Book Review - Hypnobirthing: The Mongan Method (the BEFORE blog)

Since this is the “before” blog you can expect there will be an “after” one as well.  I will be curious to see what that one is like!  I borrowed this book from my friend, who also happens to be my doctor, who used the method successfully for her two births.  She also took the class (which I imagine, after reading the book, is helpful).  But I thought I would review the book now, before labor and then again afterwards to see what I think of it.

Before I start I should throw in the caveat that it may not be completely fair to judge this method on a third labor.  Hopefully (fingers crossed) this is relatively quick compared to the others (although my labor with Asher was only 4 hours, I can’t really complain about that).  But still, I think it’s worth trying.

The reason I’m interested in this method is because I think there is definitely something to it.  I’m not saying it is “the answer” to a pain free birth (as advertised) but having attended hundreds of births I have seen with my own eyes the difference between someone who seems to be relaxed and “in the zone” versus someone who is completely out of control and screaming.  I think “hypnobirthing” or “deep relaxation techniques” or “meditation” or whatever you want to call it is one way of getting in touch with your body and maintaining that control. 

So, the book, I would say it was so-so.  It’s hard for me, as someone who believes in evidence based medicine, to go along with some of the things they say which feel completely fabricated and made up and don’t have any science behind them.  As someone who delivers babies I tried not to feel offended about some of the implications that I might not have the best interest of the patient in mind; I know they aren’t talking about “me” but it’s hard not to feel a little adversarial about that.  But for the sake of participating I pushed aside my scoffing remarks in my head and kept reading.  And like I said, even though there is not a ton of science behind this method, I think there is “something” to it and I’ll go into that a little bit later.

The main premise behind this method is that the reason we feel pain during delivering our babies is that we have “fear” and the fear causes tension which then translates to pain.  The author believes we have all been imprinted upon to believe it is painful and therefore it is.  So a big part of the book is about “releasing fear.”  As someone who has been through labor before (and had an epidural both times) it’s a little hard for me to believe that fear alone made me feel like my body was being ripped in half, like actually torn in two by sharp clawed hands, but, I’ll give them the benefit of the doubt for the moment, because I do agree that pain has a lot to do with how it is being perceived, and we have some science to support that.  There are a lot of analogies and anecdotes in the book about how animals deliver naturally without discomfort, which I don’t think is 100% true (cows bawl when they have calves).  We, as humans, also have the whole “giant head” issue which I would argue is proportionately more painful than it is for other animals.  She also tries to site historical evidence that birth didn’t used to be painful for women back in the day, or else Hippocrates surely would have told us it was.  This is not my favorite type of argument the, “well, they didn’t write down it was painful so it must have been not very painful!”  That just isn’t logical.  The author also clearly experienced her own birth traumas with her own deliveries with the old fashioned ether-forceps method and I really felt bad reading that.  It is embarrassing to me that the medical field did that to women and it makes me angry too, but it is truly not that way any more and so getting people riled up about that now doesn’t seem to be too helpful to me.  Although, I might add, that I “think” the whole thing was well intentioned.  I think doctors thought they were really helping women by putting them to sleep for something that seemed to be really painful, but in retrospect it seems sort of cruel.

After the theoretical and historical discussion, the bulk of the book touches briefly on different types of relaxation/self hypnosis exercises as well as some positioning and labor preparation.  The thing that strikes me as the most funny about the method is that they have renamed pretty much all the aspects of pregnancy and labor with their own terminology.  The author feels that medical terminology puts a negative slant on things and that negative imprinting again can lead to increased fear which leads to increased tension which leads to more pain during labor.  So there are no “contractions” they are called “surges” and your water doesn’t “break” it “releases.”  They actually have a full list of substitute words.  I would argue that it is our perception that makes those words “negative” not the words themselves, but, whatever, call them whatever you want to call them, I don’t care, I’ll stick to my own lingo.  There are some other parts I don’t completely agree with, one being that the birth process can imprint the baby for life and that a hypnobirthing baby is a “better baby” after you take them home.  I’ve seen a lot of different styles of birth and I have trouble believing that a traumatic birth is going to screw up a baby for the rest of their life.  Of course I don’t think anyone has ever studied if temperament is linked to birthing method, but that is what they are suggesting.  What about all of those poor NICU babies, should we just write them off as being future criminals since they were so traumatized as newborns?  I don’t think so!  They often are little fighters and do wonderful as children.  So that part is far fetched to me and setting people up to be potentially disappointed if the method doesn’t work well for them.  The final part that I am wrestling with regarding the book is their description of what we (in medicine) would call “pushing” and they call “breathing down.”  The author emphatically states a woman should “not push” the baby out, that it is counter productive and bad for the baby and that relaxation techniques and breathing techniques be used at this phase.  I’m intrigued by this idea and open to the possibility that maybe pushing can be counter productive at certain times right after transition (which is why we let people “labor down” occasionally).  But personally, even with an epidural, I still felt what I would absolutely describe as “an urge to push” that felt like the natural thing to do.  I also have a lot of patients who describe the pushing phase as a “relief” because it gave them something to do with the pain of the contraction.  I read that section carefully, on how exactly you “breathe down” the baby to delivery, and it sounds an awful lot like panting or quick grunty pushing.  I would be interested to actually see this correctly done and see if it does or doesn’t involve involuntary pushing because I couldn’t completely tell from the book.  Lastly, my final disagreement is that they recommend perineal massage on a daily basis.  This is something we actually have scientific evidence to show that it makes no difference in tearing so I’m completely discounting that advice.  I do have some bigger issues with management of labor stuff they suggest; avoiding intervention, arguing with your doctor and things like that, but I don’t really want to get into that here.  I fully support a natural labor, but I also have the experience and medical knowledge to spot dysfunctional labor and I know what the outcomes are for those labors if we don’t intervene.  My interventions are always an attempt to keep the wheels on the bus to get a good outcome (health mom, healthy baby is the goal!) and sometimes that means things don’t go “as planned.”  Anyway, like I said, discussion for another time.  There are a few other little tidbits here and there that I could argue with but none that seemed like they would actually make any real difference if you did them or not and are probably not harmful, so again, who cares, don’t sweat the small stuff.

The best parts of the book are, in my opinion, the relaxation techniques.  And probably the truly best parts are not the book at all but the relaxation CD that comes with it to listen to and practice relaxing.  While there is some evidence out there about pain perception and meditation there is not a ton of it, but I believe in the mind-body connection (not based on any science at all, just my own experience and belief system) and so I think that there is something to it.  I have had a handful of patients use this method and 2 in particular that I would consider to be very successful with the method and it was amazing to watch them.  It looked like they were sleeping throughout their entire labor and then all of a sudden they woke up and said, “I need to push” and pushed (in what I would describe as the normal way of pushing, not the “breathing down” way) and had completely normal and beautiful deliveries.  After seeing that, who wouldn’t want that for their own labor?  I’ve also seen people use the technique in the beginning but completely lose it during transition.  I’ve also seen people who had no training in relaxation techniques who seemed to find a place, a “zone” where they were definitely not “present” during labor and managed their pain in that way.  My only personal experience with these methods is in athletics (where I had training from a few of my coaches in meditation/relaxation/visualization techniques).  My best races in swimming contained elements of this.  My very fastest race ever was the closest I’ve come to an out of body experience.  It was a mile swim, so it was around 16 minutes of what is usually a pretty painful experience, but in that instance I was swimming faster than I ever had before and I felt no pain, and I also had time distortion where it was like time stood still and skipped forward at the same time.  So I have experienced it before, just not in the instance of labor/birth.  I believe it is possible.

Overall I think this is a good book.  I always have difficulty with these birth advice books because I really feel there is no “right” way to do this and they often suggest there is.  Every woman is unique, every baby is unique, every birth experience is unique.  To try to contain it within any paradigm is a little bit silly in my opinion.  Plus, it is one of the few scenarios in life where no one is actually in control of the outcome or can really predict very well what is going to happen.  So my plan is to try to experience the best of both worlds.  I plan to use the techniques they present to the best of my ability (without buying into the theoretical mumbo-jumbo) and see how it goes.  But being the scientific type I plan to be in a hospital with a doctor where someone can actually help me and intervene if the wheels do start to fall off the bus.  Here’s to hoping for a fast and pain free delivery, but more importantly for a healthy mom and baby in the end!