Frank Lake's Maternal-Fetal Distress Syndrome:
- An Analysis -

By Stephen M. Maret, Ph.D.
Professor of Psychology
Caldwell University



B. Morphological and Psychological Evidence for Lake's M-FDS

1. Embryonal Development
2. Fetal Development

a. Neurological Development

The morphological development of the embryonic central nervous system is extremely complex. This complexity continues to multiply during the fetal period concomitant with a ever-increasing complexity in fetal behavior.148 Of particularly crucial importance is the development of the cerebral cortex, specifically the differentiation of the dendrites and the dendrite spines since "they provide a major portion of membrane surface for integration of synaptic inputs from a variety of sources.149 Research has identified the maturational period of these dendrites between the 20th and 28th week after fertilization.150

Thus, according to Purpura and others,151 since the requisite nerve cell circuitry is morphologically present to allow for "consciousness and self-awareness", he dates the beginning of "brain life" to the period immediately following; namely 28-32 weeks.152 Others have identified the presence of viable synapses above and below the cortical plate as early as the 8th week and within the plate itself by the 23rd week.153 EEG measurements indicate neural response in the cortical areas of the brain pertaining to the auditory, visual and tactile systems from stimulation of the peripheral organs to be functioning no later than 32 weeks.154

148Julius B. Richmond & James M. Herzog, From Conception to Delivery," Basic Handbook of Child Psychiatry, vol.1, ed. Joseph D. Noshpitz (New York: Basic Books, 1979), 15.

149Chamberlain, Consciousnss at Birth, 4.

150D.P. Purpura, "Dendrite Differentiation in Human Cerebral Cortex; Normal and Aberrant Developmental Patterns." Advances in Neurology 12 (1975): 91-116; D.P. Purpura, "Normal and Aberrant Neuronal Development in the Cerebral Cortex of the Human Fetus and Young Infant," in Basic Mechanisms in Mental Retardation (UCLA Forum in Medical Sciences, No.18), eds. M.A.G. Brazier and N.A. Buchwald (New York: Academic Press, 1975), 141-169.

151Chamberlain writes, "Knowledge of the morphogenesis of these structures by 32 weeks in utero indicates a readiness of the nervous system to transmit signals back and forth through a complex mass of unnumbered cells, signals which miraculously arrive at all the right muscles, glands and organs. How these electro-chemical signals are ultimately transformed into meaningful messages, ideas, decisions, or memories cannot be explained in physical terms alone. Explanations are necessarily metaphorical or metaphysical." (Chamberlain, Consciousness at Birth, 4).

152D. P. Purpura, "Consciousness," Behavior Today, 27 (1979): 437-448.

153M.E. Molliver, I. Kostovic and H. Van der Loos, "The Development of Synapses in the Cerebral Cortex of the Human Fetus," Brain Research 50 (1973): 403-407, quoted in CHamberlain, Consciousness at Birth 4.

154H. G. Vaughn, Jr., "Electrophysiological Analysis of Regional Cortical Maturation," Biological Psychiatry 10 (1975): 513-526.


With the advance of technology, babies born as early as 28 weeks have survived outside the womb, presenting opportunities for observation of the 28th through the 40th weeks of gestation. Studies that have examined the systematic development of fetal growth have found that there tends to be great similarity of development between babies regardless of whether they are in or outside the womb.155

Further, there seems to be a regular advance in detectable development every 4 weeks in terms of "strength of responses, the degree of muscle tone and endurance, more regular waking and sleeping patterns and a more definite cry."156 EEG results have confirmed this similarity. There is a ongoing pattern throughout the fetal period of increasing organization, ever-steadier activity, the development of more regular sleep-wake cycles, and "greater synchrony within and between hemispheres."157

b. Movement

One of the first indications of a functioning nervous system is the response of movement, which begins at around 8 weeks.158 Minkowski and his colleagues examined 8- 20 week-old fetuses obtained by hysterectomy of mothers. He described the early fetal movements as slow and "worm like" but noted that, as Preyer159 had found in 1885, tactile stimulation elicited more rapid and forceful movement than occurred spontaneously.

155Arnold Gesell, ThA Embryology of R~h~vior (New York: Harper and Brothers, 1945), 107-122.

156Chamberlain, Consciousness at Birth, 5


158Liley, "The Foetus as Personality," 193.

159"ln 1885, Preyer recorded movements of the extrauterine human fetuses, apparently from therapeutic abortions. He concluded that spontaneous fetal movements could occur before they are felt by the gravida, that fetal movements continued for a considerable time even when the fetus was without oxygen supply, that fetal movements were affected by temperature, that they could be elicited by stimulus (such as touching with a feather), and that these fetal movements were apparently independent of the mother's condition." (Robert Goodlin, Care of the Fetus (New York: Masson Publishing Co., 1979), 3, referring to R. W. Preyer, Spezielle Physiologic des Embryo (Leipzig, 1885).


While some studies have found "rolling movements" as early as 6 weeks,160 Hooker and his colleagues161 found that up until the middle of the 7th week, embryos appear incapable of movement.162 The first reflex movement, contralateral (moving away) head flexion, appears at 7.5 weeks with a second, ipsilateral (moving toward) head flexion coupled with mouth opening appearing a week later.163 Hooker found that "spontaneously executed activity" was apparent at 8.5 weeks.164

According to Verny, by this time, not only is the fetus moving his head, trunk, and arms, but "he has already fashioned these movements into a primitive body language - expressing his likes and dislikes with well-placed jerks and kicks."165

Using ultrasound technology, some have observed that as early as the end of the first trimester, "regular exercise patterns have been observed including rolling, turning, leg kicks, flexing, and waving of arms.166 Others have observed that fetal movement becomes sufficiently pronounced in the 10th or 11th week to allow for a change in the position of the fetal body.167 The fetus will change positions constantly in reaction to the intra-uterine environment. Propelling himself by means of his arms and legs is the mechanism by which he changes "ends" in the uterus while the mechanism by which he switches "sides" in the uterus is a little more complex.

160J.D. Stephens and C. Bernholtz cited in Goodlin, Care of the Fetus, 4.

161 Humphrey, "Function of the Newborn Systems During Prenatal Life," in Physiology of the Perinatal Penod, Vol.2, ed. U. Stave (New York: Plenum Medical Books, 1978), 751-796.

162Davenport Hooker, The Prenatal Origin of Behavior (Lawrence, Kansas: The University of Kansas Press, 1952), 62.

163Hooker writes that numerous studies, beginning around 1920, looking at movement in 7-8 week old embryos did find some movement among some embryos of this age but ran into several problems, among them the "progressive anoxic condition of the embryo, maternal anesthesia, and a group of physical factors" (ibid., 57). Hooker began his studies In 1932 and attempted to deal with these problems in the following manner: "This team worked with over 140 human embryos and fetuses of various ages obtained by caesarian delivery in cases where therapeutic abortion was deemed necessary by a committee of obstetricians. Within two minutes of delivery they were placed in an isotonic fluid bath at body temperature and stroked gently with a fine hair to test for reactions." (Chamberlain, Consciousness at Birth, 5).

164Hooker, The Prenatal Origin of Behavior, 66.

165Thomas Verny, The Secret Life of the Unborn Child (New York: Summit Books, 1981), 37.

166L.G.R. Van Dongen and E.G. Goudie "Fetal Movements in the First Trimester of Pregnancy," Brltish Journal of Obstetrics and Gynecology, 87 (1980): 191-193.

167E. Reinhold cited in Goodlin, Care of the Fetus, 3-4.


According to Liley, the fetus employs a "longitudinal spiral roll [which] at the midpoint of his turn has a 180 degree twist in his spine."168 By 15 weeks, 16 distinct movement patterns that resemble in pre- and full-term infants as clearly distinguishable.169

Some studies of third trimester babies shows that they rarely go more than 10 minutes without some "gross motor activity including breathing spurts during REM sleep."170

As to whether movement itself can be considered significant psychologically,171 several studies172 have correlated fetal movement and lack of movement to other fetal variables. Accordingly, one researcher has stated that "alternation of movement and immobility in the fetus is in itself an expression of an existing organization."173 Further, movement in utero has been correlated with neonatal behavior.174


168Liley continues by describing the method of turning: "He [the fetus] first extends his head and rotates it, next his shoulders rotate and finally his lumbar spine and legs - in fact, he is using his long spinal reflexes. Insofar as this Is the obvious way to turn over, there would be nothing remarkable about it except that according to textbooks of neonatal and infant locomotor function the baby does not roll over using his long spinal reflexes until 14-20 weeks of extra-uterine life. However, we have unequivocal films of the fetus using this mechanism at least as early as 26 weeks gestation, and it is apparent that the reason we do not see this behavior in the neonate is not that he lacks the neural co-ordination but that a trick which is simple in a state of neutral buoyancy becomes difficult under the newfound tyranny of' gravity." (Liley, "The Foetus as Personality," 194).

169J. l. de Vries, G.H. Visser, and H.F. Prechtl. "The Emergence of Fetal Behavior, Early Human Development, 7 (1982): 301-322.

170A. B. Roberts, D. Griffin, R. Mooney, and D.J. Cooper, "Fetal Activity in 100 Normal Third Trimester Pregnancies," British Journal of Obstetrics and GynecoIogy, 87 (1980): 450-484.

171Various studies have shown that movement is very psychologically important for pregnant mothers. Perceived attachment to the developing fetus is greatly enhanced following the first sign of movement. (Jeanne T. Grace, "Development of Maternal-Fetal Attachment During Pregnancy," Nursing Research, 38 [1989]: 228- 232; Susan M. Heidrich and Mecca S. Cranley, "The Effect of Fetal Movement, Ultrasound Scans and Amniocentesis on Maternal-Fetal Attachment," Nursing Research, 38 [1989]: 81-84).

172A. Lanniruberto and E. Tajani, "Ultrasonographic Study of Fetal Movements," Seminars in Perinatology 5(1981): 175-81; A. Milani Comparetti, "The Neurophysiological and Clinical Implications of Studies on Fetal Motor Behavior," Seminars in Perinatology 5 (1981): 2; A. Milani Comparetti, "Fetal and Neonatal Origins of Being a Person and Belonging to the World," Maturation and Learning (April 1986): Supplement 5; A. Milani Comparetti and E.A. Gidoni, "Pattern Analysis of Motor Development and its Disorders," Developmental Medical and Child Neurology 9 (1967): 5; A. Milani Comparetti and E.A Gidoni, "Dalla parte del neonatal proposte per una competenza prognostica," Neuronsichiatria Infantile (1976): 175; Lil Valentin and Karel Marsal, "Fetal Movement in the Third Trimester of Normal Pregnancy," Early Human Development 14 (1986): 295-306; E.E. Van Woerden, H.P. Van Geijn, F.J. Caron, and J.M. Swarties, "Automated Assignment of Behavioral States in the Human Near Term Fetus," Early Human Development 19 (1989): 137-146.

173E. A. Gidoni, M. Casonato, and N. Landi, "A Further Contribution to a Functional Interpretation of Fetal Movements," in Prenatal and Perinatal Psychology and Medicine, ed. P. G. Fedor-Freybergh and M.L.V. Vogel (Park Ridge, NJ: The Parthenon Publishing Group, 1988), 349.

174Akashi Ishikawa and Etsuko Minamide, "Correlation Between Fetal Activity and Neonatal Behavioral Assessment Scale," Early Child Development and Care, 17 (1984): 155-165.


c. The Tactile Sense

As noted above, movement is often in response to tactile stimulation, or the sense of "touch". This sense is really a combination of three different sensory capabilities, pressure, temperature and pain. All three develop simultaneously so that by the 32nd week, "tactile responsivity can be demonstrated for all parts of the fetal body."175

The position of the fetus in utero is often in response to the tactile environment within the fetus. According to Liley, many changes in the environment provoke movement, including Braxton-Hicks contractions, maternal movements, and external palpation. The fetus will repeatedly and purposefully move to avoid a knuckle on the prominences or the "sustained pressure of a microphone or phonendoscope."176

By the second month, the embryo will kick and jerk if poked at, and by the fourth month the stroking of the eyelids will result in squinting instead of a violent jerking movement: indeed stroking the lips results in sucking behavior.177 Tickling the scalp of the fetus at the surgical induction of labor will result in movement; Liley writes that "stroking the palm of the prolapsed arm elicits a grasp reflex, and to plantar stimulation the footling breech obliges with an upgoing toe."178 According to Verny, by the fifth or sixth month, the fetus is "as sensitive to touch as any one-year old.179

In addition, the fetus will respond with "violent movement" to a needle puncture. Goodlin reports that during the performance of "hundreds of amniocenteses" normal, healthy near-term infants would invariably respond to "needle sticks" with movement and drastic fetal heart-rate changes. For some of these fetuses, Goodlin reported that prior to performing the amniocentesis, he recording the fetal heart-rate up to five minutes. He writes "if we obviously stuck the fetus with the needle during the amniocentesis, we invariably found the FHR [fetal heart-rate] abruptly changed."180

175T. Humphrey, "Some Correlations Between the Appearance of Human Fetal Reflexes and the Development of the Nervous System," Progress in Braln Research, 84 93-133, quoted by Chamberlain, Consciousness at Birth, 5.

176Liley, "The Foetus as Personality," 194.

177Verny, The Secret Life of the Unborn Child, 37.

178LiIey, "The Foetus as Personality," 195.

179Verny, The Secret Life of the Unborn Child, 37.

180Goodlin, Care of the Fetus, 193.


This change was usually in the direction of acceleration, but on occasion, deceleration occurred, or as other researchers have discovered, "a sudden crash" to a silent pattern of non-movement.181 Goodlin reports that during amniocenteses where there was no feel of puncture by the fetus, there was no observable change in FHR, suggesting to him that the fetal responses to the needle were those of pain.182

As stated earlier, many have denied the sensation of pain in the fetus based upon an incomplete understanding of the process of myelinization of the neurons in the central nervous system. deMause has pointed out that this has occurred because of an uncritical acceptance of a faulty study by Langeworthy in 1933,183 This study made the assertion that "incomplete myelinization of sensory tracts" resulted in the inability of the fetus to receive neural messages from it's specialized sense receptors.

As is clearly shown in numerous subsequent studies,184 this is untrue. According to one researcher, "the cranial nerve roots are myelinated very early",185 preceded only by myelinization in the spinal cord.186 Almost concomitant with cranial myelinization is that in the medulla and pons, followed quickly by cerebellum and the cerebral hemispheres.187

181In a study by Neldam and Peterson from 1980, six of seven of these "silent" fetuses did not even move for two minutes. (David Chamberlain, "The Cognitive Newborn: A Scientific Update," British Journal of Psychotherapy 4 (1987): 34.

182Goodlin, Care of the Fetus, 193.

183U.R. Langeworthy, "Development of Behavior Patterns and Myelinization of the Nervous System in the Human Fetus and Infant," Contributions to Embryology (Washington, D.C.: Carnegie Institute, 1933) XXIV, No. 139.

184K.J. Mand and P.R. Hickey, "Pain and its Effects in the Human Neonate and Fetus," New England Journal of Medicine 317 (1987): 1321-1329; K.J. Mand and P.R. Hickey. "Pain and its Effects in the Human Neonate and Fetus," Pre- and Peri-Natal Psychology Journal 3 (1988): 103-123.

185As early as the 24th week. (Larrouche, "The Development of the Central Nervous system During Intra­uterine Life," 273).

186In the 22nd week. (ibid., 274.)

187Jean-Claude Larrouche, "Queques Aspects Anatomiques du Developpment Cerebral," Biologie Neonatal 4 (1962): 126-153.


While full myelinization, which occurs only after birth, does increase the rapidity of conduction, it is not essential for sensory functioning. Well-organized neural activity and sense receptivity,188 including pain, occurs long before the nerve fibers are completely myelinated.189

Liley, using multiple fetal x-ray films, described the process of birth and particularly contraction as one of "frantic" flailing fetal movement, with the arms and legs being thrown about and what appeared to be an active resistance to each contraction. Liley observation was that this behavior is characteristic of the reaction of a post-birth human being to severe pain. Liley writes:

If one attempts to reproduce in the neonate by manual contraction a mere fraction of the cranial deformation that may occur in the course of a single contraction the baby protests VioIentIy.190

Further, studies have found that in the early stages of labor, healthy in utero fetuses will often respond with FHR changes or movement of some kind in response to various noises and sounds produced outside the intra-uterine environment. But as the labor continues, this reaction will cease. While some have described this as an instance of fetal habituation, others state that it is rather the distraction of the overwhelming fetal pain associated with labor.191

Liley, citing Karelitz' findings, writes that the first sleep of neonates after birth is "more profound than any subsequent sleep" based on the strength of the stimuli needed to awake them, thus testifying to the ordeal that labor has indeed represented.192

Normally, the fetus will not experience temperature less than his mother's because he lacks a truly "external" surface. In fact, the placenta acts as a heat exchanger which keeps the fetal temperature a constant .5 to 1.5 degrees Celsius above the mother's. Should she run a temperature, so will the fetus within her.

However, experimental studies have shown that the fetus will respond to temperature changes. Goodlin reports that the fetus will respond to "cold saline flushed into the amniotic space at 18-20 weeks with fetal heart rate changes and movement. He concludes that these responses reflect intact temperature receptors in the skin.193 The fetus does not, however, have the sensation of "wetness" due to his constant and total immersion in the amniotic fluid.194

188"ln a general way the functional development and acquisition of myelin by certain fiber tracts are related. Nevertheless much well-organized activity of animal fetuses is present before there is any myelin. There are no myelin sheathe on fibers of the peripheral nerves, spinal cord, or brain of cat fetuses prior to the last third of prenatal life. but many coordinated movements can be elicited reflexively before the middle of gestation." (William F. Windle, Physiology of the Fetus [Springfield, Ill.: Charles C. Thomas, 1971], 71).

189M. Bekoff and M. Fox, "Postnatal Neural Ontology," Developmental Psychobiology 5 (1972): 323-341.

190Liley continues: "And yet, all that has been written by poets and lyricists about cries of newborn babies would suggest that newborn babies cried for fun or "joie de vivre"- which they never do afterwards - and in all the discussions that have ever taken place on pain relief in childbirth only maternal pain has been considered." (Liley, "The Foetus as Personality," 196).

191Goodlin, Care of the Fetus, 193.

192Liley, "The Foetus as Personality," 196.

193"Goodlin, Care of the Fetus, 2.

194LiIey, "The Foetus as Personality," 195.

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