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A Study of Birth Stories and Their Relevance for CAT

Wilton, A., 1995. A Study of Birth Stories and Their Relevance for CAT. Reformulation, ACAT News Spring, p.x.

In this study, I have collected birth stories, with the objective of drawing the attention of psychotherapists - particularly CAT Therapists who need to be able to catch their patients’ patterns of behaviour very early - to the potentially rich source of information and understanding to be gained from asking about a patients birth at the beginning of therapy. My hypothesis is that it is possible to identify in individuals’ birth stories, reciprocal role procedures that developed from the earliest reciprocal roles between baby and mother and/or important others.

I would like to begin by clarifying what I mean by birth stories. When collecting them I made the following request to each person giving me their story:

I would like you to tell me your birth story: what you know about your birth, from any source, that has added something to your picture of how it was and the impact and effect it had upon your family: any descriptions, comments, memories, stories from parents, siblings other relatives or friends, from doctors, nurses, midwives, anyone who has added to your perception of how your birth was and how it was received. I would like to hear any myths or family tales, jokes or catch phrases about your birth, and any memories that you have yourself that you hold to be actual memories of your birth.

Therefore the stories, possibly pieced together from a variety of sources, could include both the description of an individual’s actual passage from the womb through the mother’s body to the outside world, including how both mother and infant experienced this, and also the kind of reception the newborn received from the mother and others, and vice versa. I have, for example, heard mothers complain that their babies were unresponsive, or from the beginning did not seem to want to be held. It seems to me highly likely that the nature of the experience of birth for both mother and baby would affect the bonding pr~ and so be significant in the formation of the earliest reciprocal roles. For example, a mother exhausted and angered by the experience of giving birth, would be less available to bond with her new baby, than a mother who had experienced giving birth as untroubled and exhilarating.

The nature and events of the birth would also impinge on the family, just as the family scenario at the time of birth would affect the baby. So my definition of birth story for the purposes of this study, includes both the actual birth and the earliest postnatal experience.

My interest in birth stories arose from two sources, namely my discoveries of the impact I feel my own birth experience to have bad on me and secondly, through my clinical work, where at times I have been able to see clearly the powerful shaping effect the birth experience and its perceived impact on the family, has had on the individual concerned.

My own picture of my birth experience was recovered in the course of my analysis and I would like to tell you how this came about. While on a trip to the North West Frontier of Pakistan, I found myself in wild, barren, mountainous country, and fell badly ill with malaria and amoebic dysentery. I felt very sick, exhausted, feverish and quite powerless, and in a strange and seemingly threatening environment. This illness laid me low physically and brought on a bout of depression. I found myself unable to sleep and during the following months of my recovery had a series of dreams and fantasies that were very powerful. In one I found myself in a black box, a cube, with a terrifying feeling that the wails were pressing in on me from all sides, and a suffocating sense of time standing still. In another dream, I was on the back of a motorbike with someone, bumping down a narrow enclosed, descending passage, that became lower and narrower until there was severe panic of becoming stuck, but no sense of being able to turn around and go back. There were other dreams of this kind, and a strong desire, almost compulsion, to find my way, up and through a maze of deserted dark passages in an old ruined fort passed on a journey across the French-Spanish border. I did and found fresh air much to my relief at the top.

In my analysis, and later in my CAT, I struggled to make sense of all this. My birth story seemed to me to be closely connected to the experiences described above. I was the first child of a mother terrified of childbirth, and fill of anxiety. The birth was long and excruciating as I was a big baby, and so my birth caused her much pain, as she often told.

Stanistav Grof describes what he names the four basic perinatal matrices’ the first being primal union with the mother (Intrauterine experience before the onset of delivery); the second, antagonism with the mother (contractions in a closed uterine system); the third, synergism with the mother (propulsion through the birth canal) and fourth, separation from the mother.

He wit of the second matrix, alt is, however, conceivable that the fear and confusion of an inexperienced mother or a distinctly negative or strongly ambivalent attitude of the mother towards the unborn child or towards the process of delivery itself can make this phase more difficult’2. It is my sense of it; that this is what happened to mc during birth, and that it was so difficult and frightening for my mother that at some point she gave up on me. During the second matrix, the mother/womb, becomes aggressor, bearing down forcefully on the baby, for whom all effective movement is blocked and for whom, with the closed cervix, there is no way out The baby is suddenly powerless. Grof writes that in this matrix, “The subject feels encaged in a claustrophobic world and experiences incredible physical and psychological tortures Typically this situation is absolutely unbearable and, at the same time, appears to be endless and hopeless; no escape can be seen either in time or in space”. This description matches very well with the terrible sense of time standing still in my black cube dream. In CAT terms I can quite easily trace an important (former) negative procedure of mine to my birth experience, namely, in relationship with others, them has been a fear of being too much, too heavy, so either I take care of everything and everyone, ant in control, (the parental child), or I am in the other’s control, vulnerable and powerless.

Turning now to my clinical experience, from amongst many cases where the individual’s experience of birth has seemed to have had a shaping effect, I would like to quote material from one individual, whom I shall call P, a woman of 38.

Here, the birth story particularly aroused my interest, because of the reception her birth evoked from her family and her strong perception of the effects of this which shaped the patterns of her life. P was the tenth child and the ninth and last girl in a family that welcomed and valued males but held females as worthless and a burden.

P told her birth story as follows. She had been supposed to be a boy. Her mother had had two boys and eight girls before her arrival and this time she was certainly supposed to produce another precious male. When P turned out to be yet another girl, her mother had been angry and afraid, because her husband would be so enraged. P had in her mind the idea that her mother had contemplated killing her at birth and had many dreams and fantasies about this. Her father was, according to the story she bad been told, playing cards with friends as she was being born was so angry that his wife had failed him by producing yet another girl, that he did not even come to look at the baby. There was a long delay in registering the child’s birth, and for weeks P was not given a name.

The reciprocal roles that generated the patterns that have shaped and pervaded P’s life are clearly visible in what we have come to call the ‘pact’ established from birth between P and her mother, namely. ‘if I allow you to live, you must do everything I want, be them completely for me when I need you, and at other times efface yourself: disappear into the background’. P is only now beginning to break out of these patterns and be able to own her right to her place.

Survey of the literature

When I came to survey the literature on the effects of birth experiences, (including both the actual birth and the immediate post-natal period) on development, I was surprised to find such a wealth of material. Greenacre for example, wrote a paper purely tracing the changes in Freud’s views on the relationship between anxiety and birth trauma. She emphasized the value of correlating early infant histories with the material elicited in the course of subsequent therapy. This felt an encouragement in undertaking this study of my own. Other psychotherapists who write extensively on the subject include Winnicott, Daniel Stern, Otto Rank, and Arthur Janov.

Methodology

I collected 16 birth stories by posing the request quoted above and taping the responses and in addition asked each respondent to give me either a copy of his or her SDR, or if the person had not had a CAT, I asked for a completed Psychotherapy File. I then studied each story carefully and identified in each case one or more procedures generated from the reciprocal roles discernible in the story. I found that I could clearly see procedures generated from these earliest reciprocal roles, I next examined the SDR or Psychotherapy File that came with each story and named which of the procedures identified in it seemed most closely connected to the birth story in each case, I then arranged for two independent raters to test the reliability of my matchings.

I think it would helpful to quote an example.

Birth Story from a young married woman

I had gone away to Greece by myself at a time when I had a lot of problems with my work and was lying on a beach reflecting on why I am always struggling, always tying to prove myself and suddenly like a kick from the unconscious, I had a memory of being yanked out of this comfortable place, against my will, out of my mother’s stomach. There were white figures around me and I remember a terrible brightness that was the most frightening thing, and the vision of those hands with the surgical gloves on them, that were yanking me, and it was a struggle. (7 was three weeks early so perhaps really not ready). I could feel I did not want to go and suddenly I got in touch with why I am always struggling, always feeling pushed, having to pass everything, to meet others’ expectations. Then, later, when I was pregnant and not wanting to be, and again struggling with lots of problems I began to get this crushing pain in my chest like a deep grief that I couldn’t explain, that frightened me. I felt that I couldn’t control it but was going to erupt into grief and not know why. I started to think about my own childhood and said to myself I don’t want this baby to be unwanted but I wasn’t an unwanted child, and I couldn’t fit in these terrible fears of unwantedness. Then I got back a very strong memory of being on my back in a dark place, being unable to move, not able to verbalize what I was feeling. I could see a think of light but was unable to move towards it. I couldn’t get out of the situation I was in. I felt panic, fear of abandonment, and grief I think the pain in my chest was that fear of abandonment and being pregnant myself got me in touch with it. I didn’t want my child to feel the same way, and didn’t know where the feeling had come from This prompted me to ask my mother about my own birth, and she told me that after 24 hours of labour the process had stopped, and the doctor had decided that an emergency caesarean should be done. Afterwards she did not see me for four days and was afraid that I was dead She kept saying “Where’s my baby?’ and they replied “You’ll see her tomorrow”. No wonder I felt abandoned. Mum said that I did nearly die, was very ill, and so would have been in an incubator. I thought, I can remember it. It was such a relief to brow all of that because I had battled for a long long time with a deep deep thing and had thought I was going mad … I remember lying on my back, looking into black just too frightened, nothing nobody, and I think it was almost as if I was disappointed, because I had expected life to be nice, to be comfortable like the womb. I felt everything had been dashed and I often get that feeling of disappointment, I expected better. It was four days before my mother saw me, a long time in baby terms, I think I must have thought I was going to die, hence this sense always of a fight to survive, a struggle to be alive.

I find this particular story especially interesting because this person had the memories about her birth and made her own connections before finding out from her mother how her birth had actually been from her mother’s perspective.

The RRP that I drew from her story was, Longing and expecting things to be good— I am surprised to find myself having to struggle desperately—feel let down, disappointed— feel left, helpless and hurt—I must fight alone to survive.

The RRP from her SDR that I felt matched her story and seemed very similar to the above was. Have to fight for survival— strive to prove self-worth—achieve but never enough—terror of abandonment—failure and rejection seem inevitable—success devalued.

Here we have an individual who notices in herself, and is discontent with the fact that she is always struggling, striving to perform to other people’s expectations, who suddenly has a birth memory that seems to her to make sense of this pattern, the struggle against her will when being yanked from the womb during a caesarean birth. When she is again feeling caught up in a lot of struggle at a time when she also finds herself pregnant, she becomes aware of a crushing pain in her chest and is weighed down by a powerful, grief stricken feeling about being unwanted, and again has a vivid and visceral -memory described above that seems to her connected to the grief-stricken feelings about unwantedness, At this point she at her mother for the facts of what happened at her birth, (she had only known prior to this that she had been born by caesarean) and is greatly relieved to discover that they fit and make sense of her present powerful and overwhelming feelings and the memory she has connected to them. She had been left in an incubator for four days, near to death after a traumatic birth and bad to struggle for life on her own.

Whether or not these memories are held from birth (and I feel that they are), the point I want to make is that the story itself pieced together from various sources, shows clearly the ruling RRs, abandoning to abandoned, left to struggle for life alone, disappointing to disappointed and hurt, in this person’s life and the harmful procedures developed from them, Interestingly, this individual became a physiotherapist, attending and responding to the pains and strains of the body.

Discussion

I was very impressed by the richness and diversity of these birth stories, Nine of them contained descriptions of the actual physical nature of the journey from the womb to the outside world, Others homed in on the events happening in the family at the time of their birth which had affected how the birth was received and coloured the experience. Three people felt sure they actually remembered their births.

As I had envisaged, the stories were a patchwork made up from various sources of information, gathered at different times in the individual’s life. Although each story was unique and quite different from any other, I did note that there were particular themes that ran through certain groups of them:

‘Damaging One’ theme

In nine of the 16 stories, the story teller felt she bad hurt or damaged the mother in being born, giving rise to RRs of hurt one to damaging one and evoking guilt and a need to make reparation,

‘I Remember my birth’ theme

In three of the 16 birth stories there are accounts of what are held to be actual memories of birth, All three have in common the feature of suddenly coming into bright light, In two cases the birth was by caesarean, and occurred after a dangerous, painful and difficult labour that raised anxiety. In the third remembered birth, the mood is very different This individual, reports an easy, straight forward birth, with no problems, She feels that the womb came to feel claustrophobic to her and that she wanted to get out and claims to clearly remember her first view of the world, with the sunlight streaming into the room from the left hand side, “It was lovely. A great relief”. She feels that her preoccupation with shafts of light as an architect is linked to this early experience.

‘Just We Two’ theme

In two of the stories there were strong admiring-admixed reciprocal roles, these being the narratives from the two males who offered their birth stories, In each of these there was a picture of an easy birth followed by a close and uninterrupted mother child bonding, In one case there was a sense of an absent father, and the child being the one to fill the empty place in the mother’s life. In the other story, an epidemic of influenza had precluded any visitors for the first six days after the birth, and again there was a sense of uninterrupted mother baby closeness. In both these cases, although only the idealized states were discernible, I felt it would be a long fall from such a perfect and central position with mother. In reformulating; these birth stories would prompt me to be alert for the possible other half of the ‘split egg diagram,

‘Born Under a Shadow’ theme

In six of the stories there was a theme of having been born in the shadow of someone else or of some disastrous event In three cases, this was the death of someone of great importance to the mother, causing the new life to be associated with the loss, rather than met in its own right. In the other three cases the individuals concerned were born in the shadow of earlier difficult or disastrous birth(s) in each case adversely affecting the attitude towards the newcomer.

‘Unwanted’ theme

In five of the stories, there was a sense of ambivalence in the story teller as to whether or not she had really been wanted, In the first of these, the person concerned felt her father had really not wanted her and it was possible to see here that this had influenced her relationships with men, there being always a fear of rejection, In the second story, the person had the sense that her father forced pregnancy on her mother against her will, and that her mother would not have chosen to have a baby. In the third story the person said that she had been a mistake, born only because her mother was too late to abort her, or chose not to do so. In the fourth story the person named herself a mistake and felt that she came into a relationship unprepared for the strain of a baby. In the fifth story, the individual felt her parents did not plan to have a baby when she was conceived, and therefore felt she was too much, too heavy, an imposition.

‘Joyfulness’ theme

Sadly, in only six of the stories is the joy evoked by the birth described.

My experience in examining all of the stones was that within each one it was possible to catch where self-defeating procedures were formed or likely to be formed out of the earliest reciprocal roles influenced by the birth experience The results of the inter-rater reliability tests showed a pleasingly high level of concurrence between myself and the independent raters in the matching of procedures to birth stories.

Limitations of the Study

Only a relatively small number of birth stories were examined, There is a need to do a larger scale study, perhaps taking birth stories from patients early in therapy, using them to reformulate and then later having independent raters match birth stories to SDRs.
Most of the respondents giving their stories were psychotherapists, who are probably more likely than other people to find connections and meaning of their own experience, thus making it easier for the researcher with this particular sample to catch the REPs in the birth stories.
Most of the respondents were female, there being only two men who gave their birth stories. It would be important in a further study to find a way to reduce this disparity in numbers of female to male stories.

Conclusions

This study has confirmed and demonstrated my original contention that by examining an individual’s perception of his or her birth story and its impact (the birth story’), we can often get a wonderfully rich and clear picture of the development of the RRPs that shape an individual’s life. Whether or not the birth was in actual fact as portrayed in the account is not so important Rather, what is significant is that the birth story is likely to poignantly reveal the meaning the individual made of his or her birth and how he or she sees him or herself in face of the mother and important others. I would like to propose that we make this a routine part of reformulation practice in CAT.

This, paper was delivered at the Third ACAT Conference, February 1995

Angela Wilton

Full Reference

Wilton, A., 1995. A Study of Birth Stories and Their Relevance for CAT. Reformulation, ACAT News Spring, p.x.

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