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by Michel Odent, MD The concept of birth preparation appeared suddenly in the middle of the twentieth century. “Methods” of preparation started to proliferate. Paradoxically, they were popularized by groups promoting “natural childbirth”, as if the words “methods” and even “preparation” were easily compatible with the word “natural”. The enormous credibility of all these methods is not surprising, since they were in agreement with the bases of our cultural conditioning. To claim that a woman needs to learn to give birth and needs a guiding expert during labour was just another aspect of the domination of nature after thousands of years of socialization of childbirth. Let us recall the words of authoritative pioneers in birth preparation. According to Fernand Lamaze, the father of the so-called Lamaze method, a woman has to learn to give birth in the same way that we learn to speak, or to read. The words of the American obstetrician Robert Austin Bradley were significantly similar. He compared a pregnant woman with a woman who is given nine months’ notice that she will be thrown into deep water. Of course, this woman would use the nine months in learning how to swim. In the same way, a pregnant woman should learn how to give birth. The physiological preparation Not only has this episode of birth history reinforced our cultural conditioning, but it has also postponed the interest in an important aspects of birth physiology in our species. While the focus was on preparation by experts, there was no interest in what we might call a “physiological preparation”. The point is that the signs of this “physiological preparation” are well known, but could not be taken seriously and interpreted as long as the concept of neocortical inhibition had not been assimilated. It has been noticed for ages that, at the end of their pregnancies, many women are not as mentally sharp as usual. They mention anecdotes of memory loss. Their topics of interest become different.  Their needs for socialization may be reduced and reoriented. They tend to restrict or to avoid all kinds of socialization that are not related to their “Primary Maternal preoccupation”. This term, coined by The British paediatrician and psychoanalyst Winnicott, is highly significant. Winnicott theorized that, in the last trimester of a pregnancy, through a process that has evolved for its “survival value”, the mother starts becoming more intensively aware of, and concerned about, her baby.1 The “primary maternal preoccupation” has been illustrated in the past by artists. This is the case of paintings of Mary, who is pregnant with Jesus, visiting her cousin Elisabeth, who herself is expecting John the Baptist. It is notable that, in several of these paintings, particularly a German one dated 1300, the babies in the womb are visible. This is a clear sign transmitted by the artist that, while talking together, these two mothers are mostly “preoccupied” by their unborn babies and forgetting the rest of the world. At a phase of our history when many women have a professional occupation involving intellectual activity, the focus is usually on memory loss. Empiric knowledge is confirmed by scientific evaluations of deficits of several kinds of memory, particularly “prospective memory”, which is the capacity to remember to perform an action at the right time.2 It is usual to provide some advice to “combat” this condition and to reduce its “severity”: take vitamins, have more exercise, drink plenty of fluids, rebalance your diet, etc.  Another aspect of this “physiological preparation” is a reinforced sense of smell occasionally noticed by pregnant women. Should pregnant women live in peace? We are suddenly reaching a time when it is becoming easy to interpret the “Primary maternal preoccupation” that starts before the birth of the baby. It may be presented as the preliminary phase of the reduction of neocortical activity that makes birth possible in our species. It is a component of the “physiological birth preparation”. There are many other unexplored aspects of the transitory personality changes in the period surrounding birth. In this framework, it would be worth studying in depth what is called “motherese”, this simplified and repetitive type of language, with exaggerated intonation and rhythm, used by mothers when speaking to their newborn babies. And what about the roots of the universal lullabies? By using Magnetic Resonance Imaging techniques, a joint Spanish and Dutch team has clearly demonstrated that the end of pregnancy is associated with reductions in gray matter volumes, particularly in brain regions involved in social processes.3 The publication of this study is a turning point with huge practical implications: does it mean that pregnant women should live in peace?   References 1-Winnicott DW. 1956. “Primary Maternal Preoccupation” (10) to (20) are included in: “Collected Papers: Through Paediatrics to Psycho-Analysis (London: Tavistock 1958) 2- Rendell PG, Henry JD Prospective-memory functioning is affected during pregnancy and postpartum. J Clin Exp Neuropsychology 2008 Nov;30(8):913-9. doi: 10.1080/13803390701874379. Epub 2008 Mar 14 3- Hoekzema E, Barba-Muller E, et al. Pregnancy leads to long-lasting changes in human brain structure. Nat Neurosci. 2016 Dec 19. doi: 10.1038/nn.4458. [Epub ahead of print]