katemiddletonFollowing the birth of the royal baby, leading hypnobirthing expert Katharine Graves examines Kate Middleton's preferred birthing relaxation technique:

From a very early age, most of us are led to believe that childbirth is excruciatingly painful. Movies and TV shows depicting labouring women screaming in agony, reinforce this belief, as do horror stories from those friends or relatives who have sadly suffered a terrible ordeal giving birth to their own children. It is enough to make any expectant mother-to-be nervous, if not terrified, over what potentially lies ahead.

Indeed some women experience a fear so intense that they decide not to have children at all, whilst others suffer with such debilitating anxiety throughout their pregnancy that they are unable to lead a normal life.

Hypnobirthing techniques help to release fear and build confidence. Over the years I have taught many midwives and health professionals to become hypnotherapy teachers. Midwives are often great advocates of hypnobirthing, since they really notice the difference when they witness a hypnobirth, and can immediately grasp the benefits for labouring mothers.

When the fear is intense
A Swedish study in 2011 linked increasingly high levels of caesareans with women’s fears of childbirth (Sydsjo et al, 2011). This study showed that around 30% of expectant mothers with a fear of childbirth had an elective caesarean compared to 3.8% of women who did not have this fear. These extreme cases of anxiety are known as tokophobia – or the fear of pregnancy and childbirth – and many midwives will have direct experience of dealing with these women’s fears.

It was first identified as a medical condition in 2000 in an article by Dr Kristina Hofberg in the British Journal of Psychiatry (Hofberg & Brockington, 2000). Sufferers complain of persistent nightmares, panic attacks, and difficulty concentrating on anything other than overwhelming fear of the forthcoming birth. In some cases, women develop tokophobia in subsequent pregnancies as a result of experiencing a difficult birth.

Some tokophobic women will go to extreme lengths to avoid pregnancy (even though they may desperately want to have a family), so great is their fear. Sjogren, (1997) found 13% of non-gravid women sufficiently fearful to postpone or avoid pregnancy.

Physiology of fear
The problem is that the more a woman fears childbirth the more painful it is likely to be. The main principle of hypnobirthing is to remove fear and when this is achieved pain during labour is considerably reduced (and in some cases eliminated completely), leading to an easier, calmer and more comfortable birth experience.

Midwives who are trained in hypnobirthing techniques can encourage mothers to work with their bodies in a natural way by removing these feelings of fear, anxiety and stress.

It is well known that during labour the muscles of the uterus start to work and draw up, and the muscles of the cervix relax and start to open. These two sets of muscles will work in harmony when the labouring mum is calm and relaxed. However, if the muscles around the cervix remain tense and do not release, there is a battle between the two sets of muscles. This means that each contraction (or ‘surge’ as we call them in hypnobirthing) is more uncomfortable, less efficient and longer for the labouring mother. There will also be more of them, resulting in a longer labour. In addition, because the muscles are working against each other, blood supply to these muscles is restricted and they work less efficiently.

Conversely, as the upper muscles of the uterus work to draw up, if the muscles around the cervix gently release with each contraction, then each contraction is more comfortable, more efficient, shorter, there are fewer of them and labour is shorter.

Hormone levels during labour
Fear also causes the mother’s cervix to remain tense during labour. The fear response, or the ‘sympathetic nervous system’, is how we are designed to deal with emergencies. It has evolved in us over many millennia to act as a life saver during emergencies (for example when faced with a sabre-toothed tiger) and results in a freeze-flight-fight response to danger. If a mother feels afraid, or even slightly worried or nervous, her body freezes and labour slows down or stops. It is a mother’s instinct to protect her child, and part of this instinct programmes her to be in an environment where she feels absolutely safe before her body is prepared to release her baby. If she feels under stress, the body simply doesn’t work.

When a mother feels fearful, she produces hormones called catecholamines, including adrenaline, which divert energy and resources to the arms and legs ready to run or fight – which is a great system for dealing with sabre-toothed tigers, but absolutely useless during labour!

Soothing oxytocin
The other system that controls our responses is the ‘parasympathetic nervous system’, or confident response, when we feel confident and relaxed. In this state, we produce the hormone oxytocin. Michel Odent, the French obstetrician and natural birth pioneer, calls it the hormone of love (Odent, 1999), because we produce great peaks of it at special times in our lives, such as when we fall in love and when we make love. The biggest peak of this hormone is produced after a woman gives birth to her baby. Oxytocin is also the hormone that makes the uterine muscles work during labour.

Other important chemicals produced in the confident response are endorphins, which have been said to be many times more powerful than morphine. In her book The Oxytocin Factor, Kerstin Uvnas-Moberg (2003) says when we feel calm and confident, the elevated level of oxytocin in the body seems to result in the increased secretion of endorphins. So, if the mind is in the right place, the body naturally produces oxytocin to make labour efficient, and endorphins to make it comfortable. Also, when a mother is in the confident response, all her resources, all her blood supply and oxygen, go to her internal organs – much more useful for labour!

So the best preparation a mum-to-be can make for birth is to practise letting go of all the fears, worries and negative thoughts that she has acquired about birth, which is where hypnobirthing techniques can prove helpful.

Pre-labour techniques
Expectant mothers typically attend hypnobirthing courses because they want to learn techniques to help them release their fear of childbirth and build their confidence. They want to be taught techniques which harness the power of the mind over the body and to remain calm and positive.
In the weeks leading up to the birth the breathing and visualisation techniques taught, which include gentle physical exercises and positions, are ideally

What to expect in a hypnobirthing class:
1. Fear release methods to allow you to be relaxed and confident for the birth.
2. Self-hypnosis inducing deep relaxation.
3. Massage techniques – stimulating endorphins, your body’s natural anaesthetic.
4. Visualisation exercises to keep you grounded, serene and positive.
5. How your mind and body work together efficiently and comfortably.

Why choose hypnobirthing?
Midwives with knowledge of hypnobirthing techniques will often be asked questions by curious parents, eager to find out how such methods can facilitate a better birth. In brief, hypnobirthing:
1. Lessens the physical impact of childbirth and often shortens its length.
2. Ensures the birth experience is more likely to be natural, calm and comfortable.
3. Means the mother will feel more alert and in control and may find she doesn’t need any pain relief at all.
4. Helps the father to be actively involved and feel that he has played an important role in the birth of his child.
5. Allows the baby to be born in a calm, gentle and drug-free atmosphere.

The relaxation exercises are ideally practised with the father or birth partner, so that when the mother goes into labour, the sound of his or her voice, or touch, becomes an immediate anchor for relaxation.

During labour
First stage - During the first stage of labour, specific breathing techniques are adopted to relax the body and ‘up’ visualisations are used to help the uterine muscles draw up during a surge, such as imagining a beautiful sunrise or bubbles floating into the air.

Second stage - During the second stage of labour, when the cervix is fully opened, a much more focused ‘down breathing’ technique is used, along with visualisations of images that are soft, open and downwards-focused such as a trickling waterfall or a flower opening, to help the body release the baby down through the birth passage.

These breathing and visualisation techniques are practised in the weeks leading up to birth, alongside crucial relaxation exercises supported by scripts, to help relieve tension. One of the most important parts of a hypnobirthing course is the work to release fear and build confidence. Like anything, the more expectant mothers practise at being relaxed, the more efficiently and comfortably the the body works during labour.

Jane Ingleby, midwife at Macclesfield District General Hospital and co-founder of Hypnobirth by Midwives, said: “As a midwife and a mother of three, I am passionate about empowering women and their partners so they feel confident and in control, not only through labour but in the transition to becoming a parent.

“I had my first child in 1998, when there wasn’t even water birth on offer let alone hypnobirthing. However my parents always spoke about birth as a positive and exciting experience. My mum was always telling me how she didn’t recall any pain. So I went into labour relaxed and not fearing it. I had Jack at the local birthing centre, in four hours. It was an amazing, empowering experience and the best day of my life, and from that day forward I knew I wanted to become a midwife. I realise now I was extremely lucky to have grown up with such positive enforcements about birth, and undoubtedly this helped me to remain calm and relaxed.

“I qualified as a midwife in 2007, by which time I had another child and four years’ experience volunteering at a local birthing centre to complement my training in hospital. But it was the wonderful waterbirth at home with my third child in 2010 which led me to train as a hypnobirthing teacher. I wanted other mums to feel the joy that I felt giving birth.

“I have since launched Hypnobirth by Midwives – we hire out a room at Macclesfield Hospital and run classes for local mums, and I have trained the midwives at the hospital so that they know how to look after our hypnobirthing mums in labour. In fact, we all tend to use Katharine’s amazing breathing techniques to help mothers in labour. It is never too late in pregnancy to benefit from hypnobirthing. The way you speak to and approach a labouring mum is crucial, and something as simple as asking them to relax their shoulders, dimming the lights and keeping your voice low and calm can make a world of difference.”

Of course, attending hypnobirthing classes cannot guarantee a mother a perfect and pain-free birth, but even women experiencing the most complex deliveries can find these techniques a source of great help and comfort. In fact, it is arguably even more important that a mother facing complications in birth remains calm and relaxed. If more mothers learn hypnobirthing techniques and find they aid labour the hope is that the fast accelerating caesarean rates we experience the UK will decline.

More importantly, it means the birth outcome will be a good one and there is an increased likelihood of mother-baby bonding, which is beneficial for both maternal and a baby’s health.