The nocebo affect and how it changes your experience of pain during birth

It’s the most annoying thing in the world. You’re pregnant and your bump becomes a birth story magnet. Everyone wants to tell you their stories, opinions and warnings. Not just a story magnet, you may find yourself becoming an impromptu counsellor, to friends, strangers, people at work who have had babies. 

When you are pregnant you enter a club but the rules haven’t been explained, you’re listening to a music genre that you don’t really know, and the cocktail menu is off limits - but everyone wants to talk to you about it. 

More often than not people want to share what went wrong. My cousin, a lot younger than me, said that she had heard it referred to as the “birth Olympics”, as if people were competing for the worst experience, and if you had had a normal birth, or a positive experience, you were out of the race before you even reached the start line.

Birth stories and how they can differ?

And it’s true. The number of families I speak to that have had a great birth, but daren’t bring it up amongst friends or postnatal groups because they "feel bad" about bringing up what they see as a positive, affirming birth. "Nothing really happened, there as nothing to tell", is something I hear often. But something did happen, they had a baby become a mother and gave birth - I meant that is extra-ordinary in the true sense of the word.

What this means is that stories of pain, intervention, emergencies, inductions, become the norm. When they shouldn’t be. I agree, every story matters. They are real experiences and they deserve to be heard. A few years ago, I was shocked to hear that one hypnobirthing provider was deleting stories from their social media that didn't fit their brand. 

What all of this happens is that we are entering what I see as the emergence of an online psychological birth culture that is activating intervention, and increasingly traumatic experiences of birth and fear. And we know that fear increases pain. 

Tell me more about the nocebo effect and birth. 

There's something else happening at the same time that we rarely talk about, and it’s hugely important when it comes to birth, and that's what repeated exposure to these stories does to your brain.

Most people have heard of the placebo effect. You take a medicine, that's sugar pill, and it makes you feel better, because you BELIEVE the treatment will work. This is a well-known phenomenon.

The nocebo effect is the opposite. Negative expectations make symptoms more likely or more intense.
People in medical trials regularly report side effects from pills that contain no active medication at all simply because they were warned those side effects might occur. The symptoms are real and they occur because of expectation.

Psychologist Irving Kirsch, who has spent decades researching placebo effects, has shown that expectation can strongly influence how symptoms, particularly pain, are experienced.

Your brain is always predicting, it's a prediction machine! 

It is constantly asking: What is about to happen? Is this dangerous? How am I going to cope with the pain?  it's going to be filtering information that not only answers those questions but wants to predict those risks.

If the brain expects pain and is scared, it prepares the body accordingly.

• Muscles tighten.
• Stress hormones rise.
• Attention becomes more focussed.

How is this connected to pain?

Pain itself is not just a signal from the body. It’s something the brain interprets and constructs. The bottom line here is that if you are expecting pain, your brain interprets that sensation as pain and constructs that experience.  But, if you are afraid as well, your birth physiology changes, fight or flight is activated and this impacts on the intensity and pain of contractions. 

That’s really hard to get my head around!

“Are you saying that pain isn’t real?” “I definitely felt pain!” “Are you denying my experience?”

These are some of the replies I hear when talking about this. People are angry because their experience is of pain. I’m not denying pain is real, or that people don’t feel pain, I’m asking people to think about how anxious you were of the pain before birth began, how the brain receives information, interprets it and constructs your experience.

Why Negative Birth Stories Stick

Human brains are naturally drawn to negative information this is known as negativity bias.
From an evolutionary perspective this makes a lot of sense. Your ancestors needed to remember danger, in order to know how to keep themselves self.

As a result, negative stories tend to:
• capture attention more strongly
• stay in memory longer
• spread more easily

Sadly, social media amplifies this and it can be completely overwhelming for the brain.
Stories involving trauma or fear travel further online than everyday experiences. We are hearing stories from different countries, where there are different approaches to birth. Short tempting clickbait mean that there is no context any longer. It’s hard for our brains to make sense of it. And that in itself is a threat.

If you’re pregnant and scrolling through birth content, it can start to feel as though frightening births are everywhere and your brain begins preparing for danger.

Preparing your brain for birth

This knowledge tells you that how you prepare your mind for birth matters.Techniques such as education, relaxation, imagery and hypnosis and hypnotic breathing work partly because they influence the brain’s expectations.

Instead of preparing the nervous system for threat, they help the body prepare for knowledgeable navigation.  If you’d like to explore how these techniques work, you can learn more in the Mindful Hypnobirthing - Sophie Fletcherwhich teaches practical ways to calm the nervous system and build confidence before labour.

Coming Next

In the next article I’ll explore what neuroscience tells us about how the brain interprets a contraction and why expectation, belief and meaning can influence pain.