Debby Gould's thoughts on the significance of caregivers' behavi

Debby Gould's thoughts on the significance of caregivers' behaviour

IMPRINTING... Suspend your own personal belief system for a moment now and just consider the possibility that the treatment a woman receives during her labour and birth will be imprinting on her baby. Consider also that we are now caring for women in labour whose mothers and perhaps their mothers before them had increasingly medicalised births. The sounds of the labour room will be heard and possibly imprinted on the fetus, namely the voices, the motherís emotional reactions, the fetal heart-rate monitor recording their own heart rate in labour. This imprinting can happen in two possible ways: directly, through fetal sensory reactions to the sounds heard and chemical reactions in the motherís body at the time; and later, by word-of-mouth through mother to child, adolescent and adult discussions. For labour and childbirth experiences are one aspect of life that is almost always passed through the generations. It is also worth noting that women can vividly recall their experiences during childbirth throughout their lifetime. When women are dissatisfied with their birth, it is usually associated with the memory of the pain of labour and this plays a significant role in their longer-term memory. Positive experiences tend to remain interpreted the same, while negative experiences, particularly those which are linked to pain, tend to become even more negative over time (Waldenstrom and Shytt, 2009).

Already, in maternity services, we are increasingly seeing women expressing a lack of confidence in their ability to give birth without a caesarean section. It may take many more generations to manifest all the changes occurring in this cycle of life, just as it has taken many years to recognise the cumulative and longer-term problems associated with caesarean section, such as infertility problems, increased stillbirth rates and higher rates of life-threatening maternal haemorrhage and hysterectomy associated with placenta praevia and accreta (Solheim et al, 2011, Silver, 2010).

Are we, as humans, in our attempt to maximise immediate physical safety, missing an important element of care, i.e. that which involves facilitating the imprinting seen in other animals? Some believe it is our focus on immediate safety and our tendency to practise defensively because of increased litigation (for example, using fetal monitoring even though it has been shown to be of limited use) that are driving more obstetricians to resort to caesarean sections (OíBrien, 2005). It may be that when women and doctors are confronting having to have a series of hourly fetal blood samplings due to borderline results, and all the anxiety that accompanies these interventions, that they both, understandably, opt for what seems the safest option at the time. But although these immediate actions may ensure initial physical survival of some of our newborns, inadvertently, they may be having long-term deleterious effects on overall physical and emotional well-being.

Antenatal care, and in this I include antenatal education, was established with the purpose of improving birth outcomes and, according to Grantly Dick- Read, of ridding women of the dread of giving birth [1933]. Yet some would argue that our current antenatal care is only increasing womenís fears. Many women come into antenatal care terrified of labour, with some requesting an elective caesarean section. So where does this fear originate? Perhaps this is another example of the presentation of imprinting during their own motherís labour and their experiences immediately following the birth. It could also be as a result of the influence and exposure of the media...

From Debby Gould's book,†Welcoming Baby.†