Book Review - Birth Trauma: The Psychological Effects of Obstetrical Interventions by William R. Emerson, Ph.D., Emerson Training Seminars, Petaluma, CA, 94952, pp. 114

Reviewed by John A. Speyrer

Because of our evolutionary history, birth for homo sapiens is often considered be traumatic. Though medical interventions in delivery are thought to be helpful, many believe that they often compound the traumas of birth. In this work, Dr. William R. Emerson introduces us to the ways that obstetrical interventions can add to the problems of birth and damage psychological health.

The material being reviewed was originally published as a chapter [Geburtstrauma: psychische Auswirkungen geburtshilflicher Eingriffe] in Dr. Ludwig Janus and S. Haibach's Seelisches Erleben vor und während der Geburt [ Re-living Pre- and Peri-Natal Birth Experiences ] - Neu-Isenberg: LinguaMed-Verl.-GmbH, 1997.

-- John A. Speyrer, Editor, The Primal Psychotherapy Page

This is birth. The torture of an innocent. It is futility
to believe that so great a cataclysm will not leave its mark.
Its traces are everywhere - in the skin, in the bones,
in the stomach, in the back. In all our human folly.
In our madness, our tortures, our prisons.
In legends, epics, myths. In the scriptures.

-- Dr. Frederick Leboyer, Birth Without Violence, 1975, p. 30
[quoted in the reviewed chapter ].

William R. Emerson, Ph.D., divides birth trauma into four distinct stages, each with its own psychological impacts. The impacts derive, he writes, from prenatal trauma, parental stresses and unresolved issues, and from obstetrical procedures and interventions.

Based on his research and work as a faciliator of infant regression, the author claims that the major source of birth trauma is with obstetrical procedures and interventions. Even for normal births, technological procedures are common. Often such interventions as forceps, vacuum extractions, inductions, anesthesias, scalp monitors, etc., are used unnecessarily. Sometimes, however, the to-be-born baby may feel rescued from oxygen starvation by the timely use of forceps and extractors. Even traumas of the earlier trimesters are re-experienced and felt during actual birth.

The bulk of the author's text examines the psychological impacts of the four major obstetrical interventions: anesthesia; inductions of birth by drugs; inductions of birth by instruments; and cesarean surgery.


The large majority of births are under analgesias and anesthesias and their use is the most common of all obstetrical interventions. Practially nothing has been written about the psychological effects of such drugs although some researchers have claimed that with their use, brain damage, retardation and learning disabilities can result. While the goal of pain reduction is a noble objective there are also negative aspects which should be considered. Dr. Emerson has noticed that some anesthetic babies have difficulty bonding and later have problems with substance abuse.

The earlier lack of connection to the mother due to anesthetics can extend to spousal and other relationships. Those infants who were dosed with these drugs sometimes feel dulled in many feelingful events of their life such as in sex, in situations which should be joyful and with other normal human emotions. They may lose the sense of accomplishment since they did not have the feeling of success in their own birth efforts. They may go numb when a transition or task is required of them.

Again, the effects of anesthesia will also depend on the earlier pre-natal traumas, such as the mother being in a smoky environment or by the use of cigarettes by the pregnant mother-to-be. The traumatic consequences of using anesthesia in childbirth are numerous and the author lists many of them - examples taken from his own work with clients.

Inducing of Labor and Augmentations of Ongoing Labor

The administration of such drugs as Oxytocin and Pitocin have the effect of making the fetus feel as though it is being overpowered and controlled. Both classes of such drugs interfere with subsequent bonding and sometimes result in substance abuse in later life as well as feeling of being interrupted and interferred with.

One reason why such drugs are used is to schedule the time of birth for the physician's convenience. Without such drugs the fetus begins birth on its own schedule which may be earlier or later than expected. Again, the author provides many case studies to illustrate how the effects of this class of drugs can echo through one's later adult life since they provided a blueprint for one's personality and act-outs.

Deliveries by Instrument

The use of forceps and vacuum extractors can have similiar psychological effects. The babies on whom these two instruments are used tend to recapitulate their experience in a number of ways. They have a tendency to recreate their trauma by manipulating others or else by avoiding situations which would tend to recreate their birth experience. They also may tend to re-enact on others the feelings they had while being delivered by instrument.

In primal re-livings, those who were delivered by forceps re-experience the pain in spite of the anaesthetics. They feel that they have been invaded and subjected to violence. Often they don't want to be touched and/or held. A result can be the avoidance of sex or only engaging in sex with minimum touch. Contraiwise, some subjected to this trauma may be attracted to masochistic or sadistic sexuality in order to re-live the trauma and resolve it. If indeed, the fetus did have a feeling of being stuck in the birth canal, then the use of forceps or vacuum extrators may be perceived posititively. Many case histories illustrating these points are provided by the author.

Cesarean Surgery

The most common surgery in the United States - cesarean birth - takes place in 25% of all births. The rate in the 1970's was only 2 to 3%. The increase is due to the increase in the number of lawsuits against physicians. If a physician uses this surgical intervention he cannot be faulted for not having done everything to save the infant, even though cesarean deliveries have undesirable aftereffects. In addition to the aforementioned bonding problems, cesarean birth have many negative effects including trauma crying, feeding and digestive difficulties, colic and awakening during nocturnal sleep. There may even be long-term effects such as "tactile defensiveness" as an adult because of the casual, hurried and impersonal touch of the delivery team members in the hospital . Some such children often withdraw from touch and hugging and as adults may have problems with intimacy. Oftentimes cesarean shock occurs because of the short time span which encompasses their birth. Brief discussions of the sources of other obstetrical traumas are also included. These include amniotomies, cutting the cord too early and separation of mother and baby too soon after birth.

Dr. Emerson concludes the book with a short section entitled "Treating Obstetrical Traumas." He writes that such traumas will not "go away" of their own accord. They must be treated. He feels that therapy may be begun immediately after birth. An axiom of his philosophy of treatment is that the earlier that birth trauma is treated the better the outcome. The treatment for infants can take anywhere from ten to twenty-five sessions, which typically last forty-five minutes. The resolution of some traumas, such as near death in the birth canal, attempted abortion, or simply being unwanted will take longer to resolve. An extensive list of referenced material is included.

Dr. William R. Emerson's website may be viewed at

His article Primal Therapy With Infants is on the Primal Psychotherapy Page.

A review of Dr. Emerson's first volume of Collected Works may be read at Vol. I

A review of Dr. Emerson's second volume of Collected Works may be read at Vol. II

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