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Babies, Birth, Bonding, and Beyond – What’s Love Got to do With it?

Sally Dear Healy, Ph.D.

What does love have to do with babies, birth, bonding, and the rest of our lives? The answer is, quite a lot. In fact, love has the potential for impacting how we are conceived, how we experience pregnancy and birth, as well our ability to engage in successful relationships. Moreover, our capacity for love, or the lack thereof, can influence our behaviors and relationships for the rest of our lives, including the way we mother/parent. The crucial point is that the capacity for love begins long before the baby is even born, and some argue even prior to conception. What we know for sure is that we need to be paying more attention to ‘what’s love got to do with it?’ In the words of Michel Odent, “At a time when people are focusing on violence and the roots of violence, I am convinced that we can go a step further in our understanding . . .  by turning the question on its head and looking instead at how the capacity of love develops.”[1]  We will begin with a look at romantic love, or what would be the ideal environment for a new soul to be conceived.

In 1999, researchers at the University of California, San Francisco began looking at the biological basis for human attachment and bonding. Their research clearly showed that oxytocin is “associated with the ability to maintain healthy interpersonal relationships and healthy psychological boundaries with other people.”[2]  In addition, they reported that “In humans, oxytocin stimulates milk ejection during lactation, uterine contraction during birth, and is released during sexual orgasm in both men and women.” Last but not least, the research revealed that “Women who were currently involved in a committed relationship experienced greater oxytocin increases in response to positive emotions.” From an evolutionary perspective, this makes perfect sense since ideally a woman’s body and mind are stimulated in such a way as to promote a feeling of safety so she can welcome and nurture her child from conception on.

Conscious conception means approaching the moment of life’s beginning with all the attention it deserves. Moreover, the belief that conception can and should be ‘conscious’ is long- and well-supported. In 1986, Jeannine Parvati Baker’s seminal book Conscious Conception became a comprehensive reference that engaged an awareness far beyond the process of biological conception and engaged the belief that conception is far more than ‘just’ a physical act and biological process.[4] As an example, if a woman is open to conceiving, one of the most important things she can do is to open up her heart-uterus connection, again ideally prior to conception.  This is because when a woman becomes pregnant, a channel or line of communication opens between her ‘heart’ and that of her baby.  According to the Chinese, the ‘heart’ is the spirit’s ‘home’ and is associated with the heart center (chakra).  The heart chakra, or Anahata, is the center of love, balance, and connection and is responsible for regulating the energy associated with self-acceptance, self-love, compassion, openness, and unconditional love of others. Babies receive intuited feelings from their mother via this line of communication.

Carista Luminare-Rosen’s research shows that “Prenates can see, hear, feel, remember, taste, and think before birth.”[5] In other words, babies in the womb have the emotional and intuitive capabilities to sense their parents’ love, or lack thereof. Thus, we can argue if the spirit of the baby does not feel that the mother is ‘ready’ for conception then they will not initiate the relationship by coming to that mother at that time. The spirit of the baby may also determine that the womb is not a safe place, at least not at that time. While it may be difficult for mothers/parents to reconcile with the words of James Thurber, “He who hesitates is sometimes saved,” we cannot negate the possibility that babies do in fact make ‘choices’ about when they are conceived and who they chose as their mother.  The good news is that, as Huxley (1987) suggests, “Preparing for the moment of conception offers (women) the opportunity for a renewal of (their) perspective and existence.  Rather than being a random moment, lost in the events of ordinary life, conception can turn into the culmination of in-depth work on (herself) and (her) relationships.[4] The point of this process is to have a sense of self-love and a receptive love environment for the baby. This exploration and awareness can, and often does continue during pregnancy.

Back in 1978, Tarn Taran Kaur Khalsa established Conscious Pregnancy Training for German Kundalini Yoga teachers (Kundalini Yoga is the Yoga of Awareness).  Her intent was to explore a woman’s journey to motherhood including her self-identity, as well as her relationships and building her family culture through the birthing and postpartum process.[7] Since then numerous books and articles have been written about prenatal bonding, however, while the words “bonding,” “attachment,” and “connection” are used widely and interchangeably, few if any actually mention or engage the word love, nor is the word “love” found in the Index.  This was surprising but not unexpected.  More concerning is the fact that a search for “love and pregnancy” focused on topics such as “10 Fun Date Ideas for Pregnant Moms and Partners,” “5 Ways Pregnancy Will Change Your Relationship,” and “15 Things Men Absolutely Love About Pregnant Women,” while others focused on teen pregnancy.[8] What is most important is that mothers and babies feel and experience love during the pregnancy.[9] This will allow babies to receive the message that the uterine environment is both physically and emotionally safe, which in turn prepares them for birth.  Accordingly, Nathanielsz (2001) argues that “The right kind of environment will allow (the woman/mother) to offer the right kinds of messages to (their) child so that, at birth, he is already well along the most healthy developmental path.”[10]

We would hope that the feeling and experience of blissful love is automatically present when a woman gives birth and a new life enters this world, but rarely expand this expectation beyond the birthing woman/couple and their baby to include the love or loving feelings of a care provider toward their patient/client, and even towards themselves.  While some OB’s claim that they “love what they do for a living,” and “treasure the relationships (they are) able to be a part of with each of their patients,” other than few vague references to midwives, I found no mention in the research of a care provider being taught to or purposefully communicating feelings of love towards the woman, her  baby, or the birthing environment, let alone purposely creating a space where this kind of love flourish.  In other words, mothering/parenting should ideally embrace a purposeful conveyance of love and the mindful creation of a space where love can flourish.

What does appropriate care look like in the first few years of life?  Lots and lots of love!  According to Schore (2014), “Optimal attachment scenarios allow for the development of a right-lateralized system of efficient activation and feedback inhibition of the HPA axis and autonomic arousal.”[11] Unfortunately many of today’s parenting advice focuses more on the needs of the parents instead of the needs of the baby/child.  As an example, on the website Love and Logic, in an article titled “End the bedtime Blues” (J. Fay), parents are admonished to “stick to (their) guns” when it comes to putting children to bed.  If the child “resorts” to saying they are frightened, or that there are “monsters in their room,” Fay argues that parents should respond by saying “Well, sweetie, my advice is to make friends with them.  See you in the morning.  I love you,” and walk out the door. Now imagine how this scenario plays out when the infant/child is not developmentally ready for separation.  While the spectrum of research on love and healthy human development is far beyond the scope of this article, what is most important to remember is that oxytocin is produced naturally when we love, are loved, nurture another, give selflessly, or engage in affectionate touch.”  The love invested early on will pay huge dividends later on.

In fact, the impact of oxytocin extends far beyond the time of birth and early parenting.  For example, the article “The role of oxytocin in psychiatric disorders: A review of biological and therapeutic research findings” (Cochran, 2013), looked at oxytocin as “an important regulator of human social behaviors, including social decision making, evaluating and responding to social stimuli, mediating social interactions, and forming social memories.”[12] What this review discovered is that “oxytocin is intricately involved in a broad array of neuropsychiatric functions, and may be a common factor important in multiple psychiatric disorders such as autism, schizophrenia, mood and anxiety disorders.”  More specifically, “while there is less evidence for a clear dysfunction in the oxytocin system in patients with schizophrenia,” some studies suggest that “there may be a dysfunction in oxytocin processing associated with Autism Spectrum Disorder (ASD), and that there may be developmental changes associated with the oxytocin system over the lifespan of individuals with ASD.”  Moreover, with regards to epigenetics, “Even when there is no direct genetic evidence of alterations in oxytocin-related genes, the expression of these genes may be affected by epigenetic modification and provide a different mechanism for oxytocin’s role in the clinical phenotype of ASD.”

Going back to Cochran’s study and the impact of oxytocin as an important regulator of human social behaviors, it is worth noting that Allan N. Schore (2017), looked at the psychoneurobiological mechanisms that underlie the vulnerability of the developing male.  His findings showed that “stress-regulating circuits of the male brain mature more slowly than those of the female in the prenatal perinatal, and postnatal critical period,” “developing males are more vulnerable over a longer period of time to stressors in the social environment (attachment trauma),” and that there is an “increased vulnerability of males to autism, early onset schizophrenia, attention deficit hyperactivity disorder, and conduct disorders.”[13] These results are of considerable interest given that in November (2018), the National Survey of Children’s Health updated the CDC figures of 1 in 59 children in the U.S. with a diagnosis of autism[14] to roughly 1 in 40 having a diagnosis of autism spectrum disorder.  It is also notable that autism in boys, reported by the CDC to be 4 times more common than in girls, was updated to reveal that boys were (only) 3.5 times as likely to be diagnosed when compared to girls.[15] Instead of the cultural emphasis of “toughening up” boys by treating them differently than girl babies, literally from birth on, we should instead be taking a more dedicated look at the psychoneurobiological mechanisms that impact development and treat all infants with tender, responsive care so that they can experience secure attachment.  As Shore concludes, “In light of the male infant’s slower brain maturation, the secure mother’s attachment-regulating function as a sensitively responsive, interactive affect regulator of his immature right brain in the first year is essential to optimal male socioemotional development.”

In light of the research on the connection between love, oxytocin expression, as well as  the short- and long-term impacts on infant/human well-being, it is clear that love is  likely to be one of the most crucial elements in the process, beginning with preconception and extending at least through the first few years of an infant/child’s life.  Moreover, we must begin with loving the pregnant and birthing woman, her baby, and her partner – on the birth day, and every day.

[1] Odent, M. (2014). The Scientification of Love.  London: Free Association Books.

[2] Turner, R., Altemus, M., Enos, T., & McGuinness, T. Psychiatry Interpersonal & Biological Processes, 62(2):97-113.

[3] Turner, R., Altemus, M., Enos, T., & McGuinness, T. Psychiatry Interpersonal & Biological Processes, 62(2):97-113.

[4] Parvati Baker, J., Baker, F., & Slayton, T. Conscious Conception: Elemental Journey Through the Labyrinth of Sexuality. Berkeley, CA: North Atlantic Books.

[5] Luminare-Rose, C. (2000). Parenting Begins Before Conception: A Guide to Preparing Body, Mind, and Spirit for You and Your Future Child.  Rochester, VT: Healing Arts Press.

[6] Huxley, L. (1987). The Child of Your Dreams. Minneapolis, MN: CompCare Publishers.

[7] https://www.tarntarankaur.com/

[8] One notable exception is Elizabeth Nobel’s book Primal Connections: How our Experiences from conception to birth influence our emotions, behavior, and health (1993), which not only mentions love in the Index, it cross-references the listing with “heart.”

[9] One of the songs in the BirthWorks trainings asks, “What can we do to bring her love, on the birth day, and every day?”

[10] Nathanielsz, P. (2001). The Prenatal Prescription. New York, NY: HarperCollins.

[11] Schore, A. (2014). Early interpersonal neurobiological assessment of attachment and autistic spectrum disorders. Frontiers in Psychology, 5:1049. doi: 10.3389/fpsyg.2014.01049

[22] Cochran, D., Fallon, D., Hill, M, and Frazier, J. (2013). The role of oxytocin in psychiatric disorders: A review of biological and therapeutic research findings.  Harvard Review of Psychiatry, 21(5):219-247.

[13] Schore, A. (2017) “All our sons: The developmental neurobiology and neuroendocrinology of boys at risk. Journal of Infant Mental Health, 38(1):15-52.

[14] Centers for Disease Control (2018). Data and Statistics: Autism Spectrum Disorder. Retrieved from www.cdc.gov

[15] Kogan et al. (2018). The prevalence of parent-reported autism spectrum disorder among US Children. Journal of Pediatrics, 142(6).

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The Impact of Fear, Stress and Anxiety during Pregnancy and Birth on Women and Infants

Sally Dear Healy, Ph.D.

by Sally Dear-Healey, Ph.D., PPNE, CCE (BWI), CD (BWI), TICP

Research shows that “both psychosocial stress and pregnancy-specific stresses can have marked effects on pregnancy, maternal health, and human development across the lifespan.”  Moreover, both animal and human studies suggest that activation of what is referred to as the “maternal stress response” and resulting changes in endocrine and inflammatory activity can span generations.  This is considered an epigenetic influence (Coussons-Read, 2013).[1]  Additionally, fear of childbirth can increase the number of unnecessary cesarean births, especially those which are elective (Aksoy et al., 2014).[2] Perhaps even more concerning is the fact that moms with clinical anxiety are at increased risk for postpartum depression and postpartum anxiety.

It is not unusual, nor is it always unhealthy, to fear something we have no experience with or know little to nothing about.  In fact, Carleton (2016)[3] argues that “fear of the unknown may be a, or possibly the, fundamental fear.” While the term xenophobia is often correlated with fear and hatred of strangers, it also is correlated with the fear of anything that is strange or foreign.  For many women, and men, birth, and especially birth in a hospital is a ‘strange and foreign’ land for which there is no travel guidebook, and often no designated and/or reliable guide.  Moreover, the “us” and “them” aspects of xenophobia clearly play out as beliefs and prejudices develop around certain birth practices, including but not limited to place of birth, type of care provider, the mode of birth, and beliefs and behaviors around early infant care. These beliefs can be embodied by women, their partners, as well as their care givers and differences are often a source of anxiety, stress, or fear- which can be counterintuitive in pregnancy and birth.

Tokophobia, a term first identified by Dr. Kristina Hofberg in 2000, is defined as “A pathological fear of pregnancy (which) can lead to avoidance of childbirth.  It can be classified as primary or secondary.  Primary is morbid fear of childbirth in a woman, who has no previous experience of pregnancy.  Secondary is morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy” (Bhatia and Jhanjee, 2012).[4]  Fear and anxiety are inextricably linked, and both can produce a stress response in both the mother and her baby.  Let’s unpack what this means for birthing women today.

Many women today fear pregnancy or birth, or both.  An article in the Journal of Perinatal Education suggests that one of the reasons women today are so fearful of birth has to do with its negative portrayal in the mainstream media.  The author provides examples of how these influences, as well as the way hospital births today are “managed” with technology and ‘fear-based’ attitudes can single-handedly convince most women that their bodies are incapable of birthing without major medical intervention and that they would be crazy not to want all the technology they can get their hands on.”[5]   In other words, their fears are often generated by what they have seen, heard, or experienced.  They may also be generational in the sense that they are “old” memories of the experiences of our mothers and grandmothers.[6 ]  The fear itself may be conscious or unconscious.  Either way, as we have already acknowledged, fear not only impacts the woman/mother, it impacts the yet-to-be-born and newborn infant.

While some stress is normal and considered to be healthy, and most people return to balance after a stressful experience, constant or chronic stress and the inability to regulate can have both short- and long-term negative impacts, sometimes referred to as fetal programming.[7]  For example, among other things, constant stress alters the body’s stress management system, causing it to overreact and trigger an inflammatory response.  According to Ann Borders, MD, MPH, MSc, “There are some data to show that higher chronic stressors in women and poorer coping skills to deal with those stressors may be associated with lower birth weight and with delivering earlier.”  She adds that “Chronic stress may also contribute to subtle differences in brain development that might lead to behavioral issues as the baby grows.”[8] Additional research by Myatt (2006) shows that “Untreated, significant, and ongoing antenatal anxiety exposes the fetus to excess glucocorticoids, which may influence the fetus’s susceptibility to enduring neuroendocrine changes.”[9] This is especially troubling as research by Bhatia and Jhanjee (2012) shows that between 20% and 78% of pregnant women report fears associated with pregnancy and childbirth.

While screening for fear, anxiety, and stress – as well as depression – should be incorporated into every woman’s prenatal care, or as those in the field of prenatal and perinatal psychology suggest even prior to conception, obstetricians don’t regularly, or adequately screen for them.  This may be because it is assumed that pregnant women must be happy or because women feel ashamed to bring it up.[10]  And, while treatments such as Cognitive Behavioral Therapy (CBT) or psychopharmacology can be very effective for the treatment of anxiety disorders, we can also effectively argue that practices such as conscious conception, pregnancy, and birth – as well as having a positive mental attitude – can have a positive influence.[11]  Additional benefits can be realized through relaxed breathing, progressive muscle relaxation, meditation, and changing over from less healthy thinking patterns to healthier ones that focus on strengths-building and positive states of mind.  In turn, mothers and babies can have a more positive and less fearful and anxious experience of pregnancy and birth, which sets the stage for bonding, attachment, and greater physical and emotional health for mothers and babies.

[1] Coussons-Read, M.E. (2013). Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstetric Medicine. 6(2): 52-57.

[2] Aksoy, M, Aksoy, A., Dostbil, A., Celik, M. and Ince I. (2014). The relationship between fear of childbirth and women’s knowledge about painless childbirth. Obstetrics and Gynecology International. 274303. doi: 10.1155/2014/274303.

[3] Carleton, R.N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Review. Journal of Anxiety Disorders.  Vol. 39: 30-43.

[4] Bhatia, M. S. & Jhanjee, A. (2012). Tokophobia: A dread of pregnancy.  Industrial Psychiatry Journal. Jul-Dec; 21(2):158-159.

[5] Lothian, J.A. and Grauer, A. (2003). “Reality” Birth: Marketing Fear to Childbearing Women.  The Journal of Perinatal Education. 12(2): 6-8.

[6] Those who have given birth at home often experience a model of birth that has been shown to reduce the incidence of birth injury, trauma, and medical interventions which in turn decreases the fear and subsequent stress response(s).

[7] “Fetal programming occurs when the normal pattern of fetal development is disrupted by an abnormal stimulus or ‘insult’ applied at a critical point in in utero development.  This then leads to an effect, which manifests itself in adult life” (https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/jphysiol.2006.104968).

[8] https://www.webmd.com/baby/features/stress-marks#1

[9] Myatt, L. Placental adaptive responses and fetal programming.  The Journal of Physiology. Vol. 572: 25-30.

[10] Rope, K. (2019). How to Cope with Anxiety and Depression During Pregnancy.  Parents.com. https://www.parents.com/pregnancy/my-life/emotions/coping-with-anxiety-and-depression-during-pregnancy/

[11] It should be acknowledged that in some cases women need to take medication, however it is currently unclear whether and to what extent these medications impact the infant while still in the womb and during breastfeeding.  In addition, “Information of mixed quality in lay media, stigma, and fear may lead women to decline effective pharmacological treatment, take less than the recommended dose; or stop treatment prematurely, which may lead to discontinuation symptoms, relapse of underlying anxiety, and even suicidal ideation” (See Einarson, A. and Selby, P. (2001). Abrupt discontinuation of psychotropic drugs during pregnancy: Fear of teratogenic risk and impact of counseling. Journal of Psychiatry and Neuroscience. Vol. 26: 44-48 and Gawley, L. and Bowne, A. (2011). Stigma  and attitudes towards antenatal depression and antidepressant use during pregnancy in healthcare students. Advances in Health Science Education. 16(5): 669-679).

The Impact of Fear, Stress and Anxiety during Pregnancy and Birth on Women and Infants

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Ultrasounds – Risks, Benefits, and Ethical Considerations

Submitted by Sally Dear-Healey, PhD, PPNE, CCE(BWI), Doula(BWI)

Years ago, X-ray was the diagnostic procedure of choice in pregnancy but today we understand more about the harmful effects of radiation so ultrasound is used as a safer alternative.  What we do know today is that every medical procedure has inherent risks known and unknown.  Therefore it is not wise to perform any procedure except if the known risks are higher than the risks of not doing anything.  However, instead of progressing cautiously and limiting exposure, more and more doctors/OB practices order repeated ultrasound scans for most of their patients/clients.

Ultrasounds are a form of electronic fetal monitoring that have become a normalized part of mainstream obstetric practice.  In fact, practically every pregnant woman in the U. S. will have at least one ultrasound scan during her pregnancy and most will have electronic fetal monitoring during their labor and delivery.  These women tend to be influenced by popular magazines, social media,  internet medical media, mainstream pregnancy books, news articles, and oftentimes friends and family members that purport that ultrasounds are necessary to ensure the safety and healthy development and birth of their baby. This article reviews a sampling of the issues, concerns, and benefits related to ultrasounds.

There are multiple issues and problems associated with the routine use of ultrasounds in pregnancy:

  • Most women today don’t question the procedure or educate themselves on its risks and benefits. Even if they have, few feel they have the right or ability to refuse the test(s).
  • Doctors may not have the time or knowledge to educate their patients about the risks and benefits of the procedure.  However, all women have a right to informed consent and should be encouraged to ask any questions they may have.
  • The number of scans is an issue. Instead of one ultrasound, many women have multiple ultrasounds over the course of their pregnancy in addition to “routine” scanning during labor and delivery (Electronic Fetal Monitoring and Dopplers are forms of ultrasound).
  • The integrity of the scanning machine, the length of the scan time, as well as interpretations of the results can be problematic.
  • “Gender reveal” parties based on the result of these scans are becoming more common and some parents have even purchased their own ultrasound machines so they can track the development of their unborn baby.
  • The financial cost of these scans is a significant concern for individuals and for the health care industry overall.  The average cost of an ultrasound in the U.S. is $250 – $300 without insurance.

Thirty years ago, there were concerns about ultrasound based on animal research, as in 1984, Doris Haire’s article in the Journal of Nurse-Midwifery titled “Fetal effects of ultrasound: A growing controversy,” which cited Dr. Melvin E. Stratmeyer, of the Center for Devices and Radiologic Health (CDRH), as saying “Increasing concern has arisen regarding the fetal safety of widely used diagnostic ultrasound in obstetrics,”  but to this day concerns about such things as neuromuscular development, anomalies, and genetic alterations have not been substantiated on animals or humans. In 1985, ACOG (The American College of Obstetrics and Gynecology) issued a technical bulletin that stated, “No well-controlled study has yet proved that routine scanning of all prenatal patients will improve the outcome of pregnancy.”

As a long-time birth worker, and having taught classes in human development and child and family studies for over two decades, I share their collective concerns and argue that, even though it has been thirty-five years since Haire’s article came out, we have yet to fully understand or appreciate the long-term impacts of prenatal ultrasound exposure.  Yet, there is research out that can be drawn upon to make an educated decision.

Nyborg (1987) writes, “Alterations to cell membrane structure have been reported by a number of investigators.  Some alterations include increased density of microvilli and ruffles in cell membrane following exposure that may alter growth characteristics” and “The persistence of a hereditable disturbances in cell motility after ultrasound exposure is especially important and investigations need to be conducted to determine if these effects occur in vitro” (256).

Sarah Buckley, MD, is also very clear about ultrasounds, stating that “Although ultrasound may sometimes be useful when specific problems are suspected, my conclusion is that it is at best ineffective and at worse dangerous when used as a ‘screening tool’ for every pregnant woman and her baby. […] Treating the baby as a separate being, ultrasound artificially splits mother from baby well before this is a physiological or psychic reality.  This further…sets the scene for possible but to my mind artificial conflicts of interest between mother and baby in pregnancy birth and parenting” (as quoted in West, 2015).

In 2000, Professor Ruo Feng, of the Institute of Acoustics, Nanjing University, who holds a PhD in physics and has published over 186 scientific papers summarized human studies of prenatal ultrasound and suggested five points of protection.  They are:

  • Ulltrasound should only be used for specific medical indications.
  • Ultrasound, if used, should strictly adhere to the smallest dose principle, that is, the ultrasonic dose should be limited to that which achieves the necessary diagnostic information under the principle of using intensity as small as possible and the irradiation time as short as possible.
  • Commercial or educational fetal ultrasound imaging should be strictly eliminated and ultrasound for the identification of fetal sex and fetal entertainment imaging should be strictly eliminated.
  • Avoid ultrasound in the first trimester of pregnancy. If unavoidable, minimize ultrasound.  Even later, during the 2nd or 3rd trimester, limit ultrasound to 3-5 minutes for sensitive areas, e.g. fetal brain, eyes, spinal cord, heart and other parts,
  • For every physician engaged in clinical ultrasound training, their training should include information on the biological effects of ultrasound and ultrasound diagnostic dose safety knowledge (West, 2015).

In terms of benefits, diagnostic ultrasound may be useful where there is a true medical need, although it is reasonable to conclude from the evidence that many of these conditions auto-correct themselves prior to the birth.  It could also be argued that for the mother who has experienced baby loss, either during a pregnancy or shortly after birth, seeing and hearing her unborn child may help to alleviate stress and anxiety in a subsequent pregnancy, which could also positively influence the well- being of the baby due to decreased cortisol levels.  On the other hand, scanning too much can actually create stress.  Jeffrey Ecker, M.D., chief of the department of obstetrics and gynecology at Massachusetts General Hospital, notes that “It’s important to have a specific question you are trying to address.  If by chance someone thinks they see something off, it can cause unnecessary worry” (Miller, 2016).  According to an article in the Journal of Ultrasound Medicine (2012), Miller et al. report that “Safety information can be scattered, confusing, or subject to commercial conflicts of interest.”

While some of the research presented is dated, it is widely acknowledged that very little has changed, and we still don’t have definitive answers.  If you do decide to have a prenatal ultrasound, it is wise to do the following:

  • Limit the number of scans
  • Have the procedure done by an operator with a high level of skill and competence
  • Have the shortest scan possible.
  • Be clear about what questions you have and be sure to ask them.
  • Most important, remember that it’s your baby and your choice.

 

References

  • American College of Obstetricians and Gynecologists (ACOG). (1985). Diagnostic Ultrasound in Obstetrics and Gynecology.  Technical Bulletin No. 63; October.
  • Haire, D. (1984). Fetal effects of ultrasound: A growing controversy. Journal of Nurse-Midwifery; Vol. 29, No. 4.
  • Mendelsohn, R. Dr. Robert Mendelsohn on Pregnancy and the Dangers of Ultrasound. https://www.youtube.com/watch?time_continue=208&v=YfaUQCp6L1s
  • Miller, D., Smith, N., Baily, M. Czarnota, G., Hynynen, K, Makin, I. (2012). Overview of therapeutic ultrasound applications and safety considerations. Journal of Ultrasound Medicine: 31(4):623-34.
  • Miller, K. (2016). This is How Many Ultrasounds You Actually Need During Pregnancy. Self.com https://www.self.com/story/this-is-how-many-ultrasounds-you-actually-need-during-pregnancy
  • Nyborg, W. L. (1987). Research Priorities in Ultrasound.  In: Repacholi, M.H.. Grandolfo, M., Rindi, A. (Eds.). Ultrasound. Springer: Boston.
  • West, J. (2015).  “50 Human Studies in Utero, Conducted in Modern China Indicate Extreme Risk for Prenatal Ultrasound A New Bibliography.”  Harvoa.org
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A Look at Pregnancy and Birth Trauma and Polyvagal Theory from the Perspective of Prenatal and Perinatal Psychology

by Sally Dear-Healey, CCE(BWI), CD(BWI)

Prenatal and perinatal psychology (PPP) provides a unique and critical awareness of the process of conception, pregnancy, and birth that is lacking from most childbirth education programs, doula trainings, and provider’s educations. One of the main benefits of pre- and perinatal psychology is that it recognizes the need to consider not only the mother and her experience, but also the baby and their experience.

Polyvagal Theory, developed by Stephen Porges (1994) provides us with a dynamic understanding of how and why mammals shift between a calm states that promote intimacy and optimize health, growth, connectedness and restoration to flight, flight, or freeze states, which are normal autonomic nervous system (ANS) responses to threat, fear, and lack of safety. Individuals with a history of trauma are especially vulnerable as their “neural reactions have been retuned towards a defensive bias and they (have) lost the resilience to return to a state of safety” (Porges, S.W. and Dana, D., 2018). The goal of Polyvagal Theory is to keep an individual within their “window of tolerance” in their sympathetic nervous system (SNS) (fight or flight –aggressive defense system) and parasympathetic dorsal vagal complex (DVC) (freeze – passive defense system) and focus on feelings of connection, safety, and orientation to the environment which are part of their parasympathetic ventral vagal complex (VVC), otherwise known as the social engagement system (SNS).

“An estimated 70 percent of adults in the U.S. have experienced a traumatic event at least once in their lives” (https://www.sidran.org). This estimate may be low. According to a Journal of Trauma and Stress article, “Most respondents (89.7%/N = 2,953) reported exposure to at least once DSM-5 Criterion A (trauma) event” (Kilpatrick et al., 2013). Specific to birth, a study investigating the prevalence of Post-Traumatic Stress Disorder (PTSD) following childbirth found that 17.2% of women had symptoms of PTSD following childbirth (Shaban et al, 2013). Again, these statistics may be low as PATTCh (Prevention and Treatment of Traumatic Childbirth) reports “Between 25 and 34 per cent (sic) of women report that their births were traumatic” (http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics).

Returning to pre- and perinatal psychology, Thomas Very, M.D. and David Chamberlain, Ph.D., both pioneers in birth psychology and founders of what is now APPPAH, the Association for Prenatal and Perinatal Psychology and Health, realized “There is a growing body of empirical studies showing significant relationships between birth trauma and a number of specific difficulties; violence, criminal behavior, learning disabilities, epilepsy, hyperactivity and child, alcohol and drug abuse” (Verny, 1981). For mothers and babies birth trauma often results from birth-related difficulties including but not limited to premature and postmature births, breech births, inductions, anesthesia, forceps deliveries, and cesareans. Trauma may also result from a mother’s feeling a lack of safety and support, which is transposed directly to her baby.

This is where Polyvagal Theory provides us with a method of understanding how trauma manifests during conception, pregnancy, and birth and how we can actively create feelings of safety, thereby facilitating increased social engagement, improving bonding and attachment, and increasing the overall short- and long-term health and wellness for mothers and their babies/children.

Polyvagal Theory proposes that cues of safety are an efficient and profound antidote for trauma. According to Porges, “The theory emphasizes that safety is defined by feeling safe and not simply by the removal of threat… and is dependent on three conditions: 1) the autonomic nervous system cannot be in a state that supports defense, 2) the social engagement system needs to be activated to down regulate sympathetic activation and functionally contain the sympathetic nervous system and the dorsal vagal circuit within an optimal range (homeostasis) …; and 3) cues of safety … need to be available and detected via neuroception (2018, p. 62 & 62).

Birth is an intimate event, and according to Porges “Intimacy is a state-dependent behavior.” He goes on to say that “For mammals, immobilization is a vulnerable state” (2018, p. 63). To help women achieve the state of intimacy necessary for conscious conception, pregnancy and birth we need to work with women prior to conception and throughout their pregnancy so that they – and subsequently their babies – are able to regulate and change previously disruptive autonomic states by accessing the social engagement system and ventral vagus so they are not re-activated by previous or current trauma. The social engagement system is recruited through “cues of safety such as a quiet environment, positive and compassionate … interactions, prosodic quality (e.g., melodic intonation) of … vocalizations, and music modulated across frequency bands that overlap with vocal signals of safety… (Porges, 2018, p. 66). In other words attitudes and behaviors, what people say but how they say it, as well as their facial expressions.

The primal perspective is one of the foundations of prenatal and perinatal psychology. As David Chamberlain is often quoted as saying, “Newborn babies have been trying for centuries to convince us that they are, like the rest of us, sensing, feeling, thinking human beings.” To be clear, this research is not meant to induce guilt since parents often get caught up in the type and hype of birth practices that are prevalent at the time and even the normal pressures of life can contribute to a stressful pregnancy or lead to a traumatic birth. Instead, its purpose is to increase awareness and effect changes in policies and procedures that might otherwise cause or contribute to trauma and subsequent short- and long-term harm in mothers and their babies/children. For those that have already been affected, help is available. Play therapy, womb surrounds, craniosacral therapy, birth simulating massage and various other forms of therapy and bodywork have been found to be highly effective. For more information on prenatal and perinatal psychology and polyvagal therapy, as well as opportunities for healing and working with these individuals please go to https://birthpsychology.com.