According to the leading theorists and practitioners who have spearheaded the field of birth psychology over the past century, the experience of birth is the cornerstone event that informs personality structure and ego defense development for all humans. Some posit that the process of passing out of the womb is a near-death experience for the infant; therefore, birth can serve as an original and foundational trauma, or as an event that fosters resilience and is a roadmap for healthy maternal bonding and attachment. This paper suggests that in overlooking the importance of the birth experience, mainstream psychology and social work have essentially dismissed and undervalued one of the most critical components of traumatic history and subsequent psychological, physiological, and spiritual development. The author of this paper integrates a) research, b) analysis, c) personal experience from her own birth trauma intervention as well as from various professional trainings integrating birth psychology, and, d) a synthesis of multiple discourses including neurobiology, attachment, and somatic psychology in order to explore pre- and peri-natal trauma.
The concept of birth trauma was born with the beginning of the psychoanalytic movement. Sigmund Freud included the birth experience as an important factor in his understanding of the root of anxiety. Freud¡¯s top disciple, Otto Rank, broke with Freudian theory when he wrote The Trauma of Birth in 1924 and located the source of all anxiety and psychosomatic symptomology in the birth experience of the infant. According to Obaid (2012), Rank¡¯s theory was dismissed and forgotten because it was seen as a threat to Freud¡¯s drive theory, and challenged Freud¡¯s patriarchal status in the psychoanalytic movement. Wishing to avoid being disowned by the movement and his esteemed teacher, Rank wrote Freud a letter in which he apologized for breaking away, and distanced himself from his own work on birth trauma. As a result of the controversy and debate spurred by The Trauma of Birth, Rank¡¯s findings were disinherited from the young and evolving field of psychoanalysis (Obaid, 2012).
Whereas Rank¡¯s ideas about the trauma of childbirth focused on the universal experience of the infant, most of the psychological research on birth since that time has investigated the experience of the mother. Research into the impact of birth upon the infant has been limited to the danger of physiological trauma, such as neurobiological damage resulting from dangerous conditions in the womb and during delivery. The subjective experience of the fetus/newborn has been largely ignored due to the prevailing scientific assumption that the fetus¡¯s brain in the womb is under-developed and therefore lacks capacity for consciousness and memory.
There is ongoing debate about what constitutes conscious awareness or sentience in philosophical and neurobiological discourse, as well as disagreement about when it develops. There is also a body of research that tests for the fetus¡¯s experience and consciousness in the womb. According to leading neuroscience experts including Daniel Siegel, M.D., the limbic brain, involved in the storage and retrieval of memory, is already intact during pregnancy and fully developed by the time of birth. Therefore, according to Siegel¡¯s theories of neurodevelopment, it seems likely that the birth process can make a lasting impression on the infant (Blasco Jauregui, 2006). Kline and Levine (2007) cite studies from prior decades attesting to the fetus¡¯s reactivity to environmental conditions inside and outside the womb. Kline and Levine write (2007):
For more than half a century we have known that what affects mothers emotionally also affects babies. In 1934, Drs.
Sontag and Wallace, using very primitive measures of heart and respiratory activity of the mother and fetus, found that
when a pregnant patient was pursued by a psychotic husband, the baby was alarmed along with the mother. Now more
than 70 years later, sophisticated research techniques measuring cortisol and ACTH levels in fetal monkeys are coming to the same conclusions. The fetuses whose mothers were stressed during pregnancy reflected their mothers¡¯ emotional
states (p. 35).
Recent research examining the heart rates and movements of a fetus during amniocentesis procedures have found that the fetus¡¯s heart rate slows and movement stops because the fetus is aware and afraid of the procedure (A. Blasco Jauregui, T.M., 2006). Even more striking are the videotapes presented by doctors of fetuses batting away the needle during amniocentesis procedures or moving away from the needle (Emerson, 1996). Several other important leaders in the field of pre and peri-natal trauma such as Emerson, Laing, and Lake (Emerson, 1996), have all endorsed the idea that trauma experienced from the earliest stages of fetal development (from conception through the first trimester) have the greatest impact of future development.
Other researchers have written about the traumatic impact associated with the moment of birth itself, even typical, healthy births. Dr. Stanislav Grof, the founder of holotropic breathwork and diethylamide of d-lysergic acid (LSD) therapy, spent much of his career focused on birth trauma work. In an interview on his contributions to the field, Grof says:
It seems strange that in psychiatry we don¡¯t pay attention to the psychotraumatic impact of birth. This lack of attention is a curious logical error¡the hours of potentially life- threatening situations¡ªwhere babies might have died in the birth canal and needed to be resuscitated¡ªare only taken into consideration if they were so bad that they damaged the brain. The experiences themselves are not seen as relevant (Grof, Grob, Bravo &Walsh, 2008:169-170).
Grof (2008) proposes that the process of birth can be divided into three stages, each of which informs a different aspect of the human personality. Grof based his theories on the study of thousands of his patients undergoing LSD therapy that spontaneously uncovered traumatic birth material in their sessions and organically re-negotiated each birthing stage. Based on his patients¡¯ corrective birth experiences, Grof developed a theory that the ideal birth is one in which the infant experiences a resolution of the terror of annihilation. Those who had successful corrective experiences through their sessions with Grof went through the following stages of regression and renegotiation:
a. In the first stage, the fetus feels its life is threatened by the initial birth contractions.
b. In the second stage, it fights for survival against a body that was safe but now seems to be calling for its destruction.
c. In the third stage, as the fetus emerges from the birth canal, it experiences a profound shift into what Grof labels ¡°a
transcendental state¡± of peace, higher consciousness, bonding with mother and surrender to the universe.
As a result of their rebirthing experiences, Grof reports that his patients were ¡°cured¡± of their fear of death and dying and the ego defenses developed to protect them from that fear (Bache, 1981).
In a lecture in Basel, Switzerland, Grof (2008) analyzes and compares artwork created during psychedelic rebirthing sessions with published artwork describing war trauma from across the globe. Bin Laden and Milosevic, Zionism and Uncle Sam are depicted the same ways that birth experiences are depicted in birth sessions¡ªas spiders, octopi, and chaotic, stormy bodies of water. Therefore, Grof asserts that birth is the initial imprint for humanity of violence, war, and death, and is potentially the reason that humanity compulsively repeats cycles of violence through war and crime. After all, birth can be perceived as an experience of death or near-death¡ªthe movement from one world or reality into another through a scary and even violent passage (Grof, 2008).
In his article ¡°On the Emergence of Perinatal Symptoms in Buddhist Meditation¡± (1981), Bache posits that the spontaneous physical phenomena that meditators in multiple meditation and spiritual traditions ascribe to enlightenment are actually manifestations of rebirthing.
To the psychologist it is striking that meditation practices not directly aiming at the integration of the personal unconscious with an expanded self nevertheless achieve just that. ¡Without self-consciously exploring one¡¯s past, they nevertheless succeed in eliciting and resolving traumatic perinatal memories which lie beyond the scope of most traditional psychotherapies (Bache, 1981:348).
Students of meditation all over the world have reported similar physical sensations of uncontrollable trembling, intense pain in the head and neck area, pressure and energetic discharge in the legs, a shock of electricity or seizures throughout the body, coupled with powerful emotional experience and then a shift into a transcendental state of being with ego dissolution. Remarkably, the sensations and states described by the meditators in Bache¡¯s study match perfectly with those described by Graf¡¯s patients as they underwent corrective rebirthing experiences (Bache, 1981).
According to Peter Levine¡¯s somatic experiencing model (Kline & Levine, 2007), birth trauma is a formative event that elicits a fight/flight response from the infant (and therefore aligns with Grof¡¯s theory of imprint of violence). If a baby¡¯s attempt to ¡°fight¡± its way out of a dangerous condition (its mother¡¯s contractions) was thwarted due to obstetrical intervention such as epidural, c-section, forceps, etc., the infant¡¯s neurobiological development is affected. The infant¡¯s nervous system is geared toward fight/flight mode, yet stuck without the ability to resolve the signals that the limbic and reptilian brain are sending to the rest of the body. This can result in long-term hyper-vigilant or dissociated states and can affect the development of the brain and organs involved in the nervous system¡¯s functioning.
The impact of birth trauma can extend to every aspect of body functioning and development. Dr. Michel Odent, a pre- and peri-natal trauma specialist, supports Levine¡¯s hypothesis about the ways in which the nervous system is affected as a result of birth trauma. He presented his research findings on neurobiological development and birth trauma at the Human Rights in Childbirth Conference at the Hague. He cited medical research studies that support the idea that birth trauma can affect the healthy development of gut flora in the digestive tract (Rhodes, 2012). It is possible that the gut¡¯s development is affected as a result of a chronic nervous system freeze response. In August 2012, Yale University¡¯s School of Medicine researchers found that babies with C-section deliveries did not develop a protein in the brain related to optimal development of hippocampal neurons and circuits related to long-term memory functioning (ScienceDaily, 2012). Appleby (1998) cites research that found a positive correlation between adult suicide and birth trauma due to obstetrical intervention.
In ¡°Prenatal Memories in Preverbal Children,¡± Blasco-Jauregui (2006) writes about her observations of interviews at the Building and Enhancing Bonding and Attachment clinic (BEBA) in Santa Barbara. In numerous studies, hundreds of small children with no education about pregnancy and fetal development report similar memories and experiences in the womb as well as specific birth memories later confirmed by their parents even though they had never discussed it. Chamberlain (1986) studied mother and child pairs under hypnosis and found that both shared the same memories of the child¡¯s birth. Emerson (1996) shares a case of a boy whose mother had several abortion attempts with a coat hanger. As a child, the boy would play sadistically with sharp metal objects, especially hooks. As a young adult, he was arrested 30 times for assault, usually having committed his crimes using heavy braided wire with a metal hook on the end. His mother had not shared this part of her history with him.
The author of this paper has herself experienced a birth trauma therapy session in which a spontaneous birth trauma somatic memory emerged. She had previously believed that her birth had been completely natural and normal. During the session, she experienced intense head and neck pain, numbing of the legs, and fear of movement. Based on this, her therapist suggested a surprising birth narrative: that her head had gotten stuck in the birth canal, her body was numbed because of her mother¡¯s epidural and pitocin intake, and that she was pulled out with forceps. Her mother subsequently confirmed this narrative.
Perhaps the harshest impact of the birth experience is the attachment and bonding disruption that is often caused. When the newborn enters the world, regardless of the ease of birth, she has undergone an ordeal. It is likely that her senses are dulled due to a neurobiological fear response caused by the birth experience. As a result, the infant needs time to bond with mother and to allow her body to regulate and be in fuller awareness of her experience. In most hospitals, the infant is taken away from mother before she has been given enough time to feel safe and establish a new bond outside of the mother¡¯s womb. According to Emerson (1996) this disruption, the formative imprint on attachment, can take a toll on the infant¡¯s ability to bond with the mother throughout infancy and childhood. In addition, if the mother has used an epidural, both she and the baby will be impaired in their ability to be mentally present with each other in the first hours of life. The infant is usually left having experienced a terrifying event without the time, compassion, and understanding she needs to fully recover (Emerson, 1996; Kline & Levine, 2007).
There are multiple forms of therapy that assist both children and adults in remembering their pre- and peri-natal experiences as well as resolving and healing trauma caused during those stages. Therapies used include rebirthing, art therapy, somatic experiencing, gestalt and fantasy procedures, hypnosis, primal therapy, holotropic breathwork, womb surround process workshops and water therapy (Blasco-Jauregui, 2006; Carling; 2003; Castellino; n.d.; Grof, 2008).
According to William Emerson, known as the father of pre- and peri-natal trauma work, pre- and peri- natal trauma should be treated as early as possible, ideally during gestation or the first year (Emerson, 1995). Emerson¡¯s treatment interventions include integration of somatic psychology and hypnotherapy to facilitate the body¡¯s re-enactment of an earlier somatic memory in order to resolve it. For instance, in a filmed demonstration, Peter Levine (2009) works with baby Ursula on birth trauma material. Ursula was born with the umbilical cord wrapped around her neck, and then immediately separated from her mother at birth as her mother went into medical distress. During their sessions, Levine placed Ursula on her mother¡¯s stomach and applied pressure to her feet and head (the same pressure that would be applied to the head and feet in the womb during contractions). By somatically reenacting the birth, Ursula was able to resolve the thwarted fight response she had experienced during the event. When the response was completed and Ursula experienced what Levine termed an ¡°emotional discharge,¡± or a release of the stored traumatic energy in her system, she reached for her mother and initiated a corrective bonding and attachment experience. Subsequently, Ursula¡¯s mother reported that Ursula was cured of her digestive issues and insomnia (Levine and SETI, 2009).
Lipton and Fosha (2011) describe the transformative impact of fostering secure attachment through the moment-to-moment relational dynamic between client and therapist. In other words, Accelerated Experiential Dynamic Psychotherapy (AEDP), a model integrating attachment theory and neuroscience, is premised on the therapist¡¯s use of self as a tool in which to support the client¡¯s healthy attachment style during therapy sessions. This concept is also used in birth trauma bonding. The therapist can replace the role of mother in an early bonding reenactment by creating a safe space of containment and empathic presence. Ray Castellino (n.d.), another renowned therapist and trainer in pre- and peri-natal trauma (also trained by Emerson), leads womb surround processing workshops with small groups in which he uses group bonding dynamics to re-pattern primary bonding and attachment as well as facilitate rebirthing experiences.
Birth trauma theory and treatment is becoming more integrated into attachment, neuroscience and somatic-related models. At a workshop for practitioners on healing attachment wounding through somatic approaches, Dr. Diane Poole Heller (2012) noted that an effective meditation or visualization exercise to do with people exhibiting avoidant attachment styles is to ask them to imagine being born into a welcoming world, into the arms of people that love them and are waiting for them with open arms and hearts. This exercise serves to re-pattern the earliest attachment and bonding experience.
Despite decades of research to verify its import, birth trauma has remained a subjugated discourse. While certain models have increased in popularity, on the whole birth psychology is still a niche field and lacks widespread recognition among both lay individuals and professional institutions. Several factors may contribute to this state of affairs. As mentioned earlier, initial forays into birth psychology were stymied by political opposition within Freud¡¯s inner circle. Contemporary efforts in the field face the obstacle of the scientific community¡¯s general discomfort with describing phenomena that cannot be observed empirically. Much of both the theory and practice of birth trauma therapies focuses on the impact of memories that are below conscious awareness. Moreover, many people are resistant to the idea that even a healthy birth can have negative effects on later psychological development.
Additionally, the leaders of the birth psychology movement have used unconventional treatment methods with their clients, such as holotropic breathwork, LSD trips, and somatic reenactments (Castellino, n.d.; Emerson, 1996; Grof, Grob, Bravo, & Walsh, 2008), which have not been accepted and integrated into mainstream psychology and social work. Birth psychology also suffered a blow to its public image when in 2000, Candace Newmaker, a 10 year-old girl from Colorado suffering from reactive detachment disorder, was killed during a 70 minute rebirthing session. Wrapped in blankets and pillows to recreate the womb environment, she suffocated despite her calls for help and was crushed under the weight of four adults restraining her to simulate uterine contractions. As a result, the two social workers who conducted the treatment were convicted of reckless child abuse resulting in death, and given a prison sentence of 16-48 years. Rebirthing therapy was banned in the state of Colorado in 2001. (Josefson, 2001) The incident, though atypical of most corrective birthing methods, calls into question basic safety protocols in rebirthing therapy as well as the training and certification standards of birth trauma therapists.
Given these obstacles, future studies will need to find inventive ways to verify theoretical models and validate treatments. Below are suggestions for possible directions for future birth psychology research:
- The accuracy of Rank¡¯s assertion that all personality development for every human being hinges upon experience during birth or in the womb.
- The mitigating factors to pre- and peri-natal trauma and why some traumatic births do not cause physical symptoms or attachment disruptions.
- Comparison of the impact of pre-natal versus peri-natal trauma and whether pre-natal development is more critical to the fetus¡¯s physical and mental health than the birth experience or vice versa.
- Infant Resiliency and the factors that foster a fetus or newborn¡¯s resilience to trauma.
- Early bonding post-birth and the correlation to long-term attachment trauma. Are pre- and peri-natal bonding formative imprints on attachment style or equal to all other critical stages that determine attachment patterning?
- The interaction of birth trauma with other developmental trauma. If later developmental trauma is healed, will birth trauma still be as impactful on the nervous system and attachment?
- Determining the most effective intervention models in healing birth trauma.
- Developing a more effective measure with which to study the effects of medical interventions versus the effects of natural, home and water births.
Birth psychology holds enormous potential for changing the way the medical and psychological establishment looks at and manages childbirth and trauma. Interventions can be implemented at every level of development, beginning with sparing the infant from unnecessary, distressing medical procedures and ensuring sufficient time and conditions for healthy bonding. Widespread integration of birth psychology will require a great deal more thought and research. Currently birth psychology encompasses a large variety of disparate ideas, some of which are contradictory. More clarity and consensus is needed on what birth trauma is, when and why it happens, how it can be prevented, and how it can be treated later in life.
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About the Author
Rebecca Stone is a first year MSW student and Wexner Fellow/Davidson Scholar at the Silberman School of Social Work at Hunter College, while concurrently pursuing certification in Somatic Experiencing therapy, a neuroscience-based approach to trauma healing. Prior to enrolling at Silberman, Rebecca worked in non-profit management for international human rights and peace building organizations, serving as the Director of Community Engagement for Encounter and major gifts fundraiser at American Jewish World Service. A grad?uate of Yeshiva University, Rebecca received the Presidential Fellowship and spearheaded student-led social justice initiatives.