Introducing Hypnobirthing Courses across Gloucestershire in order to reduce anxiety of and increase preparedness for birth

Qualiy Improvement Poster Download

Background & Problem

NHS resources are more strapped than ever and nationally women are often receiving poor antenatal education and in particular very little support for their emotional well-being. As a result women are turning to other providers to help them prepare both physically and emotionally for birth.

As part of a wider project – Improving the Quality and Accessibility of Antenatal Education in Gloucestershire - sponsored through Better Births - we have looked at the current provision of antenatal education within Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) and we surveyed women on their views of this service. We discovered that the quality varied across Gloucestershire, with each locality offering a different level of service.

When asked for their views, 60% of Gloucestershire women asked for a hypnobirthing or breathing and relaxation class to support them in their preparation for birth. Hypnobirthing has been becoming increasing popular over the last few years, with research showing that women who are frightened of giving birth have longer labours and are more likely to need intervention (27/06/2012, British Journal of Obstetrics and Gynaecology). It is estimated that 1 in 5 women have severe fear of birth. Hypnobirthing services are currently being run successfully in a multitude of trusts across the country.

Aim

To introduce Hypnobirthing across Gloucestershire by March 2019 in order to reduce anxiety and improve preparedness for birth.

Method

- Survey of women and midwives’ views:

•  270 new mothers completed an on-line survey on their experience of antenatal education and what they would like from NHS antenatal education.
•  We asked all the community midwifery teams to complete a questionnaire outlining what they currently provide for pregnant women in their area.
•  We asked the midwives what their view of ‘outstanding’ antenatal education looked like.

- Workshops: group facilitation skills were taught to the community midwives.

- Business plan: with a clear demand from women for hypnobirthing classes and enthusiasm from midwives to provide them we developed a business plan to run courses at GHNHSFT.

- Training: 23 midwives were trained in facilitating hypnobirthing courses.

- PILOT (PDSA) - 3 hypnobirthing courses – 1 in each hub – were advertised, set up and run March-May 2019.

Evaluation:

Couples were asked prior to the course starting and at the end of the course about their anxiety levels and preparedness (in terms of knowledge levels) for labour and birth. They will also be contacted following giving birth to see if they used the hypnobirthing techniques they were taught.

The measures used were:

• Level of anxiety when thinking about labour and birth.
• Level of knowledge for labour and birth.
• Level of positive attitude towards labour and birth.
• If couples used Hypnobirthing during labour and birth.
• How useful women & birth partners found the Hypnobirthing techniques during labour and birth.
• How supported did the woman and her birth partner feel by the staff to use the hypnobirthing techniques during labour/birth

The woman and her birth partner were asked to give their answers on a scale of 1-10.

Results

• 60% of women wanted hypnobirthing or breathing and relaxation classes
• Midwives were keen to teach more classes including hypnobirthing courses and learn some new facilitation techniques to better support women and their partners.
• 3 Hypnobirthing courses have been run – all fully booked – one in March in Stroud, April in Cheltenham and May in GRH.
• Levels of anxiety when thinking about labour and birth reduced from 7 to 3.
• Levels of preparedness (in terms of knowledge)for labour & birth increased from 5 to 8
• One woman has given birth – she and her birth partner used the hypnobirthing techniques they learnt and found them helpful, but did not feel fully supported by the staff caring for them during labour to use them.

"I really enjoyed the course and it has made me feel at ease and very calm about the birth"

"I have learnt so much more this time round (10 year gap) & feel more confident about my ability and birth options. Also feel like a team with my partner, not just me doing everything"

Implications

• It has been a huge learning curve and an immense amount of work setting up a new service from scratch including learning about: writing business plans/VCP/procurement process/financial systems, but it has been worth it. We will continue running the hypnobirthing courses monthly growing with the demand. June & July courses are fully booked and we are putting on an extra course in July.
• As the service grows we hope to roll it out to the rural areas – there will be additional costs from venue hire in these areas.
• We plan to run subsidised specialist courses for women who have had a previous pregnancy loss/still birth or neonatal death
• We plan to run workshops for staff (midwives, doctors, MCA’s, theatre staff) to help them feel confident in supporting women who are choosing to hypnobirth in labour & birth.
• Admin support is required for the service to be sustained. Bookings and enquiries are currently being handled by the project leads.
• The hypnobirthing service is self-sustainable as the cost of the courses pays for the midwives’ time to run the courses, the admin support and equipment needed for the service including promotional materials, CD players/blue tooth speakers etc.…
• Currently the staff are paid on bank and as the service grows the roles need to be made substantive.