Anxiety Disorders During the Antenatal, Perinatal and Postnatal Period and the Response from Hypnosis
|Posted on 7 April, 2018 at 10:50||comments (0)|
Pregnancy and childbirth can be profound and life-changing events in the lives of most women. It is therefore understandable that many women (and men), especially first-time parents, may feel slightly anxious. During pregnancy women may experience a range of conflicting emotions: excitement at having a baby but perhaps also apprehension. There could be concerns about bringing up a child alone if you are a single parent, or finding out you are having twins and worrying how you will cope, or if you already have a child worrying about how all of you will cope and if you will have enough time or love for the new baby. If the pregnancy was not planned but you decide to go ahead with it conflict may arise with a partner who is not quite ready. First time mothers may even experience a crisis of self-confidence and worry about not being a good enough mother or not having any maternal instincts; or there could be concerns about how your relationships will adapt as well as how your partner (and you) will feel about your changing shape. There may be worries about various pregnancy-related conditions such as pre-eclampsia or gestational diabetes and any medical tests or screenings can feel ‘emotionally invasive.’ (Kitzinger 2003, p.226) Although men do not have to cope with any physical changes the ‘passage into fatherhood is a major transition’ (Kitzinger 2003, p.30) and could also give rise to a range of emotions. Some men may have concerns about finances, especially if his partner is no longer working, he may worry about changes in his relationship, including sex, or his partner’s wellbeing. The sheer responsibility alone of having a baby can be frightening. A man’s emotional needs can sometimes be neglected as the main focus is often on how he can help his partner; this in turn can make him feel isolated. Whilst a certain amount of anxiety can actually have a positive function by nudging you to ‘examine options, develop coping strategies, plan ahead, prepare yourselves emotionally and practically for the future’, (Kitzinger 2003, p.31) the continuum of mild anxieties can also lead up to extreme fears and anxieties such as tokophobia, which is a fear of pregnancy and childbirth.
In Australia, perinatal mental health issues, experienced by both women and men, can vary in intensity and symptoms. Up to 1 in 10 women and 1 in 20 men experience antenatal depression, and anxiety is just as common, with many people experiencing both at the same time. (panda.org.au) Some of the different types of anxiety that may be experienced during the antenatal period may include: panic attacks, persistent, generalised worry, often focused on fears for the health or wellbeing of the baby, the development of obsessive or compulsive behaviours, specific phobias, such as a fear of hospitals, needles etc, social phobia, which can be marked by an intense fear of criticism or being embarrassed, and post-traumatic stress disorder, which could be the result of a previous birth trauma or sexual assault. (panda.org.au) (beyondblue.org.au) There are certain factors that may contribute to the development of perinatal anxiety and depression such as, a history of anxiety and depression or family history of mental health issues, a previous reproductive loss, such as a termination, miscarriage, stillbirth, a previously difficult pregnancy or birth trauma, a pre-existing physical illness, a history of childhood trauma or absence of a mothering figure, loss and grief issues and a lack of social connections or support. (panda.org.au) It is quite common for women to feel low in the last six weeks of pregnancy due to feeling physically tired and heavy or emotional for what lies ahead.
In most Western cultures women (and men) have been socially conditioned to believe that childbirth is ‘an ordeal, essentially painful, dangerous and something to be endured and then forgotten.’ (Berry 2015, p.33) In a society where childbirth has become very medicalised it can thought that it is not safe to have a baby without depending on lifesaving machines and although they can be very useful when required the majority of women can give birth perfectly well without them should they choose to. Childbirth is much safer today than it was 100 years ago not due to advances in medicine but ‘improved conditions, better food and better general health.’ (Kitzinger 2003, p.153) These beliefs are fuelled in our society, right from the formative years of childhood, by the often skewed portrayal of childbirth in the media and by negative birth stories from just about anyone. In contrast, in many other cultures, childbirth is considered to be a perfectly normal physiological process that is experienced without fear and sometimes even without any discomfort. This attitude is passed on through the generations creating a positive expectation of childbirth. According to neuropsychologist Rick Hanson our brain ‘is like Velcro for bad experiences and stories and Teflon for the good.’ (cited in Berry 2015, p.33) It is no wonder then that many women may feel very anxious about labour and childbirth. The three main worries that many women tend to have are ‘fear of pain, fear of having an abnormal or dead baby, and fear of dying in labour.’ (England & Horowitz 1998, p.8) In addition to these there may be other fears such as having a long labour, intervention and the consequences, complications, fatigue, dreading a loss of control such as over behaviour and physical processes, fear of failing somehow or being judged and loss of autonomy or privacy. Women have very many different attitudes towards pregnancy and childbirth and if you are feeling extremely anxious it can cast a shadow over your experience, making it difficult to enjoy. Hypnobirthing can provide information and preparation for childbirth that can allow both mind and body to work in harmony, regardless of the type of birth chosen or the outcome, so that women can ‘look forward to labour as a peak experience, not just an ordeal to be endured,’ (Kitzinger 2003, p.151) whilst feeling calm, confident and in control.
All the messages you have ever received about pregnancy and childbirth is stored in the subconscious part of the mind, and ‘from the imprints held there we formulate emotions, beliefs and thoughts.’ (Berry 2015, p.44) Some women, an estimated 10% worldwide (McCulloch, 2018), develop a pathological fear of pregnancy and childbirth, known as tokophobia, which can be classed as either primary or secondary. Primary tokophobia may start in adolescence and result in pregnancy generally being avoided later in life although some women, if they do become pregnant, may opt for an abortion, caesarean or adoption. Primary tokophobia could be the result of exposure to negative portrayals of pregnancy and birth or more often can be due to a history of sexual abuse or traumatic experiences of pain or in medical settings. Secondary tokophobia, on the other hand, usually occurs in women who have had a previous traumatic pregnancy or birth experience. If a woman has had a very traumatic birth experience, one in which she felt disempowered, she may suffer from post-traumatic stress disorder which can be marked by flashbacks, nightmares, panic attacks and a sense of isolation. This condition is classed as ‘iatrogenic – a medically produced disorder’ and is different to postnatal depression. (Kitzinger 2003, p.414) During a hypnobirthing programme, whether in a group or one-to-one setting, women or couples can be given a safe space in which to voice and work through fears and anxieties as well as learning about and preparing for childbirth physically and emotionally. Participants are also taught how our emotions, beliefs and thoughts affect our nervous system and how they can help or hinder the birth process. In many Western cultures, including Western medicine, the mind and body are still considered as separate from each other. Hypnobirthing works by harnessing the mind-body connection. As mentioned, our brains acquire certain expectations throughout life based on our experiences and received messages, particularly negative ones, so if it expects pain, or even just the threat of it, it pulses fear signals and increases the likelihood of experiencing said pain. Interestingly women’s perception of labour pain can vary depending on their country or culture. Ina May Gaskin (2008) quotes a 1988 study (Senden et al.) comparing a group of Dutch women’s expectations of labour pain with those of a group of U.S. women. Nearly two-thirds of the Dutch group received no pain medication whereas two-thirds of the U.S. group did along with some type of nerve block for birth. The U.S. women expected labour to be more painful than the Dutch women did and they expected to be given medication for pain: ‘in both groups, the proportions of women expecting pain to those who actually received medication were nearly identical.’ (Gaskin 2008, p.151) Similarly a study by Lowe (2002) found that a woman’s ‘self-efficacy for labor’ or ‘confidence in her ability to cope has a powerful relationship to decreased pain perception and decreased medication/analgesia during labour. Anxiety is commonly associated with increased pain during labor, and may modify labor pain through psychological and physiologic mechanisms.’ (Lowe, 2002) In his book Childbirth Without Fear, the British obstetrician Dr Grantly Dick-Read (1890-1959) wrote that ‘the most important contributory cause of pain in otherwise normal labour is fear;’ this is known as the fear-tension-pain syndrome (Dick-Read 2004, p.45). The origins of most hypnobirthing programmes can be traced back to his pioneering work.
Stress and anxiety can have a ripple effect on mother and baby (and birth partner), physically and emotionally, during pregnancy, birth and post-natally. When we experience anxiety, whether in response to a real or perceived threat, our sympathetic nervous system (SNS) is activated; better known as our fight, flight or freeze response. Many studies have demonstrated how our brain is ‘stimulated by an imagined experience in exactly the same way as the actual experience,’ (Berry 2015, p.67) so when the SNS, our body’s natural defence mechanism against danger, is triggered by a woman feeling frightened, stressed or threatened, it ‘can slow down the unfolding process of childbirth and make it more difficult,’ (Kitzinger 2003, p.189) as it interprets the anxiety experienced as a sign that it is not safe to give birth. It does this by releasing stress hormones such as adrenaline and cortisol, both of which affect the production of oxytocin (the hormone of love), which is required in large amounts to keep labour progressing and contractions efficient, as well as endorphins, nature’s natural painkillers, which are up to ‘200 times more potent than morphine.’ (Berry 2015, p.26) Endorphins stimulate the secretion of prolactin, the key hormone of lactation. Activation of the SNS also diverts oxygenated blood and energy away from non-essential systems such as the reproductive system (also compromising the supply of oxygen to the baby) and so it affects the uterus, which becomes resistant and tight. The uterus can literally turn white with a loss of blood supply. Tension in the body can result in muscles working against each other, causing pain. Instead of thinning and opening, the muscles of the cervix, no longer soft and pliable, remain tightly closed causing the baby to push down on a tight band of muscle. This resistant birth path can be distressing to the baby. The clinical term for this, which in itself can cause distress to a labouring woman, is ‘failure to progress’ (Berry 2015, p.36) and it can in turn lead to a greater likelihood of intervention and its effects. The ripple effect of anxiety can also cause a birth partner to feel tense and anxious and a negative experience can produce a reluctance to have more children, inhibit bonding, strain the relationship with their partner, and could leave them with feelings of helplessness, inadequacy, disempowerment and anger. During pregnancy a low level of anxiety is prerequisite ‘for the optimal growth and development of the baby in the womb’ (Odent 2014, p.96) as well as being necessary for labour to establish itself, which it does by releasing oxytcin. A study headed by O’Connor in 2005 found that anxiety in late pregnancy has been linked to higher cortisol levels in children aged 10. (O’Connor et al., 2005) The peak production of oxytocin takes place right after giving birth and so the ripple effect of anxiety can also cause attachment and bonding difficulties after birth, influenced further by a mother’s energy post-birth and subjective experience of birth.
In contrast, a woman who feels safe and warm, unobserved, free from fear and glaring lights, has privacy and familiarity and is free to move around will freely produce oxytocin and endorphins, along with dopamine, serotonin and melatonin, as she feels free to be ‘vulnerable, and open, and to surrender wholly to the experience that is overwhelming her entire body and mind’, (Bruijn & Gould, 2010) all of which allow her body to work with her. These prime conditions activate the parasympathetic nervous system (PNS), also known as the relaxation response, which is the ‘normal resting state of your body, brain and mind.’ (Berry 2015, p.34) The PNS and SNS are the two subsystems of the autonomic nervous system (ANS) and whilst both are always present, one will always be more dominant depending on what is happening around and within us. During labour oxytocin ‘triggers the muscles to work together in surges, and these surges stimulate more oxytocin and endorphins, which produce more surges in a positive feedback loop.’ (Berry 2015, p.37) The French obstetrician and child specialist Michael Odent remarked that the birth process is an ‘involuntary process’ under the control of ‘archaic’ or ‘primitive’ brain structures (Odent 2014, p.26) that needs to be protected against ‘all stimulants of the neocortex’ (Odent 2014, p.72) or ‘new brain’ (Odent 2014, p.26) (such as language) as ‘giving birth is not the business of the brain of the intellect.’ (Odent 2014, p.71) In short, ‘anything that disturbs a labouring woman’s sense of safety and privacy will disrupt the birth process’ and unfortunately ‘most of modern obstetrics involves disturbance, observation and monitoring, internal examinations, brightly-lit rooms, people coming and going and clock watching’ which can all ‘inhibit a birthing woman, just as they would any other mammal.’ (Berry 2015, p.37) Michael Odent notes that it is as if ‘we need scientific disciplines to unveil a common sense that has been repressed for thousands of years by cultural milieus’ (Odent 2014, p.74) and if we had a clearer understanding of the basic needs of labouring women ‘there would not be the promoters of home births on the one hand and the promoters of hospital births on the other hand’ as it would become apparent that ‘there is no universal recipe for feeling secure when giving birth’ (Odent 2014, p.76); some women feel more secure experiencing birth as a natural process with no intervention in a familiar place whereas others find security in a modern environment controlled by the obstetrician and machinery. In Australia the majority of women have their babies in hospital (either public or private). The option to give birth at home or in a birth centre is only really an option for women who are considered to be low risk. Although women have a legal right to give birth at home they are rapidly losing the support of health care supporters. In South Australia, in 2015, 5.8% of women gave birth in birth centres and 0.5% had planned home births. (sahealth.sa.gov.au) Regardless of place of birth, it is important for a woman to have a good quality relationship with her caregivers, including continuity of care, and for them to understand the importance of nurturing the prime conditions necessary for labour progression and emotional health. A Norwegian study found that a women’s subjective experience of giving birth has more impact on her mental condition afterwards than any real complications occurring in the delivery room. (Garthus-Niegel et al. 2013)
As the PNS is activated during hypnosis, the same hormones that play an important role in childbirth are produced during hypnosis as during undisturbed birth. The mental images a woman has of labour and birth are vitally important as ‘ninety per cent of birth, like 90 per cent of sex, has to do with what is going on in your head.’ (Kitzinger 2003, p.204) Hypnosis can be effective in replacing negative images and thoughts with more helpful and truthful ones; so helping to eliminate fear and anxiety in pregnancy and going into labour. Due to neuroscientific research we now know that our brains are not hardwired as previously thought and that we are in fact able to ‘continue to create new neural pathways,’ so repeated practice of self-hypnosis ‘can train and shape your brain and mind,’ (Berry 2015, p.47) changing your expectations and fostering a positive attitude. Hypnosis is also a wonderful tool for relaxation which is particularly vital for labour. Whilst preparing for labour it can be helpful to learn to anchor feelings of confidence and calmness to certain imagery, music or aromas, or to a partner’s voice or touch, which can then be recalled during labour and birth. Hypnobirthing teaches pain management skills and aims to boost a woman’s confidence and trust in her body’s ability to birth, allowing her to be able to ‘step gracefully out of the way and allow her body and baby to do what they know how to do.’ (Berry 2015, p.13) In addition, visualisation and breathing methods are used to prepare mind and body for birth. It can give couples ‘the confidence to navigate hospital policies and guidelines to make informed decisions.’ (Berry 2015, p.16) Hypnobirthing empowers women and couples to go into labour feeling calm and confident, and so being prepared ‘for any and all birth experiences.’ (Berry 2015, p.103) There is a wealth of research about the effects of anxiety on antenatal, perinatal and postnatal women and the positive response from hypnosis which includes: reducing morning sickness (and hyperemesis gravidarum) (Simon & Schwartz, 1999), reducing the incidence of premature labour (Reinhard et al., 2009; Omer & Friedlander, 1986), turning babies from breech to vertex position (Mehl, 1994), reducing the length of labour (Harmon et al., 1990; Gallagher, 2001), reducing anxiety and therefore having positive effects on mother and baby in pregnancy, during birth and post-natally (Zimmer et al., 1988; Downe, 2015), reducing the use of chemical analgesia and anaesthesia (Harmon et al., 1990; Smith et al., 2006; Lowe, 2002), lowering rates of intervention and complication (Harmon et al., 1990; Mehl-Madrona, 2004), reducing incidence of postpartum depression (Harmon et al., 1990; McCarthy, 1998), promoting lactation and successful breastfeeding (August, 1961; Cheek & LeCron, 1968; Kroger, 1977) and experiencing a better childbirth experience (Werner et al., 2013).
It is clear that our expectations and attitudes towards childbirth can influence and sometimes even determine the outcome of our experience. In order to have a satisfying experience it is important to feel secure and in control of what happens to you and your baby; only then can you allow yourself to let go and allow your body to work freely. Hypnobirthing offers not only ‘an amalgamation of lots of little things that, when brought together, create a huge shift in mindset,’ (Berry 2015, p.69) but also skills not just for birth but for life. There is no right way to give birth, it is not like winning a race or passing an exam, but ‘much more a question of learning how to adapt your responses to the particular challenges of your own labour.’ (Kitzinger 2003, p.181) Hypnobirthing does not guarantee that birth will be pain free; Dr Sarah Buckley as cited by Berry (2015) states that birth is a ‘peak bodily performance, for which our bodies are superbly designed’ and like an endurance athlete, a ‘woman’s task in birth is not to avoid the pain,’ (cited in Berry 2015, p.38), which can make it worse, but to optimise the functioning of our bodies and minds so that everything you have learned and practised becomes second nature and you can welcome your baby into the world calmly and joyfully.
1. ADAMS, S., EBERHARD-GRAN, M., & ESKILD, A. (2012). Fear of childbirth and duration of labour: A study of 2206 women with intended vaginal delivery. BJOG. Sep;119(10):1238-46.
2. Anxiety & Depression in Pregnancy & Early Parenthood. PANDA. Weblog (Online). Available from: https://www.panda.org.au/images/resources/Resources-Factsheets/Anxiety-And-Depression-In-Early-Parenthood-And-Pregnancy.pdf (Accessed 05/03/18)
3. BERRY, K. (2015). Why Hypnobirthing Matters. London: Pinter & Martin Ltd.
4. Bhatia, M.S and Jhanjee, A. (2012), Tokophobia: A dread of pregnancy. Industrial Psychiatry Journal. 2012 Jul-Dec; 21(2):158–159.
5. Billert, H. (2007) Tokophobia–a multidisciplinary problem. Ginekol Pol. Oct;78(10):807-11.
6. BOBART, V., & BROWN, D.C. (2002). Medical obstetrical hypnosis and Apgar scores and the use of anaesthesia and analgesia during labor and delivery. HYPNOS, 29(3), 132-139.
7. BRUIJN, M. & GOULD, D. (2010) There is a secret in our culture, but it is not that women are strong. Why some birth quotes may be damaging to women. Birthtalk.org Understanding Birth Trauma. Weblog (Online) 3rd June. Available from: https://birthtraumatruths.wordpress.com/2010/06/03/there-is-a-secret-in-our-culture-but-it-is-not-that-women-are-strong-why-some-birth-quotes-may-be-damaging-to-women/ (Accessed 13/03/18)
8. Campaign. Homebirth Australia. Weblog (Online). Available from: http://homebirthaustralia.org/campaign (Accessed 24/02/18)
9. DAHLBERG, U., AUNE, I. (2013). The woman’s birth experience – the effect of interpersonal relationships and continuity of care. Midwifery. 29(4):407-15.
10. DICK-READ, G. (2004). Childbirth Without Fear. London: Pinter & Martin Ltd.
11. DOWNE, S. et al (2015) Self-hypnosis for intrapartum pain management in pregnant nulliparous women: A randomized controlled trial of clinical effectiveness. International Journal of Obstretrics and Gynaecology.
12. ENGLAND, P. & HOROWITZ, R. (1998). Birthing From Within: An Extra-Ordinary Guide To Childbirth Preparation. New Mexico, Partera Press.
13. GARTHUS-NIEGEL, S. et al. (2013). The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study. Arch Womens Ment Health. 16(1):1-10.
14. GASKIN, I.M. (2008). Ina May’s Guide To Childbirth. Vermilion: Ebury Publishing.
15. GOVERNMENT OF SOUTH AUSTRALIA: SA HEALTH (2017) Pregnancy Outcome in South Australia 2015 (Online) Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/66323264-dc4f-4667-b118-acabd078685a/Pregnancy+Outcome+in+SA+2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-66323264-dc4f-4667-b118-acabd078685a-m13MJ0U (Accessed 13/02/18)
16. HARMON, T.M., HYNAN, M., & TYRE, T.E. (1990). Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. Journal of Consulting and Clinical Psychology, 58, 525, 530.
17. KITZINGER, S. (2003). The New Pregnancy & Childbirth Choices and Challenges. London: Dorling Kindersley Limited.
18. LOWE, NANCY.K., (2002). The Nature of Labor Pain. American Journal of Obstetrics and Gynaecology (Supp) Vol. 186, No5, pp.S16-S24.
19. Maternal Decision-Making – 2013. Australian Medical Association. Weblog (Online). Available from: https://ama.com.au/position-statement/maternal-decision-making-2013 (Accessed 24/02/18)
20. MCCULLOCH, S. (2018). Birth Options in Australia: Public, Private, Birth Centre or Home? bellybelly.com.au. Weblog (Online) 6th March. Available from: https://www.bellybelly.com.au/birth/australia-public-private-birth-centre-home/ (Accessed 12/03/18)
21. MCCULLOCH, S. (2018). Do Doctors Know Best About Home Birth? bellybelly.com.au. Weblog (Online) 6th March. Available from: https://www.bellybelly.com.au/birth/do-doctors-know-best-about-home-birth/ (Accessed 12/03/18)
22. MCCULLOCH, S. (2018). Tokophobia – Coping With An Intense Fear of Childbirth. bellybelly.com.au. Weblog (Online) 7th March. Available from: http://www.bellybelly.com.au/birth/tokophobia-what-is-it/ (Accessed 13/03/18)
23. MEHL, L., MD, PhD (1994). Hypnosis and Conversion of the Breech to the Vertex Presentation. Archives of Family Medicine, Vol. 3, Oct. 1994, Dept. of Psychiatry Univ. of Vermont College of Medicine, Burlington.
24. MEHL-MADRONA LE (2004). Hypnosis to facilitate uncomplicated birth. American Journal of Clinical Hypnosis Apr;46(4):299-312.
25. O’Connor, TG. et al (2005) Prenatal Anxiety Predicts Individual Differences in Cortisol in Pre-Adolescent Children. Biological Psychiatry. 58(3)211–217.
26. ODENT, M. (2014). Childbirth and the Evolution of Homo Sapiens. London: Pinter & Martin Ltd.
27. Perinatal Anxiety. beyondblue. Weblog (Online). Available from: https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/anxiety (Accessed 08/03/18)
28. REINHARD, J., HUESKEN-JANßEN, H., HATZMANN, H., & SCHIERMEIER, S. (2009). Preterm Labour and Clinical Hypnosis. Contemporary Hypnosis. 26(4): 187–193.
29. SIMON, EP. & SCHWARTZ, J. (1999). Medical hypnosis for hyperemesis gravidarum. Birth. 26(4):248-54.
30. SMITH, CA et al. (2006). Complementary and alternative therapies for pain management in labour. Adelaide, Australia – Cochrane Database of Systematic Reviews. (4):CD003521.
31. SOUTH AUSTRALIA DEPT. OF HEALTH (2013). Policy for Planned Birth at Home in South Australia 2013 (Online) Available from: http://www.sahealth.sa.gov.au/wps/wcm/connect/76aaf1004f3219c488eefd080fa6802e/Planned+Birth+at+Home_in+South+Australia+2013_ppg_v2.0.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-76aaf1004f3219c488eefd080fa6802e-lYyuar2 (Accessed 24/02/18)
32. STØRKSEN H.T. et al. (2013). The impact of previous birth experiences on maternal fear of childbirth. Acta Obstet Gynecol Scand. Mar;92(3):318-24.
33. Tokophobia in pregnancy. Tommy’s. Weblog (Online). Available from: https://www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing/specific-mental-health-conditions/tokophobia (Accessed 15/03/18)
34. WERNER, A. et al. (2013). Antenatal hypnosis training and childbirth experience: a randomized controlled trial. Birth. Dec;40(4):272-80.
35. “Who Cares?” Choosing A Model Of Care. Maternity Choices Australia. Weblog (Online). Available from: http://www.maternitychoices.org.au/info-sheets.html (Accessed 26/02/18)
Hypno-psychotherapy could help to provide an optimum environment conducive to conception in couples or individuals that are struggling with fertility
|Posted on 16 January, 2018 at 8:35||comments (0)|
The decision to have a baby can be a very exciting time and many people assume it is something that they will experience no problems doing, but struggling with fertility, either naturally or using assisted reproductive technology (ART), can take couples and individuals on an emotional and physical rollercoaster which can leave them feeling mentally, emotionally, physically, spiritually (and financially) exhausted and depleted.
Infertility is defined as ‘the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse.’ In Australia one in six couples will struggle with infertility and in general it seems that infertility is on the rise in many countries worldwide. This could be attributed to various factors such as many women leaving it later to have a child. This is certainly the case in Australia where in 2007 ‘women aged 30-34 experienced the highest fertility of all Australian women.’ The switch from barrier to non-barrier contraception plays a role in raising the risk of STD’s such as chlamydia, and if using the Pill it could take time for the body to return to hormonal balance. Then there are health and lifestyle influences such as alcohol, drugs, smoking, caffeine, exercise, nutrition, weight and stress. The latter can have a profound effect on fertility. In addition, excessive exposure to environmental pollutants and chemicals can play a role. In Australia 40% of physiological fertility problems are associated with men and women respectively with 20% being attributed to both sexes. Between 15%-30% of fertility problems are defined as having no biological cause and are labelled as unexplained infertility. (http://fertilitysolutions.com.au/)
Trying for a baby can take the spontaneity and fun out of lovemaking, turning it instead into a precise science, which can leave many men feeling like sperm-producing machines. Sex can easily become associated with failure and the anxiety faced by many men to perform during a fertile window can result in impotence. Women in turn can experience stress and anxiety when confronted by negative test results, unwanted menstrual periods, stressful social interactions and hurtful self-talk. In response to this constant stress and anxiety, the sympathetic nervous system can become over-stimulated and the body’s fight-or-flight response can be continually activated resulting in the release of stress hormones such as adrenaline and cortisol, which affect the body’s natural biochemical balance; with energy being diverted away from systems deemed unnecessary for survival, such as the reproductive system. Both the stress response and sex hormones are regulated by the hypothalamus and so excessive stress can interfere with ovulation as it stops secreting gonadotrophin-releasing hormone (GnRH), which in turn impacts on the release of the luteinizing and follicle-stimulating hormones. In addition the pituitary glands will emit high levels of prolactin during times of stress which can inhibit fertility (this hormone is usually released to stimulate lactation, inhibiting conception during breastfeeding). Interestingly during times of stress men can also produce prolactin and as testosterone, responsible for sperm production, is also governed by the ‘hypothalamus-pituitary-axis which is sensitive to emotional tension,’ (Hugo 2009) sperm production can also be negatively impacted. Adrenaline can impede fertility as it inhibits the production of progesterone which is important for building and maintaining a lining of the uterus. The autonomic nervous system can remain in overdrive for many people if the parasympathetic nervous system, or our inborn relaxation response, is not also activated. This ‘assault on your body could contribute to insomnia, exhaustion, increased production of stomach acid, irritability, sexual dysfunction, and a host of other ailments.’ (Domar 2002) Our emotional and irrational subconscious mind can be very receptive in times of stress as our critical thinking is bypassed and so unhelpful and negative suggestions such as ‘you can’t get pregnant’ or ‘we are trying to get pregnant’, or the word ‘infertile’, can be taken on board literally and accepted as fact by the powerful subconscious mind. As we know ‘mind and body are integrated parts of a whole being; a change in one part affects the other.’ (Eastburn 2006) This cycle of emotional and physical triggers, not conducive to conception, can have a massive impact on those wanting to conceive and the longer it continues the harder it becomes.
Hypno-psychotherapy can assist on many levels by helping to restore mental, emotional, physical and spiritual balance, giving you the best chance of conceiving, either naturally or with reproductive assistance, by providing an emotional and physical environment conducive to conception. It can give you the space to unleash your feelings and help put you back in control of your life, instead of having a diagnosis of infertility control you. Hypno-psychotherapy in the treatment of infertility is underpinned by a mind/body approach and as such an understanding of how profoundly the mind can affect the body and vice versa. The world-renowned expert on infertility, Dr Alice Domar, stated that ‘mind/body treatment has been shown to be effective in both significantly increasing pregnancy rates as well as reducing psychological stress.’ (Sizer & Dean 2010)
The challenging journey of fertility treatment can be very overwhelming and exhausting on all levels, especially for women whose bodies usually take the brunt of most of the treatments and who may experience one loss after another from failed attempts. It is worth noting that just as much depression and anxiety is reported in women experiencing secondary infertility as those with primary infertility, and women with secondary infertility have a range of other secondary-only issues to deal with. Dr Alice Domar’s ground-breaking research reveals that ‘women who’ve been diagnosed as infertile are twice as likely to be depressed as a control group, and that this depression peaks about two years after they start trying to get pregnant.’ (Domar 1992) Interestingly the depression scores of infertile women are comparable to women with life-threatening illnesses such as heart disease, cancer or HIV. In addition, there is mounting evidence that ‘not only are depressive symptoms a very common side effect of infertility, but they may also impede your chances of getting pregnant as well.’ (Domar 2002) For men suffering from poor-quality sperm or no sperm (azoospermia) it can feel like a blow to their manhood and place them in a state of crisis which can result in sexual dysfunction, anger and depression. According to Dr Sammy Lee, who was an expert on male infertility, ‘up to 25% of couples experience problems with sex when the male partner’s infertility is identified.’ (Sizer & Dean 2010) Furthermore many men who may initially have tested with a normal sperm count find that upon retesting a year later their sperm count has dropped, highlighting how the emotional strain during a year of infertility tests and procedures can affect the body. (Eastburn 2006) It can be frustrating for couples undergoing fertility treatment when there are disagreements about treatment options and when or if they are worth pursuing. It can spell the end of the relationship for some. For others the choice to stop can be taken out of their hands due to the advice of doctors or having no more money to spend.
The experience of infertility can feel like you’re holding your breath until conception occurs and so the role of the hypno-psychotherapist is to help you to let go of that breath and rediscover a sense of yourself outside of fertility issues. Initially it can feel like a huge relief to just be able to offload and talk openly and honestly about how you are feeling in a safe and supported space. It is well documented that hypnotherapy ‘reduces stress and increases confidence, instilling a sense of control, which, in turn, enables you to maximize your chances of conceiving naturally and/or increases the success of medical assistance.’ (Eastburn 2006) If your mind and body is stressed and out of sync it is important to restore calm and balance and hypnotherapy is the perfect tool for achieving this as it activates the relaxation response which is driven by the parasympathetic nervous system. When activated it creates a physical state of deep rest which becomes apparent through a ‘measurable decrease in heart rate, blood pressure, breathing rate, stress hormone levels, and muscle tension.’ (Domar 2002) Once in this state of profound mental, emotional and physical relaxation, therapeutic work can take place within the powerful subconscious mind. The inclusion of visualisation, guided imagery and ego-strengthening can assist with the reduction of stress, increase feelings of relaxation and confidence and can help you to communicate with your mind and body. The language of the subconscious mind is ‘imagery, metaphor and symbols.’ (Hugo 2009) As we know from the work of Dr Alice Domar ‘women who learn to use mind/body strategies to manage the stress of infertility dramatically reduce their levels of depressive symptoms, anxiety, anger, and frustration’ (Domar 2002) and so increase their chances of becoming pregnant.
Hypno-psychotherapy can also help you to challenge limiting beliefs and combat negative thinking and/or behaviours. Assistance can also be offered with any necessary lifestyle changes such as smoking, diet, exercise, alcohol intake and sleep. Hypno-psychotherapy can work very effectively with infertility whether a physiological cause has been identified or not and can be used safely alongside conventional medical interventions. It can aid in the restoration of menstrual health all the way through to sperm mobility and count. Whichever area needs work, the client can explore the inner workings of their body and in doing so restore trust and a connection with their body. It can help clients undergoing ART to feel mentally, emotionally and physically prepared and so enhance their chances of success. It can also assist clients with fears and phobias, such as a fear of needles, and relaxation and visualisation for IVF has been shown to increase its effectiveness. An Israeli study conducted by Prof. Eliahu Levitas and his team from Soroka Hospital in Beersheba, demonstrated that hypnosis can double the success of IVF treatment during the embryo transfer stage. Levitas’s study of 185 women found that 28% of women in the group who were hypnotized became pregnant, compared with 14% of those who were not. Therapy sessions can be tailored to work in conjunction with the medical treatments being undertaken. The two-week wait period after the embryo transfer has taken place can be a very stressful time for many women, precisely when they need to be at their most relaxed, and so enhanced support can be offered during this time.
A hypno-psychotherapist can also help to identify and resolve any subconscious blocks to conception which may be present, such as unresolved trauma, previous miscarriage, abortion, abusive relationships, fears about pregnancy and birth or ability to cope as a parent, unresolved grief and so on. Working to resolve any relationship problems, improving communication between partners, and increasing sexual intimacy and affection may be other important areas to look at. The role of the therapist is to provide support in all instances; helping clients to build coping skills and develop inner resources, teaching self-help tools, helping clients to maintain changes and providing guidance to make decisions if conception does not occur. Just because a couple or individual has decided to stop trying, or the choice has been made for them, does not necessarily mean that they have to be childless, options such as sperm or egg donation, surrogacy and adoption could be explored or re-visited. In these instances, however, it is very important to grieve the loss of biological parenthood. Being childless can go to the core of a woman’s identity and can touch deep and painful emotions but it is important to recognise that whatever the outcome, you have value, you matter and you can be whole.