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Ann Diamond Weinstein, PhD, holds a doctorate in Clinical Psychology, Prenatal and Perinatal Psychology. In her consultation practice she provides education and coaching to health and mental health practitioners, educators, individuals and families on the relationship between prenatal and early postnatal development and experience, and an individual’s health, behavior and relationships over the life span. Dr. Weinstein offers educational seminars on the impacts of maternal prenatal psychophysiological states on developing offspring, including the influence of maternal stress and traumatic stress on the prenatal origins of the maternal-child relationship. Her work highlights the opportunity that exists for parents-to-be and the practitioners who care for them to cultivate nurturing environments that support safety and compassionate connections during the preconception, prenatal and early parenting periods. Dr. Weinstein is the author of Prenatal Development and Parents’ Lived Experiences: How Early Events Shape Our Psychophysiology and Relationships (2016) in the Norton Series on Interpersonal Neurobiology. Learn more at: www.anndiamondweinstein.com
A rapidly growing body of knowledge, informed by research and theory from multiple disciplines, demonstrates how development and experience during the prenatal period, and experiences with caregivers and the family system in the early postnatal period, can impact our health, growth, behavior and relationships over the life span. In my recent book (Weinstein, 2016), I synthesize contributions from the fields of psychology, medicine, psychophysiology, behavioral perinatology, epigenetics, affective neuroscience, interpersonal neurobiology, traumatology and attachment theory that shed light on the crucial influence of the prenatal period on an individual’s lifelong physical, cognitive, emotional and social development. This knowledge illuminates the fact that the earliest developmental period holds even greater consequences for the health and development of the human organism than was previously understood.
In my own work I use this knowledge to demonstrate to parents-to-be and the practitioners who care for them the potential positive effects of intentionally creating nurturing internal and external environments that support compassionate connections and a felt-sense of safety during the preconception, prenatal and early parenting periods. Recent research suggests that doing so will support multidimensional aspects of healthy development in children and adults throughout their lives and may benefit future generations as well. The following concepts from the disciplines mentioned above have greatly influenced my work.
Stephen Porges’ polyvagal theory sheds light on how the experiences of a mother-to-be may affect the growth, health and development of her prenate (embryo and fetus). Porges (2004) uses the term neuroception to describe how an individual, in microseconds and beneath conscious awareness, perceives and reacts to their internal and external environment as expressed in the physiology of their neuroendocrine, cardiovascular and immune systems.
The psychophysiology of a mother-to-be is influenced by her neuroception of safety, danger or life threat in her internal environment (i.e., inside her body) and her external environment, which in turn influences the quality of the environment that shapes her prenate’s growth and development.
The Impact of Trauma on Mothers-to-Be
The field of traumatology provides an understanding of how past or recent experiences of trauma and/or loss can shape the neuroception of both the internal and external environment of a mother-to-be. These experiences may continue to significantly impact her neuroception of safety, danger or life threat, and her psychophysiology, well beyond the time that the events occurred. For example, a neuroception of danger and/or life threat may be evoked in females who have experienced past physical and/or sexual abuse or adverse childhood experiences, particularly experiences that affected the parts of their bodies also involved in conception, pregnancy, birth and infant feeding.
The Maternal–Placental–Fetal Bidirectional Relationship
Research and theory from the field of behavioral perinatology suggests that the mother-to-be, the placenta (an organ originating in the fetus), and her fetus share a reciprocal, bidirectional relationship (Wadhwa, Entringer, Buss, & Lu, 2011). A change or adaptation in one component of the maternal–placental–fetal environment can therefore trigger changes in each of the others, and these in turn may activate additional responses. The changes and adaptations that occur during this period of rapid early development can influence the structure and programming of essential physiological systems in the fetus in preparation for the postnatal environment (Shonkoff, Boyce, & McEwen, 2009). The fetus and placenta, or fetal–placental unit (Sandman & Davis, 2012), can detect and alert the fetus to a threat to its survival and allow it to adjust its developmental trajectory in response to the threat. In circumstances where the prenatal maternal internal environment is expressing the mother’s physiological response to stress and/or trauma, the fetus reads the environmental signals and consequently “modifies its nervous system to ensure survival in a potentially hostile postpartum environment” (Sandman & Davis, 2012, p. 2).
An individual’s earliest experiences of safety, danger and life threat often originate in the prenatal period. The experiences of practitioners in the field of prenatal and perinatal psychology suggest that imprints of experiences from conception through birth are implicitly held in our being, and their quality may span the spectrum from a felt-sense of love and safety, to danger and toxicity. Survival-related experiences are inherent aspects of development during the prenatal period and may also occur during birth.
Epigenetics: The Impact of the Prenatal Environment on the Expression of Genes
The field of epigenetics has revealed another crucial way in which prenatal experiences affect our health, growth and behavior over the life span. It explores how the activity, or expression, of genes in the placenta and developing embryo and fetus is altered by interactions between the genes and the environment. Epigenetics research has also demonstrated how environmental exposures in one generation may lead to the non-genetic transmission of health, developmental and behavioral effects in subsequent generations, often described as transgenerational or intergenerational effects.
Prenatal Origins of the Postnatal Attachment Relationship
A neonate’s neuroception of the environment that surrounds them after birth (including the quality of interpersonal interactions with caregivers) may be influenced by imprints of their prenatal experiences. Imprints from the prenatal period shape an infant’s psychophysiology and their receptivity to, or avoidance of, social engagement with their caregivers.
Development of the autonomic nervous system (ANS) and our defense system begin in the prenatal period. These include the earlier developing ANS defense strategy known as freeze/dissociation or freeze/shutdown, and the later developing fight-or-flight defense. Both strategies are repeatedly activated during gestation as the prenate responds to the environment within its own body and to the environment surrounding its body—that is, the environment inside and outside its mother (Thomson, 2007). The development and expression of these ANS defense strategies in the prenatal period may impact the quality of the neonate–primary caregiver attachment relationship in the postnatal period. The external environment surrounding the neonate and primary caregiver also influences their emerging attachment relationship. If the infant requires medical care in the neonatal intensive care unit, they may face additional challenges to the establishment of the attachment relationship.
The behaviors of neonates and infants, including ANS defense system reactions, affect their mother’s responses in their dyadic interactions. The quality of these maternal-infant interactions may trigger implicitly held memories of the mother’s early relationship with their own mother that may influence their interpersonal interactions with the infant. The interpersonal neurobiology of the maternal-child relationship begins in the prenatal period and is expressed in the bidirectional maternal–placental–fetal physiology. This means that the origin, complexity and quality of the attachment relationship has roots in this earliest period of human development and experience, well before the period that has been the focus of the majority of attachment research for decades.
Implications for New and Experienced Practitioners
It is essential that the impacts of development and experience during the prenatal period be considered in an attempt to gain a deeper understanding of the issues facing clients, male and female, at any age. The imprints from our earliest experiences shape our neuroception of our internal and external environment and thus our experience and relationships over the course of our lives.
It is imperative, therefore, that practitioners carefully consider the potential impacts of their interpersonal interactions and treatment interventions with pregnant clients because the psychophysiological effects of therapeutic experiences (for pregnant clients and pregnant practitioners) also have the potential to impact their developing babies.
Current and Future Focus
My current focus is to provide education and consultation on the crucial impacts of prenatal development and experience over the life span and to enhance recognition of the opportunity to support the long-term healthy development of children and adults from conception. I am particularly interested in increasing awareness of the effects of past or recent trauma and loss, including adverse childhood experiences, on parents-to-be and their developing offspring, and deepening an understanding of the unique needs of trauma survivors during their transition to parenting.
In the next 12 months, I will be conducting interactive study groups via video conference calls (live and recorded) to provide practitioners with an opportunity to explore the body of knowledge that illuminates the impacts of prenatal development and experience over the life span. The discussions will focus on selected topics from my book including: (a) the critical impacts of the prenatal and early postnatal periods on physical, emotional, cognitive and social development; (b) the impacts of preconception and prenatal stress, traumatic stress and loss on mothers-to-be and their offspring, including transgenerational effects; and (c) how health and mental health practitioners can best support parents-to-be in creating a nurturing environment for themselves and their babies before and after birth.
I will continue to disseminate this knowledge through publications and presentations to individuals and professionals. It is my hope that awareness of this rapidly expanding body of interdisciplinary knowledge will motivate us to reach across the artificial boundaries that separate academic disciplines, compartmentalized medical specialties and therapeutic approaches. We must come together with compassionate hearts to cultivate nurturing environments for women and girls, their developing children, and the individuals in their lives who support them during this crucial period, for the sake of current and future generations and the health of our planet.
Porges, S. W. (2004). Neuorception: A subconscious system for detecting threats and safety. Zero to Three, 24, 19–24.
Sandman, C. A., & Davis, E. P. (2012). Neurobehavioral risk is associated with gestational exposure to stress hormones. Expert Review of Endocrinology and Metabolism, 7, 445–459. doi:10.1586/eem.12.33
Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. Journal of the American Medical Association, 301, 2252–2259. doi:10.1001/jama.2009.754
Thomson, P. (2007). “Down will come baby”: Prenatal stress, primitive defenses and gestational regulation. Journal of Trauma and Dissociation, 8, 85–113. doi:10.1300/J229v08n03_05
Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011). The contribution of maternal stress to preterm birth: Issues and considerations. Clinics in Perinatology, 38, 351–384. doi:10.1016/j.clp.2011.06.007
Weinstein, A. D. (2016). Prenatal Development and Parents’ Lived Experiences: How Early Events Shape our Psychophysiology and Relationships [Norton Series on Interpersonal Neurobiology]. New York, NY: Norton.