Childbirth Education: Comparative Analysis

3.3.1 The school of hypnosis and autosuggestion

The schools of Charcot (Paris) and Berhein (Nancy) investigated clinical hypnosis [17, 18, 19]. In 1922 the obstetricians Schultze and Rhonhof proved that the introduction of educational sessions before childbirth reduced the time needed to achieve a hypnotic state. In 1923, Kogerer used post-hypnotic self-suggestion [20, 21]. These two techniques posed some difficulties so new methods were sought to relieve pain during labor [22].

3.3.2 The English school

In 1932, the obstetrician Grantly Dick Read published “Natural Childbirth.” He viewed childbirth as a physiological phenomenon in which pain is created by fear which unleashes the defense mechanisms in the form of muscular tension. He formulated the Fear-Tension-Pain concept and developed a method featuring explanatory conversations, relaxation, breathing techniques and strategies that enhance trust in the healthcare team. He did not rate gymnastic exercises and warned against any muscle training. This concept has been disseminated worldwide and has undergone many changes [23, 24].

3.3.3 The Russian school

At the same time, Drs. Velvoski, Platinov and Nikolaiev, who were working with hypnotic suggestion, were looking for new approaches (Obstetric Psychoprophylaxis) [25]. In accordance with Pavlov’s Classical Conditioning Theory, they concluded that pain in labor is a reaction conditioned by sociological and religious-cultural stimuli. They suggested de-conditioning the fear through aseptic language, relaxation (Schultze), positive thinking, the celebration of maternity and obstetric information [26]. To get the woman actively involved, they introduced breathing and muscle exercises [17, 27]. They came up with a simple and accessible method which encouraged its spread throughout Russia, Eastern Europe and China.

3.3.4 The French school

Dr. Lamaze (1940) learned from the Russian school and was familiar with the English school. He created a more technical method that insisted on the need for a loving environment with the presence of a partner. His partner, Dr. Vellay, insisted on the therapeutic power of speech and the active role of the woman [28]. Later, in his book “Birth Without Violence” (1975), Leboyer popularized the creation of an environment of tranquility in the labor room and the submersion of newborns in a small bath of warm water; he is thus regarded as the precursor of water births [29].

3.3.5 The Spanish school

In 1955, the midwife Consuelo Ruiz presented her book “Labour Without Pain” featuring the new tendencies [30]. In 1956, Aguirre de Cárcer founded the school of “Obstetric Sophropedagogy or Maternal Education” and gave a substantial change from the focus of pain during labor for that of achieving a new sociocultural standard whereby both the woman and her partner would acquire the necessary knowledge to face labor with serenity, having diminished their fears, and experience this transcendental moment in their lives with full consciousness and satisfaction, as this experience will impact on the child by encouraging the development of the “Emotional Network” [31]. In 1959, the Compulsory Health Insurance entrusted her with a program and in 1986 Maternal Education was included in the service portfolio of the National Health System. This helped with its dissemination and facilitated significant further development [32].

3.4.1 International childbirth educators’ association

In 1960 the International Childbirth Educators’ Association (ICEA) was founded, which further evolved the Lamaze method. It is a non-profit organization that promotes freedom of choice for women and their partners based on the informed knowledge of childbirth options. Its orientation is centered on maternity care and the care of the newborn by the family. It respects the individuality of the woman and her sense of autonomy [28, 34, 35].

3.4.2 Husband-coached childbirth

In 1965, Robert Bradley, in his book “Husband-Coached Childbirth,” claimed that the partner is the person who should ensure that the woman is in a safe, quiet environment and who should know her well enough to be able to help her in this process. He empowers fathers to ‘coach’ their partners with instructions, relaxation techniques and massages [36]. He was the pioneer of ‘father training’ (American Academy of Husband-Coached Childbirth).

3.4.3 Mindfulness-based childbirth and parenting

In 1970, Kabat-Zinn developed the Mindfulness-Based Childbirth and Parenting (MBCP) method at the University of Massachusetts Medical School, based on Mindfulness-Based Stress Reduction. This method emphasises the development of the conscience at a precise moment through meditation. The results indicate that this helps to reduce pregnancy-related depression and anxiety [37, 38]. It is also giving rise to new models such as “Centering Pregnancy®.”

3.4.4 Birth your way

In the 1970s, Sheila Kitzinger reinstated the wisdom of a woman’s body in giving birth. The author of “Birth Your Way: Choosing Birth at Home or in a Birth Centre” proposes that women tune in to their contractions in the way they feel they achieve harmony and rhythm and acquire the knowledge to make their own decisions. The presence of the husband, the instructor and the midwife create a favorable environment for childbirth. Her partner, Janet Balaskas, created the Active Birth Movement and proposed the practice of yoga adapted to pregnancy [39].

3.4.5 Haptonomy

In the Netherlands, in the 70’s, a new approach to preparation for birth appeared: “Haptonomy,” which passed to France in 1978 by Frans Velman and later extended to Switzerland and Spain. Dr. Etienne Herbinet explains that haptonomic work is exercised on touch, on palpation in its affective aspect, on tactile contact as a means of communication. During preparation at birth the haptonomic approach can help future parents to have a more emotional perception of the baby to be born. Through touch they develop an active affective relationship between the mother, the father and the baby. The method helps to establish and develop a sense of paternity/maternity through affective contact with the baby [40].

In 1975, in the United States, the percentage of pregnant women who used this type of practice was higher than 6–7% according to the program carried out under the name of “Prepared Childbirth” assumed by the “American Society for Psychoprophilaxis in Obstetrics” (2010) [41].

3.4.6 Primal health research center

The French obstetrician, Michel Odent (1977) popularizes birth in water and founds the “Primal Health Research Center.” He guides his work to help each woman choose the way she will give birth following her own instincts and respecting at all times the physiological process of childbirth. Author of numerous books, he postulates that the emotional situation of the pregnant mother is determinant in the psychological and physical future of the individual, and also points out the temporal importance of childbirth and the subsequent moments on the development of the person. He highlights the role of birth hormones (oxytocins and endorphins) and provides numerous investigations [42].

3.4.7 Respiratory autogenic training and psychoprophylaxis in obstetrics

In Rome, in 1984, Umberto Piscicelli, professor at the Catholic University of Rome, publishes his book “Respiratory Autogenic Training and Psychoprophylaxis in Obstetrics.” His method is known as “Respiratory Autogenic Training” or R.A.T. It is inspired by Schultz’s autogenous breathing, the laws of conditioning, group psychotherapy, relaxation therapy and his deep knowledge of psychosomatic medicine. Its objective is the psychological therapy of pain through its connections with uterine contractions, but also the correction of negative psychic aspects and non-adaptive behaviors. For this, the woman is given maximum autonomy to be the protagonist of her birth and is prepared to act in an environment full of stimuli [43].

3.4.8 Waterbirth

In the US, Barbara Harper, is one of the great scholars and disseminators of childbirth in water around the world. She founded Waterbirth International in 1987 after visiting Russia for the first time and sitting with Igor Charkovsky, where she was “influenced by her faith in the parturients and their babies” [44]. She has also worked extensively with Binnie Dansby in the early 1980s on cognitive learning and repressed experiences and memories of birth. She is a nurse, midwife, doula and perinatal educator. She has been Founder and Director of the World Association for Maternal and Child Health, and Founder and Director of Waterbirth International. She is recognized worldwide as an expert researcher and author of protocols for delivery in water since 1983 and responsible for the opening of and instituting policies for delivery in water in 140 hospitals in the United States.

3.4.9 HypnoBirthing

In 1990 Marie Mickey developed the Mongan Method, known as HypnoBirthing. Based on the premise that all women have within them the power to call on their natural instincts to achieve the best birth for their baby and for themselves, it works with mothers and families on birth expectations and taking a positive approach to the experience. It puts a lot of emphasis on language, breathing, relaxation, visualization and self-hypnosis and it highlights the fact that childbirth does not have to be painful [45].

3.4.10 Intrauterine harmonization

In 1992 a new method or program appears based on the affective bond with the baby: “intrauterine harmonization.” Dr. Thomas Verny and Pamele Weintraub prepare parents with music, deep relaxation, visualization and massage. They strengthen the bond between parents and children through dream induction, guided work with images, drawings, lullabies and words addressed to the child. The conflicts that future motherhood can arouse in parents are solved by examining their own childhood and positive thinking techniques [46].

3.4.11 Birthing from within

In 1998, Pam England and Rob Horowitz devised a holistic approach to the preparation for childbirth and the postpartum period, known as Birthing from Within. As well as information on childbirth and children’s upbringing, they also addressed introspection and self-discovery from the perspective of the woman’s own internal experience [47].

3.4.12 Awareness of welcome

In 2004, Dr. Wendy Anne McCarty, co-founder of the Masters and Doctorate programs of “Santa Barbara Graduate Institute” in Prenatal and Perinatal Psychology, reviewed 30 years of clinical research in this field. Her book, “Awareness of Welcome,” presents an integrated model of early development that was a reflection of the clinical results found in her research of prenatal and perinatal psychology. The transcendental aspects of consciousness and human rights from the beginning of life become the central thread of this holistic model. It is an integrating model of early human experience, learning, development and care (from before conception to early childhood) that includes our sensitive nature and integrates several fields such as theories of infant development, new clinical investigations of babies that incorporate a conscious state, prenatal psychology and perinatal, paternity practices and some ideas that make up the new physics sciences. The author affirms that the most important thing is to reconstruct our sensitive spiritual nature as well as our fundamental nature of Sensitive Human Beings [48].