Hypnobirthing, does it work?

Oct 20, 2020

Hypnobirthing

I’ll explain why I am so keen for women to have a realistic understanding of just how incredible hypnobirthing can be for you.

If you expect that after doing a hypnobirthing course you will magically experience a pain free labour no matter what your personal situation is – then I can pretty much guarantee it’s not going to work for you.

I’ve read many women’s personal accounts of why hypnobirthing ‘didn’t work for them’ only to discover that by ‘hypnobirthing’ they mean they listened to a 30 minute download for relaxation that had hypnobirth in the title, or they did a weekend course but didn’t listen to the recordings. And even the fact that they had a traumatic labour because they required emergency medical intervention to deliver the baby, has been cited as evidence that hypnobirthing didn’t work.

These examples highlight the problem with the term Hypnobirthing. It is broadly used to encompass any form of hypnosis to enhance preparation for childbirth. And this is also why there isn’t adequate research on it’s efficacy. The term is too broad, but continues to be used to describe the general approach, and so all reports, experiences and statistics get lumped in together.

So how is it supposed to work- what is the philosophy behind hypnobirthing?

The main principle is that when a woman approaches birth feeling fearful, her physical experience will be directly affected by her emotions. The mind- body connection is becoming much better understood in recent years and it is clear that thoughts and feelings can have a direct physical effect. If you aren’t convinced, then here’s a really simple example; if you were to take a moment to think of cutting into a plump, juicy, zesty, lemon. Imagine it in front of you, you are about to suck a juicy wedge of the bitter flesh. Just the thought you’ve conjured in your mind right now will have you producing saliva, possibly the mere anticipation of that sour juice has made your body change. Your thought has created a physical reaction. When a woman considers her labour, the thoughts she has will affect her experience. If we can positively influence her thoughts prior to labour her experience will be impacted.

Feeling anxious about the unknown is a very natural response, but to compound the problem for women expecting their first baby, labour is no longer unknown. We ‘KNOW’ it from TV, from movies, from friends, from pictures. And what we ‘know’ is that “labour = immense pain”. I challenge anyone to be told to prepare for what many people call “the worst pain you’ll ever experience” and not be fearful.

But we are only getting half of the story. The part about how birth can be empowering, can be calm, can be life affirming- is being missed. The part that even though labour almost always involves pain and endurance, it doesn’t have to include suffering and loss of control. And this has to be true, otherwise millions of women would not choose to have more babies. Women would not actively choose to have birth without intervention.

It is no coincidence that almost all women have a quicker, more enjoyable experience second and third time round. Because they now do know what to expect and they do know what is possible.

So how does fear affect your birth experience?

As with all our physical functions our hormones are in charge of labour and birth. Hormones are the chemical messengers that travel through the body coordinating complex processes. The hormones necessary for a smooth efficient birth are directly impeded by our stress hormones. The complex cocktail of hormones that birth requires include, amongst others: Oxytocin, that stimulates uterine contractions, but it also produces feel-good and nurturing feelings. And rising levels of endorphins. Which are incredibly efficient at relieving pain and can make you feel alert and euphoric.

When you are anxious and fearful you produce less of those hormones which means the contractions are less efficient and you don’t have the natural pain relief effect or the benefit of ‘feel-good hormones’. The combined result being, a labour which is slower, more painful and ultimately more stressful and so it spirals, more pain, more stress, less contractions.

How can hypnobirthing reduce fear?

A good hypnobirthing course should be multi-dimensional. It should educate you in 3 ways.

Knowledge of labour, and the possibilities and options available to you

Understanding how your body is designed to work, how you can help it, and what things might hinder it, starts to reduce fear because labour is no longer the unknown. When you have a real insight into what to expect, what might happen, what interventions are possible you can be more capable of informed decision making.

I firmly believe that women don’t need to be taught how to give birth, but when you have evidence of how your body is designed to birth you can begin to trust in your own capabilities. Trust builds confidence.

Knowledge of a variety of skills and techniques -to use in labour to facilitate the natural process

Practical techniques such as; breathing exercises, visualisations, anchoring skills, vocalization can all have the effect of reducing tension, by enhancing physiological relaxation or redirecting focus away from pain.

Because we are all different, and you don’t know what will work for you on the day, knowing that you have a full toolkit from which to pick and choose the best methods for you to relax, brings a sense of empowerment and sense of being in control, that in itself reduces anxiety.

Hypnosis to evoke relaxation and reinforce a positive mindset

Hypnosis simply involves listening to suggestions. For hypnobirthing, these suggestions are designed to induce feelings of relaxation and positive thoughts. When in a relaxed state your mind less is likely to reject new suggestions, and your underlying beliefs can adjust. You can convert from being fearful of birth and convinced you won’t be able to do it, to feeling positive and confident in your body.

Repeated listening is a principal element as it reinforces the positive suggestions. Repeated practice also enables the feeling of deep relaxation to become familiar and easier to access, in any situation. Positive affirmations are so much more than wishful thinking. They are similar to having your own mental coach- just as an athlete might in an endurance event; talking you through your strengths, convincing you that everything is OK, and reminding you in times of challenge that you can do it.

Another significant feature of hypnosis is the ability to influence your focus. For labour it is desirable to direct your focus toward feeling relaxed and free from tension, and therefore away from pain.

As previously mentioned, your ability to stay calm enhances hormonal harmony and labour is likely to be much more smooth and efficient.

Why isn’t hypnobirthing more universally practiced?

There are many different approaches and many different courses available worldwide and even if you chose one of the more well-known brand name courses you won’t receive the same material.

As a midwife who works in a birth centre supporting women in labour, I have witnessed some of the downsides of inferior classes.

The most common issue when hypnobirthing preparation isn’t effective - stems from unrealistic expectations.

Some trainers are so convinced that pain-free birth is achievable that their messaging to women is that is possible to achieve pain free if you do everything we tell you. Some books even begin with the words ‘We can’t guarantee a pain free birth but…..’

When you have an understanding of the labour process, you will be aware that functional pain is to be expected. When it is expected and you know how best to work with it, you can anticipate it and prepare. I have supported several women who once contractions began were derailed by the physical sensations. They had been led to expect it didn’t have to be painful, so all other preparation went out the window. Fear leads to heightened perception of pain and also a sense of suffering, having to endure pain when you feel you are not in control.

Lack of control and a sense of having suffered are known to be the features of an experience being perceived as traumatic, or at the very least a negative experience.

One of the main criticisms of hypnobirthing is that is has not been ‘shown’ to be an effective pain management technique. As already mentioned, that might be an issue with inadequate research data due to inconsistent approaches. And it might be the incredibly subjective nature of pain. It’s impossible to know what each woman’s experience of labour would have been without hypnobirthing intervention. Women most commonly report that each of their labour’s have been varied experiences anyway. But crucially, if it isn’t an effective pain management technique- that doesn’t mean hypnobirthing doesn’t profoundly influence other features of a woman’s labour experience. Pain in childbirth is only one factor. Feeling empowered, feeling in control and feeling you have choices can all contribute to a positive birth experience.

Another issue I encounter is that during hypnobirthing classes, women have been ‘conditioned’ to believe that some words are harsh, scary or undesirable. When their preparation involves saying ‘surges’ instead of contractions, and ‘waters releasing’ to replace ruptured membranes, when they come into contact with their health professionals- they might be triggered by the words they have been told are ‘scary’, rather than being conditioned to believe that those words are functional and useful, and therefore positive.

I’ve had some women come to the birth centre in labour, unable to relax and go with the flow because they couldn’t recall the exact breathing techniques or the specific affirmations that they had planned. They’d been led to believe the actual technique was vital to success, rather than the aim being to focus on your breathing.

Of the many texts I’ve read from the most common hypnobirthing schools, the underlying message is that the women will likely face opposition from their health professionals and that they must fight to assert their rights. This is counterintuitive to inspiring calm and confidence right from the outset. In my work I have spent much valuable time breaking down that defensive barrier with couples that have had this kind of birth preparation. Having to gently persuade them to know that I am there to support them, and respect their choices. Observing them relax, and allow themselves to do what needs to be done, when they are finally convinced.

And my personal biggest criticism is that to be a hypnobirthing educator you don’t have to have prior training in labour, birth or hypnosis. The brief course educators of the most common branded courses, cover the modules all in a few hours. And so when families are choosing which preparation to have, they may be choosing a hypnobirthing course discussing only relaxation techniques. Unaware of the vast amount of topics they are missing out on. The information covered by such narrow content can be incredibly effective for many women’s experiences. But they should be aware that it only constitutes a portion of the information that will be so beneficial to them. Some hypnobirthing courses should be considered as an additional resource to broader antenatal education.

To be well prepared women can benefit significantly from information about; options in labour, possible interventions, and what might happen when things don’t go to plan. When none of these other factors are explored in pregnancy, women might be left with the impression that everything not discussed is unlikely to occur, or is not important to know in advance. The use of pain relief and the cascade of intervention might be mentioned without real understanding of the nuances involved. Absolutely there are inherent risks to every intervention, but at times the risks of avoiding intervention outweigh them. It’s possible that ignorance of the facts suggest an undertone of disdain, thereby creating negative associations. But for many women medical intervention can be anywhere on the spectrum from helpful, to life saving. When women choose to, or are advised to consider some form of assistance it can possibly lead to negative self-regard and feelings of failure and guilt, that they weren’t able to achieve the ‘perfect birth’.

But with the right education women can be aware of these common interventions and come to understand that sometimes their individual circumstances can lead to necessary consequences. Hypnobirthing preparation should ensure your ability to maintain positive focus. Staying calm will have a beneficial impact on whatever scenario occurs, and particularly during emergency situations or advanced medical intervention.

For the majority of women, time and financial constraints preclude them from registering for a selection of classes, and so as the impending birth presents the most anxiety causing thoughts, childbirth classes are often given priority over a wider range of topics such as; feeding, newborn care, safety, sleeping, and how to cope with such a major life adjustment. Of course, being a parent is a process of continual learning and growth but starting out with some basic understanding and expectations for nurturing a tiny human, before you are coping with extreme sleep deprivation, can ensure a smoother transition for you all.

Rather than choosing a program that makes unrealistic promises, choose a course that is designed with the intention that you will be: Informed, Prepared and Confident. Everything you need for a positive Birth Experience.