracts of relevant studies

Jenkins, Mary W. and M. H. Pritchard. "Hypnosis: Practical Applications and Theoretical Considerations in Normal Labour." British Journal of Obstetrics and Gynaecology. (1993) Mar:100(3): 221-26.

OBJECTIVE: To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women.

DESIGN: A semi-prospective case control study in which women attending antenatal clinics were invited to undergo hypnotherapy.

SUBJECTS: One hundred twenty-six primigravid women with 300 age matched controls, and 136 parous women having their second baby with 300 age matched controls. Only women who had spontaneous deliveries were included.

SETTING: Aberdare District Maternity Unit, Mid Glamorgan, Wales.

INTERVENTION: Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy.

OUTCOME MEASURES: Analgesic requirements, duration of first and second stages of labour.

RESULTS: The mean lengths of the first stage of labour in the primigravid women was 6.4 hours after hypnosis and 9.3 hours in the control group (P < 0.0001); the mean lengths of the second stage were 37 minutes and 50 minutes, respectively (P < 0.001). In the parous women the corresponding values were 5.3 hours and 6.2 hours (P < 0.01); and 24 minutes and 22 minutes (ns). The use of analgesic agents was significantly reduced (P < 0.001) in both hypnotised groups compared with their controls.

CONCLUSION: In addition to demonstrating the benefits of hypnotherapy, the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women.

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Harmon, Tereas M., Michael T. Hynan, and Timothy E. Tyre. "Improved Obstetric Outcomes Using Hypnotic Analgesia and Skill Mastery Combined with Childbirth Education." Journal of Consulting and Clinical Psychology. (1990) Oct:58 (5) 525-30.

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 subjects in each group received a hypnotic induction at the beginning of each session; the remaining control subjects received relaxation and breathing exercises typically used in childbirth education. Both hypnotic subjects and highly susceptible subjects reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control subjects’ 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.

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Martin, Alice A., Paul G. Schauble, Surekha H. Rai, and R. Whit Curry, Jr. "The Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents." The Journal of Family Practice. (2001) 50 (5): 441-43.

Abstract: hypnosis has been used in obstetrics for more than a century with little empiric evaluation of the effects of this type of intervention on labor and delivery. We evaluated how childbirth preparation incorporating hypnotic techniques affected the labor processes and birth outcomes of pregnant adolescents. The study included 42 teenaged patients receiving prenatal treatment at a county public health department before their 24th week of prega=nancy. They were randomly assigned to either a treatment group receiving a childbirth preparation protocol under hypnosis or a control group receiving supportive counselling. When labor and delivery outcome measures were compared in the 2 groups, significant differences favoring the hypnosis intervention group were found in the number of complicated deliveries, surgical procedures, and length of hospital stay.

Posted by: Moira Campbell on February 26, 2004 05:30 AM

Comments

It is good to see some actual research being quoted. Not sure about the quality of the research however, as it unclear how the subjects were randomised and whether these were blinded trails (in other words, the caregivers at the birth had no idea un which arm of the study the subjects were when they were in labour). The subjects also appear to be rather select, and may have known what the trial was intended to prove. Randomised controlled trials, where neither the subjects or the caregivers know who is in the treatment arm during the trianing and the subsequent event (the birth) are the only kinds of trials that have any real validity.

I still stand by my assertion that it may have been the quality of the care provided by the caregiver that made the final difference to the birth outcomes in these studies. This is a well proven fact. The studies quoted above provide no details of the actual births - where they occurred, who was the caregiver, what was the philosophy of birthplace etc. These factors can make or break a birth experience for parents, no matter how carefully they have prepared, and perhaps practised their chosen "birth method".

Posted by: Andrea Robertson on February 26, 2004 09:38 AM