When working with a pregnant mum it is incredibly important to understand the psychological impact you have on her and ultimately her birth. Regardless of whether you are a trainee midwife attending your first birth, an experienced birth professional of many years or even one of a multitude of other care providers who come into contact with pregnant mums, if you are involved in her journey then you can have an impact the birth outcome. By creating consistent positive messages for mum, between us we can help her to relax and trust in herself, her body and her baby. A positive birth experience does not necessarily mean a natural birth or home birth, it simply means that mum recognises that her birth experience was a positive one.

"There is power that comes to women when they give birth. They don't ask for it, it simply invades them. Accumulates like clouds on the horizon and passes through, carrying the child with it." Sheryl Feldman

Factor 1 - Generating and maintaining a trance state

When women are experiencing a calm and relaxed labour they find themselves going into a trance state, this is a completely natural state and is key to the outcome of the birth. The complete unfaltering focus of attention that mum has on what is happening inside her body needs to be maintained and protected in order for her to work with her body and baby successfully. In a similar way to the telephone ringing when you're reading a good book, an interruption to this trance state will distract mum and cause her to need to refocus her attention. Achieving and maintaining trance states during labour can be quite difficult when in an unfamiliar environment (eg hospital), where comings and goings are assumed to be out of the control of mum and birth companion, however it is key that either a birth professional or birth companion recognises the importance of the trance state and removes or reduces opportunities for this to be impacted. This can include:

• Enhancing how relaxed mum is by focusing on all of her sense e.g. favourite scent, soft blanket, relaxing sounds, favourite picture to focus on, visualisations incorporating all of her senses
• Reducing volume of people present and controlling who is able to enter the room
• Removing clocks (time distortion happens during a trance and recognition of how long you have been in labour can break a trance state)
• Reducing examinations as much as possible
• Reducing medical noises in the room which may increase anxiety
• Reduce monitoring as much as possible - listening to a machine means she's not listening to her body
• Allow mum to stay in her own comfortable clothes
• Birthing pool can be particularly good, not only for how relaxed they make mum feel, but also they act as a barrier to people entering her "zone"

If any external activities do impact mums trance state, then it's important to recognise the signs of this and to understand the impact of anxiety creeping in. To gain an understanding of this for yourself, please check out my video on Fight or Flight.

Factor 2 - Resolving key emotional issues

Harbouring emotional issues can cause labour to slow down or to stop and often conversations arise during labour which have been outstanding for some time, get resolved and then labour continues. For mum to be completely at ease and for her mind and body to recognise that it is a safe time and place to give birth, resolution of these issues should happen prior to labour. One technique I have found particularly useful is to talk through the key basic needs which give us good balance in our life, this is based on a Human Givens approach. In summary, the Human Givens include;

• Sense of security - This can be both in mind and body. Think for a moment about your home, work, or where you spend a lot of your time, does this feel like a physically safe environment? From a mind perspective, how safe and secure are you in your relationships, whether these are personal or work related.
• Sense of status - It may be that you do get a sense of status from a particular role you play at work, however this can be also achieved in the home, in relationships and when taking part in outside interests.
• Connected to something bigger than oneself - This can be anything from being part of a local club or collection of friends, to joining with others with similar beliefs, to a simple interest in the world and people around you.
• Goals and Purpose - It is important to have an element of purpose within your life and by recognising what that purpose is, it becomes easier to achieve and life becomes more satisfying.
• Mind and Body Connection - This is where you have an understanding of the impact of mind over body and vice versa. This can include understanding how certain foods can make you feel differently, how a lack of sleep can make you less able to deal with the day in the short term and in the long term can start to impact your health seriously, through experiencing not only physical health issues but also depression*.
• Novelty and Stimulation - Whether you are a sudoku whizz, a football fan or a trashy novel reader, we all need something which keeps our minds active.
• Sense of control - This can be control over your job, a particular role you have, control over people around you and really any general change happening in your life.
• Giving and Receiving Attention - Whether this be through contacting old friends, meeting up with your family, joining local interest groups or even doing volunteer work or even doing volunteer work. You can also see a truly positive impact in this area when people build that unique bond with a pet.
• Feeling Understood - Feeling understood will mean that you have been listened to and your thoughts, views, values, life style or choices you have made have been appreciated (not necessarily agreed with!).

*If the mum is suffering from depression, it is key to ensure she is receiving the appropriate professional help, particularly as there will be significant changes in her life which she may need support in dealing with.

Factor 3 - Being in Control of the Birth

Regardless of the birth outcome a key factor in a mum defining her birth as positive is the amount of control she felt throughout the experience. Birth is often an unpredictable journey, so maintaining a sense of control for mum can be quite challenging for birth professionals but it is key nonetheless. In particular, here are the main areas which can really make a difference:

• Making sure mum has walked through her birth experience and considered all possible decision points
• Should unpredictable eventualities occur during labour allowing time for the Birth Companion and mum to consider all of the options
• Removing obstacles so mum can have the birth environment she wants - e.g birth pool, music, duvet/sheets/pillows from home, dimmed lighting etc
• Having people there who mum wants to be there
• To have considered the above and documented it, revisited it a few times and walked it through with the birth professionals who will be involved on the day

The key to a lot of this working is that mum should have a strong Birth Companion - whether this be her partner, a doula, friend or other birth professional. It should be someone who she can trust to help make sure that the decision she made are represented in the labour room.

Factor 4 - Believing that birth can be positive

This isn't just mums belief system, this is yours too. In order to help mum truly believe that birth can be positive, you too need to be consistent with that thinking. People (and especially pregnant mums) are both consciously and subconsciously aware of differences between what someone says they believe and what they actually believe. So the first task is to manage your own belief system by reframing your own view of birth. Re-read Ina May Gaskin, watch Birth Day, check out some of the positive posts on this blog and get yourself into the right space for creating a positive impact. Once you feel comfortable with this, then here are some ways helping mums belief system;

• Making sure mum knows how her body helps her during labour
• Making sure mum knows how her baby helps her during labour
• Build good rapport with mum and her birth companion so they trust that what you are saying
• Provide real life stories and footage of great births
• Help mum control the negative influences e.g. well-meaning but unhelpful comments from friends, limiting dramatised TV programmes which cover birth, baby magazines with sensationalised stories
• Helping mum maintain her belief system by helping her with positive affirmations

“The euphoria that follows an unmedicated labor is a very special time for anyone who is privileged to witness it. It's even better for those who get to experience it” Ina May Gaskin

However you are involved in the amazing journey of birth, I hope the above gives you extra ideas and thoughts on how to continue to positively impact birth from for mums, birth companions and of course baby too.

If you are pregnant and looking for more information as to how you can help enable a positive birth experience, or if you are a birth professional interested in more resources then please check out The Psychology of Giving Birth Programme which contains more information on all of the above topics as well as practical exercises, examples and hypnosis downloads.

Yours for calmer births, more often,

Photo credit: teddylambec

When I was pregnant, all of my focus was on giving my child the very best start in life though enabling a calm, gentle and if possible, natural birth. Once my child was born, this focus didn’t stop, it continued on into looking at how I could raise my child in the most natural and respectful way, this led me to choose to educate my child through a Montessori school. The reason I chose Montessori at the time was because it fitted well with my approach to therapy in that I work completely client centered. I act as a guide and a facilitator and recognise that a client brings their own unique resources and skills to a session which you can tap in to. I related to Montessori being very similar to this in that they use a childs naturally "absorbent mind" and the built in motivation to learn, to enable a child to become their unique selves.

As my little boy has begun his Montessori schooling and I have grown to understand more about the approach and ethos, my interest has continued to increase. In particular, some of the wording I recently came across in their literature rang so many bells not just for how it fits with my idea of how education should be, but interestingly for the actual birth of a child. For example:

• The Montessori method discourages children being obviously monitored for example taking exams and tests
• The teacher is an "observer" of the child as they go about what comes instictively to them
• Children are masters of their school room environment, which has been specifically prepared for them, rather than for the ease of the teacher
• Children spend a lot of time alone during periods of intense concentration. During these self-chosen and spontaneous periods, the child is not to be interrupted by the teacher
• There are no time limits for the child - she may work with whatever he chooses for as long as she likes.
• When a difficulty arises the teacher is able to step in and give help but is always careful never to give more help than is needed.
• Children work at their own individual pace and naturally develop their own rhythm and work pattern.

Now try replacing the word "Teacher" with "Doctor", and "Child/Children" with "Mum/s".
Interestingly, just in the same way as studies of natural birth show that birth can be calm and gentle with little or no intervention, studies have also shown that Montessori Education Provides Better Outcomes than Traditional Methods.

One study in particular comparing outcomes of children at a public inner-city Montessori school with children who attended traditional schools indicates that Montessori education leads to children with better social and academic skills. The study appears in the Sept. 29, 2006 issue of the journal Science.

The general lesson from these approaches is that guiding rather than forcing, observing rather than examining, flexibility rather than being timebound and helping only when it's needed will lead to trusting in someones (a child or a mum to be) intuitive, built in knowledge that they know what to do for the best outcome.

If you would like more information on the Montessori approach, please see this website: http://www.montessori-ami.org/

Thanks go to my local Montessori school for opening my eyes and mind to this wonderful approach: Brighton Montessori School

Yours for calmer births, more often,

Photo credit: valilouve

It was the middle of the day when Shirley started to go into labour. She had already transferred to the birth unit where she was to give birth; it was comfortable and familiar to her. As labour progressed she chose to walk around and get into whatever position she needed to in order to help the birth process. She was left alone so she could listen to her body and baby and do whatever she needed to birth calmly and gently.

People looked on in awe of her and what they were seeing, but nobody intervened in any way, she was completely protected in her birth environment. She felt safe, secure and in control. As the moment of birth came closer, she knew she needed to change positions and she was completely free to do so. There were no monitors, no noisy machines and no white coats to be seen. There were no examinations, no dilation cm's to be achieved within a set time frame, labour just progressed exactly as it needed to.

She intuitively knew how to breath her baby down and there was no forced pushing and absolutely no sounds of discomfort. She birthed her baby extremely gently; a beautiful natural birth. The baby stayed with her mum and they bonded. There was no cleaning or wiping, just mum and baby sharing that beautiful unique moment.

You might think that this wasn’t typical of births, however for Shirley and her friends and family at Combes Farm this is a regular experience. Now you've read the story, why not watch the birth video and see for yourself. I'm sure you'll agree that we can learn so many things from watching calm, gentle, natural births, even when the circumstances are not quite what you first perceived.

Yours for calmer births, more often,

As mentioned in one of my previous blog posts, there's a lot of focus about women achieving a natural birth. This post led me further down this road to consider what actually is a natural birth?

Many people would say for example that it's not natural when drugs are utilised, however both in my Programme and when I work with people on a one to one basis I share with them how they can maximise their endorphins during labour, which is a drug far more powerful than morphine. If they learn these techniques, is that natural? For those undertaking HypnoBirthing or HypnoBabies classes, how natural is hypnosis in childbirth? Many would say its a completely natural state which everyone enters, others would classify it as unnatural and inappropriate for birth.

Now lets look at greater intervention, Ceasearians for example are used when it is considered that a baby is in distress or where a vaginal birth is not possible. This level of intervention is generally considered as not a natural birth, however Nile crocodiles* may disagaree. If a Nile hatchling is unable to hatch itself or is in distress, the mother or father (there are no nearby obstetricians) will hear the high-pitched chirping and will open the nest, pick up the egg in their mouth, and roll it between their tongue and the upper palate of their mouth to help crack the shell, and release their offspring. Ask a crocodile whether they have natural births if you dare and I'm sure they would say they all are!

As animals evolve it is natural for new ways to secure the safe birth of our offspring. I'm sure there would have been a time when crocodiles didn’t crack open their eggs and then when they did, this was new and different to them. How different is it for another human to help a baby be born by similar means? We can so easily place women in boxes determined by what type of birth they had, maybe using different criteria would bring us more interesting results. When I'm reviewing the impact of my Programme on a birth, the key criteria for me isnt whether she had gas and air, an epidural or a Cesarean, some of the key measures I use are:

• Did mum and birth companion feel in control of their birth?
• Was the birth as calm and gentle as possible?
• Was mum relaxed throughout the birth?
• Did mum feel empowered after the birth?

What criteria do you use?

I didn’t create this post to give the answers, only to reframe the sometimes limiting views of what something is and what something isn't. Rather than this being so black and white, lets allow ourselves to be comfortable in the grey and continue to make a difference to the things which really matter to mum and baby.

Juliet

* Interestingly the ancient god of crocodiles (Sobek) was first mentioned in the Pyramid Texts for laying his eggs on the bank of the waters and starting the creation process. He was recognised as the god who created the Nile, a god of fertility and rebirth, as well as the symbolic strength of the ruler of Egypt.

Many women use visualisations to help them during labour. It helps to focus the mind inward as well as helps you avoid distractions. Visualisations can also help you focus on a rhythm of breathing. Visualising to help you manage a situation is a form of self-hypnosis and something that you can practise over time to increase the impact is has. One thing I've never been entirely sure about is when antenatal classes are prescriptive in what a woman should visualise. I remember being told to visualise a flower opening during my classes, but no matter how hard I tried, it just didn’t work for me, instead my mind kept going back to visualising what was physically happening. The reason this happened was that I was interested in what was actually happening and how each part of my body was working to enable a natural birth. I decided to take my own visualisation forward and utilised it during labour, as it was something I felt much more comfortable about, I believe it was much more powerful for me that something which didn’t quite fit.

So, if you're pregnant and you are finding it hard to stick with the visualisations you have been given, then think about what interests you have and how your visualisations can fit around those. For example, if you like cycling, imaging a rhythmic wheel turning in time with your breathing may help, or if you like scuba diving, imagine the slow breathing you do through your regulator and how wonderful it feels to be underwater. If you're a care provider, then utilise what resources and skills your client has rather than ask them to learn new skills. You will find they will be able to visualise things much more easily, which will enable them to maintain inner focus and work more effectively with their bodies. The Psychology of Giving Birth programme available on this website works with mum and birth companion to teach them how to create their own relaxing visualisations, once you know how to do this, you will have these skills for life and you can pass this wonderful technique on to your children too.

Following a recent question I posted on Twitter asking people to send me what visualisations helped them during their labour, below are the responses, these also include feedback from mums I have helped. As you can see, many of them are completely unique and wouldn’t be found in any antenatal class! Take a look through these and see if any of them might work for you.

• The actual mechanics of the body and focusing on each part working effectively, almost in slow motion
• Contractions/surges as pate being spread on toast (this lady really missed pate!)
• A feeling of warmth spreading over my body
• I intuitively imagined a flower opening in bloom
• Clouds of different colours - went through the spectrum
• I visualised my cervix opening the size of a football field, with my baby coming through easily and with love
• A quiet warm beach with gently lapping waves
• Being in warm soothing water
• A positive energy force washing over me body in waves (had a particular interest in reiki)
• Breathing in time with a hot air balloon rising and falling across the sky
• My uterus was an icing bag and I was gently massaging the icing down (a cake decorator of course!)
• Fields of wheat in the wind
• Blowing up balloons and watching them drift away
• In a squatting position imagining there was a magnet on the floor helping to draw my baby down and out
• My body was made up of different instruments which made an orchestra, me and my baby were conducting the symphony, each part coming in to play at just the right moment with just the right tune
• There was a wonderful imaginary carer, gently massaging my uterus with each contraction
• In the last few weeks of pregnancy I began to see a more animalistic side come out in me and during labour I completely took on the characteristics of this animal, the animal gave me confidence that my body and mind was capable of a having a natural birth

And of course it's not just the mums who can utilise visualisations, here's some from birth companions too…

• The room was a fort and I only let down the drawbridge to people we trusted
• I was a lion protecting my family
• I was on top of a mountain, being able to clearly see everything and had the strength of the mountain within me
• I was a tree, solid, strong and sheltering my partner

I will continue to share new visualisations I hear about, so if you would like to share yours, please do add a comment.

A great article was published yesterday, which explains how Midwives in Southampton, England, are helping women who have previously had a caesarean section to choose a normal, natural birth for their next baby.

The article, published on the Medical News Today website stated that nationally, the number of c-sections has dramatically increased over the last decade and that this has led the NHS Institute for Innovation and Improvement to develop a toolkit to help midwives reduce these numbers.

This toolkit has been in development at Princess Anne Hospital for the last 18 months and during that time there has been a 4 per cent reduction in the number of c-sections. This is double the target reduction.

In 2007, 24 per cent of births were by c-section. In 2008 this dropped to 20 per cent, with just 16 per cent of births by c-section in November.

Interestingly, one of the initiatives is to introduce midwife-led care for women having vaginal birth following a previous caesarean.

Helen Barnes, the consultant midwife trainee who helped set up the project, said: "We try not to medicalise the event, so from the beginning the mother will see a midwife, rather than a doctor. They will have a risk assessment to make sure they are suitable for midwife-led care and VBAC, and we fully explain the risks and benefits so they can make an informed choice."

I'm not sure of the plans for this toolkit, but it if it's working it would be nice to this that this would not only be shared with other UK Hospitals, but also internationally.

If you are planning on having a VBAC, try our free download which will help you relax and work with your body.

For the full article:

http://www.medicalnewstoday.com/articles/139288.php

Today I have had the wonderful opportunity of including Sheri Menelli’s wonderful eBook entitled : Journey into Motherhood: Inspirational Stories of Natural Birth into The Psychology Of Giving Birth Programme.

The aim of the Programme is to reframe peoples views of what birth can be like and this ebook completely supports that goal. It provides both inspiration and education. This guide to natural childbirth offers 48 personal accounts of labor and delivery without medication. Revealing the many options women have beyond birthing location, the testimonials offer insight into the joys, concerns, and realities of natural birth. From delivering at home with a midwife and hearing the right words from a hospital nurse at just the right moment to describing a combination of the Bradley method and acupuncture at a birthing center and discussing a child's birth at home in warm water, this resource combines personal insight with referential information. A glossary of terms and a resource guide to books, magazines, websites, videos, and CDs, and listings of childbirth classes and instructors nationwide are also included.

Here are some of the reviews of the book:

"...I highly recommend it." -- Gurmukh, Director, Golden Bridge Yoga and Author

"...these inspiring stories of natural childbirth show that childbirth can and should be safe, empowering and beautiful." -- Penny Simkin, founder of DONA and co-author of When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women

"women and girls need to hear these stories and know that natural birth is full of magnificent, life-changing wisdom." -- Christiane Northrup, M.D., author of Women’s Bodies, Women’s Wisdom and The Wisdom of Menopause

The book is currently on Amazon for a price of $13.46, but you get is absolutely free with The Psychology of Giving Birth Programme which is only $47.00 anyway!

Sheri has allowed me to include this ebook as she is committed to getting the message out there about how birth can be so different to a lot of people’s views. Thank you Sheri, firstly for writing the book and secondly for joining with me on the unique crusade to make a difference to birth days.

Click To Play

I absolutely love this video from Monty Python.

The interesting thing is that when this was produced back in the 1980's they were spot on in so many ways. One interaction in particular was very insightful of them:

MRS. MOORE:
What do I do?

DOCTOR SPENSER:
Nothing, dear. You're not qualified!

OBSTETRICIAN:
Leave it to us!

MRS. MOORE:
What's that for?

OBSTETRICIAN:
That's the machine that goes 'ping'.
[ping]

It can really help to see some level of humour in things which cause us anxiety and this short video clip is a great one if you have any fears of giving birth. I remember when my home birth turned into a hospital birth and I had to try and get into the back of our very small car that I really did find it amusing. We live opposite a hotel and it was a Bank Holiday so there was a line of people eating breakfast watching my attempts. Thinking of how it must have looked from their angle did make me laugh, I bet they are still talking about it too.

Changing what you are seeing into something which is amusing can have a huge impact on how we deal with a situation, whether it's imagining that spider wearing clogs and a top hat, the nasty teacher being on the toilet, or a hospital visit as a Monty Python sketch. By changing your experience in this way you are more in control, the experience will be reframed in your mind and your anxiety will be reduced.

Is there something which you are anxious about at the moment? When you think of it try adding a bit of comedy, speed it up so everyone voices go funny, make it go backwards and add a soundtrack. Really play with being in control of that experience. If you’ve heard of Benny Hill, the classic Yakety Yak soundtrack goes well!

If you have any more suggestions for things which have worked for you, I’d love for you to place a comment and share it with others.