In this passage Swartley posits birth trauma as being related primarily to the physical characteristics of the foetal head and the structure of the pelvis and cervix at the time of birth; and to a degree, to the emotional relationship of mother and child. Fodor (1949) and Swartley are largely in agreement with each other, theoretically, on the overall nature of the trauma of birth. In Fodor's passage, he places significant emphasis on the complications of labour and the reception given the newborn following birth.

Any theoretic model of the psyche can only be viewed as guide, or landmark for reference, and never should be used as a rigid formula describing all people or most people. In warning of the need for caution in generalizing, or even worse dogmatizing, psychological theories and interpretations of pre- and perinatal concerns Verny (1994) recounts a Greek myth:

Laing (1976), Mott (1960; 1964) and Peerbolt (1975) have written about the psychological constructs associated with Verny's first four stages of the Gestation Model. These prebirth developmental stages and points of possible physical and psychological peril introduce psychological foundation stones significantly before the extraordinary transition of birth.

In psychotherapy, particularly when employing art activity, it can be beneficial to acknowledge and listen to clients when they journey in the realms of birth or the womb. If the client has the courage to venture into the rhythm of the preverbal darkness the least the clinician can do is empathetically observe, acknowledge and follow. It would be considerate of the clinician to become familiar with the pre- and perinatal realm or to acknowledge the client's experience and refer to a specialist for this piece of work. In many cases, pre and perinatal issues can be resolved by using good therapeutic practice and following the path of the client. Generally clients, when respected for their own pacing and inner wisdom, will only journey deeply into those areas they have the strength to face and are ready to deal with.

Some of the most comprehensive theoretical work on the last two stages which Verny's model outlines has been developed by Grof (1975, 1985) with his theories of Basic Perinatal Matrices (BPM). I will discuss Grof's work in this area next.

I have heard many people say they were told their birth was normal. These supposedly normal births often have complications like a long labour, terrifying asphyxiation, anaesthesia, use of forceps, early cutting of the cord, being held upside down and hit, invasions in the mouth and nose, burning drops in the eyes, mutilation of the genitals and abandonment to a nursery. Janov (l977) argues, "the reason the birth trauma has such a tremendous [psychological] impact is that it's a life-and-death situation" (p. 65). The ten to fifteen per cent figure for infants with transitional problems of physical morbidity which McKilligin refers to, does not take into account the psychological and transitional problems which are not emphasized by obvious physical injury or illness.

In this age of institutional birth, the majority of infants have to cope not only with the biological ordeal of human birth, but will also be subjected to numerous medical assaults and invasions. Many of the traumas of birth which currently arise in psychotherapy exist because of conditions found in the hospital births of the past few generations of people.

Birth and the prenatal realm have another face for some. I spoke with a sculptor, who was also a grandmother. She said that she had always had a love of the sounds of hammers and construction. In the middle of all the sawing of lumber and clatter of tools she felt a special calm and relaxed feeling. A major renovation on her current house was nearing completion and she was already feeling a sadness that she was going to miss the sounds of the work. Over her life she had occasionally wondered what might have influenced these intensely pleasurable feelings.

When looking at and talking about my natalistic art, similar feelings came to her, and she made the connection that while in her mother's womb her parents were finishing construction on a house. Both the building of their own home and having a child come into their life were special to the parents. While becoming a member of a family she lived in a happy womb, surrounded with the constant pulse of the maternal heart but also surrounded with the rhythm of hammers and saws. It is possible these pleasurable conditions were still felt decades later. Sounds and the creativity of building through her sculpting were central features in her life and they seemed to have come from the initial early imprinting.

May-Gaskin (1977) forwards, "The knowledge that each and every childbirth is a spiritual experience has been forgotten by too many people in the world today, especially in countries with high levels of technology" (p. 11). Schwartz (1980) suggests that while birthing her baby the woman can have sensations which Maslow (1973) coined as "peak experiences." Schwartz (1980) elaborates, "childbearing can precipitate transcendent, ecstatic emotional states, similar to those cause by other intense experiences such as orgasm or the creation of art, contact with nature, or a spiritual experience" (p. 78). Schwartz (1980) suggests the pregnant mother, as well, may experience "complex dimensions" of an "altered state during the childbearing year" (p. 78).

Many subjects blamed their births for a variety of feelings and characterological traits (e.g., feeling crowded, fearful, frustrated, helpless, isolated, jealous, panicky, pressured, and vulnerable). Most common were disturbed relationships with mothers, and subjects generally believed this had originated during or even before birth. Subjects often felt their mothers did not help, love, reassure, support, or want them adequately. They reported a lack or loss of cooperation and contact, and sometimes became furious or contemptuous toward their mothers. (p. 55)

In the tribulation of birth the child can experience a deep sense of loss, rejection or abandonment from the person who had been the central figure of trust, dependability and nurture in life. These early feelings can leave life-long patterns of lack of trust, isolation, loneliness and longing. Some people have a global feeling that the world, all of life, has betrayed them in this sudden and unfair upheaval.

FOETAL AWARENESS OF EXTERNAL ENVIRONMENT

It seems the infant at birth can have feelings or perceptions of whether the mother, or even other people in the environment are welcoming or rejecting. There are people who report being cognizant of a variety of maternal awarenesses and emotions during the prenatal and birth periods. This is the case with particularly intense and/or repeated feelings. Verny (1981) mentions a Caesarean born woman who, "recalled her mother's dread as the surgeon prepared the incision: 'I could feel her terror as the knife began cutting across her stomach'" (p. 107). These early perceptions can establish part of the characteristics of the emotional relationship between the person and the environment of later life.

While in early regression people have reported knowing about thoughts, feelings, conditions -- not only in the mother -- but in the environment around the mother. Some individuals have reported an awareness of the experience of feelings or attitudes of the father, like whether he wanted a child of one gender or another.

One can interpret these reports as indicating that prenates have an ability, through some dynamic, to read the emotions of the people in their environment. One must wonder how this information is received. It may be difficult to explain exactly how the awareness occurs, but it is an experience reported by many at birth. Feher (1980) suggests that, at birth the child may be affected by maternal emotions when, "endorphins or similar substances known to affect pain are transmitted from the mother to the foetus during labour. If so, the degree of pain she suffers may affect him, and have repercussions on his consciousness" (p. 75). Verny suggests that, in addition to the transfer of emotions by hormones from the maternal circulatory system, there is a fetal/maternal clairvoyance which is some kind of intuitive reading of the other. Verny (1981) considers, "an unborn child can sense his mother's thoughts and feelings" (p. 43).

It is reasonable to consider that an intense emotion like maternal terror could be absorbed as a generalized feeling of fear by the foetus. This could easily be explained by the passing of triiodothyronine or thyroxine, which accelerates the metabolism, of the fear hormone ACTH, across the placenta (Ganough, 1974). But Verny (1981) and others speak of the prenate having awareness of much more discreet and specific material than generalized emotions from maternal hormones. Verny (1981) claims:

A highly complex subtle emotion such as ambivalence provides an even better example. As we have seen, ambivalence can have a harmful effect on an unborn. Yet, there is almost certainly no physiological state connected with it. The emotion is often so muted, the woman herself isn't even aware of it. I think the only logical explanation for these findings is what I have called "sympathetic communication". Evidently the child's emotional radar is so sharp that even the slightest tremors of maternal emotion register with him. (p. 89)

The connection with maternal consciousness by the foetus may be a combination of feelings generated by hormones passing across the placenta, combined with intuition or some kind of mental perception, with a knowing which could be attributed to the extraordinarily close physical proximity these two people share. If any two people were wrapped in an embrace for months on end, after a while they would likely begin to develop a fairly intuitive sense of what the other was experiencing, perceiving, or thinking about and considering what to do next. It is possible the mother perceives the larger environment and the prenate perceives her perception.

I find that when people make natalistic art, especially when using the technique drawing within a drawn womb surround, that the clients will often also incorporate psychological material, emotions and issues predominantly outside the womb surround. Inside the womb surround will be found the feelings that those maternal emotions activated for the prenates and the means by which they protected themselves or took care of their mothers. A comparison of the images, lines and colours inside and outside the womb surrounds often reflect toxic maternal material which penetrated into the womb environment. This content can be drawn completely unconsciously and unbeknownst to the artist.

Figure 5S: Two womb surround drawings: the left side explores womb trauma, the right side nurtures and repatterns the negative prenatal affect.

A vivid example of toxic parental emotions penetrating the womb can be found in the art of Dali which expressions can be found in the overwhelming feelings of his parents' unresolved grief over the loss of an earlier child. Dali spoke directly of the prenatal influence in his art. The prenatal elements of Dali's art is discussed further in Goertzen as a Natalistic Artist.

Figure 5F: As a pioneer in natalism Dali explores nagative prenatal grief through his art.

Figure 5U: Dali feels he psychologically returned to the realm of the womb through his artistic activities.

GLOBAL FEELINGS OF BIRTH

As mentioned earlier, the physical risks of birth can be traumatic due to their life-threatening nature. The attitudes and emotional atmosphere surrounding birth can impact in what Khamsi (1987) describes as, "global, pervasive impressions about existence" (p. 49). In this regard the prenate's experiences affects that person's later basic emotional and social sense of relationship to the greater world. Khamsi reports, "These 'lessons' were allegedly recognized during birth feelings and ostensibly learned at birth. The lessons included feeling held back, held down, helpless, unloved, or unwanted" (p. 49). The global perceptions in part have to do with the metaphorical physical relationships to the world and life's events; and a lifetime of self-image and self-worth. One's basic sense of personal value and purpose can be coloured by the emotional experience of birth. Khamsi ventures that in the context of global impressions:

Subjects claimed to learn that they don't have enough "space" in life, that they always have to "push like hell," or can't "get anywhere" without being rescued. Self-concepts seemed tarnished as well, with subjects reportedly learning at birth that they were stupid, inadequate, or a failure. (p.49)

THE LEGACY OF BIRTH

Early traumas are commonly at least one artifact of the various core issues in an adult's psyche and will show up in the art work and personal issues brought to or surfacing in therapy. The earliest life experiences can be viewed as the foundation stones upon which the architecture of the personality is constructed. According to Janov (1983):

These fears in adult life can be a shadowing legacy of the threatening conditions of the vulnerable and helpless infant being cataclysmically constricted during the passage of the birth canal.

Claustrophobia is not just the fear of being confined by a space; it also has a component of a fear of having one's way blocked, and a desperate need to get free. There can be a desperation to get to a place with breathing room, as in the case of the active third grade student of whom Emerson spoke. Lake (1980) explains:

The feelings and metaphors for claustrophobia arise for many people as the birth content of their personal issues begins to surface in therapy. These experiences can become particularly acute when the person is actually working with the memories.

I worked with a social worker whose paralysing fear of heights, bridges and cliffs had many of these same features of fear of suffocating, constriction and impending doom found associated with claustrophobia. In therapy, he connected the feelings with childhood threats and terror at birth. Several years later, after his birth work, we shared hot chocolate and cookies from a perch high above the top of nearby building. We scaled some open construction scaffolding, taking in the spectacular colours of a fall day in the city. A decade earlier he would have never suggested climbing a ladder, much less venturing on such a challenging adventure.

While in regression with natalistic art, feelings can come back as somatic sensation accompanying the art processes. It is important to voice the physical sensations experienced while producing therapeutic art. Being more aware of them may allow a clearer understanding of the original birth experience and its effects on life issues. Very often these somatic birth feelings need cathartic expression. This can be accomplished by projecting the sensation or feeling into a work of art, giving the body feelings sounds, movement, or words. While employing natalistic art in therapy the client often uses a combination of methods to release the emotional energy of the birth memory.

ELABORATION OF THE IMPRINT

Many pre and perinatal theorists suggest that the events surrounding birth are more likely to become life-long birth feelings or birth patterns when they are reinforced by later childhood events or strong parental attitudes (Feher, 1980; Lake, 1981; Verny, 1981; Janov, 1983; Noble, 1993). Many varied experiences can occur during birth, and in comparison, there is an even greater number of childhood experiences which can reinforce or compound the original birth trauma (Lake, 1979). Those later childhood events become interpreted through the lenses which were created to view and capture significant early events. Feher (1980), in writing of natal therapy, acknowledges that the development of personality is a fluid unfolding, "because we see all behaviour patterns as continuous: initiated in the womb, imprinted at birth, then remaining dormant until they become manifest at later critical stages of development" (p. 77).

The trauma of birth increases with the intensification of the infant's experience of isolation, helplessness, physical pain and fear. Khamsi (1987) reports:

 The sense of not being helped and that no one is there for the child during the struggles can turn turmoil into cataclysm. For the vulnerable infant who has to put aside and suppress these overwhelmingly painful feelings, later life events may be haunted by behavioural responses and feeling expressions of many of the experiences of birth.

Significant wounds to the psyche in the child can elicit the forces of a dormant early stress and in the later childhood event turn the initial birth stress into a birth trauma (Feher, 1980). The more a childhood stress or trauma coalesces with the feelings or conditions of the pre- or perinatal experience, the more likely it is that a layering will occur with the original early trauma and its feelings and issues.

For some the perinatal wounds are forever present as part of life's ongoing anxiety; these people may live in a constant state of birth feelings (Janov, (1983). For others the material of a trauma at birth comes to life in response to a particular childhood trauma or developmental stress. Grof (1985) concludes:

The actual nature and duration of childbirth is not the only factor in the development of psychopathology. It is obvious that among individuals whose birth was comparable, some may be relatively normal, while others could show various types and degrees of psychopathology. The question is how to reconcile this variation with the obvious significance of the perinatal level of the unconscious. The pool of difficult emotions and physical sensations derived from the birth trauma represents only a potential source of mental disorders. Whether psychopathology develops, what specific form it takes, and how serious it will be are critically co-determined by the individual's postnatal history and, thus, by the nature and dynamics of the COEX systems [stages of birth].

These are some of the most important messages which pre and perinatal psychology has to share: that what is most significant for the young infant and prenate in the womb is the care, empathy and love communicated to the child during and following the stresses of birth. It is not necessarily the physical trauma which creates the emotional shock which will have life-long effects on the person, but rather how empathic and supportive parents are to the child at the time of birth and later throughout childhood.

The long term follow-up studies of Emerson (1987) show that eighty-eight percent of children after having undergone his birth refacilitation therapy do not follow the usual behaviour characteristics of their particular type of birth, while twelve percent of treated infants still follow through with, "pathological symptom patterns" congruent with their particular birth schema. What seems to have happened with the treated but still traumatized children was that the parents were not supportive and empathic (that is the twelve percent failure group), and therefore reinforced the birth trauma in spite of the infants undergoing therapy (recent work of Emerson, soon to be published, shows, after further development of his approach, an even lower failure rate). In the untreated control group, eighty-five percent of children developed birth schemas in personality symptomatic of their type of birth while fifteen percent of the children showed no latent signs of birth trauma (Emerson, 1987).

AVERTING AN IMPRINT FROM TRAUMA AT BIRTH

The fifteen percent of untreated children who did not internalize a life time pattern symptomatic of their type of birth were children whose parents were sensitive and supportive (Emerson, 1987) says, "They seemed to be 'natural parents,' very much at ease with their children...they had the capacity to guess the likely outcomes of their child's birth" (p. 63). In other words, these fifteen percent of parents did not reinforce the various birth feelings that life is violent, that you fight to get what you want, that everything is pressure, and those whom you need most are going to suffocate and strangle you with their authority. The parents may even intuit the help the child needs to overcome the shadow of birth. For instance Emerson (1987) points to one father of a breech birth child who:

Guessed that his son might be directionally confused (one of the outcomes of breach birthing). The parents were able to consider negative outcomes in a relaxed (rather than serious) manner, and often with a sense of humour. The relationship with their child seemed contactful, caring, and free of manipulation or control. (p. 63)

Emerson (1987) has observed that it is more often later life conditions which entrench the initial negative life impressions perceived during birth. In his research and clinical work Emerson has observed, "children who developed pathologic patterns were exposed to exacerbating conditions. For example, one infant experienced severe containment during birth, and was also locked up in a closet by his brother and tied to a tree by friends" (p. 63). For this child, the restriction in the birth canal became part of the emotional force of specific and isolated later events. For another child, the reinforcement of being restricted could be the ongoing daily restriction of a long-term chronic illness, or a constantly controlling parent (Lake, 1981). It is when the conditions of birth are reinforced or recreated by childhood factors that a layering or compounding of the birth trauma and its influences occurs (Janov, 1983).

ENVIRONMENTAL FAMILIARITY

It is probable that when life's later conditions resonate enough with a perinatal distress, then the child or adult returns to the previous stress to seek assistance from the lessons of the earlier painful experience. Unfortunately, the repeated traumas can prove to the growing child that negative or dysfunctional learning from a painful time has some validity, and the person's wounded views may become more deeply entrenched. Lake (1978a) comments, "The experience of a bad birth becomes particularly crippling if it is locked-in and reinforced by a constrictive upbringing" (p. 11). As an example, the child of a long labour who later is pushed by a parent for whom the child can never be quite good enough. The child's birth schema of, "Getting started is really hard," becomes more deeply ingrained into "Life is really hard on me, and I can never be good enough." Their art work is hard to produce. They feel stuck with starting a picture which will not be good enough. In childhood, the unsatisfiable parent became the life long birth canal which the constricted child was always trying to get through, all the while fearing they never would.

Conversely if a child experienced a long labour with feelings of, "It is really hard to get through things. I do not have the energy to finish;" and then a supportive parent is intuitively aware the child is challenged by a sense of difficulty in life activities. The parent may naturally help the child overcome the sense of hardship. Lake (1978a), who expresses the view that a bad birth can become crippling when reinforced, also considers, "where an upbringing can provide warmth and security, all but the severest shocks to the energy-system at birth can be largely compensated for" (p. 11). In being supportive and nurturing, the parent will point out and praise the child's accomplishments with empowering praises like, "Oh, look what you did. Wow,!" or, "Look how far you've come along," or "Gee! You sure made that look easy." If the child says, "I can't do this, it takes forever," the encouraging and supportive parent might reply, "It looks hard, but I'm sure you can do it. Would you like some help the first time?" The parent gives the child some other form of healthy validation and encouragement. This intuitive support and praise will serve to repattern self-inhibiting or self-defeating birth trauma issues, the origins of which the parent may not even thoroughly know. When early life demonstrates a reality different than the initial birth trauma to the child, then it is possible that the messages of, "Life is hard, I can't get through," will not become a life long feeling pattern and belief.

Emerson (1987) found, in researching the behaviour patterns of children who previously experienced trauma during their births, that some children did not show personality traits expected to be associated with their particular birth experience. Emerson (1987) comments about these symptom-free children, "We also noticed an absence of reinforcing trauma...i.e., their childhoods were free of reinforcing conditions" (p. 63). If the child does not find their birth fears shadowing them in life, then the child can be open to new lessons. The child with a constricting umbilical cord around the neck at birth can learn from a care free childhood and supportive parents that, contrary to the birth experience, change does not always "tie you up" and there are lots of opportunities for fresh air and open spaces.

INJURY OR ILLNESS AS BIRTH TRAUMA REINFORCEMENT

Birth traumas are not reinforced solely by dysfunctional parenting. There simply are some life hurts and tragedies that come with the territory of living. Sometimes accidents during birth can cause the initial trauma: and then unfortunately, an accident(s) or operation(s) in later childhood will cause the reinforcement of the original negative response pattern. For example, if a child had a shoulder caught or even broken during birth, and then broke an arm or shoulder early in childhood, those incidents can become compounded into a life message like, "When you try out something new you get hurt." These messages are initiated as a form of self protection, but can develop into hypersensitivity or an alertness which can verge on hyper-vigilance. Problematic life patterns and messages were initially specific remedies most often carefully chosen, for dealing with some trauma or ongoing stress. Lake (1979) affirms:

They become imprinted, and there is a tendency later in life to have them as a kind of scanning mechanism, seeking out possibly similar experiences so as to be forewarned and forearmed of their approach and be prepared to deal with them. Often in the same way: that's the problem. The remedy is out of date. (p. 14)

The child who breaks a shoulder when moving into a new environment outside of the womb, and then again breaks an arm when trying out a new kind of swing, tries to prevent broken bones by avoiding new adventures. Unfortunately exciting activities and events may be avoided or passed over with the unintended repercussions of boredom and lack of challenge for a bright and inquisitive child.

Another example of psycho/social reinforcement of the birth trauma with an added physiological factor would be the situation of a child from a family with a history of asthma; who, due to asphyxiation in a long drugged birth, experiences difficulty in breathing. The original birth trauma could be interpreted as, "During life's stresses it is hard to breathe;" or "It is hard to get breathing room;" "The harder you try something, the harder it is to breathe" (Holden, l983). In part, the breathing trauma of birth would register psychophysiologically in the lungs, which is also a part of the body which is primarily genetically vulnerable for this particular child. Environmental allergies, bronchitis or pneumonia occurring in infancy can solidify the onset of childhood asthma. In this case, the child's asthma would have roots first in a biological weakness, second in the asphyxiation trauma at birth and third in illness or environmental allergies (Mellet, 1978). If subsequently in childhood, breathing is difficult, particularly during stressful activities or at certain times of the year, and if, as well, a parent is over protective and smothering,the child can feel there is no room to breathe. The physical and emotional conditions of childhood help to create a compounded layering of the original birth trauma perceptions and feelings around breathing difficulties as a metaphor symbolizing life (Noble, 1993).

CHILDHOOD TRAUMA AS REINFORCEMENT

In a case similar to the one of the boy who was tied to a tree by friends, Emerson (1984) discusses a third grade student who was referred to him because of hyperactivity and being behind academically several grades. It was observed, "She preferred to sit near the door or windows of the classroom and if she were to sit elsewhere her anxiety and activity would increase" (p. 8). Over a number of birth refacilitation sessions with Emerson, the child:

experienced intense anxiety about the contractions, and about containment in the womb. Several associated memories occurred, she'd been locked in a closet by her brother and another time she'd been locked in a small sitting room by her mother. Both scenes were very traumatic and very frightening to her. (p. 8)

Again the confinement of birth was compounded by later childhood confinements with the result that the child needed to be sure that, close by, there was a way to get out. In daily life, when the way out was not near by, the girl was very active, perhaps partly as a tension release and partly as an expression of needing to be on the move -- "To get out of here, NOW." Emerson reports that after working with the traumatic birth and childhood material over a number of sessions:

The hyperactivity disappeared almost completely, and was understood more in terms of claustrophobia, a specific anxiety reaction to birth and associated reinforcing conditions following birth.

Follow-up study a year later showed that she was making better than age grade progress and that progression towards more concentration and relaxation was increasing. (p. 8).

If she had been untreated it is possible that over the years her childhood hyperactivity would have resulted in further restrictions and control from her teachers and parents with the result of further feelings of overwhelming containment and a need for greater rebellion.

PHYSICAL TRAUMA AT BIRTH

One of the keys to resolving the legacy of early trauma is for clinicians not only to accept infant consciousness, but to have some of the skills to recognize the reverberations of birth issues. Pre- and perinatal traumas often involve some degree of physical threat. As such it is generally those psychotherapies which give credence to painful physical experiences and their later somatic expression in which clients will discover issues related to birth trauma. Freudian and psychodynamic models have generally focused on psychological interaction, the history of personal relationships, family dynamics, and object relations. Generally these approaches ignore the various physical traumas of life, unless in some way the physical peril was a direct expression of relationships and then it is often the psychology of the relationship and not the psychology of the physical injury which is therapeutically explored. Grof (1985) assures that, "In traditional psychology, psychiatry, and psychotherapy, there is an exclusive focus on psychological traumas. Physical traumas are not thought to have a direct influence on the psychological development of the individual or to participate in the genesis of psychopathology" (p.97). There usually is not much of a consideration of how illness, an operation, a broken leg or other physically threatening medical or accidental experiences can become interwoven in the fabric of the psyche. Grof (1985) explains that when a child has to cope with, "a serious life-threatening disease," the psychology of the physical threat would not be of primary concern; rather, "conventional psychology would focus on the fact that the child, having been separated from the mother at the time of hospitalization, experienced emotional deprivation" (p. 98).

On the other hand experiential therapies focusing on feelings often recognize and acknowledge body urges and somatic sensations as part of the expression of the inner psyche. These body expressions allow another layer of the psyche to be explored therapeutically. Grof (1975; 1985) was one of the first to recognize the fundamental significance of extreme physical discomfort, trauma, illness or operations in his theoretical model of psychodynamics. Grof (1985) observes that in the practice of:

powerful experiential approaches, reliving life-threatening diseases, injuries, operations, or situations of near-drowning are extremely common and their significance clearly far exceeds that of the usual psychotraumas. The residual emotions and physical sensations from situations that threatened survival or the integrity of the organism appear to have a significant role in the development of various forms of psychopathology, as yet unrecognized by academic science. (pp. 97-98)

As has been noted previously, the experience of birth can be filled with various forms of physical trauma. Through acknowledging physical trauma and the impact of physical experiences on personality Grof, (1975) ended up hearing from his clients about operations or illnesses that might have had an effect on personality. He also ended up reviving client accounts of birth material which often involved physical risk as a major component of the psychological trauma.

SOMATIC EXPRESSION OF BIRTH MEMORY

When the beginnings of life have been perilous, the area where the trauma was impacted during birth is generally the same area where other later stresses are stored and processed by the body. When the somatic expression of anxiety and life patterns is explored, a relationship between physical events and sensations of the perinatal environment may be found to coalesce with a person's interpretation of later environments and conditions. In processing later life stresses, the person will have employed the areas of the body and psyche which previously dealt with stress, and will be therefore familiar with coping with stresses. Feher (1980) notes, "The point of most traumatic climax in birth will predispose the person to a pattern, and mark the choice of symptom formation in any response" (p. 191).

Through somatic echoes of the stresses of birth, later life stresses can be interpreted as various forms of pressure, different means of having to get through something, a variety of challenges to one's freedom or various expressions of not being able to breathe. Being cheeky, heady, elbowy, shouldering, a pain in the neck, a headache, breathless, spineless, butt first, can all be somatic expressions of birth conditions. They are birth elements to listen for in clients' language, sentences and in art process and imagery. In clients' drawings of an adult, child, baby or fetus, the points of birth impact may unconsciously come out in the figure of the drawing. When the client lies on a large piece of paper to do a drawing, the point of perinatal impact on the body may show up on the paper corresponding to the location of that body part which was laying on the paper.

When the physical impact of trauma at birth was to the shoulder, the person may develop a response pattern of carrying the weight of the world on his or her shoulders, or will be concerned with "just putting a shoulder into it and pushing right through" -- perhaps a good lineman. The area of the body which was impacted by trauma in birth or during some prenatal injury is a site which first learns to deal with stress. That region or exact spot may "take the fall" in later stresses or accidents because it "knows" what to do. Most people will have a particular shoulder, leg, side of the body or area of the head where a number of injuries have occurred.

Emerson suggests that this pattern of absorbing stress in particular areas is an extension of the original birth body schemas and is part of a movement pattern associated with the patterns of a person's birth movements and birth trauma. When the person slips and bumps into something, or an object moves toward the person, the unconscious learned instincts of the body spontaneously respond with the "right place" to absorb and manage the impending trauma. In art works, these sites of natal and repeated trauma may show up as patterns or colours in particular areas of the drawings. While doing art in therapy, those areas of birth impact may become sore, tense or in some other way distressed.

CRANIAL BIRTH TRAUMA

Verny (l981) claims, "Most infants present frontally, which means the head and neck are the two body areas that receive the greatest battering during birth" (p. 118). The fascia or muscle tissue surrounding the cranium may reveal some of the history of each individual's birth. Areas of tension, soreness or pressure may be sites of body memory about the stresses of birth. A light massage or light pressure may assist the birth trauma memory to surface therapeutically and reveal some of the feelings and issues surrounding the trauma of birth.

It should not be surprising that two common reactions to stress and life's obstacles are a headache or feeling like things are "a pain in the neck". Indeed, creating natalistic art can be associated with pressure headaches or neck and back pain. As early as 1945 Greenacre saw a relationship between the head sensation and headaches which appear under stress and the experiences in the birth canal. Greenacre (1945) forwards:

In my experience the type of head sensation may often be correlated quite definitely with the form of birth experience of the individual and appears under any conditions of very severe anxiety, but especially in later life situations in which the subject of birth is being stirred in the unconscious of the patient. (p. 48)

Noble (1993) agrees:

Headaches commonly are birth related and consist of many types. They can arise from natural birth or instruments. Neck tension may be traced to improper head rotation during birth. Migraines differ from pressure headaches because they often result from oxygen loss at birth, coupled with an associated build up of excess carbon dioxide. Carbon dioxide is a powerful dilator of blood vessels, and that sudden dilation is the chief ingredient of a migraine. Adult stress evokes that original loss of oxygen with all its painful repercussions. (p. 125)

Grof (1985) broadens this perspective, and considers symptoms which point to birth traumas:

The typical physical concomitants of various emotional disorders make much sense if considered in this light. They involve belt headaches or migraine headaches; palpitations and other cardiac complaints; a subjective sense of a lack of oxygen and breathing difficulties under emotional stress; muscular pains, tensions, tremors, cramps, and seizure-like activities; nausea and vomiting; painful uterine contractions; activation of the gastrointestinal tract, resulting in spastic constipation or diarrhoea; profuse sweating; hot flashes alternating with chills; and changes of skin circulation and various dermatological manifestations. (p. 250)

The overwhelming terror experienced while being trapped in or against the birth canal can be very real for the infant. Roedding (1991) describes the feeling in this way:

The experience in the birth canal can be a devastating and hopeless one, to say the least. Crushing from the constriction of the vagina, suffocation from prolonged pressure on the cord, forceps clawing at a delicate and vulnerable head, drugs rendering the fetus limp and even more helpless. (p. 155)

The head and lungs are the most severely affected during the birth process. In the process of being pushed against and then moving through the cervix, the body is compressed and crushed to the degree of causing the skull bones to reshape in a process called moulding. May-Gaskin (1977) explains:

Moulding is the change in the shape of the baby's skull that takes place when the moveable bones of the skull that are loosely joined by membranes slide over each other, reducing the circumference of the skull. When these bones overlap, the frontal and occipital bones pass under the partiental bones, and one of the parietal bones may lip over the other. (p. 308)

During moulding the volume within the skull does not change (May-Gaskin, 1977), but as the plates of the skull can actually overlap each other and the volume displacement inside the cranial cavity can be as much as 25%. The adult head could not withstand the stresses and assaults which occur to the infant head during birth. In a comparable assault to an adult's head the cranium would be broken in several locations with fatal consequences. Fortunately the neonate's head is quite malleable and as yet not solidified, plates of the cranium temporarily remould themselves in order for the head to navigate the various obstacles in the passage of the birth canal. Indeed more brain cells are lost during birth than at any other time in life.

Often the cranium does not fully return to its original shape after birth. The shape of most people's heads show clearly some of the experiences of birth. While slipping through the birth canal, the cranium becomes slightly elongated in a direction in relation to the presenting features. Oxorn (1980) describes as the soft bone infant skull moves through the birth canal:

Illustration by ADAM from U.S. National Library of Medicine

Cosmetic molding reminiscent of the
impact of birth

"Artificial cranial deformation by the prehistoric Peruvian people."

Compression in one direction is accompanied by expansion in another, and hence the volume of the skull is not reduced....

Alteration of the shape of the head is produced by compression of the presenting diameter, with resultant bulging of the diameter that is at right angles. For example, in the occipitoanterior [upper back of the skull] position the suboccipitobregmatic [a diagonal circle above and behind the ears from top front to lower back] is the presenting diameter. The head therefore is elongated in the verticomental diameter, with bulging behind and above. (p. 44)

When not remoulded, the cranium does not fully return to its original shape after birth, rather an imprint of birth is sculpted into the shape of the head. A smooth straight forehead and a smooth straight face will likely belong to a person who went through a no-labour, elective caesarian section. The cranium of the person born by elective caesarean generally does not have to engage the birth canal or experience the deforming toil of the birth canal. In a last minute caesarean section due to fetal distress in a long labour, some cranial moulding may have begun, but as a whole, the head and facial features are not significantly reformed by the process of moving through the birth canal. The c-section babies are the cute little darlings in the nursery. Their faces are not all scrunched up from the arduous passage through the birth canal. Lake (l966) has observed that, while in birth regression, some people:

are acutely aware that their experience of the crushing of the head in the birth passages was so severe as to reach the margin of tolerance and even to exceed it. They have wished, like Job, that the gates of the womb would close against them and that they might return deep into the womb. Several patients have spoken of this moment of indecision, as if it depended on the baby either to will to go on, through the pain to the point of birth, or whether to dissociate entirely from that forward movement in a death-wish, or a regressive wish to return to the safe place (p. 625).

Fortunately, the fear and terror of birth can be resolved and left behind as a memory of what was, and no longer of what is. To be able finally to leave those overwhelming emotions in the past it seems important to recognize and appreciate their existence.

BIRTH TRAUMA TO THE LUNGS

If the stress was to the lungs, the person copes with stress through their lungs and issues around breath. For instance, when the toddler is presented with a stressful experience, the body remembers the initial stress of birth, which became the prototype for stress. When the young child's body is triggered into the shadow of the not too distant birth feelings and memories, the body and psyche employ the learning from the earlier stress to cope with the current stresses. Lake (1979) suggests, " This occurs because the dissociated primal experience is still taking place on reverberating circuits and in cell memory. This is exacerbated by current crises, ordering mobilisation on all the old battle fronts" (p. 14). The child interprets the ongoing life problem as emotional pressure, a parental barrier or a hardship which has to be struggled through.

Figure 5W: "Oxygen deprivation is a continual threat in traumatic birth." image by Giger.

Birth anxiety, as well as being stored in the skeletal musculature, may be stored and resonate in the organs as well. An example of a body carrying the anxiety of birth is the lungs in the condition of asthma. Adults or children may come to birth refacilitation therapy for dealing with both behavioral and physical issues around asthma. Asthma is about breath and not letting it go. The asthmatic's problem is in not letting all his/her air out so new fresh air can replace it. The asthmatic may be holding on and not letting go in other physical or emotional ways as well. Janov (1983) claims that oxygen deprivation is a continual threat in a traumatic birth as a result of, "temporarily drowning in amniotic fluid.... having the oxygen supply cut off by a twisted umbilical cord.... being too drugged to take that first breath outside the canal" (p. 83)

In these people, the initial trauma occurred to a therefore is associated with, the lungs. Somatically, this is like when impacts to the cranium and musculature are stored in the traumatized site and become habituated schemas.

Stress to the lungs resides in the tissue and musculature surrounding the lungs. The lungs can therefore be a site that resonates specific perinatal anxiety. Janov (1983) refers to a study at the Pediatric Allergy Clinic of New York Hospital where, "asthmatic children were found to have twice as many neonatal complications as non-asthmatic children. The researchers concluded: 'Clearly this study shows that a stressful birth significantly increases the chances of a child's developing asthma'" (p. 83). English (1985) drew a natalistic drawing as a way of further exploring natal feelings of suffocation and aesthesia which surfaced in a dream. According to English (1985):

I awoke with an intense dream image: A baby bottle tilted, nipple down, filled with water or a pale juice. In it, there is a baby drowning

This dream seems to be about the aesthesia. I may have experienced a lack of oxygen that felt like drowning. the baby bottle is perhaps the uterus, and the fluid the amniotic fluid [English's italics]. (p. 52)

SOMATIC METAPHORS

When the older child starts acquiring developed language with metaphor, phrases like: "under pressure", "up against the wall", and "can't get through" feel right and congruent with the internal experience of stress. Greenacre (1945) observes, "Birth seems to organize the anxiety pattern, setting in motion the genetically determined elements fused with those individually determined ones resulting from the special or unique birth experiences of the given infant" (p. 44). Essentially, language and all its elaborations become layered on the long term body responses which were manifested in birth and which have been interpreting stressful situations since. Feher (1980) concurs:

If he chooses a response learned during birth, the response is thereby reinforced and so has a greater possibility of being chosen again. The next time he may again choose and modify it, and again, so that by the time he enters adulthood all his responses may be duplicated or modified birth responses. (p. 19)

Over the decades, the threads of birth can become quite woven into the fabric of life, so that physical sensations, emotions, movement patterns, metaphors, language elaborations, and life scripts can all be partially wrapped in the unconscious cloth of birth. Janov (l983) presents one client's brief account which demonstrates the complex twists a highly traumatic birth experience can take:

I could never tolerate anything over me - anything overpowering me. My body seems to remember something I can't really explain. It just feels like basic survival. I know that I was born not breathing and almost dead. My mother said I wasn't breathing at all and that I was blue. Even the spanking by the doctor didn't help; they had to give me an injection. It must have made me nauseous, because nausea seems to be my first reaction to almost anything. In any catastrophe I get a funny taste which seems to be the dope they gave me at birth. I sort of smell it rather than taste it. As soon as I get that smell I get all fuzzy-headed and confused. (p. 20)

This man's struggle for survival was manifest in his body telling him to avoid anything which might overpower him. When he was in a crisis, it returned to quite vivid sensations of the drugs used during the birth. Greenacre (1945) considers there are a great variety of individual variations: one person feels his anxiety with creepy sensations in the skin, another in weakness in the legs, a third with headache, a fourth with diarrhoea. One could go on to many more examples. From a careful scrutiny of reconstructed material from analytic patients, it seems that such patterning of the anxiety reaction always represents the genetic constitutional elements fused with birth experiences and further mediated through and increased by the traumata of the early years, with which we are so used to dealing in our analytic work. (p. 44)

When directly explored, the many metaphors for the physical events and conditions of birth are often fairly straight forward to identify and understand. When life responses are viewed from the perspective of possible birth content, many things quickly fall into place. Buchheimer (1987) has observed "patients may be talking about their birth when they use idiomatic expressions or metaphors" which express the physical process and sensations of birth (p. 75). To look at the metaphorical expressions of birth it is important to review the physiological conditions of birth.

Asphyxiation and other physical hardships and threats which take place in the process of birth seem to leave physical impressions that later come out in the person's world view, personality, life patterns or reactions to stress. Janov (1983) also observes:

Later situations of stress will tend to elicit the prototypic sensations. Someone who fights with his wife may find himself choking or becoming dizzy. A grown child watching his parents fight may suffer from feelings of suffocation which have no organic basis. Or, the sensations can also persist in chronic form such as a kind of endemic fatigue where fatigue is the result of an excruciatingly long birth which became a stamped-in condition. Under later stress the person's first response will be overwhelming fatigue. (p. 71)

BIRTH SCHEMAS

Emerson calls the physical echoes of birth "birth schemas". Emerson (1984a) has delineated the various schemas which evolve out of birth movements. He found that schemas are characterological, that they persist into adulthood, and that they express as well as perpetuate unintegrated primal trauma. Emerson (1987) asserts, "For these reasons, it is important to diagnose dysfunctional birth schemas.... and to initiate the discovery and repatterning of more functional movements" (p. 66).

Emerson (1989) suggests:

Most early traumas are associated with movement and with schematic development. For example, the attempt to save oneself from an abortion attempt is primarily one of movement (i.e., moving away from the threatening force, whether biochemical or physical). Birth is a movement experience, and an attempt on the part of the fetus to move from the uterus to the world. Bonding and attachment involve attempts on the parts of newly born children to move toward (or away from) the birthing parents (with eyes, ears, and/or anatomical parts). Movement forms an integral part of fetal and infant learning, and associated schemas accrue into adulthood. It is common to find prenatal and birth schemas in the physical (although unconscious) repertoire of adults, and to find that significant life patterns do not resolve themselves until the prenatal birth schemas are repatterned. (p. 200)

Emerson (l987) used video tapes to observe and explore movement patterns in various settings, and in particular people who were under stress or discussing significant life issues. He noted, "These tapes show that birthing movements become stylized, and are spontaneously repeated in various postnatal circumstances. Repetition of these movements allows a 'Diagnosis' of the movements and pressures which occurred during birth" (p. 62)

The qualities of movement associated with producing art can allow both assessment and repatterning of the physical schematic level of birth trauma. To facilitate clients' schematic repatterning, the clinician needs to become familiar with these physical birth schemas and their meaning. In the therapy setting, repatterning can be facilitated through studying the clients' movement patterns while they are producing art or while they are talking about their issues on video tapes.

It is fascinating to review these video tapes in either fast or slow motion. The person seems to have a series of quirks in body movement while they are talking. Usually, a movement pattern or set of movement patterns emerges as a long segment is viewed. These movement patterns repeat themselves and involve specific head movements and/or perhaps a hand repeatedly touching a specific head or shoulder location. For example during speech, the head may push down. As the theme of conversation develops the person touches a particular spot on the side of the face. A few words later the head will push out in that direction. As the "point" of the argument emerges, the person twists the head as though navigating it up and out. When the point is finished the person will physically gesture his/her relief at getting through this ordeal. While engaged in conversation, the person has followed a head motion and movement sequence pattern similar to that of his/her passage through the birth canal. It is as though the person's birth schemas are impacting on life patterns and are being continually relived in the physical manifestation of language. Observation of physical movements and their patterns during conversation can give an encapsulated view of larger birth patterns manifested in the individual's response to the stresses of adult life.

BIRTH SCHEMAS IN ART

It is quite remarkable that, in a body schema which has developed from a traumatic forceps birth, the person will reach a point of confusion in conversation or in drawing. At this point, their head may shake back and forth as the person somatically tries to wrestle free of the forceps and the current argument or conflict with the art which his or her forceps-oppositional personality has got him/her into. When a shoulder has been stuck particularly painfully or for a long time during birth, the person may lean into the conversation or push with that shoulder while drawing. Some people will grab their head just as they are trying to get through a particularly difficult part of their conversation or art; others touch their navel when feeling something is missing in what they are saying or drawing. They are reaching for or pointing out that there are issues around a lost umbilical friend.

In daily life and relationship patterns, the body schemas are often accompanied by associated language, belief system and behavioral metaphors. The "forceps person" may be heady and oppositional, trying to use his or her head to break free from, and work out, the stresses which often "grip" his/her head while working through a task. Their art work may involve some form of oppositional struggle which is solved through using the head. Somebody with breathing or asphyxiation problems at birth may place a palm on his/her chest or mouth, (subconsciously indicating where the stress is occurring speech and drawing. They may use metaphors of being suffocated in relationships or needing room to breathe.

REPATTERNING PHYSICAL SCHEMAS

In working with infants and young children around an assortment of conditions, Emerson (1987) discusses problematic personality traits or physical disorders which are beginning to develop, and diagnoses, through observation and physical manipulation, birth movement schemas which have begun to habituate in the tissue and in movement patterns.

One infant Emerson (1987) describes had a right-occiput (ROA) presentation:

her birth position was on her right side, facing the left arm of her mother. As she emerged from the womb, her head rotated counterclockwise a quarter turn, and then corrected back to its original position as the right occiput and anterior portion of her head presented itself upon birth. As we placed her in this position and physically simulated the womb and the pelvic orifice with our bodies and hands, she initiated these exact movements, with associated emotional catharses. (p. 62)

To support birth refacilitation, Emerson (1987) frequently uses the techniques of womb-simulation, psychomotor re-stimulation and physical simulation which, "involves a gentle re-creation of the physical aspects of birth" (p. 62). With the gentlest of "birth massage" and "birth refacilitation" the birth anxiety is brought to the surface. At first, seeing his work, it is often surprising to observe how the infant will clearly take charge of recreating his/her birth drama. This provides a means of telling the story, discharging the anxiety, and accepting the empathy and acknowledgement offered to him/her.

These children seem to know that they need to release the pent up anxiety in their bodies and gravitate towards empathic recognition and acknowledgement. To observe this work with infants is a telling experience. It demonstrates the naturalness and validity of the therapeutic growth process. These youngest of people have at their core an innate motivation to work towards psychological health, resolution and integration.

LABOUR LIE

Emerson identifies one form of body schema as being related to what he calls the labour lie. The labour lie is the side and position the baby is in before labour starts and before the baby's head engages for the descent through the birth canal. The baby often lies on one side or the other for a couple of weeks before the labour starts. The side of their labour lie is often also the side a person will tend to sleep on. Often the side the client naturally and intuitively chooses to lie on to do a birth regression drawing will be the side of the labour lie.

The side of the labour lie holds stress and physical and emotional stress cause a degree of muscular tightening and contraction. Habitual contraction on one side of the body will cause the head to tilt slightly to that side; the shoulder on that side to drop; the torso to compress on the one side causing the body to curve; and the leg on the more tense side to contract and actually become shorter. The birth lie may actually be seen in slightly distorted and drooping features on one side of the face over the other. In this way, the entire body responds to the initial birth trauma and the unique pattern forms in which many later traumas will be interpreted and stored by the body.

When there is an incident of possible injury, like falling off a bike or slipping on the ice, it is common to have the side of the birth lie try to protect the person from the impact of the fall. Over a lifetime, the side of the birth lie often has had more physical injuries than the other side.

A person who is a right lie will often experience the traumas of birth, like pushing in a hard long labour, in the right side of the head or the right shoulder. The body schema of right-sided lie is a simple model of a straight forward uncomplicated right sided lie birth posture. As with other life events, people and their births are idiosyncratic and theories and models generally serve at best only as guidelines to reflect upon when watching and listening to someone's experience. A right sided lie who has a forceps impact on the left side of the face or got the left shoulder caught can have a compound left sided lie. Here much of the body may be torsioned to the right and a shoulder or a portion of the face may be contracted in a manner reflecting the left side assault.

TRANSMARGINAL EXPERIENCE OF BIRTH

It is unfortunate that so few realize that tiny helpless infants can actually be waiting to die because of the degree of pain being inflicted on them in the crushing, constricting annihilation of birth. The infant locked in the container of birth may simultaneously experience a significant deprivation of oxygen and thus have the terror of suffocation added to the intolerable torture of being crushed. Lake, 1966, allows:

There is no doubt in the mind of several patients that they had already passed the limit of tolerance of pain during this descent, in the second stage of labour. They had already lost all trust in the world into which they were being thrust out. They would much rather have been annihilated on the way. (pp. 626)

During the intolerable burden of birth, the infant can feel, "I am dying. Why is she doing this to me? What have I done wrong to deserve this?" In the midst of a life/death crisis the prenate contemplates, " For my very life, I have to fight to get out of here, or go all the way back to there." The infant cannot make sense of why the all-powerful and all nurturing universe of mother would betray him with such brutality. Pain, logic and naive innocence weave a rationale of self-blame. Lake (1979a) portrays the vulnerable infant trying to make sense of a contracting uterus which feels like a crushing assault:

"It must be something that I have done wrong." It is too difficult to blame "the other". A profound guilt arises that "I got myself into this mess. It was all right. Then all this started after one of my mischievous kicks. Instead of just getting the expected mild reaction, all hell was let loose and the world as I knew it is coming to a violent or a sticky end. And it's all my fault." (p.10)

 At certain points in birth the baby may even feel as if death is imminent and unavoidable. Numbing drugs can add to the sense of hopelessness and impending death. The baby can also feel the devastation of perceiving that the mother has died -- "Why else would she give up like that?" This is particularly true when drugs are used in birth. The infant feels that the mother has given up and that she may be dying or dead. A difficult birth can be quite cruel to a vulnerable and innocent tiny child.

BIRTH RAGE

There can be feelings of rage against all the cruelty surrounding the transformation of birth. Indeed, some children come out raging. One mother of a grown daughter told me in reflection, "I have never seen her as angry as she was when she came back from the nursery after birth." Verny (1981) agrees, "Anger is another birth legacy we all share. It is a widely accepted psychological principle that pain produces anger and, since even the best births involve pain, it is inevitable that all of us are left with a subconscious residue of primal anger" (pp. 123-4). When being hurt and betrayed it is natural to feel anger. When the overwhelming hurt and betrayal and anger at birth become buried, they follow as shadows through life.

If the initial anger of birth evolves into life patterns they can become ways of expressing resistance or needing freedom such as the birth metaphors of: "Being headstrong," "No one is going to stop me," or "Fighting to get through", "Don't get in my way," just to name a few. Projected birth rage and indignation emerges as metaphorical expressions of violence such as, "Who do they think they are to push me around," "Wanting to rap him in the head," "Knocking some sense into their heads," or "Squeeze the life out of the S.O.B." The rage of birth often evolves from a sense of intrusion, invasion and violation. The art work of Giger clearly expresses the violent rage of being violated and invaded during birth (Grof, 1985). Emerson (1989) has observed that, "many children with aggressive behaviours also have birth traumas which involve an "overuse" of medical interventions (e.g. using forceps or suction devices when they may not be required, doing extensive postnatal and paediatric examinations, etc.)" (p. 201). Later life language elaborations for the anger against the invasive medical interventions can come out as, "Get out of my face," -- all the penetrations to the infant's face directly after birth; "Stick it to him," or "They're going to stick it to me" -- deep heal lancing; "Shove it down your throat" or "Don't make me gag" -- suctioning; "Cut them off," -- cutting cord before breathing has been established. One client of Janov's (1983) acknowledged:

Anger has been my lifelong defense. It started in the womb as a means to stay alive. In fact, that aggression was the only thing that kept me alive. I fought and struggled to try to make myself understood at birth - to make it understood that I was dying. (p. 20)

The anger occurs because the life threats and pain and hurts feel like they are being senselessly inflicted. Working through the intense anger of birth can be difficult, because often, underneath that anger, are the terrifying memories of the innocent infant-within who struggled against death at birth. Farrant (1987) shares the insights of a man who was working with the underlying causes of his nearly constant feelings of anger which were coming out in the work setting. As a result of a preverbal regression, the client says:

I quickly discovered it [the anger] in my own birth as I couldn't barely breathe at all.... Every time I went into a deep breathing state and a deep feeling state I soon got to the point where I couldn't actually get my breath...it was absolutely terrifying. I used to think I was dying....

I found it quite hard at first to face that... I began to understand that maybe my difficulty with breath may be related to some of the anger... That was very helpful to me in my work. (p. 30)

BODY MEMORY METAPHORS OF BIRTH

Generally the lasting traumas of birth involve various assaults and threats which are later associated with similar experiences. Due to body memory and the dynamics of physical and emotional shock, when early experience is at the root of later character traits and adult symptomology, the particular conditions which were at play at birth will often be, at least partially, expressed in the original physical sensations of that birth, or will be coded in symbolic or metaphorical expressions of the physical conditions of the events of the birth. Hendricks and Hendricks (1987) allow: "Clients who are replaying elements of birth trauma frequently say they feel stuck. The word 'pressure' comes up in their conversation, and they may use other metaphors such as 'jammed' or 'can't get out'" (p. 234). These are psychological metaphors which originate in, and reverberate, with early physical conditions. They may be viewed as the psychophysiological memory of birth (Janov, 1974).

many of these deeply depressed patients were experiencing physical symptoms. Feelings of heart strain, breathing difficulties not related to bronchial pathology, tightness round the chest, headaches and localised pains that shifted. Nobody had ever explained what these might be related to. Well, now we know. They are the remembered physical concomitants of this phase of birth, resonating because similar patterned events are obstructing this man's forward momentum in life. And the typical feelings of worthlessness, uselessness, irrational guilt and culpability, loss of competence and power to make progress, which are incomprehensible as adult responses to this constricting life situation, are actually recalled as part of the experience of this stage of labour, as soon as "reliving" it takes place. I am often amused at the relative ease with which these stubborn, silent men move into reliving their births.(p. 11)

Often, just giving permission to have a birth regression or to make birth art or poetry will be enough to allow a person to connect deeply with the pre-and perinatal realm. Once healing contact has been made with birth material there may be a reservoir of issues and connections which flow down the therapeutic causeway.

LIFE SCRIPTS OF BIRTH

As people work through birth material, their understanding of the influence of birth becomes increasingly more specific to the idiosyncrasies of their particular birth experiences. Life scripts as a result of specific types of birth experiences fall into general patterns. This can be helpful but should not be referred to dogmatically. Different birth stimuli can send distinctly separate messages: breech births, head first births, long-drugged births; or quick elective caesarian births. As groupings, these can be significant in reflecting different imprints and affect one's expectations later in life. Emerson (1987) explains:

For example, caesarian babies are more likely (as adults) to have rescue fantasies and to rely on others to "help them through." Forceps and induced infants are more likely to develop symptomatic issues around intrusion and authority. Infants with prolonged containment (during second stage labour) are more likely to manifest claustrophobia. (p. 62)

BIRTH AS PROTOTYPE FOR TRANSITIONS

Birth is a beginning and birth is an ending. Birth can imprint the messages for what people expect to take place in their life surrounding closures and endings. The experiences of birth can also set expectations for what is anticipated with arrivals, opening up and coming into things. Noble (1993) reports:

For example, a patient who couldn't quite make it out of the birth canal always sets up situations in which he never quite finishes anything properly. Another client who was lifted out by Caesarean section may never let anyone else set the time for her arrival or departure. Some people allow deadlines for work or study to creep up until there is hardly any time left, then they mobilize themselves into action. Memories of our labour may enable some of us to work well under pressure and to channel aggression into more subtle acceptable forms. (p. 127)

In creating art or birthing art, birth issues that relate to beginnings and endings can find their way into the work or the art process. Birth is life's most dramatic metamorphosis from one environment to another, one world to another, one way of interacting to another, one sensory theatre to another, one way of giving and receiving to another, one form of biology to another. All of these profound transformations occur early in a person's life. It is therefore not surprising that biological birth may be a prototypic influence on life's subsequent transitions and rebirths, personally, socially, politically, culturally. Hendricks and Hendricks (1987) suggest that, as a legacy of a traumatic transition at birth some people can, "feel rattled by rapid change. Since contemporary life is fraught with rapid change, it is easy to see why some clients can stay in a perpetual state of reliving their birth traumas" (p. 234).

Hendricks and Hendricks (1987) continue that as a result of the burden of the birth stresses surfacing within them:

Common physical experiences and symptoms appear in those clients replaying perinatal issues. They tend to have histories of respiratory distress or illness, such as strep throats, bronchitis, allergies, chronic colds. Breathwork will often elicit tremendous congestion or mucous discharge. Stress or energetic situations tend to create nausea with headaches, dizziness, or head pressure. Clients who have been heavily anaesthetized will tend to get sleepy in stressful situations. The body is often extremely rigid (ie., one woman who had steely skeletal muscles had a forceps delivery so gruelling she had been administered last rites) or extremely flaccid over a rigid core. A head torque to one side or the other will often appear in those clients who were delivered by forceps. (p. 234)

For making natalistic art work I often have the client lying on a large, (in effect, relatively womb-size), piece of paper. The massive drawing allows a sense of being present within a womb. Movement patterns, feelings, sensations and issues of birth will be presented to the client who is lying down, breathing, and focusing on the body and being contained by this womb-size piece of paper.

RESOLVING THE FEELINGS OF BIRTH

At times it is difficult and even overwhelming for adults to face these feelings, which are really decades-old memories. It is no wonder that the vulnerable infant, originally going through these "absolutely terrifying" near-death experiences, had to split off and bury them. Birth feelings can have a high valence of emotion when they surface in therapy. For some, direct abreaction or primalling may be too overwhelming.

Art work can be a more palatable approach for those not at ease with the intensity of birth primals. It is also true that individuals conversant with birth primals have found that natalistic art expression does facilitate emotional release. They have found that, when used with deep feeling expressive work, the use of art has advantages; it can progressively reduce overwhelming material; it clarifies preverbal issues; and it greatly assists the client separating from and letting go of long habituated birth feelings. The repatterning value of artistic expression has been surprising to some who have done most of their birth work through deep feeling regression.

Resolving the latent feelings and patterns of birth can be quite freeing. Life-long issues that have been there, since birth, can be released and transformed. Because birth material represents core issues with strong emotional force, working through them can effect significant and fundamental changes in the psyche. In part, the person can achieve noteworthy transformation because the very foundations through which many later experiences were filtered are being examined and reformed. Janov (1983) allows:

The important thing to understand about prototypic behaviour is that it is a memory of the beginnings of neurosis. All the later elaborations and manifestations can ultimately be traced back to those beginnings. That is why the resolution of neurosis must involve a return to the originating prototype. (p. 50)

In whatever form the person returns to birth memories they do so to sort through the primary core of later life issues. Anger and fear are only two of many adult feelings left from the early turmoil of birth.

As a result of the reverberations of birth the person may also carry conflictive feelings of confusion, hopelessness, numbness, hurt, rejection and loneliness, among others. These initial and varied birth feelings become the kaleidoscope which interprets and views the greater world. Habituated birth feelings can be obstacles which the person trips over and can become walls and barriers unto themselves. There are many varied experiences of birth and many diverse feelings in response to those birth experiences. Similarly, over the years people create many different types of walls or castles out of their original birth feelings. Lake (1979a) explains:

There are as many variations here as people. Sometimes the forceps are put on and rotation and extraction are re-enacted with vivid detail as to where the steel dug in. The marks reappear. At times they knew they were stuck and would have to be helped out; at others they deeply resent "unnecessary" interference. The re-enactment of birth by Caesarian section is varied. A finger in the mouth turns the head and they are dragged out backwards. People's reaction to being "Caesars" is not unlike being a "Forceps". Sometimes they say "Well--I've done as much as I can--someone's got to get me out" and they are grateful. Or they are still gamely struggling: "If only you'd left me to it. I could have got out." Or, "You stopped me. I never got born properly--you baby-snatcher, I've never had the achievement of birth." These people have a greater tendency to regress to inter-uterine states, psychologically, philosophically and religiously, because they have never gone through that half-way point of giving up inter-uterine attachments and deciding to live towards the outside world. (p. 11)

RESOLVING CORE ISSUES

The importance of understanding the compounding and reinforcement of birth trauma by childhood experience is emphasized by fact that the resolution of major or core life issues often returns a person to foundational early stresses. Similarly, birth feelings which surface in therapy are often interwoven with later childhood trauma which needs to be explored for full resolution of the adult issues. Life problems and patterns which seemed to be worked through therapeutically for childhood content, but which still persist as unresolved and problematic material may well be worth exploring for perinatal content. The dynamic also applies to clients who repeatedly return to birth material but cannot get full relief of feelings and symptoms. There may be childhood wounds intricately linked to birth, awaiting resolution. Psychotherapeutically, it is important to recognize that birth content in the psyche rarely exists as independent and isolated issues.

In the therapeutic returning to birth the person re-experiences aspects of the birth events. The initial interpretations of the birth events have been played through so many times that connections and insights may leap out at the person. In some cases, insights come over a period of days, weeks or months. Because a birth regression may have much non-verbal expression, it is helpful to talk about the regressive experience and its meaning after the person returns to a verbal mode.

A significant advantage of using art work as the means of birth regression, or in conjunction with other forms of birth regression, is that the expressions and content of the art work remain intact. When the person is no longer in the birth regressed state, the message expressed with the art work is still vividly present and does not slip away as emotions and memories recede. As the process of therapy unfolds over months, the birth regression art can be returned to, to gain additional insights in understanding the tentacles of birth. As other therapeutic issues arise, the person also has the birth art to help them make sense of how the birth pains have been carried through life. It can be valuable for a person to place into context the legacy of birth feelings and traits.