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Cesarean Birth and Psychotherapy - Jane English

This is the very first of Jane's writings that was published. It was in the Association for Transpersonal Psychology's Fall 1982 newsletter

Introduction

Only in the past 80 to 100 years have there been appreciable numbers of people walking on the earth without having been through the hitherto universal human experience of labor and delivery, the trip down the birth canal. In 1882 advances in surgical technique made caesearean delivery a reasonably safe procedure for both the mother and the child. Before that, most of the mothers died. Now, a little over 100 years later, seems an appropriate time to look at the psychological, social and spiritual aspects of the experience of being born caesarean, especially in light of recent research1,2 that shows the importance of the birth experience in formation of self image and world view.

Already published work on caesarean birth includes books on the mother's experience,3,4 government reports,5 histories of the medical procedure,6 articles in medical journals, 7 and occasional references in books on psychology and behavior.8,9 None of these have a transpersonal perspective, and most tend to view caesarean birth as abnormal, pathological, or unfortunate, rather than simply appreciating it as different.

My interest in caesarean birth emerged from my experience over a period of years of reliving in dreams, meditation, therapy, body work, etc., the patterns of my own birth which was non-labor caesarean. Even after nearly twenty years of exploration, I am at the beginning stages of conceptualizing this subject and its far-reaching implications. I have come to view the emerging map of caesarean birth primarily as a tool for personal growth and transformation, and only secondarily as an area of scientific research or as an explanation or justification for various patterns of awareness and behavior.

Caesarean Personality

The following summary of some of the characteristics of people born non-labor caesarean is based on my own personal process, on observation of and conversation with other caesarean born people, and on observations by therapists, doctors, nurses, and parents of caesareans. These characteristics are by no means unique to caesarean born people; they are perhaps just more pronounced. This is a preliminary formulation of this material, and the process of gathering more information is continuing.

One way of conceptualizing this material that I have found useful is in terms of the drama of non-labor caesarean birth. Union with the mother is disturbed by the anaesthesia used in the surgery, followed by the experience of the cutting open of the mother with whom the child is still unified physically and psychially. The child then begins to emerge into the world still very much in a state of cosmic union, then experiences being unwillingly and abruptly pulled out of the womb. Though the actual birth could be considered complete at this point, I have found it necessary to include as part of the birth the encounter with the obstetrician. The struggle with the doctor who forcefully stimulates breathing is not unlike labor, and there also seems to be something that can best be described as bonding with the doctor following this struggle. Soon after this, the bond is broken as the child is taken away to the nursery, and a physical and emotional shutting down may follow. This drama may be different for some recent caesareans as some hospitals are using local anaesthesia, allowing the father to be present, and allowing the mother to make eye contact with the baby and even to hold and breastfeed it immediately. The last stage of birth extends over a period of may years as the caesarean born person person transforms the melodrama learned from the experience of caesarean delivery and learns to choose to give birth to his or her self as an individual in the world.

Among the habits, expectations, and patterns, some of them paradoxical and contradictory, that might be learned in non-labor caesarean birth are:

-The expectation that nourishment will be followed by poisoning and attack.

-Defensiveness in relation to all approach; touch sensitivity and paradoxically a love of physical contact once the defensiveness has passed.

-Habit of opening only when exhausted or invaded.

-Some different residual body tension patterns, e.g., neck tensions related to the head being pulled rather than pushed in birth.

-Dependence, a feeling of needing to be rescued, inability to act on one's own, and paradoxically, an unwillingness to ask for help.

-Anger toward would-be helpers who fail to satisfy on a physical level the impossible demand of total rescue.

-Distortion of relationship and sexual patterns with people of the same sex as the obstetrician. Expectations of struggle and defeat, and of merging, bonding, and being totally cared for.

-Perception of self as separate, and paradoxically, less sense of personal boundaries.

-Easy access to transpersonal awareness but lack of appreciation of this capability because of having less sense of personal boundaries.

-Continual testing of limits and boundaries.

-Relationship patterns that are colorful, abrupt, intense, and arrow-like rather than like the waves of contraction and expansion that would be learned in labor.

-Little sense of process, expectation that a relationship either exists and doesn't need to be nourished, or doesn't exist and is impossible.

-Being not particularly goal oriented, feeling criticized for this, wanting to have goals but feeling unable to find any that seem real.

-Strong negative self-judgement that seems to be connected with not meeting others' unconscious expectations that the CB know the relationship patterns and sense of limit learned in vaginal birth.

-Trust that help will always be there without one having to ask for it.

Relation to Psychotherapy

Knowledge of this material will be helpful in psychotherapy with caesarean born people. When a therapist of the same sex as the obstetrician works with a caesarean born client, much of the dependence, desperation, fear, and anger the caesarean born person feels about helpers are projected onto the therapist, especially when the therapy focuses on breathing. Knowledge of the origins of these feelings can help the therapist neither take them personally nor judge them negatively. Caesareans dealing with the rescue/dependence issues need a therapist who trusts them to stay alive on their own no matter how bizarre and precarious the mental, emotional, and physical situation seems. With the non-labor caesarean born person's less well defined boundaries, the therapist needs also to be aware that the person may not have a clear sense of what staying internalized means, and the therapist may need to help them find the balance between rigid shutting down and unconsciously identifying with everything around. The caesarean born person needs people who will "labor" with him or her and not expect knowledge of vaginal birth-learning. The therapist may easily confuse this necessity for labor with manipulation and demand for attention by the caesarean born person.

In the process of transforming caesarean birth-learning, there is a need for awareness of transpersonal levels of reality in both the therapist and client. This is especially important in relation to the pattern of dependence, of intense attachment to a helper or rescuer. Chinese folk wisdom says that a baby that falls off a boat should not be rescued because it will become totally dependent on its rescuer. For me, this story was a challenge, almost a koan, as I sought to reconcile a deep sense of dependence with a desire to be responsible for my life. Eventually I came to know that the "seed of truth" at the core of the dependence was an experience of union, of mergence. In the context of the caesarean birth experience, the way out of dependence and defeat is to know the union of the doctor, mother and child, to identify with all three at once. The release of the dependent behavior patterns comes not through effortful independence but through full awareness of inner or transpersonal connectedness in the light of which physical separation is trivial or playful. Experience of real independence in the world has to be preceded by a surrender or death of apparent independence or separateness. The fears associated with separateness, dependence, and defeat form a barrier of pain that has to be experienced on the way to awareness of union, to experience of the archetypal Cosmic Mother, One Heart, One Mind, etc.

In working with dependence the therapist needs to be adept at establishing and maintaining inner connection with the caesarean born person, a connection the person can experience being sustained through physical separation. This inner connection forms an intermediate step toward experience of connectedness atthe archetypal level, at which point the therapist is no longer needed. (see ref. 8)

Differences as Opportunity

Situations where a vaginally born therapist works with a caesarean born client, or vice versa are actually opportunities for both the therapist and the client to transcend their particular birth learning and meet at a deeper level of shared humanness. There is, however, need for a high level of commitment and good will from both the therapist and the client because each will challenge the other's deeply held beliefs and self-images. Each can also offer the other new and useful patterns of behavior and consciousness. For example, a caesarean born person can learn the wavelike give-and-take relationship pattern that a vaginally born person learns in birth, and a vaginally born person can learn the arrow-like directness a caesarean born person learns in the caesarean delivery.

When both the vaginal birth pattern of aggressive action, of pushing through, and the caesarean birth pattern of helpless inaction, of inability to push through, are known as options rather that absolutes, one may experience a new kind of effortless action that is akin to the Chinese "wei we-wei", action that doesn't create an experience of subject/object split.

Conclusion

A person born non-labor caesarean experiences a somewhat different way of being in the world and has some different illusions to transcend on the way to integrating personal and transpersonal realms of experience. Birth can be seen as a gateway between the personal and transpersonal realms. The demons that guard this gateway in the experience of a caesarean person are different from those of a vaginally born person. A comparison, an appreciation of differences, is useful to both in perceiving their own demons more clearly. A map of the experience of caesarean birth, a "Field Guide to the Demons" is a useful tool, a temporary scaffolding to stand on in the process of transformation in psychotherapy. And as with any scaffolding, it should be set aside after the transformation is complete.

References

1) Feher, Leslie, The Psychology of Birth, New York, Continuum, 1980.

2) Grof, Stanislav, Realms of the Human Unconscious, New York, Dutton, 1976.

3) Donovan, Bonnie, The Cesarian Birth Experience, Boston, Beacon Press, 1977

4) Mayer, Linda D., The Cesarean (R)evolution, Edmonds, WA, Chas Franklin Press, 1977

5) Marieskind, Helen, An Evaluation of Cesarean Section in the United States, Washington, Dept of HEW, 1979

6) Pundel, J.P., Histoire de L'Operation Cesarienne, Brussels, Presses Academiques Europiennes, 1969

7) For example, Stichler and Affonso, "Cesarean Birth", Am. J. Nursing, March 1980.

8) Montagu, Ashley, Touching, New York, Harper and Row, 1971, pp. 48-58.

9) Hidas, Andrew, "Psychotherapy and Surrender: A Psychospiritual Perspective", J.Transpersonal Psychol., Vol 13, No 1, 1981, p.27.



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