Interview: The effect of violence on a woman’s ability to nurture

Therapeutic intervention can reduce the mental health impact of violence and help the mother care for her baby better

In this interview withWhite Swan Foundation,Dr Maria Muzik, medical director, perinatal psychiatric clinic, University of Michigan, talks about the impact of a difficult birthing process, maltreatment faced in childhood and domestic violence in adult life on the mother's ability to nurture, and its effects on the baby's mental health. You can watch the full interviewhere.

What is negative birth experience and how is it related to the mental health of the baby?

Birthing is a natural and wonderful process. And for many women, a painful, stressful, and yet empowering experience. The more that medical interventions are necessary or delivered, the higher the likelihood of birthing becoming complicated. If that happens, it is regarded as being more difficult for the woman to get through. The interesting thing is that according to accumulated research these highly medical complications — pain, hemorrhage, unexpected C-section — are potentially traumatic experiences. But they don't actually impact the woman or the baby if there is a safe and nurturing environment. One that is provided by doctors and nurses where space is held for the mother, she is given the information she needs, and support is provided during the experience.

In the presence of such factors, the mother recovers very well from this experience. The concept of a negative subjective birth experience focuses on the subjective nature of the birth experience that might carry consequences for the mother. It determines whether she develops depression orpost-traumatic stress disorder (PTSD)after this or if she heals well and recovers. On the other hand, if she is dehumanized, treated badly, if there is poor communication or maybe a violent approach to birth, the woman will feel alone and abandoned. In this case, this subjective experience of negativity adds on to the medical trauma. This combination, in particular, carries weight and creates a risk for even the strongest woman to become depressed and post-traumatic with stress.

What emotional impact does a negative birth experience have on the child? Can this last into childhood and adulthood?

Young children need to be exposed to a parent who is able to provide them with positive parenting. This means being sensitive and responsive to the child's needs. Whether it’s physical needs — feeding, diaper changing, and providing a safe environment  — or emotional needs like giving love and nurturing, both are important. Young babies need a lot of positive stimulation, just being neutral is not enough. They need the parents to be singing, talking, and smiling. If the parents can’t do this because they are depressed or anxious, the child will pick up on this and internalize these negative experiences. A lot of things get set in place very early on. As the child grows older this becomes more complex. But the origin of trust, self-esteem, of feeling good about yourself, feeling competent, strong and resilient is set early in childhood. It’s really important to not miss the mark and start early.

How does the mistreatment of mothers affect their mental health?

I want to talk about the concept of the ACES (Adverse Childhood Experience Study). It was a large study, where patients in family medicine were interviewed for their experiences while growing up. They were asked about the risks they faced in childhood as well as in the present time. The doctors were trying to understand why these patients weren't doing well and why they were physically unhealthy. They found out that it was not what was going on in the here and now, but what had happened to them 40 or 50 years ago that had had a high impact on their health as adults. That was the first time that we realized how important it is whether you grow up with a lot of stress and adversity or not. Ten factors that are really important while growing up were identified, and it's basic things such as:

  • Do you have enough food?

  • Were you cared for? Or were you neglected - physically, emotionally?

  • Did you have loving parents or caregivers, grandparents, family?

  • Were you abused - physically, sexually, emotionally?

  • Were your parents having problems with alcohol, or with violence at home?

All of these factors are important. In fact, in the study, it was found that 20-25% of the group had faced sexual abuse in the United States. On average, one out of five, one out of four women  — as well as men, but women more than men — have a high likelihood of having suffered maltreatment while growing up and this has an impact on their physical health and psychological well-being. After entering parenthood, many studies  — my own included — have shown that it’s not the child abuse that impacts how you parent. But, it increases the chances of you developing depression, post-traumatic stress, anxiety, and other symptoms. This impacts how you are able to parent.

What is important for us to focus on is, what can be done to help? There are two things. One, we can treat depression and anxiety and help the parent feel better. The second is to increase the capacity to — despite all the mental health problems, despite the abuse  — stay insightful or reflective. This means that you take on your baby's perspective, put yourself in their shoes and consistently view the world and your actions from their point of view. If you manage to do this — despite depression or having trauma — your baby is protected from all the stresses in the here and now. And we can train and help parents be more insightful through means of therapeutic interventions.

Can this apply to any other stressors in life, like domestic violence faced in adult life?

Absolutely, this is applicable to any kind of trauma and in particular to interpersonal trauma. Domestic violence has an impact on a person's physical and mental health. But we do understand that the younger you are, and the earlier your brain experiences development trauma, the higher the impact on your body and your emotional functioning. In fact, we now know that in the first 1000 days of a child’s life the most amount of development takes place in the brain, the most number of synapses get formed and the most number of experiences get encoded in your brain. You learn the most in the first three years of life. So what happens at this time has a huge impact on your life's trajectory. It doesn't mean that you can't change, but it does mean that you have to be particularly aware of instances where trauma and abuse happen early to a young child. In this case, the child will be less able to buffer against this because the brain is not yet mature and so much is still forming. If the trauma occurs later, you might already be strong enough to cope with it. The experience of it is always negative and we need to do everything we can to prevent trauma, but the younger you are, the more impact it has.