August 17, 2002

Placebo effect and pain in labour

There is a very interesting article in the Sydney Monring Herald today written by Dr Norman Swan. He explores the powerful influence of the placebo effect (and the even more powerful Nocebo effect) on people's health, and looks at the reasons why many treatments are no more useful than placebos in improving outcomes for patients.

No where could this be more true than in labour and birth. These are not even illness conditions, yet they are treated as though they were, and women are offered various remedies, medications and even surgery, to "ease" or "relieve" their symptoms. If a positive result occurs, it will be attributed to the medication, treatment or gadget even though it may well have been the placebo effect of thinking something was helping that did the trick. Emphasising the effectiveness of the treatment and downplaying the woman's own role is a sure way to undermine her confidence and maintain her compliance and submissiveness to the medical message.

A great example of this is the TENS machine. This gadget, hugely popular in Britain, had been adopted by midwives, even childbirth organisations, as a "safe" alternative to drugs for managing pain in labour. It is enthusiastically promoted in pregnancy magazines, Boots the Chemist shops, by childbirth educators who hire out the equipment and even midwives. It is a prop for those with no firm belief in women's innate abilities to give bith without "help" and who want to be seen as rescuers; it makes people feel good to be doing or offering something; and it makes money for the manufacturers and the retailers.

How have women been so effectively duped into buying these gadgets? Clever advertising, that's how, by claiming that TENS machine raises endorphin levels during labour. There is no evidence that this is the case and no studies have been undertaken on labouring women. Perhaps natural levels of endorphins are raised, but it this due to the machine, or the placebo effect resulting from a belief that one's endorphin levels are being raised during labour by the machine? Does it matter if it is the machine itself or the placebo effect that is working here?

Yes! If the woman places her faith in the machine and believes that it was the TENS that got her through, then she completely discounts her own natural abilities, and this can undermine her faith in her own strength. As a result we are at risk of producing women who believe they are weak and incapable instead of strong and resilient. Of course, women with little confidence in themselves will be easily manipulated, more readily coerced, and more dependent on others. It becomes a circular problem - next time women will say "I needed the TENS last time and will need a bit of help again this time..." - music to the ears of the health professional who is ever willing to take over and "help out".

Given the power of the placebo, this is the time to use it to great effect - women need tobe told "you can do it!" and all those other positive messages that true midwives use to encourage women to give birth by themselves.

Norman Swann also talks about the "nocebo" effect, another fascinating influence on the way we deal with health problems, but that will have to be the subject of a diary entry for another day. In the meantime, check his article out : " Doctor feelgood".

http://www.smh.com.au/articles/2002/08/16/1029114012780.html

Posted by andrea at August 17, 2002 02:19 PM

Comments

I used a TENS machine during my labour with my first and only child. I found it to be absolutely spectacular! I had planned to birth my baby at home in water and so once I'd reached 6cms I reluctantly took the TENS off and got into the pool, and boy did I miss my TENS. I found the water far less effective in enabling me to manage the pain. Due to complications with my labour I had to get out of the pool and go to hospital, and it was so good to get that machine on again.
At one point close to transition I relaxed so deeply in a visualisation that I let go of the gadget and it fell to the floor pulling the connecting wires out of the control unit. I then got the full sensation of the contraction without the TENS. Needless to say it wasn't with polite words that I demanded the wires be reconnected immediately.
I found that the TENS transformed the pain sensations into a different although just as intense sensation, which somehow was easier to bare. I will definately use one again.
Hope that this is useful.
Victoria

Posted by: Victoria Marshall-Cerins on January 23, 2003 01:35 PM

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Posted by: mimi on April 10, 2003 12:10 AM

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Surely it is the right of a "strong and resilient" woman to choose whichever tools or techniques she may consider appropriate for her own labour.

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