Hypnobirthing: The psychology of childbirth

Hypnobirthing is a concept that has been described as the 'psychology of birth'. It aims to teach and foster feelings of calmness and deep relaxation during pregnancy and childbirth, to promote a positive birth experience. Hypnobirthing typically comprises of a 'toolbox' of skills including (but not limited to) guided relaxation, breathing techniques, light touch massage, visualisations and positive affirmations. Additionally, hypnobirthing teaching may also include antenatal information on the physiology of birth, the role of a birth partner and how people can make informed choices during birth (for example, where to give birth, use of medical interventions and so on). 

The research into the effectiveness of hypnobirthing so far has been mixed. There is some evidence to suggest that hypnobirthing increases birth satisfaction and  psychological wellbeing, and decreases fear and pain perception during birth. However, some studies have found little differences in terms of outcomes such as epidural use. Hypnobirthing can be accessed in many ways (e.g. 1:1 classes, groups, pre-recorded videos, books) and the content of hypnobirthing classes can vary greatly, which makes it difficult to reliably measure the impact. 

An important part of hypnobirthing is the fear tension pain cycle. This refers to the concept that, during childbirth, if a person is fearful/scared/anxious, they will naturally experience increased muscle tension throughout the body, including the uterus (the muscle responsible for contractions during labour). This will lead to increased pain or pain perception, intensity of contractions and cause labour to slow down. On the other hand, if a person is calm and relaxed during childbirth, they will be more likely to experience less muscle tension and, subsequently, less discomfort and pain during contractions. 

Hypnobirthing: A tool for managing fear of childbirth?

My interest in hypnobirthing came about during my first pregnancy. As someone who would readily admit to being extremely apprehensive of childbirth, the psychologist in me wondered where that ingrained sense of fear comes from, and what (if anything) I could do about it. 

As soon as people knew I was pregnant, I noticed how eager they were to share their stories of pregnancy and birth. It struck me that these stories were rarely positive or empowering, and often left me feeling increasingly anxious and powerless about my own ability to have a positive experience of childbirth. I also noticed how childbirth is portrayed in the media – rarely is it depicted as a positive or calm event. Rather, it is often depicted as dramatic, risky, scary, and excruciatingly painful. So, of course, I found myself more and more worried about the prospect of giving birth; and now it was impacting my ability to enjoy my pregnancy. 

I found myself googling 'what can help fear of childbirth', and that is when I came across the concept of hypnobirthing. At first, I would be lying if I said I wasn't sceptical. Firstly, the name 'hypnobirthing' has connotations associated with hypnosis; the first images that came to mind were around being in a 'hypnotic state' or not being in control. This is a common misconception. In fact, hypnobirthing promotes being more in control of your mental state and less aware of external stimuli. 

A large aspect of the hypnobirthing course I completed was antenatal education. I very quickly realised how much I did not know about how childbirth works. Surely, I couldn't be the only one? It made me reflect on how childbirth is one of the biggest life events a person can go through and yet I knew next to nothing about it…and I had to do it in a few months time! 

For example, I had no idea that during labour and birth, the sutures in a baby's skull allow the skull bones to overlap, allowing the baby's head to fit through the birth canal and protect the brain from being damaged! I also thought about how I had been conditioned my entire life to fear childbirth and view it through a biased lens – rather than focusing on how incredible the human body is. 

The more I learnt about the physiology of birth and what to expect during labour, the more prepared and confident I felt, and I began to feel a little more at ease. I practised several hypnobirthing techniques throughout pregnancy, including using positive affirmations, relaxation, breathing exercises and writing my birth preferences. I also watched birth stories on YouTube and discovered that for the most part, childbirth and labour is quite boring and un-dramatic much of the time, unlike on Coronation Street! 

Inspiration for my thesis project

When my little boy was a few months old, a conversation with my best friend who had given birth at a similar time sparked some curiosity in me. While I had had a relatively straightforward birth with minimal interventions, my friend had had an extremely traumatic birth which required a high level of medical intervention and aftercare. My friend expressed that she regretted doing a hypnobirthing course and on reflection, it had heightened feelings that her birth was 'not good enough', and that her body had 'failed' her in some way. 

This made me wonder about the importance of how hypnobirthing is taught and the messages it conveys. Sometimes, it is possible that hypnobirthing can inadvertently promote a 'natural' birth as the 'best' birth. So, when a person intends to have a natural birth and this doesn't go to plan, it can have a negative impact. 

This, on top of the emotional impact of having a potentially traumatic birth experience can reinforce negative feelings of failure. I believe that hypnobirthing courses that promote the usefulness of the techniques, no matter how you plan to give birth, or how you end up giving birth, can be helpful.

When I began working as a trainee clinical psychologist, I realised that fear of childbirth is extremely common, with a global prevalence of tokophobia (phobia of childbirth and/or pregnancy) around 16 per cent. However, there is little research into people's experiences of hypnobirthing specifically. My thesis project is exploring people's lived experiences of using hypnobirthing. Specifically, I am looking to understand more about motivations for seeking hypnobirthing courses, the positive and negative aspects of using hypnobirthing, the barriers and facilitators to implementing the techniques, and whether expectations of using the techniques differ from reality. 

Currently, in the UK, hypnobirthing is not regulated and there is no governing body overseeing how it is delivered. Additionally, most hypnobirthing courses or materials are accessed at a financial cost, meaning it is inaccessible for many, particularly within the current economic climate. The more research conducted into the area will hopefully provide a clear rationale and justification for making hypnobirthing more widely accessible for those who wish to access it.