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

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

Chapter 5


    A. Critique of the M-FDS as a Scientific Paradigm
      1. The Old View
      2. Methodology
      3. Birth and Pre-natal Memories
      a. Birth and the Fetal Period
      b. First Trimester

      c. The M-FDS as a Paradigm: The Fetal Period

The huge wealth of research regarding the importance of prenatal life on subsequent functioning has accumulated mostly in the past 20-30 years. Based upon the evidence presented in chapter three, it seems quite clear that the previously accepted conventional understanding of fetal life as inert, hypoxic, and pain-insensitive is incorrect. Far from this view, fetal life is intensely active and reactive; far from being an inert dependant passenger in pregnancy, the fetus is, to a great degree, actually in control. As Liley has clearly stated:

It is the foetus who guarantees the endocrine success of pregnancy and induces all manner of changes in maternal physiology to make her a suitable host. It is the foetus who, singlehandedly, solves the homograft problem -- no mean feat when we reflect that, biologically, it is quite possible for a woman to bear more than her own body weight of babies, all immunological foreigners, during her reproductive career. It is the foetus who determines the duration of the pregnancy. It is the foetus who decides which way he will lie in pregnancy and which way he will present for labour. Even in labour the foetus is not entirely passive.123

Indeed, one researcher in the area has stated that "present available data would suggest that the mature human being in utero is neither in a stupor nor in an hypoxic coma124 and that it will respond to various extra-uterine stimuli and to maternal emotions."125

The pivotal assertion of Lake's M-FDS was that "powerfully impressive experiences from the mother and her inner and outer world . . . reach the foetus, defining its relation to the intra-uterine reality in ways that persist into adult life."126 Confining for the moment our discussion to the second and third trimesters, roughly corresponding to the fetal period, does the evidence allow for an affirmation of this assertion? Based upon the evidence presented in chapter three, the answer is a qualified yes.


123LiIey, 'The Foetus as Personality," 192-193.

124This term is from R.W. Preyer Spezielle Physiologic des Embryo (Leipzig, 1885).

125Goodlin, Care of the Fetus, 1.

126Lake, "Research into the Pre-Natal Aetiology of Mental Illness, Personality and Psychosomatic Disorders", 5.


The qualifications necessary for answering in the affirmative result from several important points. The first is the gradual morphological and psychological development that results over the span of the fetal period. The increasing sophistication and complexity of the central nervous system in conjunction with the specialized sense receptors is concomitant with an ever-increasing complexity in fetal behavior.127 Thus, morphologically and psychologically speaking, what might be manifestly obvious and observable at 32 weeks after gestation is less obvious and observable early on. Thus, our conclusions regarding the viability of Lake's M-FDS as a paradigm must be more tentative for earlier dates and can be less tentative for later ones.

Nevertheless, speaking generally regarding the fetal period, one can affirm that the requisite structures and capabilities are present which allow for a profound influence upon the developing fetus by the immediate environment of the womb. That this environment, to a great degree, is dependant upon the mother and her immediate environment is the essence of what Lake was saying.

What are these requisite structures that allow for influence of this sort? Regarding the fetal period, they are the similar to the structures and capabilities necessary for environmental effects that are post-natally influential. Of primary importance are the various morphological components of the nervous system: the cerebral cortex, the spinal cord, the tactile, visual, auditory, gustatory, vestibular, and gustatory sense receptors and their corresponding areas of the brain. The capabilities stemming from these structures and often promoting their further development are also present: movement, tactile sensitivity, REM sleep, crying, vision, hearing, tasting and hearing. Further, the intermodal fluency between senses and the "higher- level" processes of learning, habituation, conditioning, imitation, memory, cognition, however rudimentary, are all indications of the ability of the fetus to apprehend "powerfully impressive experiences from the mother and her inner and outer world."128
127Richmond and Herzog, "From Conception to Delivery," 15.

128Lake, "Research into the Pre-Natal Aetiology of Mental Illness, Personality and Psychosomatic Disorders", 5.


The second qualification necessary within the general framework of affirmation of the M-FDS for the fetal period relates to affect. whether fetal or even neonatal emotion exists in the same or similar manner of infants or adults is impossible to determine due to its subjectivity. Research with both preborn and newborns, however, has shown clear evidence for at least the external behavior normally associated with internal emotion. For instance, crying and smiling, of both the intra-uterine and extra-uterine varieties have been connected to the internal states of pain and satiation respectively. Research with prematurely born and neonates seems to find that certain facial expressions are indicative of affect states such as sadness, fear, disgust, happiness, surprise, anger, interest, distress, and shame. Using videotape of neonates in the first week of life, Eisenberg and Marmarou129 revealed of full range of clear-cut expressions of emotion. Thus, the research again seems to indicate that if "powerfully impressive experiences from the mother and her inner and outer world" do "reach the foetus,"130 that the fetus can, at least in a rudimentary manner, respond emotionally to these experiences.

Absolutely key to the affirmation of Lake's M-FDS is the concept of "umbilical affect."131 Certainly the biological morphology for this exchange is present at the very beginning of the fetal period.132 The morphological structures which allow for "natural" exchanges to occur also allow for the passage through the placental barrier of various teratogens, including drugs, viruses, and significantly neurohormones.
129Eisenberg and Marmarou, "Behavioral Reactions of newborns to Speech-like Sounds and Their Implications for Developmental Studies," 129-138.

130Lake, "Research into the Pre-Natal Aetiology of Mental Illness, Personality and Psychosomatic Disorders", 5.

131 Lake's understanding is essentially that of Mott's, who conceptualized a bi-directional flow of blood from mother to fetus as mediated by the placenta through the umbilical cord, which gives rise to various physical "feelings" such as aggression, submission, emptiness, fullness, giving and taking. that are the basis for subsequent psychological "feelings". Lake picked up on Mott's term "umbilical affect" to designate this exchange, defining it as the "feeling state of the fetus as brought about by blood reaching him through the umbilical vein." (Moss, "Frank Lake's Maternal-Fetal Distress Syndrome: Clinical and Theoretical Considerations," 203). As both Lake and Mott define this exchange, the umbilical vein not only conveys nutritive resources and as such could be experienced as a "life-giving flow, bringing . . . renewal and restoration" but could also "be the bearer of an aggressive thrust of bad feelings into the foetus if the mother herself was distressed and 'feeling bad."' If the mother felt emotionally unsupported, then "this feeling of deficiency, lack of recognition and the failure of looked-for support, would be just as specifically felt by the fetus. It became distressed by the fallure of its immediate environment to provide the expected acceptance and sustenance, not so much at the level of metabolic input . . . but to nourish the earliest beginnings of the person in relationship." (Lake, "The Significance of Birth and Prenatal Events in Individual, Family and Social Life," 51).

132From about the fifth week after fertilization.


As previously noted, a large body of research evidence exists which has clearly shown the impact, both positive and negative, of a mother's environment on her fetus. Numerous studies have correlated various maternal affect states such as anxiety during the fetal period with newborns who suffer from higher heart rates, lower birth weight, irritability, poor sleep patterns, gastrointestinal difficulties, hyperactivity, excessive crying, and who are perceived by their parents as having a difficult temperament, score lower on mental and motor skills tests, and have a much higher incidence of birth complications of all types. Various studies have also connected higher rates of spontaneous abortion, birth complications and preterm delivery with fear, anxiety, guilt, negative attitudes toward the pregnancy, emotional immaturity, difficulty in accepting the pregnancy, and husbands who offered little or no support.

Neuroendocrinological studies done over the last decade are illustrating more and more why and how the above results occur, namely, the physiological mechanisms which allow "umbilical affect" to occur. The neuroendocrinological interactions of the mother's endocrine and nervous systems in response to the environment profoundly affect the fetus within her.133
But what of Lake's contention that the "umbilical affect" flow sets up reaction patterns that persist into adulthood? For instance, persons who early on reacted "hysterically" tended to react hysterically as adults. Persons who adopted the typical "depressive" defense patterns early on, tended to utilize them as adults. Is there evidence that the reaction to early emotional stress tended to set up a pattern of similar reacting that is life-long?

As previously cited, numerous correlational studies have found a strong connection between fetal "stresses" and later dysfunctional behavior. Research studies have associated maternal anxiety during pregnancy with offspring who have much higher rates of childhood autism, psychosis, schizophrenia, emotional and behavioral disorders, and psychiatric disorders in general.

133For instance, when the mother is anxious or fearful, various hormones, including adrenaline, flood into the blood stream and easily cross the placental barrier, thus provoking, biochemically, the physiological reaction to anxiety and fear in the fetus. The mechanism that allows this process to work begins with the mother's brain, which is sensing and perceiving the environment. External circumstances, actions and thoughts are perceived in the cerebral cortex and subsequently affectively reacted to in the hypothalamus. The hypothalamus, in turn, directs the endocrine system and the autonomic nervous system to produce affect­appropriate physiological changes. For instance, sudden fear in a pregnant women quickly results in the hypothalamus directing the sympathetic division of the autonomic nervous system to make the heart beat faster, the palms to sweat, the blood pressure to rise, the pupils to dilate and the muscles to tense. The hypothalamus also directs the endocrine system to flood the woman's body with hormones, which, of course, pass through the placenta to the fetus.


What appears to be causing these long-term dysfunctions is nothing other than "umbilical affect". While the effect of the various neurohormones released by the endocrine system seem to be reversible in infants and adults, they seem to be less reversible in the fetal period; indeed, they appear to be more-or-less irreversible at certain critical periods in development during the embryonic and fetal stages. what seems to be produced is a psychophysiological predisposition to respond that some researchers have traced into adulthood. while there is not yet a precise understanding as to how the psychological and physiological dimensions interact to cause long-term psycho-physiological behavior changes, it is clear that something is going on. Recent evidence seems to indicate that the hypothalamus, as the "emotional regulator" of the body is key in this transaction.

Lake described the fetus' response to these experiences as follows: "The tendency is to feel identified with all of these invading maternal emotions in turn and to react to each."134 It is this response, according to Lake, that is so determinative for subsequent functioning, especially when the fetus is responding to an emotive flow of severe distress. The result, depending upon the specific intrapsychic dynamics, is an emotional "colouring of a person's life";135 the appearance of a particular group of symptoms and signs that characterize a particular psychopathology. Thus, "this intra-uterine interaction is the source of images, perceptions, meanings, values and personality defenses to cope with them."136

In addition to Lake and other early researchers such as Mott and Lietaert Peerbolte,137 others have more recently also broached the notion of predispositions to respond stemming from the fetal period, terming them engrammes,138 imprints,139 or patterns.140 Ployé suggests that three categories of engrammes or imprints exist: imprints of

134Lake, Tight Corners in Pastoral CounseIIing, 21.

135Lake, "Report from the Research Department #1," 3.

136Lake, "Theology and Personality," 65.

137Lietaert Peerbolte, "Psychotherapeutic Evaluations of Birth-Trauma Analysis," Psychi~ric Ouarterly 25 (1951): 596-600.

138Ployé, "Existe-t-iI Un Psychisme Pré-natal?" 667.

139Lake, Tight Corners in Pastoral Counselling, 16. He writes that "any severe maternal distress, whatever its cause, imprints itself on the foetus."

140J.R. Turner, "Birth, Life and More Life: Reactive Patterning Based on Prebirth Events," in Prenatal Psychology arid Medicine, ed. P. Fedor-Freybergh and M.L.V. Vogel (Park Ridge NJ: The Parthenon Publishing Group, 1988), 309-316.


early threats to the pregnancy such as attempted abortion, etc.; imprints related to toxemia or poisoning, and imprints related to later threats to the pregnancy. Interestingly, Lake's formulations and language would correspond quite exactly to Ployé's suggestions.141 For instance, the idea of the imprinting effect of an experience akin to being poisoned can be readily found in Lake's writing. In Tight Corners in Pastoral Counselling he describes a negative experience of umbilical affect flow as an "invasion of the fetus in the form of a bitter, black flood . . . of incompatible . . . and alien emotions"142 or as the "foetus being 'marinated' in his mother's miseries."143

An intriguing suggestion to explain imprints or predispositions has been proposed by Hepper as similar to "learned helplessness." According to Hepper: The foetus has little control over the stimulation it receives and it is unable to escape from it. A number of stimuli may be aversive, for example, loud noises, nicotine, or perhaps most interesting, stress. The foetus responds to maternal emotions, including stress, reactions which may be mediated by substances (e.g., hormones, catecholomines) crossing the placenta, by increased maternal arterial pressure, or by increased maternal muscle tone reducing the available space for movement in the womb . . . It may be that the fetus in highly stressed mothers experience a situation very similar to that of animals in learned helplessness experiments. Such experiences may contribute specifically to the onset of particular disorders, for example depression. or, perhaps most likely, will predispose the individual to respond in certain ways that increase the likelihood of suffering from psychiatric disorders in later life. 144

141Ployé describes how a possible "biological imprint" of the first trimester may manifest itself later as a dream: "Comme type d'engramme possible, on pourrait cite l'exemple hypothéque suivant: Un enfant rêve qu'il escalade Ia berge abrupte d'une riviére et a trés peur dans le reve quand il se sent en danger de Iâcher prise et de tomber à l'eau. Les rêves de chute, surtout quand Ia présence d'eau aggrave le danger, sont souvent interprétés comme étant des rêves de naissance. Si cepedant Ia mêre de notre enfant hypothétique présentait nettement une histoire de menace de fausse--couche pendent les deus premiers mois, et si par allieurs Ia naissance eIIe-même s'était pratiquement passé sans incident, ne pourrait-on pas considérer ce genre de rêve comme l'engramme possible de I'anxiété biologique éprouvée par l'embryon en face de cette menace à son existence? Je suggèrais qu'iI pourait y avoir grand intérêt à suivre ces rêves d'enfants quand ils presentent le thème de quelqu'un qui se cramponne des pieds et des mains à une paroi verticale sans attachement à aucune corde, ou qui se falt déloger de quelque niche ou cravasse ou il avait pris refuge. On pourralt alors, s'enquèrir, par exemple, au sujet d'une menace possible de fausse-couche ou d'une tentative d'avortement pendent les premières semaines. période ou' I'embryon est implanté dans Ia muqueuse utenne et s'accroche ensuite à Ia paroi utérine, sans I'intermédiaire d'un cordon ombilical non encore déveIopé." Ployé. "Existe-t-iI un Psychisme Pré-natal?"668.

142Lake, Tight Corners in Pastoral Counselling, x.

143Ibid., 141.

144Hepper, "Foetal Learning: Implications for Psychiatry?" 292.


Based upon the broad evidence presented regarding the physiological and psychological capabilities of the second and third trimester fetus, Lake's M-FDS could be commended as a paradigm, a "generally accepted system of ideas which defines the legitimate problems and methods of a research field." The one important qualification would relate to memory. If "umbilical affect" causes some type of "proto-memory" or physiological alteration in the nervous system, which sets up later predispositions to respond to stress, the M-FDS can be legitimately utilized as a conceptual scheme, "a set of concepts (abstracted by generalization from particular clinical experiences) which is inter-related by hypothetical and theoretical propositions."145 Thus stated, the M-FDS does not depend upon the veracity or even the accessibility of early fetal "memories", but rather on the negative effects of maternal stress on the fetus within her and the correlation of that experience with later psychopathology.

145Lake, "The Internal Consistency of a Theory of a Maternal-Foetal Distress Syndrome," 1.

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