November 30, 2007
HypnoBirthing: The Mongan Method
By White, Kerry
Abstract HypnoBirthing* has been described in many print media articles and featured on at least two evening television programs in Australia since 2001. This media coverage has generated great interest in the community - as much among the mothers, and mothers- to-be as the hypnotherapists. Many hypnotherapists have been curious about this well-known HypnoBirthing program. Some have already been specialising in preparing mothers for childbirth using hypnotherapy, whilst other hypnotherapists are keen to discover more information about the program with a view to adding HypnoBirthing to their practices.Introduction
Throughout this article, when I refer to conventional hypnosis for childbirth, I suggest the approach used by those hypnotherapists who throughout the years have been assisting and preparing mothers for childbirth hypnotically. I draw an example from The Handbook of Hypnotic Suggestions and Metaphors, edited by D. Corydon Hammond - a 602 page textbook recommended by hypnotherapy schools. An example of the approach recommended in this book is that, "Hypnosis may be successfully used to reduce pain in delivery, reducing the need for medications and chemoanesthesia, thereby eliminating its risks and post-delivery effects for both mother and child" (Hammond, 1990).
HypnoBirthing* is the registered trademark of a comprehensive program of childbirth preparation for natural birthing developed by Marie Mongan. The following factors are the major differences between the approach and that of the hypnotherapist using conventional hypnosis for childbirth.
* Childbirth education
* Focus on birthing as a normal, natural event
* HypnoBirthing is not based on pain management, as is conventional hypnosis for childbirth
* Emphasis on pre-natal bonding
* Inclusion of the birthing companion
* Focus on education and learning
* Emphasis on mind/body education
* Presentation and training
* Training of the HypnoBirthing practitioner
* Structured syllabus
* HypnoBirthing resources
* Group sessions
Many of the hypnotic techniques and education used in HypnoBirthing are common techniques used in conventional hypnosis for childbirth. For example;
* Convincers such as light arm/ heavy arm, pen dropping, lemon experience
* Fear release
* Laws of the mind
* Imagery - sensory gate/glove relaxation, future pacing birth rehearsal
* Relaxation/self hypnosis training
* Focus on breathing
* Language reframe
* Post-hypnotic suggestions
HypnoBirthing Practitioner Requirements
A HypnoBirthing practitioner is required to be either a qualified hypnotherapist or a person with a maternal health care background (with exceptions to these requirements considered individually). Practitioner training requires the student to complete relevant sections of the HypnoBirthing technique plus the supplementary courses in either Birthing Basics for hypnotherapists or Introduction to Hypnosis for maternal healthcare workers.
At the completion of the training a student gains official qualification as a HypnoBirthing practitioner and is authorised to use the name 'HypnoBirthing' and HypnoBirthing materials, which are copyrighted. As with most registered organisations annual recertification is a requirement.
Unlike a hypnotherapist working independently with the mother and responding and providing for the different client needs, the HypnoBirthing practitioner agrees to follow the structured syllabus. The practitioner agrees to comply with the Code of Ethics and Standards for the Practice of Educators affiliated with the HypnoBirthing Institute. These are intended 'to preserve the integrity of HypnoBirthing -The Mongan Method - and to assure its continuity' (HypnoBirthing Institute, (2006). The intent is also to provide uniformity of the prescribed course outline and to meet the high standards of quality of instruction expected by the HypnoBirthing Institute.
When Marie Mongan became pregnant in 1955, she challenged the belief that birthing, by nature, had to be a painful, excruciating ordeal. The idea was unacceptable to her. Marie wrote that she, "could not believe that a God who had created the body with such perfection could have designed a system of procreation that was flawed", and, "that a loving God woukL.make the means through which we would birth our children so excruciatingly painful" (Mongan, 1992).
HypnoBirthing is based on the premise that childbirth is a normal, natural function for women and that "when a woman is given the proper preparation for childbirth, she and her birthing companion can experience a safe, serene, and satisfying birthing, free of the fear that causes tension and pain" (Mongan,1998).
Therefore, HypnoBirthing teaches that there does not need to be pain in birthing. A HypnoBirthing mother learns to trust that her birthing body knows exactly what to do, relaxes deeply during the birthing process and, using her natural birthing instincts, works with her body and her baby to birth her baby in a calm, safe, easy and more comfortable manner. Dr Michel Odent, a famous obstetrician and advocate for gentle birthing, states, "One cannot help a physiological process. The point is not to hinder it" (Mongan, 2005).
HypnoBirthing is changing the view of birthing as being a medical incident. This is a welcome, refreshing, and reassuring natural method of childbirth education for those searching for an alternative to our modern day tendency towards increasing intervention in childbirth.
In HypnoBirthing the focus is on education, used to change and dehypnotise mothers. Most mothers arrive at their HypnoBirthing session already hypnotised by the belief that there is something 'wrong' with labour. The scope and depth of education varies greatly from much conventional hypnosis focused on preparation for childbirth. HypnoBirthing emphasises
* Childbirth education
* Mind/body connection
* Dick-Read's teachings on how fear affects labour - the feartension-pain syndrome
* The uterus as a muscle
* The autonomic nervous system
* Belief systems
* The process of bonding
* The birthing companion's integral role
* The four basic HypnoBirthing techniques.
The Childbirth Education
Selecting the obstetric caregivers and the birthing environment
The course of a natural childbirth depends on the co-operation and support of the obstetric caregivers, both during pregnancy and during birthing. Therefore, the couple needs to be confident that their provider's attitude, care, and direction will be compatible with the natural birthing goal of HypnoBirthing.
Mongan states that, "HypnoBirthing is a collaborative method of childbirth, not an alternative method" (Mongan, 2005). Conflict will be minimised for the couple supported by caregivers who are interested and co-operative with natural childbirth.
HypnoBirthing training does not offer medical or obstetrical advice. A signed Enrolment Agreement is a pre-requisite for a couple attending the course. One of the understandings of this agreement is that they are aware that they should seek the advice of a medical doctor or registered midwife to answer any health-related or pregnancyrelated issues surrounding their pregnancy, labour, or delivery.
Preparing the Body for the Birthing Process
The practitioner educates in nutritional requirements, instructs in exercises to avoid back strain and toning the inner thigh muscles, as well as birthing positions to practise, pelvic floor exercises, and preparation of the perineum. This education is part of the role of the practitioner and a requirement of the syllabus.
Preparing the Birth Preferences Sheet
During this preparing and planning stage the couple becomes aware that they can have control over their birth, except in the case where special circumstances exist or may arise. It is recommended the couple communicates with their care-givers before finalising their birth preference sheet.
Special Circumstances in Pregnancy
Breech position of the baby will almost certainly result in a Caesarian birth - a surgical birth, currently in Australia. The practitioner is required to arrange a special session with the mother to coach the baby to turn, or refer the mother to a qualified hypnotherapist. The therapies used are relaxation, visualisation, and release therapy (releasing emotions).
Of interest to clinical hypnotherapists is a 1990's study on breech positioned babies presented by Dr Lewis Mehl-Madronna, formerly of the psychiatric department of the University of Vermont Medical School and Arizona University School of Medicine. The research involved a study group of 100 women who received hypnotherapy and the comparison group of 100 women who had no hypnotherapy. The findings were that in the study group, 81 of the 100 breech babies turned spontaneously from breech position (bottom presenting) to vertex position (head presenting). The average number of hours spent with each woman was only four, and half of the successful 81 turns required only one session. In the comparison group only 26 babies turned spontaneously.
Acupuncture is also effective in assisting the baby to turn.
There are some other medically risky situations that can occur in late pregnancy and the couple is alerted to the signs and symptoms requiring medical attention, sometimes urgently.
Challenging to the mother is the artificial induction, almost always suggested when the mother is past her due date. An artificial induction may lead to a slippery path of further interventions, medical and/or surgical, during labour and birthing. This scenario is an obstacle to natural birthing and the program explores natural alternatives to avoiding the artificial induction (because of post- dates). Some mothers may need a special session with their HypnoBirthing therapist at short notice, to assist their efforts to avoid this intervention. In HypnoBirthing we also recommend acupuncture as an additional, effective therapy. Equally challenging to the couple is the augmentation of labour (use of artificial stimulants to enhance the 'surges' after labour commences).
The Childbirth Process
The practitioner instructs the couple in the physiology of pregnancy, early signs of labour, when to visit the hospital, the physiology of the birthing process, and the postnatal stage. The HypnoBirthing program provides sufficient education for the couple to achieve a complete understanding of birthing and not instill fear. What is omitted is intentional. In a HypnoBirthing class you will not find discussions of difficulties and hardships during labour.
Some hospital, and private childbirth education, classes create fear and anxiety in the mother by providing information, and using resources which are not relevant to a normal birth. This information relates to what we call 'special circumstances' in HypnoBirthing*.
There are couples who choose to use HypnoBirthing as their only form of childbirth education. Marie Mongan stated in a radio interview in June 2007 that more medical doctors are referring their patients to HypnoBirthing practitioners. As well, almost 200 hospitals in the USA are now organising staff training in HypnoBirthing and offering HypnoBirthing classes in their hospital facility.
The program focuses on educating our couples about why there is no pain associated with normal birthing. Dr Grantly Dick-Read, on whose method of natural childbirth HypnoBirthing is based, states that "nothing is more natural or more in keeping with the simple principles of physiological activity than childbirth" (Dick-Read, 1959).
Following the teachings of DickRead we specifically focus on:
The Fear-Tension-Pain Syndrome
Read states, "The fear of pain actually produces true pain through the medium of pathological tension. This is known as the Fear-Tension-Pain Syndrome and once it is established a vicious circle demonstrating a crescendo of events will be observed, for, with the true pain, fear is justified, and with mounting fear, resistance is strengthened" (Dick-Read, 1959). This fear of childbirth pain can become ingrained in the mind of a mother long before she even reaches her birthing day. Sources of fear or concern/ anxiety in HypnoBirthing and credited to Louis Mehl-Madronna's study on turning breech are: one's own birth, others' birth stories, previous labours, parenting, level of support, marriage/ relationship, career, housing, medical care, finances, prior relationships, and personal experience of abuse.
Our couples benefit from a hypnotic fear release, with further work if necessary by a qualified hypnotherapist. The birthing companion is instructed to be vigilant in observing any sign of tension in the mother so that they both share the knowledge and understanding of the consequence of body tension anywhere in the body and its effect on the uterus.
The Muscle Layers of the Uterus
Another critical understanding we draw from the work of Dick- Read is his description of the anatomy and physiology of the uterus. There are three layers of muscle in the uterus which, unencumbered by fear and resistance, are designed to work in harmony and assist birthing - a normal, natural function. This understanding, along with the illustrations we use in the textbook and classes, is the crux of the entire HypnoBirthing program.
Autonomic Nervous System
This is a critical factor in the education and learning of HypnoBirthing. Our couples, sometimes for the first time, learn of the sympathetic, and parasympathetic nervous branches of the autonomic nervous system and the effects on labour. Dick-Read describes observing an experiment in which the sympathetic nerves to the uterus were stimulated. Very soon the organ, "appeared pallid, firm and bloodless, but when the stimulation was removed it rapidly filled with blood and became an elastic deep-pink uterus" (DickRead, 1959).
Through this education and understanding, the hypnobirthing couple learn how vital it is for the mother to remain deeply relaxed to maintain optimum blood flow to the uterus, thereby enabling the muscles of the uterus to work in harmony as nature designed.
As Marie Mongan states, "They [couples] simply need to learn about birth. They come to understand that when the mind is free of stress and fear that cause the body to respond with pain, nature is free to process birth in the same well-designed manner that it does for all other normal physiological functions" (Mongan, 2005).
The four basic HypnoBirthing techniques below are taught and expected to become a daily routine. Our couples are aware that by using these techniques correctly, they can manage their nervous systems and bring themselves into the 'relaxation response' creating endorphins, thereby avoiding the secretions of catecholamines of the 'fight and flight' mechanism.
Our couples learn how labour can be affected by their belief systems and the beliefs held by family and friends, as well as their care workers. They need to be observant of their own thoughts - alert to negative, limiting thoughts and beliefs, and to change them.
During the birthing, when the mother is in a trance state, she is especially receptive to the attitudes and beliefs of her obstetric care-givers - persons of authority - whose professional opinion she may adopt at that late stage (especially if she is highly hypnotisable). To remedy this, the practitioner provides the couple with a letter of introduction requesting that the staff communicate only with the birthing companion, or, if they want to assist the mother, to use the prompts (HypnoBirthing language) the birthing companion provides.
Laws of the Mind
* The Law of Psycho- Physical Response
* The Law of Harmonious Attraction
* The Law of Repetition
* The Law of Motivation
In common with hypnosis for childbirth we teach these laws and in particular the Law of Psycho-Physical Response. This law gives rise to the 'Robot Theory' forwarded by Dr Al Krazner in his book, The Wizard Within. Our couples learn that for every suggestion, thought or emotion one experiences, there is a corresponding physiological and chemical response within the body. Mongan refers to Krazner in her 2005 textbook. My favourite reminder phrase is 'What the mind believes, the body achieves' (source unknown).
Harsh, medicalised words which add to fear, are reframed, as is common to hypnotherapists.
Prenatal, Perinatal and Postnatal Bonding
Prenatal bonding is paramount in HypnoBirthing and is one of the reasons why Marie Mongan has suggested that we commence HypnoBirthing from early in the second trimester. Our couples learn that, as Thomas Verny says, "Many things go into the molding of a new life. Maternal thoughts and feelings are just one element in the mix, but what makes them a unique element is that unlike givens such as genetic inheritance, they are controllable" (Verny & Kelly, 1988). Therefore, the active involvement of the father, and a loving, sensitive relationship with the father, provides a mother with ongoing emotional support and is of vital importance to both the mother and the baby. As stated in the video shown in the program, Knowing the Unborn (Ballard, Royda & Kelly, 1988) studies have shown that the number one stress to the foetus is the mother's concern about the relationship. So a mother who is supported, supports the foetus. Messages such as these are intended to enhance the couple's relationship, impacting positively on the developing foetus.
David Chamberlain writes of learning and remembering in the preborn, "Lullabies you sing in pregnancy may have unusual power to calm your child after birth. Fathers who have identified themselves to the preborn by saying, "This is your father speaking...' have reported to me how riveting these words appear to be to the child when spoken after birth" (Chamberlain, 1998).
In essence, HypnoBirthing is a family-centered program.
Inclusion of the Birthing Companion
This is an integral part of the program and is tremendously valuable for the mother and baby.
Home practice of the HypnoBirthing techniques are strongly recommended and encouraged. The birth companion understands that, to achieve the best birth, the mother needs to become conditioned to responding to his/her voice and touch, and crucially to remain free of tension.
In the final class our couples experience an active birth rehearsal during which different birthing positions are suggested and they work together integrating the techniques learnt throughout the program. This brings together and reinforces exactly what needs to be practised at home and what each needs to do during the labour and birthing.
If the father is the birth companion, this is a priceless gift to the baby, the family, to have the mother enjoying the father's attention, responding and relaxing to the sound and touch of the father deepening the mother's relaxation, practising throughout pregnancy and guiding the mother through her labour and birthing.
These are critical to the success of the birthing. They need to be learned thoroughly and practised daily.
The four basic HypnoBirthing techniques are:
Breathing correctly is fundamental to achieving success with the breathing techniques. As well, the mother is taught to respond automatically with her breathing technique to her practice surges during the third trimester of her pregnancy. She is learning to condition her mind/body to the surges (contractions). Relaxation
Relaxation/Self Hypnosis training is critical to achieving a calm, gende labour and birthing. The mother needs to become accomplished at reaching a deep level of relaxation.
Visualisations to enhance the breathing techniques, for ultradeep relaxation and hypnotic birth rehearsal are also taught.
Deepening is the role of the birthing companion. However, the mother is advised to become skilled in her own self-hypnosis and deepening in the event that, during labour and birthing, she prefers her own company. Birth companions are taught the Light Touch Massage technique to help create endorphins and promote/ deepen relaxation. Light Touch Massage was developed and promoted by Constance Palinsky, a Michigan hypnotherapist born in 1927, as a result of her research into pain management and the release of endorphins.
Videos of hypnobirthing mothers during labour and birthing are used throughout the program. These are wonderful, powerful convincers for our couples and feature many of the techniques taught in the classes.
The 302 page textbook, HypnoBirthing The Mongan Method, (2005) is provided to each couple as a part of the fee. Our couples are encouraged to read the textbook a number of times to develop a conscious understanding of the teachings.
Relaxation CDs are, of course, critical to the daily relaxation required by the mother as she becomes conditioned to a deep, euphoric state of relaxation.
These resources are available only to currently, certified HypnoBirthing practitioners from the HypnoBirthing Institute.
The training classes differ vastly from conventional hypnosis for childbirth. HypnoBirthing provides 5 sessions of 2 hours or longer. The classes (Sessions 1 & 2) can be commenced as early as the beginning of the second trimester. I offer them from 14 weeks. The reason for this is to introduce HypnoBirthing philosophy and techniques early; dehypnotising and instilling a positive expectancy, providing the mother with the resources - textbook and CDs, and motivation to practise daily relaxation and breathing techniques and to enhance the family bonding process. Couples have told me that a major benefit was to have many months to read the textbook extensively. The baby also benefits incredibly from these early experiences.
Groups are common (no more than 5 couples). However, sometimes a practitioner can offer individual sessions.
Christine and Ben attended my classes, pregnant with their second child, and relating a previous negative birthing history. Christine described feelings of panic, not knowing what to do, feeling disempowered, and seeing the whole experience as very painful and intense.
Ben described his experience of childbirth as a 'sense of distance, and of helpless spectatorship as my wife endured more agony than I could conceive. Despite classes and the best of intentions I could do little more than hold her hand and watch'.
The couple attributed their positive change of attitude and feelings of reassurance to the teachings of the fear-tension-pain cycle, the physiological response of the mother's body, the mind/ body phenomena, relaxation and breathing techniques, the positive language (refraining), importance of positive thinking, and especially the role of the birthing companion.
This mother, despite caring for an active 18 month old baby, had thoroughly summarised relevant sections of the Mongan textbook and practised the techniques daily as advised. The couple practised their deepening techniques regularly and were thrilled to achieve a most satisfying, empowering, second birthing experience.
Christine stated that her confident attitude and preparedness for birthing resulted from many other factors of the program; the absence of references to words like 'hurt' or 'pain' aided her to perceive labour from a new frame of mind. She stated she was prepared for unexpected events (foetal distress, Caesarian section), which confirms the effectiveness of our program, especially our affirmation - T am prepared to meet whatever turn my birthing takes'.
Christine, describing her Hypnobirthing experience, talked about managing her birthing, being in control, everything coming into place and feeling right. She said that the breathing techniques 'worked wonders' and even though the surges were coming one on top of the other, she was fine with that.
Many parents, including Christine, comment on the positive impact of the program on their babies, using words such as 'mellow, placid, calm, peaceful'. She believed it resulted from the relaxation practice.
Ben, equally satisfied, wrote about his involvement, 'Fathers are encouraged not merely to support their partners but to assume a firm leadership role; coaching the woman through the birthing process and affirming her self confidence, and becoming her advocate in the respect of her desires and safety. In other words, HypnoBirthing provides an opportunity for fathers to assume their role at the most important time; at the beginning of their family'.
Also of interest is the mother's conversation with the obstetrician care-giver for her first birthing. When she spoke with him excitedly about her Hypnobirthing experience, she said, "Intrigued, he commented on how every woman needed to find their 'own something' to 'deal' with the pain of labour".
Christine states, "From my point of view and experience, HypnoBirthing is more than a way to 'get through' labour. It is a journey of self-discovery, of changing your whole outlook and understanding of the process of giving birth and of finding your inner strength when you need it the most. It is about giving' birth. Actually giving and enjoying the process, not just the result".
Training couples in HypnoBirthing is as satisfying and rewarding for the practitioner as it is for our couples. After Sessions 1 8c 2, our couples are already relieved and excited about managing their own birth. Using the HypnoBirthing techniques they continue to learn and practise. Freud is given credit for stating that subconsciously a child lives again and again the moments of its birth. I, believe that this is the best gift that a couple could ever give their baby. Imagine being that baby, enjoying the mother's daily routine of relaxation, benefiting as much as the mother, learning to relax whilst in utero, approaching birth with joy and anticipation (rather than fear and anxiety), and being eased into this world in a calm, gentle, and safe manner that most mirrors nature.
Ballard, Royda & Kelley (1998). Knowing the Unborn: Pre-Birth parenting. Palm Springs.
Chamberlain, D. (1998). The mind of your newborn baby. Berkeley, California: North Atlantic Books.
Dick-Read, G. (1959). Childbirth without fear The principles and practice of natural childbirth. New York: Harper & Brothers.
Hammond, D.C. (Ed.) (1990). Handbook of hypnotic suggestions and metaphors. New York: W.W. Norton & Company, Inc.
HypnoBirthing Institute. (2006). Code of ethics and standards for the practice of educators affiliated with the HypnoBirthing' Institute sm.
Mongan, M. F. (1992). HypnoBirthing: A celebration of life. Concord: N.H. Rivertree Publishing.
Mongan, M. F. (1998). HypnoBirthing: A celebration of life. Concord: N.H. Rivertree Publishing.
Mongan, M. F. (2005). HypnoBirthing: The Mongan method. Deerfield Beach, FL: Health Communications, Inc.
Verny, T. and Kelly, J. (1988) The secret life of the unborn child. New York: Dell Publishing.
HypnoBirthing Fertility Therapist, Sydney
Kerry White is a qualified hypnotherapist and a member of the ASCH. In her hypnotherapy practice in the Hills District in Sydney she has been specialising in HypnoBirthing since 2001 and, in 2007, became a certified HypnoBirthing Fertility therapist. Kerry is also a registered midwife and yoga/meditation instructor.
Copyright Australian Society of Clinical Hypnotherapists Spring 2007
(c) 2007 Australian Journal of Clinical Hypnotherapy and Hypnosis. Provided by ProQuest Information and Learning. All rights Reserved.