The Nocebo and Placebo Effect and How they Affect Birthing People

The human body's health is directly impacted by the thoughts that are held by the person. You are essentially what your beliefs are. If you believe you will be young and beautiful, you will be. If you believe you will become old and decrepit, you will. Our thoughts and actions become the basis of our health.

Equally as important are the messages that we hear from others regarding ourselves. When we hear positive feedback from others about our appearance or achievements, we strive to do better or look better. When we hear negative comments consistently, we become disengaged with who we are and apathetic to achievement and appearance.

Our beliefs ultimately shape who we are and what our realities become.

Most people have heard of the placebo effect- which is the body's ability to regain health when the mind believes that the placebo treatment provided will heal it. The mind's ability to heal the body is an essential part of all healing. Indeed, health outcomes improve when the mind believes that the treatment provided (whether medical or a placebo) will be effective. The Placebo Effect is well documented because many drugs and health treatments are tested against placebos to verify their efficacy and determine whether or not they are as effective as the mind's ability to heal the body. The placebo effect proves that the mind has an incredible ability to impact positive health outcomes.

The same is true in birth. When it is believed that a positive birthing outcome will be achieved then the likelihood of complications reduces. Furthermore, when you have a care provider who supports you and reaffirms positive birthing outcomes and reassures you, this contributes to your underlying belief and can increase the positive impacts of the placebo effect. Your likelihood of a positive birthing outcome increases when you have the support of those who care for you.

The nocebo effect is the opposite of the placebo effect and is equally if not more powerful as it is still the mind that is generating the beliefs about the outcomes. Essentially, the nocebo effect is when the mind believes that a negative outcome will occur as a result of a treatment. Regardless of the effectiveness of the treatment, if it is believed that the treatment will cause more harm than good, the likelihood of a negative health outcome increases.

The nocebo effect can be exacerbated by care providers as well when they go over possible negative outcomes resulting from any given treatment. When the person receiving the treatment believes that negative side effects will result from the treatment, and their healthcare provider has reiterated the risks of taking on the treatment, therefore reaffirming the belief held, the health outcomes usually go awry as well.

How does this relate to birth?

In many countries, birth has become a highly medicalized event. Caesarean births have been normalized and many birthing people question their own ability to birth without having this major abdominal surgery. Additionally, a hospital setting and medical interventions are seen as necessary for a natural vaginal birth. As a result, many pregnant people doubt whether or not they will be able to give birth without active medical management. The media has contributed to this distrust of the pregnant body by portraying birth as a scary, painful experience and perpetuating the belief that birth is something to be feared.

Birth is unpredictable.

Often, birth is seen as something that needs to be managed or controlled in order to ensure safe outcomes. But what happens to the pregnant person's mindset when they are consistently inundated by social and medical cues indicating that birth is unsafe? Trust in the body's innate abilities and wisdom are lost and the nocebo effect can prevail.

When care providers suggest that extra ultrasounds are needed or it is dangerous to carry a pregnancy past a certain amount of weeks, this can indicate to the pregnant person that their body is no longer safe for their baby and that they can no longer trust the their pregnancy or the natural physiological process of birth. When the media shows portrayals of birth as painful or frightening, this can lead the birthing person to feel unsafe in their body and not trust in the natural physiological process of birth. Ultimately, it can lead to poor health outcomes for both the pregnant or birthing person and baby when fear becomes the baseline for pregnancy and birth.

So how do I prevent the nocebo effect from taking hold of me?

Positive Birth Stories:

Listening to positive birthing stories can be really beneficial for changing your perspective of birth. When you hear stories about gentle, natural, physiological birth you believe it is possible for you and that horror stories aren't the only experience. By limiting your exposure to negative stories from the media or friends and relatives you can also prevent these thoughts from becoming your experience.

Care Provider:

Your care provider has a tremendous amount of responsibility in ensuring that you do not experience the nocebo effect prenatally and postnatally. How they communicate, how you are made to feel by them, and the nature of your relationship all contribute to your perspective of how your birth will unfold.

Do you feel heard, listened to, and respected about your concerns? Are tests and procedures offered from a place of care or fear? Does your care provider help alleviate your concerns or create more anxiety and worry? All of these questions are a good start to ensuring that your care provider is not creating the nocebo effect in you.

Mindset:

By thinking about positive birth outcomes and planning for a positive birth experience you reduce the likelihood of the nocebo effect taking hold of you. You can literally change how you experience your birth with affirmations, hypnosis and visualizations that are positive.

When you think about your body what are you telling yourself? When you think about your pregnancy are these thoughts positive or negative? How does your baby's birth look and what do you think about it? How do you think about your postnatal recovery? Can you change negative thoughts and words to positive ones?

Statements like these can help create the placebo effect and avoid the nocebo effect...

"I am looking forward to my birth and meeting my baby."

"Birth is a natural process and my body is able to give birth with ease."

"My body and baby remain healthy throughout birth and my recovery is easy."

Reflection:

If there is a legitimate reason for a concern that you are having, do you know where it is coming from? For example, if you are afraid of needles, and you are choosing an epidural, you might be afraid of the insertion process. Notice where this concern is coming from, what you are telling yourself about it, and see if you can change your internal dialogue to being a positive experience.

Without creating false positivity, and instead genuinely acknowledging the place where any negative perspective comes from, you will discover the source of your concerns and be able to change the way you think about them. With regards to the previous example, one possible discovery could be...

"I am afraid of choosing an epidural because I think it will be painful due to the size of the needle. My fear of epidurals stems from my fear of needles that I acquired as a child which was very painful and traumatic. Epidurals are a completely different type of experience that I have not experienced before. I don't know that epidural insertion is inherently painful, and most people describe having an epidural as a good, pain-relieving experience. I can accept that my experience of an epidural will be different than I anticipate because I've never had one before. My experience of having an epidural, like other people's, could also be good and I will appreciate the relief it provides to me, should I need it. I will put my attention on the relief it provides and have a positive outlook towards the epidural should I choose to use it."

Yoga

Yoga can help you connect with others prenatally and postnatally to help keep your body and mind healthy. By keeping your body strong and your mind clear of negative thoughts with the integration of yoga, you can release fears contributing to the nocebo effect in your body. Fear can result from trauma, and trauma is often held in the body. By moving the body mindfully, yoga can help release fear and trauma in the body which has a positive psychological effect- particularly perinatally.

I will be offering prenatal yoga classes out of Chacra Wellness in Leduc on Tuesday evenings this fall. Mom and baby or postnatal classes will be held at the same location on Wednesday mornings. These are ongoing classes but need a minimum of 5 people to register in order to fill them.

Have you heard about Renewed Resilience? It is a local business that focuses on mental health, wellness and connection in Leduc. I am excited to be working out of their space and offering programs and workshops at their location. Most of these programs and workshops will be with a focus on womxn's health including pregnancy, birth, postpartum and pelvic health. My upcoming pregnancy and birth preparation program is called Birth From The Inside. Get on the waitlist here!

For more information about all of my programs, classes and offerings you can check out my Facebook page or website for dates, times and details.

For now, I hope you are enjoying the transformation that pregnancy, birth and the fourth trimester are providing you and that you can find new ways to love your self while connecting with your baby.

Love Your Body. Love Your Baby. Love Your Self.

Much Love;

Colleen