UK and Ireland Outcomes

Report on HypnoBirths® in the United Kingdom and Republic of Ireland 2005-2009

Sources

All data relates to 277 HypnoBirths® in the United Kingdom & Republic of Ireland between October 2005-January 2009. The data is derived from Birth Reports completed by the parents after the birth and returned to the HypnoBirthing® Institute. The total number of parents undertaking a HypnoBirthing® course during this time period is unknown so it is impossible to state what proportion of the total number taking the course have completed birth reports.

Comparative data for the UK is taken from Government health statistics (hospital episode statistics) for the year 2006-7 found online at http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=1009 except where otherwise stated.

Key Findings

  • Couples started learning HypnoBirthing® (HB) at an average of 29.4 weeks gestation. The proportion attending private classes (42%) was similar to the proportion attending group classes (46%).

  • The average HB baby weighed 7.76lbs and was born at 39.7 weeks gestation. There was a smaller proportion of low birth weight babies (<2500g) among HB mothers (4.3%) than nationally (7.1%).

  • While in the UK 4.3% of women birthed at 42 or more weeks of gestation, among HB mothers 11.9% birthed at 42 or more weeks suggesting that the HB mothers were more willing to wait until the baby was ready and more confident to negotiate this with care providers.

  • Though the majority of HB mothers (84%) gave birth in hospital, 12.9% of HB mothers gave birth at home compared with 2.7% of women in the UK.

  • In the UK 35% of births are delivered by hospital doctors. Among HB mothers 20% reported being under the care of an obstetrician and a further 3% in the care of a GP. Most births nationally and among HB mothers are attended by midwives.

  • The majority of HB mothers were satisfied with HB, their care providers and birth companion. The small proportion of women who were not satisfied with HB was similar to the proportion dissatisfied with either care provider or staff respectively; around 4%. 1.4% of HB mothers were not satisfied with their birth companions.

  • 13% of HB mothers were prevented from doing a desired activity by the hospital.

  • A third of HB mothers gave birth on their backs (though this includes a reclining position as well as supine).

  • 6% gave birth in water.

  • There were fewer inductions among women having HB births (2.3% of the 266 answering the question; 16.6% of total sample) than nationally (20.3%)

  • Among the 46 women known to be induced 37% was for being past their due date and 28% for ‘medical’ reasons.

  • 40% of HB mothers in the UK used HB only to manage their labour whereas 72% of HB mothers in the US did so.

  • Many more women in the UK used gas & air (37%) than in the US. This might reflect the higher availability of gas & air in the UK, the fact that it is carried by home birth midwives and an attitude that nitrous oxide is ‘just gas and air’ and not a medication leading more women to feel like trying it even if aiming for a birth free of interventions. It is worth noting that, according to Anaesthesia UK “N20 is a strong analgesic. 20% N20 is equivalent to 15 mg of subcutaneous morphine. The optimal analgesic concentration was found to be 70% but some mothers became unconscious. 50% N20 in oxygen is safer and has become standard.”

  • Around a quarter of HBs were artificially augmented

  • The caesarean birth rate amongst HB mothers (15.9%) was less then the national rate of 23.4%.

  • The main reasons for surgical birth among HB mothers was failure to progress (36%) and medical reasons pertaining to mother or baby (39%). Whilst the details of what is deemed to be failure to progress in each case are unknown, it is possible that this figure reflects a lack of patience on the part of care providers combined with mothers succumbing to others inducing a sense of panic that has led to them deviating from their birth plan.

  • 39% of HB mothers had other interventions such as continuous or internal monitoring, IV drips, instrumental deliveries, episiotomy or antibiotics.

  • The episiotomy rates in this sample were the same as nationally at around 13%.

  • The proportion of women having ventouse or forceps in this sample was greater than national rates.

  • The level of comfort experienced during labour, birthing and post-partum was variable with around 10% of women rating their comfort as 5 during the time the baby emerged.

  • Around 80% rated health of the baby as 4 or 5

  • Around 67% of mothers rated their own health as 4 or 5

  • Around 53% rated the ease of breastfeeding as 4 or 5

  • 78% of respondents were satisfied or very satisfied with HypnoBirthing®.

Details

Table 1. Birth Weight

Number answering question

273 (98.6%)

Minimum weight

4.06lbs

Maximum weight

11.3lbs

Average weight

7.76lbs

1 twin birth 2nd baby weight

6.8lbs





  • 4.3% of HB babies were low birth weight (<5.5lbs or 2500g) compared with 7.1% nationally

Table 2. Gestational Age at Birth

Number answering question

259 (93.5%)

Minimum gestation

32.5 weeks

Maximum gestation

45* weeks

Average gestation

39.7 weeks




* Although this could be an error (nearest maximum was 43 weeks) national data records births at 47 weeks so it is within the realms of possibility.

Table 3. Distribution of Gestational Age (weeks)


34

35

36

37

38

39

40

41

42

Unknown

HB

2 (0.7%)

6 (2.2%)

4 (1.4%)

15 (5.4%)

27 (9.7%)

47 (17.0%)

78 (28.2%)

47

(17.0%)

33 (11.9%)

18

(6.5%)

UK

4.4%

1.4%

2.6%

5.5

13.2%

21.6%

27.7%

19.0%

4.3%

46.6%


  • 4.3% of HB mothers known to have birthed before 37 weeks compared with 8.3% nationally.

  • More HB mothers are giving birth at or beyond 42 weeks gestations (11.9%) than nationally (4.3%)

 


Table 4. Number of weeks pregnant when started HypnoBirthing® classes.

Number answering question

203 (73.3%)

Minimum

14 wks

Maximum

39 wks

Average

29.4 wks


<20 wks

20-24 wks

25-29 wks

30-34 wks

35-39 wks

Unknown

5 (1.8%)

29 (10.5%)

47 (17.0%)

93 (33.6%)

28 (10.1)

75 (27.1%)


Table 5. Type of class attended

Number of private classes attended

115 (41.5%)

Number of group classes attended

127 (45.8%)

Unknown

35 (12.6%)

 


  • Number of couples in group classes varied from 2 to 11.

Table 6. Location of birth

Home

36 (12.9%)

Hospital

232 (83.8%)

Birth Centre

8 (2.9%)

Unknown

1 (0.4%)



Table 7. Care Provider

Obstetrician

55 (19.8%)

Family Doctor

8 (2.9%)

NHS Midwife*

159 (57.4%)

Independent midwife

29 (10.5%)

Unknown

40 (14.3%)

*have taken Certified Nurse Midwife (CNM) to mean NHS midwife

  • Percentages do not equal 100 as categories not mutually exclusive

  • nationally 35% of births in hospital are delivered by hospital doctors 2006-2007

 

Table 8. Birth Companions

Spouse

241 (87.0%)

Doula

15 (5.4%)

HBCE

13 (4.7%)

Other

17 (6.1%)

Unknown

34 (12.3%)

  • Percentages do not equal 100 as categories not mutually exclusive

Table 9. Duration of Labour

Number

219

Total Minimum

1 hr

Total Maximum

86 hrs

Total Average

16.8 hrs*


Average labour at hospital

9 hrs**

Average labour at home

12 hrs**

*This figure had a very wide standard deviation of 14.6 hrs meaning that the average has been skewed a lot by outliers so it doesn’t really tell us much.

** these figures also not particularly reliable due to difficulty stating when labour starts and inconsistencies in reporting (ie numbers not adding up!)

Table 10. Satisfaction

 

HypnoBirthing®

Care Provider

Staff

Birth Companion

Number

241 (87.0%)

234 (84.5%)

222 (80.1%)

222 (80.1%)

Average (scale 1-5)

4.45

4.44

4.40

4.8

Score 1 or 2 (unsatisfied)

11 (3.9%)

11 (3.9%)

12 (4.3%)

4 (1.4%)

Score 3

(Neither satisfied nor dissatisfied)

14 (5.1%)

15 (5.4%)

15 (5.4%)

5 (1.8%)

Score 4 or 5 (satisfied)

216 (77.8%)

208 (75.1%)

195 (70.4%)

213(76.9%)

Unknown

36 (13.0%)

43 (15.5%)

55 (19.9%)

55 (19.9%)


 

Table 11. Activity at hospital

Activity

Number

% of respondents answering these questions n=176

% of total respondents n=277

Eat

74

42.0%

26.7%

Drink

151

85.8%

54.5%

Ball

84

47.8%

30.3%

Walk

89

50.6%

32.1%

Tub

63

35.8%

22.7%

Desired activity not permitted by hospital

35

19.9%

12.6%

Didn’t answer any of these questions

101

N/A

36%


Table 12. Birth Position

Position

Number

% of respondents answering these questions n=188

% of total respondents n=277


Sit

22

11.7%

7.9%

Squat

17

9.0%

6.1%

Back (includes reclining)

92

48.9%

33.2%

Stand

9

4.8%

3.2%

Hands & Knees

37

19.7%

13.3%

Side

15

7.9%

5.4%

In water

16

8.5%

5.8%

Didn’t answer any of these questions

89


32.1%

 


  • Natural birth (no interventions or medication) n=78 (28.1%)

Table 13. Onset of Labour

 

Number

% of respondents answering these questions n=266

% of total respondents n=277


Spontaneous

220

82.7%

79.4%

Inductions

46

17.3%

16.6%

Unknown

17*


6.1%

* also includes 7 cases who said labour started spontaneously and that they had a membrane sweep

 

  • National figures show 20.3% of women having inductions while 16.6% of HB mothers were induced

Table 14. Inductions

Method

Number

% of induced n=46

% of total n-277

Oxytocin

25

54.3%

9.0%

Artificial Rupture of Membranes

15

32.6%

5.4%

Strip/Sweep

23

50.0%

8.3%

Cervical

19

41.3%

6.9%

Acupuncture

11

23.9%

4.0%

CO

1

2.2%

0.4%

Other

2

4.3%

0.7%


  • Some women had more than one method of induction

Table 15. Reasons for Induction

 

Number

% of induced n=46

% total n-277

Post dates

17

37.0%

6.1%

Ruptured membranes

2

4.3%

0.7%

Medical

13

28.3%

4.7%

Other

1

2.2%

0.4

Unknown

13

28.3%

4.7%


Table 16. Pain Relief

 

Number

% of total n=277

HypnoBirthing® only

111

40.1%

Epidural

65

23.5%

IM/IV

28

10.1%

Gas & Air

102

36.8%

Unknown

20

7.2%


Table 17. Augmentation

 

Number

% of augmentations

% of total

Oxytocin

59

73.8

21.3

Rupture of membranes

31

38.8

11.2

Natural

11

13.8

3.9

No augmentation

197


71.2

Number of augmentations =80. % don’t = 100 because some women had more than one method


Table 18. Other Interventions

 

Number

% of interventions n=109

% of total

n=277

IV

50

45.9

18.1

Antibiotics

32

29.1

11.6

Vacuum / ventouse

23

21.1

8.3

Forceps

19

17.4

6.9

Continuous external monitoring

61

56.0

22.0

Internal monitoring

18

16.5

6.5

Episiotomy

37

33.9

13.4

Caesarean birth

44

40.4

15.9


  • Of the 109 individuals who experienced other interventions, the most common were continuous external monitoring, IV drips and caesarean sections.

  • The UK caesarean birth rate is 24.3% and with a rate of 15.9% HB mothers are well below the national rate. The caesarean birth rate in the Republic of Ireland was 17.8% in 1998 which are the most recent figures found (The Caesarean section rate in the Republic of Ireland in 1998. Farah, Geary, Connolly & McKenna. Irish Medical Journal  2003, vol. 96, no8, pp. 242-243) 

  • The UK national statistics give rates of 13% for episiotomy, 7.0% for ventouse and 4.6% for forceps. HB rates are the same for episiotomy and higher for ventouse and forceps

 

Table 19. Reasons for c-section (n=44)

 

Number

% of caesareans

% of total

Foetal distress

11

25.0

4.0

Failure to progress

16

36.4

5.8

Malposition

8

18.2

2.9

Breech

11

25.0

4.0

Dates

0

0.0

0.0

Medical

17

38.6

61.4


Table 20. Comfort in labour

Score

1

2

3

4

5

Unknown

Early

10 (3.6%)

25 (9.0%)

51 (18.4%)

76 (27.4%)

69 (24.9%)

46 (16.6%)

Late

35 (12.6%)

39 (14.1%)

63 (22.7%)

60 (21.7%)

21 (7.9%)

59 (21.3%)

Birth

37 (13.4%)

46 (16.6%)

52 (18.8%)

52(18.8%)

27 (9.7%)

63 (22.7%)

48hrs postpartum

20 (7.2%)

11 (3.9%)

28 (10.1%)

78 (28.2%)

94 (33.9%)

46 (16.6%)


Table 21. Health of mother & baby and ease of breastfeeding

Score

1

2

3

4

5

Unknown

Health Baby

3 (1.1%)

3 (1.1%)

8 (2.9%)

27 (9.7%)

195 (70.4%)

41 (14.8%)

Health Mum

6 (2.2%)

15 (5.4%)

27 (9.7%)

36 (13.0%)

150 (54.2%)

43 (15.5%)

Ease breastfeeding

28 (10.1%)

22 (7.9%)

33 (11.9%)

59 (21.3%)

89 (32.1%)

45