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The first encounter between a pregnant woman or girl and her developing prenate (embryo and fetus) occurs deep within her body and most often beneath her conscious awareness. Both the mother-to-be and her prenate experience the "sameness" and "otherness" of their cellular material at the biological and energetic levels. For the woman or girl, accommodating an "other" inside herself, one who may have half of her genetic material if she is the biological mother, or none of her genetic material if her embryo was conceived with a donor egg, may evoke a wide range of emotions and visceral experiences for the duration of the pregnancy.
The mother-to-be's feelings, thoughts and beliefs about this pregnancy and her experience of the rapid physiological changes occurring inside her body are shaped by her previous life experiences from her own conception to the present. She may have experienced stress in her mother's womb, as well as trauma and loss as a child and/or adult that created persistent patterns of response to her external environment and to the feelings she experiences (or avoids experiencing) inside her body. Transgenerational imprints may also influence her current response to her developing prenate. As her baby grows, the spontaneous physiologicial changes the mother-to-be experiences are outside of her control. Within weeks, the mirror reflects back to her how the pregnancy is changing the external shape and size of her body. Adjusting to the felt-sense of the boundary between her physical body and the surrounding environment can be challenging as these changes progress over the course of the pregnancy.
For pregnant trauma survivors in particular, the lack of control over the progression and experience of the changes occurring inside and outside their bodies and the fact that the pregnancy itself is inescapable if it proceeds, may activate traumatic stress reactions. The pregnant trauma survivor may feel her body has been taken over by the baby and internal sensations associated with the pregnancy as it progresses, may trigger memories of past or recent sexual assault or abuse. Stress and traumatic stress reactions in the mother-to-be affect her neuroendocrine, immune, and vascular systems and may impact the health and development of her prenate. These reactions may also influence the expression of genes in her developing baby through epigenetic processes in the prenatal period and beyond. These epigenetic effects may impact the health, growth, development, and behavior of the child she is carrying over its life span, and that of subsequent generations (4).
The context within which a woman or girl is impregnated leaves an imprint on both the mother and her child and may shape their prenatal, birth, and postnatal experiences. The quality of the relationship between the mother and her developing baby during pregnancy and their emerging attachment relationship after birth may be influenced by the circumstances that surrounded the conception of the child.
Becoming a mother may begin with a consensual sexual experience, artificial insemination, or medical transfer of embryos during in vitro fertilization (IVF). Porges (2011) explains that female reproductive behaviors are best supported by states of "immobilization without fear," but impregnation may also occur when females are "immobilized with fear" during sexual assault and abuse (2). Women may experience "immobilization with fear" while attempting to conceive with the assistance of reproductive endocrinology procedures. Survivors of sexual abuse and assault may experience "immobilization with fear" during later consensual sexual experiences with a desired partner, and during reproductive endocrinology medical procedures to conceive.
Pregnancy is an experience in which the boundaries between the mother and her developing child are continually changing and at times may be somewhat blurred. The mother and her prenate coexist in a bi-directional, two-person biology that must be viable for both in order for the pregnancy to be sustainable and to result in healthy maternal-child outcomes. Changing physical boundaries are experienced over the course of the pregnancy by the mother as her uterus grows to accommodate the "other" within, compressing and displacing the internal organs that surround her uterus possibly causing physical discomfort. As the prenate grows, its physical boundaries are also changing and space to move within the uterus is increasingly limited (4).
As described in my recent book (4), "The determination of boundaries between the mother-to-be and her prenate begins at conception. A significant early boundary experience occurs during the process of embryo implantation in the womb. Prior to this process, which occurs a week after conception, the membrane called the zona pellucida surrounds the embryo and creates a 'boundary' between the embryo and the mother. During the process of implantation, the embryo, which is called a blastocyst at this stage of development "hatches" from the zona pellucida. The breaks in the continuity of the zona pellucida that result from the hatching of the blastocyst allow the embryo, which is secreting chemical enzymes to erode the already softened uterine lining, to latch on to the wall of the mother's uterus. The cells of the embryo are now in direct contact with the cells of the uterine wall, and the mother's immune system must make accommodations so that the embryo, whose genetic material is half the father's [and half hers, or none of hers if a donor egg is used], is not rejected as a foreign invader or threat to her system" (pp. 292–293) (4). Traumatic stress states may affect the mother's immune system which plays a critical role in the successful implantation of the embryo.
Kirkengen and Thornquist remind us, "Human experiences can only be lived in and through the body and...people cannot but express and convey their history in bodily ways. Experiences remain with us, not only as thought and conscious memories, but also as part of our embodiment. We may mentally and consciously forget, but our body remembers; what we have experienced [including our prenatal experience] is both imprinted and expressed in our bodies (Thornquist, 2006) (3)...The lived and expressive body is, in other words a source of knowledge both for observers—fellow men and women, health care providers—and for the persons themselves" (Kirkengen & Thornquist, 2012, p. 1098) (1).
Experiences of safety that enhance the healthy growth and development of babies during the prenatal period may be elusive for trauma survivors. The psychophysiology of the mother-to-be which reflects her nervous system's assessment of safety, danger, or life threat is affected not only by her experience of the pregnancy and the "other" within, but is impacted by her nervous system's assessment of the quality of the immediate environment that surrounds her and the local, national, and global environments that extend well beyond her home and interpersonal relationships. Local, national, and global environments that exude ambient toxicity and are blind to, ignore, or undermine the knowledge reflected in pregnant trauma survivors' "lived and expressive" (1) bodies, contribute to the felt-sense of danger and life threat in these mothers-to-be which may negatively impact their and their offsprings' long-term health and well-being.
It is vitally important that all women and girls receive trauma-informed care at this crucial time in their and their prenates' lives. The most helpful caregivers and support people are "observers" (1) who recognize and understand the lived body expressions of pregnant trauma survivors and compassionately and mindfully contribute to experiences of safety in the lives of these mothers-to-be and their developing babies. In so doing, they support the healthy bi-directional prenatal maternal-child relationship and, in turn, the health and well-being of subsequent generations.
References
(1) Kirkengen, A. L., & Thornquist, E. (2012). The lived-body as a medical topic: An argument for an ethically informed epistemology. Journal of Evaluation in Clinical Practice, 18(5), 1095–1101.
(2) Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W. W. Norton, 178-180.
(3) Thornquist, E. (2006). Face-to-face and hands-on: Assumptions and assessments in the physiotherapy clinic. Medical Anthropology, 25(1), 65–97.
(4) Weinstein, A. D., (2016). Prenatal Development and Parents' Lived Experiences: How Early Events Shape Our Psychophysiology and Relationships. New York: W. W. Norton, 292–293.
