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Prenatal and Natal Care
Wilhelm Reich, M.D.
Excerpted from Man in the Trap
The American College of Orgonomy
Anyone who deals seriously with the problem of emotional disease, either in its cure or in its prevention, must be prepared for bitter attacks from those who represent society, because he must meet and handle the sexual problem. Broadly speaking, men can be divided into two categories: those who make social mores, and those who are crushed by them. The former, of course, have also been made sick by society, but in defending their own sexual anxiety must crush everything that excites natural feelings within them. These are the emotional plague characters discussed above. Those in the second category are made to abide by the rules of the former, but have never incorporated them into their structures. They are the simple neurotics and those few who have maintained health. It is always easier to rear a repressed child than a healthy one who asserts his independence and demands his rights. Everyone is familiar with the way Freud was plagued and ostracized. Probably few are aware that Brill, who brought psychoanalysis to America, was threatened with jail and the loss of his license by a group of narrow-minded physicians. I personally heard a well-known neurologist say at a meeting, "Dr. Brill, keep your filthy hands off our children." The attacks on Margaret Sanger are history. Reich experienced similar violent attacks. Natural sexuality is the great "do not touch it."
But if there is to be an end to the misery of the world, natural sexuality has to be faced and accepted, especially for children and adolescents. To treat the neuroses is not enough. It is an endless and slow process for which there could never be enough therapists. Prevention can be the only successful solution, and prevention entails the acceptance of natural genital functioning.
Toward such prevention, about fifteen years ago, at the suggestion of Reich I started a project for pregnant mothers, preparing them for delivery and the care of the infant and, where possible, continuing to see the child at intervals through the years. I wished to see what could be done to bring up children in as natural a way as we knew. And to see how well they could meet life.
In preparing the mother for delivery, the object was to increase her ability to accept delivery and the baby, not to effect a cure of her neurosis. Preparation included sex-economic counseling, routine hygienic measures, removal of common practices which are known to harm the growth of the embryo, such as the use of tight girdles, lack of orgastic release during pregnancy, and so forth. Careful periodic examination of the bioenergetic behavior of the organism in general and the pelvis in particular was also made. Particular attention was paid to the eyes, to prevent going away and development of possible psychotic tendencies during delivery. Correct breathing and expression of emotions (screaming, crying, or rage) were also established. The pelvis was mobilized to allow a relaxed uterus for growth of the fetus and to facilitate delivery. The patient was encouraged to let out her emotions freely during delivery in order to avoid holding. Where possible, it was considered desirable to be present at the delivery to aid the patient in case difficulties should arise.
Labor naturally should proceed smoothly with strong but not severely painful contractions. This is because the uterus contracting down on the fetus does not meet an immobility, but rather the fetus pushes on the cervix and finds that it gives with the pressure and each contraction advances the progress of delivery. Pain occurs only when the uterus contracts down on a fetus that cannot give with the contractions because of lower holding. In many primitive peoples labor is said to be very short in duration and taken rather nonchalantly. Similar cases can occur in our society.
When I was eighteen and teaching school far in the country, I was awakened in the middle of a cold February night by the husband of the family with whom I lived. He said his wife was in labor and asked me to ride horseback two miles to a phone to call the doctor. Before I arrived there, the husband caught up with me to say it was all over and not to bother with the doctor. The next morning the mother was up and cooked my breakfast as usual.
I was present as a medical orgonomist at a natural home delivery of this kind. The mother, a former patient of mine, was well prepared. My duty was to see that the mother did not suffer any acute contraction that would interfere with delivery and that she maintained contact in the eyes. Very frankly I had nothing to do except occasionally remind the mother not to hold her breath when she became too interested in what was happening and forgot to breathe. I did have a pleasant conversation with her, which may in itself have assisted the process by helping to prevent the development of any anxiety.
It is true that in both cases it was not a first child, but labor generally should be of this order. It can be expected to last somewhat longer in primiparas but the process should otherwise not be much different.
Difficulties arise in such cases only when the pelvic opening is unusually small or where the fetus shows an abnormal presentation. These are factors which should be known and prepared for prior to the onset of labor.
When the cervix is fully dilated and labor enters the second stage, unarmored mothers have reported feeling a sense of exhilaration and power with no further discomfort. This sense of exhilaration and well-being may last for several hours. It is sometimes accompanied by a feeling of floating and mild ecstasy.
Real problems arise when the mother approaches delivery with a great deal of anxiety. She may have experienced considerable discomfort during her pregnancy, such as persistent vomiting, backaches, urinary frequency, constipation, and a myriad other complaints, until she has resented the whole thing and even her husband for his part in it. Perhaps she has heard stories of the suffering of labor and the dangers to her own life. She has heard it spoken of as travail, an ominous-sounding word. She has even worried that she might give birth to a malformed or idiot child. She has known nothing of the joy of expecting a new birth, her very own child. She has perhaps not done too badly with the initial pains of labor until she finds herself in the hospital. 1 There, in an unfamiliar environment, a bare room next to the delivery room, she hears the groans and screams of other women. The nurses are businesslike and unsympathetic, too busy to bother with her fears, and her doctor is not there to offer her reassurance. In fact she is told they cannot possibly call him yet. She may see doctors coming from the delivery room in gowns covered with blood, sometimes hears rumors of a labor-room tragedy to mother or child.
Understandably, she becomes panicked and her whole organism clamps down severely. With this her pains increase to the point that she must cry out in spite of herself. Nurses admonish hr to be brave and stand it and she feels ashamed and contracts more. She tightens her jaw, pulls up her shoulders, clenches her fists and holds her breath. She presses her legs together, pulls back her pelvis and contracts the pelvic floor. Pains continue to increase because the uterus is contracting against an immovable object and little progress is made toward expelling the baby, which is held high in the uterus and cannot descend. This state can go on for two and even three days until, utterly discouraged and exhausted, she feels she cannot stand another moment. Everything terrible that she had heard about delivery was true and more.
In the meantime the fetus is being squeezed unmercifully and its heart rate may go up alarmingly. The nurses who are watching the fetal heart rate become worried and anxious, which only adds to the mother’s distress. Eventually narcotics are administered to give the tired and distraught mother some rest. This only adds to the baby’s precarious state. When she awakens the mother is given drugs again to resume the contractions and the whole picture is repeated. At last the cervix is fully dilated and delivery either occurs spontaneously or by the use of forceps or manual rotation. The mother is of course given an anesthetic to relax the muscles, but tears or the cervix and perineum are certain to occur. Even more important the baby too is anesthetized and enters the world pale, half dead, or half asphyxiated from drugs, anesthesia, a tight cord around the neck, or from contractions of the mother that have cut off circulation in the cord. What an event for the mother, when she should feel joy in the new baby and the baby should be able to respond to her. All this matters not to armored man. The baby is given oxygen or artificial respiration, mucus is sucked out of his windpipe, and then he is hurried off to the nursery with businesslike efficiency. There is no understanding warmth, no emotional contact, all is done with mechanical routine. The mother, sick from anesthesia and exhausted, is rushed off to a room to recover from her experience and sob in her loneliness. She receives no evidence of empathy from her environment after the greatest emotional experience of her life. Because of all this the mother may not produce milk in her breasts for a day or two, sometimes not at all. The baby is too drugged and half-asphyxiated to nurse for twelve, twenty-four, or even forty-eight hours. This is so common that it is now taken for granted and no one will believe that a really alive baby will nurse within an hour or two after birth and the mother will have the milk.
What can a medical orgonomist do in cases like this? He understands her emotional state and her contraction. This understanding can very quickly be conveyed to the mother, giving her reassurance. He first explains the situation that is preventing the progress of labor and that this is simply a result of her anxiety, her terror. He next explains what both must do about it to relieve the chaos into which she has fallen. This may accomplish a great deal in itself. At least the orgonomist hopes to obtain the mother’s cooperation. Now he sets about relieving the contraction and holding back. Of first importance is the tight jaw. She is encouraged to let her jaw drop as in sleep and to breathe through her mouth. If she cannot do this herself the mouth must be manually opened. This eliminates some ability to hold and establishes a better respiration. Her shoulders are then loosened and pushed downward and the chest mobilized by pressing on the sternum or sides of the chest during expiration. She is encouraged to scream or shout, especially with the pains, and otherwise to sigh out loud. Sometimes she will give in and sob if one holds her hand and says something comforting like, "don’t hold back, it’s all right." This produces relaxation. She is further encouraged to loosen her legs and bring her pelvis forward to "go with" the pain instead of bracing against it. This is easier if the mother is on her side, and in fact delivery is best accomplished in this position, although it is seldom used. Contractions of the uterus will increase, but the pain will diminish and she may feel drowsy or even become interested in the process of labor instead of fighting it. During this time her eyes must be made to regain contact. One must be very insistent about this and it is often quite difficult to bring the woman back to awareness. With relaxation of the mother the precarious situation of the baby improves and its pulse will slow down and even return to normal. 2
All of the foregoing is illustrated very clearly by the following two case histories reported by Dr. Chester M. Raphael. Dr. Raphael writes,
In the first of the two cases I am reporting here, labor was abnormally prolonged. In the second, labor appeared to be accelerated. The assistance given both mothers was stimulated by the spontaneous appreciation of the armoring process, which, under these circumstances, represented an acute armoring in response to fear and pain, an appreciation which I have gained from orgonomy and the biopsychiatric treatment of chronically armored states.
The first case is that of a twenty-seven-year-old primipara who had been unable to conceive during a period of four years. The studies of the reason for her sterility, including tubal insufflation, semen analysis, vaginal smear study, and endometrial biopsy disclosed no positive findings except an endocervical secretion of the type found in chronic endocervitis. This was felt to be sufficiently severe to block the upward migration of the sperm into the endometrial cavity. For this reason, intrauterine insemination of the husband’s semen was attempted but the procedure was not successful. The examining physician found her to be "tense and anxious out of proportion to the situation."
Finally, she conceived. In a letter to me she wrote:
"After several attempts at artificial insemination, we decided to take a respite from doctors, thermometers, daily temperature charts, Rubin tests, and regulated intercourse. Result; conception."
Her friends and relatives were oversolicitous because she had had such difficulty in conceiving. She was very tense and unstable during the first months of her pregnancy. She had a few severe attacks of vomiting but then her pregnancy proceeded uneventfully. There was no history of serious illness prior to her conception, and she had the reputation of being a rather stoical person.
The expected date of delivery passed. There was talk of interference, although the mother expressed the feeling that there was no need to meddle. However, when she visited her obstetrician he recommended that labor be induced. No complications had been anticipated. Her pelvis was ample, there was no undue gain in weight, and her physical condition appeared to be good. A dose of castor oil and an enema were prescribed. Several hours after receiving the castor oil she had a few contractions and was rushed to the hospital. She herself objected that it seemed too early.
Some comments made by the patient on her experience in the hospital throw some light on the factors which contribute so often to the fear of childbirth.
"Until I was admitted to the hospital, I was in excellent spirits. I wasn’t particularly afraid. I knew that I would not find it intolerable. When I was taken to the labor room, however, my attitude changed with a suddenness that was startling. I was greeted with blood-curdling screams and pleas for assistance which were coldly disregarded. While I was speaking to the admitting nurses on the floor, there were two deliveries in progress, every detail of which I heard. Then while still there, I saw two doctors emerge from the delivery rooms in bloodstained uniforms. The room I was taken to was barren, two beds, a chair and a window that contained mesh wire within the panes of glass, giving the impression of a barren cell. I slowly gained the impression of being in a medieval torture chamber."
For the first five hours she continued to have contractions and then received an intramuscular injection of demerol. She fell asleep. When she awoke a few hours later, the contractions had practically disappeared. She was examined by a resident physician and her obstetrician was notified that the cervix was not dilating. That same afternoon she was still feeling quite well, although somewhat shaken by the tortured screams all around her. That evening contractions resumed and it was suggested to her that she continue to move about to help the process of dilation. In her words: "That night I must have covered about ten miles." Toward morning of the second hospital day, following another sleepless night, the contractions became very strong. No medication was administered at this time for fear that it might again cause an interruption of labor. I should like to return to her description of the proceedings:
"I had no idea that I could scream so loudly. When a pain came, I would seek something to press down on until it subsided, a radiator if I happened to be near one, or a table in the hall, anything that I could press down on with all my strength. I was ashamed of myself for screaming so loudly, and when I felt a pain coming on I would head for the bathroom, where I could scream by myself. I remember apologizing to the girl who shared my room for screaming so much. My room, by the way, was directly across the hall from a sort of supply room and laboratory, and next to the delivery room so that I could hear everything that was going on. During the night, or it must have been Saturday morning, one woman had a stillbirth and I saw the nurses carry a bundle which I presume was a baby, into a room across the hall. All the nurses gathered around and spoke in hushed voices. I was quite disturbed about this. I remember telling my obstetrician that I felt I would go slowly mad, that I couldn’t take it much longer and that I had heard of a stillbirth during the night."
At his point, she received another enema and the contractions continued to be severely painful. Then she received three injections of obstetrical pituitrin. The pain became unbearable. The obstetrician, continuing his efforts to hasten matters, ruptured the membranes. Meconium was found in the fluid and the nurses were cautioned to stand by and follow the fetal heart carefully.
At this time I was called and heard that things were going badly. The fetal heart rate was 164 and thready. When I arrived at the hospital the patient had been in labor for more than forty hours. Her condition seemed desperate. I found her sitting up, supporting herself with her arms held rigidly against the sides of the bed, her face was ashen, her lips cyanotic, her pulse thready, her hands cold and clammy, and her shoulders acutely hunched up. With each contraction, occurring at five-minute intervals, she screamed that she could not endure it any longer and wanted to die. Between contractions, her eyes rolled up into her head and her distress was extreme with each contraction. She held her breath and her body stiffened. The picture was one of acute contraction of the entire organism.
It took considerable effort to make her lower her shoulders. Succeeding in this, I asked her to breathe more deeply, to prolong her expiration. In less than two minutes her body grew tremulous, clonic movements appeared in the lower extremities and extended upward to her lower jaw and teeth, which began to chatter uncontrollably. She clenched her jaws, but I discouraged it immediately and helped her to let her jaw drop. The spasm in her shoulders and intercostal muscles, which were exquisitely tender, was gradually overcome. Her respiration improved. Then she herself complained of a block in the region of the diaphragm. Fibrillations appeared in her thighs and strong sensations of current appeared in her hands and fingers. The severity of the pain of uterine contractions began definitely to subside.
The color returned to her face, her pulse grew fuller and slower, and her respiratory movements now proceeded with an involuntary rhythm. She then began to belch and with this the discomfort in the region of the diaphragm subsided. She grew quieter and began to smile. Very quickly the contractions began to occur at two-minute intervals. There appeared to be relatively little discomfort with each contraction and she was able to rest between them. Despite more than forty hours in labor, a good part of it agonizingly painful, she began to look comfortable and pleased. An important quality of her reaction to pain was a distinct withdrawal in her eyes. When she did this, she appeared to lose all contact. She did not hear me, seemed confused, and it was difficult to bring her back.
‘When you arrived, [she told me later] I remember telling you that I could not go on and that I simply could not stand much more. You told me to bend my legs and while pressing down on my chest, told me to breathe regularly and exhale all the way down. You established a rhythm of breathing while pressing down on my chest that I tried to keep, but the pains were strong and once again I cried I could not go on. But you persevered and I tried awfully hard until finally we seemed to be having some results. My extremities began to tingle and feel numb. Slowly a drowsy numbness began to envelop me, my legs felt heavy, my gaze would wander. Only when you called me back would I, with a very definite effort, bring my gaze back. It was so easy to go off that I believe you had to call me back quite often. By this time, I was tingling all over, I began to feel warm and relaxed, whereas previously I was chilled and tense. Once when you left the room the nurse who was standing by commented that she thought you had hypnotized me. The pains were certainly bearable now. You told me that they were coming more frequently although to me it did not seem that way, for in the interval between the pains I was able to rest. I can’t quite understand it myself. I only know that it helped me tremendously.’
I had been with her for about two hours by this time. The fetal heart rater was 179 and it was obvious that something was wrong. The obstetrician was called; he arrived a few minutes later, examined her and found the cervix to be completely dilated although the head was still high. He found the fetus to be right occiput posterior position. This position, coupled with the infant’s distress, made him decide to deliver the infant immediately with forceps. Working quickly, the mother was now under an anesthetic, the head was rotated and then delivered, the infant exhibiting three loops of cord around its neck. It was flaccid and pallid; the throat was aspirated immediately, artificial respiration was applied and oxygen administered. The infant responded quickly and was placed immediately in an incubator. Again the mother,
"When I finally realized what had happened, I had a feeling of great euphoria and exhilaration, my recuperation was very rapid, I felt well immediately and had no post-delivery despondency, which I had been told could be expected."
The second case was that of a twenty-three year old primipara who had been studied during her pregnancy by the Orgonomic Infant Research Center of the Wilhelm Reich Foundation. The period of gestation had been entirely uneventful and she, in general, appeared to fulfill the criteria for relatively healthy functioning. In this instance the hospital agreed to refrain from the routine use of medications, anesthesia, and routine episiotomy, and even the premonitory spank with which the infant is frequently greeted had been carefully discussed with him and he had agreed to refrain from it as a routine gesture. Plans for immediate contact of the infant with its mother after delivery were made. The entire hospital situation was as favorable as possible, so as to reduce the minimum the pathological atmosphere and emotional contagion of the labor room.
The patient experienced her first faint contractions at approximately 8:00 a.m. and continued at about twenty-minute intervals. She arrived at the hospital at 10:30 a.m. Shortly thereafter the contractions practically stopped and she was dubious that she would proceed. The occasional contraction she likened to a menstrual cramp. Her obstetrician estimated that she would not deliver before midnight.
I arrived at the hospital at 4:45 p.m. Contractions were mild, of short duration, and approximately seven to ten minutes apart. She was calm, with a somewhat exaggerated attitude of unconcern. She complained of slight discomfort in her lower back, her face was placid, her jaws relaxed. However, the shoulders and upper chest were held somewhat and breathing was moderately restricted. She complained of some pain in the left groin. The thigh adductors were moderately spastic and while the thighs were held initially, they could be moved easily. I proceeded to help her establish fuller respiration. The almost immediate effect of this was to induce a state of sleepiness. I encouraged her to rest. About fifteen minutes elapsed when she suddenly experienced a strong and much prolonged contraction. She reacted to this with an inhibition of her breathing, for the moment, a facial grimace, a tightening of the abdominal and thigh muscles. I encouraged her and helped her reestablish fuller respiration. The entire organism relaxed again. Within a few minutes, another contraction occurred with the same contraction of the organism in response to pain. Thereafter, the contractions occurred regularly and intensely at two- to three-minute intervals. What appeared most prominently with each contraction was a reaction of withdrawal, particularly noticeable in the eyes. This required almost constant attention until delivery. She felt disinclined to breathe deeply, complaining that it increased the pain. At first, with strong contractions, she felt dizzy and appeared restless and slightly confused. This could be mitigated to a considerable extent by insisting that she "come back" every time she showed and sing of withdrawal. At first, she was reluctant to do so, but as time went on she appreciated its advantage. The pain was less severe when she could achieve it and progress appeared more orderly and effective. Sensations of current appeared in the upper part of the body and to some extent in the lower extremities.
At the spot in the left groin where she complained of pain, a hard, tender core, running longitudinally, could be palpated. I was not able to overcome this in spite of my efforts. It was not until the cervix had dilated completely and the head of the fetus had passed through the birth canal to the pelvic floor that this painfully tender spot disappeared. Now she began to experience sensations of current in her abdomen and pelvis. She began to belch and finally felt much more comfortable. Then the sensations of pressure on the rectum began to increase and she grew more apprehensive and restless and slightly confused.
She felt she wanted to leave to have a bowel movement and wanted to walk to the bathroom, but then decided against this. Her face became flushed and she complained of a feeling of heat throughout her body. Then coldness, a clammy sweat, and marked dryness of the mouth occurred. She grew less cooperative. Her jaws and legs were held stiffly and much more effort had to be exerted to overcome this holding. I had to proceed more energetically to get her to "come back" in her eyes. The vegetative sensations were now very intense. As they began to subside, the procedure became simply one of voluntary effort with rest and at times sleepiness between contractions. The entire process became more rhythmical. Her respirations increased in amplitude and she was able to bring herself back; at times she was actually able to prevent the withdrawal.
At 6:30 p.m. a slight bulging was observed. The membranes then appeared at the introitus and passed through without rupturing. The obstetrician was called and the patient was removed to the delivery room. At 7:15 p.m. she began to deliver the head of the infant. And now, again, an acute contraction set in. It was more marked than at any time before. I could pry her jaws apart only with the greatest effort and her breathing required considerable attention. She began to tremble, and exclaimed with an expression of terror that it felt like something terrible might happen. She later said that she had the feeling she wanted to push but was afraid she might burst. The infant was delivered at 7:20 p.m., appeared moderately cyanotic but responded immediately, cried lustily, and became healthily pink. Two and one-quarter hours appeared to be the span for really active labor. A moderate first-degree laceration of the perineum occurred in the delivery of the head and required suturing under an anesthetic.
Dr. Raphael concludes:
I have gained the impression from both cases that with the establishment of full respiration, the dissolving of acute armoring, the overcoming and prevention of the tendency to withdraw, and the acute contraction of the total organism, the process of labor and delivery is, in general, very much accelerated. Knowledge of the orgasm reflex and the segmental arrangement of the armoring as discovered and described by Wilhelm Reich excites an immediate appreciation of the problem and technique to be used in rendering assistance during labor. Without this knowledge, the physician must view the problem with bewilderment, helplessness, and dismay. His only recourse is to drugs with attendant danger to both mother and infant; more or less ineffective persuasion to relax; callused indifference; or meddlesome interference of one sort or another, as for example, the so-called prophylactic forceps, routine episiotomy, etc. What Reich has said concerning the bodily attitude of the armored organism and the dissolution of this attitude is readily applicable to the acutely contracted organism. Active assistance is necessary for overcoming this "holding back." It is expressed automatically and the individual is unable to comprehend or respond to exhortations to relax, or other such persuasion. The holding back process is so acutely manifest that the obstetrician cannot fail, now and then, instinctively to suggest to the patient to stop holding her breath, or to take a deep breath, but he is generally unable to help actively. His assistance is, at best, abortive. He is unable to proceed systematically or consistently. Without the knowledge of the function of pulsation and the armoring process, he is unable to formulate his therapeutic task. It goes without saying that the amount of assistance required in labor is dependent on the previous state of the organism. The prevention or effective dissolution of chronic armoring, prior to pregnancy or before delivery, would facilitate the process of labor. In a primipara, to whom childbirth is new and who approaches it with superstition and trepidation, the shock of the experience can be allayed to some extent by correct education regarding the mechanism of labor. The setting, as was apparent from the first case presented, plays a significant part.
From this preliminary study, it would appear that there are very practical preventive and therapeutic measure, the application of which would alleviate much of the discomfort of labor and many of its dangers. The most important results of such a facilitated process would be the reduction of danger of injury to the child to the very minimum. It is this result which interests us in this study and encourages its continuation.
To Dr. Raphael’s conclusions I would like to add: Delivery should occur at home in a familiar environment with loved ones near. Unfortunately few obstetricians today will consent to this. They argue that in case of emergency the hospital is a safer place to be and besides there has to be more preparation at home since the home is not set up as is the hospital for childbirth. Also it is much more convenient for the obstetrical. He has a nurse to watch the progress of labor and has to be called only at the last minute. All of this may be perfectly true, but if we are concerned only with the welfare of the mother and the baby both fare better at home except in the presence of some complication, which can usually be foreseen long in advance. Further, both are less apt to suffer subsequent infection, which can easily be incurred in the hospital.
The baby should remain with the mother after it is born so that each can be a comfort to the other. The baby is allowed to nurse as soon as it shows desire by sucking movements of its lips. Under these conditions both mother and baby respond quickly after the strange event they have experienced. One can scarcely believe the difference between babies born in this manner and the usual baby born in a hospital under the routine procedures. Stinging drops in the eyes, tight wraps, separation from the mother, and feedings that are withheld for twenty-four hours following birth are not in the best interest of the baby’s development. They may contribute to many difficulties the baby will suffer in the following months and even perhaps affect his whole life.
1. The following is not typical of the better hospitals today, but it does represent all too many.
2. This is part of an article entitled, "Orgone Treatment During Labor," reprinted from Orgone Energy Bulletin, April, 1951, with permission
