“Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere [do no harm]” (Kloosterman, 1982)
Toward a More Humane Paradigm of Birth
Over the last fifty years, neonatal mortality rates in Western countries have drastically decreased, largely due to changes in technology that have allowed for more accurate fetal assessment, and earlier, more proactive obstetrical intervention (Harper, 1994). Dr. David Chamberlain describes a typical hospital birth in the developed world:
In hospitals, natural birth seldom survives the cascade of well-intentioned interference. Deliberate rupture of membranes will eliminate the hydraulic covering which protects the (infant) head; birth in the lithotomy position will nullify the effect of gravity and make progress difficult…complications may be assessed with electrodes implanted in the scalp, and blood samples taken by making a scalp wound. If chemicals have upset the normal processes of labour, the baby may have to be turned forcefully and removed by forceps (Chamberlain, 1989, p. 8).
While opportunity for physical survival may be less fragile for the human neonate, more progressive research suggests that the medicalization of childbirth undermines human life in other, more profound ways. Prominent obstetrician and natural childbirth advocate Michel Odent states, “Humanity is at a turning point, when all our deep rooted perinatal beliefs and rituals are losing their evolutionary advantages” (Odent, 1999, p. 24). While medical-model childbirth proponents approach birth as a process that must be “managed”, by excessive monitoring, pharmaceuticals, and violent interventions, there is evidence that sheds light on the need for a gentler paradigm of birth. This gentler paradigm is necessary to accommodate an expanding body of research that supports our growing understanding of neonatal consciousness and response to pain.
The Medicalization of Childbirth
Prior to colonial times, birth was viewed as a social event, and babies were born into the hands of their mothers or other women, gently and without fear (Feldhusen, 2000). In the mid-18th century, before midwifery was driven underground by male obstetricians who were operating with a primitive understanding of the infant brain, minimal damage was done to neonates in the process of childbirth, which was, for the most part, non-invasive (Feldhusen, 2000). After this point, though women actively surrendered their bodies, the event remained a spiritual rite of passage until the association between midwifery and witchcraft forced many women into complete resignation to the medical model (Feldhusen, 2000). Currently, though some work has been done to reclaim childbirth as a rite of passage, obstetrical interventions are rapidly increasing (Buckley, 2005). In most urban centers in Canada, more than one third of infants are born by cesarean section, most labours involve some synthetic hormonal intervention, and the vast majority of neonates are born under the influence of narcotics (Buckley, 2005). In this culture of technocratic birth, a question lingers that must be asked: How much does the manner in which we are born affect who we ultimately become? It is obvious, states Dr. Sarah Buckley (2005) that “such deviations from the natural order, whose lore is genetically encoded in our bodies, must have enormous repercussions” (p.32).
Why, in the 21st century, has this model of technocratic birth become normalized, when research indicates that most medical interventions in childbirth are not only unnecessary, but destructive? There are many answers to this question, not the least of which is monetary greed. Czechoslovakian psychiatrist, Stanislov Grof, has studied the phenomenon of this self-perpetuating cycle of greed and violence for over fifty years. According to Dr. Grof: “It is not hard to imagine that the perinatal level of our unconscious which ‘knows’ so intimately the history of human violence is actually partially responsible for… (human) atrocities. If this is true, it should be possible to reduce the amount of malignant aggression by a change in birth practices (Grof, 1995, p. 16). Why, then, has this cycle been allowed to continue? A partial answer to this question can be found in current obstetrical understanding of neonatal psychology, and the fact that we may be operating from an outdated perception of the consciousness level of the human neonate (Randolph, 2011).
The Conscious Neonate
Though the study of neonatal consciousness dates back to the emergence of modern psychology, it was not until 1929, when Otto Rank published his work entitled Das Trauma der Geburt (The Trauma of Birth), that most research on this subject began (Sheets-Johnstone, 2008). Rank, a student of Freud’s, who disagreed with Freud’s analysis of the origins of trauma, began to study the experience of the neonate (Sheets-Johnstone, 2008), especially as these experiences relate to neurosis. Rank believed that “birth was the individual’s original encounter with anxiety and that it would inevitably plague him throughout his life”(Randolph, 2011, p.1). Rank also traced many physical ailments back to an individual’s experience of birth trauma, contending that “all neurotic disturbances in breathing (asthma), which repeat the feeling of suffocation, relate directly to the physical reproductions of the birth trauma… the migraine goes back to the specifically painful part allotted to the head in parturition…(Rank, 1952, p. 23). Following Rank’s contribution to our current understanding of the experience of the neonatal experience of childbirth, other researchers have since corroborated his findings (Buckley, 2005).
But just how conscious is the neonate? There is mounting evidence to suggest that the perception of neonates as “primitive” beings with immature, underdeveloped brain structures without the capability of complex activity, is incorrect at best (Prechtl, 1984). According to Dr. David Chamberlain (1989), neonates, and even prenates are conscious and able to respond to pain:
… American physician, George Ryder, heard the sound of a baby crying after he had applied traction with forceps. Listening via stethoscope his assistant and nurses said the sounds were “high and squealing, much like the mew of a kitten.” This moving event led to a world literature search… in many languages, reported by 114 different authors. Analysis of these records showed that crying (in utero) was almost always associated with obstetrical procedures. About 20% of the crying prenates died – indicating the urgent nature of the cries (p.4).
Further research found this report to be irrefutable. Babies were witnessed crying in utero when experiencing “a hand entering the uterus to bring down a leg, application of forceps, injections of analgesia, inserting a catheter, or rupturing the amniotic sac” (Chamberlain, 1989, p. 4). Dr. Chamberlain describes an account of a group of doctors, midwives, and a mother, who heard a baby “cry five different times over a twelve hour period before labour began, describing it as a startling and awesome event” (p. 4). Though some scientists have judged pain to be healthy for the neonate because it “activates endorphins and prepares the baby for real life” (Chamberlain, 1989, p. 2), research points to the fact that they could not be more wrong. Dr. Sarah Buckley (2005) questions the impact of modern birth practices on more than just neurosis:
We live in a society where depression and anxiety are among the largest burdens of disease worldwide, according to the World Health Organization, and children as young as four are being diagnosed with these conditions; and where young people, at the prime of their lives, are choosing in large numbers to opt out of reality, with mind-altering drugs, or to opt out permanently through suicide (Buckley, 2005, p. 32).
The Impact of Childbirth Interventions on Psychological Functioning
A handful of researchers in Sweden questioned these social issues, and, interested in the correlation between addiction, suicide and birth interventions, studied the birth records of opiate addicts born in a twenty year span, comparing them with the records of their non-addicted siblings (Jacobson, 1990). Individuals whose mothers has been administered pain medications in labour, such as nitrous oxide, opiates, or barbiturates, were predisposed to amphetamine and opiate addiction later in life, especially if the administration of these drugs was ongoing throughout a woman’s labour (Jacobson, 1990). Grof (1995) sums up another research study by Jacobson (1987) which examined the link between suicide and birth interventions. This study found that there was an alarming correlation between the type of intervention, and chosen suicide method. Grof points out: “Suicides involving asphyxiation were associated with suffocation at birth, violent suicides with mechanical birth trauma, and drug addiction leading to suicide with opiate and/or barbiturate administration during labour” (Jacobson, 1987, Grof, 1995, p.16). These studies have since been repeated in America with strikingly similar results (Buckley, 2005).
This research points to a process called ‘imprinting’, which is described as “an unconscious need to repeat a traumatic experience at birth as an adult” (Jacobson, B., 1987, p.370). Randolph (2011) describes the infant perception of pain in terms of “concept of time” (p.5), stating that every experience, to the neonate, feels like “forever” (p.5). This complicates the therapeutic process for individuals attempting to heal issues related to birth trauma, due to the fact that “when they are reliving birth feelings, the pain feels as if it is unending” (Randolph, 2011, p.5). The same author relates her own experience as a professional in the field of primal therapy, the process of reliving one’s birth in a controlled, therapeutic setting:
This perception of unending pain may cause a patient to become hopeless and suicidal. We… have found that all suicidal feelings arise from the individual’s first confrontation with severe pain and near death from morbid conditions in the womb. It’s not just the pain that plunges one into suicidal gestures, but these infantile feelings that go with it; the sense of timelessness, that the pain will never end (Randolph, 2011, p.5).
Randolph (2011) continues by stating that neonates have a built-in reflexive response that can filter “some of the sensory process” (p.5). She states: “As the infant’s total consciousness is reduced, he loses some of his ability to fight for survival, and, to varying degrees, relinquishes his participation in the birth process” (Randolph, 2011, p.5). The result of necessitation of this specific defense mechanism can be devastating. Randolph (2011) concludes by stating that “Some infants may have blunted consciousness so extensively, owing to the unrelenting pain, that they are delivered half dead” (p. 5).
Though the medical community is currently operating on the principle that most self-destructive behavior has its roots in early childhood and infant frustration (Grof, 1995), “modern consciousness research has revealed additional significant roots of violence in deep recesses of the psyche that lie beyond postnatal biography and are related to the trauma of biological birth” (Grof, 1995, p. 7).
What can be done to reduce the amount of suffering attributed to neonatal birth trauma? Recognition that neonatal pain is inevitable in childbirth due to the physiology of the birth process itself is not enough to justify the normalization of obstetrical interventions that have been proven detrimental to the human psyche (Chamberlain, 1989). We must change our perception of beings smaller and seemingly “less intellectually sophisticated” than ourselves to include the possibility of inflicted harm. Medical professionals can no longer plead ignorance, and continue to ignore a body of research that indicates that the experiences of the infant, neonate, and even the prenate, are an important aspect of how we live, and who we ultimately become. In the words of Dr. David Chamberlain (1989), a “cultural lag” exists between “what we know and what we do” (p. 9). We must confront this cultural lag, and insist on gentler, less invasive management of labour and birth. We must consider not only the experience of the mother, midwife, or doctor, but also the tiny human being who is not only sentient, but wise, and conscious. Let his first experience with touch be gentle, his eyes given opportunity to adjust to a world with light, and his future be spared painful body-memory of an event under which he had no control. Let us follow the research toward a more humane paradigm of birth.
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