Student Response by Cara Koehlerth
(Editor Note: This was first submitted as an assignment in our program. This student’s response is reprinted here with her permission.)
There are many different types of birthing classes & theories designed to explain labor pain and the best approach for coping with it. Most of these methods are based on the idea that birth is painful. Alternatively, hypnobirthing is based on the principle that:
When a woman feels fear during childbirth, her body releases stress hormones that trigger the body’s “fight or flight” response. This causes muscles to tighten and interferes with the birthing process. By training the subconscious mind to expect a safe, gentle birth, they say, women can avoid going into the fight-or-flight state, allowing for a smoother birth.
There is ample anecdotal evidence to suggest that this theory is true. Of course, there are many sources of pain in labor and in order to truly test the validity of this principle, we must realize that external factors as well as physiological abnormalities can contribute to a woman’s level of pain and her perception of pain during labor.
It is also important to note that this principle is just one theory in the technique of hypnobirthing and to maintain the technique throughout labor and delivery requires a deep level of focus and skill that is mastered through many weeks or months of practice and preparation before labor begins. As noted in The Birth Partner by Penny Simkin:
Recent research studies that compared self--hypnosis with more conventional comfort techniques in labor have found less need for pain medications among women who used self--hypnosis. The drawback for some is the intensive practice time required to master the technique and use it successfully in labor.
However, there are differing opinions on the scientific validity of hypnobirthing. According to the reviews found on Cochrane.org, there is not enough specific scientific evidence to support the hypothesis that hypnobirthing results in a lower rate of the usage of pharmacological pain relief or a lower cesarean section rate. It was noted in the same conclusion that there are two major studies currently underway which may result in more conclusive evidence in the near future.
There are several possible medical explanations for the phenomenon described in this theory. Dr. Dick-Read introduced the idea in the 1930’s that:
The fear felt by a woman during childbirth also caused blood to be filtered away from her uterus, so it could be used by the muscles that would flee the dangerous situation. As a result, the uterus was left without oxygen and could not perform its functions efficiently or without pain.
Another complimentary, and well accepted theory called “gate control” suggests that the science behind the fight and flight response may lie in the balance of nerve impulses traveling through the small nerve fibers versus the large nerve fibers. As Paulina Perez states in The Nurturing Touch at Birth:
…Based on the ‘gate control’ theory devised by British neuroscientist Patrick Wall and Canadian psychologist Ronald Melzack in early 1960’s. They hypothesized that birth pain is a function of the balance between the information traveling into the spinal cord through large nerve fibers and through small nerve fibers. If the relative amount of activity is greater in larger fibers, the person experiences little or no pain. If there is more activity in small nerve fibers, the person feels pain. In other words, non-painful stimulation (such as massage given to a laboring mother) primarily activates large nerve fibers, while painful stimulation (such as contractions) primarily activates small nerve fibers. If the amount of non-painful stimulation outweighs the amount of painful stimulation, then the laboring and birthing pains will be felt less acutely.
Although this theory varies in its medical root cause conclusion, the theory still supports the idea that guarding the laboring woman and protecting her environment, keeping her from entering into the fight or flight response to labor, is the key to keeping her system functioning efficiently and with the least amount of perceived, or actual pain.
Margaret, a mother of three and hypnobirthing advocate, recently explained:
Being in my own space was HUGE for me — going back to your adrenaline thing — my flight or fight reflex [has a] hair-trigger. If I even think I might have conflict with someone, my adrenaline kicks in. A hospital is no place for me to birth for that simple fact: if I have to completely relinquish control or expectation, my labor would shut down.
This concept is clearly illustrated by Pam England CNM MA & Rob Horowitz Ph.D. in Birthing from Within:
Believing there’s a tiger in your birth space instantly would stimulate a healthy ‘fight or flight’ reaction. Labor contractions would slow down or stop and not resume until you felt safe. No mother can give birth if she feels unsafe or senses danger. Fear activates the nervous system to produce adrenaline, which fuels the ‘fight or flight’ response. This increases heart and respiratory rates and shunts blood away from internal organs (including the uterus) to the large muscles. Increased levels of adrenaline also neutralize the effect of oxytocin (the hormone responsible for stimulating uterine contractions).
As an example of what it might look like to put this into practice, Margaret explained how she applied this method to her first birth.
I was fine and relaxed through every single contraction — just picturing my body opening and relaxing muscles all the way down to my toes. Then my water broke and I truly thought, “It’s going to hurt now because I don’t have that cushion of water there!” For that one contraction, I was in crazy pain — just fulfilling my fear. I re-centered for the next contraction and I was fine! They felt exactly like the previous contractions, though they certainly grew in intensity. I actually made it all the way to transition thinking that I was in early labor because it was so easy.
It is tempting to dismiss Margaret’s experience as an anomaly. We could assume that hers was just a well-paced, easier labor. However, Margaret used this same technique with her daughter’s birth even though the pace was completely different. “It worked for Jennings’s birth (though hers was more intense from the start — and much shorter).”
It can be concluded that though there is ample anecdotal evidence to be found supporting hypnobirthing as a way to avoid the body’s fight or flight response and ease the pain felt during labor, there is little in the way of scientific evidence to validate this specific theory and/or to explain the underlying medical root cause. This seems to be, in part, due to the lack of any published root cause analysis or stand-alone reviews of the subject. The studies in progress may give more clear evidence of the efficacy of these related theories and practices in the near future.
What we can currently assess is the overwhelming support of the professional birthing community as a whole. Whether it is related to hormone release, diverted blood supply, or a balance of nerve impulses, medical and birthing professionals seem to agree that controlling a woman’s fear, as it relates to her birthing ability and environment, is the key to a more natural form of birthing, requiring less medical intervention.
It is a matter of the woman being comfortable, not stressed, in a place where she feels safe, without people fussing, without other people stressing, without anyone else trying to have her baby for her, no clocks, no timing, no telling her what her body already knows. —Libby Williams
Additional information you may be interested in:
handout: The side effects of pitocin
blogpost: Why I want to be a doula