History dates back as early as 300 BC, Hippocrates and Aristotle, medical philosophers and leaders of the Grecian School of Medicine were using hypnosis with mums-to-be. Interestingly, neither wrote of pain in their notes on normal, uncomplicated birth. They believed that the needs and feelings of women in childbirth were to be accommodated. Aristotle wrote of the mind-body connection and emphasized the importance of deep relaxation during childbirth. In the event of complication, women were brought into a relaxed sate so that the complication could be resolved and treated.

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Florence Nightingale further wrote extensively about the mind-body connection in her 1859 nursing volumes.

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Historical Perspectives

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Early drawings and pictures often depict women squatting during labour - either over a shallow hole in the ground, or on a low platform to allow room for delivery. Kneeling or sitting with the aid of another person or a support, was also commonly adopted. A birthing stool was first mentioned in Babylonian times and became popular in many European countries in the Middle Ages. 

During the seventeenth century it seems to have become fashionable for women to labour horizontally in many European countries. Various reasons have been suggested for this change in posture. A trend towards medical supervision in childbirth meant that the physician needed to have easy access to the vagina for the purpose of examination. Pain relief may also have contributed to reduced mobility - secondary to drowsiness or leg weakness for example. Accordingly, many people have become accustomed to the notion that childbirth is limited to lying passively in bed. But this is not the case by any means!

Nowadays most centres encourage women to be mobile during labour and choose positions which they find most comfortable. This freedom of movement can still apply when using nitrous oxide or low-dose epidurals for pain relief.

While most centres nowadays encourage women in labour to be up and about, certain medical conditions may prevent this. For example, if you have high blood pressure or your baby's head is not engaged in the pelvis, then your obstetrician will want you to stay in bed. If your baby is preterm, or is being monitored continuously, then - depending on the type of monitoring being used - it may not, be feasible for you to walk around. Your obstetrician or midwife will explain the reasons concerning any limitation on your freedom of movement.

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BREATHING

From the earliest days of childbirth education, attention has been placed on learning breathing techniques for use during labour. Breathing patterns were (and in some centres, still are) taught primarily as a distraction during uterine contractions. As labour progressed and the contractions became longer, more painful and closer together, women were taught to alter their pattern of breathing. It is now recognised, however, that a rigid adherence to breathing patterns is often associated with over-breathing (hyperventilation), fatigue and inability to maintain the pattern - resulting in feelings of failure. Since the early 1980s, much less emphasis has been placed on rigid, pre-learned breathing patterns and women are encouraged more to 'do what comes naturally'.

MUSIC

Historical records reveal that the ancient Greeks played soothing instrumental music to women in labour. Music can have a relaxing effect in labour due to its ability to alter mood, reduce stress and promote positive thoughts. It can be used as a trigger for a breathing response or as a cue for relaxation. It may also be used as a distraction although this is a less effective use for music in labour. Music can be comforting not only for you, but also for your supporters.

Velvovsky - Soviet Union -
pioneered pschyoprophylaxis in childbirth. The theoretical basis of this is that normal handling of impulses arriving at the brain from the contracting uterus rely upon a balance between excitatory - inhibitory processes in the cortex and sub cortex of the brain. Any disruption of this balance paves the way for the misinterpretation of nerve impulses as pain. Hence non painful impulses are translated as pain. Psychoprophylaxis endeavours to prevent this imbalance from occurring through deep breathing during contractions; pressure applied to ‘pain-prevention’ points and stroking.

This method emphasises that ‘non-painful’ impulses are translated in the brain as painful ones as its premise that labour is not a painful process. This view is inconsistent with current understanding about the sensory mechanism of labour pain. Nonetheless, it like many ‘natural’ and pharmacological techniques addresses the importance of reducing the effects of stress on labour pain and the normal progress of labour. Moreover, pressure point stimulation may along with techniques like TENS, therapeutic massage and acupuncture act to inhibit the transmission of pain carrying impulses in the spinal cord through counter-stimulation.

Fernard Lamaze - French obstetrician -
embraced and modified Velvovsky’s methods in the 1950s. During the second (delivery) stage of labour breathing was rapid and shallow during contractions, with panting when the head crowned. He added the use of controlled neuromuscular relaxation in order to ‘conserve oxygen’ and omitted timing of contractions, pressure applied to pain prevention points and stroking. Along with education and relaxation training, Lamaze’s breathing techniques form much of the basis of current approaches to ‘prepared childbirth’ training.

Frederick Le Boyer - French obstetrician -
childbirth without violence’ - believed that the harsh environment of the traditional delivery room caused psychological trauma to the infant. In the Le Boyer method, the infant is delivered in a dimly lit, quiet room and placed on the mother’s abdomen until the umbilical cord stops pulsating whereupon it is placed in a warm bath.

Dr Grantly Dick-Read - English gynaecologist-
 rejected the need for pain relieving drugs during childbirth on the grounds that pain was principally a product of preconceived fear and tension ( he called it the 'fear-tension-pain' syndrome). He believed that women who were properly prepared could control labour pain themselves - without having to resort to medication. In order to achieve this, he stressed the importance of education, exercise and relaxation.

The method is based on English obstetrician Grantly Dick-Read’s 1944 manual ‘Childbirth Without Fear’. Dick-Read said that hypnosis during labour helps women break what he described as the “fear-tension-pain syndrome”. Once contractions start, fear kicks in as a reflex, causing blood to flow away from the uterus to muscles in the legs. The reduced blood flow causes the uterus to cramp, resulting in pain. So, if women could only relax, they would have less pain, more effective contractions and shorter labour. 

That’s where hypnosis helps. “It allows a woman to enter a state of deep relaxation. The feeling is similar to daydreaming or when one is lost in a book or movie,” explains Mongan. She named it as HypnoBirthing Mongan method. A review of patients who had used hypnobirthing was published in the British Journal of Anaesthesia in 2004. The review suggested that there was evidence of a reduced need for pharmacological analgesia. A controlled trial is currently under way in Australia, which is seeking conclusively to prove that hypnosis can make a significant difference to women in pregnancy and labour.

“The method has been gaining acceptance in the US, where there is a growing trend of moving towards natural birthing. Of the 1,059 cases that came to us between October 2005 and January 2008, as many as 80% were from the US,” says Kathie Dolce, who works at the Hypnobirthing Institute and is assistant professor, paediatrics, at the University of Colorado.