Love’s Labor Lost
ADVERSE EXPERIENCES
IN THE WOMB AND AT BIRTH
. . . Sancho Fergus,
my boychild, had such great shoulders,
when he was born his head
came out, the rest of him stuck. And he opened
his eyes: his head out there all alone
in the room, he squinted with pained,
barely unglued eyes at the ninth-month’s
blood splashing beneath him
on the floor. And almost
smiled, I thought, almost forgave it all in advance.
When he came wholly forth
I took him up in my hands and bent
over and smelled
the black, glistening fur
of his head, as empty space
must have bent
over the newborn planet
and smelled the grasslands and the ferns.
—GALWAY KINNELL,
The Book of Nightmares
My grandma told me that when I was first born I didn’t breathe for seventy-nine seconds. Everybody was freaking out. The umbilical cord was wrapped around my neck, and I was blue. So they rushed me away, and I wasn’t crying and I wasn’t breathing and I wasn’t doing nothing. I was totally blue. Finally, my grandpa had to take one of the doctors and slam him up against a brick wall before they would tell him anything. And they said that I hadn’t breathed for seventy-nine seconds and right now they were going to do some tests to make sure that I was okay. And the whole time my mom was screaming, “I want my baby. I want my baby.” And they wouldn’t let her see me. So for the whole time she was in the hospital, I think it might have been about six days or so, the whole time she was in there she didn’t get to see me until the day they finally released us. She was freaking out and screaming. The nurses wouldn’t tell her nothing. By the time she was healthy enough to get up and walk—she was really weak after I was born—she was throwing things around. She was going into that manic depressive thing where one minute she was depressed and the next minute she was just like totally anxious and totally just real aggressive to everybody and spouting off at the mouth and acting like they was doing wrong to me. . . . At first my grandma and grandpa thought it was post-partum depression. . . . They figured it would be anywhere from like a week after I was released from the hospital up to a month. And after that is when they began to start worrying really. . . .
My mom and dad were living in a house behind my grandparents. . . . My grandmother thought maybe I cried so much because of the gas leak. My mom left for the day, and [Grandma] took me over to the house to make sure everything was okay, and there wasn’t nothing burning and she said that I was fine the whole time I was in the house that my mom wasn’t there. . . . She was there eight hours or so cleaning up my mom’s house because my mom wouldn’t clean. There was dirty diapers from my brother everywhere, and the whole time I was there I was fine. And she said she didn’t think it was the gas. It was my mom being so stressed out and so uptight it was causing me to maybe sense it. [Mom] was freaking out the whole time, real depressed, bouts of screaming and crying and outrageous fits. Then she’d clam up and wouldn’t talk to anybody. My grandma said she was acting like a little ten-year-old kid that was throwing a fit.
—JEFFREY, AUGUST 1996
He was born blue. He had yellow jaundice. He had a lot of medical problems. It wasn’t anything he had to have surgery for. He was just always sick. There was always some sort of an illness that he was in the hospital for. I was upset, you know, ’cause my little brother that they kept on talking about all this time that he was comin’, that he was comin’, that he was comin’! Then he comes and it’s like I can’t be there with him. Why can’t he be there with me, you know? All I know is that he was always sick. He was just sick. That’s all my mother would tell me. I really don’t think my mother could have taken care of him, anyway.
—JOHN, AUGUST 1996
While she is still wet from the womb, as she breathes her first breath, cries her first cry, feels her first gusts of cool air, her brain is building itself at a rate never to be repeated. She already knows the sound of her mother’s voice and turns to it. She gazes at her mother’s face with great concentration. Synapses in her tiny brain are sprouting in response to each sensation. The most powerful computer in the world has been waiting for these moments of light, and smell, and touch, and sound, and taste—the carpenters of the human brain.
She will turn toward her mother’s voice to keep it coming. She knows her mother’s smell and her father’s voice if he has been close to her mother in the last two months. She may already recognize and prefer a familiar nursery rhyme, or song, or concerto. Her limbs may move spontaneously toward her mother’s voice in a dance that mirrors the rhythms of the words. Within a few weeks her own sounds will replicate those rhythms. She can imitate facial expressions. She can follow a bright object moving slowly across her field of vision. She sees the world in color and contrasts. She is fully equipped to engage her people, to learn, to connect. Everything is new. And every system is poised to take in information—for the first and perhaps most incisive impressions of a lifetime.
Most of us remember our first date, or our first airplane ride, or our first loss of a pet. Those memories are now long-ago perceived, processed, and stored in the cortex of our brains where they have been at least somewhat gentled by time and reason. But for the newborn, while conscious memories of the day will be lost, the first somatic sense of what this world is like begins with the tugs and touches of emerging from the womb. Our first experience of this life begins here on the first day. This won’t be recorded in language or be retrievable into rational thought. But the limbic brain remembers, and our body remembers. Here is when we begin to build our model of what to expect, of who will be there, of how we will be received, of how safe it is out there, of how we can make ourselves known and be comforted.
This scene, the birth of a competent and complex organism learning at an unimaginable rate, occurs thousands of times every day in our nation. But it occurs too often with little appreciation, let alone celebration of the potential that has just arrived in our midst. We are just beginning to lift the veil on the reality of the competent newborn. Many Americans still view babies as inattentive and unaware. Infants are routinely brokered to whomever will abide the anticipated boredom of physical baby tending, perceived essentially in our culture as a routine and nonskilled series of feedings and diaper changings. In spite of a growing group of educated and very involved fathers, most American men regard their newborns like newly birthed kangaroos that need several months to ripen in mother’s pouch. Personhood seems to go hand in hand with a hearty size and control over one’s mouth, limbs, and elimination. Says Dr. Richard Restak, author of The Infant Mind: “If you start off assuming that infants know nothing, then by a kind of self-fulfilling prophecy, the infant’s competence escapes attention.”1
Until very recently, the notion of connected interactive communication between an adult and a newborn, let alone a fetus, would have been viewed by most parents as foolish. Just three generations ago, the Atlantic Monthly described as “a godsend to parents” the following advice from Dr. John B. Watson, who was at that time America’s leading child care authority and author of The Psychological Care of Infant and Child, published in 1928:
The sensible way to bring up children is to treat them as young adults. Dress them, bathe them with care and circumspection. Let your behavior always be objective and kindly firm. Never hug and kiss them. Never let them sit in your lap. If you must, kiss them once on the forehead when they say goodnight. Shake hands with them in the morning. . . . Put the child out in the back yard a large part of the time. Build a fence round the yard, so that it can come to no harm. Do this from the time it is born . . . let it learn to overcome difficulties almost from the moment of birth . . . away from your watchful eye. If your heart is too tender, and you must watch the child, make yourself a peephole, so that you can see without being seen, or use a periscope.2
But parents and those who advised them weren’t alone in overlooking the capacities of their infants at birth. Until the late 1980s, doctors considered babies to be unseeing and unfeeling at birth. Newborns were routinely held by their feet upside down and slapped at delivery. Routine welcoming for most of us born in the late 1970s and earlier included immediate removal from our mothers to a table where we were wiped off, weighed, and received stinging drops into our new eyes. Then we were swaddled and laid in a sterile and portable plastic rectangle aptly named the “isolette,” where we were wheeled to a brightly lit room full of medical equipment, antiseptic smells, hospital noises, and other distressed newborns. For premature babies, expectations of sentience have been even lower; thought, feeling, and even the capacity for pain were dismissed in the baby born early. From the advent of neonatal intensive care units in the late 1960s through the late 1980s, breathing tubes, suction tubes, feeding tubes, and shunts were routinely installed without any anesthesia. Shrieks of pain and terror were discounted by medical professionals as being reflexive and without meaning.
Dr. David Chamberlain, president of the Association for Prenatal and Perinatal Psychology and Health, recounts that one routine procedure necessary for 50 percent of infants weighing less than 1,500 grams involved cutting a hole in the chest and in both sides of the neck, making an incision from the breastbone to the backbone, prying the ribs apart, retracting the left lung, and tying off an artery near the heart. This operation took an average of an hour and a half, during which the baby was flooded with pain and terror. Many died from pain and shock. Yet until 1986, anesthesia was routinely withheld.3
A 1993 survey showed that 12 percent of doctors performing circumcisions believed that babies do not feel pain; 35 percent believe they will not remember it even if they do; and only half used any form of anesthesia.4 The newborn has simply not been seen as whole, as perceiving, as sensitive or thinking in any meaningful way. “It” is the typical pronoun of choice referring to the fetus and as often as not to the newborn. Practices at birth have reflected this objectification. For babies born to loving, welcoming, nurturing families, these early rituals have been a rude shock but have been ameliorated by parental handling and family support. But for babies born into negative or compromised family circumstances where stress has been and will continue, this awakening to life as a painful and discounting experience provides the first factors in the violence equation.
The dismissal of the sentience of the baby is a major obstacle to the curtailment of violence. As long as sensitive attention is denied to the fetus, the newborn, and the toddler, we need not look very far to observe rage in the making. For infants whose birth is compromised by physical difficulties coming into the world, such as struggling with a breech birth or threatened with suffocation from a cord wrapped around the neck, there is exceptional vulnerability and need for reassurance and comfort. When a traumatized baby is instead rejected by his mother, the stage is set for rage and often for violent criminality in adulthood.
Dr. Patricia Brennan at Emory University studied a group of 4,269 males born in Denmark between 1959 and 1961. Birth complications had been recorded at the time of delivery. Demographic, family, and psychosocial factors were recorded during pregnancy and when the child was one year of age. Information collected included whether the pregnancy was wanted or unwanted, whether there had been an attempt to abort the fetus, and whether there was placement of the infant into an institution for more than four months during the child’s first year. When the boys were seventeen to nineteen years of age, their criminal status was assessed through a search of the Danish National Criminal Register. Violent crimes were defined as crimes that intentionally threatened, attempted, or inflicted harm on others. These included murder, attempted murder, assault including domestic assault, rape, armed robbery, illegal possession of a weapon, and threats of violence.5
Children who suffered birth complications together with maternal rejection in their first year of life were far more likely than others to become violent offenders as adults. Only 4.5 percent of the number of boys had both risk factors. Yet this relatively small number accounted for 18 percent of the total crimes committed by the entire group. Most people would assume that poor social circumstances—especially poverty—would exert an impact at least as strong as maternal rejection, but poor social circumstances combined with birth complications did not produce violent outcomes. The effect was specific to the interaction of maternal rejection with birth complications in this study. Drs. Patricia Brennan, Adrian Raine, and Sarnoff Mednick, also of USC, found a significant correlation between delivery complications (e.g., ruptured uterus, eclampsia, or prolapsed cord), parental mental illness, and violent crime during adolescence and adulthood. In this 1993 study, the highest rates of violent crime occurred when subjects had experienced both a high number of delivery complications and a mentally ill parent. Of those subjects who experienced both parental mental illness and high delivery complications, 32.3 percent were violent as adults compared with 5 percent for mental illness only and 0 percent for high delivery complications only.6
When mental illness results in the institutionalization of a parent, the chances of violent outcomes for the children are further increased. The disruption of the mother-infant attachment process due to institutionalization of a child or mother has been associated with affectionless psychopathic criminal behavior.7 This breaking of the web of trust between primary caregiver and vulnerable infant is often the first step in reducing a child’s capacity for empathic connections within other later relationships. It appears that maternal deprivation or separation, especially when combined with a biological factor due to birth complications, greatly increases the likelihood of violent behavior. The influence of birth complications in this equation may be indirect (e.g., cognitive deficits that lead to school failure, then to occupational failure, and ultimately to violence) or direct (e.g., explosive and impulsive behavior due to neuropsychiatric deficits). In either case, a negative familial environment is an exacerbating factor.8
This equation doesn’t wait for birth. The first environment actively shaping the human brain is the womb. Even before first smiles or tantrums, the womb is host to an interactive biological and neurobiological dance between the mother and the fetus. For more than half a century we have known that what affects mothers emotionally also affects babies. In 1934, Drs. L. W. Sontag and Robert F. 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 right along with the mother.9
In the same way that the external environment after birth can shape positive infant neurological responses such as curiosity and normal exploratory behavior, and negative responses such as fear of exploration and extreme emotionality in response to stress, researchers suspect that the mother’s experience, which is conveyed through the chemistry of the womb, exerts a clear and pervasive influence on the fetus, both emotionally and cognitively. Drs. Susan Clarke and Mary Schneider, of the Harlow Primate Laboratory at the University of Wisconsin, have studied this phenomenon in juvenile rhesus monkeys.10 Dr. Clarke and her colleagues removed six pregnant monkeys from their home cages once a day and exposed them to three brief, unpredictable bursts of sound from an alarm horn over a ten-minute period. This was done beginning in mid-gestation for ninety days. The sound produced a startle response (a stress symptom) and raised the mother monkeys’ blood levels of brain chemicals associated with stress. Six undisturbed monkeys, matched for age, weight, and time of gestation, served as controls. On four occasions, blood samples were collected from all the fetal monkeys under anesthesia and were assessed for the level of brain chemicals associated with stress (cortisol and ACTH). The fetuses whose mothers were stressed during pregnancy reflected their mothers’ emotional states.
After birth, the babies of the stressed mothers and the control mothers were subjected to a series of stressors, including change of cage, change of cage plus noise, separation, and separation plus noise. When the monkeys were assessed at fifteen and eighteen months of age, the baby monkeys stressed both during gestation and after birth were more likely to experience extreme stress and extreme emotional responses to later stressful events. Monkeys stressed only after birth showed some difficulty as well, but not to the extent of those stressed before birth. The researchers are unsure of exactly how this experience is transferred from mother to baby biologically but theorize that the mother’s production of stress hormones has a negative effect on the hippocampus of the baby’s brain, which affects the baby’s later stress responses. Permanently set on high, the stress response systems of such babies may have a domino effect on their developing brains. Other systems in the brain attempt to counterbalance the high levels of stress hormones produced by such experiences and move to establish normalcy. Researchers hypothesize that prenatal stress sets off a series of reactions in the brain that may ultimately result in depression, premature aging, Cushing’s disease, and post-traumatic stress disorder.11
Studies on this same group of prenatally stressed infant monkeys as youngsters showed increased and unpredictable defensive behavior and reduced interest in exploring a new environment as compared with the nonstressed control group.12 Additional studies comparing the two groups show six times more play behavior in the nonstressed group; stressed baby monkeys showed more clinging behavior and less grooming, less approaching, and less sitting with peers. The lack of normal social behaviors among prenatally stressed babies resulted in less adaptive social relationships and ultimately a much higher risk of aggressive behavior to the point that four abnormally stressed animals attempted to kill or actually killed their cage mates. This violent behavior came as a surprise to the researchers; it was not a predicted outcome for the studies. For ethical as well as economic reasons these researchers do not deliberately undertake studies in which aggression is a likely outcome.
Evidence of the long-term impact of prenatal stress on monkeys raises troubling questions about human babies. The abnormal behaviors of rhesus babies resemble that of children described in human temperament research as “inhibited.” These children explore their worlds less, are less playful, and become more extremely upset in unfamiliar situations. Their later behavior under stress is more rigid and often self-defeating. The research on primates seems to indicate that prenatal stress is very likely a factor that predisposes children to a “difficult” temperament.13
A new generation of researchers at the Harlow Primate Laboratory at the University of Wisconsin has found that prenatal stress induces attentional disorders, diminished cognitive abilities, and neuromotor problems in rhesus monkeys. The earlier the stress is experienced in gestation, the more intense the symptoms. In addition, stress experienced early in rhesus pregnancies produces offspring that weigh less at birth and spend more time in sleep and in a drowsy state. These early stressed babies show greatly increased stress responses by comparison to nonstressed monkeys when they are separated from their mothers.14
Rodent studies provide even more troubling evidence of the damage that prenatal stress may cause. In one study, pregnant mice were exposed to unfamiliar laboratory mice, which physically attacked them. High levels of prenatal attacks during late gestation—not early—consistently produced offspring that were aggressive in adulthood. These behavioral differences were accompanied by measurable increases in plasma corticosteroid levels,15 indicating high stress. This team of researchers hypothesizes that antisocial behavior in children may include the fetuses’ experience of domestic violence before birth.
During his annual address to the Association for Prenatal and Perinatal Psychology and Health in 1995, Dr. David Chamberlain illustrated how this prenatal adaptation to stress can play out in a human life. He told the early story of Robert Harris, who had been executed in the state of California’s gas chamber:
Harris was born three months early after his mother was kicked brutally in the abdomen by her angry husband and began hemorrhaging. This was only the first of many violent experiences this murderer-in-the-making suffered at the hands of his mother and father, a violence he later turned on innocent animals and people. At age twenty-five, he shot two teenagers point blank, laughed at them after he pulled the trigger, and calmly ate the hamburgers they had just bought for lunch. We could not find a more dramatic example of a life that began and ended in violence.16
In humans, stressful life events during pregnancy obviously include unwanted pregnancies and unwanted babies. In Europe several studies have documented links between being prenatally unwanted and increased rates of both suicide and juvenile criminality.17 Several large groups of babies were followed in Finland, Sweden, and Czechoslovakia over a period of thirty years. Mothers denied abortions were forced to raise children they did not want. As those lives unfolded in comparison with groups of wanted children, the unwanted children were at much greater risk of psychiatric and social problems.18 The study done in Sweden showed that juvenile criminality among unwanted youths was double that of those who had been wanted. In a Prague study, unwanted children had almost three times the risk of appearing in the criminal register. There is little doubt that later environmental and biological factors contributed to those outcomes. But there is strong evidence that the womb does in fact provide powerful early environmental forces that interact with genetic factors to create the biological roots of these behaviors.
An interesting small study of a handful of boys by Andrew Feldmar in 1974 followed four suicidal boys. Through extensive interviews of the families of these adolescents, Feldmar found that in all cases the suicide attempts were taking place at the same time of the year as their mothers had tried to abort them, a fact that none of the adolescents had consciously known.19 Another study of eight thousand pregnant women provides strong evidence of the impact of prenatal maternal rejection. The women were divided into those who wanted their babies and those who did not. The unwanted babies were 2.4 times more likely to die in the first month of life.20
While correlative information is not to be confused with proof of causality, the preponderance of new data from so-called hard science on the human brain and brain chemistry increases the interest in such correlative information. As studies and their implications accumulate, we can turn for hope to empirically tested program models that focus on prenatal education, parental attachment to the fetus, and prenatal stimulation. Enhanced knowledge, support, and communication can turn the fetal experience from one of rejection to one of acceptance and security.
Many adults in our culture find it difficult to acknowledge that the child they once were continues to live at the core of the adult they have become. It may be an even greater leap, therefore, to acknowledge that the experiences of the maturing fetus and the baby who preceded the child exert a powerful influence. Even among childhood-focused professionals, there is a view that life really only begins after birth. It is ironic that it takes the cumulative effects of irrational behaviors to bring people to therapy, where the relationship between earliest experiences and later behavior can be unlocked.
Historically in our society there is a denial of any connection between the earliest stages of life and those that follow. At the beginning of this century, following the work of Sigmund Freud and his followers, there was a shift toward recognizing the significance of early childhood. But even Freud was affected by the criticism of his detractors, who accused him of exaggerating the capacities of infants, particularly the capacity for memory. Prior to Freud, our culture’s denigration of childhood was evidenced in the ways parents were allowed, if not encouraged, to treat their children as property with the full support of society. Culturally, it was beneath the upper-class citizens of the Western world to care for their own children; strangers of lesser means were hired to raise the children of the elite—a practice still in place.
In his book Echoes from the Womb, Dr. Ludwig Janus poignantly makes this connection:
We still remain estranged from the very small baby within us and unquestionably rely on external norms and authorities to determine what happens to our newborn and unborn children. As long as we deny any personal awareness of our life before birth, of our birth and earliest baby years and repress the significance of early experience for a fuller understanding of human life, then we are also condemned to distancing ourselves emotionally from our unborn and newborn offspring. The next generation then remains unprotected from blind repetition of the same mishandling and trauma which lie buried but quite alive and active within our unconscious minds. . . . Earliest experiences remain within each of us. Our whole existence is based upon the vitality and the dynamic experiences of our very beginning. This period is physically and psychologically the foundation of our life and our experience and of our relationship to the world.21
For centuries primitive cultures have believed that what mothers see and experience, babies reflect. Now modern science is corroborating this ancient wisdom. When we are not protective of mothers’ experiences during pregnancy, our communities may give birth to the reflection of those experiences.
POSTSCRIPT
As we were preparing to publish Scared Sick, we received a call from our publisher’s attorney whose job was to read the manuscript and go over all of the facts cited to ascertain veracity. Clearly interested in—and empathic with—the subject matter, the attorney was concerned because the manuscript claimed that only twenty-five years ago (Scared Sick was published in 2012) the American Academy of Pediatrics called for pediatricians and surgeons to end the practice of operating on newborns and infants without any form of pain control. A mother herself, she couldn’t believe that in this country before 1987, it was common to operate on very young children using only a paralytic drug to keep them still.
We have come a long way. Most—though not all—surgeons use both anesthesia and pain medications with youngest children. Some controversy still surrounds the idea that pain medication or anesthesia presents more risk than the consequences of overwhelming trauma.
A major catalyst for increasing consciousness of the exquisite sensitivity of newborn—and preborn—nervous systems is Dr. Kanwaljeet “Sunny” Anand. A Rhodes scholar, chair for pediatric critical care medicine at Le Bonheur Children’s Hospital in Memphis, and professor of pediatrics, anesthesiology, and neurobiology at the University of Tennessee, Anand is a deeply spiritual and compassionate advocate for the extraordinarily vulnerable babies—and parents—who are fortunate enough to find themselves in his care. In a series of clinical trials, Anand demonstrated that operations performed on newborns generated a “massive stress response” as evidenced by a measurable flood of hormones. When anesthesia was administered, babies had lower stress hormone levels, stabilized breathing and blood sugar levels, and fewer postoperative complications. Most important, after hospitals began using anesthesia on infants undergoing heart surgery, newborn mortality rates dropped from 25 percent to less than 10 percent.
Still the debate continues regarding fetuses. Observing babies in the NICU as young as twenty-two weeks gestational age, Anand noticed that most of these babies grimaced when poked with a needle. He asserts that by twenty weeks gestational age, the human nervous system is developed enough to experience pain—a claim strongly debated by many other physicians. Anand argues that because the nervous system is still so new and raw at this stage of life—and because the child does not have the ability to self-comfort and is easily overwhelmed—these babies actually experience more extreme pain, which is emotionally, physically, and cognitively harmful to the baby.
In his words: “We’re not losing the educational battle with China or Korea because of the math and science scores of our high school students . . . we are losing because our babies are losing synapses at an alarming rate in the beginning of life.”22
Anand explains that new neurons can be lost either by overstimulation (primarily from pain) or by understimulation (primarily from being separated from the mother or equivalent attachment figure). The impact of earliest life—particularly when it is compromised by prematurity, but also by induction, cesarean section, or challenges to normal gestation due to the mother’s health—is one of many “little traumas” that can contribute to the dysregulation of the relationship between the brain, immune system, and endocrine functions. However, if such traumas are competently handled and the baby goes home to stable, loving caregivers, the impact can be minimal and leave few if any traces of negative effects.
Current rates of prematurity, inductions, and cesarean sections are receiving increased scrutiny as these correlations are recognized. But we are still far from recognizing what constitutes “little traumas” from a baby’s perspective, most of which are due to ignorance of the sensitivity of the undeveloped nervous system at this crucial point in life.