The Psychosomatic Concept of “Intranatal Inward Orientation” (IIO) as a Background Mode of Experience in the Birthing Process: A Scale Development Study with 73 First-Time Mothers

Werner Stadlmayr^1,2,3*, Daniela Bielinski-Blattmann^2,4, Sakari Lemola⁴, Kai von Klitzing^5,6, Heidi Simoni^5,7, Felix Amsler⁸, Daniel Surbek², Johannes Bitzer⁹

¹Department of Obstetrics and Gynaecology, Kantonsspital, Aarau, Switzerland.
²Department of Obstetrics and Gynaecology, University Hospital, Bern, Switzerland.
³Department of Clinical Research, University of Bern, Bern, Switzerland.
⁴Department of Psychology, University of Basel, Basel, Switzerland.
⁵Department of Child and Adolescent Psychiatry, University Hospital, Basel, Switzerland.
⁶Department of Child and Adolescent Psychiatry, University Hospital, Leipzig, Germany.
⁷Marie Meierhofer Institut für das Kind, Zürich, Switzerland.
⁸Amsler Consulting, Basel, Switzerland.
⁹Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland.

DOI: 10.4236/oalib.1100281                

Abstract

Objective: In order to describe maternal intranatal processes from a common psychosomatic perspective, the clinical notion of “intranatal regression” or “intranatal psychophysical withdrawal” was presented. However, this idea of an underlying mode of experience pervading the birthing process has never been explored systematically. We further elaborated on this notion by introducing the concept of Intranatal Inward Orientation (IIO), supporting a psychosomatic approach in modern obstetrics. Methods: 73 first-time mothers were interviewed 3 - 4 days postpartum. IIO was evaluated on four axes of perceptions: a changing sense 1) of time, 2) of space, 3) of attachment, and 4) a change in the predominant communication style with significant others (partners, midwives). In addition, other subjective variables (questionnaires) and obstetric variables were assessed. Results: A one-factor solution (Eigen-value of >1.0) provides firm statistical support for IIO as a consistently integrated scale (C’alpha 0.74). Inter-rater reliability is very good (Intraclass correlation 0.83). IIO is independent of other subjective qualities, like anxiety, coping, and control. IIO is correlated with fewer epidural blocks. Likewise high IIO is more frequently associated with a low birth complication profile (spontaneous delivery, not longer than 12 hours, no oxytocin for augmentation of labour, and no epidural block). Conclusion: IIO is a promising psychosomatic concept. It supports the idea of a psychological, relationship- and interaction-oriented approach to promote more natural childbirth. It may also lead to a better understanding of the emerging of a traumatic birth experience. Further elaboration of the concept is recommended.

Keywords

Birth Experience, Psychosomatic Theory, Intranatal Inward Orientation, Intranatal Dissociation, Mode of Experience

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bewley, S.C.J. (2002) The Unfacts of “Request” Caesarean Section. British Journal of Obstetrics and Gynaecology, 109, 597-605. http://dx.doi.org/10.1111/j.1471-0528.2002.07106.x
[2]	Rich, O. (1973) Temporal and Spatial Experience as Reflected in the Verbalizatons of Multiparous Women during Labor. Maternal-Child Nursing Journal, 2, 239-325.
[3]	Molinski, H. (1989) Emotionale und interpersonale Aspekte der Geburt [Emotional and interpersonal aspects of labor]. Der Gynakologe, 22, 96-99.
[4]	Stauber, M. (1996) Geburtshilfe [Obstetrics]. In: Uexküll, T.V., Ed., Psychosomatische Medizin [Psychosomatic Medicine], Urban & Schwarzenberg, München, Wien, Baltimore, 1046-1056.
[5]	Spitz, R.A. (1945) Diacritic and Coenesthetic Organizations. Psychoanal Review, 32, 146-162.
[6]	Bernstein, E.M. and Putnam, F.W. (1986) Development, Reliability, and Validity of a Dissociation Scale. The Journal of Nervous and Mental Disease, 174, 727-735. http://dx.doi.org/10.1097/00005053-198612000-00004
[7]	Putnam, F.W. (1989) Pierre Janet and Modern Views of Dissociation. Journal of Traumatic Stress, 2, 413-429. http://dx.doi.org/10.1002/jts.2490020406
[8]	Waller, N., Putnam, F.W. and Carlson, E.B. (1996) Types of Dissociation and Dissociative Types: A Taxometric Analysis of Dissociative Experiences. Psychological Methods, 1, 300-321. http://dx.doi.org/10.1037/1082-989X.1.3.300
[9]	Beck, C.T. (1994) Women’s Temporal Experiences during the Delivery Process: A Phenomenological Study. International Journal of Nursing Studies, 31, 245-252. http://dx.doi.org/10.1016/0020-7489(94)90050-7
[10]	Beck, C.T. (1983) Parturients’ Temporal Experiences during the Phases of Labor. Western Journal of Nursing Research [Comparative Study], 5, 283-300.
[11]	Birch, E.R. (1986) The Experience of Touch Received during Labor. Postpartum Perceptions of Therapeutic Value. Journal of Nurse-Midwifery, 31, 270-275.
[12]	McKay, S. and Roberts, J. (1990) Obstetrics by Ear—Maternal and Caregiver Perceptions of the Meaning of Maternal Sounds during Second Stage Labor. Journal of Nurse-Midwifery, 35, 266-273. http://dx.doi.org/10.1016/0091-2182(90)90079-K
[13]	McKay, S. (1993) What Are They Talking About? Is Something Wrong? Information Sharing during the Second Stage of Labor. Birth, 20, 142-147. http://dx.doi.org/10.1111/j.1523-536X.1993.tb00439.x
[14]	McIntosh, J. (1988) Women’s Views of Communication during Labour and Delivery. Midwifery, 4, 166-170. http://dx.doi.org/10.1016/S0266-6138(88)80072-X
[15]	Melzack, R. (1984) The Myth of Painless Childbirth (the John J. Bonica Lecture). Pain [Research Support, Non-US Gov’t Review], 19, 321-337.
[16]	Lowe, N.K. (1996) The Pain and Discomfort of Labor and Birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25, 82-92. http://dx.doi.org/10.1111/j.1552-6909.1996.tb02517.x
[17]	Lowe, N.K. (2002) The Nature of Labor Pain. American Journal of Obstetrics & Gynecology, 186, S16-S24. http://dx.doi.org/10.1016/S0002-9378(02)70179-8
[18]	Salmon, P. and Drew, N.C. (1992) Multidimensional Assessment of Women’s Experience of Childbirth: Relationship to Obstetric Procedure, Antenatal Preparation and Obstetric History. Journal of Psychosomatic Research, 36, 317-327. http://dx.doi.org/10.1016/0022-3999(92)90068-D
[19]	Stadlmayr, W., Bitzer, J., Hosli, I., Amsler, F., Leupold, J., Schwendke-Kliem, A., Simoni, H. and Burgin, D. (2001) Birth as a Multidimensional Experience: Comparison of the English- and German-Language Versions of Salmon’s Item List. Journal of Psychosomatic Obstetrics and Gynaecology, 22, 205-214.
[20]	Waldenstrom, U. (1999) Experience of Labor and Birth in 1111 Women. Journal of Psychosomatic Research, 47, 471-482. http://dx.doi.org/10.1016/S0022-3999(99)00043-4
[21]	Alehagen, S., Wijma, B. and Wijma, K. (2001) Fear during Labor. Acta Obtsetrica et Gynecologica Scandinavica, 80, 315-320.
[22]	Niven, C. and Gijsbers, K. (1984) A Study of Labour Pain Using the MCGILL Pain Questionnaire. Social Science & Medicine, 19, 1347-1351. http://dx.doi.org/10.1016/0277-9536(84)90023-6
[23]	Lederman, R.P., Lederman, E., Work, B. and McCann, D. (1985) Anxiety and Epinephrine in Multiparous Women in Labor: Relationship to Duration of Labor and Fetal Heart Rate Pattern. American Journal of Obstetrics & Gynecology, 153, 870-877. http://dx.doi.org/10.1016/0002-9378(85)90692-1
[24]	Lowe, N.K. (1987) Individual Variation in Childbirth Pain. Journal of Psychosomatic Obstetrics & Gynecology, 7, 183-192. http://dx.doi.org/10.3109/01674828709040278
[25]	Lowe, N.K. (1992) Differences in First and Second Stage Labor Pain between Nulliparous and Multiparous Women. Journal of Psychosomatic Obstetrics & Gynecology, 13, 245-253. http://dx.doi.org/10.3109/01674829209009197
[26]	Brown, S.T., Campbell, D. and Kurtz, A. (1989) Characteristics of Labor Pain at Two Stages of Cervical Dilation. Pain, 38, 289-295. http://dx.doi.org/10.1016/0304-3959(89)90215-7
[27]	Ranta, P., Jouppila, P. and Jouppila, R. (1996) The Intensity of Labor Pain in Grand Multiparas. Acta Obstetricia et Gynecologica Scandinavica, 75, 250-254.
[28]	Lundgren, I. and Dahlberg, K. (1998) Women’s Experience of Pain during Childbirth. Midwifery, 14, 105-110. http://dx.doi.org/10.1016/S0266-6138(98)90007-9
[29]	Green, J.M. and Baston, H.A. (2003) Feeling in Control during Labor: Concepts, Correlates, and Consequences. Birth, 30, 235-247.
[30]	Waldenström, U., Borg, I.M., Olsson, B., Sköld, M. and Wall, S. (1996) The Childbirth Experience: A Study of 295 New Mothers. Birth, 23, 144-153. http://dx.doi.org/10.1111/j.1523-536X.1996.tb00475.x
[31]	Mould, T.A.J., Chong, S., Spencer, J.A.D. and Gallivan, S. (1996) Women’s Involvement with the Decision Preceding Their Caesarean Section and Their Degree of Satisfaction. BJOG: An International Journal of Obstetrics & Gynaecology, 103, 1074-1077. http://dx.doi.org/10.1111/j.1471-0528.1996.tb09585.x
[32]	Niven, C.A. and Gijsbers, K. (1996) Coping with Labor Pain. Journal of Pain and Symptom Management, 11, 116-125.
[33]	Lowe, N.K. (1989) Explaining the Pain of Active Labor: The Importance of Maternal Confidence. Research in Nursing & Health, 12, 237-245. http://dx.doi.org/10.1002/nur.4770120406
[34]	Lowe, N.K. (2000) Self-Efficacy for Labor and Childbirth Fears in Nulliparous Pregnant Women. Journal of Psychosomatic Obstetrics and Gynaecology, 21, 219-224.
[35]	Wuitchik, M., Bakal, D. and Lipshitz, J. (1989) The Clinical Significance of Pain and Cognitive Activity in Latent Labor. Obstetrics & Gynecology, 73, 35-42.
[36]	Wuitchik, M., Bakal, D. and Lipshitz, J. (1990) Relationships between Pain, Cognitive Activity and Epidural Analgesia during Labor. Pain, 41, 125-132. http://dx.doi.org/10.1016/0304-3959(90)90016-7
[37]	Chapman, C.R. and Gavrin, J. (1993) Suffering and Its Relationship to Pain. Journal of Palliative Care, 9, 5-13.
[38]	Derogatis, L.R. (1977) SCL-90-R, Administration, Scoring & Procedures Manual—I for the R(evised) Version. John Hopkins University School of Medicine, Baltimore.
[39]	Franke, G.H. (1995) SCL-90-R: Die Symptom-Checkliste von Derogatis. Deutsche Version [SCL-90-R. The Symptom-Checklist of Derogatis. German Version]. Beltz, Göttingen.
[40]	Anastasi, A. (1976) Fundamentals of Biostatistics. 4th Edition, Macmillan, New York.
[41]	Rosner, B. (1995) Fundamentals of Biostatistics. 4th Edition, Wadsworth Publishing Company, Belmont.
[42]	Mayring, P. (1995) Qualitative Inhaltsanalyse. Grundlagen und Techniken [Qualitative Content Analysis. Basics and Te-chniques]. 5th Edition, Beltz, Weinheim-Basel.
[43]	Pope, C. and Campbell, R. (2001) Qualitative Research in Obstetrics and Gynaecology. British Journal of Obstetrics and Gynaecology, 108, 233-237. http://dx.doi.org/10.1016/S0306-5456(00)00077-2
[44]	Patton, M.Q. (2002) Qualitative Research & Evaluation Methods. Sage, Thousand Oaks, London, New Delhi.
[45]	Sandler, J. (1960) The Background of Safety. The International Journal of Psychoanalysis, 41, 352-356.
[46]	Stainton, M.C., Harvey, S. and McNeil, D. (1995) Understanding Uncertain Motherhood. A Phenomenological Study of Women in High-Risk Perinatal Situations. Faculty of Nursing, University of Calgary, Calgary.
[47]	Stadlmayr, W., Bitzer, J., Amsler, F., Simoni, H., Alder, J., Surbek, D. and Burgin, D. (2007) Acute Stress Reactions in the First 3 Weeks Postpartum: A Study of 219 Parturients. European Journal of Obstetrics & Gynecology, 135, 65-72.
[48]	Marmar, C.R., Weiss, D.S. and Metzler, T.J. (1997) The Peritraumatic Dissociative Experiences Questionnaire. In: Wilson, P. and Keane, T., Eds., Assessing Psychological Trauma and PTSD, Guilford Press, New York and London, 412-428.
[49]	Marmar, C.R., Weiss, D.S., Schlenger, W.E., Fairbank, J.A., Jordan, B.K., Kulka, R.A. and Hough, R.L. (1994) Peritraumatic Dissociation and Posttraumatic Stress in Male Vietnam Theater Veterans. American Journal of Psychiatry, 151, 902-907.
[50]	Klaus, M.H. (1986) Effects of Social Support during Parturition on Maternal and Infant Morbidity. British Medical Journal, 293, 585-587.
[51]	Gürber, S., Bielinski-Blattmann, D., Lemola, S., Jaussi, C., von Wyl, A., Surbek, D., Grob, A. and Stadlmayr, W. (2012) Maternal Mental Health in the First 3-Week Postpartum: The Impact of Caregiver Support and the Subjective Experience of Childbirth—A Longitudinal Path Model. Journal of Psychosomatic Obstetrics and Gynaecology, 33, 176-184.