Home HypnoBirthing® How Hypnosis Eases Childbirth
BY Carrie Myers Smith, B.S.
Childbirth Instructor, July/August 1999
Like most childbirth educators, I embrace a personal philosophy regarding birth. And like many educators, I haven't quite found the perfect program that reflects all my personal beliefs about birth.
Recently, however, I stumbled across a Web site called HypnoBirthing® (www.HypnoBirthing.com ) that claimed that the women who use its method give birth pain-free. Over the years, HypnoBirthing® has been referred to variously as “the missing link in childbirth” and “nature's anesthesia.” Intrigued? I was so I went to the source.
Marie Mongan, M.Ed. and M.Hy., is a clinical hypnotherapist and founder of the HypnoBirthing® Institute in Central New Hampshire. The technique uses hypnosis to help women cope with labor and delivery and Mongan trademarked the name.
Basing her method on the work of the late English obstetrician Grantly Dick-Read, MD, who published Childbirth Without Fear in 1944, Mongan and the HypnoBirthing® proponents adhere to a set regimen to prepare for childbirth. Thus, as it states on the Web site, the woman and her “birthing companion can experience a safe, serene, and satisfying birthing, free from the fear that causes tension and pain.”
For HypnoBirthing® advocates, the key phrase is “free from the fear.” A major part of the program is what Mongan calls “dehypnotizing” the woman of her fears, including fear of childbirth, fear of parenting, financial fears, or fears of parenthood changing the spousal relationship.
Self-Hypnosis?
Just how a woman goes to the task of alleviating her fears seems to be a bit controversial. “I gave birth to all four of my children pain-free using this method,” Mongan told me when we spoke recently, “but I didn't realize it was self-hypnosis until I became a hypnotherapist.” In his book, Dick-Read denies it's hypnosis, she added.
She's right. In Childbirth Without Fear , Dick-Read describes HypnoBirthing as really deep relaxation—“a reverie, twilight state, usually experienced just before falling asleep.” He goes on to say that it is nearly impossible to be anxious about anything while in this state. Also, while in this condition, the muscles are totally relaxed, including the muscles of the uterus. Therefore, he explains, the body interprets uterine contractions the same way it would a contraction of the bicep. The result: no pain.
Mongan believes that self-hypnosis is the key, and is the basis for the name of the program. “Hyno” comes from the Greek for “sleep.” Unlike the hypnosis most of us are used to seeing on TV, though, clinical hypnosis does not put people into a trance. During labor, “They're (the women) are able to talk, think, move about, etc., but the difference is through practice they have removed fear and tension and have conditioned themselves to be able to reach a profoundly relaxed state in a matter of seconds,” says Mongan.
But some practitioners strike a cautious note. One is Sue Weinstein, a trained hypnotherapist and the director of the Parent Education Program at Saint Barnabas Medical Center, Livingston, NH. “I personally never say the birth will be ‘pain free' utilizing hypnosis. I certainly agree that self-hypnosis reduces pain considerably, but the degree of pain relief depends on many factors that may not present themselves until the onset of labor, for example, the fatigues of the mother,” she says.
The Physiology Behind the Method
More concrete thinkers prefer to emphasize the mind-body connection. They reason that the uterus is a muscle, with muscle fibers like the other muscles in the body. It has three layers of muscle fibers: The outer longitudinal fibers, that run vertically; the middle layer rich in blood vessels, and the innermost circular muscle fibers, found mostly in the lower neck of the uterus, which run horizontally. The longitudinal fibers function to draw up the circular fibers and to push the baby down and out of the uterus.
When these fibers work in harmony, birth goes smoothly and easily. But when fear and tension are present, and the circular muscles resist the longitudinal fibers, the cervix is taut and pain is increased. As Dick-Read wrote, “A tense mother translates into a taut cervix.”
Hormones
We know how estrogen and progesterone are related to pregnancy, but what about hormones like catecholamines and endorphins? OK, so maybe they're not directly related to pregnancy, but they can affect it. When a person is put into a fearful situation, such as labor, a fight-or-flight stress response is triggered. Blood is shunted away from the organs that don't play a part in defense, such as the uterus, and flows to other muscles. Therefore, the uterus and baby are deprived of oxygen and nutrients. To top it off, as catecholamines are released, they also act as constrictors; the longitudinal and circular fibers work in opposition to each other, pain is increased, and labor is lengthened.
If the fear is removed, however, and the mother is relaxed, the fight-or-flight response is unnecessary. Neuropeptides called endorphins are released. But did you know that endorphins have an effect 200 times that of morphine? They work by suppressing synaptic activity that leads to pain sensation. Now the mother is relaxed; the muscles in her uterus are working in harmony, and as Mongan says, “she can call upon her own birthing instincts.”
OK, maybe you're not totally convinced. You already knew about what Dick-Read called the fear-tension-pain syndrome. And you teach relaxation and visualization in your classes, too. What really is so different about HypnoBirthing® ?
The Breathing: Unlike other methods, there are no fast-paced breathing patterns. All the breathing is done very slowly and is designed to assist the longitudinal muscles in their work of pulling up the circular fibers and dilating the cervix. Babies birthed using this method are not pushed out forcefully from the mother, but rather “breathed out.” And the “pushing breath” is not used until the baby has crowned.
The Timing: HypnoBirthing® courses can be taken at anytime throughout pregnancy. “We have had some women take the course quite late in their pregnancies and do very well,” says Mongan, “but we encourage couples to take the course early in the second trimester.”
Dick-Read agreed. He wrote that relaxation should be started early and that by the fourth month, mothers should be getting good at it. This allows couples time to explore their fears, make peace with them, and practice the relaxation, self-hypnosis, and guided imagery, until it becomes second-nature. Expectant mothers practice with specific HypnoBirthing® tapes as well as in the labor and delivery room. Because this conditioning has taken place and become instinctive, the laboring woman can achieve deep relaxation within seconds.
The Content: Part of the HypnoBirthing® program is “dehypnotizing” the mother's fears. Mongan feels that it is unfortunate that so many other childbirth classes really add to those fear. For instance, most childbirth education videos show laboring women trying to cope with agonizing pain. Mongan tells her women that they can experience a pain-free labor and delivery, and shows evidence of just that in videos of couples using the HypnoBirthing â methods.
In many childbirth education courses, the only other time you may see a client is if they come to the post-partum reunion. Mongan and her faculty feel it's vital to follow-up with their clients after the initial course, right up to or even through the baby's birth as labor support. This allows the couple to continue to perfect the methods learned.
Also included in the HypnoBirthing® course is exercise. Although there is no mention of aerobic exercise, which is known to have favorable results on labor and delivery, there are exercises for strengthening and stretching the muscles used during labor and delivery. Women learn how to properly perform a squat and stretch the abductor muscle group, and are encouraged to perform them frequently on a regular basis as training for delivery.
The Terminology: One major difference is the use of the term “surge” in lieu of contractions. Because “contraction” is associated with pain, Mongan uses “surge.” A much more cal, peaceful sounding word, and one that describes a contraction without pain.
The Coach : “Come On! You can do it!” “You're doing great! PUSH!” These are the sounds you may hear from a coach rooting on his team—or a birth partner encouraging the laboring mother. In HypnoBirthing®, though, the partner is taught to be much more than a cheerleader and ice fetcher. The partner is an integral and necessary exponent to the equation. He is taught how to direct the guided imagery and taught how and where to massage his partner. For example, the birthing partner gives the mother prompts that help in drawing up the surge. He might say, “Turn your birthing over to your body, over to your baby. Go with your breathing. Release and relax. Trust your body, it knows what to do.”
The Relaxation: As childbirth educators, most of us teach some form of relaxation. Why? Typically it is to instruct the mother to rest and calm herself between contractions and as much as possible during contractions, particularly in the beginning stage of labor. But HypnoBirthing® seems to go beyond typical relaxation in what Mongan believes is self-hypnosis. For example, in “glove anesthesia,” the birth partner talks the mother through the surge using guided imagery, while touching certain parts of her body. As he touches her, that body part goes numb. Mongan has seen women undergo cesarean sections using this method, without medicated anesthesia. Then there's the process of ridding the mother of her fears. “Taking them for a ‘walk on a beach' is useless,” says Mongan, “if there's still fear present.”
The Baby Prenatal bonding is another part of the HypnoBirthing® course. The baby is not just this “fetus” inside the mothers' womb. Instead it is a thinking, living little human being, who can begin to bond with its parents while still in utero. Couples are taught about prenatal development—at what point a baby can hear in utero and how to “play” with their babies by gently pressing the mother's abdomen and watching the baby kick back.
Babies born using the HypnoBirthing® methods also seem calmer following birth, according to Mongan. “They don't cry much after birth,” she says, “and they nurse very well.”
The benefits of self-hypnosis, deep relaxation, and guided imagery may go beyond labor and delivery. It is well known that stress increases blood pressure. Mongan has had clients in the early stages of preeclampsia with increased blood pressure, and claims that after one session of hypnosis, the blood pressure was brought down to a safe level.
Hypnosis may also help in turning breech babies into the vertex position. A 1992 study by Dr. Louis Mehl of the University of Vermont Medical School psychiatric department found that 81 percent of women carrying breech babies between 36 and 37 weeks gestation had their babies turn spontaneously compared to only 26 percent in the control group turning spontaneously. Another 20 percent were able to be turned in the control group using ECV. Mongan has had the privilege of helping five couples turn their babies into the vertex position using hypnosis and guided imagery.
Perhaps the philosophy of this program pretty much mirrors your own personal philosophy, except that you are uncomfortable with the hypnosis aspect. You are not alone. In the September/October 1998 issue of Childbirth Instructor , Kathy Nesper, CCE, warned that hypnosis may be linked with occult issues such as envisioning “so-called past lives or astral travel.” Some devout Christians would steer clear of these practices, and would instead, give their fears to God. Helen Wessel, in her book Under the Apple Tree: Marrying, Birthing, Parenting , describes hypnosis in itself as not “evil”, but warns about the troubling potential because of the possibility of subjecting one's spirit to undue influences by other human being, instead of remaining fully subjected to the Holy Spirit.
Because this was a personal concern, as well as an issue for other educators, I went back to the source. I asked Mongan about these “paranormal” techniques, and if they are integrated into the HypnoBirthing® program. Her answer was clear: “ HypnoBirthing® is really not metaphysical at all. It is simply integrative, or what I call collaborative, medicine. The body-mind is the only vehicle. The key is the mother's ability to bring herself into deep relaxation during surges and into that usual amnesiac state that laboring mothers experience during the end of the first stage and through transition. While perhaps it could be argued that some of the “paranormal” techniques could enhance the process, we use none of them either in educating the pregnant couple or when we go in as labor support.”
She adds that HypnoBirthing® is really a “very clinical and anatomically based approach…It's the law of expectation. When we change the expectation, we change the outcome. Fear is the enemy of the birthing room. When mom is free of it, she is also free of the constricting, pain-causing catecholomines. It's the old fight-or-flight syndrome. Since the laboring mother can do neither, she has to learn to release fear so the blood and oxygen can flow to the laboring muscles of the uterus and alleviate pain—often even eliminate it entirely. Her state of deep relaxation also produces endorphins. Not very bizarre, I'm afraid---just logical!”
Perhaps I will never find the perfect program that completely mirrors my personal doctrine, but many of the techniques and philosophies in the HypnoBirthing® program certainly come close. And although there seems to be some question as to whether the main component is hypnosis or simply deep relaxation, it doesn't really matter. As I tell my students, “Here are the tools. Use what fits your own personal beliefs and values, and be creative!”
An Interesting Study
A 1990 study by Scientists at the University of Wisconsin, Milwaukee, found that women who received hypnosis in preparation for childbirth reported reduced pain. Hypnotically-prepared-women had shorter Stage 1 labors, less medication, more frequent spontaneous deliveries, and newborns with higher Apgar scores, than women who had not been hypnotized. Highly-susceptible-hypnotically-treated-women had lower depression scores after birth than women in the control group.
Carrie Myers Smith, B.S., is an exercise physiologist, as well as a childbirth and health educator, and perinatal consultant in northern New Hampshire. She is authoring a correspondence course on advanced topics in perinatal fitness.
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