Birth: The Foundational Imprint

I hold the following principles of pre-natal psychology to be basic:

1. In our present day life, birth is traumatic in almost every instance.

2. The longer the labour, the more serious the physical complication, the greater the trauma of birth.

3. The intensity of the trauma of birth is proportionate to the shocks or injuries which the child suffers during labour or immediately following delivery.

4. The love and care which the child receives immediately after birth is a decisive factor in the persistence and intensity of the traumatic pressure. (33)

The perceptiveness of these concise criteria of the trauma of birth are remarkable in light of the later research of Emerson (1987), Janov (1983) and others. The early insights of Fodor have been confirmed by tens of thousands of accounts from breathwork, hypnotherapy, and deep feeling regressive therapies (Grof 1975, 1985; Laing 1976; Feher, 1980; Verny, 1981; Janov, 1983; Noble, 1993)

Swartley (1978) worked with birth regression through deep feeling abreaction and concluded from observing thousands of birth regressions, in North America and Europe that the:

Degree of Trauma: Correlates positively with the degree of mutual cooperation between mother and foetus which is determined by many factors, such as:

1. Degree to which mother (i) desired and (ii) planned pregnancy.

2. First delivery or not. In general, the first child suffers most trauma for physical and emotional reasons. The mother is usually most frightened during the first delivery. Any trauma during the mother's birth is usually "triggered" most by the birth of her first child.

3. Size of mother's pelvic bone (smaller the pelvis, more traumatic the birth).

4. Size of the child's head and shoulders, umbilical cord, etc. (larger the head and shoulders, the more traumatic).

5. Health of the mother, as influenced by diet, addictions, amount of sleep and rest, etc.

6. Age of mother (can be too young or too old).

7. Drugs administered by obstetrician which inhibit participation of the mother (most of which pass through to inhibit participation of the foetus).

8. Age of foetus (premature, full term or postmature).

9. Disease(s) in mother (heart disease, diabetes, anaemia, etc.).

10. Foetal position - head first usually least traumatic; a breech (buttocks first) is usually most traumatic. (p. 39)

Enthusiastically fitting clients into the theories of the clinician can do much for the ego of the therapist, but the expected client compliance does little for the person seeking emotional health, and may even be harmful if it robs clients of their own reality.

Feher (1980) suggests we need to avoid, "making dogmatic statements: rather it must be seen that we are describing the patterns we have observed, and attempting to initiate imaginative thinking about the subject" (p. 164). After experiencing a particular birth condition a person may acquire feelings, life scripts or behaviours described in this section or they may not. There may be personal resilience, or other more positive life experiences which offset the stress of the trauma of birth: in addition, infants and young children can, in their own creative wisdom, find resourceful means of interpreting life events which are unique to that person. The stones cast in the ripples of birth are not islands unto themselves.

Birth issues in the psyche can be compounded with other life stresses which may have occurred in the nine months before birth or during the years of childhood. The more painful, and the earlier that prenatal trauma first occurs, the more likely there is to be a clustering of prenatal and birth traumas. In fact, in medical births, perinatal issues often come in clusters due to a series of traumas at birth, or in response to a spiralling of mishaps during birth.

Earlier prenatal trauma may make an infant more vulnerable to traumas during the rigours of birth, or set the foundations for a predisposition in the child to interpreting birth's severe stresses as trauma. Research of Barnett (1987) revealed, "of the 76 patients with a negative birth experience the surprising finding is that 48 (63%) had a prenatal negative experience responsible for, or contributing to, the negative birth feelings" (p. 202).

Various global birth feelings such as a sense of a lack of connection or sense of betrayal at birth can be particularly predominant when birth was preceded by significant prenatal stresses or traumas. Findeisen (1993) points to a few prenatal and other early wounds which may combine with the cataclysm of birth to haunt the person with a continuing sense of loss and disconnection:

Adoption, abortion, drug abuse, miscarriage, infant or maternal death, mental and physical illness, emotional rejection, and even anaesthesia have the potential to create life-long feelings of separation and loss. Healing these feelings requires that professionals acknowledge the causal relations between a human being's first imprints and later behaviour and development. (p. 65)

The psychology of birth can be significantly influenced by events and conditions of the prenatal period. This current work only sparsely addresses some of those prenatal issues, which will be discussed more thoroughly in a volume in preparation. The vast majority of therapeutic work in pre and perinatal psychology clinical practice and psychological theory has been done on the psychological issues surrounding birth. Perhaps an extensive area of discovery about human psychology will be the emotional foundations which result from the long genesis in the womb.

To develop an understanding of this area, more clinicians and clients will have to journey into the darkness and rhythm of embryonic waters. From my experiences of personally working with art and clinically working with art, I suspect that drawing, painting and sculpture will be important aids in the exploration and cartography of the prenatal realm. At times, that which can not initially be spoken or cognitively understood can be expressed in art. Art activity can help identify when and where a trauma occurred, how the trauma was perceived and interpreted, and in what way that prenatal trauma may have layered with subsequent psychological material. Verny (1994) suggests that a, "systematic study of the [pre- and perinatal] material that emerges in the course of psychotherapy is facilitated by identifying it with a specific stage of pre- and perinatal development (p. 161)." He proposes:

to use a Gestation Model in which I arbitrarily divide the first phase of life into six stages as follows:

A. Primary Germ Cell Stage

B. Conception Stage

C. Oviduct Stage

D. Implantation Stage

E. Uterine Stage

F. Labour and Birth Stage (p. 166)

BASIC PERINATAL MATRICES

Grof organizes perinatal experiences and their corresponding interweave in the fabric of the unconscious into four levels of "Basic Perinatal Matrices (BPM)" (p. 100). These perinatal matrices correlate with conditions and periods of the transition of birth, and according to Grof correlate with some innate structures which interpret human experience. Perinatally:

BPM I is associated with: Symbiotic Unity and the realm of the womb;

BPM II is associated with: Antagonism and the period of heavy labour when the cervix is still closed and the prenate is being crushed and contained and is not moving;

BPM III is associated with: Synergism and the transition of moving through the birth canal on dilated cervix;

BPM IV is associated with: Separation and being released from the birth canal and includes material from conditions immediately after birth.

When the conditions of life recapitulate the conditions of perinatal traumatic material, the psyche forms associative bridges linking seemingly similar events and feelings. There are many ways in which later life experience can be associated with perinatal conditions. These are likely to be in the context of: similarity to environmental conditions, sensation in any of the senses, type of feeling or depth of affect; whether the conditions are non-verbal or associated with change or transition; or if the external origin of the stress is coming from another individual one who is acting out from his or her perinatal matrix.

Organizing perinatal experience into four matrices provides a structure for relating the influence and interrelatedness of the perinatal realm with other life experience. When the individual's language elaborations are highly reflective of a sense of, "Not getting anywhere, being suffocated by the road blocks, and will die before anything moves on this" it may be worthy to explore material from BPM II. Whereas, metaphors of, "I've almost got it, I just need a little more time, I can barely breathe but I see the light ahead," may be indicative of material associated with BPM III. Verny (1994) suggests that therapist should, "familiarize themselves with the relationship between certain symptom clusters and perinatal matrices. I think this knowledge will improve considerably their ability to help clients with problems that originated at birth" (p. 180)

A person who indicates manifestations of a particular BPM matrix in the therapy setting can do so as the consequence of many different provocations and/or background causes. To name a few: it can mean that this is the particular stage of birth which created the primary trauma of birth; or this was the particular condition(s) of birth which was repeatedly reinforced by childhood circumstance or parenting styles; or there is something in the current life which is triggering or recapitulating a specific matrix; or that matrix and its issues are the ones that are surfacing in the client's natural progression of healing.

The therapeutic process can unfold along the lines of the Basic Perinatal Matrices, particularly when current issues are intricately interwoven with birth material, significant life changes or personal transformations, the breaking down or building up of relationships, new beginnings or endings; or psychological material associated with crises, transitions and transformations. The working through of any of these conditions can be found to follow the stages of the Basic Perinatal Matrices. Transitions or crisis can be viewed as unfolding in the order of the matrices starting from the first, BPM I, and moving through each to the last, BPM IV; or, more rarely, a person or situation may follow the categories in reverse order, moving from BPM IV back to BPM I. When trauma is overwhelming at a number of stages, the progression can go from the most recent to the earliest; or from the least severe stage to the one most difficult to face. These two scenarios are probably an artifact of the process of moving down psychologically into material in increasingly deeper layers of the psyche.

Some people live out of, and are in effect reliving, one particular Basic Perinatal Matrix, or they interpret or respond to certain life conditions or circumstances from one particular matrix or another. It is helpful to clinically identify and observing the particular Basic Perinatal Matrix a person is immediately associated with. This can allow therapist and client to understand and put into context some of the feelings, metaphors and issues the person is grappling with. The person can be more clearly supported in what they are moving through and can be assisted with resolution. Also therapist and client can anticipate and accept the next stages of therapeutic healing.

People may experience a hopeless no-exit crisis after a time of feeling everything is perfect. This conflict can be understood as a stage in the progression of healing. There is movement from BPM I to BPM II. The crisis is the surfacing of birth material from the Antagonism of BPM II after having connected with the Symbiotic Unity of BPM I. Client and therapist can realize that the person is not decompensating or digressing after a positive plateau, rather the person feeling the no-exit hopelessness is moving through the next stage in healing the effects of a traumatic birth. The person can be helped to understand the nature of their feeling of being pushed down and not getting anywhere. BPM II material may arise in association with a present situation which legitimately reflects the BPM II conditions. As an artifact of the birth issues which are surfacing, the intensity of the feelings are out of context with the current problem. It is in this sense that the original birth experience needs to be connected with and resolved.

Some clients find it highly useful to work with a model and language framework of birth matrices because it allows them a context to understand and organize their experience. Some people classically identify with the patterns and categories, or their birth work aligns with the various stages. For others the model does not make sense, feels too clinical, stereotyping or in some other way stifling.

Many find that when their life history and life patterns are viewed as a larger whole, one specific matrix and its elements and issues stand out slightly more than the others, but that they can see their issues, feelings and response patterns in several of the matrices.

Not all clinicians who work with birth material will find a divisional model of the birth process a helpful tool. For example Feher (1980) views:

pregnancy and birth as a continuous process, amenable to detailed phenomenological description, and full of "fringe facts" (events which cannot be precisely measured), both emotional and psychological. We thus oppose the more conventional view of birth as discrete, with entirely separable phases. (p. 61)

The theory or approach which is "right" is the one which works for and is in harmony with both client and therapist. Following below each Basic Perinatal Matrix will be discussed in greater detail.

First Basic Perinatal Matrix (BPM I) "Symbiotic Unity"

During BPM I, the intra-uterine experience of symbiotic unity prior to the onset of delivery the person largely feels security, protection, satisfaction and cosmic unity. Grof, like deMause (1982a) and others, does recognize that, although in utero conditions may be highly ideal, for various reasons there may be experiences of a toxic or threatening womb. The first perinatal matrix is associated with the period of time in the womb before birth. Grof (1985) describes:

The biological basis of this matrix is the experience of the original symbiotic unity of the fetus with the maternal organism at the time of intrauterine existence. During episodes

of undisturbed life in the womb, the conditions of the child can be close to ideal. However, a variety of factors of physical, chemical, biological, and

psychological nature can seriously interfere with this state. Also, during late stages of pregnancy, the situations my become less favourable because of the size of the child, of increasing mechanical constraint, or of the relative insufficiency of the placenta.

Pleasant and unpleasant intrauterine memories can be experienced in their concrete biological form. (p. 102)

Grof allows this matrix to incorporate the entire prenatal period. The prenatal period is a long interval to be influenced by the environment. The prenatal period is not just the passage of nine months of the same kind of life experience, but consists of the many extraordinary developments and changes which occur during conception, implantation, embryonic development and fetal growth. It is more likely that over the long duration of development and diversity of experience before being born that the conditions and psychological issues of the in utero period are far more complex than one prenatal stage would imply. Verny's theoretical model of a five prenatal gestational stages during the time in the womb is perhaps more in keeping with the great diversity of personal experiences reported in the prenatal period.

It is likely that for many the womb provides varying degrees of symbiotic union, and some interludes of being enveloped by an all nurturing and all protecting world. According to the cartography of Basic Perinatal Matrixes, BPM I would intersect with later life experiences of pleasure, relaxation, beautiful and natural scenery and art. In this light it may make sense that natalistic expression has such a powerful ability to return clients to womb experience. Artistically connecting with BPM I can provide a means of identifying and resolving prenatal distress. Additionally there may be significant strengths and fundamental foundations of connectedness or creativity which are reconnected with and/or further enhanced by BPM I natalistic activity.

Second Basic Perinatal Matrix (BPM II) "Antagonism"

BPM II, the second matrix, "Antagonism", is the reaction to the contractions in the first clinical stage of birth. It is here that the person feels the onset of the pressure of birth which may be accompanied by feelings of physical torment, claustrophobia, and hopelessness often mixed with guilt. BPM II may be associated with feelings of wanting to go back in order to seek relief from threat or despair. Of BPM II, Grof (1985) forwards:

This experiential pattern is related to the very onset of biological delivery and its first clinical stage. Here the original equilibrium of the intrauterine existence is disturbed, first by alarming chemical signals and then by muscular contractions. When this stage fully develops, the fetus is periodically constricted by uterine spasms; the cervix is closed and the way out is not yet available.

As in the previous matrix, this biological situation can be relived in a rather concrete and realistic fashion. The symbolic concomitant of the onset of delivery is the experience of cosmic engulfment. It involves overwhelming feelings of increasing anxiety and awareness of an imminent vital threat. (p. 111)

The infant locked in this stage of birth is experiencing physical pain and risk, with the feeling there is no way out. There may be a sense of betrayal by a nurturing universe and the mother. Lake (1979) portrays, "The mother for the first time, having supported the foetus for nine months, is now the aggressor, the relentless force that is against you, that seems determined to kill or destroy you" (p. 9). The tragedy the infant is locked in appears unresolvable, with death a possible outcome. If death does not come, death may be desired because of the overwhelming physical and emotional pain (Roedding, 1993).

Lake (1981) notes:

Although for most people the process of birth may be tough but tolerable, for some it can be devastating. Cataclysmic muscular convulsions turn a peaceful haven into a crushing hell. This "no-exit" phase, before the cervix begins to open, can last for some hours. The next phase, of travel through the pelvis, is at best an energetic struggle, at worst a brain-destroying, suffocating, twisting, tearing, crushing torture, in which the will to live may be extinguished and a longing to die take its place. (pp. 18-19)

THE MEDICALIZATION OF BIRTH

Both the complications during labour and the treatment following birth have been radically altered from nature by modern obstetrics. Medical routines and procedures have become major factors adding to the trauma of birth, thereby compounding and deepening its long term psychological wounds. Many of the physically intrusive medical interventions of birth are also psychologically threatening and their damage potentially, can be compounded. In addition to the difficult passage of the birth canal there may have been other assaults to the infant such as forceps, the intense and erratic contractions of inducted labour, fetal monitor wires painfully screwed into the scalp, and drugs. Not an overt assault but perhaps even more psychologically invasive and undermining is the general lack of acknowledgment, support or encouragement of the powerful primal mother-infant flow, the cooperation and knowingness of birth. In the twentieth century, The Century of Violence, Birth has been made more painful and psychologically unsensitive for infants.

Fodor (1949) did not know that in the second half of the twentieth century the psychological plight of the perinate would actually worsen in the majority of births. The proliferation of medical interventions has created more complications, not fewer, during hospital birth; in a spiral these birth complications have been medically responded to with additional complication-prone interventions. The solution for physicians who could not control the primal nature of vaginal birth seemed to be to reject the powerful biological, psychological and spiritual flow of birth.

As the ultimate statement of medical authority and power, children on a scale never before seen began entering the arms of parents through radical and invasive surgery. Caesarian sections became the passageway for twenty-five percent of births. In some hospitals ninety percent of births were surgical. For some doctors and social classes, ninety-nine percent of births were celebrated by the sterile and shiny knife of major surgery. In an attempt to avoid those regrettable incidents where nature might reign, C-sections were scheduled two weeks before expected term.

As the ultimate statement of medical authority and power, children on a scale never before seen began entering the arms of parents through radical and invasive surgery. Caesarian sections became the passageway for twenty-five percent of births. In some hospitals ninety percent of births were surgical. For some doctors and social classes, ninety-nine percent of births were celebrated by the sterile and shiny knife of major surgery. In an attempt to avoid those regrettable incidents where nature might reign, C-sections were scheduled two weeks before expected term.

Fodor suggests that a positive human reception following birth might ameliorate some of the psychological traumas of labour and indeed, the work of Emerson (1987) and Klaus and Kennell (1976) supports this position. Unfortunately, more often than not, the immediate post-birth medical technological theatre does not attempt to soothe and nurture the psychological distress of the human infant, rather physical and emotional pain is the prescription of the hour. After surviving the cataclysm of the crushing and suffocating passageway of birth, the already fragile and overwhelmed infant is further subjected to cold air, bright lights, early cutting of the cord, being hung upside-down by the ankles, abrasive rubbing of the skin, burning drops in the eyes, painful heal lancing, mutilation of the genitals and extended deprivation of maternal contact. With all these insensitive and cruel acts being inflicted on the infant there is little opportunity for psychological recovery. More likely, any conclusions and interpretations of the previous experience as being a negative trauma will be further validated and become more deeply entrenched as core feelings, world views and life patterns.

Opportunity for the mother or father to soothe, comfort and reassure the newborn is undermined by the authority of the neonatal nursery, which sends the message, "The medical authorities know best the needs of your child." Rather than continual touch, stroking and sharing glances, the newborn, in her infant-sized plastic petri dish is occasionally observed without touch for signs of her biological functions and stability.

It would seem that the director, writers and principle actors in the theatre of modern obstetrics studied Fodor's portrait of the genesis of the trauma of birth and decided to routinely produce the ultimate perinatal tragedy. As in the theatre, the non-speaking bit part actors do not really die, but unlike theatre they are tragically destined to continually relive the initial scenes of their first dramatic rite of passage.

A majority of children and adults born during the medicalization of childbirth are likely to be found to have some degree of birth trauma. It is likely that a good portion, or even as Houston (1993) figures, "most of the people alive today" (p. 53), are natally wounded. Noble (1993) points out that, "In 1988, 40 percent of births were unwanted" (p. 246). It is likely that a good number of adults seeking psychotherapy were unwanted pregnancies, and their "normal" births were all but normal (Liedloff, 1985). Noble (1993) further reports, "Less than 10 percent of women give birth naturally, without drugs or instruments" (p. 229). Research by Verny (1981) showed a significant percent of his adult subjects report pre- and perinatal stresses:

BIRTH AS A HAZARDOUS TRANSITION

It must be placed into psychological perspective that the real degree of distress at birth is reflected in the fact that, according to Stave (l970), "The drastic changeover from the intrauterine to the extrauterine environment is certainly the most hazardous event during the entire life-span of mammals" (p. 38). McKilligin (1970) punctuates, "More individuals die on the first day of life than on any subsequent day, and about ten to fifteen percent have transitional problems with varying degrees of morbidity" (p. 34). What McKilligin, like the majority of his medical colleagues, fails to recognize is the psychological experience of the child at birth. The combination of physical and emotional stresses and assaults at birth can be trying and even life-threatening. The life threats a birth cause devastating emotional distress.

ONLY TRAUMATIC BIRTHS ARE TRAUMATIC

There are some who suggest birth is nearly always traumatic (Rank, l923; Fodor 1949), there are some that suggest that only traumatic births are traumatic (Chamberlain, 1988; Peterson, 1984) and there are references to some people reporting having experienced positive births that influenced them in a positive way (Gabriel, 1992; Noble, 1993).

Much of what is know about the long lasting psychological consequences of the pre- and perinatal psychological realm comes from subjective and anecdotal accounts of clients working through distress and emotional problems (Verny 1981; Janov, 1983). As Furth (1988, p. 2) comments, "A positive complex is not usually why a patient seeks a therapist." The reports from the clinical setting are often biased toward "looking at what needs to be fixed and therefore what went wrong". Much of what we have clinically discovered about the lasting influences of the pre- and perinatal experience is apt to be skewed to the natally wounded. Verny (l981), remarking on his study of birth experiences of individual in therapy, agrees:

For some, the final exit in the birth process can vary from pleasurable to ecstatic, ranging from a sense of relief to one of accomplishment and victory (Grof 1985). Feher (l980) suggests that in the last stage of birth, "Some children just slip out. Others find this part of birth an ordeal, especially if instruments are used" (p. 191). The intervention of forceps at the victorious time when the exuberant struggle of birth is nearly over can be a patriarchal insult to the woman giving birth and to the infant who has worked so hard. Having someone step in and take over and interrupt the natural progression unfolding can be a let-down and disappointment for woman and child, and can create life-long feelings of resistance -- "Leave me alone," and "Let me do it myself," for the person robbed of the accomplishment of birth.

If the unity and flow of birth for mother and child is not interfered with, birth can have elements of pleasure and empowerment, as Khamsi (1987) notes: