Psicología prenatal y perinatal
The right to the postnatal reparation of pregnancy and birth traumas
By Juana Fernández
The greatest trauma that a fetus can suffer during pregnancy is rejection by its mother either consciously or unconsciously. The reasons for this rejection may be the result of a lack of emotional maturity, which makes it difficult for her to assume the role of mother, an insecure relation with her partner, hostility within the family, or possible economic or professional problems. In all of these cases, we find a mother who, in not completely accepting her maternity, will have difficulties in establishing the peaceful, profound and nourishing contact with her child that all new beings need in order to develop and, as a result, this child will gestate in a medium that he/she will find hostile. The most important consequence of difficulties in establishing good intrauterine contact is that her child’s basic sense of confidence may be damaged. He/she will begin to create a register of being neither loved, welcomed, or unconditionally accepted. This situation may become further aggravated, because this lack of contact between mother and child considerably increases the risk of complications occurring during birth.
When we speak of traumatic situations during birth we are referring to all of those in which, for some reason, the life of the fetus was endangered. This is the case with premature babies, labor longer than 14-15 hours or with births in which the baby is born with the umbilical cord wrapped around its neck. A birth is also traumatic when the natural process of childbirth is significantly interrupted, preventing the child from realizing the complete biological process for which we are genetically programmed. This occurs in cases of induced labor, in births whose duration is less than six hours, when forceps are used or in cesarean births. For many people this affirmation may come as a surprise, since the false belief exists that in births by cesarean section the child suffers less or that a fast birth is a good birth. It is evident that when the fetus has to pass through the vaginal canal, the pressure becomes continually greater and, therefore, the oppression and exertion as well. The umbilical cord may even become wrapped around the baby’s neck and place its life in danger. Although childbirth is always a difficult situation, it is important to note that the contact that is established between mother and child is for the first time so intimate. The movement of propulsion and exit from the vaginal canal is an orgasmic movement in which the baby’s entire body finds itself in the most intimate contact with its mother and clinical experience has confirmed that the child may be able to feel immense pleasure. How must a child who is being born experience the reality that his/her mother is depriving him/her of this most singular experience of our entire existence? If the mother does not dilate, she will not allow him/her to enter the vaginal canal and he/she may remain trapped without being able to come out by him/herself. It may also occur that his/her passage through the vaginal canal is so rapid that he/she experiences this as if the mother is expelling him/her. The imprints of these situations vary from child to child, but the common factor, in all cases, is that he/she was not able to establish the intense, intimate and pleasurable contact with his/her mother that should have occurred.
This lack of intimate pleasurable contact is aggravated in those births in which the newborn is not permitted to reestablish the relation with its mother immediately. This is the case of children who are born by cesarean section or who must remain in an incubator. Moreover, in complicated births, the father’s presence is not permitted either and therefore the contact that the newborn receives is the cold impersonal contact provided by sanitary personnel and not by his/her parents.
The difficulties with intimate contact that a person may suffer as a consequence of this entire situation may be repaired in large part by prolonged maternal lactation (until approximately three years of age). The intimacy and contact between mother and child may compensate part of the trauma. However, it is quite frequent that after a traumatic birth maternal lactation does not occur. This is usually due to the early separations between mother and child, to medical complications, to the stress inherent in this type of birth and even to feelings of guilt often unrecognized by the mother.
The imprint that remains in children who have suffered a birth trauma is, therefore, one of frustration, fear, pain, impotence, rage and helplessness. It is important that we help them to process and integrate these emotions with the objective of trying to avoid, as much as possible, the suffering and difficulties they may have in the future.
When faced with a child who has suffered a birth trauma, the first thing to consider is that all people have a natural biological tendency to health and physiological balance. As a result, under optimal conditions, babies are able to recover from many of the effects of stress and trauma. However, they are unable to undertake this process alone. Given the situation of extreme dependence they find themselves in, they need their parents to be in tune with what they are going through and know how to interpret the body signals they send out. We speak of bodily signals and signs because when dealing with a preverbal experience it is in the body where the trauma accumulates.
If parents are attentive and emotionally prepared to share this experience with their child, they will be able to observe how in just a few hours the baby will tend to repeat their birth spontaneously. Our experience is that babies who have suffered a birth trauma respond to very gentle corporal stimuli reliving the trauma with a strong emotional connection. This is the case of a child born by cesarean section and who despairingly breaks into tears merely because one of his/her parents gently rests their hands on top of their head. The impulse to push strongly against the hands emerges automatically.
To help these children to begin to repair birth trauma, it is important to make an effort, from this emotional connection, to have the child reconstruct the traumatic experience, but this time succeeding where he/she was not able to originally. For example, the child born by cesarean section must reconstruct the experience of a vaginal birth, and the child who was born with the help of forceps, the experience of being able to finish coming out of the vaginal canal by him/herself. This facilitates a change of register through which the child is able to recover the strength, power and dignity that were robbed from him/her during birth.In closing, I would like to emphasize the need to try, as much as possible, to prevent traumas before they occur. Currently the monitoring of pregnancy and preparation for birth are confined to purely physiological aspects. This demonstrates the need for greater consciousness on the part of parents, the medical institutions and society in general, of the relation between the difficulties and emotional deficiencies of the gestating mother and the problems that arise during pregnancy and birth. It is for this reason that we consider essential, the need to routinely include psychological attention in maternity facilities.
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