Birth trauma

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The term birth trauma refers to both physical and psychological impairments of the baby that occur as a result of the birth process. The term trauma was first used in medicine and describes an injury or wound caused by external violence. The meaning of “trauma” in the field of psychology ( psychotrauma ) is based on this original meaning .

Physical birth trauma

Stages of birth

In the physical area, birth trauma describes injuries to the tissue and organs as a result of physical forces that act during the birth process. The term also includes long-term consequences such as impairment of the brain or cognitive functions that are associated with skull or brain injuries. Birth injuries represent a separate medical field. In the ICD-10 , the codes P10 to P15 refer to specific impairments.

A distinction is made between brain injuries caused by birth trauma and those caused by intrauterine asphyxia . In the narrower sense of the word, birth trauma only refers to damage caused by mechanical forces, damage not occurring during the period of birth due to a lack of oxygen, lack of coagulation factors or circulatory disorders.

The consequences of a traumatic birth can affect the baby and mother. Birth trauma is considered rare in the western world compared to the corresponding frequency in the third world. In the West, birth defects occur in 1.1% of all births. Numerous physical conditions increase the likelihood of birth defects, including:

A number of birth defects can be caused in the newborn. The childhood plexus palsy , for example, is produced at 0.4 to 5.1 babies per 1,000 births. Head trauma and brain damage during childbirth can cause different clinical pictures, including birth tumor , cephalic hematoma and various forms of intracranial bleeding. The most common fracture that can occur during childbirth is a fracture of the collarbone ( clavicle fracture ) in 0.5% of births. Other typical birth defects are: hematoma in the sternocleidomastoid muscle possibly with torticollis , facial paralysis , Upper plexus (Erb-Duchenne), Lower plexus (Klumpke) both refer to the brachial plexus , hypopituitarism by demolition of Hypophysenstieles and the dislocation of the nasal cartilage.

Illustration of a prolapse arm in childbirth and obstetric approach

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Evolutionary peculiarities of birth in humans

X-ray image of a female pelvis

The birth of humans is shaped by physical characteristics that arose in the evolutionary process of hominization . With the development of the upright, two-legged gait, a multitude of changes in the skeleton and muscles arose . In connection with childbirth, the adjustments to the spine and pelvic girdle are particularly relevant. The resulting pelvic canal, which the fetus has to cross at birth, is very narrow in comparison with all other human species . Its internal dimensions are almost identical to the head size of the newborn. As a result of the evolutionary growth of the brain ( cerebralization ), the human skull is very large compared to the skulls of other primates. The width of the shoulders also plays a larger role here, as it exceeds the width of the fetal skull. The evolutionary relationship between the size of the child's skull and the size of the mother's pelvic ring means that “the mother and the newborn bear a considerable risk of a traumatic birth”.

During the birthing process, the large head and broad shoulders have to move through the relatively narrow birth canal. The birth process remained a normal biological process, but because of the evolutionary peculiarities mentioned, there is a particularly complicated birth mechanism that makes every birth difficult. The child's head has to perform a complicated screw movement through the maternal pelvis. The child can get stuck, especially if due to a particularly pronounced disproportion between the mother's pelvis and the child's head, the forward movement cannot take place appropriately. The child's delicate brain is protected by the skull's movable bone plates. Ossification only occurs after birth. In this way, the human skull developed the special feature of deformability so that the vaginal birth canal can be passed through. These deformations probably take place at a limit reached in evolutionary terms and endanger the child's brain. The possible injuries to the skull and brain mentioned above are the result of these anatomical features.

After the birth, there are further physiological changes, each with their own risks: the newborn has to switch to lung breathing, it has to take food orally, and it is exposed to much more than before the stimuli of the outside world. A stress event can be assumed for this.

Mental birth trauma

The term birth trauma is also used in connection with the negative psychological consequences of childbirth. It probably goes back to Otto Rank , who published the book The Trauma of Birth and its Significance for Psychoanalysis in 1924 . In it he dealt with the psychological consequences of childbirth and also with considerations about the prenatal experience of the fetus. Rank assumed that the birth leads to overwhelming fear in the fetus. He suspected that this trauma could be the trigger for numerous later fears, including the fear of the female genitals, and that the subject of birth can be demonstrated in dreams, symbols, myths and works of art. Rank attributed some fears to memories of the womb, such as the fear of being alone in a dark room. He further assumed that at least the late prenatal period can be remembered in certain aspects. Thus Rank had developed a prenatal psychology that he applied to cultural aspects. For example, he understood the Christian notions of hell to be the consequences of the “intrauterine situation with negative signs”.

In psychoanalysis, assumptions about experiencing childbirth are inconsistent and controversial. Freud recognized that childbirth was the first human fear experience. However, this event has no psychological content, since the fetus has no object. To date, most psychoanalytic theories assume that objects, self, and consciousness develop after birth. In psychoanalysis, pre- and perinatal issues are usually viewed as fantasies. The manifest prenatal content - such as swimming underwater, staying in caves, fighting underwater monsters - is then understood as a temporal back projection into the early phase. However, some psychoanalysts assume that an experience develops before birth. Thus, they allow the birth experience to play a role in postnatal symptom formation. In addition to Rank, these theorists also include Nandor Fodor, Francis J. Mott, Donald Winnicott , Gustav Hans Graber and Ludwig Janus .

If the fetus can already be assigned an experience, then it has early emotionally relevant experiences such as perceptions in the various sensory modalities, oxygen deficiency, fearful situations, pain and stress experiences, which can be internalized in a memory. Under certain circumstances, a birth can therefore be understood as traumatic. The baby is born with some sort of memory of these early experiences. Corresponding memories can then emerge in psychotherapy. For example, Donald W. Winnicott described how his five-year-old patient climbed on top of him during a therapy session, crawled through his jacket and finally slid along his trouser legs to the floor. He repeated this scene over and over again. Winnicott interpreted the game as a regression and a repetition of birth. He believed that some babies develop paranoid experiences because of problems during childbirth (such as lack of oxygen). In particular, he interpreted psychosomatic symptoms (such as headaches, chest and breathing difficulties and downright suffocating feelings) as possible secondary effects of perinatal problems. However, he rejected the concept of a universal birth trauma.

Important impulses for the depth psychological consideration of the pre- and perinatal experience come from the LSD research of the psychiatrists Hanscarl Leuner and Stanislav Grof . In 1962, Leuner described the experiences of his patients under the influence of LSD in Die experimental Psychose . Without establishing a relationship with the pre- or perinatal experience of the fetus at the time, these hallucinative scenes act like reactivation of pre- and perinatal experiences. For example, some patients hallucinated fights with octopuses or spiders, which prenatal psychologists see as prototypical symbols of the placenta. One patient described his experience under the influence of LSD as labor pains. He hallucinated how a tube appeared in front of him, from which an octopus came. At the end of the hallucinated scene, the patient saw a newborn baby cry and be breastfed.

In Topography of the Unconscious of 1975, Grof interpreted the experience of his patients in the LSD intoxication directly with the help of his pre- and perinatal psychological conceptions (the so-called “ perinatal matrices ”). Like numerous prenatal psychologists, in the course of his theoretical developments he increasingly placed these reflections on memories of his own birth in a quasi-mystical context with comprehensive world designs. Nonetheless, Grof influenced the work of the American social scientist Lloyd deMause , who did not take over the metaphysical implications. In an essay from 1981 DeMause compiled both the various psychoanalytic theoretical approaches to the prenatal period and the empirical findings on the physiological peculiarities of human ontogenesis. In his approach he combines prenatal psychology and the assumptions about experiencing one's own birth. DeMause assumes that in every pregnancy - especially towards the end - there are problems with the oxygen supply to the fetus. Pre- and perinatal experiences create a kind of psychological script, a kind of template on which the later experiences are classified and internalized. He does not interpret the birth as pure trauma, but rather as a kind of experience of liberation from the oxygen deficiency conditions of the time before. As with all of the drafts mentioned, it remains unclear whether such an experience is to be understood as a universal event or whether it can only occur in individual cases.

literature

  • Lloyd DeMause: The fetal origins of history. In: The Journal of Psychohistory. 9 (1), 1981, pp. 1-89.
  • Lloyd DeMause: The Fetal Origins of the Story. In: Lloyd deMause: Basics of Psychohistory. Suhrkamp, ​​Frankfurt 1989, pp. 230-349.
  • Nandor Fodor: The Search For the Beloved. A Clinical Investigation of the Trauma of Birth and Pre-Natal Conditioning. Hermitage Press, New York 1949.
  • PG Hepper: The beginnings of the mind: evidence from the behavior of the fetus. In: Journal of Reproductive and Infant Psychology. 12, 1994, pp. 143-154.
  • David K. James: Fetal Learning: a Critical Review. In: Infant and Child Development. 19, 2010, pp. 45-54.
  • Ludwig Janus : The psychoanalysis of the prenatal lifetime and the birth. Centaurus, Pfaffenweiler 1993.
  • Francis J. Mott: The nature of the self. Wingate, London 1959.
  • Otto Rank: The trauma of childbirth and its significance for psychoanalysis. Fischer, Frankfurt am Main 1988.
  • Donald W. Winnicott: Birth Memories, Birth Trauma and Anxiety. In: Collected Papers: Through Pediatrics to Psychoanalysis. Routledge, New York 1949, pp. 174-193.

See also

Individual evidence

  1. ↑ VV Vlasyuk: Birth trauma and perinatal disorders of cerebral circulation. Nestor History, St. Petersburg 2009, ISBN 978-5-98187-373-7 .
  2. ^ Dieter Palitzsch: Pediatrics: Pediatrics for students and doctors. 3. Edition. Stuttgart 1990, p. 72.
  3. ↑ JM Alexander, KJ Leveno, J. Hauth, MB Landon et al: Fetal injury associated with cesarean delivery. In: Obstetrics and Gynecology. 108 (4), 2006, pp. 885-890.
  4. ↑ K. Demissie, GG Rhoads, JC Smulian, BA Balasubramanian, K. Gandhi, KS Joseph et al .: Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis. In: BMJ. 329, 2004, pp. 24-29.
  5. ↑ J. Andersen, J. Watt, J. Olson, J. Van Aerde: Perinatal brachial plexus palsy . In: Pediatr Child Health . tape 11 , no. 2 , February 2006, p. 93-100 , PMID 19030261 , PMC 2435328 (free full text).
  6. ^ Dieter Palitzsch: Pediatrics: Pediatrics for students and doctors. 3. Edition. Stuttgart 1990, p. 72 f.
  7. ^ MH Beall, MG Ross: Clavicle fracture in labor: risk factors and associated morbidities . In: J Perinatol . tape 21 , no. 8 , December 2001, p. 513-515 , doi : 10.1038 / sj.jp.7210594 , PMID 11774010 .
  8. ↑ Katherine K. Whitcome, Liza J. Shapiro, Daniel E. Lieberman: Fetal load and the evolution of lumbar lordosis in bipedal hominins. In: Nature. Volume 450, 2007, pp. 1075-1078, doi: 10.1038 / nature06342
  9. ↑ Richard E. Leakey: The Importance of an Enlarged Brain in Human Evolution. In: Heinrich Meyer, Detlev Ploog (Hrsg.): Man and his brain: The consequences of evolution. Piper, Munich 1998, pp. 121-136.
  10. ↑ Wenda Trevathan: Primate pelvic anatomy and implications for birth. In: Philosophical Transactions of the Royal Society. B, 370, 20140065, p. 2. doi: 10.1098 / rstb.2014.0065
  11. ^ Scott W. Simpson et al: A Female Homo erectus Pelvis from Gona , Ethiopia. In: Science. Volume 322, No. 5904, 2008, pp. 1089-1092, doi: 10.1126 / science.1163592
  12. ↑ Narrow pelvis, large heads and the difficult birth in humans. On: idw-online.de from April 21, 2015.
  13. ↑ Wenda Trevathan: Primate pelvic anatomy and implications for birth. In: Philosophical Transactions of the Royal Society. B, 370: 20140065, pp. 1-7. doi: 10.1098 / rstb.2014.0065 Cf. the figures showing the relationship between the head of the fetus and the width of the pelvic ring, p. 2.
  14. ↑ Description in E. Schleußner: Normal birth. In: Marion Kiechle Marion (Ed.): Gynecology and obstetrics. 2nd Edition. Urban & Fischer, Munich 2013, p. 314 f.
  15. ^ Gerhard Martius, Uwe Cammann: gynecology, obstetrics and neonatology. Kohlhammer, Stuttgart / Berlin / Cologne 1997, p. 150 f.
  16. ↑ Otto Rank: The trauma of childbirth and its significance for psychoanalysis. 1924. (Reprint: Frankfurt 1988, p. 61)
  17. ↑ Otto Rank: The trauma of childbirth and its significance for psychoanalysis. Fischer, Frankfurt am Main 1988, p. 98.
  18. ↑ Otto Rank: The trauma of childbirth and its significance for psychoanalysis. Fischer, Frankfurt am Main 1988, p. 142.
  19. ↑ Sigmund Freud: Inhibition, Symptom and Anxiety. In: Collected Works. Volume XIV, Fischer, Frankfurt am Main 1926, pp. 111-205.
  20. ↑ Ludwig Janus : The psychoanalysis of the prenatal lifetime and the birth. Centaurus, Pfaffenweiler 1993, pp. 21-75.
  21. ^ Donald W. Winnicott: Birth Memories, Birth Trauma and Anxiety. In: Collected Papers: Through Pediatrics to Psychoanalysis. Routledge, New York 1949, pp. 177 ff.
  22. ^ Donald W. Winnicott: Birth Memories, Birth Trauma and Anxiety. In: Collected Papers: Through Pediatrics to Psychoanalysis. Routledge, New York 1949, pp. 185 ff.
  23. ↑ Hanscarl Leuner: The experimental psychosis: its psychopharmacology, phenomenology and dynamics in relation to the person. Springer, Berlin / Heidelberg 1962, p. 148 ff.
  24. ↑ Lloyd DeMause: The Fetal Origins of History. In: Lloyd deMause: Basics of Psychohistory. Suhrkamp, ​​Frankfurt 1989, p. 257 f.
  25. ↑ Stanislav Grof: Topography of the Unconscious: LSD in the Service of Depth Psychological Research. Klett-Cotta, Stuttgart 1975, p. 122ff.
  26. ↑ Lloyd DeMause: The Fetal Origins of History. In: Lloyd deMause: Basics of Psychohistory. Suhrkamp, ​​Frankfurt 1989, p. 250 ff.