Sheila Barratt-Smith tells Denise Winn that the images and language used to describe birth can determine whether a woman experiences pain – or euphoria.

Winn: Sheila, I'm looking at a few testimonials from mothers who came during their pregnancies to your GentleBirth classes. This is from Sarah, a petite first-time mum: "My 11lb baby was born at home after only one hour. I didn't need any pain relief or stitches. It was a wonderful experience." This is from Jan: "The midwife who came to assist my delivery said it was the calmest birth she had ever seen." And Maria says, "Thanks for all your support. People are amazed when I tell them I had no painkillers."

Now, as a late mother myself, I had the opportunity when I was pregnant to go to active birth classes and learn all the breathing and different positions that could aid a natural birth, but we weren't ever told not to expect any pain. Yet don't you tell your mothers-to-be that birth doesn't have to be painful?

Barratt-Smith: I tell them that having a baby is a normal bodily function and so it is not logical automatically to expect pain when using a part of the body for the purpose for which it was designed. Pain is a sign that there is something wrong and nothing is wrong with normal birth.

Winn: So how did we end up with this very unhelpful idea that childbirth pain is just about the worst pain you can get, worse than stomach ulcers and kidney stones?

Barratt-Smith: Religion played a big part because, by the Middle Ages, the Church had weighed in and denied women help from other women, as atonement for their sins as seducers of men. Once, women in labour were cared for by other women, often their mothers, and their every need was attended to by those they knew and loved. Herbs and aromatic oils were used to soothe, relax and create the gentle atmosphere into which the baby would be welcomed. But, during the Middle Ages, labour assistants — the midwives, homeopaths and aromatherapists of today — were burned at the stake, as witches. Then surgeons decided to take over delivering babies and midwifery started to die out.

So that medical students — all male, as only men were allowed into medical schools — could learn the 'craft', women got brought into hospitals and put into beds, even though they weren't ill, at least at that point. The students would often come straight from dissecting corpses to give the women internal examinations, going from one to another — until Florence Nightingale came along, hygiene was not even thought of. Huge numbers of women died from what was called childbed fever — obviously caused by infection — within 48 hours of the birth. It wasn't till the end of the 1800s that doctors started to realise that the concern that Dr Ignaz Semmelweiss had voiced 40 years before made sense — that poor hygiene was causing infection. But, by that time, the idea of birth as something gentle and joyous had completely gone. Women were terrified of dying in childbirth.

Queen Victoria insisted on chloroform when she gave birth — the first of the "too posh to push" brigade. But it took days for women who had chloroform to recover from the effects of the gas, and who knows how it affected the babies.

Winn: The development of safer anaesthetics was considered a boon by women, unsurprisingly in the circumstances, and, of course, still is today. A lot of women have decided on an epidural while still early on in their pregnancies. But it was an insightful physician called Grantly Dick-Read who realised just how different things ought to be, when there are no complications.

Barratt-Smith: Yes, Grantly Dick-Read was an obstetrician who was born in 1890 and died in 1959. He recognised that the accepted methods of delivering babies, with the emphasis on intervention and anaesthetics, were fundamentally wrong and was author of the bestseller, Childbirth without Fear. He studied how midwives behaved with women in labour, helping them relax, and it was after attending a woman giving birth in the slums of Whitechapel that he first became aware of what he later termed the fear- tension-pain syndrome. He offered the woman chloroform and she refused, so he stood and watched as she gave birth to her baby in silence, with only gentle breathing. Afterwards, he asked her why she had refused the chloroform and she said, "It didn't hurt. It wasn't meant to, was it, doctor?"

That was quite an eye-opener. He soon recognised from his experiences in the slums of the East End that fear and anxiety produced tension in a labouring woman and, in turn, that tension produced pain. Unfortunately, his ideas were seen as ridiculous and he was booted out of the London clinic that he had set up with some fellow obstetricians.

So what is the difference between us today and those women in the slums all those years ago?

Even women in the villages of Africa and India seem to have much easier births than we do. Can you remember the woman in the floods of Bangladesh who gave birth up a tree? So why are our experiences here so bad? Our bodies are the same; the only difference is our thoughts. Whereas women once looked upon childbirth as a beautiful, peaceful event, we have now come to see it, in many cases, as a long-drawn-out battle.

Winn: Yes, women do love recounting their dreadful births!

Barratt-Smith: Absolutely! Horror stories told by our mothers, family, friends, colleagues, health professionals and even total strangers, or overheard as girls, and then reaffirmed by images on TV of women screaming whilst giving birth, and sessions in antenatal classes on available methods of pain relief — they are all guaranteed to programme our minds with a negative picture of birth. The message that comes across loud and clear is: "Childbirth is painful". These stories are an accepted part of mother and baby meetings; they go very well with a cup of coffee and a biscuit. Aristotle gave us a vital clue all those years ago, when he said, "The mind of a pregnant woman needs to be cared for". Yet in many pregnancies today that is a far cry from what happens.

Winn: I remember being told that pain in childbirth was something to do with the size of human babies' heads – that is, they became bigger, to house our larger evolved brains, and were no longer well adapted to the birth canal. But then there is also the theory that we are especially immature when we are born because we have to be born at an earlier stage, while the head can still be got out.

Barratt-Smith: Unless something is wrong, a woman's body can manage to give birth to a baby, whatever size it is. There is a perception that the bigger the baby the harder the birth. But that isn't right. The baby's head moulds to the shape of the body. My own daughter had a traumatic first birth and swore she would never have a baby in hospital again. I had started my birthing courses by the time she was pregnant the second time and so she and my son-in-law came along. Alice is only 5 feet 3 inches and weighs just eight stone and she had what is called a posterior presentation — baby's back to her back.

Winn: Ah yes. What pregnant women are warned will be a bad 'backache labour'.

Barratt-Smith: Yes, that is what they are told. Alice had already had to fight for a home birth, being told a week before the birth that she couldn't have one, but she insisted. The community midwives who attended were very supportive and it wasn't until she gave birth that she found out the baby was back to back. She used the breathing and visualisation techniques we had practised and walked a lot, remaining very calm. The midwife who was present couldn't believe it. She said that usually women with a baby in this position would be screaming for an epidural. What's more, the waters stayed intact. I was told once by an independent midwife that the amniotic membrane doesn't have to break before the birth; it protects the baby and cushions the baby's descent down the birth canal. Indeed, the baby of one of my couples, who gave birth at home, was born with the membrane still intact.

Winn: That's very interesting.

Barratt-Smith: In Alice's case, the midwives suggesting breaking the waters so that the birth would occur sooner, as they felt she was getting tired. Ten minutes later, little though she is, she gave birth without any problem to a 9lb baby boy. I saw his head as it came out and what happened was amazing. Because the baby was the wrong way round, his head was like the cone of a rocket. But it sprang back within a second. It you weren't watching, you would have missed it.

Babies are aerodynamically designed to be born as easily as possible. It is not in their interests, or the mothers', to have a difficult birth.

Winn: Well, that makes a lot of sense and you never actually hear that said. So is it the fear–tension–pain syndrome that stops it happening?

Barratt-Smith: Yes. Many women today, once they have recovered from the initial euphoria of finding out they are going to have a baby, can become highly anxious about what they think the birth is going to be like. The problem is that fear and anxiety set off the flight or flight response in the body. A woman needs to feel safe and secure, just like an animal does, before she can give birth. In an animal, fear usually means that its life is in danger. So if an animal that is about to give birth feels endangered, the birthing process is suspended until it feels completely safe. It may need to take action first to save its life.

The effect of the fight or flight response during birth is to direct all the oxygenated blood to the arms and legs, away from the uterus and the baby. When nothing life endangering is actually happening, there is no action to take and the baby and the mum are both just left stressed. If this happens at a late stage, a woman may be told that the cervix is stuck and that baby is in distress, and needs to be born quickly. That means more stress for the mum and even less oxygen for the baby — horror, trauma, screams, panic and finally an emergency caesarean.

Or it can happen at an early stage. How often do we hear of women who go into labour at home and are getting along quite well and progressing nicely, and then they are advised to go into hospital. They get there and perhaps it is a busy night so they are put into a side room and left to get on with it by themselves. It is an alien environment. The fight or flight reflex responds to this situation and the freeze part of it kicks in. The contractions suddenly stop in response to the perceived danger. Sometimes the women get sent home again or sometimes they end up being induced, to move them along, but the anxiety has already set in. Aristotle said, "Nature does nothing uselessly" and how true that is of giving birth. Everything that we need to give birth easily, comfortably and safely is at our disposal. Our bodies are like finely tuned instruments and, given the right frame of mind, will perform perfectly. But today, everything seems to be designed to stop us doing that.

Winn: It is interesting that you mention the need for safety because, as we know, that is a basic human need. And, when I heard you speak about your work, you quoted champion of natural birth Dr Michel Odent, when he said, "There is a basic need for mammalian privacy. For decades women have been told they need a guide to tell them what to do and when to do it. To give birth, women must release the hormone oxytocin, and it is a shy hormone. If there are people around it doesn't appear."

Barratt-Smith: Exactly. In the normal scheme of things, a woman about to give birth is going to feel most safe if she can do so in private, when someone she loves and who loves her is around her and soothing her (her partner, close friend or her mother), rather than a possibly previously unknown midwife fussing around with monitors or an obstetrician being very medical. When birth is the experience it should be, it can be a very sensual experience and a woman will want to move in accord with the energy in her body. It is for this reason that, in Russia, the natural birth movement teaches belly dancing. But you don't want to be watched by strangers, however well meaning, when making those intimate kinds of movements. So a woman is more likely to feel uncomfortable and clam up.

Winn: Can you say some more about oxytocin?

Barratt-Smith: Dr Michel Odent describes it as a cocktail of love hormones released during labour! It makes you fall in love with your baby. There is a theory that so many American children are aggressive and out of control these days because so many mothers are having caesareans. Apparently, if chemical oxytocin is given it prevents the release of natural oxytocin. So, as there is no flood of oxytocin and often mum does not get to hold baby immediately, bonding between mother and baby is a problem. Oxytocin acts on the uterine muscles and helps them work in harmony. The ligaments soften so the pelvic bones can click out a bit to let the baby through. You could say that oxytocin allows the horizontal muscles to go floppy and stop holding baby in, while the vertical ones work to nudge baby down from behind.

Winn: Now, that's important, isn't it — the way you explain to women what is happening during the birth process — words like 'imagine the baby wriggling its way down the birth path' and 'sensations'? You never use the word 'pain'. And that is clearly a good idea — otherwise women will pattern match to pain.

Barratt-Smith: That's right. But midwives are taught that the vertical muscles 'squeeze' the baby out. The 'pain' of it tells them that the contractions are coming properly. And the lull between is supposed to tell them that the muscles are relaxing again. Now, that doesn't sound very comfortable! I say to my mums-to-be that the muscles work together in harmony to open the space to let the baby out and nudge the baby down gently.

Winn: That creates a very different picture.

Barratt-Smith: Unfortunately, because midwives expect women to be in pain, and for the pain to increase as the cervix opens further, sometimes they actually don't realise when a Hypno-Birthing® mum is ready to give birth! One young woman, Sarah, a second-time mum who did my course because of an awful first experience, was told she needed to be induced because she was overdue. Now that is another thing. A baby is perceived to be overdue at 42 weeks. But scanning is not totally accurate and can be out by two weeks and weight can be under- or overestimated by 2lbs. More importantly, the due date was established 150 years ago by a German obstetrician called Franz Karl Naegele, who used historical rather than observational data. So it doesn't take a mastermind to realise that this could do with updating. Yet many mums-to-be will be persuaded to be induced, a painful way of giving birth, when they don't need to be. This is what happened with Sarah. She was only 22 and when you have professionals insisting they know what is best for you in the circumstances, it is hard to stand against them.

The midwives put her to bed and gave her the artificial form of oxytocin that is used to start labour going. Then the ward got busy and they forgot about her. So she decided to listen to her relaxation tape and go to sleep. She felt a few twinges, thought they were Braxton Hicks [false contractions] so went back to sleep. When she woke up eight hours later, she knew she was ready to give birth. But the midwives didn't believe her. They just insisted she couldn't be ready and they would need to get her to a delivery room first, when she was. She was ignored a few times. It was only when her mum, who was training to be a midwife herself, came to see her, had a look and saw the baby's head that she was finally taken seriously. The midwives couldn't believe that Sarah wasn't in any pain.

Winn: That's astounding! Tell us a little about the courses you run. As you've mentioned, certainly some of the women who attend are there because of horrendous first births and they want things to be different.

Barratt-Smith: Actually, most of the women who attend my courses come because of bad experiences or sky-high anxiety — or else they are first-time mums looking for a good experience.

Winn: How do you turn around those bad experiences so quickly, so that fear and tension turn to confidence? After all, as we know, some women

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© Human Givens Publishing Limited (2008)

This article first appeared in the Human Givens journal, Vol 15 No 4 (2008)

Sheila Barratt-Smith is a clinical hypnotherapist DHyp MBSCH and a HypnoBirthing® practitioner. She runs weekly and weekend GentleBirth courses for mums-to-be and their birthing partners in Worcestershire and the West Midlands. She also lectures student midwives on HypnoBirthing® and the benefits of relaxation during birth and runs day workshops for midwives and other medical professionals. She can be contacted on 01562 882662 or sheila@gentlebirth.co.uk; her website address is www.gentlebirth.co.uk

> More information on the human givens approach can be found in the following books both by Joe Griffin and Ivan Tyrrell

Dreaming Reality: How dreaming keeps us sane or can drive us mad

Human Givens: A new approach to emotional health and clear thinking

Return to top

> More information on the human givens approach can be found in the following books both by Joe Griffin and Ivan Tyrrell

Dreaming Reality: How dreaming keeps us sane or can drive us mad

Human Givens: A new approach to emotional health and clear thinking

Return to top

Return to top