Letter to The Psychologist

Peter Hepper's article on foetal psychology was comprehensive and should be part of the education of every student midwife. However I should like to make some points.

When Freud described birth as an impressive caesura he was contrasting the huge physiological changes with what he imagined was a psychological continuity between intrauterine and extrauterine life. Foetuses become babies and babies are born into a social context. In this country at the moment this social context includes a high caesarean section rate and a very low breast-feeding rate. In London a first time mother runs a 33% risk of caesarean section and in this country generally the majority of babies are no longer breast-fed by six weeks. Peter Hepper states that normal gestation is 38 weeks. I think it is better to say that it ranges from 37 to 42 weeks. Too dogmatic an insistence on shorter gestation leads to unnecessary inductions to avoid questionable risks associated with postmaturity and induction of labour in turn leads to an increased incidence of caesarean section.

In the section entitled Getting ready for the breast he describes artificial feeding as though it is an equivalent to breast-feeding. I know of no index where artificial feeding is in any way superior to the breast. Babies are born neurologically incomplete. Myelination requires a certain composition of essential fatty acids which artificial breastmilk substitutes cannot provide. In addition there is increasing research evidence that the way in which a baby is communicated with influences the nature of its neurological development. The work of Bessel A. van der Kolk and Alan N. Schore is an example. Breast-feeding is intrinsically superior in terms of mother-child interaction: a newborn baby at the breast sees its mother's face at the optimal distance for focusing; the rhythmic supply of milk in response to the baby's sucking is also conversational in its give and take. If the baby is held correctly bottlefeeding can reproduce the former but can never reproduce the latter.

In short I think an excellent article has been marred by an uncritical assumption of the medical model of childbirth and social norms regarding infant feeding.

Yours, Meg Taylor BSc, MSc, SCM, retired midwife and psychotherapist.