A placebo is a suggestion. You are told something will make you better, so you believe that you are being offered a drug or vitamins that will improve your situation in some way.  There is overwhelming evidence that demonstrates, in different ways, how when you think you are getting better, improving physical performance, reducing pain with an intervention, or even taking a drug you know to be a placebo, your body makes actual physical changes in line with the suggestion of what that placebo is meant to do.

The chemistry in your brain changes, just because of how you think!

This means that if I were to give you a drug and tell you that it would get rid of morning sickness, but it was in fact a capsule filled with cornflour, you would more than likely see an improvement in your morning sickness.  This is not to say that you aren’t experiencing morning sickness and it’s all in your mind, what it shows is that if you are experiencing it your brain is able to make adjustments to the chemistry in your body that reduce that feeling of nausea.

Even more interesting is the power of ‘nocebo’. If I were running a randomised drug trail I would have to tell you about the side effects of the drug you were receiving even if you were receiving the placebo. Research shows that this suggestion also causes chemical changes in the brain, and that people receiving a placebo experience the side effects of the real drug.  You can read a lot more about this in Prof Irving Kirsch’s book ”The Emperor’s New Drugs”.  Kirsch used Freedom of Information to extract trials from drug companies that hadn’t been published and he dissected them, particularly in relation to antidepressants. This was the book that really helped me get to grips with the extent to which the effects of placebo were understood but hidden from us.

The programme also talked about the role of expectation in the experience of pain. If I were to tell you that something is painful, you will be more likely to experience pain even if there is none.  Evidence now also shows that how we think about pain, actually can overpower strong opiate drugs such as remifentanyl, which in some hospitals is offered through an iv in labour.  When receiving a positive suggestion, the front part of the brain becomes more active.  As an area associated with endogenous pain modulatory system, including the anterior cingulate cortex, which releases dopamine and your body’s own natural opoids.  If you are given a negative suggestion of pain or of side effects, it activates the area of your brain more associated anxiety and the increased levels of pain, the hippocampus, in particular the amygdala.  You can read more about expectation and pain here.

Pretty amazing, I think. So how does this type of suggestion relate to birth?  A great deal and sadly it’s completely under explored, trials that are set up rarely take account of the nature of hypnosis, suggestion and the subtleties of how it works, but I’ll talk about that in another blog.

First of all if you are told to expect pain, you are likely to trigger activity in the hippocampus and amygdala during birth, the part of your brain associated with anxiety and increased levels of pain. This is also known as your limbic system.

On the other hand, imagine that you have been given the positive suggestion by your doctor or midwife that birth is completely normal, that it’s perfectly manageable; perhaps  society around you told you it was just an intense pressure and it didn’t last long.  Or you were given a drug during labour and told it was an epidural, even though it wasn’t, what would happen?  I know anesthetists that have said on siting an epidural, but not administering it, women say, “oh that’s so much better, oh that’s wonderful thank you”.  I know many midwives who agree that women ring or come in complaining of stomach upset; when they are examined and told they are in active labour, their pain suddenly goes through the roof, ‘they can’t cope’ or ‘they need and epidural’.

Placebos, have given us insight into the profound changes our beliefs and expectations can make in the chemistry of our brain. Hypnosis is a vehicle where we can ethically use the power of suggestion with the full knowledge of our clients.

Preparing for birth using hypnosis, makes absolute sense, it is based on genuine contemporary research around expectation, belief and the extraordinary power of our minds to alter our experience in each and every moment.

You can read more about the power of suggestion, placebo and pain in my book ‘Mindful Hypnobirthing’ and by attending one of our Mindful Mamma classes, which show you how you can use hypnosis to create a positive experience of birth.

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by Sophie Fletcher

Many years ago I met a friend of my husband who was 24 and had a 10 year old daughter. The story goes that her mum phoned her dad in the pub and asked him to come home because Anna was having a baby. He replied “I’ll finish my pint and I’ll come home and we’ll sit down and discuss what we are going to do”. Then her mother shouted “ now, she’s having the baby now”.  Anna gave birth to her little girl within the next couple of hours, with little more than a bit of stomach ache and sitting on the loo. So apart from thinking she had a bit of an upset tummy, she was fine. I thought “how on earth could someone be pregnant and not know and is that what you would call a pain free labour?”.

When I became pregnant I was in very good shape, it was just after I got married and had spent months toning and exercising to squeeze into my dress.  Throughout my pregnancy I had intermittent bleeding, I had no morning sickness at all, and I didn’t show until very late on in my pregnancy. In fact I recall at 24 weeks, putting on my new Isabella Oliver trousers on the tightest setting to go to work and then proudly sticking my tiny rounded tummy out. When I did go into labour early my ‘tiny bump’ was commented on.  I’m sure if I had been on birth control and not  planning a family that being pregnant would have been the last thing I’d have thought of.  In my years of teaching I have seen women with very very small bumps, and women with huge bumps. Conversely a friend of mine who definitely isn’t pregnant has IBS and is always complaining she looks pregnant, another has fibroids and her abdomen can get quite swollen.

I can see how possible it could be years before pregnancy tests, or even today if you are taking precautions that have failed. It’s rare but it happens.  When researching this, I stumbled across a show that is running in the US called “I didn’t know I was pregnant”. If you want to see it, google it, it’s full of Discovery Health drama so I won’t post it, but you can read this very funny critique of it here.  How could I have not known about this show!

What really interested me is how women who don’t know they are pregnant experience having a baby, do they have what would be considered a pain free labour?   There are many antenatal classes today that focus on the aspect of fear and expectation; the ideology that when we are pregnant, we become anxious of labour which creates physical tension, which in turn make birth much more painful than nature intended it to be. Some hypnobirthing models avoid the word pain altogether and say birth isn’t meant to be painful. It’s certainly true that expectation of pain, whatever that pain is, increases our perception of the intensity of that pain.  Prof Irene Tracey at Cambridge University has undertaken some significant work on expectations of pain and in a recent study examined how manipulating participants’ expectations of pain can influence their response to an active drug. So in theory if you aren’t expecting to give birth, you don’t have the same level of expectation could you have a pain free labour.

 A study published last year by her, showed that volunteer’s experience was influenced not by the drug but whether they were told the drug had or had not been administered. This showed the volunteers really did experience different levels of pain when their expectations were changed, although the administration of pain relief remained constant.

I’ve heard an anesthetist say that he frequently goes to administer a epidural, he may put pressure on the area, insert the needle and ask “how is that”, for the mum to say “oh thank you that’s fantastic such a relief” before he’s actually put the drug in. I heard mums ask if their partner can put the tens machine up, only to get relief before the partner has turned it up.

The power of hypnosis is also undeniably a brilliant pain management tool. Suggestions used during hypnosis distract the mind through disassociation, but also embed the belief that everything is well and fine and that the more they let go the more comfortable they are, and the more comfortable they are the easier it is to let go. Effectively reducing the expectation of pain.  As a hypnotherapist in my general practice, I often work with people who have chronic pain; their pain is constant and yet when they are under hypnosis the pain disappears, and remains much less even after the session has finished.  To read an extreme example of how hypnosis can manage physical sensation and pain read this article by Dr John Butler on his own hernia operation using hypnosis.

As a doula I use deep hypnosis for women, that are in a long latent stage, to get rest. After a short session of hypnosis people generally feel energized so it’s a great way of helping to manage this. Recently a client who had had an epidural with her first birth said that it was amazing and as effective as the epidural, she said during the deep hypnosis she went from having a labour with pain, to it being a pain free labour.

Expectation of pain during labour can create tension, which can create pain. However there is no denying that labour can trigger sensations for some women, sometimes powerful sensations, similar to stomach aches. This can be unexpected for women who are taught that strong sensations aren’t a part of labour.  If we are not prepared for the sensation of labour, our brains then fall back to default position and perceive it as pain, rather as pressure, tightening or aches.

Women who don’t know they are pregnant don’t build up that expectation of pain in labour.  Even if they are in unconscious denial of pregnancy they will avoid reading up, or listening to pregnancy related horror stories.

So I googled for stories, and found that as well as the show in America on the subject, a surprising amount of stories demonstrated consistencies in how women experienced the unexpected birth of a child.

•  This one from Leanne Carter, who felt a bit bloated before Christmas, but was still having her periods and had no other symptoms. She did experience stomach cramps but thought they were period pains, when they got bad (probably transition) they took her to hospital where she took herself off  to the loo and felt the urge to push, her baby boy was born shortly after.
•  Another girl, a student, again thought she had bad period pains, eventually went to hospital where they discovered she was pregnant, assumed she was 32 weeks, hooked her up to an ECG, she unhooked herself as she needed the loo. As she tried to go for a poo, things didn’t feel quite right and she reached down and could feel the top of her baby’s head. She said “a few pushes later and I had given birth. Amazingly I felt calm and focused. My oft potty mouth was expletive free. The only words I spoke were ‘I don’t need to’ when my friend told me I could make a noise”.
•  Someone worked a night shift in a hospital, stuck it out till she finished at 9am, went to A and E because of abdominal pains and a baby arrived just before lunchtime.
• A young teenager had played a hockey match and  then thought that she had a bit of stomach upset. Baby arrived a couple of hours later.

From all the stories I encountered there were consistencies on a number of things, the women complained of a stomach ache or feeling out of sorts, or back ache, but just put it down to other symptoms, went to lie down or managed in the same way they would a headache or flu. If the sensations got troublesome, usually only a short while before their baby was born, they took themselves to A&E. This is likely to be transition and that natural short surge of adrenaline just before baby is born. Without exception they all seemed to have very short labours simply because they treated it as they would a virus or stomach bug until the last moments before the baby was born.

The internet is awash with forums trying to second guess when a woman is going into labour, in many ways we are over educated and women are much more alert to the signs of their body warming up, thereby often assuming labour was longer than it was. For some women attention turns almost obsessively to those small indictors of labour being closer and the mind becomes focussed on every minute change, often exaggerating signs. On the other hand,  it’s not uncommon for very laid back mums to carry on with everyday tasks until they are no longer able and baby’s arrival is imminent.

I’d be really interested to hear your thoughts or stories of finding out you were pregnant very late on in your pregnancy, or anecdotal stories from your parents or grandparents. Especially if you felt you had a pain free labour. I’m sure there are plenty more out there!