La Bonapace method preparation for birth is used to control pain during the last weeks of pregnancy and during childbirth. Overall, this non-pharmacological approach aims to increase the couple’s skills and abilities to experience the perinatal period, and more specifically:

• reduce medical interventions through effective management of pain;
• reduce the stress experienced by the couple by promoting the participation of the father during pregnancy and childbirth.

Developed in Quebec by Julie Bonapace (master of education and accredited family mediator, graduate in science and social work), in collaboration with the University of Quebec in Abitibi-Témiscamingue (UQAT), the method is based on several scientific research. It is taught in several local community service centers (CLSCs) and is gradually making its way into birthing centers and maternity hospitals in Quebec. It is practiced in conjunction with other methods used in thedelivery natural, like breathing controlled.

The method is based on understanding the role of pain and its transmission mechanisms in the body as well as the use of various endogenous mechanisms. The whole would allow modulate oneself the perception of pain. Here are the 4 stages of learning the method.

It is recommended that massage and trigger point stimulation be performed by the joint.

A massage chair, designed specifically for back massages, appeared in the early 1980s. Like many of the trigger points used by the Bonapace method are located in the lower back, it is interesting (but not essential) to use this accessory. The massage chair allows the pregnant woman to lean in a forward tilted position, which decreases the pressure of the baby on the organs. The back is then completely free and makes work easier for the spouse. The chair can be used throughout pregnancy. It can also be used during part of the labor during childbirth. (A massage chair can be rented or purchased.)

The method is based on the following scientific research:

• The pain gate theory developed in 1965 by Canadian psychologist Ronald Melzack and British physiologist Patrick Wall. These researchers were the first to present a model taking into account the complexity of the phenomenon of pain and its sensory, cognitive and affective components. According to this theory, painless massage of painful areas block partly pain messages sent to the brain¹.
• The work of D^r Le Bars (Neurophysiology Laboratory, CHU Pitié-Salpètrière, Paris) on endogenous mechanisms of protection against pain, and more particularly on trigger points whose stimulation allows the release ofendorphins².
• The work of D^r Serge Marchand on the for sustainable persistence and traitement pain³. The D^r Marchand holds a university chair in the pathophysiology of pain⁴ and author of pain phenomenon: understanding in order to cure.

Although it is based on principles that can be applied to other contexts of pain Bonapace method was designed specifically to provide relief to women Pregnant during the last weeks of pregnancy and during childbirth. Couples who practice this method say that they approach the time of childbirth with much more confidence and calm.

For the moment, the validity of the method relies mainly on observations. However, the initiator of the method, Julie Bonapace, and D^r Serge Marchand, neurophysiologist and director of the UQAT Pain Research Laboratory, conducted a small-scale study on 28 couples⁵. In this non-random study, half of the couples used the Bonapace method as preparation for childbirth while the others used conventional techniques (control group). Using a visual scale, the researchers assessed the intensity of pain every 15 minutes during the job anddelivery in both groups.

The results indicate that the Bonapace method reduced the intensity and unpleasant aspects of pain by about 45% more than conventional methods. However, no difference was observed between the two groups in the consumption of drugs (sedatives, epidurals).

Being a non-pharmacological approach without side effect Bonapace method could be a method of preparation for childbirth to consider for couples expecting a child. However, as this study is the only one listed, further well-controlled research on a larger number of subjects will be necessary before a decision can be made on the effectiveness of this approach.

The method is presented as being centered on the couple. The initiation to the method is therefore done in pairs.

The Saint-Luc Hospital in Montreal, the Center hospitalier St-François d’Assise in Quebec and the Center hospitalier de l’Université Laval provide training in this method in 4 meetings of 2 hours, spread over 4 weeks. Accredited trainers (nurses, midwives et massage therapists, in particular) teach the method in several regions of Quebec and in certain CLSCs. Training is also provided in Europe (France, Italy, Switzerland, Belgium), in French Polynesia on Reunion Island. You can register at: http://bonapace.com/page.php?s=formations (see Sites of interest).

You can also purchase the multimedia box entitled Pregnancy and childbirth gently – When the father steps in … (see Books, etc.).

The Bonapace organization offers direct training to health workers in Quebec and France. Prerequisite: University training in a field of mental or physical health sciences, or college diploma with relevant experience (see Sites of interest). In Quebec, training is organized by the Mère et Monde group (http://www.formationdoula.com/formation-methode-bonapace.php), in France by the Medic Formation group (http://www.medicformation.fr /formations/formation-sages-femmes-c1.htm), in Belgium by the Professional Union of Belgian Midwives (http://www.sage-femme.be/sages-femmes/formations/) and in Italy by the Scuola elementale di arte ostetrica (http://www.marsupioscuola.it/image/PDF/CORSI_2011-12/ipoalgesia_x_sito.pdf). You can register by contacting each of the training centers.

Bonapace Julie. Giving birth without stress with the Bonapace method, Éditions de l’Homme, Canada, 2009.

The basic manual written by the creator of the method.

Marchand Serge. Le pain phenomenon: understanding in order to cure, Chenelière/McGraw-Hill, Canada, 1998.

Written by one of Julie Bonapace’s collaborators, the book helps to better understand and tame the phenomenon of pain.

Multimedia box Bonapace including :

— Giving birth without stress with the Bonapace method, book by Julie Bonapace

— Giving birth gently, interactive CD-ROM

— Relax and visualize, compact disc (60 minutes), guide for the daily practice of relaxation and visualization.

— Josée Lavigueur presents the Bonapace method, videocassette (56 minutes) with practical exercises.

The box can be purchased through the Du coeur au belly website.

From heart to stomach

The official site of the Bonapace method. List of trainers in Quebec (click on Training) and links to contact the organization and order the multimedia box.

www.bonapace.com