Origin and goals
The Bonapace Program is the result of many years of university research and practical application in a community setting. Clinical experience, together with research on the inception of a family and the management of obstetrical pain led to this innovative program, modeled on the needs of families today.
The program complements many of the approaches taken to prenatal preparation and is taught in a number of local community service centres (CLSC's), as well as a good number of Quebec hospitals. A series of teaching documents have been developed to meet distance training requirements. A team of accredited trainers teaches the Bonapace Program in many areas of Quebec and throughout the world.
The program's philosophy is based on a ecological model, which is progressive and looks at individuals and their interaction with their various systems (family, work, leisure, culture, politics, etc.). This approach considers that people are subject to many stressful changes during their lives. They have to adjust if they are to maintain their equilibrium. Primary prevention programs, like the Bonapace Program, are designed to help couples develop the skills and competence required to live through the changes inherent in awaiting the birth of a child. The shift to ambulatory care, initiated in Quebec in 1997, focuses on this same goal: to develop self-confidence and self-esteem by teaching the public how to take a responsible attitude towards health-related matters.
The Program's general objective is to improve a couple's competence and skills in coping with the perinatal period and, more specifically:
- To reduce medical intervention by the effective management of pain; and
- To reduce the couple's stress level by encouraging the father to play an active role during the pregnancy and at the moment of birth.
Special Features
The Bonapace Program focuses on the couple and the birth of their child. The parents' competence is reinforced by giving them practical tools suited to their needs and limitations.
Pain modulation is one of the major ways in which this program differs from others. Pain reduction does not lie solely in various techniques used (breathing, massage, relaxation, etc.). It is based on an understanding of the role pain plays in the body, its transmission and, in particular, the use of three endogenous mechanisms in other words, ways in which the body itself can modulate its perception of pain.
It is thanks to research carried out by Dr. Serge Marchand, Ph.D. on the non-pharmacological aspects of pain that these mechanisms have been so clearly defined. His book, "The Phenomenon of Pain" is an indispensable tool for all health professionals.
Mechanisms
Couples learn how the three endogenous mechanisms can relieve pain.
1. The higher centres of the brain play a role in the perception of pain, establishing direct and indirect links between themselves. Cognitive structuring (understanding what is happening and why) and a recurring positive concept on which to focus attention when experiencing pain are both beneficial. That is why it is important that the couple understand the role and function of pain during childbirth and also the progression of the various stages of labour and delivery. Proper preparation enhances self-control. Breathing (diverting attention) and awareness of an internal dialogue -- "I feel calm and I am confident" -- are examples of this.
2. Drs. Melzack, Ph.D. and Wall, Ph.D., have developed the gate control theory, whereby non-painful stimulation (light massage of painful areas) blocks part of the pain message transmitted by the spinal cord. To activate this mechanism during childbirth, the fingers must be run lightly over the painful area, particularly during contractions.
3. The diffuse noxious inhibitory control (DNIC) mechanism developed by Dr. Le Bars, Ph.D., in fact gives rise to a paradox: it involves creating a second area of pain in order to cause the release of endorphins (which are produced by the body and are related to morphine). These act throughout the body, except in the area where the second pain is instigated. The brain wants to lessen the pain felt by the body as a whole, and only keep the second pain area intact. It wants to check the nature of this pain and provide the appropriate reaction. During delivery, sensitive points in the body (trigger areas) are usually massaged, causing pain. These frequently correspond to acupunture sites.
Scientific Validation
Although no longitudinal evaluation has been conducted on the impact of the Bonapace Program on family-building, the "pain reduction" aspect has been the subject of a very stringent research protocol.
This required that pain felt during labour and delivery be measured every 15 minutes. The subjects were women who had used the Bonapace Program and others who had followed conventional prenatal courses.
It was found that the Bonapace Program decreased the pain experienced during labour and delivery by almost 50% more than the other conventional methods with which it was compared. This is an important finding, because the approach used is non-pharmacological and causes neither side effects nor complications.
To know more about the details of this protocol, Click here.
How to use the Bonapace Program
The Bonapace Program is designed to complement other conventional prenatal programs. It covers the non-pharmacological treatment of pain during delivery, whereas other prenatal programs deal with the general aspects of preparing for childbirth, such as the mother's diet, anatomy and physiology during pregnancy, physical and psychological changes during this period, labour and delivery, medical intervention, care of the newborn and postnatal adjustment.
The Multimedia Box was developed to help you learn the Bonapace Program by yourself. Accredited trainers can guide you through the program and make sure you are following it correctly. If you are fortunate enough to have such resource persons in your area, we recommend you take advantage of their expertise. The number, length, cost and frequency of sessions depends on the individual trainer. Generally speaking, four 120-minute sessions are given over a period of 4 weeks.
Parents can learn the Bonapace Program at the Centre Hospitalier de l'Université de Montréal- Hôpital St-Luc. Training is given by a certified nurse of the CHUM and lasts 8 hours over a 4 week period. Program begins on the first Tuesday of each month from 19 h to 21 h at the Pavillon Edouard Asselin (corner of Sanguinet and René Lévesque).
Registration fees (150 $ + taxes) include the parents' participation, 8 hours of training and the reference guide "Labor of Love" by Julie Bonapace, M.Ed..
Content of the 8 hour training at the CHUM:
Lesson 1
- Prevention, postures and breathing
- Phases of labor and delivery
- Massage of the piriform
- Parents roles
Lesson 2
- Origins of labor pain and Non-Pharmacological Pain Relief
- Non-painful Massages (piriform, hip)
- Painful Massages (piriform, sacrum, feet, hands)
Lesson 3
- Positions during labor and delivery
- Relaxation and visualization
Lesson 4
- Relaxation and visualization
- Massages
Most couples begin studying the Bonapace Program around the 26th week of pregnancy. In many cases, it is the approaching delivery that triggers their interest. But there are also certain contraindications to using the program. We urge you to obtain your caregiver's professional opinion on this aspect. This will also give you an opportunity to discuss your intentions and your expectations concerning childbirth.
Many couples feel more confident after four or five weeks' practice.
- They know what happens during the course of childbirth.
- They have a good idea of the extent and intensity of the pain.
- They know that pain can be modulated by understanding three endogenous mechanisms.
- They put practical pain reduction techniques into effect.
- They know the importance of a pharmacological approach, if acute pain management proves difficult.
To learn more about the effectiveness of the Bonapace Program, please refer to the study conducted by a research team from the Université du Québec en Abitibi-Témiscamingue.
If you are expecting a baby, why not use the next few months to adjust to the changes that are going to occur? You may feel uncomfortable or concerned about the new roles facing you. Don't wait any longer: ask for support from those near to you or from local organizations.
In the meantime, live this new transitional stage to the full, with serenity.
With heartfelt wishes for your happiness,
Julie Bonapace.