Anxiety Disorders associated with Childbirth and the benefits of Hypnobirthing
Pregnancy and childbirth for any woman are major physical, psychological and social events and there maybe a whole spectrum of emotions experienced when a woman first discovers she’s pregnant. For many the dominant feelings are of joy and happiness. But sadly instead of being a joyful experience, for some women pregnancy and childbirth can become a fearful event and in a small number of cases this fear may assume a psychological and pathological dimension.
We will all at some time experience something that makes us feel afraid. It could be a spider or a roller coaster, or turbulence on an aeroplane. Fear is a natural reaction to danger, a survival switch that turns on the body’s fight/flight/freeze response. Symptoms of anxiety may include, raised heartbeat, sweating, trembling, dizziness, nausea and shortness of breath. In most cases we calm down naturally but occasionally this fear can be prolonged and excessive.
During pregnancy some anxiety may occur as the realisation of how life-changing bringing a child into the world can be hits home. There may be financial or social impacts that cause stress. There may be worries that a relationship will change and that life itself may never be the same again. I think Grantly Dick-Read in his book, ‘Childbirth without Fear’, sums things up nicely by saying, “…It is not unnatural, therefore, to presume that very few, if any women can set out upon this great adventure without having some misgivings as to its outcome.”
For some women, at the extreme end of the fear/anxiety scale is Tokophobia, a pathological fear of pregnancy and the associated avoidance of childbirth. According to Billert (2007), Tokophobia affects about 6-10% pregnancies and can be classified as primary or secondary. Primary Tokophobia is a morbid fear of childbirth in a woman who has no previous experience of pregnancy. Secondary is a morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy. It is rare but men can also suffer from Tokophobia.
So what are women commonly afraid of during pregnancy and in childbirth? According to online pregnancy and childbirth magazine, Parenting.com, women’s greatest fears during pregnancy are a fear of miscarriage, morning sickness, eating or drinking something that could harm the baby, birth defects, early onset of labour, weight gain and the effect that stress may have on the baby. Interesting that women are aware that stress can affect unborn babies but perhaps not really understand why? I will discuss the effect of stress on babies later.
So what about childbirth? I think most women would agree that anxiety peaks around the time of their baby’s birth. But why? Well according to Kaitlin Stanford’s article on www.thebump.com, women’s most common fears surrounding childbirth include; not coping with the pain, labour going on for a long time, not getting to hospital in time, having to have a caesarean birth or other intervention, and dying in childbirth. Online pregnancy, birth and parenting magazine BellyBelly, reported that women’s top five fears were; a fear of having an episiotomy, loss of sexual enjoyment following birth, worries concerning death or injury to the baby during birth, having a bodily function from bladder or bowels, and having to have an emergency caesarean. Looking at other sources most fears seem to focus on pain and length of labour, and fear of intervention. Of course there are additional fears we may see as Hypnobirthing practitioners which may include a fear of hospitals, needles, medication or previous negative experiences. I have worked with one lady who suffered from emetophobia and had spent most her pregnancy terrified of feeling nauseous or vomiting.
But women are not the only ones to experience anxiety about pregnancy and childbirth. Partners too can have fears and anxieties. These may include a feeling of being trapped in a relationship once a partner is pregnant, being scared and overwhelmed by the responsibility of having a child, the financial strain of bringing up a family on possibly a lower joint income. They may also feel anxious about how they will feel as their partner’s body changes and how they will cope with the birth; gynaecological, maternity and women’s health can be alien environments to men. They may worry about the wellbeing of their partner during the birth. They may not feel familiar with the stages of childbirth or pain medication on offer. Some partners may even worry that they will feel left out.
So what could be the origins of these fears? Well some fears can be real and others imagined, so they can be divided into two main categories, primary and secondary fears. Secondary fears are based on negative experiences from the past. These could have occurred in the parents-to-be’s own childhood, for example child abuse or neglect, or cold/distant parenting. New parents may be afraid of the intimate and private nature of childbirth. They may feel that they do not have the skills to be good parents themselves, or may worry that they will not feel that natural bond for their child. Perhaps a traumatic event in the past has contributed to the fear, such as rape or a termination of pregnancy. Couples may have had traumatic birth experiences in the past, including late miscarriage or still birth. Storksen et al (2012) found the association between a previous subjectively negative birth experience and fear of childbirth was high. But fear was greater when there was an association between previous obstetric complications and subsequent births. In some cases women (and partners) had even developed the symptomatology of post-traumatic stress disorder.
Occasionally fears may not be directly linked to childbirth itself. If one of the parents has a phobia of hospitals or needles for example, this can trigger anxiety where all medical environments are linked, even to happy events like childbirth. The brain pattern-matches previously feared objects and situations in the amygdala. If a threat is perceived, then the fight/flight/freeze is triggered.
A primary fear of pregnancy and childbirth does not have to come from a previously negative birth experience however. Sometimes fears can be learnt. Negative ideas about periods, sex, pregnancy and birth, learnt while growing up, can affect confidence in our bodies and how they work. Increased medical management of pregnancy and birth can sometimes add to our belief that birth is dangerous. Difficult birth stories are retold more, than easier ones. “Some women have increased fear because of what they’ve heard or read or seen on television,” reports Dr Elizabeth Eden M.D., a Clinical Assistant Professor at New York University School of Medicine. “Horror stories from friends, television and the Internet can be particularly anxiety-provoking because they dramatize and overemphasize the pain and risk of childbirth.”
So what are the potential physiological and psychological effects of anxiety during pregnancy? Even before conception, anxiety may interfere with a woman’s ability to become pregnant. Psychogenic infertility is often linked to stress. Men too may experience loss of libido and according to a study led by researchers at Columbia University’s Mailman School of Public Health and Rutgers School of Public Health, there can be a reduction in sperm quality.
Dr Healy Smith, M.D., a Reproductive Psychiatrist at the Women’s Mental Health Clinic at New York-Presbyterian Hospital in New York City reports that anxiety during pregnancy may lead to a number of risks for babies, including premature birth, low birthweight, low APGAR score, poor adaptation outside the womb, including respiratory distress and jitteriness.
Adams et al (2012) found that the duration of labour was longer in women with fear of childbirth than in women without fear of childbirth. This is thought to occur as anxiety inhibits the body’s production of oxytocin (an important hormone for labour to progress) and levels of cortisol (the main stress hormone) rise. This basically tells the body that it is not safe to give birth. There are also the effects of adrenalin which increase respiration and heart rate, putting the body into the ‘ready for action’ or ‘freeze’ state. Blood is diverted away from the uterus and birth canal and out to the muscle responsible for motor movement. The cervix becomes taut. This also slows down labour and with increased muscle tension, this in turn can lead to increased pain and a greater chance of vaginal tearing. Because anxiety also increases blood flow, there can be increased bleeding during and after childbirth.
Severe fear in childbirth may also lead to an increased risk of postnatal depression according to Räisänen S., et al (2013), and posttraumatic stress disorder, as reported by Soderquist J., et al (2009). Moreover pre-natal exposure to maternal stress, anxiety and depression is thought to affect the emotional, physical and mental health of the child. O’Connor et al (2005) provided the first human evidence that prenatal anxiety might have lasting effects on HPA axis functioning in children. (The HPA axis is a complicated set of relationships and signals that exist between the hypothalamus, the pituitary gland and the adrenals. Their relationship is an indispensable part of human existence) It was concluded that pre-natal anxiety might constitute a mechanism for increasing vulnerability to psychopathology in children and adolescents, such as attachment disorders and ADHD.
Hypnosis has been widely used in obstetrics, particularly around childbirth. Research is showing that there are many advantages to the use of hypnosis in childbirth. For example it can be used to ease pain in labour and reduce the need for analgesia and anaesthetic. August (1960) performed more than 1,000 deliveries using hypnosis as the sole anaesthetic. This was further backed up by studies from Fuchs, Marcovici, Pertez & Paldi (1983), Mody (1960) and Mosconi & Starcich (1961), which showed an average of 69% of women were using hypnosis as the sole anaesthetic. There is also evidence from Abramson & Heron (1950), Callan (1961), Davidson (1962), Fuchs et al (1983) and Mellegren (1966) that show hypnosis may reduce labour by two to four hours.
According to the 2014/15 Maternity Statistics for England, the induction rates were up 1.8% to 26.8%. The caesarean rate has increased by 0.3% to 26.5%, with a rise in both the numbers of elective caesareans to 11.1% (up 0.1%) and the number of emergency caesareans to 15.4% (up 0.2%). The instrumental delivery rate has increased by 0.2% to 13.0%, with a rise in the forceps rate from 7% to 7.2%, while the use of venteuse increased by 0.1% to 5.9%. In contrast using hypnosis techniques, Harmon et al (1990) found that thirty-eight out of forty-five birthing women, delivered spontaneously without the use of forceps, venteuse or caesarean. This was found to be 84% higher than the average rate for first time mothers in normal. Evidence that was confirmed by Martin et al (2001) in a study of forty-two young women receiving treatment at a county public health department.
Hypnosis techniques can help reduce the occurrence of premature labour. Despite advances in the medical model, the incidence of premature labour has not decreased much over time. Teaching expectant mothers hypnosis techniques, like self-hypnosis to modify negative thoughts, anxiety and fears about childbirth was found in a study by Reinhard, Hatzmann & Schiermeier (2009) to greatly reduce the incidence of babies born before 37 weeks gestation. Omer (1987) and Omer, Friedlander & Palti (1986) showed that brief hypnotic interventions greatly prolonged the pregnancy of women in premature labour, than compared to a medical treatment group.
During pregnancy, hypnosis has been shown by Fuchs (1983), Fuchs, Brandes & Peretz (1967), Fuchs, Paldi, Abramovici & Pertez (1980), Henker (1966) to be effective in the treatment of hyperemesis gravidarum. It has also been found to decrease levels of anxiety amongst pregnant women. Downe (2015) observed six hundred and eighty women, and found that women in the hypnosis intervention group had lower than anticipated levels of fear and anxiety. The ongoing benefits of reducing anxiety during pregnancy and childbirth, have been observed by McCarthy (1998) who found that a group of six hundred hypnotically trained women showed a virtual absence of post-partum depression, and Harmon et al (1990) found a reduced rate of postnatal depression in women who had used hypnotic analgesia. Hypnosis techniques have also been shown by Mehl (1994) to be able to turn 81% of breech babies. There is also evidence collected by August (1961), Cheek and LeCron (1968) and Kroger (1977), that hypnosis may promote and supress lactation.
In an article entitled, “Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents”, The Journal of Family Practice concludes that, “Our study provides support for the use of hypnosis to aid in preparation of obstetric patients for labour and delivery. The reduction of complications, surgery, and hospital stay show direct medical benefit to mother and child and suggest the potential for a corresponding cost-saving benefit”.
So to conclude, there is much evidence that hypnobirthing techniques can benefit women (and their babies) greatly during pregnancy and childbirth. Good hypnobirthing practitioners aim to empower and educate women (and their partners) through pregnancy and childbirth. And a women who is calm, relaxed and feeling confident is far more likely to have a positive birth experience.
For more information on how hypnobirthing can help you or to find out more about my courses, please call me on 01363 85130 or 07966 288604.
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