Prefer to Listen? Find the accompanying podcast episode on the Unschooled Homebirth podcast, Episode 39, wherever you get your podcasts!
Nocebo, placebo all these interesting terms we have to tell you what your experiences are. Amongst academics, the nocebo effect is described as, experiencing a negative response to a drug or treatment based on the belief that you will respond negatively.
The nocebo effect in regard to pregnancy and birth is intertwined with the expectation that has been created that pregnancy and birth are medical events waiting to happen, that the normal stress of pregnancy and the physiologic adaptations that a woman’s body has to support her growing baby are somehow a problem to be managed, always a risk, and that risk comes with fear, and that fear comes with side effects, which may present as the very thing everyone around a pregnant mom is scared of.
In taking a deep look at the concept of the nocebo effect, I hope to help you recognize if this is happening to you or the pregnant mamas in your care, or your loved ones, or anyone else you might notice who is affected by this influence.
"… doctors and medical students frequently address obstetrics only as it pertains to pathology. They spend most of their time preparing for all the awful things that could go wrong during pregnancy and childbirth. Students learn all about placenta previa and acute toxemia, but by the time they are doctors, they have learned very little about the physiology of normal labor and are ignorant of the perfectly common factors which might modify the process without being cause for alarm or intervention. The end result is that birth itself, every birth, is seen as a potential problem." ~Michel Odent, Birth Reborn p. 94
Here's where the nocebo effect starts
To manage the fear from within the system, we now test everything - blood, urine, your baby’s heart tones, how fast or slow your belly’s growing, your blood pressure, amniotic fluid levels, group beta strep, and on and on, no crevice left unswabbed, no fluid left unmeasured.
As if to say your body needs constant help doing one of the very things that has us all here today - growing and birthing a baby. It implies women can’t go through a pregnancy without having hypertension, or a misplaced or misshapen placenta, abnormally high blood sugar, abnormally low amniotic fluid, a short crevice, a bacterial infection, or she just needs a c-section because birth is hard and you probably can’t do it.
The nocebo effect can start insidiously, maybe innocently, maybe it starts as a true belief that all this monitoring is saving babies and moms. I don't mean to imply that all of this medical management is applied with malintent; often it's truly what a caregiver thinks is needed, based on their own biases, their own experiences, their own fears, fears induced by their training, their environment, or their colleagues.
The problem is they spend so much time focused on the negative, watching and waiting for the sign of a problem, that a problem is exactly what they find, whether it's normal, physiologic swelling that is now a sign of early pre-eclampsia, normal amounts of protein in your urine from the normal, physiologic changes in your kidneys to support your increasing blood volume, which can also be interpreted as an early sign of pre-eclampsia. Or your due date is approaching and suddenly, for known specific reason, your baby may be at risk in the very womb that has nurtured them for 39 weeks of pregnancy.
The constant exposure to these words, to these thoughts, to the testing involved in the expectation that something will go wrong, this itself may lead to the very complications they are concerned about. Nocebo. Even referring to a pregnant person as a patient, which means "one who suffers" begins the notion of illness, of something wrong that needs attention. Slowly eroding away any confidence, disassociating her trust within her own body, open the gap for vulnerability and manifesting the very concerns she was trying to avoid. Nocebo.
And at these visits, how often are women asked about their baby? How often are they consulted as the only one who truly knows how their baby is doing? How often are women trusted with their inner knowledge of their body and their baby rather than expected to blindly trust an outside expert who is here to tell them what may be going wrong, rather than to act as a patient seeking the medical care and treatment of a doctor, or even a midwife in some cases.
The very act of not establishing trust in the pregnant mother, in her body, in her capacity to care for her fetus, this creates the potential risk, a risk that leaves her open to the fear of her caregivers that her body really can’t do this, that something is bound to go wrong and she will need help, she will need monitoring; it’s not a matter of if there is a complication, but when.
This is the risk of the nocebo effect, when the message is, without our help, the ones who know what to do, with the knowledge to save you, to save your baby, when those who can take your power to know your body and baby, do take that power, the nocebo effect follows and the signs appear - hypertension, infection, failure to progress, failure to thrive, failure to conform, failure to give birth the way a woman in the modern system should give birth...failure, failure, failure.
Is it true that at least 70% of pregnant people fail at being pregnant or fail at giving birth? When we look at all the statistics, pregnancy interventions, birth interventions, newborn interventions, over 70% of pregnancies experience some kind of intervention or diagnosis, some kind of failure. Where does this come from? Is it the health of our modern women? Is it a nutrition factor? Is it a stress factor? Is it an evolutionary flaw? Or is it a result of the very treatment of our pregnant population? I am not here to answer this question, I don't even think there is one correct answer, but there is an answer for you, that comes from within you.
When the words or the thoughts, the ideas or a diagnosis comes to you, what do you do with that? Does it feel true? Did you somehow seek this opinion, this diagnosis? Did you compromise in your pregnancy and end up with an answer that you weren't expecting? Does it define your pregnancy and your birth outcome? Does it define you? Where do you go from here?
Avoiding the Nocebo Effect
The nocebo effect is powerful - those who have the education, the book knowledge, clinical experience, those we expect to help us also have the power to cause self-harm. Although the nocebo effect may be triggered by an external exposure - a lab test, careless use of words, even a birth story or a social media post, your reaction to that exposure is what determines your physical and emotional response, whether you let it in or hold onto it and evaluate it's truth for you and your pregnancy before making a decision.
In today's birth culture with such a flood of information everywhere, it is more difficult than ever before to make truth-based decisions. It takes doing a lot of work around being clear and honest with yourself about yourself, getting into those deepest layers where you find out how much you trust yourself, and those you choose to allow into your sacred pregnancy and birth space.
Can you take objective information and view it from all angles and all levels and make a confident decision? This is part of the transformative gifts of pregnancy and birth, all the experiences, the joys and the challenges, of pregnancy and birth and raising children, it all becomes a part of you and who you become. The choices are yours, the path is yours, do you choose to be a patient or a self-directed woman during your pregnancy? Even in the event that something arises for which you choose medical care, these choices are always yours if you choose to make them and accept the responsibility of those choices.
I expect the nocebo effect to be a part of our lives in many, many ways, for some time to come. The subtle manipulation techniques that are a part of human nature seem alive and well today, so be aware of the grasp, take time on a regular basis to stop, center yourself, quiet your mind and check in with yourself, what's there, what's nagging, what's keeping you from that perfect night of sleep, what is left when the external distractions are gone. If you find it's peace and contentment, you check in with your baby and all is well, then keep on doing what you're doing. If you find there's voices of fear, of concern, of worry, some kind of "what if's", evaluate them objectively, from all angles, from all levels, is this your concern, your fear, an authentic issue to dig into, or is it a seed planted from outside of you that is not yours to keep? If so, identify every reason that these fears, these words are not yours until you feel the fear release. Keep these reassurances with you and your confidence will build. Gradually you may notice that you recognize the triggers that could lead to the nocebo effect earlier and earlier until they can't even grasp you any longer.
This is letting go of things that don't support or serve you, this is building up your deep Yin strength, lowering your external Yang defenses, finding your way in a complicated birth culture. For more on what that means, I will refer you to a previous post, The Yin and Yang of Birth, where I explored what it looks like to prepare for birth with a more subtle, inner strengthening Yin approach versus the suit of armor Yang approach that so many birth approaches rely on today.
Placebo, nocebo, these are just words to describe your reaction to the medical world, but if you can learn to stop reacting and focus on your true needs, if you can leave room to evaluate the incoming information, stories, everything that comes through your senses, you can find your way on your path, your natural birth compass will guide you because it comes from your own truth, that only you know.
If you have stories of the nocebo effect, how it affected you or how you recognized it and what you did, how you found your way through, I would love to hear them! Send me your story at info @ naturalbirthcompass.com or find me on the socials @ naturalbirthcompass.
