Assisting Women In Labor Using HypnoBirthing®-The Mongan Method

Fear, stress and tension have long been known to be associated with increased levels of pain as reported by patients.  Grantly Dick-Read, MD, described the “Fear-Tension-Pain Syndrome” in the 1920s, and since that time obstetrical care providers have noted that education and stress management strategies have been effective in decreasing the level of pain reported by women in labor.

Hypnosis has been used effectively in the management of pain for over a century, but fell out of favor with the advent of safer, more effective analgesia/anesthesia.  Over the years, several studies have been undertaken to research the efficacy of hypnosis in childbirth.  A meta-analysis of these studies, “Hypnosis for Pain Relief in Labour and Childbirth: A Systematic Review,” appeared in the British Journal of Anesthesia in 2004.  The article states 

This report represents the most comprehensive review of theliterature to date on the use of hypnosis for analgesia duringchildbirth. The meta-analysis shows that hypnosis reduces analgesiarequirements in labour. Apart from the analgesia and anaestheticeffects possible in receptive subjects, there are three otherpossible reasons why analgesic consumption during childbirthmight be reduced when using hypnosis. First, teaching self-hypnosisfacilitates patient autonomy and a sense of control. Secondly,the majority of parturients are likely to be able to use hypnosisfor relaxation, thus reducing apprehension that in turn mayreduce analgesic requirements. Finally, the possible reductionin the need for pharmacological augmentation of labour whenhypnosis is used for childbirth, may minimize the incidenceof uterine hyperstimulation and the need for epidural analgesia.¹

Obstetrical patients using self-hypnosis have been shown to have lower scores for pain associated with childbirth, shorter duration of both first and second stage labor, increased number of spontaneous births, decreased use of analgesia, anesthesia and labor augmentation and infants with higher average Apgar scores.

HypnoBirthingÒ teaches women to relax quickly and completely with uterine contractions, and to use visualization to help facilitate cervical effacement, dilation, and fetal descent.  Women and their birthing companions are taught that fear and tension lead to increased levels of catecholamines, which ultimately causes increased pain during labor.  The positive effects of visualization are thought to be similar to those achieved by athletes using mental imagery to prepare for competition.  Rather than using multiple types of breathing and imagery to distract the laboring woman from her discomfort, HypnoBirthingÒ allows a woman to become deeply focused upon the birthing process.

When in labor, a woman using this method is not asleep or unconscious, and is receptive to suggestions made by her birthing companion and others.  For this reason, references to pain, medications and procedures are best kept to a minimum.  Women using HypnoBirthingÒ will ask for analgesia or anesthesia if they need it.

HypnoBirthingÒ encourages the laboring woman to allow passive descent in second stage and to “breathe the baby down” with release of air as she “feels the urge.”  The HypnoBirthing method discourages Valsalva pushing, and beginning to push before the woman has the involuntary urge to do so.  Recent studies have shown few risks and some benefits in allowing the mother to “labor down” in second stage, allowing passive descent, as opposed to “pushing” as soon as cervical dilation is complete.   With passive descent, there are fewer fetal heart rate decelerations and less fetal acidosis. Maternal benefits include a shorter period of “pushing” and less fatigue.  Unless specifically instructed otherwise, women begin bearing down spontaneously when the fetal presenting part is well down in the birth canal; they will generally wait until the contraction peaks and then give a series of “mini-pushes” with air release.

HypnoBirthing^® stresses that the goal is a gentle and safe birth for the baby.  Staying relaxed and focused upon her baby and the birthing process enables the birthing woman to remain calm and more comfortable.   Her companion(s) will help her to maintain this calm focus with music, dim lights, soft touch, and speaking words of encouragement.  They will also help her to remain well nourished and hydrated and assist her in moving about.  The companions will advocate for the mother and baby if interventions are suggested and help the woman to make informed decisions.

We find that, no matter what turn the labor and birth may take, most couples are very satisfied with their birthing experience.  Because they are calm and relaxed, they will feel empowered to make good decisions if interventions become advisable.