Hypnobirthing doesn’t reduce labour pain

Giving birth needn’t be painful, if you just banish fear. So goes the mantra of hypnobirthing instructors, who tell you to “embrace each gentle birthing wave” and imagine yourself in a beautiful garden, plucking fruit from a bowl, or soaring high in a hot air balloon and casting your anxiety overboard.

It’s an attractive idea – even Kate Middleton is rumoured to be considering giving it a try – but does it really work? Up until now, the only studies to investigate hypnobirthing have been relatively small and not particularly well designed, making it difficult to determine whether it is any good or not.

But a new study published in the British Journal of Obstetrics and Gynecology may finally provide an answer. Anette Werner at Aarhus University in Denmark and her colleagues took 1222 healthy pregnant women expecting their first child, and randomly assigned a third of them to receive three hours of instruction in self-hypnosis, plus audio-recordings to help them put themselves under; another third were taught general relaxation and mindfulness techniques; while the remaining third received no training.

If hypnobirthing is effective, the researchers reasoned, then fewer women would request epidural pain relief and they would rate their labour as less painful overall. Unfortunately, that’s not what happened. There was no difference between the three groups in terms of their epidural use, or in their self-assessment of pain.

This study doesn’t mean that hypnobirthing isn’t effective for a subset of women – maybe if the researchers had only selected women who believed from the outset that hypnosis would work, they would have got a different result. But then, such women may have been biased in how they reported the experience. The point about this study is that the women were chosen at random.

It’s also true that labour varies massively between individuals, and even between different pregnancies. But if this is your first baby, you have no idea how your body will react to labour or how things will progress.

My own experience of hypnobirthing was that it was great for reducing my anxiety about birth in the run-up to labour, and even useful in the early stages, before the contractions got too intense. However, I felt that its focus on describing contractions as surges, and pain as pressure left me totally underprepared for just how intense the “pressure” actually was. As a result I panicked, and I suspect that this undid any good that hypnobirthing might have achieved in terms of relaxing into labour. Maybe it would have been more useful second time around, when my eyes would have been more open to what I could expect – but I’ll never know: I had to have a c-section as a result of complications from the first birth.

My advice to women considering self-hypnosis would be to by all means take those hypnobirthing classes (if you can afford them), but keep your mind open to other forms of pain relief and to the idea that things may not go as smoothly as your teacher might suggest. And know that if you don’t achieve a “perfect” natural birth, then you’re perfectly normal and you’ve still done a fantastic job in producing a healthy baby.

Birth freedom or setting pregnant women up to fail?

I recently heard about a campaign called “the birth I want”, by an inspiring woman called Vicky Garner who believes there should be greater continuity of care during pregnancy and childbirth so that women are better supported in achieving the type of birth they want. While I wholeheartedly agree, I think there’s also something missing from this argument that could improve women’s birth experience – even in the absence of a personal birth attendant: a greater honesty about just what birth entails.

I’m certainly not against natural childbirth. My first daughter was delivered naturally, although I did request an epidural after 31 hours of contractions had failed to make my cervix dilate more than the width of a milk-bottle top (which was dispiriting, to say the least). I think every woman should have the right to choose the type of birth she has, but I also think that it should be an informed choice guided by facts and not the opinions of those around her.

What bothers me is the suggestion by some in the natural childbirth movement that all medical intervention is to be frowned upon, and that labour can be pain-free if you just relax, banish fear, and think positive thoughts. Suggesting that you can choose whether or not to experience pain (unless it’s through the use of drugs), or that you can control whether or not you’ll need a medical procedure like a c-section is in my opinion, simply setting women up to fail.

Before my daughter was born, I attended classes run by the National Childbirth Trust (NCT), which aims to empower women about their birth choices by giving them access to evidence not opinion. The trouble is that my NCT teacher at least, seemed to hold pretty strong opinions about the superiority of natural childbirth, and frightened us with tales of “spirals of medical intervention”. To give an example, we were told that if we requested an epidural, we’d likely end up flat on our backs with heaps of straps and cables hanging off us, and would be more likely to end up having our babies ripped out of us with a pair of forceps, or on the operating table undergoing an emergency caesarean section. Combined with the hypnobirthing course I had attended, I came away with the message that doctors couldn’t be trusted and that since pain is in the eye of the beholder, I could choose not to experience it. My birth plan strongly stated: no epidural!

Unfortunately, for the majority of women, childbirth hurts — a lot. I for one, was unprepared for the level of pain I was going to come up against, and (despite the hypnobirthing training) I panicked, which undoubtably made it worse. A recent study found that while 36% of women anticipated suffering extreme pain during labour, 65% reported experiencing it. Of course there are a lucky few who sail through labour with only mild discomfort, but they are in the minority. When I eventually requested an epidural, I felt guilty, but when my baby then took another eleven hours to make her appearance (42 hours in total), ultimately vindicated.

This isn’t the case for every woman who sets out wanting a natural birth, but ends up needing medical assistance. I recently came across this small study which found that women who went into childbirth with a relaxed and flexible attitude towards what they could expect were more likely to be satisfied with the experience than those who went in with fixed expectations of a certain type of birth, or who focused on specific results like having no medical interventions.

I don’t want to frighten women who are expecting their first child, but I do think there’s a case for greater honesty about what to expect during birth so women are more open-minded to the possibility of drugs, or to the idea that they may need medical assistance at some point. I say this because there’s also evidence that those women who go into birth with their eyes open to the fact that it’s likely to be tough are the ones who are more likely to achieve their goal of a natural birth.

One study of women who planned to have a natural birth found that those who anticipated more pain, who already had children and knew what to expect, and who had higher pain thresholds were more likely to succeed without drugs than first-time mums who had no idea of what to expect. What saddens me about this study is that of those women who had an epidural, 88% said that they thought it made their childbirth unsatisfying, even though it relieved their pain and they gave birth to a healthy baby. Why? Among the reasons given were a sense of failure, and a misplaced concern that an epidural might have harmed their baby somehow. I’ve heard similar anecdotes, including one friend who said she’d feel unable to look her NCT friends in the face if she asked for an epidural.

And epidurals really aren’t as bad as some would have us believe. During the research for my book, Bumpology, I fell pregnant with my second child, and I was forced to revisit much of what I had been told the first time around. This is when I realised that much of what I’d been told wasn’t necessarily true. Take the risk of needing an instrumental delivery (one involving forceps or a ventouse) following an epidural. There is an increased risk, but if you look at the numbers you realise that it’s a small one, and one which has to be weighed against the great relief an epidural can bring. In fact, twenty women would have to undergo an epidural for just one of them to end up with an extra instrumental delivery – and not necessarily because of the epidural drugs, but perhaps because doctors are more ready and willing to get the forceps out if a woman already has an epidural in place. There is no increased risk of a c-section, despite popular belief.

Another midwife friend of mine has just left the labour ward to become a community midwife specialising in home births. I asked her what the majority of pregnant women she sees expect from birth, and she confirmed that many of them come to her with very fixed ideas — be it of a water birth, one completely free from drugs, or one involving alternative ways of managing pain, like hypnotherapy. She tells them: “how can you possibly plan how you’ll react to birth, if you’ve never been through it before.? Let’s just take it as it comes.”

And this is a key reason why we need more midwives to accompany women throughout that bumpy journey into motherhood. For just like a good friend will support your decisions, but let you know if you’re being unreasonable or kidding yourself about sensitive issues (even if you don’t want to hear their advice), a good midwife who has the time to get to know you and your wishes, but who can also counsel you on the true nature of what you’re up against, has got to be a better advocate than a stranger who only meets you once you’re in the throes of labour and has to leave at the end of their 12 hour shift.