BBC1 Childbirth - all or nothing - Refreshing but could have done more

When I heard that one of Natal Hypnotherapy's mothers was going to be on a TV documentary I felt the usual slight trepidation at how she, her brith and her choices were going to be portrayed. Over the years I have become quite cynical about these kinds of programs as usually they are looking for the "entertainment/trauma" value. Women who have chosen to use hypnosis for their birth preparation have been portrayed as very alternative, a bit hippy dippy, and often the editing focuses on the few times when the woman has been more vocal or going through self doubt, so giving the perception that the hypnosis "has not worked".

However I was pleasantly surprised and relieved that the BBC program "childbirth – all on nothing" showed a very impartial and nonjudgemental view of the different choices that women make when it comes to childbirth.  Also very refreshing, was the positivity of the healthcare professionals in their support of the women. Even if the healthcare professional was not fully in agreement with the woman's choice (free birthing without a midwife), they remained supportive and nonjudgemental.

It was also refreshing that three out of the four women had chosen to give birth at home. This is very unusual compared to most birth related documentaries. Not only had the women chosen to give birth at home, but all of them had a very positive outlook on their bodies ability to give birth and felt very confident in their choice, their birth partner and, where applicable, their healthcare professionals support. 

Only 2 of the actual births were shown and in many ways they could not have been further apart. The first birth was a planned cesarean which showed the medical procedure in great detail, including breaking the waters and lifting the baby out. 

 The second was Kati's home birth using Natal Hypnotherapy.  Sadly it only showed about three minutes of the birth, however those three minutes were beautiful, empowering and inspiring.  She was so calm, focused and obviously had complete trust in her body and the birthing process. She gave birth in the water in a darkened room where she felt completely safe.  Her birth partner and supporting midwives were there for her but gave her the space she needed to follow her body's cues and her instincts.

I have been in contact with Kati and although she feels the program was well made, she also feels that it did not really represent the actual labour and birth as well as they could have. She felt that it focused more on the fact that she wanted to eat the placenta rather than on her preparation for birth and the techniques used. As a result she has started a fundraising campaign to be able to re - edit all of the footage to show the birth in the way that she feels gives it justice. Anyone can donate from as little as £5 to enable her to create some bite-sized videos which will empower women to feel more confident and less fearful about birth. You can read more and make a donation here  www.indiegogo.com/projects/birth-you-in-love--3 

Some people will find the program quite extreme and will no doubt have their opinions on the women's choices, however overall this is a very positive and useful documentary for women who are pregnant and want more information on the choices available, especially as it shows the option of Homebirth as one which is normal safe and acceptable.

As for my personal opinion, if a woman is given the right support, there was less fear mongering, more positivity about the body's ability to give birth and increased awareness of techniques to help her stay relaxed and reduce pain, then more women could have the kind of birth experience that Kati had. Her birth undoubtedly was less risky, more healthy for her and her baby and less painful in the long run, in comparison to the woman who chose elective abdominal surgery to bring her baby into this world. 

Breech birth using Natal Hypnotherapy

Guest blog from Alison Barker

"I attended the Natal Hypnotherapy workshop with Sandra in Wimbledon and regularly listened to the CDs throughout my pregnancy. I believe the tools with which natal hypnotherapy equipped me allowed us to have the home birth we desired. I wanted to write to you to directly to thank you as I will always be grateful for the incredible benefits of natal hypnotherapy.

There was a slight nuisance to my daughter's birth which I thought it may be worth explaining briefly - my daughter was a breech presentation. Breech was not diagnosed until 40 weeks + 2. I had planned a home birth and therefore this potentially jeopardised this. However, after a failed ECV I spent time researching the area of breech presentation, having been told by the NHS that the only option was a C section. 

I came across Ruth Atkinson from a google search (and Sandra separately also recommended I speak to Ruth). Ruth had given birth to a breech baby vaginally and she kindly took the time to speak to me and discuss her experience. Ruth put me in contact with Maya midwives who I subsequently engaged to assist with the birth. 

In short, my experience was that the NHS simply do not have the experience of delivering babies vaginally as a result of (In my view) a now discredited trial study. Therefore, the only option for us was to hire an IM. I also believe the only way for me to attempt a vaginal delivery was if I was at home without hospital intervention and to avoid the NHS policies/guidelines which could, in my view, have significantly affected the outcome.

Firstly, I believe I would not have had the confidence to commit to a vaginal breech birth if it wasn't for the skills with which natal hypo equipped me. I truly believe my body knew how to give birth and trusted my instincts. Second, I was able to relax with the benefit of the CDs during the stressful period from the breech diagnosis which I believe allowed me to go into spontaneous labour (at 42 weeks). Third, I was able to have a beautiful home birth with no pain relief, other than a TENs machine and massage. It was an incredible experience.

Andrea Barker of Maya midwives mentioned she has met you previously and that a breech CD may be in the pipeline. If you would like my birth story for the website or indeed for any other literature, I would love to spread the word to hopefully encourage more women to make informed decisions for their birth, particularly breech births.

Finally, I wish to note that Sandra has been incredibly helpful throughout the latter stages of my pregnancy. We thoroughly enjoyed her workshop in Wimbledon and am very grateful for Sandra's assistance whenever I have asked questions of her regarding issues with the NHS as to my birth preferences, even at ungodly hours of the morning when I have been frantically researching! Also, Ruth has also been a true inspiration and, again, has taken the time to lend her support to me. I think Ruth and Sandra are great representatives of natal hypnotherapy. 

Thank you for creating such a fantastic product which we will passionately  recommend to friends and family."

The impact of fear on a pregnant woman

If you were to ask the average pregnant women what emotions she feels when thinking about giving birth, a large percentage are likely to use words such as scared, worried, anxious or even frightened.  For many pregnant women, their only knowledge or experience around giving birth has been horror stories told by many friends and family and often skewed media portrayal ranging from so called “reality TV” to newspaper coverage of the negative issues surrounding maternity services. It is no wonder that this view of birth has led to increasing feelings of anxiety and fear.

So what exactly happens in a woman’s body if she is feeling frightened or anxious, and what effect will this have on her, her baby and her body’s natural process of birthing?

1. Fear or anxiety will trigger the production of a hormone called adrenalin, which prepares the body for “fight or flight”.

2. This leads to blood rushing away from the centre of the woman’s body and being redistributed to her brain and limbs. This takes blood away from the uterus – the set of muscles that really need fresh oxygenated blood – and away from her baby. When the muscles of the uterus are not getting fresh oxygen, they are not as easily able to get rid of the lactic acid which is produced when muscles are working hard; lactic acid needs to be excreted, or else pain increases. The muscles therefore lose some of their elasticity (essential when flexing and releasing), becoming harder and tighter. On top of that, the baby is not getting an abundant supply of fresh oxygen through the mother’s blood, and so, over a long period of time, can begin to get distressed.

3. The muscles in her body will tense up, ready to fight or run away. In a birthing woman, the most significant muscles to tense up are the circular muscles of the cervix – keeping those tight to make sure the baby CANNOT be born when a mother does not feel safe. However, the long muscles continue to stretch and flex to try and open the circular muscles. So, essentially, the cervix and the uterus are fighting against each other.

Imagine how much harder it will be for the muscles of the uterus to open the cervix if it is all tense and refusing to budge! As all the muscles around the uterus and cervix are also tense, the poor old uterus is having to fight against the strain, rather than being free to contract and release.

You already know how much more painful things are if you tense your muscles, for example if you are having an injection. So, is it any wonder that, with all the tension in her body, the contractions are far more painful and less productive? 

4. The adrenalin neutralises the wonderful birthing hormones, including oxytocin (the one that makes the uterus contract and release), endorphins (natural painkillers), and relaxin (helps with elasticity of the muscles). The hormones, oxytocin and endorphins influence the degree to which we interpret feelings as pain or pleasure. If you reduce these hormones, then the perception of pain will go way up.

5. All this “fight or flight” preparation uses a great deal of energy. As our bodies were only designed to be in this heightened sense of being prepared to fight or flight for a few minutes at a time, you can imagine that staying in this state for prolonged periods of time will be extremely draining and possibly even harmful to the woman’s baby. In addition, the longer she is in a state of tension, the less efficient her body becomes at flowing with the rhythm of birth.

All of the above are incredibly useful if there is a true reason to fight or run away; however, when there is no actual object of fear that can be dealt with, such as a wild animal, this state can go on indefinitely. This adrenalin-pumped situation was designed to last a few minutes. However, if it is prolonged, a woman will become exhausted, her baby can become distressed and her cervix may stop opening, or even close up.

Imagine now that a woman is labouring beautifully at home, managing the sensations, feeling at ease being in her own surroundings, watching TV or listening to music. Then things are hotting up and it is time to go to the hospital. First of all, making sure she has everything with her, she has turned off the lights, called whom she needs to, locked the front door, gone out into the cold and got into the car. Just these alone use up valuable energy and can create a level of anxiety.  She then has to sit, with a seatbelt on ... Ugh ... the worst position to be in when having a contraction. Her next thoughts may revolve around the traffic, breaking down, not getting there on time – stress ... anxiety ... aahhh – she finally gets there. 

She then enters the hospital and is suddenly surrounded by strangers, and is being asked lots of questions; there are new and strange smells, noises, and machines; and from now on she is being observed. At a primal level, she is so far removed from the natural instinctive birthing environment that her levels of adrenalin have shot up and her body is attempting to try to stop or slow down labour until she feels safe and calm. As time goes by, her levels of adrenalin and anxiety reach excessive levels. By now her body is so tense that even though her uterus is still contracting, her cervix stops opening.

People around her start using terms like  “oh, not  dilating fast enough”, “failure to progress” and “baby in    distress”, which leads to more anxiety, more adrenalin and usually a roller coaster of intervention to “speed things up”. Once she is given any artificial hormones or chemical drugs, her body stops producing the right amount and balance of natural hormones, including the wonderfully powerful endorphins or natural painkillers, and so her body is struggling even more to flow through birth.

All of these factors have the ability to slow down or even stop labour, and a woman going through this truly does experience excruciating pain, which in turn reinforces the fear of the next contraction, and so the cycle goes on.

As you can see, a woman can become so entrenched in this horrible cycle that her body continues to hold back from birthing her baby, which may partly explain the current drastically high rates of chemical augmentation of labour and increase of Caesarean sections due to “failure to progress” – the most common reason for Caesarean sections today. It may also help to explain the rising rate of inductions, as the fear of birth may even prevent some women going into spontaneous labour.

With all this in mind, it is so important to help pregnant women to identify what it is that worries them and then give them tools and techniques to overcome those fear, to be informed about their options and to learn ways to counteract any adrenaline during labour through relaxation, letting go of fear and keeping their birth environment as “mamalistic” as possible. 

One very powerful and beneficial tool in helping fight the fear is the use of hypnosis as it enables you to identify and metaphorically let go of worries and concerns as well as learn the tools to stay calm, relaxed and in control of your responses.  

My new "letting go of fear" track helps women at any stage of pregnancy or birth. 

http://www.natalhypnotherapy.co.uk/shop/Letting-go-of-fear.html

NICE guidelines - Home birth is a safe option

Today is a great day for all those midwives, doulas, antenatal teachers and men and women who believe that giving birth is a normal, physiological and emotional event in a woman's life and should be treated with the utmost respect, dignity and awe. It is indeed a great day - women will now finally be given a more realistic (evidence based) view of home births.

Giving Birth does not have to be a traumatic and medicalised process during which the woman feels scared, out of control and a cog in the NHS maternity system. The NICE guidelines, which were published today, have recognised that the evidence to date indicates that women who choose to have their babies in the safety and privacy of their own home under the care of a Midwife, or in a Midwifery led birthing unit have less complications and hence intervention.

But we should not forget that this day is the accumulation of years and years of hard work by some unbelievably dedicated and passionate women and men. I remember being at the launch of the Birthplace study in London and the buzz then was amazing - everyone truly felt that the tide was turning, and that was 3 years ago.  We need to keep up the momentum, support midwives in the amazing work they do, encourage our friends, sisters, daughters to believe in their bodies and to spread the word that feeling safe, positive and prepared will help all women to have better births.

10 things to say to a pregnant woman

One of things which never ceases to amaze me is how much negativity there seems to be around pregnancy and childbirth. In spite of the fact that everyone on this planet has been through the process, so many people find the whole subject more of a concern than a joy.  I understand why this has happened and why people who have found it a difficult experience, find solace in talking about their experiences to others. However if we all started promoting a sense of positivity and empowerment when talking to a pregnant woman, maybe we could break the viscous cycle. 

So I came up with my top 10 things I say to pregnant woman:-

1. You look wonderful - pregnancy obviously suits you
2. This is going to be one lucky baby
3. You and your baby will be life long best buddies
4. What are you most looking forward to?
5. What has been your favourite moment of pregnancy so far?
6. The body is simply amazing - every baby truly is a miracle
7. (If this is a second pregnancy) I’d be happy to look after your    
    child so you can have some time to yourself
8.  I am so jealous!
9.  Birth was the most amazing experience of my life
10. I am here if you need me at any time

The secret to coping with labour and birth

If you are currently pregnant or even planning to have a baby then the thought of giving birth will have crossed your mind once or twice!  From those cringe worthy sex education videos to One Born Every Minute to well-meaning neighbours, the message most women get is that birth hurts like hell, that you will be in labour for days, that you are likely to scream the place down and turn the air blue with a few choice words begging for drugs.  Is it any wonder then that 8 out of 10 women in a Mother and Baby survey were terrified of giving birth?  And yet if you were to switch over to the Discovery channel and were to watch a programme of any other mammal giving birth, she would be quiet, calm, mobile and seem to just get on with it.  We know that mammals register and feel pain, yet somehow during labour they don’t seem to show the same characteristics as women on OBEM.

So do you think that maybe there is a chance that us women could also experience labour and birth being calm, more in control and better able to deal with the pain?  More and more women, have discovered that by listening to hypnotherapy CDs, they can learn safe, simple and easy ways to stay calmer, be less fearful, be better able to cope with labour and have a more positive experience. 

So how you can turn from a potential screaming banshee to a calm, serene birthing goddess by just listening to a relaxing hypnotherapy CD?  Well, it all comes down to hormones and how you are feeling in the lead up to and during the labour.  If you are scared your body will be in a “fight or flight” mode and birth becomes tough; if you are calm, relax and breathe slowly, your body can just get on with it. To put it into context, imagine you are labouring alone out in the wild. Suppose you saw or even thought you saw a dangerous animal lurking in the shadows. What do you think would happen? Would you have a conscious choice on what happens next? Simply believing there is a wild animal in your birth space would instantly stimulate the “fight or flight” response. Your muscles would tighten, blood would flow to your limbs and contractions would slow down or stop and would not resume until you felt safe.

This fear, whether real or imagined, activates the nervous system to produce adrenaline (danger hormone), which gives you a burst of power to fight or to run away. Your cervix tightens (to prevent giving birth where it is not safe) and the increased level of adrenaline neutralises the oxytocin (the hormone responsible for your contractions) so that your body slows down or even stops labour. All this “fight or flight” preparation uses a great deal of energy and as our bodies were only designed to be in this state for a few minutes, you can imagine that staying in this state for prolonged periods of time will lead to prolonged labour, horribly painful contractions which will be extremely exhausting for both mum and baby.

You may be asking, “what does a women giving birth in a jungle have to do with me?” This is essentially about fear – fear of pain, fear of dying, fear of tearing. Your nervous system does not know the difference between fear from real danger or imagined fear, from what you may have seen on the tele or told by friends and family and so your body will respond in the same way to both. If you go into labour feeling and being frightened, your system will respond accordingly.

So how does being relaxed and calm make a difference? By being able to relax during labour, your body responds in a very different way to the fear scenario described above. When you are relaxed, your breathing is even, ensuring a high level of oxygen is entering both you and your baby’s body, helping your baby remain calm and stable. Increased oxygen stimulates the production of oxytocin (hormone responsible for contractions) and the natural pain killer, endorphins. As the uterus has no resistance or tension from surrounding muscles, the contractions are more effective and more manageable. Other natural hormones also increase in including relaxin which allows the tissue of the birth canal to relax, soften and expand.

One of the easiest and most relaxing ways to help you shift from being anxious to being calmer, is to listen to a Natal hypnotherapy CD in the weeks leading up to the birth. Over 2000 midwives now recommend Natal Hypnotherapy as they have seen how beneficial it can be for both mum and baby. Listening to the CD is a great excuse to go and lie down for half an hour knowing you are doing something really practical and useful to prepare for the birth. My voice guides you into a deeply relaxed state using breathing techniques, guided imagery and visualisation. Once you are deeply relaxed, your conscious mind becomes quiet and you become open and receptive to positive suggestions about the birth, learning coping strategies and pain management techniques, all geared towards helping you stay calm and able to deal effectively with contractions.

As any midwife will tell you, the secret to coping with labour is to relax and breathe. By listening to the CD over and over again before labour you become brilliant at relaxing and effective breathing and are mentally familiar with the processes of giving birth, which naturally increases your confidence and reduces any fear associated with birth. The hypnotherapy techniques put you in control, so that you have all the coping strategies you need for the big day, no matter who else is there to support you. All this for just £10 – it’s a no brainer really!

A mums review of the "The Effective Birth Preparation" by Maggie Howell.

Thank you Kate for your honest and candid review of the book

"Before the Birth

This was the most useful tool in the preparation for the birth that I came across and reading it prior to doing any Yoga or NCT classes was really beneficial. In a very practical (and never patronising) way it describes what will physically happen to your body and this. Along with the practical exercises, and by understanding the process I was able to logically address my fears.  From my personal experience I am most afraid of placental abruption - so I have been able to eliminate this by understanding it as much as I can and opting for the injection to artificially deliver the placenta post birth to reduce the risk.

Real life experiences

 I was already a convert of this type of therapy as I used a similar system to give up smoking many years ago so I already have the confidence that what Margaret talks about will work but in addition I particularly like the real life stories and as my NCT friends are gradually giving birth its interesting that those who are the most prepared and calm are having the easiest experiences.

 Advice for birthing partners

 I think this is probably the most important part of the book. The bit about asking is mine or the babies life in any danger and then taking the time to consider I think will be one of the most powerful tools on our side once in the hospital environment.  Having already done a short stay at the hospital where I am having the baby I know that they are very process and procedure driven which may or may not be right for me. (Note I am a high risk pregnancy so hospital only option)

 Things that could be added

I thought this book was excellent as a whole but if Margaret had any plans to expand it - it would be really interesting to know any projects or case studies she has done in hospitals that have utilised this process and hear from the point of view of the hospitals, consultants and GPs (not the midwives). I have come across numerous midwives and birthing centres that strongly support this approach from friends, to birthing centres that run hypno birthing courses and a student midwife at my yoga class keen to learn more.... but the GPs and Consultants I have come across told me (and I quote) 'birthing plans are a waste of time I don’t understand why anyone would opt for anything than an epidural!' This is the reality of the medical system that operates and it’s the consultants and GPs (not the midwives) that make the decisions about your care all the way through the antenatal process especially if you are a high risk pregnancy- and they are supposed to be the experts so its a brave person that challenges their thinking. This is probably a bit much to put on Margaret's shoulders but it would only take a few GPs to support this system and the ball would be rolling.

After the Birth

So did it work… yes!

 Although I didn’t think so at the time! My labour story is by no means the horror story that many of my poor NCT friends seemed to have suffered. There were a couple of things that swung in my favour that really helped.

 Positive events that I believe were linked to the hypno – therapy and the effective birth prep book: 

• I remained in a zone for every contraction. The 321 relax technique and turning down the dial on the pain really helped. Interestingly they helped not just with the contractions but also for the internal examinations. 
  
  
• I ended up having to get my husband to tell the hospital that I was coming in as they thought I sounded too calm on the phone. When I got there I was 5cm dilated.
  
  
• Unfortunately, when I entered the self-doubt phase I was asking for an epidural. My cervix got stuck at 9cm dilated. I had a hugely supportive midwife who had read and understood my birth plan. Between her and my husband they persuaded me to go back into my ‘zone’ I did this as some of the words from the tape came to me from nowhere. Every contraction takes you one step closer to meeting your baby’

The midwife said my labour was really inspirational.  I had a chuckle at this because it was way more painful than I had expected and calm/ inspirational would be last word I would use to describe what was going on in my head! But all in it was a positive experience. My husband said that although I had felt I was out of control compared to the other wailing women in the delivery unit I was incredibly calm! I didn’t even give a second thought to the issues with my placenta and Maia got two 9s and a 10 on her APGAR tests straight after birth and I couldn’t ask for more than that.

I would definitely recommend this book but I think it needs to be read in conjunction with other activities such as the NCT classes and the yoga classes (It does say this in the book).

Things that didn’t work for me – I went so far into my own zone that I didn’t want anyone near me! Including my husband. It wasn’t the candles and massage oil Zen like experience I had imagined but it got me through and a healthy baby."