Episode 156 Hypnobirthing with Megan Rossiter Birth-Ed

Ever wondered how hypno-birthing can change your childbirth experience? Today's special guest, Megan Rossiter, will take you on a journey through the transformative power of hypno-birthing. Megan went from an initial skeptic to becoming an inspiring advocate and teacher in this field. Dive in as we explore how hypno-birthing techniques influence the subconscious mind, helping parents reframe their thoughts around childbirth and enhancing their connection with their bodies and babies.

Our enlightening conversation doesn't stop there. Get insight into various relaxation techniques that keep expecting parents in the calm part of their nervous system during this momentous journey. Learning how to negotiate the maternity care system, ensure informed consent during labor, and manage conversations with professionals are also touched upon as we underscore the importance of starting early and maintaining a serene demeanor. Megan provides profound guidance on these areas, all essential tools for maximizing the best possible birthing outcomes.

Finally, we delve into the empowering effects of hypno-birthing, fostering parents' trust in their instincts and informed decision-making abilities. Discover the immense power of language in childbirth and its profound impact on both mind and body. Megan emphasizes the role of midwives in quickly building a connection with expecting parents and highlights the importance of self-advocacy. If you're seeking to take control of your childbirth experience, this episode is a must-listen, packed with powerful tools, techniques, and insights that can revolutionize your journey into parenthood.

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Transcript

Florence: 0:00

Hello, my name is Florence. Welcome to the ObsPod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife. Maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the ObsPod is for you. Episode 156, hypno-birthing. I am very excited to welcome today to the ObsPod Megan Rossiter. Megan is the founder of the BirthEd podcast and does antinatal and hypno-birthing teaching, and I've actually been on her BirthEd podcast talking all about cesarean birth. So it is lovely to have her come back and reciprocate and join me on the ObsPod and we're going to talk all things hypno-birthing. So welcome, megan, to the ObsPod.

Megan: 1:28

Thank you so much for having me. It's nice to kind of do a tip for tatoo.

Florence: 1:32

I guess briefly, it might be nice to know how you got into antinatal teaching and hypno-birthing.

Megan: 1:40

So I originally trained in midwifery before my eldest son was born and was introduced to hypno-birthing by a family friend when I was pregnant with him during my second year of training and was very skeptical. This was now seven or so years ago. So hypno-birthing is definitely being spoken about much more widely now than even seven years ago and it wasn't something that I had encountered much yet in my training or in kind of practice supporting families in their pregnancies or in their births, and so yeah, I was a little bit concerned about what it might be. Was it going to just be really alternative, really strange? Was I going to be hypnotised? Wasn't sure. But anyway, the set of circumstances at the time meant that we kind of owed this person a favour. So we were like, oh, do you know what? We'll just sign up for the course because basically she had offered to lend us her house while our house was being redone. So we decided to go ahead and do this hypno-birthing course, kind of as a favour to her, and it basically then was like the grounding to change the rest of my both personal and professional life.

Megan: 2:53

So I went back to midwifery for a short period of time after my eldest was born, but due to the cost of childcare and everything else that is thrown at you once you have babies, it just wasn't a viable thing to kind of continue with and my sort of alignment in the work that I wanted to be doing had really shifted.

Megan: 3:11

So I decided that I would train to teach hypno-birthing and anti-native classes and founded birthing. And the work that I do now is all kind of totally out of the NHS working with families whilst they are pregnant, preparing them to what to expect for birth and labour, how to kind of navigate the maternity system, what to expect as you kind of take those very first steps into parenthood, both from the kind of perspective of hypno-birthing and the incredible things that that can do for somebody in their kind of birth preparation. But hopefully with a kind of having worked on the inside of the NHS, with a kind of understanding of what that looks like for the staff that are working within the NHS and the people that are trying to navigate their way through giving birth in that kind of environment. Amazing.

Florence: 4:00

I love that story. That's such a great story. Like I did this just as a favour to do that and then it shifted my whole life. It really did. That's such a great story. So you touched on there that idea that, ooh, hypno-birthing might be a bit alternative, bit kind of. And when you messaged me saying how about an episode on hypno-birthing, I thought, oh yes, definitely, because this is something I definitely do not really understand and it is something, as you say, I'm encountering a bit more often. And when you say hypno-birthing, I agree you kind of think, ooh, hypnosis, that's all a bit weird and wonderful and, mmm, bit sort of. There's a sort of area of mysticism, bit of magic, bit of a ooh, not sure. So I would love you to tell me what hypno-birthing actually is.

Megan: 5:01

So with regards to the word hypno-birthing, it basically just has a really stupid name, and if I could change the name and the people that are interested in doing it still know what I was talking about, I kind of absolutely would, Because it's the name itself that is the issue, rather than the actual practice of the tools, the techniques, the approach to birth preparation. Now I think the easiest way to break down what hypno-birthing is is to kind of break it into two parts. So you've got the hypno aspect of it and the birthing aspect of it. So I should point out at this point actually that hypno-birthing is not a regulated practice, so it is not standardized. Different teachers will teach it slightly differently, different programs might interpret it slightly differently. So I can absolutely talk about it from kind of my perspective and my take on hypno-birthing. But you may find that different families, different people, different teachers might be doing it with a kind of slightly different slant, in the same way that quite a lot of maternity practice. Everybody has their own slightly different slant on any number of things, and you certainly see that within hypno-birthing as well. But yeah, to break it into two parts the hypno and the birthing, so the birthing part of it is simply an approach to anti-natal education, so the kind of real foundations of it are giving families an understanding of what happens on a biological level inside your body when you are getting your baby from the inside to the outside. What are the processes that take place hormonally, physically, within your baby, within yourself, and a kind of understanding of what it might be along the way that can impact that either positively or negatively.

Megan: 6:47

An understanding of what the maternity system is in 2023, how did it get created to be like this? What are the things that you might encounter? How can you make the most of it? How can you take back power and control and autonomy and agency in the decisions that you are making? How can you know what questions to ask so that you're really getting the most out of your care provider's expertise, and what are your rights? What are you actually able to ask for, what are you able to do so that, hopefully, you are as close as possible, able to have a birth that feels really personalised to your circumstances rather than?

Megan: 7:30

I think it's mainly a mixture of parents and professionals that listen to your podcast, isn't it? But you've probably heard the phrase the conveyor belt of care you step on at the beginning and you tick a load of boxes and this is the birth you get at the end. Actually, it's how do you almost stroll alongside it and work out which bits you want to take, which bits you don't want to take. So that's a really key part of the message that I teach within hipno birthing is actually understanding all of that. And then comes the kind of almost what you'd consider more kind of standard anti-natal education is like. What kind of pain relief can you have? What are the potential interventions that might be offered or recommended? Where can you have your baby? Those sorts of things that you might want to know about as well. So that's the one side of it, and all of this is going with a thread, I suppose, of confidence building, positivity, making hopefully those things not feel frightening and scary. And that is starts to be where the link is then made to the hipno aspect of hipno birthing.

Megan: 8:31

So the word hipno is a shortening of the word hipnotherapy, and hipnotherapy is a practice that is used effectively for basically anything that would require your mindset or something within your thoughts or thinking or subconscious mind to change. So hipnotherapy people use for things like quitting smoking, for fears, phobias, anxiety, losing weight, those kinds of things are where we tend to see the practice of hipnotherapy used in more kind of day to day situations and the idea is that the tools of hipnotherapy and the tools, therefore, of hipnobirthing can be used to start to reframe some of the kind of thoughts, ideas that might be sitting in the subconscious part of our mind before we've got pregnant, before we've given birth or as we step into future birth. And if you are thinking about kind of how the mind exists, if you think of it as like an iceberg, the top of the mind is the kind of cognitive thinking neocortex bit that we're using right now, that we're kind of engaging in conversation with, the bit we're very aware of, and underneath is like the vast, vast, vast subconscious, which is full of information that we have taken in from our entire lives, whether we think we have or we haven't. And, with regards to birth, this can be your own mum's experience of giving birth, your sister's, family's, friends' experiences of giving birth, everything that we've ever seen on TV about giving birth, everything that we see in the media, everything that we see in social media stories. All of that is going in and starting to sit in the subconscious part of our mind, and the reason why this is so relevant is because your subconscious mind influences both the voluntary and the involuntary actions that we take absolutely every single day.

Megan: 10:26

With regards to birth, all of the decisions that you know you're making and all of the decisions that you don't realise you're making about labour and birth will be influenced by what is in that subconscious part of the mind.

Megan: 10:37

So the idea of the hit no birthing tools is to start to kind of unpick some of this, start to layer in positive confidence building ideas so that you are able to trust yourself, so that you are able to build your confidence, so that you are able to kind of tune into what you're feeling, what your body is telling you, the connection between you and your baby.

Megan: 10:58

And when we marry those two things up the kind of information side of things and the sort of sense of self trust that we can build in hit no birthing then hopefully it means you are stepping into your birth from a place where you can really really ensure you remain centred in that experience, and that can be.

Megan: 11:18

You know, when I talk about trusting yourself and tuning into what your body is saying, in a big part that is trusting in the process of birth and actually the sensations that you're feeling and knowing how to move and those kinds of things. But just as similarly it's trusting yourself to go. Actually this doesn't feel quite right or something isn't quite right or actually this isn't what I want. And we can chat a little bit as we go about how actually hit no birthing plays into, yes, kind of physiological birth, as sometimes it might be presented to, but actually also induction of labour or caesarean birth, if those things feel like the right things for you to do, trusting yourself to make those choices as well. So that is my very, very not in a nutshell version of that what hit no birthing is.

Florence: 12:03

No, but that's really clear because in my mind so sometimes I come across a woman who's hit no birthing and there might be a sticker on the front of the notes kind of like flag don't, don't interrupt me, I'm hit no birthing. And often she is very turned in on herself and centred on herself, and so I kind of think more about maybe breathing and relaxation techniques, whereas actually you're talking more about connection with your body and feeling and understanding your body, which is slightly different to what I imagined.

Megan: 12:51

Yeah, and I suppose there are absolute what the hit no birthing, the hit no therapy part of the techniques are. They are breathing techniques and relaxation techniques, but the purpose of those is to allow you to kind of tune back into your body. So the reason for doing them is for, yes, managing the sensations that you're feeling, for blocking out everything else that might be going on around you, to really really support the physiology and it's ultimately supporting the kind of mind body connection and we really really underestimate in birth and in life just how connected your mind and your body are and how one can influence the other in a massive, massive way. There are practical techniques which form part of a hit no birthing program which you absolutely include relaxation, massage, breathing techniques. But the kind of grounds at the purpose of them being there is to support that mind body connection, to support physiological processes in your body. Okay, and the preparation.

Florence: 13:56

So sometimes I've got women who are perhaps very anxious and they might be choosing a cesarean birth. But I will still say to them actually hit no. Birthing might be useful to you, because I've seen some of those techniques and grounding can be really helpful at keeping them calm. You know, not everyone that chooses a cesarean feels theatre is a good environment either. It may be it's the best of the worst, if you see what I mean. Both options don't feel good and I'm never sure, when I suggest it, at what point you need to start practicing maybe some of the techniques to be able to then use them at the end of pregnancy. So you know, if you're because it's not something you can easily just do kind of go. Oh yeah, it's my subconscious and everything you've just explained. It takes a bit of practice, doesn't it?

Megan: 14:56

Yeah. So I mean, ultimately, it's never too late, like if you were listening to this and you're 40 weeks pregnant and you're like, oh well, that's it, my chance has been blown. There is information that you can gather, there is learning that you can do. There are tools and techniques like breathing technique. You can learn that very quickly. You can practice it a bit, and it should, particularly for a plant, as an area where you're not completely thrown by actually the sensations of labour, where actually you can reach for that and utilise it pretty quickly. Ultimately, though, there's also there is no too early time to do it. If we could start giving this information to people long, long long before they got pregnant, a lot of it is beneficial for even at the very beginning, navigating your booking appointment, the conversations that you're having your 12 week scan, all of those kinds of things. Actually, if you've got this information then and people find it helpful with if they don't like having the blood taken or that kind of things, these tools and techniques can be helpful in those situations as well. So, never too late or too early. Most people that I work with tend to feel most comfortable to wait until after their 20 week scan. I think that just tends to be a milestone that people feel comfortable with. But ultimately, as soon as you've got an interest in it, I would just kind of get going with learning a little bit more about it. But if you're right, right, right at the end and you're like, oh, I just want a couple of things to kind of reach for, yet there is plenty that you can take from it. Even I've worked with somebody literally at 41 weeks of pregnancy and it's completely transformed their approach, their understanding, the tools that they had at their fingertips. So, yeah, absolutely, and, as you said, using the tools for a planned or an unplanned cesarean birth that what we are trying to do and what the main purpose of the actual kind of practical tools that you can reach for is.

Megan: 16:46

I'm probably teaching you to suck eggs here, but for anybody that is listening, it's all to do with your nervous system. So your nervous system has got two sides your parasympathetic nervous system and your sympathetic nervous system. In short, we can call it your calm mode and your emergency mode. When you are in that emergency mode, that's when we feel like nervous, we feel panicked, we feel on edge, we might have a slightly higher heart rate, we might be breathing a little bit more quickly. We're just sort of not feeling in a way that you would want to be feeling when you're giving birth, and the impact that that can have on a labor is that, ultimately, the hormones that you need for birth are not created when we're in that state. So you need tools and techniques, environment support that is going to help you remain in the calm part of your nervous system.

Megan: 17:33

But and I think we might have mentioned this a little bit when we chatted in the in my podcast about cesarean birth actually feeling calm is important, even if you aren't in labor and being in that parasympathetic part of your nervous system, having tools that actually help you pause, that help you relax that is going to enable you to have better bonding with your baby, to remain more kind of grounded and centered in the moment, for it to feel safer, for it to feel more special.

Megan: 18:06

So all of those feelings that you would, if you write a list of feelings that you want to feel when you're in giving birth to your baby, most of them will only be possible when we are in this part of the nervous system, which is that calm part of the nervous system, and so, like literally deep breathing, stimulate something called the vagus nerve that runs through our body which activates this calm part of the nervous system.

Megan: 18:28

Guided relaxations they really, really kind of help to settle yourself, settle your mind, move yourself back into that part of the nervous system. So those tools and techniques are there, However you're giving birth to your baby, and the idea of them is to help you remain calm and relaxed, because when we are calm and relaxed, the physiological processes that happen, regardless of how you're giving birth to your baby everything from stopping bleeding, postnatally establishing breastfeeding, contracting the uterus back down, bonding with your baby all of that is hormones that are made in that part of the nervous system, so absolutely suitable for a physiological birth, which is you're definitely, definitely going to need them and it's not going to work unless you're feeling those things but transferable to however you give birth to a baby.

Florence: 19:14

Yeah, I'm thinking as you were talking then.

Florence: 19:18

I mean we see a lot when women come in in what we might deem to be early labor, that you know you come to the hospital and then everything stops dead because you're in that kind of alert state suddenly because you're in a different environment with different people that you've probably never met before. But I was also thinking actually for some women. So you know that I'm the link consultant for the home birth team or I see a lot of women who want maybe a vaginal birth after cesarean and I normally suggest to people that they make a series of birth plans or birth preferences, because then, whatever happens, they know, okay, we're not doing plan A, we're doing plan B, or actually we're maybe doing plan C because that keeps them calm. Okay, this isn't what I expected, but I know I've still got a plan for that type of birth or that eventuality. But I was thinking also about the fact that sometimes people feel like, oh my God, I've been sent to see the consultant because something's wrong, I've got to go and see this scary obstetrician. And that does happen.

Florence: 20:32

I have people come in and they're like, oh it, completely alert and terrified. And actually I work with a wonderful midwife who does yoga and mindfulness and she's very good at just trying to bring them back down and calm them so that they can then actually have the conversation they want to have with me. Because the other thing that happens when you're super agitated and stressed is your brain goes and you can't actually remember the things you wanted to ask, the conversation you wanted to have, and then you go home and you haven't got any of them. So I think actually maybe people need hit and a birthing just for the anti natal.

Florence: 21:14

Yeah, consultations, but yes, there's so much in in pregnancy that we expect people to just do Like. I often get women who haven't had blood tests or find having blood tests very difficult, and staff say to me huh, they haven't had any blood tests, you know, and it's like, well, okay, but we need to work with them and explain why and what strategies we might be able to use to make it easier and whatever, but they are still something that a woman could opt out of. I wouldn't recommend it. There's reasons why we do them, but actually we take for granted that a woman's going to just sail through and do everything.

Megan: 21:59

Yeah, and going back to your point about kind of the actual going into anti natal appointments, all of these things. But like and because we're all so different, some people are really comfortable in a hospital environment. Meeting a doctor doesn't bother them, feels fine. Other people like this is the first time they've ever really interacted with health care services at all, or they have deliberately opted out of health care systems for a long time, or they have had previous very difficult experiences engaging or previous difficult conversations engaging with health care services. So you know, from a kind of provider perspective, who's walking in each appointment and how they're kind of feeling. So having, from a kind of service user perspective, somebody who's actually about to have a baby yes, these tools are helpful for labor and birth. But something that we talk about.

Megan: 22:50

Going back to the nervous system, when we enter that emergency mode, what we can trigger when we trigger this production of a hormone called adrenaline, which is our kind of fear hormone. Most people have heard of adrenaline like an adrenaline junkie loves roller coasters, loves that kind of feeling of fear Anytime we don't feel safe, relaxed, unobserved or undisturbed. Those are the four things that we need to feel to remain in that calm part of the nervous system. If we don't feel those things, we run the chance of producing adrenaline and when we produce adrenaline it triggers a response in our body called the fight or flight response and that basically sends blood to your arms and your legs so that you can kind of fight danger or run away from it, which from an evolutionary perspective, very helpful. If you were giving birth in the woods and suddenly you saw a saber tooth tiger, you would want to get away from that danger very, very quickly or potentially fight it. But you can actually extend this response and I don't think I mean you can probably share from the kind of inside perspective of working in the maternity system, but I don't think we tend to see fight or flight as the initial response.

Megan: 24:01

That often you don't see that many people ready to have like a real confrontation argument if something has been suggested that makes them feel uneasy. You don't really see that many people just stand up and walk out the room. What you tend to see is the third response which is called for, which is essentially complying with something to make your life easier, just doing what you are told. Because it is that I feel uncomfortable. How can I make this as easy as possible. I'm just going to nod my head and do what I'm told, and that is not because you're bad at advocating for yourself or because you don't know what you want. It is like an automatic response from your body to try and keep you safe.

Megan: 24:42

Your body's going right. Something's being suggested. I don't like it. Am I going to argue? No, that feels uncomfortable. Am I going to get up and walk out the room? No, that feels uncomfortable. Should I just nod along? Yeah, that feels like the easiest thing to do here. And that's when we end up agreeing to things or not asking the questions that we wanted to do, and so so much of the Hypnoburthing course is actually working out. Actually, how do you manage that? But it is much easier to manage that if you are sitting in a place where you are feeling calm, where you are feeling safe, where you are feeling relaxed, and then engaging in those conversations, as you mentioned, is so much easier than actually it just being a kind of automatic response from our body, a physical response from your body.

Florence: 25:25

That's really interesting. And that sort of brings me on a little bit to the thing that I find a bit difficult with Hypnoburthing. Sometimes is, I'm told, this woman's Hypnoburthing and sometimes in the birth preferences is the idea that I do not talk to her and do not interrupt her. That is very difficult as a professional because we have this whole issue of consent and it may be something that she's learned about and understood antinatally, but it may not be and I can't make that assumption. So I have to have some kind of interaction and conversation which is then going to immediately bring her out of that zone, and that's sometimes quite difficult to kind of navigate for me or for listeners that are midwives perhaps. So do you have any kind of tips or sort of thoughts on how to do that in a way that is not overly disruptive?

Megan: 26:42

Yeah, absolutely, and I think this is sometimes where the if the message of hipney birthing has become kind of confused or diluted in the way that it has been taught, where sometimes you can get mixed messages that aren't particularly helpful. So I would never say to anyone that I'm working with don't ever talk to anybody the whole time that you're in labor, because if there's a conversation, as you mentioned, that actually needs to happen for their safety or their health or for their consent or something like that, then it is important that they are engaged with and that they have that conversation. Sometimes I might see people write for conversation initially to go through somebody else. So can you speak to my partner first? Can you speak to my doula first? Those kinds of things you sometimes see there. So it might depend slightly on what is written in the kind of birth plan or birth preferences. So the first thing is just that I think most people are happy to be disturbed when it is really essential that they are the person that needs to be spoken to, and I think a lot of it is sometimes conversation that happens or that does need to happen. But it might be something like a question of oh Megan, can you just confirm what address you're going home to, because I need it for the notes. Like there is absolutely no reason why that question has to go to the person that is in labor whilst they are in labor, and sometimes, if it's a question like that, if it's a kind of clarification of something, there's often no reason why the other person in the room wouldn't be able to answer that. If it is a we would like to offer you I don't know we're recommending continuous monitoring of your baby because of X, y and Z, and we would therefore need your consent or conversation with you about why we're offering this and for you to decide whether or not.

Megan: 28:32

Something that you want to do, I think, as a first instance, is just sort of pitching the time of it. So you're strolling up to somebody mid contraction and saying we're just asking you if you want this. You know, somebody asked me in my first labor if I consented to having the injections in my placenta whilst my baby was crowning. Now, there is absolutely no way that you can give informed consent whilst there is a baby's head sitting on top of your perineum. You just go, yeah, yeah, whatever, I don't care, go away and you'll say so. It's about pitching.

Megan: 29:06

The timing, you know, between contractions is probably a better time to start that conversation. Or if they have asked really not to be disturbed, it might be that you can say to a partner or to a doula let's say, it's me and Labour, it's important that we speak to Megan for this, and if you just let her know that we would like to speak to her and in the next few moments, whenever she feels ready, then we can kind of engage in the conversation, just so that that maybe that preempting is coming from somebody that she feels safe with and so, or if there's no kind of instruction like that, then it's, you know, in between those contractions. Megan, we would really like to talk to you about a recommendation that we would like to make about continuous monitoring. Have your next contraction and then, if you're ready, we can have a little chat about it. And so just giving like an almost office consent for the conversation yeah, yeah, okay, yeah, exactly Before you kind of launch into something and know that they haven't had a chance to kind of actually prepare their mind for that conversation is very, very, I think, a very good way of engaging it in the first place and then, if it is something that's quite clear in the birth preferences and is only being offered because it is routine, then it might be a question of going.

Megan: 30:23

Do we actually need to ask this question? Or you know, it's been four hours since the last vaginal examination. Everything's completely fine. She's written very clearly in her birth preferences that she doesn't want vaginal examinations and less a clinical need arises. Do we really need to be having a full on conversation now about the pros and cons of vaginal examinations? If it's actually X, y and Z has happened and there are now complexities and now things are looking different and it might give us some helpful information, then maybe that is a good time to engage in it. But actually otherwise, is it a necessary conversation? Or is it one that you can kind of look through the birth preferences? Or even if it's just a quick, it says in your birth preferences that you don't want vaginal examinations. Are you still happy with that or do you want me to talk you through them? A very kind of quick question yeah.

Florence: 31:14

Yeah, okay, that's really helpful. I mean, I do a lot of that on the wall, dr. I'm kind of we're having a conversation pause for contraction, tell me when you're ready and we'll restart it, so that that makes complete sense. I always find the talking to somebody else the birth partner or the do-love I always find that a bit weird. But you just explain that quite nicely that they're an intermediary, as someone that the woman trusts and their sort of heads up so she can get her head in the game.

Megan: 31:52

Yeah, because they're never going to be able to make sense to me, because otherwise it just feels weird.

Florence: 31:58

Sorry, we're all in the room, or maybe I've stepped outside the room and got the partner outside, if it's sort of specifies that, and then it's a bit like I'm going to talk about you to your partner so I don't interrupt you. But so that's really helpful how you've just described that actually.

Megan: 32:16

Yeah, because they're never. They're never going to be able to give consent on somebody else's behalf and you're never going to be able to know that you have passed on the message in the way that you want it to be communicated, unless you speak to them directly. But sometimes, particularly when people are feeling very anxious about intervention or the way that conversations are happening, even if it is a case of and it will obviously depend on the urgency of the situation but sometimes being spoken to by somebody that you know, that you have a relationship, that you trust, that already knows how you are likely to respond to the conversation, so is it going to make you feel very uncomfortable, very scared, very you're going to feel happy with it. Is it going to make you feel really allowed to swear? Is it going to make you feel really pissed off? Those kinds of conversations? If that came from a doula that you had a relationship with, or your partner, let's say, you had an instrumental birth in your first birth. It was your second birth and something had come up that meant the conversation was going to happen again. Your midwife was there, you were in labor, you have been pushing for a really long time. There wasn't really any kind of obvious signs of progress.

Megan: 33:31

But sometimes happens in that situation is they either press a button or they go out and say we're just going to get the doctor and they're just going to come in. Unless you understand the maternity system, you have no idea what that means. But actually, if there was a heads up to a partner, we're going to have a doctor. They may want to have a conversation about assisting the birth with the use of instruments, and if that then is partners head to head, look, megan, they're going to have a conversation about potentially helping baby out. The doctor's going to come in and this is what they're going to talk about. Let's take a couple of deep breaths, calm ourselves down and then we'll be ready to engage in that conversation. That can be like, really transformationally different to and you know, it's not always you that walks in the room, florence, it's sometimes it isn't somebody that really has that maybe kind of gentle bedside manner. It can be somebody that walks in Okay, we're just going to give baby a bit of help. Whoa, whoa, whoa, whoa, whoa.

Megan: 34:22

That, for somebody that has had a previous difficult experience, is potentially going to be contributing to trauma, making it very difficult to say no, put you in that foreign position where you're like, okay, just do whatever you want, and it really, for some people, gives them back a kind of element of control. And I think, when we're talking about almost like trauma, informed care as well is, if somebody has come to hit new birthing or is writing a birth plan that is incredibly detailed Generally, if it's because they've had a traumatic birth the first time, that is what they're asking for, is they are really really asking for absolutely everything to be explained, absolutely nothing to happen without very kind of considered informed consent for them to feel as safe as possible. And if that request is there because it's making them feel safe, we need to find a way to respect it, in the same way that if somebody had come in and part of their religious practice or their culture was at, the first voice they heard was the voice of their father. The way that we should be respecting that in birth we should also be respecting. I don't want conversation in the room or I would like initial conversations to go to my partner.

Megan: 35:39

When we start to look at it almost as like a cultural decision or a decision that is based upon somebody's personal values, then it sometimes starts to make it a little bit easier to respect and less of a kind of imposition on the maternity system as it exists. They're not just saying it to be annoying, even though it does make things sometimes a little bit more tricky when we dig a little bit deep and we go why? Why would they not want to speak to me when they're in Labour? Because you know, in an ideal world you would only have people in that space and midwife that you knew, a doctor that you had met before, and if that is what it looked like, most people wouldn't care at all if a midwife that they knew, that they had known the whole way through their pregnancy, came up to them and said I came again.

Megan: 36:27

Remember we talked about this during pregnancy. This situation's come up, so now we might want to consider it whatever. That is completely different to a stranger walking in the room and launching into a conversation and say part of the decisions that people sometimes choose with hypno birthing is in direct response to the way that the maternity system runs and what it looks like, rather than actually anything to do with the birth itself or their preferences itself. It's actually caveating or buffering. What the maternity system can't provide in its current state is okay. Well then, what can we do to make sure I still feel really protected? But after all of that conversation, I don't know that many people that would actually be that opposed if you just very gently went and spoke to them about something that was completely essential to talk about.

Florence: 37:22

No, that's really helpful and I definitely see it. With some postnatal debriefs. People have said I was in the zone, I was doing this and then, bam, the doctor came in. Why did the doctor come in and offer me an assisted birth? And I've explained. Well, you know, there's some guidance on the timing and it may be the midwife in charge asked them to go in the room or you know, but it shouldn't have been that. It was unexpected. Yeah, it should have been that you knew they were coming and you knew why they were coming and what they were coming for and whatever. So, yeah, I definitely agree with what you're saying there and it can be something is a big surprise.

Florence: 38:07

Yeah, and it is about that fit between the system and the individual, isn't it?

Megan: 38:14

And that relationship building like, yes, ideally it would be for everybody, continuity of care throughout pregnancy and then in labor, but it's not for 99% of people. But that relationship building does happen if you've been in labor for a while and you've had a midwife for that entire time. That midwives are fantastic at building those relationships very, very quickly. So it can be that that just comes from them initially, because you're like hang on, I know you. I try, I don't know you. You are dangerous to me right now. You know this is our evolutionary responses. Who are you danger? Don't know you. You've been here a while, you're all right. I want to hear it from you. I will trust you, you're the person I want to talk to. Yeah, and those things stick with you forever.

Megan: 38:56

I really vividly remember in my first birth the midwife said and because I had worked in the maternity system by this point I knew what it meant but she said we're just going to call the doctors in because you might need a little bit of help. Now I know that that meant a doctor was coming in to see if they needed to do an instrumental birth. If I didn't hadn't worked on a labor ward before, I would have absolutely no idea what that meant. So then if a doctor walked in and was like, okay, yeah, we're going to do four steps, what? What?

Megan: 39:28

That's the fact that everyone else in the room thinks it's already been mentioned, but to the person giving birth, that is brand new information. So it can literally be as simple as Megan baby's heart rate's dropping a little bit. It might be that they need assistance with instruments to be born. I mean to call a doctor in to come and have a conversation with you about what that plan might or might not look like. It can be as simple as that, but coming from somebody that you trust is different to someone that's bold in and happening in that kind of gentle, preemptive way. Yeah, as you said, it stops it being a surprise, because that's not fun to the price Amazing.

Florence: 40:06

So another question that I wanted to ask you is a little bit about the sort of dreaded F word of failure in inverted commas. So sometimes women who may have prepared beautifully they're going to hit no birth and then, for whatever reason, the way the labor's going or they're having an induction or something else happens, they decide actually I'm going to have an epidural. And sometimes I think possibly not within themselves, but maybe when you see social media posts and things afterwards well, I meant to hit no birth, but I ended up with an epidural. Or, I'm sorry to say, sometimes I hear staff going well, she was going to hit my birth, but now, look, she's got everything. So how do you, the couples that you're seeing, or the families you're seeing, how do you prepare them? Because they may never have been through labor before, they don't know what it's going to be like, that if that's what they need in that moment, that that is okay and they can still use that toolkit you've given them and it's not a negative thing.

Megan: 41:39

So I think there's sort of three points that I would want to make it so first of all just goes back to that kind of the fact that hit no birthing is unregulated. So I am extremely careful in the way that I talk about hit no birthing, in the way that I talk about the ways that you might give birth to your baby and the decisions that you might make along the way to not put a certain type of birth on a pedestal. And that came from having sort of joined when I created the kind of birthed version of hit no birthing. I had done a slightly more traditional hit no birthing course which I do feel in a lot of ways put an unmedicated home birth on a pedestal, as, like this is the aim, and then I think it's fine. It's fine but it's not the best. It's not the best thing for you and for your baby. So I saw that and then saw the kind of slightly more traditional form of anti natal education which was either just a list of pain relief or was almost sort of grooming people to just comply with whatever was being recommended and not giving them that agency and autonomy in the decisions that they were making. And I very much felt that there was something in the middle that was missing, because that agency and autonomy and trust that hit no birthing teachers is so important, even if that leads you to go.

Megan: 43:06

Actually, I really, really want the plan to zarean. Can you all stop telling me to do something else? This is what I want to do. This is what feels best for me and my baby. You need confidence and you need self trust to be able to make that decision. And but on the flip side, that if people were either making those choices or there were genuine medical complexities in their pregnancy, that meant an induction was the right thing to do, or labor had been long or particularly painful, or they just wanted an epidural. Those are also choices that you are making and there are no wrong choices. As long as the choices are yours, the person that is in labor, as long as those choices are down to you and you're not being forced or coerced or pushed into doing something that you don't want to do, it doesn't matter what those decisions are. So in the course that I teach, I very much actually specifically talk through you've got an epidural.

Megan: 44:03

How to use hypno birthing. You're having an induction. How to use hypno birthing. You're planning a cesarean, how to use hypno birthing and actually just really making it blatantly obvious how hypno birthing fits into those situations.

Megan: 44:15

Now I think one thing that and you didn't actually mention this, but I do wonder if it ever comes up in your debriefs and you're maybe being a little bit kind because I teach hypno birthing but I do think we have to be very careful teaching hypno birthing because I think when it is taught wrongly, or if it is taught that there is a certain better, correct way to do it, or that it sort of semi guarantees something that, rather than reducing trauma in birth, it can be something that contributes to trauma in birth. If somebody felt like they were promised the world and they didn't get the world, they had something that was really particularly hard, particularly difficult, particularly clinically hard, then if you spend your whole pregnancy just going like I was made for this, my body was made to give birth and then it didn't go the way that you expected, that's a whole nother layer to unpick that can be contributing to trauma, which is why I think we have to be very careful about the way that we are sharing this information and that for me, forms a really big responsibility in the way that I teach hypno birthing and the way that I share it, and I know that that isn't necessarily an approach that is taken into account across the board of hypno birthing. And then the final thing that you mentioned about either from kind of staff thinking that you were supposed to do it a certain way, is there is almost like a big misinterpretation that hypno birthing is something that you do, like it is an active thing that you do in labour. Now hypno birthing to me is an approach to birth preparation. That's kind of it, and there are tools and techniques that you might use in labour but you might not use them in labour. So we have guided relaxations, we have breathing techniques, there are massage techniques. I present it more as like a toolbox of techniques for you to kind of pick and choose what you need, what you want in the moment when you're giving birth, and some people will literally labour starts. They'll put headphones on, they'll play affirmations or guided relaxations or something on a loop until their baby has been born and it might very much look from the outside like they have been hypno birthing. I would say they've been using relaxation techniques, they have been using breathing techniques. Equally you could have done hypno birthing preparation and in labour, not listen to a guided relaxation.

Megan: 46:44

Once In my second birth I didn't listen to a single guided relaxation. I didn't want to, I didn't need to. It is more about the kind of changing the subconscious mind and giving you those tools and techniques. It's not something that you actively have to do when you're in labour, because you've kind of already done it, if that makes sense, and because it's not something that you do. It's therefore impossible to do it wrong because it's not something that you do or don't do. It's a journey, a way of reaching the point of birth and approach to birth, rather than a kind of tick box. The whole of hypno birthing is trying to move away from like a tick. It's not a checklist of stuff that you have to have completed by the time the baby is born. It is a kind of holistic programme of education.

Florence: 47:32

That makes so much sense. Thank you, I feel like that's been a really good conversation and I'm conscious I don't want to use up too much of your time, so I'm going to ask you what do you think should be our zesty bit for the kind of take home message and there may be two. Maybe there's one for maternity staff and one for pregnant women, families listening what's the kind of bit you'd like people to remember from our conversation today?

Megan: 48:09

I don't know if it's whether to remember or whether I'm just going to add in a little tiny bit extra. So, from a kind of maternity staff perspective, one of the first conversations that we have with families in hypno birthing and I suppose actually this can go for staff and for anybody that's about to have a baby is understanding the link between your mind and your body and understanding how your subconscious mind works. And one of the very, very early conversations we have is around the use of language, and this is something that is just massively overlooked in the entire maternity system is the impact. The main tool of hypno therapy is literally the use of words, the way that words impact your subconscious mind and in the maternity system. We have a specific language that you use in the maternity system that isn't necessarily used or is interpreted differently by people accessing the maternity system, and there are particular phrases that you want to be aware of when you are looking after women, who are not just people that are using hypno birthing but literally anybody that is having a baby Phrases like the word only, words like have to, words like allowed to, and thinking of what it is that somebody is hearing.

Megan: 49:28

If you say somebody is only three centimetres dilated, whilst the factual information that you're passing on I mean we could talk about vaginal examinations a different day completely irrelevant. But the word only to you as somebody that is potentially doing an examination, is only because it's the lower part of the measure that you're using. When you hear it, what you are hearing is you're not doing very well, you've got a really, really long way to go. If it hurts this much now, how on earth are you going to keep going? That's what you hear through the use of one word. Switch it to already or just eliminate the word complete. You're doing so well, you're already three centimetres dilated. What do you hear? You go, okay, I'm doing so well, that's good, I've already done this much.

Megan: 50:12

And what that does to the subconscious mind then impacts what is happening physiologically. So it's about that connection between the mind and then the body. So if the mind has gone, ah no, can't do it. We tense up, things get more painful, things stall, they slow down, we feel supported, we feel safe, we feel relaxed. Then, actually, things are then more likely to go as expected and unfold more quickly, more comfortably, and they feel like really, really, really tiny changes to make. But they are also really, really, really easy changes to make.

Megan: 50:46

Losing the word. Only you have to move to the late award. Now, that's different to we would recommend, we would suggest. Shall we chat about what that does? The person giving birth may well do exactly what is being suggested, but that takes the power away from you and puts the power onto them. It gives them back that agency and autonomy and so much of the and you'll know this through you're supporting of kind of people postnatally. So much of how we experience birth isn't actually what has happened on a physical level, but it is how we were made to feel.

Megan: 51:26

So, having an induction of labor where you were given a date, you were told you have to come in and your baby has to be born by induction. You've got gestational diabetes, so we've booked your induction for this day. You've got to do this, that and the other, and that's it. That is a very, very different conversation too. We'd recommend an induction of labor. This is the reason that we are recommending it. It's completely up to you whether or not you decide to have it. You can go where you can think about it. Let us know your plan If that person goes away and decides they want to have an induction of labor.

Megan: 52:00

Those two people going into birth are going into birth from a very, very different place. One is feeling like they have handed themselves over, that it is being done to them and they are not a part of it. The other is going and feeling like the most important person in that space, which is exactly what they should be feeling like when they go into birth. So, being very, very aware of the language that you're using and the way that somebody might be hearing it, that's the key question is yes, this is what I've said, but what have they heard? And actually clarifying with them. If you're not sure, ask them to say it back to you will give you a good idea of if what you are saying has actually been heard in the way that you think you have communicated it.

Megan: 52:40

And similarly, for anybody that's about to have a baby, if you're feeling like you're hearing these words, hearing these language, a really, really helpful way to almost reframe it is to repeat it back to somebody and change the word. So it's never coming from an unkind place, somebody saying only three centimeters dilated. They are not deciding that they're going to derail the rest of your birth. That's not the intention behind it. It's come from a place where they've never had this conversation, never considered.

Megan: 53:10

What does that actually feel like? To be told that sentence? Could I say that sentence, could I pass on that information in a way that makes you feel better? And then, when we start to look at it from that perspective so if you hear it, if you hear, or particularly if you're a partner, maybe, and somebody has said you're only three centimeters dilated, I always say to any birth partners that I'm helping prepare, repeat it back. So did you hear? They said you're already three centimeters dilated, and what that kind of just does is very gently but pointedly marks the shifting language that needs to take place, and sometimes that's enough for somebody to go oh, yeah, yeah, see, already, already, and it can be a nicer conversation. I love that tip.

Florence: 53:50

That is brilliant. Zesty there To repeat it back, but change the language.

Megan: 53:54

I like that and you can do that as staff, as well, yeah, if you're a midwife in the room and an obstetrician's done an examination and it's come out as well, there are only two centimeters dilated. And it's said to the midwife across the room, then repeat it back. Who am I talking to? Am I talking about somebody in front of them? Actually, they've said that even as a student, that's. You know, sometimes there there's a. It feels sometimes like there's a hierarchy in that space and if you're somebody that feels like smaller in that room which nobody should do in that space, but sometimes you do If you're a student midwife and there's somebody you know, coordinators walked in and said they're only two centimeters dilated. We need to get this going. Looking at the person in labor and going, did you hear? You're already two centimeters dilated. You're doing such a good job. It's a really, really sneaky shift of power back to the person that's giving birth.

Florence: 54:44

No, that is great. I really like that. I think that is totally brilliant and a good place to leave it. So thank you very, very much. It's been a fascinating conversation and I really hope people are going to enjoy it and look you up on the BirthEd podcast and you've got a website too, haven't you?

Megan: 55:05

Yeah, wwwbirth-edcdcouk.

Florence: 55:11

Fantastic and I will put a link in the show notes. Thank you very much. Thank you for having me. I very much hope you found this episode of the Obspod interesting. If you have, it'd be fantastic If you could subscribe, rate and review, on whatever platform you find your podcasts, as well as recommending the Obspod to anyone you think might find it interesting. There's also tons of episodes to explore in my back catalog from clinical topics, my career and journey as an obstetrician and life in the NHS more generally.

Florence: 55:52

I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary.

Florence: 56:16

If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes, where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at the Obspod, on Twitter and Instagram, and you can email me theobspodcom. Finally, it's very important to me to keep the Obspod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free via my link. To buy me a coffee, don't feel under any obligation, but if you'd like to contribute you now can. Thank you for listening.

Megan: 57:36

I'll see you in the next episode.