The Nocebo Effect and Childbirth

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                       Have you heard of ‘nocebo effect’ before?

The nocebo effect is different to general fear or uncertainty.  The nocebo effect is the opposite of a placebo effect: it is the absolute belief in a negative outcome. In Latin it means “I will harm”.

                    Do you think it effects women in labour?

I would argue that if your medical care provider suggested that your baby was too big, too small, not positioned optimally, or at risk in some way, it can actually lead to problems arising.  A women starts to doubt, and then gradually becomes convinced something is wrong – she doesn’t relax, her blood pressure increases, her ability to birth naturally becomes inhibited, and a medical issue arises (failure to progress, incompetent cervix, distress in baby, failure to start labour).  This mind over matter effect is very real (Ina May Gaskin talks about it in relation to fear and perceived safety as the Sphincter Law).  It can lead to genuine medical problems.

Women who enter pregnancy and birth without knowledge, who put their trust completely in their care providers, may be at greatest risk of the nocebo effect.  Care providers may only have to mention risks, or side effects, and susceptible women can start believing it is happening.  Likewise, women who do not trust their care provider but present with genuine medical difficulties, may not respond to treatment effectively because of negative emotions involved with the care provider.

Perhaps this nocebo effect is why it is crucial that maternity care systems need to change.  Continuous care, where a mother develops mutual trust with her support, where she is free to come to a truly informed decision, where her birth plan is acknowledged and respected and she can choose the location of her birth, has freedom to move as she needs and birth in whatever position she needs.  Many studies show that in such conditions, birth is quicker, less painful, with far better outcomes for mother and baby (short term and long term).

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Michel Odent has written extensively about the nocebo effect, in particularly regarding gestation diabetes.  Michel Odent speaks of birth as scientific versus technological. By scientific he means natural, biological.  By technological he means interventions.  Here are a few examples:

http://www.realpeacework-akademie.info/graz/e/eScience/Michael2.pdf:

“I have realized that in general, ignorance is the basis of the widespread nocebo effect of antenatal ‘care’.”

“Many practitioners do not realize how powerful the nocebo effect of the term ‘gestational diabetes’ can be!  When a woman is given this diagnosis she tends to confuse what is a transitory response to fetal needs with a serious chronic disease. Such a term can transform overnight a happy pregnant woman into a sick person. The point is that this diagnosis is useless.”

http://www.bellybeginnings.com/Handouts/GestationalDiabetes-Odent.pdf:

“Nowhere in obstetrics is there such a discrepancy between evidence and practice as in the matter of gestational diabetes. This diagnosis has been mentioned briefly in several issues of our newsletter, in order to illustrate the frequent ‘nocebo effect’ of prenatal care.”

A few general articles on the nocebo effect:

http://www.guardian.co.uk/science/2011/nov/13/nocebo-pain-wellcome-trust-prize:

“Observations like these suggest we should think twice before overmedicalising the human experience.”

http://www.forbes.com/sites/sap/2012/01/24/the-nocebo-effect-is-serious-medicine-2/:

“To avoid being sued, doctors might be tempted to emphasize drug side effects to their patients but the mere act of highlighting these side effects might make them more likely to happen”

http://www.anesthesia-analgesia.org/content/110/3/868.short:

“Our data suggest that using gentler, more reassuring words improves the subjective experience during invasive procedures. “

See also: http://www.sarawickham.com/quotes-and-shares/quote-of-the-month-for-may-gestational-diabetes/

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