BETHESDA, Md.
My parents definitely thought I was a bit crazy when I mentioned a hypnobirth," Adrienne Pratt said. Ms. Pratt, eight months pregnant, and her husband, Armando Guato, gathered with two other expectant couples on Easter Sunday afternoon to learn a newly popular technique for helping women remain serene during childbirth.
For many, the word "hypnosis" conjures up an image of a swinging pendant lulling a hapless woman into a trance. But hypnobirth is not about inducing a trance; it is a combination of relaxation, breathing and visualization techniques to control labor and birthing pain, said Linette Landa, the hypnobirth teacher.
Slow, smooth breathing counteracts what Ms. Landa called "the fear-tension-pain syndrome," the notion that women fear birth, so their muscles tense up, resulting in pain.
"We're all about the subconscious mind," said Ms. Landa, a tall, tranquil woman who teaches yoga. "The conscious mind is out of the picture."
Move over, Lamaze. Today, many women are reaching out to a variety of other drug-free childbirth alternatives, including aromatherapy and birthing pools, according to experts on gynecology and obstetrics.
They are inspired by Web sites like Urbanbaby.com, reality birth television shows like "House of Babies" on the Discovery Health Channel and celebrities like Angelina Jolie, whose sojourn with Brad Pitt in Namibia spurred speculation that they would have their baby using water birthing. Tom Cruise caused a stir when he said Katie Holmes would give birth in silence. (He later explained that she could make noise, but that others had to be quiet for a calm delivery of their baby, a girl, born on April 18.)
While "silent birth" raised eyebrows, even the more widely practiced hypnobirth, with more than 2,000 instructors nationwide, still draws its share of skepticism.
"When you hear 'hypno,' you think weird, hippy, earthy type stuff," said Kelly Yeiser, 31, of Ashville, N.C., who had her first baby last August using the technique. "But it's really more about meditation and getting yourself into a calm, relaxed state."
Byron Bailey, a government worker in Washington who attended the hypnobirth class with his wife, Jaylin, said, "The idea of someone swinging a pendant Ñ that's the sideshow aspect." The couple are expecting their first child in May.
The women attending the class said a big appeal of hypnobirth is that it builds confidence. Mothers-to-be complain that people are quick to share their worst childbirth stories, in excruciating detail, at the first sight of someone else's pregnancy, feeding worries about labor and delivery.
Ms. Pratt, 36, a project specialist with the Inter-American Development Bank, in Washington, said hypnobirth helps banish such fears because it focuses on the positive.
She was practicing its deep, distinctive breathing Ñ no Lamaze-style panting. The mother "breathes the baby down" and out instead of pushing, according to the tenets of HypnoBirthing. (The name was trademarked in 2000.) During sessions over several weeks, and daily home exercises, the mother also practices visualizing the baby easily descending and leaving her body so often that the image becomes imprinted in her mind; a CD is available for practice and for last-minute guidance. A birthing companion Ñ husband or midwife Ñ tries to keep the mother in a positive, totally relaxed state of mind.
HypnoBirthing mothers even use a different vocabulary. For example, a contraction is a uterine surge or wave, pushing is birth breathing, and false labor is practice labor.
Getting used to all this takes practice, admitted Jennifer Stanton-Brand, 38, who was attending the class with her husband, Stephan, a sales manager in Baltimore. They are expecting their first child next month.
Ms. Stanton-Brand has not yet developed a routine that is second nature, as the method recommends, but said the exercises "have helped me become more inward."
"When something gets tense, I breathe and go inward to a place I can control," she said.
Obstetricians interviewed said that expectant mothers are more focused on finding new ways to reduce, or even eliminate, labor and birth pain.
At one end of the spectrum, women are opting for Caesareans in record numbers. According to the National Center for Health Statistics, the combined percentage of women who had C-sections or used drugs to induce labor was about half of the 4.1 million childbirths in 2004.
Of the remaining women, many fear that drugs will hurt their newborns and want a way to avoid them as well as to control the pain.
Some of the alternatives they are selecting include water birthing, in which the woman immerses herself in a tub or pool to reduce labor discomfort, and sometimes for the birth. Another technique is for the woman to change positions so she is not always lying down, but is sitting on a giant ball, for example. Some women have acupuncture, and others use aromatherapy to create a soothing environment.
The trend is toward nonmedical methods, said Dr. William Camann, associate professor at Brigham and Women's Hospital in Boston and co-author of the recently released "Easy Labor, Every Woman's Guide to Choosing Less Pain and More Joy During Childbirth" (Random House).
Once, he said, "there was no overlap, and there tended to be animosity and distrust" between those who espoused natural childbirth and advocates of medical procedures. But that has changed, he added, because women are researching alternatives and finding them on the Internet.
Hospitals today are also more accepting of a woman's desire to be in control during labor and delivery, Dr. Camann said. "There's been a gradual trend toward acceptance of alternative methods, even though five years ago, asking for a hypnobirth was almost unheard of. Now it's much more common."
SO, does it work? In 2004, The British Journal of Anesthesia said studies involving 8,000 women found that those who used hypnosis techniques during childbirth rated their pain as less severe than those who did not.
Jennifer Macris, 38, of Annapolis, Md., said that during the three-hour labor for her baby, born on March 26, she listened to a HypnoBirthing CD through headphones. She was so calm that nurses asked her husband, Jeff, if she was sleeping.
"There was no pain," she said. "I felt a bit of pressure, and the baby was out. There was only a little tear that required one stitch."
Still, Dr. Camann and other doctors warned mothers against rigidly adhering to any single alternative.
Ideally HypnoBirthing allows a woman to remain so relaxed through contractions that there is no screaming to tire the mother or alarm the baby, and labor is shorter.
It doesn't work for everyone: Jennifer Richards, 29, said she gained self-confidence from hypnobirth methods, but had an epidural because of the intense back pain during her 30-hour labor.
"I used some of the things I learned," she said, "but not as many as I would have liked."
In contrast, Ms. Yeiser of Asheville, whose baby was born after only two and a half hours of labor, said, "I was so relaxed that I slept through the first stage of labor."
That's what Marie F. Mongan was seeking when she set up HypnoBirthing after her first two deliveries, the first in 1954, when women were routinely strapped down and given ether, and their legs tied to stirrups.
The first birth using her program, which is based on her training in hypnosis, was that of her grandson, Kyle, in 1990.
The number of those taking HypnoBirthing's four-day instructors' course has doubled in recent years and has increasingly included nurses, she said. Her 1992 book, "HypnoBirthing, the Mongan Method" (Health Communications) is in its third printing.
Her HypnoBirthing Institute, outside Concord, N.H., is just starting to keep statistics on how many women deliver using her techniques, something hard to measure because women who take the classes may later find that a medical necessity calls for drugs. The course is usually a series of five classes, which in Bethesda cost $200.
Ms. Mongan said natural childbirth has been derailed by medical intervention. When Queen Victoria insisted on chloroform during the deliveries of her nine children, she set the precedent for ceding control of birthing to doctors, Ms. Mongan writes in her book.
While many hospitals now permit hypnobirth, doctors are wary because they fear litigation. The American College of Obstetricians and Gynecologists leaves it up to the individual doctor's judgment.
Such techniques are not a surefire way to avoid pain, but rather "adjuncts and not the end-all to birth," said Dr. Jeffrey M. Segil, an obstetrician who offers the HypnoBirthing option to every patient in his practice in Dover, N.H.
"Women should not be set up to feel that they've failed if they can't follow through to a totally natural delivery," he said.