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Evidence, practice and support for birth professionals

Teri Gavin-Jones, Sandra Handford

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eBook - ePub


Evidence, practice and support for birth professionals

Teri Gavin-Jones, Sandra Handford

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About This Book

Maternity services and choices for labour and birth are fast evolving. Hypnobirth involves preparation for childbirth using tried and tested hypnotherapy techniques in harmony with midwifery best practices and increasing numbers of women are turning to the technique.

Written by two experienced practitioners, this is the first evidence-based practice book for medical professionals on this subject. Chapters include coverage of:

  • What hypnosis is and the history of hypnobirth

  • The power of the mind and the effect of language

  • Relaxation and breathing techniques

  • The neocortex and hormones

  • Birth partners, relationships, women's advocates and primary supporters

Throughout the book the authors provide health professionals working in clinical midwifery practice with information and evidence-based findings to support the use of hypnobirth. The book includes case studies, scripts and reflective questions to encourage a deeper understanding of the techniques and issues and to engage and inspire the reader.

Hypnobirth is essential reading for midwives, obstetricians, student midwives, doulas and any practitioner involved in preparing and supporting pregnant women for labour.

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1 The history of antenatal education

DOI: 10.4324/9781315707174-1

From Mothercraft to the National Childbirth Trust (NCT)

In 1918, Dr Truby King established ‘mothercraft’ training, focusing on the value of pre-parenting and breastfeeding. The Mothercraft Training Society was the forerunner of antenatal education in the UK. King George V knighted Dr King as mothercraft education spread and, in 1927, the British Journal of Nursing wrote about the Mothercraft movement:
‘It is [sic] the duty of every mother to fit herself for the perfect fulfilment of the natural calls of motherhood, both before and after childbirth, and especially to advocate and promote the breastfeeding of infants.’
The duty of women in 1927 was to raise children within marriage and the law of the church. Education for women around the subject of childbirth was unheard of at this time.
The British Journal of Nursing states: ‘to teach them to fear God, and to honour the King, to be loyal citizens, and to share in the duties and responsibilities of the community. What higher destiny can a woman desire?’ (RCN Archive, 1927).
The introduction of the National Health Service (NHS) in 1948 enabled maternity services to be offered to all women. Pre-war health insurance schemes had left women and children particularly vulnerable. Maternal mortality rates had risen in England and Wales between 1900 and 1937 to over 40 deaths per 10,000 births. After 1948 this rate steadily declined (Davis, 2013).
The idea of a more natural birthing experience was pioneered by English obstetrician Dr Grantly Dick-Read. He had experienced a conversation with a woman living in Whitechapel in the 1920s that childbirth was not meant to be painful, leading the young Dick-Read to dedicate his life to exploring natural childbirth. Dick-Read was early to suggest the ‘fear–tension–pain’ cycle in his work, Natural Childbirth (1933). He argued that, when we are afraid during childbirth, the body draws blood away from non-vital organs, such as the uterus, to the extremities, which results in pain. By removing fear and its physiological consequence, the uterus can function as intended, eliminating extreme pain. Breaking or removing this pain cycle is a central concept in hypnobirth.
In contrast to Dick-Read's exploration of childbirth, the NHS began offering mothercraft classes to women in the 1950s. This would involve advice on pregnancy (no swimming, but cigarettes were fine) and practical advice on baby care. There was no information about the actual birth and certainly no advice on coping with labour.
Inspired by the writings of Dick-Read, the Natural Childbirth Association (NCA) was founded in 1956 by Prunella Briance. She placed an advert in the personal columns of the The Daily Telegraph, and The Times, inviting interest in the formation of an association to promote and better understand the Dick-Read system of natural childbirth. She received overwhelming interest and support. There were early years of conflict between the medical profession and the NCA, but eventually in 1961 it obtained charitable status and became the National Childbirth Trust (NCT).

Lamaze and the Bradley Method

Whilst the NCT was being formed in the UK, in France, in 1951, Dr Fernand Lamaze was introducing childbirth education that he had originally observed in Russia. The Soviet Union was routinely using psychoprophylaxis as an alternative to analgesia for pain relief. Here, women were not choosing the method, but were forced to use it by a central government that was unwilling to provide access to obstetric analgesia. Lamaze had travelled to the Soviet Union after hearing Soviet obstetrician Anatoly Petrovich Nikolaev speak at an international congress. Lamaze was given permission to observe birth in Soviet Russia and went on to say that he wept with joy at witnessing a woman giving birth with no sign of pain or discomfort. Lamaze returned to Paris and sought to implement psychoprophylaxis techniques. He joined forces with obstetrician Pierre Vellay and kinesiologist André Bourrel to establish the first obstetric prophylactic clinic in the West in 1952.
Figure 1.1 1960s midwife with mothers-to-be
Source: Photo courtesy of the QNI; copyright Barnet Saidman
By the early 1960s France and the United States were discovering psychoprophylaxis. In an effort to distance it from Russia, the method was named the Lamaze method. Elizabeth Bing was a childbirth educator teaching the Dick-Read method in New York. Bing contacted Marjorie Karmel, who had given birth assisted by Dr Lamaze. Karmel was an American woman in Paris who had sought the help of Lamaze to birth her first child. She was so enamoured with the experience that she wrote a book – Thank you, Dr Lamaze (1959). Together Bing and Karmel founded the American Society for Psychoprophylaxis in Obstetrics in 1960, later becoming Lamaze International. Michaels (2014) describes the typical woman drawn to this method as ‘well-educated, married, white, middle and upper-class’. Some might say that until very recently the NCT has also attracted this demographic in the UK.
Alongside the popularity of the Lamaze method, the Bradley Method was being conceived. Robert A. Bradley, a Denver obstetrician, developed ‘husband-coached childbirth’ in 1947, publishing his first book in 1965 (Bradley, 2008). The method claims that, of over 1,000,000 couples trained in The Bradley Method, over 86 per cent of them have had spontaneous, unmedicated vaginal births. Bradley was a pioneer in including men in the childbirth process and expanding the husband's role into birth coaching. Childbirth preparation across the continents was evolving and adapting to women's needs. However, the combination of breathing techniques, relaxation and childbirth education has much in common with hypnobirth today.
As women in the UK continued to seek education and choice, the role of the National Childbirth Trust as a provider of information became pronounced. By the 1970s childbirth was more medicalised than ever. The Peel Report (Department of Health and Social Security, 1970) resulted in almost all birth taking place in a hospital setting. The NCT was a vocal critic of routine medicalisation and became increasingly polarised from some of the medical profession. The allegiance between many midwives, pregnant couples and the NCT was building in strength. The NCT published its first research into mothers’ experience of induction of labour, and women were looking toward it as a source of information as well as support.

Women's rights for birth – 1960s to the 1980s

The 1960s to the 1980s were times of great change and a growing awareness of women's rights for birth. Authors such as Sally Inch, Marjorie Tew and Sheila Kitzinger added to the weight of evidence for women-centred care. Frederick Leboyer's Birth without Violence (1974) began to focus the attention on the birth room environment and considered birth from the baby's perspective. French obstetrician Michel Odent added to the concept of natural birthing, introducing birthing pools and exploring the impact of the birth environment. Janet Balaskas and Yehudi Gordon pioneered the active birth movement, which is still as relevant today. The Society for the Prevention of Cruelty to Pregnant Women, founded in 1960, quickly renamed itself the Association for Improvements in the Maternity Services (AIMS), and The Association of Radical Midwives (ARM) was formed. It says much about maternity services today that these organisations are as well used and necessary as they were then.
Beverley Beech writing for AIMS in 2011 comments, As far as the evolution of women's choice since the 1960s, there is clearly much work still to be done. This also applies to antenatal education. Classes on offer today are limited to NHS or private sector classes. Research suggests that many NHS classes are of poor quality and do not provide the small interactive sessions that couples are looking for (Barlow et al., 2009). A review of maternity services conducted by the Commission for Healthcare Audit and Inspection (2008) found that antenatal education was not being adequately addressed by many trusts. It found that 86 per cent of trusts offered first-time mothers an opportunity to attend classes; 71 per cent of trusts offered classes to mothers who had previously given birth; 15 per cent of women reported the classes were not at a convenient time of day; 28 per cent of women reported that there were an insufficient number of classes in the course; and 20 per cent of women reported that the classes did not cover the topics that women wanted.
letters women wrote in the 1960s are little different from letters written today. Maternity care is dominated by obstetricians who have moved from a position where they were called in to assist with a problem labour to the current situation where they control the majority of pregnancies and births.
The expectations of pregnant women and their families is that within the pregnancy there will be some kind of antenatal education. This may be within an NHS setting and taught by midwives (sometimes referred to as ‘parentcraft’) or women may seek private sector classes.
Whilst research into antenatal education remains limited in comparison to other areas of childbirth, what is known is that good birth preparation is of value. Research published in 2009 stated: ‘Participation in antenatal preparation courses can be associated with higher satisfaction with the birth experience.’
‘When birth partners are well prepared for their role, a woman's experience of birth is likely to be more positive’ (Schrader McMillan and Stuart-Brown, 2009).
Although the research into this area of pregnancy is comparatively new, the findings have not reached a wider audience. Many women and their partners do not understand or appreciate the benefit of attending antenatal classes. Male birth partners fear that the classes will be uncomfortable, irrelevant to them and women focused. It may be that, given the poor quality of the traditional NHS antenatal class, both midwives and parents feel that they are of little value.

Antenatal education today

The Department of Health published a document in 2011, ‘Preparation for birth and beyond’. This document is unique in addressing the relationship between pregnancy and its impact on later health outcomes. ‘From pregnancy onwards, the relationship between a baby and his or her primary caregiver has a lasting impact on that child's future, including on his or her health as an adult.’
The same document also discusses the difficulty of the NHS providing antenatal classes, describing a ‘narrow focus’ on the process of giving birth. This has historically been the divide between NHS and NCT classes. The NCT has offered a product where small groups of participants explore birth in an unhurried, friendly atmosphere. Couples value the time to discuss issues and the lasting friendships often made. NHS ‘parentcraft’ classes are seen as second rate. The name ‘parentcraft’ is a modification on ‘mothercraft’ when it became apparent that fathers would like to be included. The fact that the NHS still uses the 1960s name to describe an antenatal class says a lot about progress and evolution. Antenatal education is unreported in national statistics, with some hospitals offering a lot, and some offering nothing. In certain parts of the UK, classes have been cut or the service withdrawn as a result of financial restraints (Clift-Matthews, 2007).
Redshaw and Heikkila (2010) showed that in England most NHS antenatal classes were offered in the North-East (73 per cent) and fewest classes were offered in the East Midlands (62 per cent). Tomintz et al. (2013) state that, although the NHS provides classes free of charge, a shortage of staff and resources means a limited universal provision of such services.
Providing antenatal classes within the NHS is problematic and multifaceted. Constraints such as funding, adequate training and resource allocation all have an impact on the provision of classes. From an organisational perspective, antenatal classes historically have been seen as non-essential work and therefore are undervalued. Midwives themse...

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