PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 4 NEUROSCIENCE AND ITS IMPORTANCE TO PRENATAL AND PERINATAL PSYCHOLOGY

PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 4

NEUROSCIENCE AND ITS IMPORTANCE TO PRENATAL AND PERINATAL PSYCHOLOGY

-Shivakumar Belavadi, PPNE, Bangalore, India

TOPIC - Working with the chapter of the nervous system by John Chitty, compare and contrast the Old and New Views of the Nervous system and why it is important for PPN educator.

OLD VIEW : The older view of the nervous system in human beings was of a reciprocal system which had two branches viz. Parasympathetic and Sympathetic. The parasympathetic branch had the Rest & Rebuild functions associated with it while the sympathetic branch had the Fight & Flight functions associated with it. In this view, the two branches functioned to mutual exclusion so that when the fight and flight response operated, it would cause the cessation of Rest & Rebuild mechanism, and vice versa.

NEW VIEW: In the new view, which was pioneered by Stephen Porges through the Polyvagal theory, there are three branches of the Autonomic Nervous System (ANS) viz. Social, Sympathetic and Parasympathetic. The new inclusion is the Social branch. The new view of the ANS is of a phylogenically progressive system in which the three branches of the ANS function sequentially. The social system is the superior and newest system which has come about in the evolved species viz. mammals and human beings.

COMPARE / CONTRAST AND IMPORTANCE TO A PPNE

John Chitty compares the Old and New views of the Autonomic Nervous systems in a tabular form as given below. I have taken the liberty of putting in my thoughts on the importance to a PPN educator alongside each of the comparative aspect of the chart.

ASPECT	OLD VIEW	NEW VIEW	IMPORTANCE TO A PPNE – MY THOUGHTS/ COMMENTS
Importance	Under-appreciated	Supreme Importance	The value and relevance of the new view comes from the fact that it is “life empowering”. Once a PPNE appreciates the linkages between the three branches and how they function, it can be used to empower babies, parents and caregivers.  In fact, society at large will benefit from such universal and empowering facts about how we function in the voluntary and involuntary domains.
Action	Reciprocal (Sym- and Parasym are seesaw, on/off)	Sequential based on phylogeny (evolutionarily newer vs. older	By appreciating the sequential nature in the functioning of the branches, one can notice that the Social Branch has the potential to cause a cascading impact on to the Sympathetic and Parasympathetic parts. Hence if the Social Nervous System is addressed and tapped by a PPNE or parent, it can empower a child for a lifetime since the patterns made at the early stages get imprinted into a baby and can be referenced at any stage  in the rest of life – at any age !
How many parts?	Two (Sym-, Parasym-)	Three (Social, Sym-, Parasym-)	The three branches of ANS operate as a flow in continuum and not in a reciprocal manner. The first and natural recourse for a baby in the neuroception process is the Social branch. If this is dysfunctional for any reason, it then progresses downwards towards Sympathetic and Parasympathetic branches.  The clear messaging is that a PPNE can tap into the contimuum at any point, recognize the potential and cause bonding, attachment, self-care and other triggers to operate.
ANS Categorization of Vagus Nerve	All Parasympathetic	Mixed (Ventral branch of Vagus is not Parasympathetic)	The Ventral Branch of the Vagus (Cranial Nerve X) gives a new dimension to human life. It is autonomic and yet transcending the traditional Sympathetic and Parasympathetic paradigms.  This is the social dimension of human beings, which makes prenatal  bonding, secure attachment, care giving, empathy, safety and such other concepts a bigger purpose through human interactions. The ventral part of the Vagus nerve is myelinated and accesses heart, facial muscles, throat and voice thus opening human communication to higher possibilities. Thus it will be a rich source for a PPNE who can tap into this potential right at the early phases of a baby’s life through maternal bonding, social cooperation and also counsel parents / care givers to a better and interactive life to a baby/child.
Therapy goal	Parasympathetic relaxation	Re-establish newer branches	With the new understanding of the ANS through the Polyvagal theory, the goal of therapeutic effort is to use the full flow or continuum in the sequential matrix of the three branches viz . Social è Sympatheticè Parasympathetic. At each level, a PPNE would recognise opportunities for both Normal Functions OR Stress Responses. Hence we can use techniques like touch, contact, authenticity,  communication, safety and the like to foster a quicker social interaction with a Child/baby and make use of the higher opportunities which the Social branch provides. In fact, John Chitty states that ‘When in doubt, operate through the Social Branch , which will set off a cascading impact through the other branches ‘. He has also given clear examples though “Rescue Hug, Roots of Empathy and Reading Dogs” which have created newer opportunities and therapies. A great learning for a PPNE is that ‘Secure attachment does to the ANS, what Immunization would do for the body.’
Babies	Feel no pain and have no memory	ANS is hyper-sensitive & records experiences, particularly betrayals	Many of the aspects of dealing with a baby have undergone a sea change with the new understanding. If subjected to physical abuse or damage through pulling, slapping, holding baby by the leg or circumcision without anaesthesia, a baby could regress into a Parasympathetic state and thus cause regressive immobilization or even permanent damage. Hence we need to be “Nice” to babies and not welcome them with betrayals. On the contrary, the new paradigm is to recognize that babies are super-sentient, treat them well and create resilience and adaptability in them.
Popular characterization	Parasympathetic “Rest & Rebuild” Sympathetic “Fight-or-Flight”	Differentiate “normal functions” from “stress responses	We first recognize that a baby hitchhikes on the mother’s nervous system in the course of pregnancy.  The “normal and stress” functions both happen as a part of the sequential flow over the matrix.  Hence a PPNE would clearly understand this flow across the matrix of branches and work to create appropriate interventions at each stage – either to minimize the regression towards Parasympathetic state OR maximize the progression towards Social Interaction stage. If we recognize the possibilities and calibrate the engagements of the PPNE/ Parent/Care-giver to meet a baby’s expectations created through pregnancy and pre-birth states, the child will flourish and progress throughout life, based on the first imprints created. If not there could be triggers of stress response which in turn could have limiting or damaging consequences for the baby, family and society at large.

In summary, the new understanding of the Autonomic Nervous System and the Polyvagal Theory , has thrown open new doors for PPNEs and society.  This gives us an opportunity to empower babies, parents and care givers into what human potential is and work towards tapping the higher realms.

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PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 3 PRENATAL DEVELOPMENT & EPIGENETICS

 PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 3

PRENATAL DEVELOPMENT & EPIGENETICS

-Shivakumar Belavadi, PPNE, Bangalore, India

TOPIC - Define epigenetics and explain why it is important to human development and most especially prenatal and perinatal psychology.

DEFINING EPIGENETICS

GENETICS - gives us the understanding of DNA and Genes. A gene is a segment of the DNA strand, which contains a basic sequencing code causing a particular biological development or transaction to take place. This was understood to be locked in at the time of conception when 23 chromosomes from the mother and 23 from the father combine to create a new life in a cellular form called Zygote. It was believed that this pattern would not change and thus what was determined at conception was what one lived with for his/her lifetime. This was the foundational premise of genetic determinism.

EPIGENETICS - While the sequencing of the code within the DNA may not change, it is now known and understood that modifications could be caused in the way a gene expresses itself. This is usually referred to as the “switching on and switching off” of genes. Certain mechanisms called environmental signals could cause the switching on/off of genes and thus alter their expression. Such mechanisms go beyond the ab-initio determining code and cause the on/off events in gene expression.

Epigenetics opens up the understanding from the limited range of cause and effect being orchestrated only through genes and genetic coding within them, to the larger aspects of influences from outside and the interconnections between the outside and inside.

Signals could be from the environment within the body as in chemicals and hormones or from the environment outside the body like radiation or traumatic events of rape, accident or large scale ones like 9-11. Knowing and understanding the signalling/switching on/off mechanisms is being done through super sciences like “Signal Transduction”. These modifications may not change the DNA sequence, but instead, they affect how cells "read" genes. An example would be the addition of a methyl group to a DNA molecule which will not alter the DNA sequence but can prevent genes from being expressed.

In summary, Epigenetics literally means "above" or "on top of" genetics. It refers to external modifications to DNA that turn genes "on" or "off."

IMPORTANCE OF EPIGENETICS TO HUMAN DEVELOPMENT

Genetic Determinism had limited human endeavour, form, expressions, thoughts, feelings, emotions, diseases ……… indeed all of life because of a definitive event which take place once in a life-time i.e. at the time of conception. Once that determination happened, there was no further scope for change or modification. Thus one had to live life in accordance with that. We had no further control on our life. For instance, we had to contract a particular disease, if it were to be caused by a gene, we had to have a certain defined bodily form and structure and all of what we are and live to was determined by the sequencing code in a DNA.  This had severely affected inspiration to change and put creativity of humanity at the mercy of genetic determinism. 

Epigenetics has brought back a new hope into mankind. It is now clear that environmental signals could alter gene expression and therefore we could still be masters of our life and perceptions! We need not be enslaved by “deterministic body, thoughts and feelings” but regain a sense of purpose, control or modify our lives to charter new avenues using epigenetics. Thus we can lead a more holistic life and not be stifled by genes.  

We can clearly sense that we are not helpless being purely under the control of genes but can look upon ourselves with renewed confidence. The way my body is, my thoughts, feelings and emotions are and connections to everything in and around me is- that’s  what makes me – ME ! I am no prisoner of genes!

Today chemicals and physical surgery are the two known medical means. New paradigm for growth and development are opening up. There could be new cures for diseases. These could expand to energy healing, psychic healing and the like which could be through usage of pure environmental signals.

We can alter expression of genes to make living more meaningful and purposeful. But, we also need to exercise due caution as environmental signals could be a double edged sword if we catch-on to wrong signals!

IMPORTANCE TO PRENATAL AND PERINATAL PSYCHOLOGY

In the understanding fostered by genetic determinism, it was felt that no further intervention was possible in shaping the life of child/human being once conception had happened.  With the advent of epigenetics, that has changed. In the light of the new understanding through epigenetics, we now know that a child in the womb and in early stages of life is capable of taking in inputs. Parents and care-givers can be empowered and they in turn can infuse energy, life and purpose into a child.

Our understanding of childbirth, child growth, childhood and role of parents, caregivers and society will be more purposeful. Gene selection, genomic imprinting and gene expression are all subject to influences. From the preconception phase, through pregnancy and infancy, efforts could be made to improve the quality of life of a child. A child can take inputs and respond to those - all through these phases.

Congenital diseases, prenatal and perinatal disorders, manifestations of diseases like cancer in adults may be addressed differently. New and holistic methods of prevention or treatment could emerge for the likes of autism, Downs Syndrome and childhood conditions disorders. On the positive side, inputs could be given to improve health, immunity, intelligence, behaviour and such other aspects of development of a child. Parents and society will have a role to play in the growth and development of children.

This leaves humanity with hope. We have an opportunity to improve the quality of lives of our children - make them healthier, endow them with immunity, fill them with more abilities and make them worthy members of society. Indeed earth could become a better place. We can look forward to bringing up children in a new light.

The limitations which were placed on human construct are not so severe now. The burden of genetic determinism is off our backs now. We could engage with each other with positivity. Such engagement at prenatal and perinatal stages is bound to help children, parents, families, society and the humanity at large. Thus epigenetics opens up a whole new world of possibilities right from the formative or primary stages of live!

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PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 2 ETHICAL CONSIDERATIONS IN PRE AND PERINATAL EDUCATION

 PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 2

ETHICAL CONSIDERATIONS IN PRE AND PERINATAL EDUCATION

-Shivakumar Belavadi, PPNE, Bangalore, India

TOPIC - Identify and discuss at least two ethical issues facing the pre and perinatal psychology educator.  Give examples of how these issues can rise up in the process of education, and how they can be addressed.

I am outlining two issues which have come up in the context of my engagements with parents at the Prenatal Stage (in the course of Pregnancy) in India. I am considering myself ‘as a PPNE’, since I have been taking up similar engagements over the years.

A. Where the Parent(s) seek the advice of a PPNE on a medical opinion given by the consulting Obstetrician.

It is common in India for expecting parents to seeking information and opinions from multiple sources. A typical scenario is in the case of pregnant women/parents who first consult with their regular doctor (Obstetrician) and subsequently seek the Guidance of PPNE on what action they should take.

As a PPNE, I first recognise that the area in which a PPNE operates is primarily of sharing information leading to education of the listener. A PPNE is not a therapist and does not possess medical knowledge and skills of a licensed medical practitioner or a professional Obstetrician. As a first step I recognize my limits.

At a secondary level, there is an element of trust between the consulting Obstetrician and the pregnant lady. Any words spoken by a PPNE which disturbs or shakes the trust between a doctor and patient, should be avoided.

That said the PPNE, also stands in a position of trust as the parent/pregnant lady is seeking guidance. This becomes even more relevant where the words of the obstetrician seem to be coming a notch below the expected level of knowledge of a practicing professional. A case in instance would be where the pregnant lady is routinely advised to take medication for Gestational Diabetes or Hypertension. In such situations, I as a PPNE do know that medication should not be the first recourse.

To bestow the sense of autonomy and choice to the parents, I inform them that now there is a respected and recognized body of knowledge that speaks of minimal medication, especially for Gestational Diabetes or Hypertension. I give them reference of the writings / works of senior medical professionals including obstetricians and gynaecologists. These infuse a sense of dignity for the parent & child and the parents develop a sense of respect for natural processes.

I suggest to them that they should revisit their consulting Obstetrician with this information and seek guidance from them. More often than not, I have seen that when the empowered parents revisit the obstetrician, it improves the relationship between them and irrespective of the final advice given by the doctor. In some cases , it has also avoided unnecessary medication being given to the pregnant lady. Where medically necessary, the parent is always informed that the guidance of the obstetrician should prevail.

B. Where a pregnant lady begins to consult at a Hospital/Provider where there is a well-known predisposition for performing C section deliveries.

There are certain hospitals/providers in India where over 80% of pregnancy cases result in Caesarean deliveries. When I as  the PPNE becomes aware that the pregnant woman is going to such a provider- an ethical dilemma comes up on further course of action.

In India, in cities the concept of midwifery/doulas/birthing centres are almost non-existent. It is routine for pregnant women to begin the process of consulting at a Hospital or Nursing homes as they are called in India and finally admit themselves at the same place in the final stage of pregnancy when they are about to deliver the baby.

Again the PPNE is not the competent person to guide a pregnant woman on the choice of a doctor/provider. That is respecting the pregnant woman’s choice and autonomy. However, Integrity and responsibility would expect that the situation be considered in a wider perspective.

The system of taking ‘informed consent’ is observed more in breach than in observance by the providers/hospitals in India. This is patently unfair and unlawful, but a common practice in India. In many ways it demeans the autonomy of the parent who visits the provider.

In such a scenario, where hospitals / providers are known to perform a disproportionate number of C sections, it may be necessary for the PPNE to educate the pregnant woman/parents on the benefits of normal delivery and also mention the alternative providers they may approach.  This will obviously be easier to handle earlier in the course of pregnancy.

It may be a good point to mention of 3 or 4 alternate providers whose statistical record of C section and normal deliveries are well known. This is done to provide the parents with choice and also avoid any imputation of bias or undue favouring.

Both situations mentioned above are fairly common in India. There may be more than one course of action and multiple factors to consider. The attempt made above is to deal with the same situations in a fair, just and ethical manner.

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PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 1 FOUNDATIONAL INFORMATION AND INTRODUCTION

PRENATAL AND PERINATAL EDUCATION SERIES -  ARTICLE 1

FOUNDATIONAL INFORMATION AND INTRODUCTION

- Shivakumar Belavadi, PPNE, Bangalore, India

TOPIC - Define Pre and Perinatal Psychology (PPN) and describe why it is important to human development.

Wikipedia states that “Pre and Perinatal (PPN) Psychology explores the psychological and psycho-physiological effects and implications of the earliest experiences of the individual, before birth (prenatal), as well as during and immediately after childbirth (perinatal)”. This is probably a simplistic and minimalistic definition, but a good point to begin exploring the scope.  

First, the emphasis on the period viz. - “Birth of a Child” is significant. If the reference is to the time before birth, it will include the period:

• ·        in the womb of the mother after conception
• ·        before conception i.e. Preconception – within the DNAs of the parents.

The period after the birth of a child is also seen as a critical period.

Hence PPN periods would include a period preceding conception, the course of  pregnancy and the early period after child birth.  

Second, psychology deals with unity of both the body and mind. The notion that ‘preceding birth, a prenate has no mind’ - has been dispelled. A prenate is sentient and a live being. Further, in addition to the mind and body, the dimension of spirit may need to be formally reckoned into our understanding. Religions and mythology across the world accept the spiritual realm. Anecdotally and through research, evidence has been gathered about the spirit/energy realm. Today, science is possibly moving to that conclusive dimension.

Thirdly, the vista of PPN is ever expanding. While psychology may have been at the root, today it has many collaborating fields including epigenetics, neurosciences, sociology, health, medicine and obstetrics. Thus PPN seems to be the melting pot functioning actively with many other branches of knowledge.

Why is it important to human development?

It is important for at least three reasons:

1. What happens in the pre and perinatal stages, impacts subsequent development of a person. To build a better human being, knowledge of these stages becomes important. With this the Health of a person would be better addressed.

2. Collectively, human beings make society. Society faces many problems including violence, abuse and intolerance. Solutions to many of them could lie in understanding the problem at the root – which may well be the PPN period. Healing would be more purposeful with this awareness.

3. As a branch of pure knowledge, it helps in better understanding of human beings through the mind-body construct, the actions and emotions which are in play and explore dimensions of spirit or energy. Society at large would benefit from this and so would all of mankind. The world will hence be a better place for all!

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AN EMOTIONAL RESPONSE to Ms SANCHITA SHARMA - Science and Health Editor’s Article IN HINDUSTAN TIMES ON 13 JUNE 2017

AN EMOTIONAL RESPONSE to Ms SANCHITA SHARMA - Science and Health Editor’s Article

IN HINDUSTAN TIMES ON 13 JUNE 2017

BY SHIVAKUMAR BELAVADI

Prenatal and Perinatal Educator and Member of APPPAH,

Mentor at the “Temple of Excellence” – A school for the Unborn Child, Bangalore.

Ms Sanchita Sharma , the Science and Health Editor Of Hindustan Times has written an article on 13^th June 2017 under the headline of “No meat, no sex, pure thoughts: Modi’s Ayush ministry gives tips to would-be moms for healthy baby”.  http://www.hindustantimes.com/india-news/no-meat-no-sex-pure-thoughts-modi-ministry-s-prescription-for-pregnant-women/story-bZUaaQ9i8MTn7DkgdiapxO.html

 I understand similar articles have appeared in the Times of India and Indian Express.

 Any reader will notice the articles’ tone is jeering, mocking and ridiculing right from the headline. The tenor of the Articles are certainly offensive (notwithstanding the Gynaecologists quoted therein). I begin by wondering why she invokes the Prime Minister’s reference in the headline.  

The recommendations mentioned in the media articles are part of a booklet called Mother and Child Care released by India’s minister of state for AYUSH, Mr. Shripad Naik in the run-up to International Day for Yoga on June 21.

I would like to ask the media, what research has been done to make the articles truly relevant? Are they aware of an organisations called Association for Prenatal and Perinatal Psychology and Health (APPPAH) based in California, USA and another called OMEAP which works with United Nations to promote Prenatal and Perinatal Education? First, I suggest media persons should read books like Secret Life of an Unborn Child – by Dr Thomas Verny, Windows to the Womb by David Chamberlain, Birth Models that work by Dr Robbie Davis Floyd and In the Realm of Hungry Ghosts by Dr Gabor Mate. These authoritative works will open their eyes. Next, I suggest they listen to a Ted Talk by Annie Murphy Paul, a prominent Science Reporter, and their knowledge levels will surely improve in these matters. If media would like to be truly scientific, they should not merely mock, but learn and understand the new sciences and facts!

The impact during the Preconception, Prenatal (Pregnancy) and Infancy (up to 2 years after birth) produces life-long consequences. It affects the Health, Immunity, Diseases (associated Heart, Lung, Liver, Brain, Kidneys and major organs), Social attitudes including relationship with parents, school mates, family and society, Learning abilities at schools and later stages, Proclivity to Depression, ADD, ADHD, Substance Abuse, Drugs, Alcohol and many other behaviours, Worksite behaviour, Absenteeism. Virtually every aspect of life! Babies in the womb during the 9/11 attacks experienced severe trauma and suffer today. Is the reverse not possible with a conducive environment?

The entire body of scientific and evidence available with APPPAH, based on knowledge gathered by Doctors, Researches, Obstetricians, Sociologists, Neurologists, Biologists and Social workers has been given a flamboyant go by media responses to the government publication. In a truly pseudo-intellectual style! There is a primary body of evidence in the ACEs research done in the USA, hailed as an authentic and landmark study, that adverse early period experiences (including womb experiences) manifest into major problems and complications later in life. The evidence with APPPAH and gathered by luminaries like Dr Thomas Verny, Dr William Emerson, Dr. Robbie Davis Floyd, Dr Marshal Klaus, Dr. Gabor Mate and many others have gone to systematically prove that Pregnancy and Infancy needs to be handled with awareness. But not the kind prescribed in media articles !

Food should be nutritious, but laced with love and affection. Sex is not forbidden, but one should be aware that the baby in the womb reacts to every move – its heartbeat goes up manifold times during orgasm. Is this an act that should be promoted as a happy and enjoyable activity in such a critical period? What about the non-medical aspects of pregnancy? Is “science”, as known today, the only basis in life? The national pledge of India says …”I shall respect my parents and teachers…” - what is scientific about it? And if not, is it not needed today? Is Santa Claus scientific?  True science is an open quest for truth and does not mock or speak loosely about other bodies of knowledge.

Simple things like beautiful surroundings including pictures, nature, food, sounds (including music), make a big difference in making a healthy environment in the womb. Research has now proved babies hear and react in the womb from the early days. Does the media know know that when babies in the mother’s uterus listen to Mozart, Brahms and Vivaldi’s music, they appreciate in the womb (evidenced by lowering of heart rate) and in just the same way, babies show their disgust when other compositions of Brahms, Beethoven and rock music are played by kicking the mothers stomach violently. Should the mother enjoy herself listening to appropriate music or only what she enjoys? Simple and effective prescriptions like these are advised by doctors and knowledgeable sources who advocate Prenatal and Perinatal Sciences. Many obstetrical practices in India and the world are definitely anti-baby and are painful, stressful and harmful to the mother and baby.

There is a huge body of knowledge and evidence in our scriptures (Garbhopanishad, Garuda Purana , Prasuti Tantra in Ayurveda ) which speak of the needs, necessities, situations and prescriptions during pregnancy, conception and infancy. And these are dated many thousands of years ago! Quantum sciences, Advanced Neurosciences, Epigenetics, Signal Transduction and Authoritative Psychological studies today have also contributed to the body of knowledge available with APPPAH. These are now in consonance with what our scriptures said. One can only hope that media and intellectuals appraise themselves of this body of knowledge before calling something weird or unscientific.

Pregnancy is not just a medical event; it is largely natural, cultural, spiritual, social and familial event. The medical part could be taken care of by doctors and other parts by people who are competent to do those. Is the media aware that there are many knowledgeable doctors in India are taking to Holistic Practices in the context of Pregnancy? They should look up the website of Dr BM Hegde or Virtue Baby of Dr Nitika Sobti, a Senior Practicing Gynaecologist at Max Hospitals, Delhi

Vedic and Scriptural treasures including Ayurveda of India should not be belittled. Suggestions by AYUSH or Modi should not be mocked at because they don’t appeal to an intellectual mind. They should at least be researched and understood before being scoffed at. One can only hope that a truly open and scientific approach will be taken by the media, doctors in India and society at large. If this does not happen, the distance between the common masses and intellectuals, journalists & doctors will only widen. And this is not healthy for babies in the womb, mothers, families and society as a whole. Doctors and Media do have a big responsibility in spreading awareness of the right kind !!!

AN UNBORN BABY IN THE WOMB HAS A RIGHT TO LIFE AND HENCE A

RIGHT TO BE EDUCATED HOLISTICALLY!

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