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Hypnosis and Yoga for Pregnancy and Birth (excerpt)

Posted Sep 14 2009 8:19am

Hypnosis and Yoga are now well-known modalities used with pregnant women who wish to prepare for a comfortable labor and birth.

Hypnosis is a therapeutic modality that received many names throughout the centuries and it has been used in many cultures. It has been used as a natural anesthetic for childbirth before the new medical models offering narcotics came into place. Chiasson (1990) states that natural childbirth with hypnosis is possible in 25-30% of the pregnant women, while Kroger (2008) contends that only 20% of the "selected patients" used hypnoanesthesia successfully. According to Kroger, approximately 50% of the women are able to give birth with hypnosis and drugs (in lower dosages) (Kroger, 2008). Both Kroger and Chiasson indicate that hypnosis proved successful in performing surgical interventions such as episiotomy, forceps delivery, and repair (Chiasson, 1998; Kroger, 2008).

The advantages of using hypnosis during the pregnancy and in childbirth are well documented and established (Kroger, 2008): prevention of miscarriage; reduction or elimination of nausea and vomiting in early and mid- pregnancy; reduction or elimination of fear, tension and pain; reduction or elimination of chemoanalgesia and anesthesia, which means better blood and oxygen supply to the child and the mother; increased control of uterine contractions; reduced incidence of intervention (cesarean); reduction/lack of post-birth side effect (nausea, vomiting); speedier recovery and better bodily functions (eating, digesting, emptying bladder and bowels); shorter labor (by 3 hours in first-time mothers and 2 hours in second-time mothers); increased mental alertness during the labor and birth; hypnosis can be induced or maintained with minimal cues from partner or hospital staff. 

In her work, Rabuzzi acknowledges the depersonalizing effect of standard medical examination; she  regards the relationship male doctor-female pregnant woman as a relationship of inferiority meant to reinforce patriarchal values, ignoring that the relationship with a female doctor is also a relationship of inferiority. According to Rabuzzi, pregnancy is a time of "self-interrogation", challenging the woman's very self of identity; it is often presented as a "medical condition" that needs medical attention which prompted a surge in women's movement to regain control over their bodies. She considers the medical model of birth "the worst excesses of patriarchal and technological domination" (Rabuzzi, 1994: 72). Characterized in the past (40's-70s) by rigid hospital procedures, the women were often laboring for hours without any or little painkillers as they were inhibiting dilation. Later, a wide range of pain killers became available to women which numbed the pain, slowed down the dilation process and created a disconnection between the woman's psyche and her body and between the mother and the child.

Some cultures still perceive the pregnant woman as a vessel carrying life, rendering her nothing but a reproductive or sexual commodity. As a "vessel", the woman becomes a priceless object that provides essential nutriments for fetus and newborn.

Rabuzzi criticizes the patriarchal meanings of birth as results of sins, and including "fear, pain and violence". For hundreds of years, the mystery of birth was "known" only to men; women would learn about their body from men. Metaphorically, birth is perceived as spiralling through a tunnel (birth canal) into this world, similar to death (where a tunnel takes us to the other side). Through the body's movement of outward expansion and inward contraction, the birth touches two infinites: the inifinitely large and the infinitely small (Rabuzzi, 1988: 208). 

Today, many women perform amniocentesis and sonography (ultrasounds/dopplers) to detect potential problems with their child, transforming pregnancy into a medical condition. Technology is more and more used to manipulate or find out the child's gender.

The role of the midwife. In some countries (i.e., Netherlands), midwives are increasingly becoming a part of the medical model. In Netherlands, midwives are required to refer women to an obstetrician if women are considered "high risk" (i.e., a woman over 38 years old would be automatically referred to an obstetrician; a woman who underwent IV fertilization would be in category even if the pregnancy goes well) (Pasveer & Akrich, 2001). Medical technologies (costly, but "safer" as they lead to low mortality) are taking over traditional practices of natural childbirth, changing the women's perceptions of birth and discarding the importance of labor for the child and the mother. Also, the role of midwives and doulas is diminishing.

Women's anxieties/fears of birth contribute to the increasing number of Cesareans. In the USA, women who had a Cesarean with her first child, would be recommended the same procedure for future pregnancies. Vaginal Birth after Cesarean is now considered a (high) risk (Medscape, Dr. P.K. Spry, Lamaze International). These women would rarely attend a hypnosis program for childbirth. The women who choose/are recommended Cesarean have no incentives to enroll in childbirth programs (i.e., Lamaze, yoga for pregnancy and birth, hypnosis for birth, etc.). Highly educated women are also more likely to opt for Cesarean procedures. The vagina is reduced to merely being a sex organ, a receptacle for sex and sperm. The uterus also loses its function of a muscular chamber that opens when the child is ready to be born. The body no longer decides when to give birth.

Brief Literature Review.
In a comparison of hypnosis and psychoprophylaxis for antenatal and intrapartum use, 96 women chose between hypnosis (n = 45) or psychoprophylaxis (n = 51). In the hypnosis group the first stage of labor was significantly shortened by 98 minutes for primiparas and 40 minutes for multiparas. These women were more satisfied with labor and reported other benefits of hypnosis such as reduced anxiety and help with getting to sleep. (Brann & Guzvica, 1987)

A randomized trial of self-hypnosis for pain relief, analgesic requirements, and satisfaction in women during their first labor was conducted with 29 patients in the hypnosis group and 36 in the control group. No difference was observed between the groups in the proportion of women who elected to use epidural anesthesia, other analgesic requirements, or mode of delivery. However, the hypnosis group had a statistically longer mean duration of labor than the control group (12.4 vs 9.7 hrs). The mean duration of pregnancy was also increased in the hypnosis group (39.9 vs. 39.3 wks). There was a trend for labor to be more satisfying for women who used hypnosis. (Freeman, Macaulay, Eve & Chamberlain, 1986)

A study of 60 nulliparas evaluated the effects of hypnosis as an adjunct to childbirth education to see if a technique that combined the two could produce greater benefits than either treatment alone. All women received six sessions of childbirth education and skill mastery (stress inoculation) using an ischemic pain task (repeated exposure to a mild form of pain until subjects developed a psychological immunity through skillful coping). The women were divided into high and low hypnotic-susceptibility groups. One-half of each group was randomly assigned to receive hypnotic induction at the beginning of each session. The remaining control subjects received relaxation and breathing exercises typically taught in childbirth education. Hypnosis resulted in shorter stage 1 labors, less medication, more spontaneous deliveries, and higher Apgar scores. Women who were highly susceptible and hypnotized had less postpartum depression than the women in the other groups. Hypnosis had no effect on stage 2 of labor. The authors concluded that the superior outcomes in the hypnosis group primarily resulted from reduced perceptions of pain. (Harmon, Hynan & Tyre, 1990)

A comparison between hypnosis babies and newborn infants from mothers who received varying amounts of analgesics or local anesthetics showed that hypnosis babies had a significantly greater ability to recover from the asphyxia of birth in their first hour of life (Moya and James, 1960).

Hypnosis has been used successfully to reduce the length of labour; to reframe/dissociate the perceptions of body sensations during labour and birth; to strengthen the associative connections between body and mind; to experience higher alertness and less tiredness during these stages; to recover from birth faster; to bond with the child; to cope with more difficult, but rare, situations (i.e., turning the baby; resuming a stalled labour; coping with unforeseen surgical procedures); to prevent post-partum depression; to stimulate lactation, etc.

Yoga is another modality that has proved effective with pregnant women. Yoga has been used succesfully to reduce the incidence of preterm births and low birth weight. The pregnant women who practice Yoga experience fewer complications during pregnancy (i.e., pregnancy-induced hypertension, growth retardation) and have better neonatal outcomes (Field, 2008). An Australian study of the obstetricians' and midwives' perceptions of complementary therapies in pregnancy found that 81% of the obstetricians believed Yoga to be safe while 96% of the midwives considered this modality safe. Also, 78% of the obstetricians found both hypnosis and meditation to be safe modalities for pregnancy, while 88% of the midwives found meditation safe for pregnancy (Gaffney & Smith, 2004).

Many programs of hypnosis for birth are being offered all over the world. One of them, the HypnoPregnancy and Birth (based in Ottawa, Canada) uses guided visualization and breathing exercises, body sensations understanding and self-hypnosis techniques to help the expectant mothers go through the pregnancy, the stages of labour and the birth, as well as provide them with post-birthing strengths. The course helps the women communicate with their baby throughout their pregnancy and solidify the bond between the mother/parents and the child. During the program, the women are encouraged to address emotional issues or concerns, and, if necessary, the women might be seen individually (for a discounted fee).

The HPB course was created by Dr. Liana Voia and it consists of enhanced and evidence-based hypnotherapy exercises for pregnancy and childbirth (associative and dissociative); the program contains progressive relaxation, hyperempiria, double/dual induction, Gestalt-based visualization, dream inducement, mindfulness, meditation, Meridian Tapping Techniques (MTT) and NLP exercises to reframe, desensitize and cope with challenging situations while maintaining a balanced and positive attitude during labour and birth. The expectant women are advised to begin the program earlier in the pregnancy (15-20 weeks) (Voia, 2009).

References

Brann, L., & Guzvica, S. (1987). Comparison of hypnosis with conventional relaxation for antenatal and intrapartum use: A feasibility study in general practice. Journal of the Royal College of General Practitioners, 37, 437-440.
Chiasson, Simon W. (1990). Group Hypnosis Training in Obstetrics. In Handbook of Hypnotic Suggestions and Metaphors. Edited by D. Corydon Hammond. An American Society of Clinical Hypnosis Book. First Edition. W.W. Norton & Company, Inc.: New York.
Field, T. (2008). Pregnancy and labor alternative therapy research. In Alternative Therapies in Health and Medicine. Vol. 14, No. 5, pp. 28 - 33.
Freeman, R. M., MacCauley, A. J., Eve, L., & Chamberlain, G. V. P. (1986).  Randomized trial of self-hypnosis for analgesia in labour. British Medical Journal, 292, 657-658.

Gaffney, L. and Smith Caroline A. (2004). Use of complementary therapies in pregnancy: the perceptions of obstetricians and midwives in South Australia. In Australian and New Zealand Journal of Obstetrics and Gynecology, Vol. 44, pp. 24-29.
Kroger, William S. (1990). Preparation for Obstetrical Labor. In Handbook of Hypnotic Suggestions and Metaphors. Edited by D. Corydon Hammond. An American Society of Clinical Hypnosis Book. First Edition. W.W. Norton & Company, Inc.: New York.
Moya & James (1960). Medical Hypnosis for Obstetrics. Journal of the American Medical Association, 174(16):2026-2032.
Pasveer, B. & Akrich, M. (2001). Obstetrical trajectories.On training women/bodies for (home) birth. in Birth By Design. By R. Devries, C. Benoit, E.R. Van Teijlingen, S. Wrede; Routledge: New York, London.
Rabuzzi, Kathryn Allen (1994). Mother with Child. Transformation through Childbirth. Indiana University Press: Bloomington and Indianapolis.
Voia, Liana (2009) HypnoPregnancy and Birth (forthcoming)

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