The Psychological Processes of Childbearing

Fourth Edition

Joan Raphael-Leff

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429921926
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Childbearing seems eternal, primordial and universal. Yet human reproduction in the 21st century is in a state of flux. This accessible book highlights dramatic changes that have occurred over the last decades, focusing on both individual and cross-cultural diversity across the now elongated childbearing cycle and the uniqueness of desire and emotional experience. It does so by locating the transition to parenthood in its psycho-sexual and socio-economic context, emphasising interweaving internal/external realities and our inherent interconnectedness with others. Included are conscious and unconscious factors determining beliefs, expectations and parenting practices, and ways in which these are affected by rapid urbanisation, shrinking families, societal instability, HIV, governmental maternity and child care policies, and attitudes of professionals. Drawing widely on empirical and clinical research from disparate disciplines psychoanalytic, neuro-scientific, neonatal, sociological, obstetric, anthropological and midwifery this resource book synthesises these to illustrate a spectrum of processes affecting each person's mental health.

Part One
Pregnancy Expectation

Chapter 1
The wish for a baby: psychosocial and cultural factors

1.1 Introduction

This chapter locates the wish for a baby in the contexts of cultural, social and personal motivation to reproduce. It also presents an extended exposition of unconscious intrapsychic (within the psyche) factors based on a psychoanalytical understanding of early human relationships. This material may be completely novel to some readers and consequently difficult to absorb at first reading without reference to the clinical situation with which they are familiar.

Here and elsewhere, you are advised to follow your interests. If you wish, omit this chapter and move on to Chapter 2 which deals with the decision to become parents (paying special attention to ethnic minorities, and lesbians) or if you prefer to get directly to the psychological aspects of infertility or pregnancy, go to Chapters 3 or 4 and return to the beginning when you have completed reading the clinical application of the theory. The summary of key points at the end of each section map the terrain and can serve as a guide on your journey through this volume.

1.2 Motivation for Reproduction

Why do we have babies? In this era of rapid social and technological change our accepted view of reality has been undermined. Whereas previously sex and pregnancy were inextricably linked, efficient contraception, artificial insemination and free access to abortion have created a new climate in which female sexuality is potentially freed from reproduction and both sex and childbearing can be unhitched from the social institution of marriage. Recent developments in western society have revealed that the human desire to reproduce is not inbuilt as we have been led to believe but has both conscious and unconscious roots embedded in the particular origins of each individual - the family in which one was brought up, the culture into which one was born and the society in which one lives as an adult. Today, we can no longer cling to myths of 'maternal instinct' or beliefs that 'anatomy is destiny' or even teleological assumptions that we are governed by a purely biological drive of 'selfish' genes but we have to account for pregnancy in terms of a complex psychosocial wish to reproduce. Although motivation for reproduction is complex and highly personal, there are a few constant factors:

1. Genetic immortality. Faced with the uniquely human fore-knowledge of death, individuals wish to prolong their existence by casting their genes into the future to survive after their death.
2. Becoming 'adult'. Since our earliest interaction is with people who are parents, 'mummies and daddies' become synonymous with adults. Even when we grow up, irrationally it may seem to us that we never finally achieve true adulthood until we parent our own children.
3. Emulating the parent(s). While growing up, children are aware of the difference between their own limited abilities and those of the mother and father. This discrepancy is most marked in the fertile parents' capacity to 'make babies' in contrast to the child's pre-nubile infertility and pubertal postponement of procreation. Having a baby erases this primal dividing-line and enables the 'child' to assume the productive sexual identity of a parent finally engaging in all the hitherto prohibited or withheld activities, emulating the admired parent with whom they have identified.
4. Reciprocating parental care. Human babies are born dependent. In fact, a British psychoanalyst once went so far as to suggest that 'there is no such thing as a baby'[1], since no infant can survive on its own without a caregiver. One way of repaying all the caring love and attention received is to lavish it on an equally dependent being, the previously needy child now occupying the position of a generous parent.
5. Second chance. No parent can be perfect. We all suffer from recollection of frustrating times when the quality of care did not meet our exact needs. To some, these were not rare occasional lapses but the ongoing stuff of infancy. Having a baby offers a rare opportunity actively to correct that experience by vicariously giving the infant all one would have wished to have had. Being in control this time helps master old anxieties. Close contact with a growing baby can enable some parents to relive painful passages of their own infancy, resolve, repair and reintegrate them. Others may abuse their position of power.
6. Love object. The indulged baby can thus represent one's own ideal or brutalized baby-self. But babies also reciprocate in a unique way, loving the mother or father despite their lapses and failures, making them feel lovable and invested with a special warmth. This loving response may be sought as a novel variation of that early unconditional love which we all unconsciously continue to crave.
7. Cultural transmission. The point at which individual and societal goals intertwine is the parent's wish to pass on a fund of experience, knowledge, skills and personal-lore accumulated in one's lifetime.

1.3 Cultural Expectations of Childbearing

'Culture consists of abstract patterns of and for living and dying' Samuel Johnson.

Pregnancy and birth are social as well as biological events. With our new technologies a fundamental discrepancy has been revealed: for society procreation is survival; for the individual it is a choice. In any particular society, should women cease to become pregnant, that society would die out. Thus, all cultures develop means to ensure that women will continue to reproduce. Virtually all known human societies have organized around a social division into two genders with woman defined by her biological role of reproduction of the species.[2]

To begin at the beginning. Ethological, archaeological and anthropological evidence suggest it is likely that the original social unit was that of the foraging mother and her suckling [3, 4]. Upright posture and consequent reshaping of the pelvis reduced the diameter of the birth canal, with natural selection for small-headed premature babies [5] necessitating ongoing maternal care. How human social networks evolved is open to speculation. One possibility is that the invention of containers (mimicking that first container, the womb?) permitted food-gathering, storage and, hence, mobility, sharing and cooperation. These contributed to the formation of small social groups, enabling individuals to gain access to a greater variety of materials and services [6], It has been argued that the loss of oestrus in human females cemented heterosexual pair-bonding [7], and although it is not known when man's role in procreation was recognized, we may assume that acknowledgement of paternity provoked patrilineal (father-line) kinship bonds [8]. To this day, fatherhood remains a social construct. Whereas the mother-infant connection is unquestioningly demonstrated by pregnancy and birth, paternity is based on trust, and in all societies the social father is marked by declaration (such as couvade or naming) and need not coincide with the biological impregnator.

Patriarchal societies thus need to grapple with the problem of male genetic immortality. To this end they elaborate rules and regulations which prescribe, restrict and organize female sexuality and procreation. In other words, (male) authorities define social mores which determine which women can become mothers and at what age, the context in which pregnancy is permissible ('legitimate') and even the interval between babies is regulated by social taboos on intercourse after a birth. Woman's identity in most societies is defined by her procreativity, whereas man has to define his role in cultural terms. Male elders exert control over female fecundity by ideological and magico-religious means, through monopoly over communication with ancestors and the spirit world and rituals which regulate fertility. On an unconscious level, woman is associated with Nature. Pregnant and lactating, she is regarded as closer to natural functions unavailable to men who deem themselves superior. They, in turn, create artefacts in their attempt to transcend natural conditions by evolving "Culture' [9] from which women are excluded, confined as they are to domestic intimate childrearing rather than public realms [10]. Reproductive obedience and female subordination are thus ensured by the exclusion of women from political, religious and public organizations; psychosocial, medical and sometimes legal non-ownership of their bodies; confinement to childbearing and rearing and lack of economic control over the material surplus when they help create it, even though in many traditional societies women make the bulk of produce. (WHO statistics show that women do two-thirds of the world's work; provide 45% of its food; earn 10% of its income and own 1% of its property [11].)

Moreover, children not only signify survival and continuity; they can constitute wealth. In horticultural and agricultural societies, successful men can increase production of a surplus by having many labouring children, who also provide heirs, ensure property succession and security in their father's old age. In societies in which a wife is vulnerable because marriage uproots her from her home, by having a male baby she may enhance her status and secure her precarious position as a stranger to her husband's tribe.

I am suggesting here that cultural transmission of the vital wish for a baby across generations and within a caring family unit has so far been ensured by limiting the social definition of women's role to childbearing and childrearing and by promoting economic and political advantages to men who produce offspring. However, today, western societies are facing an unprecedented reproductive upheaval as women claim a right to control their own fertility and be non-breeders if they wish, and to occupy public roles in non-domestic cultural institutions and in the workforce as automation reduces the excuse of physical differentiation of the sexes in division of labour. Social and political pressures have emphasized maternal exclusivity as primary caregiver. However, as more fathers are included in the birth process and infant survival no longer depends on a lactating woman, the importance of the father for the infant's well-being is becoming apparent and some men are claiming their right to 'mother'. Concurrently, a multidisciplinary approach is contributing ever refined understanding of the complex psycho-bio-social (as opposed to purely biological, psychological or sociological) roots of the wish to reproduce, and it is to these that we now turn.

1.4 Early Experience and Expectations of Childbearing

'The Child is father of the Man'. Wordsworth

We cannot generalize about early experience. Although in traditional societies the lore of baby-care is passed on from mother to daughter (or to son's wife) thereby remaining fairly constant over time, the way babies are nurtured, the tenor, style and quality of maternal care varies across societies and in industrial societies across and even within classes. In the West, changing beliefs about babies have engendered different childcare patterns between generations of mothers and daughters [12] and it is also possible to note variations in the same mother with different babies. Clearly, since some extended families practise surrogate mothering and in certain households in our own society mothers share childcare with nannies and au pairs, exclusive mothering is neither inevitable nor biologically determined by pregnancy. Furthermore, a variety of constellations occur - we encounter adoptive parents, lesbian couples, group parenting, single fathers and older siblings rearing their brothers or sisters. Nevertheless, tracing the intergenerational development of my theme of the 'wish for a baby', I shall focus here mainly on the heterosexual progenitors, present or absent, embedded in the generative matrix, and within it on the basic triangle of mother-father-child. I do so advisedly, since psychological processes do not always deal with the objective external reality that a child actually encounters, but are concerned with the internal reality - what each individual subjectively makes of the world s/he experiences.

To begin again at the beginning. At birth, each baby differs in its innate endowment of sensory-motor, cognitive and proprioceptive capacities. Research findings suggest that newborns already display 'personality' characteristics which are genetically determined and affected by gestational factors. Each infant also encounters particular nurturers through which his/her world is filtered. These parenting figures both display idiosyncratic features of their own and also convey prevalent ideas and features of their culture. As infants take in milk, so they also imbibe aspects of the social environment with which they interact in an ever widening circle, initially containing only the parent(s) and/or other significant figures. This interplay is gradually internalized becoming an unconscious substratum which persists in the internal psychic world independently of the relationships in which it originated.

Traditionally, not only have women given birth, they have also been allocated main responsibility for infant care. In any society where the mother is the primary caregiver, she will form the foundation of her infant's emotional self-image. The baby absorbs not only her milk but her smell, warmth, touch, sound of her voice, her gaze arid her disappointments and desires, her social status and self-image and her concept of her newborn baby. Inevitably, the mother relates differently to her son and daughter. However, both male and female babies form identifications with their early intimates, and when the primary caregiver is the mother, both boy and girl baby learn to 'mother'.

The composition of the household is very important in determining the experience of those early years: whereas extended family households may include a variety of influences from several consecutive generations, and/or different parallel groups related by blood or marriage (such as brothers and their wives and children all living under the same roof, or one man and several wives) industrialized societies (and hunter-gatherers living at subsistence level) have evolved an insulated separate household for the nuclear family, composed of a triangle of (present or absent) father, mother and her child(ren). Thus, in western societies where often each mother is isolated in her own home and exclusively responsible for care of her infant, the baby will develop an intensely specific 'monotropic' attachment to her [13] unmitigated by other influences. In such 'mother-care' societies, at some point the growing boy is required to 'dis-identify' from his nurturing female [14], by emulating males instead and being socially initiated into the rites of masculinity. In our culture, male identification with an often absent father has been found to pose particular problems for the little boy, who has been exposed to the minutiae of the feminine daily routine at home, and later to a female teacher at nursery school. Lacking direct access to male caregiving and enterprise, a western boy has had to construct a masculine identity on his father's elusive and often idealized non-domestic role, which some feminists regard as one root of female denigration, and which many men are now trying to rectify by becoming nurturing fathers.

1.5 Psychosexual Definitions and the Wish for a Baby

In exploring the complex area of psychosexual identity it may be helpful to examine three components separately:

1. Core gender identity - the sense of being male or female.
2. Gender role identity - establishing oneself as masculine or feminine in terms of social definitions.
3. Sexual partner orientation - choice of a heterosexual or homosexual love relationship [15].

Core gender identity begins very early, with sex-specific hormonal influences [16], innate anatomical and biological factors, parental and self physical-handling [17], growing male or female body image [18] and sex assignment at birth leading to a sense of belonging to one sex and not the other [19]. From very early on, parental attitudes towards their child's biological sex will be subtly conveyed in the quality of their differing interactions with boys and girls, the roughness or gentleness of touch and tone, the encouragement of some aspects of behaviour but discouragement of others. However, the picture is further complicated by differences between male and female parents in their own patterns of interaction with the newborn. Micro-analysis of parental behaviour reveals that in general, fathers provide more auditory and arousing physical stimulation than soothing maternal rhythms [20].

Gradually, the infant has to realize that being male or female will also define what is allowed. Thus, the growing infant develops a complex unconscious understanding of gender role expectations, which as discrimination increases, is supplemented by imitation of admired behaviours, conscious learning and practice. In the first year or two, before such limitations are acknowledged, both little girls and boys may wish to have a baby, too, like their mothers, or, in the irrational logic of the unconscious, even wish to have the mother herself turn into a baby, so that the child can nurture her in turn. It is not uncommon to see a baby feeding his/her mother reciprocally, or nursing a doll or pet, in imitation of and identification with the parent. Such games of becoming the mother reflect a host of different and ambivalent wishes; emulation of her power; angry revenge on her for frustrations; mastery of the situation of dependent helplessness; active learning through practice; gratitude and a desire to repay this debt of nurturing; a vicarious re-experiencing of earli...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Update Section 2005
• Psychosocial Process of Childbearing Revisited
• Preface
• Acknowledgements
• Foreword
• Part One Pregnancy Expectation
• Part Two Pregnancy
• Part Three The Expectant Partner
• Part Four Pregnancy as Transition to Parenthood
• Part Five Experiences of Labour and Birth
• Part Six Coping with the Outcome
• Part Seven Complications
• References and notes
• Appendix A - 2004 Factors influencing breastfeeding
• Author index
• Subject index
• Appendix B- 2004 FRQ postnatal questionnaire
• Appendix C - 2004 PPQ Placental Paradigm questionnaire
• Appendix D - 2004 AMOM questionnaire