Prenatal Counseling and Birth Hypnosis: A Clinical Model

by Gayle Peterson, LCSW, PhD
The question may be raised... whether the improvement in medical management, in lessening the physical dangers of pregnancy, has contributed to a waning concern with the concomitant psychological changes." Greta Bibring (1959)

The biological processes of pregnancy and childbirth ready a woman for motherhood psychologically as well as physically. The birth of a baby is the birth of family. A myriad of births take place at once: women become mothers, husbands become fathers, and so on. One birth ripples through generations, creating subtle shifts and rearrangements in the family web.

Pregnancy and childbirth presents women with an opportunity for profound insight and self-understanding. Yet this stage of the family life cycle has gone unrecognized and unnamed. The perinatal stage has its own developmental tasks and unique characteristics. Forging an identity as a parent from past experience is one such task that a woman faces as she crosses the threshold to motherhood. The impact of the childbirth process significantly aids or hinders this process. This stage is indeed a critical period of the family life-cycle which deserves attention apart from the stages that follow: rearing young children, raising teenagers, and launching young adults. Pregnancy and giving birth form an extremely fertile time in the family's life cycle, providing an opportunity for needed adjustments in beliefs, attitudes, and family relationships to occur. As most family therapists are fully aware, transitions are periods of tremendous growth and activity, which can either result in new kinds of adjustment in healthy family systems, or in maladjustments that repeat, causing developmental delays and emotional pain.

I have worked as an early pioneer in the field of perinatal psychology since 1973, to plumb the depth of this transformative period in a woman's life. The result of my clinical work and research is a brief term perinatal counseling model that addresses the specific anxieties a woman experiences at the threshold to motherhood. Psychological counseling using this method enables a therapist to effectively transfer the powerful experience of pregnancy and childbirth to her client's core sense of self, at a critical time in a woman's development. Pregnancy is an emotionally as well as physically stressful process of bringing forth new life. In our present-day society, due to the changing roles of women and a fluctuating definition of family, it is an even more stressful process than has been the case for past generations. Changing definitions of what a family is have created considerable confusion over family roles. New family forms such as single-parenting, step-parenting, and lesbian and gay parenting have thrown families into flux. Additional stress is placed on women by newly developed medical technology. Technological advances that provide an alternative for early abortion of a Downs' Syndrome fetus, for example - leave women with emotionally stressful decisions, which impact their subsequent pregnancies.

Instead of emotional support, our society has increasingly responded to women's needs with a high rate of cesarean and other technological interventions. While these procedures can help resolve certain difficulties in the physical birth process, more often than not they further augment the emotional stress level of the birthing mother, contributing to difficulties in maternal-infant bonding, maternal self-esteem, couples' relationship problems, and overall stress in the postpartum period.

In the treatment of pregnant women, it is important to understand a woman within her societal context. Cultural attitudes and beliefs about motherhood, a woman's experience of her femininity in the culture, and her role in the family are other variables which impact her resources for bringing forth life. She is not pregnant just with baby, but also with the expectations, responsibilities, and wishes that she and others harvest with the birth of a child. The biological condition of the pregnant woman mirrors her experience as a member of her family as well as a member of society. It is the mother herself that exists at the hub of the transitional stresses of pregnancy and birth, literally embodying the biological changes necessary for this new beginning. She must "body-forth" the energy needed for a healthy pregnancy and birth despite the stresses we have just noted. Mental Health Professionals and the Perinatal Period

There is an increasing need for counselors and mental health professionals to specialize in addressing the needs of women and their families during the Pregnancy and childbirth stage of the family life cycle.

Reduced maternal anxiety is the psychological factor most significant in normalizing pregnancy, labor, and birth outcomes. High-anxiety states, which affect oxygenation and the flow of nutrients to the fetus, have been correlated with abnormal decreases in fetal movement since 1978. Anxiety has also been associated with uterine dysfunction in labor, other debilitating labor patterns, as well as prematurity and miscarriage as early as 1961. As anxiety levels drop, these conditions improve.

To effectively transform maternal anxieties several researchers and practitioners now recommend the use of hypnosis. Some have pointed to the need for hypnosis in obstetrics, primarily to address the psychological needs of the mother. Others have used hypnosis to address the needs of the family as they prepare for labor. Still others have recommend hypnotherapy to reverse the potentially debilitating emotional factors that can arise with pregnancy.

Over the past 30 years, I have developed a body-centered hypnosis for childbirth to address the psychological aspects of the childbirth and their impact on labor and postpartum adjustment. Using techniques that engage portions of the brain, I create a hypnotic experience of birth, including the sensory patterning of labor. I link the pregnant woman's experiential input with hypnotic suggestions for labor and birth that are based on her personal history. I also link the hypnotic experience of childbirth to the woman's individual needs, weaving suggestions for conflict resolution via Ericksonian storytelling into a guided journey through labor. Overall, I strive to create a subjective experience of having already mastered the birth process.

Women who have engaged in this form of hypnosis report that phrases and images from the hypnotic experience reemerge during labor. Many laboring women even feel that they are "reliving" the birth. My belief is that the sensation aroused by the hypnotic birth journey becomes encoded in the nervous system through the brain's memory tracings, and that the suggestions for coping with labor and birth become activated by the physiological processes themselves.

Whereas some forms of hypnotherapy involve dissociation from bodily experience, body-centered hypnosis deepens a woman's bodily sensation, taking her into a focused experience of physiological processes. Body-centered hypnotic suggestions are communicated, through a variety of images and sensations, to the visual, auditory, and somasthetic cortices of the brain. Here, I believe, the images and sensations that carry sufficient emotional impact trigger the release of acetylcholine (a neurotransmitter involved in the formation of memories) through the hippocampus and into long-term memory storage. Later, the physical processes of the developing pregnancy and labor activate these hypnotic messages. If anxieties have been addressed successfully in hypnosis, then maternal anxiety lessens and labor is more likely to progress smoothly.

Body-centered hypnosis mediates a woman's fears about childbirth and motherhood through bodily sensation and physical memory, and the effects are observable. Provided that pain has been adequately addressed, the flow of oxytocin during labor tends to be sustained and the ejectory reflex remains largely unimpeded. In addition, some birthing women retain a conscious awareness of the hypnotic messages given. Others do not; yet, upon recall they will repeat a phrase or two, demonstrating that the messages have become an intrinsic part of their birthing experience. One woman reported the following recollection soon after her second birth: "And so 'straight down and out he came' (a phrase from her hypnosis session, used to help counteract the effect of her previous posterior birth) in a two-hour labor."

Facing Pain

Pain in labor is a reality. And the expectation of pain, as well as some means for coping with it, goes a long way toward healthy birth outcomes. The hippocampus plays a major role in this respect, for it mediates between the expectation of an experience and its actuality. One researcher notes that when differences between expectations and realities remain minor, the hippocampus "inhibits the reticular activating system," but as soon as major differences emerge, the hippocampus stimulates the reticular activating system "to alert the entire cortex to these discrepancies" and, in the process, precipitates higher levels of tension in the central nervous system. Another researcher suggests that women who experience cognitive dissonance between what they expect and what they undergo have more birth complications than women who experience no such dissonance.

Uterine inertia, or the cessation of contractions, is one such complication; another is the occurrence of strong, unrelenting contractions that produce no cervical dilation in both instances, the involuntary processes of the uterus go haywire due to the firing of conflicting messages from the limbic system, the emotional center of the brain. Accompanying the message for labor to proceed comes a new message elicited by the woman's response to unexpected pain or fear--for labor to turn off. When both "fight" and "flight" polarities of the limbic system are activated in this way, labor can easily become dysfunctional. When the expectation of pain is addressed in advance, however, the limbic system is better prepared to create a self-regulating feedback loop that will facilitate the progression of labor.

Body-centered hypnosis reaches into this self-regulating limbic activity, helping women cope with the likelihood of pain in labor. Sensations evoked by the use of vivid imagery, meaningful metaphors, and the repetition of certain phrases all produce memory tracings in the brain--tracings that are further developed by listening to an audio recording of the hypnosis session. Stimulated by the hypnotic messages, pregnant women thus re-experience the sensations evoked during hypnosis, all the while reactivating limbic pathways that feed into the autonomic nervous system. The hypnosis is rendered even more effective when pregnant women identify their unique coping styles and utilize active coping techniques before labor begins In my Prenatal Counseling Model, a pregnant woman has opportunity to identify her coping styles before labor, rendering her a sense of mastery in coping with pain, before labor begins. This body-centered approach to pain management not only decreases anxiety levels during the upcoming birth, but profoundly affects subsequent births as well. In contrast, most other forms of hypnosis used for childbirth focus on "transcending" the pain or blocking it out, offering few long-range benefits The laboring woman whose experience of pain is denied or rendered inaccessible often has more difficulty resolving her birthing anxieties the next time around.

Case Study in Prenatal Counseling and Birth Hypnosis

Jill is a 37 year old woman, married to Steven for 5 years, expecting her second child. Her first child, Daniel, is 3 years old and the natural son of Steven and herself. She is 7 months pregnant when she came to the author for hypnosis in preparation for her second child's birth.

The author conducted the kind of birth counselor interview described in An Easier Childbirth (Peterson, 1994), which is a means of gathering information and history relevant to childbirth. During her interview with Jill, she discovered that Jill had three main concerns, which encroached, on her ability to trust and surrender to the childbirth process. These were (1) her mother's history of neonatal loss, which she lived with throughout her childhood; (2) her anxiety surrounding her son's readiness to accept a new sister; and (3) her very negative and frightening postpartum experience following Daniel's birth. In addition, Jill's first birth was a prolonged, complicated childbirth resulting in forceps delivery, of which she remembered very little, until after her second childbirth. Jill described her first childbirth as a "nightmare".

Jill could not give a clear description of her first experience in the prenatal interview. Instead, she said she could not really remember it at all. I discovered later that Jill had previously experienced hypnosis for childbirth, having procured an audiotape for listening to prior to her first birth. However this hypnotist had focused on forgetting the pain and blocking it out. This was the main goal of the first hypnosis, which the author believes deleteriously affected Jill when she approached her second birth. My experience with Jill, as with other patients in clinical practice, leads me to the conclusion that hypnosis used to block out childbirth pain serves only as a form of denial, which leaves the experience of pain out of reach, rendering it even more difficult to resolve the anxieties around childbirth the second time. This belief was corroborated by Jill when her anxieties continued to rise prior to the birth.

The second session of the model took place with Jill and her husband, which focused on identifying her coping styles for pain. Her husband reported seeing her in pain during the first birth, which she could not remember, until after her second childbirth. However her anxiety lessened greatly, following the session on coping with pain. She also repeatedly relived several of the images from the body-centered hypnosis throughout the last two months of her pregnancy. Her husband commented on how often she related the "slide metaphor" to him, following her use of the hypnosis audio recording that was made during the initial session.

There are some similarities between my method and an indirect, Ericksonian approach in which the subject's motivation to create positive suggestions is tapped. However the emphasis on bodily sensation in the author's method of hypnosis, has greater potential for emotional impact and relates specifically to the physiological sensations suggestive for childbirth.

Throughout the body-centered hypnosis, I addressed Jill's three areas of concern surrounding this second childbirth. A live and healthy bond is created between Jill and her unborn daughter, which implies a certain strength and health on the baby's part. Suggestions for "The gift of brotherhood"--implicitly intended to facilitate the bonding of Daniel with the new baby -- are intertwined throughout the birthing journey. Suggestions for a smoother, faster delivery are superimposed with metaphors about a paved road, and a slide that a child can go down, implied that birth can be approached for the second time with less fear and more excitement. All of these images and verbal suggestions are a part of a larger relaxation process of the body, as we travel through all parts of her body, as well as a part of the larger birthing process and process of making family. Future images and experiences she can look forward to with a family of four, "a very stable number," imply not only safety and security in the process of childbirth, but of a security in the family relationships, as well. Suggestions for strength, replenishment and future excitement at a family basketball game so much influenced Jill that 2 months after her birth, she took her whole family to a basketball game, reporting that postpartum depression was not a problem this time and that she was enjoying herself immensely.

Jill's two and one half hour labor represents a conclusion to our hypnosis that is quite similar to another client, Terri, who experienced a two hour labor, even though for Terri it had been twelve years between babies, and for Jill it had only been three years. Obstetricians expect that the laboring-time for babies born following a ten-year interim to resemble more closely the statistics for a first time mother. Labor length is not expected to decrease dramatically, if at all. In the author's clinical practice, however, these unusual occurrences abound. Jill reported no postpartum depression at last contact, which was four months after delivery. Her enthusiasm about her second childbirth experience remains high, and she describes Daniel's adjustment to his little sister as much easier than expected. It is the author's belief that the hypnosis helped to decrease Jill's anxieties and maximize her ability to creatively adjust to the changes of this period in her life, including the childbirth and postpartum events. Through this model, I am able to support the contemporary woman's entry into motherhood, helping her meet her needs through this significant transition. When women experience a sense of mastery rather than assault during childbirth, they are more available to their newborns and they seek naturally to apply the newfound mastery to other areas of their lives. Women regularly report a sense of mastery that transfers to their overall development. The best part is that everyone benefits. Women who are supported in transforming areas of distress into wellsprings of resourcefulness learn to make the delicate adjustments needed in giving birth, in creating family, and--with each subsequent birth--in creating family anew. Childbirth is not a neutral event. It can be either very positive or extremely traumatic. This model allows a practitioner to harness the natural power of nature to assist a woman in feeling not only empowered by this process, but to become ready for motherhood.

Therapists can learn to identify birth related issues in a woman's personal history and apply principles of hypnosis and counseling to improve both psychological and medical birth outcomes. Family history, past childbirth, present family support, the woman's own birth experience and realistic preparation for giving birth are important considerations for assessment.

Furthering our understanding of the whole woman as we support her growth and development through this pivotal life experience is a cornerstone to the development of healthy families, from the start. There is a great deal of potential for growth and development within the ordinary miracle (and ordeal) that is childbirth.

Gayle Peterson, MSSW, LCSW, PhD is an international expert specializing in prenatal and family development. She trains professionals in her prenatal counseling model and is the author of An Easier Childbirth, Birthing Normally and her latest book, Making Healthy Families. Dr. Peterson is the founder of: www.makinghealthyfamilies.com, an online resource that has won acclaim from the California division of AAMFT for guidance about what contributes to healthy family relationships. Her articles on family relationships appear in professional journals and she is an oft-quoted expert in popular magazines such as Woman's Day, Mothering, Fit Pregnancy and Parenting. She also serves on the advisory board for Fit Pregnancy magazine.

Copyright 2012, Gayle Peterson, MSSW, LCSW, PhD, All Rights Reserved.

For more information visit www.MakingHealthyFamilies.com.