Summary:
Caesarean birth can be seen as a traumatic birth for the baby with immediate and long term consequences. C-section is a trauma
because of its abrupt and sudden interruption of the biologically programmed vaginal birth process. Shock, bonding
deficiencies and invasion/control complex are the major symptoms of the trauma.
Baby therapy is based on the new paradigm about prenatal and perinatal life. Babies are aware before and during birth and can
be traumatized. The treatment of caesarean born babies consists of two aspects: regressively re-experiencing the traumatic
aspects of the c-section and the processing of vaginal birth. In exploring the traumatic aspects of the c-section so called traumasites are gently touched by the therapist. The baby can get activated and within the safety of a containing relationship, catharsis
can take place. By supporting the baby to release his emotional pain the reprocessing of the c-section birth takes place in small
steps. Baby have a knowledge about how they should have been born vaginally. Through a process of vaginal birth simulation
the baby descends in the birth canal, rotates in the pelvis. Than the expulsion takes place and the baby ends up in the arms of
his mother. Results of baby therapy show that babies benefit from the treatment.
Keywords: caesarean birth, psychology, trauma, baby psychotherapy
Introduction:
In the last half century hospital birth has become the standard birth and in the same period csection rates have risen up to 25 – 65%. Ironically birth has become more painful for babies.
Pain-inflicting technological protocols of routine obstetrics are causing more traumatic
births. Pain in babies is still denied (Chamberlain, 1999). Up to now many scientists and
medical practitioners still believe that babies are born without an awareness and sensitivity
about what is going on to their bodies and psyches; babies don’t have any recollection of
their prenatal life; babies are unable to experience what is going on during birth and no
possible harm can be done to their emotional well being. From this point of view Caesarean
birth is considered to be an easy and painless way of being born that has many advantages
for both the mother and the baby. In the medical profession c-section is considered to be a
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safe, quick and routine surgery. This attitude gives rise to the increasing c-section rates for
which there are numerable additional non medical factors responsible (Verdult, 2009).
Although caesarean birth has physical disadvantages and risks, the possible traumatic
aspects of c-section birth in babies are ignored and denied.
Most parents seek help in baby psychotherapy because they have problems with their babies.
Intensive crying, sleeping difficulties and eating problems are the most common symptoms.
Most parents don’t have any idea what causes these problems; most of the time they don’t
have any idea about the emotional pain the baby is suffering from; they are surprised when
we speak about the traumatic aspects of their child’s birth. Trauma in children and especially
in babies is still not recognized. Prenatal and perinatal psychology has shown differently.
Babies are aware, conscious, interactive and social human beings. Fetuses and babies can
react to signals from their environment and can be traumatized by overwhelming input to
their system. Through the work of pioneers like Thomas Verny (1981, 1992, 2002), David
Chamberlain (1988) and William Emerson (1998ab) we now know that babies can experience
emotional pain, anxiety, rage, loneliness or sadness during and after birth. We now know
that c-section birth is a traumatic experience to the baby with immediate and long term
consequences.
Through thousands of years of human evolution (phylogenese) the human baby is being
born through a narrow birth canal, which is developed out of a compromise between the
narrowing pelvis of his mother enabling her upright position and the baby big head
containing his human cortical brain (Janus, 1991) . The human baby is the only species on
this planet that needs an internal rotation in the birth canal in order to be born. This makes
birth difficult and painful. Both the mother’s and the baby’s body have biochemical options
to ease this pain. Birth is, in the words of Odent, a biochemical symphony, stating that we
have biochemical solutions for this difficult process of entering the world. This birth process
is biologically programmed in every baby. The baby knows when to activate his birth
process, knows how to go through the birth canal, knows how to cooperate with his mother,
and expects to end up in her arms.
Any interruption of this process can be harmful, stressful or even traumatic to the baby. Csection birth is an abrupt and sudden interruption of this natural birth process. It is not only
a different doorway being used, but also a violation of the biological birth programme that is
stored in the baby and activated during birth. Trauma happens when any experience is
threatening the baby; it overwhelms the baby, leaving it disconnected from the body. Any
coping mechanisms are undermined and the baby is in a state of helplessness and
hopelessness. Modern trauma research has shown that trauma is not in the event itself,
rather trauma resides in the nervous system (Levine & Kline, 2007). This is also the case for
babies. As trauma resides in the nervous system, the body is not going to forget about
trauma. Caesarean birth can be seen as a traumatic event for the baby who has only very
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limited coping skills to deal with the situation and this trauma is stored in his body leading
to physical symptoms.
Physiological aspects of caesarean birth.
The technology of caesarean delivery includes an array of interventions that are opposite to
unmedicated natural birth. Odent (2004) stresses the importance of birth physiology. His
thesis is: de-humanize birth and give priority to mammalianize childbirth. That is to say:
what is specifically human, namely the neocortex must be eliminated, while the mammalian
needs must be met. Birth is a process that is not controlled by the neocortex but more by the
mammalian brain, that is the limbic system. To state it even stronger: neocortical activities
during the birth process should be reduced to the minimum and labouring women should be
allowed to function from there limbic system. To feel secure in the surrounding where she is
giving birth is a crucial factor for reducing the release of hormones of the adrenaline family
so that the neocortex is not stimulated. The labouring woman is allowed to withdraw in her
own inner world where she can focus on her body and her emotions and not on external
data. Privacy is a major condition. She is accompanied by a motherly, silent, low profile
doula. In other words: to create conditions for an authentic foetus ejection reflex . According
to Odent this reflex is the effect of a sudden spectacular reduction in the activity of the
neocortex, making possible the release of a complex hormonal cocktail. During the reflex
there is a short series of irresistible, uncontrollable contractions, while the labouring woman
can be in the most unexpected postures. There is an sudden explosive release of oxytocin
which makes birth, breastfeeding and bonding easier. The foetus ejection reflex is not seen in
c-section.
A caesarean born baby is physiologically different from a baby born by the vaginal route.
More after-birth complications can be seen after c-section birth in comparison to vaginal
birth. The lungs and heart do not work in the same way; they have lower Apgar-score,
indicating physiological problems; the glucose levels tend to be lower (especially in non
labour c-sections); the body temperature is lower in the first 90 minutes after birth. C-section
babies show more respiratory problems and breathing difficulties: respiratory distress
syndrome which is a major cause of neonatal death; serum protein and serum calcium are
lower; due to less stimulation of the nervous system and the respiratory system, breathing
and reflexes are slower. Caesarean babies need more aspirations. They have more difficulties
in adaption to the changing environment due to lack of skin stimulation and hormonal
exchange. There is more iatrogenic prematurity because the c-section was performed too
early, before the end of the pregnancy. More c-section babies are referred to NICU and show
more and longer stays in incubators. They have more risk of asthma, more risk of autism,
more risk of food allergy, more problems with breastfeeding (especially non-labour
caesareans).
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The conclusion can be that c-section birth can have serious physiological disadvantages for
baby in comparison to vaginal birth and can lead to long term problems. There can be no
discussion about life saving c-sections, but in most countries the WHO-limits in c-sections
(10 to 15%) are overruled. In caesarean birth the foetus ejection reflex is missing and more
medical complications are seen in c-section birth. But even in critical literature like the
writings of Michel Odent (2004), the emotional experiences and emotional consequences of
caesarean birth for the baby are widely overlooked.
Psychological aspects for the baby
Jane English (1985) in her book ‘Different doorway’ stresses the non-labour caesarean birth
as ‘different’ instead of ‘pathological or abnormal’ and she wants to see these differences as
opportunities. For her, at the level of soul intention, there is no such thing as imperfect birth.
C-section birth, she stated, can be exactly what the soul needs in order to learn lessons for
which they are choosing to come to earth. I don’t want to go deeper into this transpersonal
perspective and stick to the psychological child perspective. Most prenatal reseachers and
baby therapists consider caesarean birth traumatic, both physically and psychologically. In
his pioneering work ‘The secret life of the unborn child’ Thomas Verny (1981) already called
caesarean birth a shock for the baby, a deprivation of the physical and psychological
stimulation associated with vaginal birth. Caesarean birth has an intense all-or nothing
quality, not like give and take of the waves of labour. The procedure is fast and abruptly to
the baby. Since the baby does not have the boundary-giving experience of labour through the
birth canal through which to filter subsequent stimuli, the c-section baby is very sensitive to
the atmosphere in the operating room.
English (1994) has drawn a map of the baby’s experiences during the steps of the non labour
c-section.
Stage External procedure Baby’s experience
0 before any procedure primal oceanic union
1 anesthesia poisoning, nausea, hot-cold, alone, fear, being attacked
2 incision shock, rape, shuddering, unable to resist
3 a first touch pleasure/pain
3b delivery of the head ecstatic explosion into the light, sense of going home, awareness into
head not body, meeting the obstetrician’s eyes
4 suctioning bad tastes, unsatisfied sucking reflex, strange sensations, some scary
5a body being pulled out terror, loss, explosion, falling, fragmentation, loss of boundaries
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explosive dying, futile attempts at control
5b cutting the cord death, defeat, total loss of support, tension in belly
6 stimulation to start breathing being attacked, anger, fighting, own breathing as a strange sensation
7 moment of awe and wonder surrender, bonding with doctor, accepting his help
8 separation from doctor grey, bleak stillness, depression, some relief
9a being handled mechanically apprehension, scary intensity, separation
9b being taken care of opening, accepting, feeling nourished
This map certainly gives some clarity to the experiential world of the baby during c-section.
Aspects of the medical procedure and its psychological consequences are being attended to
in baby psychotherapy.
According to William Emerson (1998) birth trauma’s, as caused by obstetrical interventions,
have three most common long term outcomes on the psyche of the baby: bonding
deficiencies, chronic shock and invasion control complex. His clinical research for over more
than thirty years indicates that caesarean deliveries can result in immediate symptomatic
effects in babies such as: nocturnal awaking, hyper alertness, extensive and prolonged crying
(trauma crying), feeding difficulties, digestive difficulties, colic, tactile defensiveness and
bonding deficiencies .
The bonding deficiencies in caesarean born babies have two major sources: the
unacknowledged trauma and the tactile defensiveness. If neither the parents nor the
doctors/midwives acknowledge the traumatic experience the baby has had during his
caesarean delivery, than the baby remains alone with his emotional pain. His symptoms are
not recognized or interpreted correctly. This lack of empathy with his suffering can lead to
withdrawal. During caesarean surgery touch is often cold, objective, hurried and painful,
with no respect for the boundaries. The first touch outside the womb can become associated
with anxiety, leading to a defensiveness to touch. As touching and hugging are major aspects
of the newborn baby’s bonding to his mother, attachment relations can be disturbed
permanently. Some babies withdraw from touching and hugging, get stiff when picked up,
overstretch their body, or avoid eye contact. In our practise we often see caesarean born
babies having insecure attachment patterns. They have difficulties in finding safety with
their mothers, can’t accept comfort from their mother and at the same time panic when their
mother leaves the room or just put them on the ground.
The caesarean shock results from the sudden, unexpected, rough and frightening changes
that occur within the two minutes of the surgery. Shock is the result of an overwhelming
frightening experience in which the complete body is functioning in an extreme anxiety state.
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The body is in a survival mode. Not only the speed of the surgery, but also the invasion of
the babies intra uterine world by forceful hands is a severe crossing of boundaries. C-section
goes against the biological programmed vaginal birth, against the timing and cause of this
process. Shock results in startle and fear responses. Hyper alertness and sleeping difficulties
can be associated with the caesarean shock.
During caesarean birth babies tend to experience all the features of an invasion/control
complex. Their world is being invaded suddenly and roughly and they experience a lack of
control on what is happening. C-section babies have to be dislodged, rotated, lifted,
suctioned, examined and tested, and this in a very short time and without any coping
possible. The tactile defensiveness is directly linked to the c-section.
Shirley Ward (1999), an Irish prenatal psychotherapists describes c-section babies as
followed: ‘they may sit back and wait for everything to be done for them; they lack the
empowerment and self worth – being ‘taken out’ they did not have the vaginal struggle and
feel they haven’t done anything to deserve what they have; they have difficulties in doing
things for themselves and in setting boundaries; for them help is a put down or a
disempowerment’. If older babies (from about one year old) come for therapy this pattern
can be seen clearly, especially in caesarean babies with a parasympathetic shock.
A distinction can be made between non-labour and labour caesarean births (English, 1985;
Leverant, 2000). Labour caesareans experience a strong state of separation, because the
biologically programmed process of labour is curtailed by intervention and surgery. Instead
of coming down and out of the birth canal the labour caesarean is pulled backward and
removed from the uterus by an abdominal incision. The task of being born is interrupted,
also energetically. After the c-section the baby’s muscles, connective tissues and nervous
system remain contracted by shock and the deep relaxation that can happen after vaginal
birth is not happening. The timing of the non-labour c-section is not biologically
programmed by the mother and the foetus, but it is determined in accordance with the needs
of the medical staff. C-section babies can have difficulties with being interrupted while
performing a task or while playing. Sudden changes can activate them. Anesthesia deprives
the foetus of using his legs to push and kick down the birth canal in tandem with the
mother’s contractions and movements. Thus the foetus is prevented from completing the
self-initiated task of being an active participant. On a psychological level the loss of the use
of legs can be translated in the inhibition of walking to personal goals and in an inability for
self-support. Labour caesarean babies tend to rely on external support, expecting external
rescue when they are in stressful situations.
Casus Emile (part 1)
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Baby Emile was 6 month old when he was referred to our practise by his osteopath. His
parents were desperate because Emile was crying ‘day and night’ and could not be
comforted. He was eating badly and during the day he hardly slept. During the osteopathic
treatment the tension in his body does not seem to go away. He became better oriented
towards his midline and the reflux improved. The crying and sleeping problems remained.
Emile’s parent were exhausted and his mother did not recognise this behaviour in his two
sisters. What we saw was a very pale and alert little boy, insecure attached to his mother,
with little or no eye contact neither to her nor to us (in baby psychotherapy my wife and I
work together). His eyes looked anxious to us.
His mother told about Emile’s birth. One night she had strong pains in her belly and she
thought that the contractions had started, although it felt different from the first two births.
In the hospital the obstetrician diagnosed a placental abruption and the c-section was
executed immediately. Emile was born at 36 weeks. The mother felt sad and felt a failure not
having given birth in a natural way, like with her two daughters.
After the c-section the mother only had a short glimpse of her newborn son, before he was
taken away to the NICU. Emile stayed there for five days and the first two days the mother
did not see, nor touch her son. The mother felt it was hurtful to him and to herself not being
bonded immediately after birth. She felt guilty about this.
Baby psychotherapy
Since 1974 William Emerson (2000, 2001) has developed a model for treating babies with
prenatal and perinatal traumas. Karlton Terry (2005) has expanded this model. I myself am
trained within this model and work from this frame work, of course with the modification
and limitations that go together with the assimilation process of learning baby therapy. As I
am also a trained psychotherapist and psychotherapeutic interventions are being used
during baby treatment I prefer to speak about baby psychotherapy, stating that a
psychotherapeutic background is not only very helpful but also preferable. Baby are very
vulnerable in their feelings and needs. The psychotherapeutic concept of containment, as
developed by Winnicott, is crucial in baby psychotherapy.
The Emerson baby therapy model is based on theoretical assumptions, stresses the
importance of certain conditions and is a combination of cathartic and empowerment
techniques.
The baby psychotherapy is based on assumptions of the new paradigm on prenatal life
(Emerson, 1989;1998b). In this new paradigm prenatal children are considered to be
sensitive, communicative, active and conscious human beings. They are vulnerable, both
physically and psychologically. Babies can have experienced prenatal and perinatal trauma,
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which can be encoded in their bodies. Prenatal memories are possible. Prenatal experiences
can have dramatic and long term influences o subsequent life events. Prenatal trauma’s have
impacts on birth, as more birth complications occur when there was prenatal stress or
trauma. Prenatal and birth trauma impair bonding at birth. For the healing process two
aspects are crucial: the accurate conceptualisation of the baby’s psyche and its expressions,
and catharsis of feeling that are associated with traumatic events. Babies can recover from
the effects of the hurtful experiences by releasing their feelings when these feelings are
accurately and empathetically mirrored by the therapist and/or the parents.
In the Emerson–model baby therapy is permission-based and containment-based. In baby
psychotherapy babies are allowed to express their pain through trauma-releasing crying.
Emerson has called this trauma-crying (Emerson, 2000; Terry, 2005). This is an intense crying
by which the babies expresses the pain that was stored in his body during the traumatic
situation. The baby is allowed to express himself through his crying, without being
interrupted and within the safety of the present therapist an parents. Baby therapy can lead
babies to the edges of their birth memories and the therapist provides them with options to
accept or to refuse their memories at any time. Babies give permission to work with their
trauma or not. Babies have defense mechanisms and these are respected by the therapist.
Resistance is seen as a survival strategy indicating that the released pain is overwhelming.
As baby therapy can bring babies in contact with very painful memories, containment is
crucial, so that within the safety of the relational field as set by the therapists and the parents,
the baby can express his anger, sadness and anxiety. The mother must always be present at
the treatment; the father can be present. During baby therapy the therapist is continually
monitoring for signs of resistance and refusal, as the work is permission based, meaning that
the baby is in charge of the treatment. Emerson calls this baby-centered control. It can be
compared with the non-directive attitude of the original client centered psychotherapy
(Verdult, 2009b). To access painful memories this also means to strengthen the baby’s ability
to maintain boundaries and control .
Baby psychotherapy requires accurate empathy (Emerson, 1998ab; Terry, 2005). As the entire
body of the baby is a profound expressive instrument, the therapist has to be in empathy
with the baby who is telling his story through his body language. In accurate empathy the
parents and the therapist can agree on the fundamental emotions being expressed as well as
on the nature of other subtleties and details. The therapist is not only reflecting the feelings
of the baby, but also tries to establish a compassionate contact with the ongoing feelings in
the baby. Deep and accurate empathy with the baby’s pain is very healing. With his
sensitivity to the baby’s signals and his responsiveness to the expressed pain, the baby
psychotherapist can support the baby to go deeper into his pain releasing process. Empathy
and containment go together. What is true for psychotherapy with adult, is even more true to
baby therapy: the therapist must be in a process of resolving his own prenatal and perinatal
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trauma’s (Stroecken, 1994;Terry, 2005; Verdult, 2009b). As baby’s are very sensitive they can
sensor emotional activations in the therapist very easily. In baby therapy it can be horrific to
see the baby go through so much pain. The healing is saving them from a lifetime of pain or
preventing dysfunctional behaviour emerging in later years from unresolved traumatisation.
But it can easily activate unresolved trauma in the therapist or parents.
As the baby tells his story about birth and prenatal life and as his body is his expressive
instrument, the therapist tunes in with the body of the baby. Structural signals (f.e.
malformations of the skull), psychodynamic movements, (f.e. restless movements in the
legs), shock patterns (f.e. contracted body or hyperactivity), physical symptoms (f.e.
breathing patterns), communication patterns (f.e avoidance of eye contact), energetic
symptoms (f.e. cold feed), attachment patterns (f.e. rejection of contact with the mother).
In working with caesarean born babies the therapist listen to symptoms and looks for signals
by the baby. As caesarean delivery is a very invasive process, the first signals the therapist
looks for have to with the invasion/control complex. Most c-section babies are hyperalert.
They can be overwhelmed by emotion very easily. Containment is important. They want
help to express their anger and pain, but at the same time they have experienced that outside
help can be very brutal and threatening. Caesarean babies show extreme separation anxiety.
C-section babies can be very ambivalent about receiving outside help, so the therapists waits
for signals of permission from the baby. As we saw caesarean babies show tactile
defensiveness, in his pacing the therapist gives the baby time, space and safe boundaries to
explore the contact with the therapist which is necessary and crucial for the therapeutic
work.
Birth simulating massage techniques that involve gentle stroking and holding patterns
simulating pressures on the infant’s body that were traumatised most during the birth
process. By this massage the baby can get activated and can release his emotional pain that
has been blocked in his system. For this the therapist uses feather-tip pressures. For these
technique the therapist must have a clear view on how the baby was actually being born. By
re-experiencing the actual birth positions and movements the baby can further release his
pain. This process starts with trauma posturing, in which the baby is put back in the position
just before trauma. Than the actual birth process is simulated and as the baby goes through
the birth canal he can re-experience the possible traumatic situations and positions he has
encountered. The baby can exactly tell his birth story. In c-section babies the therapist looks
for the places on the body where the obstetrician has put his fingers during the surgery.
Touching these spots can be very activating. This can be the head and neck, in case the head
is delivered first, or the pelvis in case of a breech presentation. These trauma-sites are
directly related to the touching during the c-section operation. Being pulled can also be
activating for a c-section baby;
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Empowerment techniques are an important aspect of trauma therapy. This is also the case in
baby therapy. In order to heal birth trauma’s babies need to undergo corrective experiences
that allow them to use their bodies in confident ways. The therapist tries to identify specific
movement patterns that were impotent or ineffectual during birth. For example: caesarean
born babies did not have use their legs to push out as in vaginal birth. In working with csection babies the therapist invites the baby to use his legs and arms as a way of
empowerment. In this way the baby can fight against the loss of control or against invasion.
Caesarean babies have experienced an extreme loss of control over their birth process. They
have to endure the surgical procedure. The therapist looks for possibilities to empower the
baby. The baby is allowed to fight against the outside helper; the baby can stop of time out
the process of rebirthing; the baby can ask for resourcing like making contact with a
comforting mother.
In addition to the Emerson-model we also use attachment techniques in order to restore the
attachment relation to the mother which is usually disturbed in c-section birth. The
ambivalent aspect of the attachment relations are worked through; the baby needs the
contact and comfort of the mother and at the same time his is afraid of being hurt again,
being abandoned again.
After the emotional release schematic re-patterning is the next step. This is called the process
of re-patterning. The movement patterns that babies use to get born are deeply embedded
and retained in the nervous system and body. The therapist offers the baby the opportunity
to re-experience his birth as it should have been from the perspective of his biological birth
program. The baby can drawn inwardly and work through the emotions of these new
experiences, namely the releasing of his traumatic pain and the re-experiencing of how his
birth should have been. During this inner process new neurological connections are being
built in his brain changing his original traumatic experience for ever. Re-patterning can make
other painful memories accessible. In c-section babies this can mean that the baby can
experience how he should have been born if the vaginal route was open for him. For
example, by using a tunnel where the baby can crawl through, the caesarean baby can
experience successfully pushing through the birth canal as in vaginal birth. He can be given
the opportunity to descend in a birth canal, do the rotation and push himself out in the
expulsion phase of the delivery. The therapist creates a birth canal with pressure on the scull
that are associated with the birth process.
In the French tradition of baby therapy giving words to the experience of the baby is
considered to be extremely important. Francoise Dolto and her pupils Eliacheff (1995) and
Szejer (1997)stress the importance of giving words to what the baby has experienced
(Verdult & Stroecken, 2004; Verdult 2009b). Baby can listen intensively to what they are
being told about their birth history, if the therapist is able to formulate the story in an
empathetic way. It is not just talking, using words, but making an emotional contact with the
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baby through words. Dolto assumes that babies are able to understand language if the words
used are related to their experiences and if the words are used in a empathetic way. In csection baby the therapist gives words to the anxiety that the baby has experienced, to his
anger about being pulled out of the womb abruptly, about his loneliness in the first moments
outside the womb, about missing the intimate contact with his mother. The therapist is the
advocate of the baby and gives words to his painful memories.
Casus Emile part 2
The treatment of Emile took 8 sessions of 1,5 hours. In this treatment we focussed on three
aspects of the traumatic situation of his c-section birth. My wife’s primary focus was on the
mother’s pain and on how she felt in the relationship to her baby. My focus was on the reexperiencing of the c-section, on the experiencing of the lacking vaginal birth process, and on
the attachment relation to his mother, from the baby’s perspective.
In the first two sessions we carefully try to figure out how Emile was exactly pulled out of
his mother’s womb, where the obstetrician had touched Emile during the c-section. Emile
was very defensive to touching and I gave him lot of control over my hands touching him
softly. I try to deepen the eye-contact so that I would be more in safe contact with him. I gave
containment by holding his feet which he could accept. The so called trauma-sites are used to
activate the pain stored in the body of the baby. By softly touching these sites the baby can
release his pain. As Emile was a labour caesarean born baby he was already descended in the
birth canal and has to be pulled out. He was overstretched in his neck. The pressure on his
cranium was opposite to normal birth process. In a second phase of the surgical provcedure
he was pulled out under his shoulders. Emile could get very activated and start trauma
crying when hands were put softly on his head and little pressure by pulling softly was
forced on his cranium. After the third session his mother reported improvements in sleeping
and eating not in contact. The fourth session seems to us of vital importance. During this
session Emile was in deep pain and for the first time during the treatment he could make eye
contact with his mother while being in pain. His mother was involved in his process deeply
and mirrored his pain. After the moment, which took about five minutes of intense eye
contact, the bonding between mother and baby, changed for ever. Emile’s mother was
overwhelmed by joy and pain, because for the first time in his life she felt so deeply
connected to her little son. During the firth and sixth session the emphasis was on
experiencing vaginal birth. As Emile had descended in the birth canal we simulated the
rotation and the expulsion phase which were followed by direct physical contact with his
mother as this did not happen during his actual birth. The lack of body contact after birth
was part of his traumatic scenario. The last two sessions were a combination of simulating csection and vaginal birth. Emile was activated less and less, and seem to enjoy his vaginal
birth play more and more. His mother reported no more sleeping problems and emile slept
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in his own bed; no more startle responses when his sisters were making too much noise or
were playing with him unexpectedly; more relaxation in his body with deeper breathing and
no more overstretching. What was most important to her was that the contact with Emile
was established and remained. The mother gave us a phone call about three months after the
treatment was finished saying that Emile was happy, playful and more exploring his world.
His symptoms had disappeared.
Concluding remarks
Caesarean birth can be seen as a traumatic birth to the baby and to his family. Baby
psychotherapy can be an answer to this painful situation. Baby psychotherapy offers the
baby the possibilities to release his pain within the safety of a containing therapeutic setting
and to heal his traumatic experience.
Emerson (1989, 2000ab) did research on the effects of his treatments and his research showed
the following. He observed four types of outcome in his research:
– Changes in somatic symptoms; it was common to find reversals or remissions of
various pediatric diseases like asthma, bronchitis, dermatitis
– Resolution of psychological disorders; temperamental behaviours in infants were
very responsive to the treatment, i.e. fussiness, breastfeeding difficulties, sleeping
difficulties, irritability, hyperactivity and lethargy. In several dramatic cases, autism
and attachment disorders responded to treatment.
– Prevention of anticipated forms of psychopathology; in most cases the anticipated
forms of dysfunctionality did not develop. In the few cases where dysfunctionality
did develop, intervening trauma and family dysfunction were found to be
responsible
– Self transformation; the most universal outcome, and one which was not anticipated,
had to do with tranformational phenomena and contact with the Self. Treated infants
were described by others as ‘lighter’ and more joyful, contactful, creative and
independent. They were also described as emotionally aware, expressive and
resolving. They have found themselves and have developed more unique human
qualities.
In summary, Emerson concluded, after fifteen years of treating infants and doing research,
that the results from the therapeutic work are quite clear. In many cases, psychological and
physical symptoms are resolved. In addition, a type of maturation occurs (in Self and
transpersonal dimensions) that seems entirely absent in the infants and children who
required therapeutic attention but did not obtain it. However, these results need to be
Rien Verdult Journal of Prenatal and Perinatal Psychology and Medicine, 2009, 21,½, pg 29–41
generalized with discretion. Parents of infants who completed therapy seemed to possess
high degrees of psychological mindedness, empathy and caring (Emerson, 1989).
In our practise we have treated 18 caesarean born babies in the last two years. Their average
age was about 9 months and the average number of sessions was about 7. Fourteen babies
finished treatment and four parents stopped before finishing. From our clinical observations
and from the reports of the parents we can state that we have similar results. The treated
babies showed an improvement in physical and psychological symptoms. It is too soon to
say if we have prevented psychopathological development as we did not do a follow up
check-up. Although this is not a scientific research, the clinical indications confirm that the
Emerson-model for baby therapy can work to treat caesarean born babies.
The Emerson-model of baby therapy is one of the many new models that have been
developed during the last two decades. In a report on the ISPPM congress in London 1998 I
wrote that prenatal psychology was no longer a theoretical scientific project and that more
and more applications were developing for babies and adults with prenatal and perinatal
trauma (Verdult, 1999). This positive tendency has strengthen in the last two decennia.
William Emerson can be considered to be a pioneer on baby therapy integrating osteopatic,
cranio-sacral and psychotherapeutic insights and techniques. Others therapeutic strategies
have been developed by for example Harms, Castillino, Renggli and others (Harms, 2000).
Babies can only benefit from these new therapies. Baby psychotherapy can be seen as a
preventive strategy, because the earlier in life prenatal and perinatal traumas can be treated
the less impact they will have on later development.
