The Nocebo Effect

​Have you heard of the '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". 

 In pregnancy and childbirth the Nocebo Effect can manifest a need for  interventions.  The care provider you choose, the location of the birth and the support you surround yourself with, and the childbirth education you attend , will influence you: one way or the other.  

Choose wisely, and you will protect yourself from the Nocebo Effect.

Committing to the standard care, and you are at greater risk of the Nocebo Effect. This article on Midwifery Today (2003) discusses the role of fear in childbirth.  This highlights just how aware the system is of the impact of fear (the nocebo effect)...but that does not mean the system is actively preventing it.

CHOOSING THE RIGHT CARE PROVIDER, LOCATION AND SUPPORT TEAM FOR YOU
A medical care provider suggests 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. 

Choosing a Care Provider that offers continuity of care is shown to have positive outcomes.  If continuity of care with a midwife is not offered, you can consider adding a doula to your birth team.  This kind of support is proven to improve outcomes.

CHOOSING THE RIGHT CHILDBIRTH EDUCATION FOR YOU
Not all childbirth classes are the same.  If you only attend the ones offered by the hospital, you may be vulnerable, increasing the risk of the nocebo effect.  

Perhaps this nocebo effect is why it is crucial that maternity care systems need to change.  The best outcomes involve:

• Continuous care, where a mother develops mutual trust with her support,
• Freedom to come to a truly informed decision,
• Autonomy, where her birth plan is acknowledged and respected,
• Freedom to move and birth in whatever position feels right. 

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).               
                           
THE NOCEBO EFFECT AND GESTATIONAL DIABETES
Michel Odent has written extensively about the nocebo effect, in particular 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:

"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."

"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."

From a few general articles on the nocebo effect:
 "Observations like these suggest we should think twice before overmedicalising the human experience."

"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"

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


KNOWLEDGE IS POWER
The best way to avoid being impacted by the Nocebo Effect is to become Informed, Supported and Confident.  

Here is how:

• Understanding normal birth and when interventions are genuinely necessary.are an important part of the Informed Birth Preparation process.  
• Creating a Birth Map helps your birth team to communicate your needs in the absence of continuity of care.
• Join free Member Area!

This will give you the knowledge and tools you need to build YOUR support team and BIRTH YOUR WAY.