Clinical Meeting: On Birth and Art Therapy

“It seems many health professionals involved in antenatal care have not realised that one of their roles is to protect the emotional state of pregnant women.” Michel Odent, M.D.

This recent clinical meeting on Birth and Art Therapy was prolifically presented by art therapist Pia Jones. Prior to giving her talk, those in attendance were asked to take time for art making while considering the word “surrender” and keeping in mind what birth may mean to them. This brought focus to how the natural process of birth is so often out of the full control of those involved in it. A life force event, much like that of a storm or large weather pattern with its own intensity, duration and outcome.

BIRTH in the past was seen as both miraculous and inherently dangerous for mother and baby. Talismans and charms were used across cultures. For example, birth bricks were used in Ancient Egypt to help invoke powers of Hathor, goddess of midwifery to aid and protect mother and baby. The standard practice of childbirth in ancient Egypt has long been known from papyrus texts. A woman would deliver her baby while squatting on two large bricks, each colourfully decorated with scenes to invoke the magic of gods for the health and happiness of mother and child. But archaeologists had never laid their hands on a single one of these magical “birth bricks” until last year. In excavations at Abydos, ruins of an ancient city in southern Egypt, archaeologists from the University of Pennsylvania have uncovered such a brick, 14 by 7 inches, among artefacts from a 3,700-year-old house.

Religion and birth are often linked. In medieval times, pain in labour was seen as a punishment of Eve’s transgressions in the Garden of Eden. It is only around 2005 that the Church of England prayer book removed the service for the ‘churching of women who had recently given birth’ which starts by giving thanks to God for: ‘The safe deliverance and preservation from the great dangers of childbirth.’ Across most cultures, mothers and babies traditionally stayed for a period of confinement of 40 days, or six weeks which may also have helped newborns stave off infection from human contact.

In modern Western Europe, hospitals have revolutionalised and medicalised childbirth practices, while a growing midwife/birth centre and active birth/doula, home-birth movement counter acts medical intervention. Women going through maternity wards have ever decreased periods of stay and care. The new “enhanced c-section” means mothers are out the day after the operation. For a population of increasingly older mothers, who often have no previous experience of babies but are used to being capable in a work-context, they can find the messiness inherent in early motherhood overwhelming.

Pia helped us explore the theme of Birth as a major life transition for mothers/babies, as evidenced in her ‘rest and nest’ work, as well as an archetypal state relevant for clients of any age or gender. She referenced Joseph Campbell who spoke about looking at motherhood as a woman’s “Hero’s Journey” where she is called to adventure and is changed through experience.

We looked at the various themes of difficulties, core beliefs, culture, medical attitudes, changes in society, mothering styles, and pondered many questions –
• How does art-making assist in working through fear associated with birth?
• How may art therapy be transformative in reflecting on birth?
• What does having a baby do to the attachment system and female psyche of women?
• Who looks after the emotional well-being of mothers during childbirth?
• Who mothers the mothers when we don’t live next door to our Mums anymore?

Potential additional pressures affecting mothers-to-be around birth include:
• Tension between natural birth agenda and reality of growing rise of C-sections
• Birth trauma and perceived birth failures “When I got rushed in for an emergency C-section, it goes against everything I believe in. Our birth was spoilt from the start.”
• Breastfeeding pressures and difficulties and how it’s handled by health visitors. “She didn’t ask me how I was doing with my baby, she just wanted to know about the breast-feeding. It was as if I’d failed from the beginning.”
• Attachment/bonding with baby “I didn’t just look at him and fall in love like I thought I would.” “I didn’t feel like they said in all the books.”
• Relationship difficulties/single mothers
• Issues around going back to work and maternity leave
• IVF/fertility/donor eggs/sperm– processing no genetic connection
• Tokophobia – fear and phobia of giving birth, perhaps more common that we realise
• Previous birth trauma which might have been devastating

The NHS and media are starting to become more vocal of some of the issues relating to maternal mental health. Specific mental health risk areas identified are post natal depression and post partum psychosis. Postnatal Depression is a depressive illness which affects between 10 to 15 in every 100 women having a baby. Symptoms include feeling depressed, tired, irritable, anxious, with appetite and sleep changes, worries about hurting the baby or their self, hopeless, unable to enjoy anything including their baby. Women often find it very hard to communicate feelings of postnatal depression because they are supposed to be “happy” and they are terrified of having their child taken away. Also, tricky to acknowledge and sometimes gets mixed up with baby blues and women wonder if it’s a general adaptation to birth.

Postpartum psychosis (or puerperal psychosis) affects thousands of women in the UK each year. It is a severe episode of mental illness which begins suddenly in the days or weeks after having a baby. Symptoms can include high mood (mania), depression, confusion, delusions and hallucinations. Postpartum psychosis is a psychiatric emergency and can happen to any woman, often occurring ‘out of the blue’ to women who have not been ill before. It can be a frightening experience for women, their partners, friends and family. Women usually recover fully after an episode of postpartum psychosis. It occurs in about 1 in every 1000 women (0.1%) who have a baby. The risks are higher for women with a diagnosis of bipolar disorder or schizoaffective disorder or another psychotic illness.

Usefully referring to three types of mothering styles, described by Joan Raphael Leff, we reflected on the mother as –
1. Regulator – needs baby to adapt to her adult life, tends to enforce feeding/sleeping regimes early, a need to socialize asocial infant, denies maternal devotion/love
2. Facilitator – needs to adapt fully to her baby’s life, tends to do feeding/sleeping on demand, very identified with baby self, denies any hate, separation or ambivalence
3. Reciprocator – sees baby and her, as both inter-dependent, two different people, working together to find mutually rewarding routines, accepts ambivalence of love/hate

Pia described the work she does. Her ‘Rest and Nest’ art therapy sessions offer a creative and reflective space to mothers-to-be to become aware of their underlying feelings around pregnancy and childbirth, to help connect them with inner resources, while also bringing in some sacred aspects of childbirth. On hearing about Pia’s work we concluded –

* Art therapy helps women explore shifting identities in life transition from maiden to mum
* Art therapy is useful in being able to connect women into their bodies, feelings and baby
* Art therapy can help women explore their relationship with and fears about pain
* Art therapy offers very tactile materials, helps get mother ready for sensuality of motherhood
* Art therapy offers ways to explore the bond and externalise fantasies about birth and baby
* Art therapy offers useful way to work with dreams (often hyper-active in hormonal mothers)
* Art therapy helps women connect into their inner resources and self-support, or lack of
* Art therapy as a process can help women tap into the unknown, very relevant to motherhood!
* Art therapy can help women have an experience of trusting a creative process, and therefore can help women explore polar themes of surrender/control, receptivity/activity
* Art therapy can help women explore their relationship with their external/internal mother
* Often women have to clear some feelings around their own mother, their own family situation, their own relationships, history of pregnancy, before they can concentrate on the baby.

There is so much tied up in the lead up and the moments of our births, the birth of us as mothers, as therapists, the births of our clients and the birth of our therapeutic relationships. There is so much work to be done with birth stories, even when we have passed the child-bearing part of our lives.

“Muscles send messages to each other. Clenched fists, a tight mouth, a furrowed brow, all send signals to the birth-passage muscles, the very ones that need to be loosened. Opening up to relax these upper-body parts relaxes the lower ones.” ~William and Martha Sears

“When you change the way you view birth, the way you birth will change.” Marie Mongan Hypnobirthing

– Mirella Issaias and Colleen Steiner Westling
Clinical Meeting Co Coordinators

Excerpt from Medieval Childbirth by Lisa Yarde

Christians showed great concern about the spiritual well-being of mother and child. A month before delivery occurred, the mother withdrew from public life, but not before she took communion in case she did not survive her ordeal. Birthing required a shuttered chamber with cloth hung over the windows. The midwife and other women assisted in bringing the child forth. If it lived, a sprinkling of salt and baptism closely followed, with exceptions in England during the week before Easter and Pentecost.

Many superstitions evolved about women before and after childbirth. The English believed that the newborn baby had to sneeze as soon as possible after its birth, to drive out any evil spirits lurking inside it. The After birth, the churching took place, where the father, godparents and child went to church for the baby’s baptism–the mother could not attend religious services until after 40 days or six weeks. German folklore warned a woman recovering from childbirth may not look out of the window for six weeks, or else every wagon that passes will take a bit of luck with it. Women could not draw water from any well for six weeks following childbirth, or the well would dry up for seven years.

Jewish women in childbirth had candles lit on their behalf. The men in the household recited various Psalms to ward off spirits and the evil eye, and her female companions brought the Scroll of the Torah to the birthing room. They also drew a sacred circle around the bed and inscribed the words, “Sanvi, Sansanvi, Semangalef, Adam and Eve, barring Lilit,” on the walls and door of the room. The midwife swaddled the newborn after salting and kept the child with its mother. Jewish mothers of sons could not go outdoors until the rabbi circumcised their boys, eight days after birth. On that occasion, the father formally recognized his son.

Muslim society in the Middle Ages extolled the virtues of motherhood, especially those who birthed sons, as did their Christian and Jewish counterparts. “Paradise is at the mothers’ feet.” Women wore charms and amulets to conceive, or relied on aid from homemade remedies like khitmi, an extract of marshmallow root steeped in hot water.

Several traditions evolved for the birthing. The mother withdrew to a room where the midwife, family and friends gathered around her as she sat on the birthing stool. The arrival of a daughter marked a muted celebration compared to the delivery of a son. Midwives washed the baby’s mouth with a piece of cotton dipped in a sacred potion. They also cleaned and wrapped the baby in a white linen cloth. After the highest-ranking male in the house whispered the profession of adherence to the Muslim religion into the child’s ears, he returned to his mother’s side. Salt scattered around the room warded off the evil eye. No one could pass between the child’s bed and the fire lit in the room for three days. The mother lay confined to her bed, considered ritually impure for a period of forty days.

While some of these rituals may seem archaic, some were practical and beneficial for child and mother. Less exposure and handling for the child must have helped keep away transmissible diseases at a time when the newborn was vulnerable. A woman confined to the birthing room ensured as much as rest as possible. What new mother would not have preferred to relax after the ordeal of childbirth?

Bibliography

England, P and Horowitz R. 1998. Birthing from Within. Partera Books.
Raphael-Leff, J. 2009. The Psychological Processes of Childbearing: Fourth Edition. Anna Freud Centre.
Raphael-Leff, J. 1993. Pregnancy, The Inside Story. Karnac Books.