PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 5 PRENATAL AND PERINATAL PSYCHOLOGICAL AND SOMATIC THEORIES

PRENATAL AND PERINATAL EDUCATION SERIES - ARTICLE 5

PRENATAL AND PERINATAL PSYCHOLOGICAL AND SOMATIC THEORIES

-Shivakumar Belavadi, PPNE, Bangalore, India

TOPIC - Many prenatal and perinatal psychology theories include the subject of consciousness.  Why is this important to PPN?  Refer to Wendy Anne McCarty and William Emerson especially in your answer.

At the basic level “Who am I”, “What Am I here for” and “How do I engage with others”   become existential questions for every human being. However, at the more esoteric yet fundamental level, these profound questions seek a larger foundation for life, living and purpose.

It is thus inevitable that when one goes into a realm beyond the physical, mental and emotional components of a human being, we enter the domain of “Consciousness”.

Primal Questions and Consciousness

Deep questions have engaged psychologists and PPN practitioners over the decades. Knowledge and understanding of Consciousness, Awareness, Universe , Soul , deepest layers of the Mind have been pursued , discussed and debated over years.

William Emerson, quotes RD Laing in his book Facts of Life as saying “How can one cell generate the billions of cells I now am? We are impossible, but for the fact that we are”.  Clearly this question leads us to a dimension which transcends the physical, mental and emotional planes we are exposed to through our senses/ sense organs.

Wendy McCarty poses the primal question thus -  “Are we first and foremost biological beings or nonphysical consciousness? She has postulated a comprehensive understanding of life, beyond the Newtonian/Objective understanding, to include the dimension of the ‘spirit’.   She states “Our fundamental nature is as nonphysical consciousness. Our human self is seen as a manifested expression of our more fundamental primary consciousness.”  

She evolves this into a model of Integrated Self – integrating the transcendental and human dimensions. By itself, this becomes the third dimension. According to her, babies are teaching this to adults and this is where we should cognize that there is a spiritual journey from spirit to human life.

The effect and importance of the concept and understanding of Consciousness to PPNEs can be considered from two perspectives – (A) Wider Foundational one and (B) Immediate Operational one:

A.  Wider Foundational Premise for Prenatal and Perinatal Educators

Pioneering work of persons like William Emerson and Wendy McCarty has widened the purpose of Pre and Perinatal Education, both as a discipline and practice.

Wendy McCarty states that the prenatal and perinatal experiences affect the ‘embodiment process of prenate and children’. This is a very important understanding. It widens the vista of PPNE and enable practitioners to move from the realm of dealing with ‘traumas and downsides of life’ to creating a ‘developmental paradigm for a holistic development of life’ (i.e.  inclusive of a  spiritual dimension) right from the earliest stages.

A baby’s transcendental perspective is present prior to conception and thereafter. From this perspective, the incarnating consciousness already has a sense of a ‘Self or I’. With this understanding, Wendy states that the new proposition from the prenate to the parents and others with whom it is engaging is - “I know I am a person. I know you are a person. And, I am seeking connection. I am seeking relationship”.

William Emerson similarly refers to an “Unconscious” matrix connecting a prenate or baby with its parents. This is indeed the realm of “Consciousness”. Emerson alludes to this as the innate transpersonal cognition.   It is the realm of transformational and/or spiritual energies. He mentions that “transformational energies” refer to the essential energies that connect us to the Self. He further mentions that such energies can be accessed through meditation, or other spiritual disciplines.

Emerson postulates on the root cause of suffering as being the lack of awareness of the spirit / observer/ unconscious realm in human transactions. He states that “This lack of awareness has two aspects. The first is repression or forgetting, wherein unresolved suffering resides in the unconscious, out of awareness. In order to be externalized and healed, the unconscious material forces itself into conscious experience and into awareness in dreams, symptoms, or behaviour, causing suffering in the here-and-now. The second aspect refers to a historical disregard of prenatal consciousness from the time of conception onwards. So long as we refuse to acknowledge the consciousness of the prenate, we cannot make the protective discrimination between what we as parents are feeling as compared to our feelings for and toward infants in the womb.”

PPNEs deal with lives at the earliest stage viz. before conception, though pregnancy and the early period after birth. It is important for the PPNE to recognize all the dimensions of life and the way things truly are. As Human Beings we have dimensions beyond body, mind and feelings. But as PPNEs, we are not merely remedying problems and traumas but dealing with growth and progress in human life – which has a connect with the Universe or Consciousness.

B. Widening the Operational Bases for PPNEs

At the ground level, when a PPNE engages in work, a wider awareness of/through Consciousness, helps in linking up the three players viz. Prenate / Baby, Parents and PPNE.

There are many benefits at the operational stage with this understanding. Both William Emerson and Wendy McCarty have touched upon many, including the following:

(a) PPNEs can appreciate better their own lives and purpose.

(b) Higher spiritual purpose underlying actions at all levels. Hence the preconception stage becomes a potent space for a PPNE to act in.

(c) PPNEs can recognise/create a synergistic effect in the work they carry on with Prenates, Babies, Children and Parents - the whole being greater than the mere sum of parts. Healing and resolving traumas in prenatal and perinatal stages becomes more meaningful.

(d) PPNEs should widen the terms of engagement through empathy, care, compassion and love. It should in turn make the babies/parents/participants see the larger perspective. This facilitates a higher dimensional engagement which includes progress, opening of new doors or opportunities in children, growth, development and connectedness

(e) Working out Holistic approaches and solutions in dealing with Body, Psyche and emotions with with transpersonal phenomena, or self-manifestations.

In summary, there is a much wider frame for the functioning of PPNEs. It maybe apt to end this essay with two quotations of Wendy McCarty –

1. “(PPN) has taken the dynamic understanding of human development deeper by studying how babies’ earliest experiences in the womb, during birth and bonding, and as newborns shape and set in motion fundamental life patterns. These core patterns may be life-enhancing or life-diminishing”.

2. “The findings from PPN revolutionize our notions of who babies are, who we are, what is going on during this primary period of human development, and how these very early experiences form babies’ core foundations at every level–physical, emotional, mental, relational and spiritual. PPN offers a unique lens of exploring this developmental period from the baby’s point of view.” 

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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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