literally are traumatised by the birth they have had and suffer post-traumatic stress symptoms. Do you need to deal with that first — for instance, by using the rewind detraumatisation technique?

Barratt-Smith: The course is specifically designed to help the mum- and dad-to-be understand the physiology of birth, how language and your thoughts affect you and why there is no logical reason for pain to be an automatic part of birth – if you can't change the event then the only possibility is to change your thoughts about it. This generally has the desired effect, although I have used the rewind technique on a woman who had been through a particularly traumatic caesarean, and I do what all good human givens counsellors do – I give women hope in the very first session that things can be different.

The GentleBirth course, using HypnoBirthing®, runs for four three-hour sessions on a Saturday. The dads-to-be or birthing partners are an integral part of the course. What we aim for is the best and safest birth possible, according to individual circumstances. I would never promise a pain-free birth and I am very clear about that; the emphasis is on explaining how the muscles of the body work, changing the language and changing the focus so that the expectations are of being in control and having a more comfortable relaxing experience. We never want to set up unrealistic expectations. For this reason part of the course covers what to do in 'special circumstances' — complications to everyone else.

What I teach, in line with what Grantly Dick-Read taught, is that, if pain is not caused by fear and anxiety, then something is wrong and needs to be taken care of. Sometimes medical intervention is necessary and so we look at how to make the right choices in those situations. Caesareans can and do happen but mum and baby can still remain relaxed. One mum had a caesarean because she was told the midwives weren't experienced enough to attend a breech birth. But she recovered much more quickly than other mothers who had had caesareans because she remained calm and her baby was very relaxed. I saw her and her daughter a month ago and everyone says what a calm, contented, happy one-year-old the daughter is.

Winn: So what is the first thing you do to start to change women's minds about the expectation of pain?

Barratt-Smith: I explain the fear–tension–pain connection. I explain how the fight or flight response diverts blood to the wrong places — to the arms and legs so that they can take 'survival' action — instead of to the uterus, which needs it for the job in hand. And the women all relate to the idea that labour can come to a halt on arrival in hospital, either because they have been through it themselves or know someone who has — it is so common.

I tell them a bit of the history of childbirth, as much as I've told you, and how a natural process was medicalised and made painful. And then we start to change the language. If you tell a woman that birth doesn't have to be painful, she equates this with feeling nothing, as with an epidural, — and that is not true. So we talk about the labour 'sensations' she will feel, such as pressure or tightening, and describe contractions as 'surges' or 'waves'. I talk about other sensations in our bodies that we are used to feeling and responding to on a daily basis. We instinctively know how to do what is right. When we feel hungry, we eat — it can be a pleasant sensation when we know we can have food but an unpleasant one when we can't. Similarly, when we need to empty our bodies of waste products, we just go to the toilet — and feel uncomfortable only if we can't.

In human givens terms, we 'normalise' and 'reframe'. When women understand how their bodies work — the role of the uterine muscles, for instance — they can help the contractions along, making them shorter and more effective. When they stay attuned to their bodies and the sensations they are experiencing, they know instinctively which way to breathe at the different stages.

Winn: Is this something you teach them?

Barratt-Smith: Yes. It's called 'sleep breathing'.

Winn: Is that the same as 7/11 breathing?

Barratt-Smith: Same principle, yes, but I have women breathe in to a count of 4 and out to a count of 8. That teaches them to relax — which they have often never done before. Balloon breathing, a specific type of breathing, different from 4/8 breathing, takes them through the contractions. But when birth is imminent, a woman will want to breathe in a different way — it is what is called 'birth-breathing'. They do this by directing their energy and their breathing behind the baby.

Winn: Do they do that while pushing?

Barratt-Smith: Oh, we don't do pushing! Did you know that, if you push, you actually close the cervix, instead of opening it? Pushing causes tension, is hard work and uses a lot of energy. It is a matter of changing the breathing to achieve the same effect. Of course, my mums-to-be say to me, “But how will we know when we need to change our breathing?” And I say, “Trust me. You will know.” And they do. They go with their body sensations and they are relieved to relax and surrender, rather than struggle to control. Birth movements and birth positions come naturally in the course of a surrendered birth. And post-natal depression is very unlikely after this sort of birth. The amount of endorphins released and the sense of achievement, in such circumstances, keep new mothers on a high for a long time afterwards.

I have personally seen all this, at home births and on DVDs and I just wish I could have experienced it for myself! Unfortunately, when I gave birth, it was when you were still shaved and given an enema, then told to have a shower, and then made to lie on your back and give birth uphill. I had been fine at home but I absolutely lost it once in hospital; they took my control away and I nearly ended up with a caesarean. But I had always known my births could have been different, which is why I was drawn to run these courses.

Winn: As I mentioned, I was luckier and, as a health journalist, I had written a lot about natural birth so that, by the time I got pregnant, that was what I hoped for — and luckily got, although it was certainly by no means pain free either time. I didn't expect it to be, come to think of it, because I had never received the message that it would be. But I did know of people who did think that they would float through it all, if they diligently learned their breathing techniques and practised their squatting. Then, when their contractions started, they were suddenly completely overwhelmed and, because this was contrary to their expectations, were even less able to cope. They lost it completely and often had the works, in terms of anaesthesia.

Barratt-Smith: Well, what you focus on is what you get and what you have in your mind transfers itself to what is going on in the body. Just because you have a healthy body doesn't mean that you automatically know how to give birth and, with all the negative images, it is no surprise that women end up in pain. Also, because of words like 'labour pains' they are still focused on pain. Perhaps they were thinking beforehand, “I can beat the pain”.

Winn: I think they probably were.

Barratt-Smith: So, immediately there is struggle. And then there is the hidden anxiety: “Will I really be able to cope?” As we know, the sensations of excitement and anxiety are pretty much the same. When there is genuine curiosity and anticipation — “I wonder how it is going to go?” — the sensations are very different from when we have anxiety and dread.

Winn: That makes good sense. What else happens on the course?

Barratt-Smith: Well, interestingly, part of the course addresses the fears and anxieties of both the mum- and dad-to-be. At the end of the second session they are asked to go away and write down any fears or anxieties they have about the pregnancy, the birth or after baby has arrived. The most amazing thing is that, although at the beginning of the course the main topic is pain, the worries have changed completely by the end of the second session. So when, in the third session, we get to discuss them, I find that the women have concerns about how they will look after a baby with an existing child, or what it will be like to go back to work and leave the baby, and the dads-to-be are wondering whether the car will be big enough. Not a thought or mention of pain.

Winn: I am sure that, as a clinical hypnotherapist, you work a lot with visualisation. Do you get mothers to imagine wafting off to some pleasant beach during labour, and so on?

Barratt-Smith: We do a lot of visualisation and it would work, of course, in terms of relaxation, to imagine being on a beach. But what I am teaching is that the mother and baby work together. So they very much want to stay focused on the baby and in touch with their sensations. They tend to choose to imagine a balloon image for the birth canal, creating more room for the baby to come out, and concentrate on seeing the baby wafting down it safely.

The GentleBirth course totally changes their perspective of birth. The mums go from stressed to relaxed, sleeping well even at the end of their pregnancy. They have more energy and confidence and look forward to giving birth. The change in them is amazing.

Winn: You said you like partners to come to the course as well. Do you think they have a useful role to play or do they try to take things over and run the show?

Barratt-Smith: I think they have a vital role to play! Often dads are anxious bystanders, watching the birth play out before their eyes, sometimes feeling like spare parts or just not knowing how they can help — and transferring their anxiety to their partner.

But these days maternity units are large impersonal places. The system dictates that a labouring woman is attended to by strangers. Midwives do their best to make things as comfortable as possible for women giving birth, but they have to conform to hospital protocol. So the dad, or other birthing partner, is often the only known face, and it is a fitting role that he should be the one who can protect her and give her the security she needs to be able to give birth.

Birth is not a mental process. It is instinctive and the mum-to-be cannot think clinically during her birth. We know that, generally, women are very good at multitasking and men are good at being single minded. This is the one time in their lives when they benefit from swapping roles. During birth a woman needs to be totally focused on herself and her baby. For the dad-to-be, it's a case of doing everything else — seeing to his partner's every need, from food and drink to communicating with those present at the birth. A woman often doesn't feel listened to in hospital, as I've explained. The dad can listen and make sure that whoever needs to know hears. This is a practical role and brings an enormous sense of satisfaction, so dads can actually feel part of the birth and, as a result, much closer to their baby.

I think that, as with conception, birth is an intimate joining of male and female energy.

Winn: How do you explain the transition stage, as it is known, when the cervix is fully dilated and the mildest-mannered women are often said to start swearing like troopers at their dearly beloved and wish they had never got pregnant in the first place?

Barratt-Smith: Ah, transition. We are told, aren't we, that that is the hardest and most painful bit and we hear horror stories like the one you've just told? But transition just means the baby is ready to be born and the woman needs to breathe a different way.

Winn: You said wisely at the start that it is not in a baby's interest for their birth to be difficult. We know that babies can be born addicted to drugs, if their mothers are, or be affected by alcohol intake. What, if anything, do we know about the effect on a baby of a mother's emotions during birth? We certainly now know that anxiety during pregnancy can adversely affect the cognitive development and behaviour of young children.

Barratt-Smith: It is a good question. There is some evidence — I think it is in the Secret Life of the Unborn Child by Dr Thomas Verney — to suggest that whatever the mum goes through the baby goes through during birth. When a baby is induced, we know that contractions are very strong and extremely difficult for mum to cope with. Imagine, then, that same pressure on the baby. When mum gets stress hormones, so does baby. When she is in pain, is the baby suffering too? Peter Jackson, a registered nurse, was quoted in the HypnoBirthing® book as saying, “A pregnant woman is like a beautiful flowering tree, but take care when it comes time for the harvest that you do not shake or bruise the tree, for in doing so you may harm both the tree and the fruit.”

Winn: Powerfully put. You mentioned earlier some midwives who didn't know how to deliver a breech baby. And I saw an American film clip in which four young midwives, sitting in a row, were asked how often they had attended a natural birth. There was absolute silence and their faces were blank and then embarrassed smiles started to lift the corners of their mouths and one giggled, “Never!” Do you think it is getting harder and harder for mothers to get the births they want, even though our government has called for an increase in home births now?”

Barratt-Smith: Well, that's rhetoric, isn't it? How can they if they haven't enough midwives to take the responsibility for doing them? In the UK, midwives apparently have an obligation to attend a birthing mother wherever she wishes to give birth. In the early 1990s, the House of Commons officially mandated that the needs of birthing women be the central focus of the healthcare providers and that maternity services be fashioned around them, not the other way round — unfortunately, this still is not the case. But the NHS could save a lot of money if there were an increase in home births because the caesarean rate would drop considerably. Midwives will tell you that the longer a woman stays at home when giving birth the less likely she is to have medical intervention. In America, they have a 46 per cent caesarean rate and the second highest newborn death rate in the developed world, but, then, birth there is a billion-dollar business.

Here, birth is a postcode lottery. If you live in one area, you may be told that you are not allowed a home birth, or you need a caesarean if your baby is breech. If, however, you happen to live in Powys, Wales, for example, you will get personal visits at home all the way through your pregnancy. You may never see a doctor or the inside of a hospital. The midwifery service in Powys is purposely arranged around a woman's needs, the belief in normal birth and the understanding that a woman feels safest in her own environment. When asked at a conference on normal birth what qualities make a good midwife, one midwife offered the suggestion, “Being able to drink tea intelligently”. That sums it up so well. By sitting calmly drinking tea, they convey confidence in a woman's ability to give birth without unnecessary assistance, but they use their intelligence and skill to judge if and when there is a need to intervene.

Winn: I know you give a lecture on 'normal birth' twice a year to student midwives at Worcester University. Are you starting to change expectations?

Barratt-Smith: It goes down well but a lot of midwives have set beliefs that are difficult to shift, as yet. But I'm hopeful. I have just put together, with the help of Mia Scotland, a practitioner in Nottingham, a workshop for midwives, at which I plan to show videos of these births. Whenever midwives see these, they can't believe the women are having contractions. But the women are clearly giving birth!

I think, for a baby, birth is like going on a journey. Imagine you are going somewhere exciting, new and unfamiliar and it is going to be quite demanding when you get there. If you could choose your method of transport, would it be a crowded tube train where you are pushed about and squashed; you're too hot or too cold; it's too bright and too noisy; and maybe you even have a panic attack thrown in for good measure, arriving stressed and with a headache? Or would you choose a Bentley? Luxurious seats, soft music, some light nourishment of your choice along the way; a chance to rest comfortably if you get tired, arriving at your journey's end feeling refreshed, relaxed and ready to begin your new experience? I know which one I would choose — and it's the same for a baby.

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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