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Pregnancy: The Inside Story

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Utilising her wealth of material and experience, Raphael-Leff explores various aspects of 'the inside story' of pregnancy. She answers such questions as: What meanings does childbearing have in the internal world? How does a pregnant woman live with two people under her skin? What is the expectant partner's experience? Which dreams, fears and fantasies proliferate around pregnancy and birth?

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1. Conceived Fantasies


A group of pregnant women relate their stories at a workshop:

‘I was utterly convinced I was sterile when I didn’t conceive the first time’, says Rita, a teacher, early on in her pregnancy. ‘Then I missed a period, but I still couldn’t believe it, so I had an extra test to make absolutely sure.’

‘Mine was an unplanned pregnancy’, Nina says, stroking her twenty-three week ‘bump’. ‘It took me a while to come to terms with it, and even now I’m terrified I may have made the wrong decision.’

‘When I had my coil removed, I imagined I wanted a daughter, thinking I’d dealt with all those old mother/ daughter tensions. But as soon as I became pregnant, everything was thrown up again. Now I dread having a girl’, volunteers Pat reflectively.

‘Whatever my baby’s sex, I believe its personality was forged by the passionate way it was conceived: in the white-heat longing, when David and I finally came together’, Diana, who lives separately from her partner, tells the group.

‘We were much more prosaic’, replies Nancy, stretching her bare legs. ‘As we turned thirty-five, I felt we were getting a bit long in the tooth, and said, “How about it?” Luckily, he felt the same, and my body responded despite my age.’


2. Pandora's Box


What of the end, Pandora? Was it thine
The deed that set these fiery pinions free? […]
What of the end? these beat their wings at will,
The ill-born things, the good things turned ill
Powers of the impassioned hours prohibited.
Aye, hug the cascet now! Whither they go
Thou may’st not dare to think: nor canst thou know
If Hope still pent there be alive or dead.

Dante Gabriel Rossetti, ‘Pandora’

Hugging the ‘casket’ of her pregnant belly, a woman returns to her creative origins. Like Pandora’s, the opening of an expectant mother’s ‘box’ is associated with awakening of dormant passions and a release of internal ambivalence.

Sandra, a social worker, comes to see me in mid-pregnancy with severe depression. She says, ‘I’m nobody and the baby seems more important than me - it has everything and I have nothing.’ She expresses her fear of the envied baby becoming ‘a monster’, and, in the absence of friends and partner to centre her, anticipates herself acting out ‘craziness’ alone with the child for hours on end - an indefinable ‘essence of witchness’.


3. The Placental Paradigm


‘The cords of all link back, strandentwining cable of all flesh … Spouse and helpmate of Adam Kadmon: Heva, Eve. She has no navel. Gaze. Belly without blemish, bulging big, a buckler of taut vellum, no, whiteheaped corn, orient and immortal, standing from everlasting to everlasting. Womb of sin.

Wombed in sin darkness I was too, made not begotten. By them, the man with my voice and my eyes and a ghostwoman with ashes on her breath. They clasped and sundered, did the coupler’s will. From before the ages He willed me and now may not will me away or ever….”

James Joyce, Ulysses

Throughout the generations, each of us - male and female - has begun life inside a maternal body. Our first impressions were the walls of the womb, the taste of amniotic fluid, and the muffled sound of a female voice. For most of us, a woman wielded power over our infantile helplessness, the source of joy and anguish. Pregnancy is our sensual bedrock, and this state revitalizes primitive experiences in the woman, herself turned container. Shadows from the past permeate her present, and as her body recaptures the maternal stance, her inner world is galvanized into emotional upheaval.


4. The Place of Paternity


Caesarean over, as the doctor takes the baby back to cut the cord, the father peeps over the screen. Alphonse, his pet fetus, has been swapped for a girl! The child he is handed isn’t the one he’s held in mind and played imaginary games with all these months. This little scrap, her eyes screwed tight against the bright lights, is female like her mother. His son, his male stake in the future, his claim to connectedness has evaporated with the appearance of a penis-less newborn.

As a major operation begins to dock the wrapped baby on to the nipple, the new father stands by, throat congested with unshed tears of joy, impotence, frustration, and relief, feeling like an intruder in the female scene. All he wants to do is to unwrap the baby and stick it under his shirt, skin to skin, and laze about crooning and babbling to smooth her way into the noisy harsh ward. But he is overlooked in the nurses’ efforts, and anyway, he’s afraid she’ll think he smells wrong …

Faced with the female prerogatives of pregnancy and birth, the male partner finds himself, as did his father, struggling to establish his own contribution. Even at rest, his partner’s pregnant body sustains the baby growing within her, while he has to work to maintain contact, and to find his place within the productive sphere. After the birth, too, the father’s link remains an act of faith, based on trust and social acceptance.


5. A Model of Differing Orientations


In an airy carpeted room, seven pregnant women sprawl as they talk about their feelings:

‘This pregnancy business is certainly over-rated’, says Lisa, fanning herself.

‘I love being pregnant’, Vicky croons. ‘It makes me feel so special. I wish it could go on forever

‘I’m enjoying this pregnancy,’ says Maggie, ‘but last time I couldn’t stand the feeling of being both me and about to be taken over. I’d wanted a baby but hadn’t bargained on enormous changes and no control. It was quite a relief when I miscarried at eleven weeks.’

‘Last time my baby was late’, Clarissa says, holding her very large bulge. ‘It was as though my whole body clenched, not letting him go. I felt it was all so lovely, we were so close, and it wasn’t safe to let him out. But once he was out we were close in a different way - I just devoted myself to his every wish. It’s funny. This time, since twenty-eight weeks I’ve wanted pregnancy to be over. Sometimes I wish this baby could take care of itself, so I could go back to work and get on with my life.’


6. Changing Relationships


‘Up to now, professionally, I am who I am because of what I do’, says Gabriella, a highly placed professional woman in her early thirties. ‘At present what I’m doing is being pregnant. Sometimes I’m so exhausted it’s the only thing I can do with any vigour, concentrating on trying to keep this pregnancy going. It’s so perturbing to think that I’m going to suddenly change into being a mother and be at home cut off from outside and dependent on my husband for news of the world. Everything is changing - my relationship to him, to my parents, to my body, to my women friends, my male colleagues, my work - it’s no wonder my dream life is in turmoil. I seem to spend my nights trying to sort it all out.’

Of all chosen relationships, the intimate one between adult lovers is perhaps the most complex, offering a sanctuary for the intense interplay of multiple conscious and unconscious exchanges. For many couples, it is the closest equivalent to the primary emotional relationship with their own parents during childhood. Often partners are selected with uncanny precision to replicate loved or hated aspects of a parent, or to duplicate, validate, or mirror unexpressed or cherished selves. Emotional collusions occur in all close relationships, as receptive partners are unconsciously induced to enact scenes from their internal worlds. As I have suggested elsewhere, when the scenario is predetermined, as it is between partners who feed off each other, they may come to inhabit each other’s fantasy worlds, rather than meeting as individuals in their own right.


7. Conceived Realities — Technological Gains —and Loss


He laughed like an irresponsible foetus.
His laughter was submarine and profound
Like the old man of the sea’s
Hidden under coral islands

T. S. Eliot, ‘Mr. Apollinax’

In the West we are living through a time of extraordinary changes. Traditional extended families have been dismantled in favour of nuclear units. Rising life expectancy, coupled with safer childbearing and smaller families means Western women no longer spend most of their adult lives in a state of reproductive activity. Despite their shortcomings, female-controlled contraception and the sexual liberalization of women has enabled us to distinguish more clearly between sexuality, reproductivity, and female identity. It is now feasible to be feminine without being a mother, to become pregnant and choose not to have a baby; intercourse need no longer be associated with fear of conception. Today, when we not only can ensure sex without pregnancy, but pregnancy without sex, we are having to reformulate every aspect of our thinking about sexual differences, as even the foundations of the most elementary facts of life are being revised. Embryological research has come up with truth-stranger-than-fiction findings. It seems that before five weeks, irrespective of chromosomal markers, all embryos are essentially female until some are triggered hormonally to develop male characteristics.


8. The Birth


‘I wouldn’t be so stupid as to pretend I have any idea of what Claudia was going through during the hours leading up to the birth. I goofishly hovered at the edges of her very own unique drama. It still didn’t hit me that within hours we would have a baby: I vaguely felt I was immersed in some surreal soap-dream that constantly receded back into itself … She had an epidural. There was no shrieking agony or sweating exhaustion. Something was happening … a drifting, wafting hallucinatory journey towards a crazily peaceful and lovely, truthful climax that was far too cosmic and private and delicious and graceful a moment ever to write about… A moment that has become singly the most searing and beautiful and shimmering memory that I have. A great magnificent image … We had a baby; there she was and as far as I was concerned she was history. I was sopping and I didn’t care less. I held her, trying to appear calm and composed on the outside, a shaking wreck inside

Paul Morley, ‘On fatherhood’


9. Different Approaches to Parenting — Facilitators, Regulators and Reciprocators


‘I thought I’d get straight back to my original identity immediately,’ complains Lisa, three months after having her baby, ‘but my body shows I’m a mother. I’m damned tired all the time, and my work capacity is up the creek.’

There’s a conspiracy to believe you can get back to normal,’ says Maggie, holding her plump seven-week-old daughter, ‘but you’re no longer the same person. The reality is that life is different with a baby. It’s irrevocable.’

‘My mother treats me as if there’s been no change. She just doesn’t see me as a responsible adult. She can’t bear having no control over how I’m bringing up her grandchild’, Vicky says sadly, stroking her sleeping son’s hair.

‘I know what you mean’, says Colleen. ‘Now she’s coming here, I have this overriding desire to get rid of my mother. I’ve always felt she didn’t mother me as much as I’d like, but now, when I’m anxious and insecure with the baby, I’m filled with dread at her visits. She thinks she’s coming to be helpful, but she really can’t believe I can cope.’


10. Journey to the Interior — Pre- and Perinatal Psychotherapy


I may have had my baby by next session’, says the woman on my couch, holding the rounded fullness of her belly. ‘Next week I may be lying here with a new baby in my arms. What an amazing thought! … But it won’t really be new - the baby’s been here all along, not just me … .’

The emotional demands of pregnancy and parenting are very great. In these last chapters we shall be looking at ways in which parents can benefit from psychoanalytic psychotherapy during pregnancy and the early months following the birth. Although it is written largely with psychotherapists or counsellors in mind, expectant couples or parents may also be interested to know more about such therapy.

I shall not be making a strict division between the pre- and postnatal periods, since an overlap often occurs. In the relatively new field of parent/infant therapy, I draw on work of pioneers and on my own cumulative experience of preconceptual, pre-and perinatal psychoanalysis and psychotherapy over the past two score years, in a clinical practice devoted to problems related to reproductivity. My work varies in frequency from one to five sessions a week, and ranges from relatively brief (6-18 sessions) to long-term (two to seven years) individual therapy and group work with many pregnant women.


11. Therapy in Early Parenthood


As it is my patients from whom I have learned most of what I know, it is apt that I begin the concluding chapter with the words of one whom we have met several times before:

‘I was thinking about the baby in the womb needing something to push against…’, she says after a silence, lying on the couch holding her pregnant belly. ‘With my mother there’s nothing there. If I push I get nothing in return, either she caves in or goes beserk … nothing firm to push against that recognizes my individuality, or counters in an elastic, resilient way - it’s like hitting a punctured balloon. It’s left me with no strong sense of myself impinging on others, as if she has no internal homespun trust in either herself or me. She just collapses or cites an external authority who ‘knows* what’s done.

‘Daniel’s a delight these days. We have short-lived trantrums when he’s tired or hungry or jealous of the baby, but usually no run-ins. Am I too lax? I don’t know. We sort it out between us, or he goes off to his room until he cools off. Most of the time when we play he’s being a Tyrannosaurus, and such fun to be with! Trouble is, I get very tired, whereas he has masses of energy and curiosity, and if I let him do everything with me -cook and clean and all - he’d be on top of the world. But my main failing is that sometimes I have to put on a video for him when I need to do something myself quickly …




Timely therapy benefits people unable to contend with reactivation of previous traumatizing experiences or current emotional overload. Working through troubling issues and precursors of bonding disturbances during pregnancy can pre-empt parental dysfunction and forestall costly treatment of established conditions. The following chart offers guidelines to overlapping risk factors in women susceptible to distress.

Conflicted Pregnancies

•  unplanned;

•  untimely (too young, old, early, late);

•  ‘wrong’ mother, father, baby;

•  acute ambivalence;

•  bipolar conflicts of extreme Facilitator/Regulator;

•  psychosomatic discharge.

•  post-infertility pregnancy (AIH/AID, IVF, GIFT, ovum donation);

•  family history of perintatal complications;

•  borderline disorders;

•  neurotic defences;

•  psychiatric history.

•  physical condition of the mother (multiple pregnancies, substance and fetal abuse, eating disorders, HIV positive, illness, disability);

•  life events (bereavement, eviction, miscarriages);

•  socio-economic factors (poverty, housing, unemployment);



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