Hypnobirthing & Pain Control
Hypnosis helps many women during childbirth. Some clinicians believe that as many as 20% of the general population can be trained to use hypnosis as their primary analgesic. Not everyone may wish to rely solely on hypnosis, but a large percentage – probably everyone - can benefit from hypnosis to allay their fears of pain, including labour pain. Hypnosis helps women to keep calm during the stages of early labour to minimize discomfort, even if the woman opts for pain-relieving medication later on. However, the vast majority hypnobirthing clients don’t find it necessary to use any other form of pain relief in labour. Every woman – and partner – trained in hypnobirthing to date has reported that it gave them a far greater sense of confidence in their ability to cope with any eventuality and a much greater sense of control over both their emotions and physical sensations.
One well-known method of hypnobirthing has been trademarked in the USA as ‘HypnoBirthing’. This approach was originally developed by the American childbirth educator Marie Mongan. This method, along with many other ‘natural’ or ‘woman-centred’ approaches to pregnancy and childbirth, is based on the work of pioneering English obstetrician, Dr Grantly Dick-Read. Hypnobirthing proponents find that when a woman is given the proper preparation for childbirth, she can experience a safe, serene and satisfying birth, free of the fear that causes tension and pain.
Hypnobirthing takes advantage of the ‘Robot Response’ in which the body, controlled by the subconscious, can act according to whatever is determined in the conscious mind. For example, a football player who sprains an ankle in the last part of the game may focus his conscious attention so totally on playing and winning that, although he may feel the pressure of the swelling in his ankle, he feels no associated pain. His mind has narrowed its focus so much that it only accepts the suggestion that he must remain in the game and play his hardest to win. The pressure of the ankle is relayed by the subconscious as only a minor consideration that does not warrant a sympathetic or pain-stimulus response. So even though the sharp twist would normally be accompanied by strong sensations of pain, this message is over-ridden by the conscious mind’s focus on winning. It is only when the game is over and he can relax his focus and stop worrying about finishing the game successfully that the message of the sprain is relayed to the mind and the pain response kicks in.
In the same way, during childbirth, if the mind accepts the belief that, unless there are specific complications, birthing is a natural process, is not painful, and that no extreme – or even any - pain or discomfort will be experienced, the body’s physiological response is to feel only the tightening or pressure of the uterine waves as they dilate the cervix and then push the baby out naturally. This belief is learned and reinforced through a process of education and preparation using hypnotherapy.
Childbirth Without Fear
Pain is considered by medical professionals to be the ‘watchdog of medicine’, i.e. a signal that something is wrong. So if labour is experienced by so many women to be very painful, what’s wrong with labour? A common obstetrical answer to this question is that there are two sets of muscles that work in resistance to each other. However, this does not explain why these two particular sets of muscles should work in opposition if birth is a normal physiological process. Dr Dick-Read had a different theory, based on many years’ study of women in childbirth. He concluded that in the absence of fear during labour, the pain-causing constrictors are not prevalent, and the uterus is able to naturally efface, open, swell rhythmically, and expel the baby with ease. His ‘Fear-Tension-Pain Syndrome’ described how, in the absence of tension, the body releases a natural anaesthesia.
The stress response of ‘flight or fight’ which is the body’s natural reaction to fear, triggers the release of the stress hormones or catecholamines. These hormones play a major role in the body’s physiological response. When circumstances are such that neither ‘flight’ nor ‘fight’ are appropriate options, such as in the case of a woman in labour, the catecholamines act as constrictors, causing the muscles in the uterus and elsewhere to tense. It is thought that catecholamines are released in large concentration prior to and during labour when a woman approaches childbirth with unresolved fear. Hence the importance of allaying her fears, which may be conscious and/or subconscious.
In simple terms, fear creates sensations that are felt all through the body and put it into a state of alert. To protect itself when it is in a state of defense, the body directs all its efforts to those areas that can assist in flight or fight. Since the uterus plays no part in the body’s defence, blood is sent to other organs and muscles by constricting the arteries going to the uterus. If this occurs over a short period of time, there is little harmful effect, however, if oxygen supply to the uterus is limited over a prolonged period of time, this can be detrimental to the baby. The lack of blood flow to the uterus also results in constriction of the muscles so that, instead of relaxing and opening, the circular fibres at the neck of the uterus tighten. When this happens, the vertical muscles continue to try to draw the circular muscles up and back, but the cervix is resistant.
In addition to creating considerable pain for the woman in childbirth, when these two sets of muscles work in opposition, the situation can also have an adverse effect on the baby. As the vertical muscles push to expel, the taut neck of the cervix refuses to budget. The baby’s head is then forced up against an unrelenting, constricted muscle. This has the effect of slowing down labour and causing stress to the baby.
According to Dr Dick-Read, in childbirth, FEAR can be seen to be F=False, E=Evidence, A=Assuming, R=Reality; in other words, what’s wrong with labour for most women has nothing to do with their physiology but rather with the negative programming to which they have been subjected. This fear is thoroughly ingrained in the minds of women long before they come to give birth. Most healthcare providers and birthing educators, as well as women themselves, believe that childbirth is a painful and difficult process. This fear is perpetuated through a self-fulfilling continuum – pain is expected, fear is prevalent, the body is tense, and pain is experienced. However, when a labouring woman is in a comfortable state of relaxation, the two sets of muscles work together in harmony, as they are intended to do. The surge of the vertical muscles draws up, flexes, and expels; and the circular muscles open and draw back to allow this to happen. When properly prepared, using breathing, relaxation and positive imagery, the vast majority of women can over-ride the constricting hormones by the body’s natural relaxant endorphins (see below), and can enjoy labour with minimal discomfort so that birthing can proceed smoothly and easily.
“Contractions don’t have to hurt. They are energy rushes that enable you to open up your thing so the baby can come out. If you have the attitude that they hurt, then you’ll tense up and not be able to relax, and it will take the baby longer to come through and you won’t have any fun either.”
‘Barbara’ quoted in Ina May Gaskin’s ‘Spiritual Midwifery’
Pain Control Hypnosis - ‘Hypnoanalgesia’ and ‘Hypnoanaesthesia’
How hypnosis relieves pain
Dr Dick-Read was more than half a century ahead of his time. Although he did not give it a name, he was aware from observation that when labouring mothers were free from fear, their bodies relaxed; the muscles of their cervix relaxed and something happened to them that permitted an easier birth.
Scientists have long searched for alternatives to pain medication but it was not until the 1970s that it was discovered that the source of natural analgesic lies within the body. Studying the way in which opiates work upon the body, American researchers discovered that opiate molecules, locking on to special receptor sites of neurons in the central nervous system, slowed down the firing rate of the neurons. They found that if they decreased the firing rate of the neurons, it resulted in a decrease in the sensation of pain. Many of these neurons are located in the spinal cord, where pain is eventually processed into an actual bodily sensation.
These findings led to the isolation of endorphins, the neuropeptides in the brain and pituitary gland whose effect is 200 times that of morphine. Because they suppress synaptic activity that leads to pain sensation, endorphins produce a tranquil, amnesiac condition. At the same time, smaller breakdown products of endorphins, called enkephalins (literally ‘in the head’) were discovered.
Because it is one of the most effective ways of inducing the relaxation response, hypnotherapy is a powerful tool in managing and controlling pain. During the 19th century there were a number of active and pioneering practitioners in the medical profession who used hypnosis for pain control, including the most extreme form i.e. surgical anaesthesia. Unfortunately, interest in this approach declined with the development of increasingly sophisticated chemical methods for managing pain. However, as we become more aware of the limitations and potential risks of chemical interventions, there is a growing interest in the less invasive techniques for managing and alleviating pain.
Hypnosis has continued to be used to good effect in dental work (not only for pain control but also in overcoming dental phobia), childbirth, and in managing chronic pain of various types. Pain control is one of the most reliable and most studied of the hypnotic phenomena. An excellent review of the research into the exact physiological effects found to result from hypnotic suggestions may be found in T.X. Barber's articles in the 1960s editions of the Psychological Bulletin. There are many other examples of research in the field of clinical hypnosis.
There are three main elements in hypnosis that make it effective in relieving pain:
1. Physical relaxation
When people are in pain, their muscles tense and exacerbate the pain. Conversely, relaxation reduces physical tension and reduces pain.
2. Sensory alteration
This involves changing the perception of pain, using the mind to take control of the pain and imagining that it is transformed into another sensation. The brain itself does not feel pain, but instead sends signals to the rest of the body in the form of pain to let you know something is wrong. Pain control hypnosis teaches the brain to redirect energy away from experiencing pain.
By focusing on sensations in some other part of the body, attention is diverted aware from the area where the pain is located.
There are a number of specific methods employed during pain control hypnotherapy to help a client lessen discomfort and shield the body from pain and unpleasant feelings, and to alter perceptions of sensations. With practice, these effects can be activated at will, spreading endorphins around the body and focusing them on areas that may be experiencing tension or stress.
Enough research has been done over the years to prove conclusively that hypnosis is an effective tool in preventing, reducing, and even eliminating, nearly every kind of pain. The list of conditions that can be helped by hypnosis includes: back pain, cancer pain, labour pains during childbirth, dental anaesthesia, headaches and migraines, and arthritis or rheumatism. Hypnosis can be used effectively for both acute and chronic pain and is used successfully to alleviate the suffering of people with terminal conditions.
Hypnosis is very easy to induce when a person is in shock, which is why surgeons like Dr Jack Gibson (see his book ‘Relax and Live’, available from Anglo-American Books), who performed over 4,000 operations in hospitals in Ireland using hypnosis as the only form of anaesthesia/analgesia, have been so successful in using hypnosis with patients suffering from trauma in Accident and Emergency departments. However, it is also quite easy for people who have experienced a few sessions of hypnotherapy to learn how to use self-hypnosis. After some practice, it is possible to become very good at reducing your own pain levels quickly.